In response to the 2014-2015 Ebola virus disease outbreak in West Africa, Johns Hopkins Medicine created a biocontainment unit to care for patients infected with Ebola virus and other high-consequence pathogens. The unit team examined published literature and guidelines, visited two existing U.S. biocontainment units, and contacted national and international experts to inform the design of the physical structure and patient care activities of the unit. The resulting four-bed unit allows for unidirectional flow of providers and materials and has ample space for donning and doffing personal protective equipment. The air-handling system allows treatment of diseases spread by contact, droplet, or airborne routes of transmission. An onsite laboratory and an autoclave waste management system minimize the transport of infectious materials out of the unit. The unit is staffed by self-selected nurses, providers, and support staff with pediatric and adult capabilities. A telecommunications system allows other providers and family members to interact with patients and staff remotely. A full-time nurse educator is responsible for staff training, including quarterly exercises and competency assessment in the donning and doffing of personal protective equipment. The creation of the Johns Hopkins Biocontainment Unit required the highest level of multidisciplinary collaboration. When not used for clinical care and training, the unit will be a site for research and innovation in highly infectious diseases. The lessons learned from the design process can inform a new research agenda focused on the care of patients in a biocontainment environment.

In response to the Ebola outbreak in 2014, many hospitals designated specific areas to care for patients with Ebola and other highly infectious diseases. The safe handling of category A infectious substances is a unique challenge in this environment. One solution is on-site waste treatment with a steam sterilizer or autoclave. The Johns Hopkins Hospital (JHH) installed two pass-through autoclaves in its biocontainment unit (BCU). The JHH BCU and The Johns Hopkins biosafety level 3 (BSL-3) clinical microbiology laboratory designed and validated waste-handling protocols with simulated patient trash to ensure adequate sterilization. The results of the validation process revealed that autoclave factory default settings are potentially ineffective for certain types of medical waste and highlighted the critical role of waste packaging in successful sterilization. The lessons learned from the JHH validation process can inform the design of waste management protocols to ensure effective treatment of highly infectious medical waste.KEYWORDS Ebola, sterilization, medical waste, serious communicable diseases, autoclave T he Ebola outbreak in West Africa in 2014 revealed potential gaps in the abilities of U.S. hospitals to safely provide care for patients with highly infectious diseases. Prior to the outbreak, the capacity to care for patients in the United States infected with high-consequence pathogens was limited to a few specialized facilities, or biocontainment units (BCUs) (1-3). In response to the crisis, the Centers for Disease Control and Prevention (CDC) recommended a tiered approach wherein U.S. hospitals serve as frontline health care facilities, Ebola assessment hospitals, or Ebola treatment centers (ETCs) (4). The Office of the Assistant Secretary for Preparedness and Response (ASPR), a federal office in the Department of Health and Human Services (HHS), created a regional response plan, which called for the creation of Regional Ebola and Other Special Pathogen Treatment Centers (RETCs) (5). These RETCs were modeled in part on the U.S. facilities that provided care for Ebola patients, namely the University of Nebraska Medical Center, the National Institutes of Health, Emory University, and Bellevue Hospital Center, and also include design elements based on local capabilities and lessons learned from the outbreak (6).

Telemetry monitoring is a limited resource. This quality improvement project describes a nurse-managed telemetry discontinuation protocol aimed at stopping telemetry monitoring when it is no longer indicated. After implementing the protocol, data were collected for 6 months and compared with a preintervention time frame. There was a mean decrease in telemetry monitor usage and a decreased likelihood of remaining on a telemetry monitor until discharge. A nurse-managed telemetry discontinuation protocol was effective in decreasing overmonitoring and ensuring telemetry availability.

Therapeutic endoscopy is emerging as an innovating alternative to gastroenterology surgery. Due to the increase in new technologies, endoscopy clinical staff require ongoing education to develop safe, competent practice for new equipment and supplies. Maintaining competencies with new equipment and supplies can be challenging. This article illustrates the development and implementation of a continuous educational program for endoscopy clinical staff at a major academic medical center. An initial needs assessment of staff education and competency led to the multidisciplinary plan for continuous education. Development of the Nurse Product Procedure Group enabled endoscopy staff to standardize care and maintain competency in advanced therapeutic procedures. The Nurse Product Procedure Group offers various pathways of learning to meet clinical staff's individual learning needs. Over a 5-year span of implementation, staff satisfaction of education and resources improved. Key implementation elements of the Nurse Product Procedure Group include monthly staff education, resource development, multidisciplinary collaboration, cost savings, outreach education, and external collaboration with national and international gastroenterology professional organizations and societies.

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