The Creation of a Biocontainment Unit at a Tertiary Care Hospital. The Johns Hopkins Medicine Experience

Abstract

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.

Validation of Autoclave Protocols for Successful Decontamination of Category A Medical Waste Generated from Care of Patients with Serious Communicable Diseases

“…Steam intake and electrical and mechanical infrastructures are located on the clean side of the waste-handling area to facilitate autoclave maintenance even while the BCU is caring for a patient. The entire system is connected to the hospital's backup power system, which has two substations and enough backup fuel to maintain power for up to 90 h in the event of a citywide loss of electricity (6).…”

“…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).…”

Impact of air‐handling system exhaust failure on dissemination pattern of simulant pathogen particles in a clinical biocontainment unit

“…One type of specialized healthcare environment, a clinical biocontainment unit (BCU), is designed to care for patients infected with HIDs and incorporates specialized environmental controls and isolation protocols to prevent pathogen transmission. In response to the 2014‐2015 Ebola virus disease (EVD) outbreak, Johns Hopkins Medicine created a BCU by redesigning and renovating existing clinical space . The Johns Hopkins BCU (JH‐BCU), along with nine others around the United States, were funded by the Office of the Assistant Secretary for Preparedness and Response (ASPR) to serve as Regional Ebola and other Special Pathogen Treatment Centers (RESPTCs).…”

“…The Johns Hopkins BCU (JH‐BCU), along with nine others around the United States, were funded by the Office of the Assistant Secretary for Preparedness and Response (ASPR) to serve as Regional Ebola and other Special Pathogen Treatment Centers (RESPTCs). These centers have enhanced capabilities to care for patients and offer fully contained routine laboratory diagnostics and testing of bio‐specimens from patients infected with or suspected to be infected with high‐consequence pathogens, such as viral hemorrhagic fevers and highly drug resistant Mycobacterium tuberculosis (TB) . Similar to other BCUs, the JH‐BCU includes the capability to isolate airborne pathogen transmission via negatively pressurized patient rooms and a negative pressure laboratory space …”

Responding to the Global Threat of High-Consequence Pathogens: Protecting Health Care Workers and Caring for Patients

“…600-608) in this issue of AnnalsATS describes the construction and implementation of one such biocontainment unit at the Johns Hopkins Medical Center in Baltimore (6). Although thus far it has only been used to rule out persons under investigation, the Hopkins unit appears to have achieved a critical balance between health care provider safety and the ability to provide effective patient care.…”