Beyond the Biocontainment Unit: Improving Pathogen Preparedness for Health Workers

Prior to the 2014-2016 Ebola outbreak, only a handful of hospitals in the United States had specialized units to care for patients with highly infectious emerging diseases. The outbreak, though, brought forth the advent of the special pathogens units and regional treatment networks through the tiered hospital approach that the US Department of Health and Human Services helped create and fund through the Assistant Secretary for Preparedness and Response (ASPR).

These specialized designations within hospitals have allowed for 10 Regional Ebola and Other Special Pathogen Treatment Centers (RESPTCs) that not only work to enhance preparedness for high-consequence diseases, but have also taught us some critical lessons and provided novel insight into what this level of preparedness means for hospitals.

A recent article published in Health Security focused on the impact that the creation of the BioContainment Unit (BCU) at Johns Hopkins Medical Center brought to infection prevention, preparedness, and evening nursing. The investigators found that beyond ensuring they could care for multiple patients with high-consequence pathogens, the BCU supported institutional efforts including research, educational training, and strengthening infection prevention practices. The BCU also facilitated preparedness networks and collaborative efforts. Within their article, the investigators pointed to several specific examples of how the hospital’s investment in the BCU impacted other facets of health care efforts.

First, the investigators delve into environmental cleaning, which was a huge focus of infection prevention efforts during the 2014-2016 Ebola outbreak. By way of enhanced environmental disinfection and cleaning via the BCU, staff from their Hospital Epidemiology and Infection Control program performed additional monitoring and cleaning compliance, via the testing of high-touch surfaces and use of fluorescent gel markers. They also were able to support the training of 500 environmental care staff members in 2015 on cleaning and disinfection, with the rooms within the BCU used as a hands-on training ground. By marking the rooms with the fluorescent gel on 20 high-touch surfaces prior to cleaning, they could assess competency of environmental services staff.

Following the implementation of this enhanced training and usage of the BCU as the simulation center, the hospital observed a drop in their health care-associated Clostridium difficile rates from 8.3 cases per 10,000 patient days to 5.2 cases per 10,000 patient days year-over-year.

Another bonus of the BCU is that the increased focus on infection prevention efforts actually served to help strengthen daily infection control practices throughout the hospital. The unit not only serves as a training ground for personal protective equipment (PPE), but allows staff who have been trained on the unique PPE required for BCU work also to serve as champions in their regular hospital units for infection prevention efforts. In addition to this, the infection prevention staff were also able to benefit through opportunities to work with the US Centers for Disease Control and Prevention to create educational materials that are used throughout the country.

Lastly, the establishment of the BCU also created multidisciplinary training opportunities in response to the complex and broad spectrum of roles that are necessary in the care of a patient in the BCU. Many other specialties, like the cardiopulmonary resuscitation education team, use the space for training, as well as the intensive care units, which now require 48 hours of time in the BCU for registered nurses as part of the orientation process for new graduate nurses.

The sheer design of the BCU has also provided insight for other RESPTCs, whether it be through managing Category A waste or installing autoclaves specific to the BCU. Furthermore, the BCU has provided research opportunities, including investigating the dynamics of health care worker practices or the implications for surface contamination particles.

Although these units are rare and represent a regional approach to high-consequence pathogens, the investment that hospitals and government grants make towards their presence is critical. Furthermore, the unexpected perks of special pathogens units go beyond the walls of the patient rooms and expand to benefit the hospital system as a whole.