Biocontainment Patient Care Unit--Consensus Standards Philip W. Smith, MD University of Nebraska Medical Center Omaha, Nebraska, USA

Nebraska Biocontainment Unit History Collaborative: University of Nebraska Medical Center The Nebraska Medical Center State of Nebraska Department of Health Activated by the Chief Medical Officer of the Nebraska Health Department and Medical Director of Unit July 2004 Construction Began March 2005 Opened Unit

BIOTERRORISM INPATIENT UNIT UNIVERSITY TOWER LEVEL 7 UNIT II

Design Features 10 critical care beds in 5 double rooms Separate air handling system with no re-circulated air Negative air pressure – entire unit HEPA filtration – exhausted air 15 air exchanges in each room Dunk tank Pass thru autoclave Ultraviolet light – surface of fan filter Decontamination shower on exit Controlled access and egress

Professional Staffing Registered Nurses -16 Respiratory Care Practitioners – 8 Care Techs - 6 Highly trained- over 80 hours of orientation Basic and Advanced Disaster Life Support Adult and Pediatric: CPR, ACLS, PALS Highly protected Smallpox vaccine eligible Hepatitis A & B, Meningococcal & Influenza Vaccines Staff Competencies Monthly Meetings Quarterly drills

Community Support Training/Education by staff Donning and Doffing Procedures Use of Isopod transporter Body Sealer System – Contaminated Remains Basic and Advance Disaster Life Support Classes EMS, Fire and Police Staff are a Community Resource Advance training for pandemic Just in time training when needed Participation in local and state biological drills

Consensus recommendations: Topic areas The role of units in overall preparedness Medical care issues Infection control issues Facility issues Psychological and ethical issues

Facility Recommendations-Airflow Negative air flow with 12 or more air exchanges per hour Airflow from "clean" to "dirty" No recirculation of air Dedicated exhaust at least 25 feet from building openings High velocity upblast fans with redundancy HEPA filtered exit air Wall mounted, digital pressure gauges with alarms Quarterly airflow testing Interlocking double door access and egress

Other Facility Recommendations The unit should be separate from other patient care areas if possible Secured access Firewalls (1 hour fire separation) Tornado-proof windows Standard equipment: pass-through autoclave, dunk tank and decontamination shower Seamless surfaces for walls and floors Compliance with local, state and federal life safety codes

Infection Control Recommendations: Personal protective equipment: May have various levels of isolation Develop a biosafety program Occupational health program (eg, staff competencies, routine vaccines, vaccinia eligible, fitness for duty evaluations, symptom surveillance) Waste handling Cleanable surfaces

Infection Control Recommendations: (cont.) Large equipment disinfection Patient transport Integrate with existing hospital policies Visitors generally not allowed Anterooms recommended

“The times, they are a changing” Bob Dylan