Key Design Attributes: Biocontainment Location: Tertiary referral hospital Separate building or self-contained unit Secured, controlled entry/exit routes

Key Design Attributes: Biocontainment One-way flow: Segregation of clean/dirty Clean: Personal Protective Equipment (PPE) Clean Supplies Donning PPE Dirty: Doffing PPE Disposal

Emory University Hospital

Nebraska Medical Center, Omaha Biocontainment PCU Five-Room Unit Leo A. Daly

Johns Hopkins Biocontainment Unit A portion of the biocontainment unit: Patient rooms have dedicated space for donning (green) and doffing (yellow) personal protective equipment (PPE) One of three private patient rooms that allow for critical care activities On-site laboratory allows for safe and rapid diagnostic testing in special biosafety hoods and separate donning and doffing rooms Staff entrance provides showering facilities and serves as a clean-in/ clean-out anteroom for entire unit Special air-handling system 3 Patient Rooms 7,900 SF 100 Staff Members

High Level Isolation Unit: Patient Suite Patient Room: Private critical care room size or larger with automatic door closer Specialized equipment (ventilator, monitoring, hemofiltration) Free movement of staff wearing bulky PPE Private toilet room Hands-free lavatory operation NIH Emory University Hospital

High Level Isolation Unit: Patient Suite PPE Storage & Donning Area (Ante Room): Adjacent room/marked area in hall Clean PPE stored and PPE doffed Clinical supplies (IV fluids and tubing, syringes, dressings, etc.) Hands-free lavatory Protocol signage Nebraska Medicine https://app1.unmc.edu/nursing/heroes/

High Level Isolation Unit: Patient Suite PPE Removal Area: Adjacent room/marked area in hall Separate from clean area and route, if possible Clearly designated area near patient room door Access to clean gloves Packaging clinical specimens Space to remove PPE and perform hand hygiene Supplies for PPE disinfection Sit and remove boot covers Leak-proof infectious waste containers

Key Design Attributes: Biocontainment Decontamination/Soiled Holding: Access to autoclave in suite or dedicated access Hazardous material waste removal contractor Sealable area for decontamination of large equipment and packaging clinical waste Deceased patients/mortuary equipment

Key Design Attributes: Biocontainment PPE/Clean Storage: Large equipment PPE Pharmaceuticals (including controlled drugs) Clinical supplies

Key Design Attributes: Biocontainment Staff Accommodations: Large amount of staff rotation Staff lounge/office Changing and decontamination shower

Key Design Attributes: Biocontainment Family Accommodations: Extremely stressful situation Cannot remain with patient Patient room window Amenities that provide additional comfort

Key Design Attributes: Biocontainment Laboratory: BSL-3 Rated POC University of Nebraska Medical Center

Key Design Attributes: Biocontainment Finishes: Ease of cleaning and decontamination Seamless floors and walls – welded/anti-microbial sealant Solid surface counters – minimal Airtight – monolithic ceilings Sealed doors and windows Mt. Sinai Hospital, NYC

Retrofit Existing Unit: Biocontainment Froedtert Health Special Pathogens Unit: Conversion of eight inpatient rooms into ICU level unit Typically used as medical/surgical beds Four weeks of renovation – complete August 2015 90 minutes to accept first patient on unit Utilize existing BSL-3 Lab Transfer waste via 55-gallon drum Home monitored family – Skype connection Froedtert Health, Milwaukee, Wisconsin

Engineering Perspective for Biocontainment Units Freeman White MEPT systems support and contain isolation environment Assist staff in patient care while limiting service access to isolation environment

Biocontainment Unit – Mechanical Negative pressure with respect to adjacent spaces Pressure monitoring at all isolation room doors TCH – West Campus

Laminar Airflow

Airflow CFD Maximize clean to less clean airflow Minimize turbulence in care giver zone

Isolation Exhaust System

Biohazardous Waste Mechanical system design addresses material handling path Biohazardous waste/ decontamination exhausted

Biocontainment Unit – BSL3 Lab Mechanical system maintains negative pressure in BSL3 Lab Lab and associated hoods exhausted separately from isolation rooms

HEPA Filter Exhaust Dual HEPA filter exhaust housing Dual exhaust fans Vertical discharge

Biocontainment Unit – Plumbing Minimize cross contamination by electronic controls on all fixtures Patient acuity flexibility provided by ICU level of medical gas outlets Remote water shut-off to limit access to isolation environment Picture of electronic controls on hand wash fixture: John will send 10/29

Biocontainment Unit – Electrical Electrical systems must maintain sleeved isolation room environment Conduits are rigid type with screwed fittings and sealed at wall penetrations Light fixtures are clean room LED type and designed for all service from below Drywall “tents” or second ceiling above fixtures are used to form airtight barriers All junction boxes are located in adjacent corridor

Biocontainment Unit – Low Voltage Remote communication and video monitoring key support systems for staff in isolation zone Intercom system provides staff communication while in PPE Video monitoring supports staff in limiting exposure in doffing spaces Video monitoring of isolation room assists staff in patient assessment

Existing Space Retrofit for Biocontainment Unit Frontline healthcare facilities may need temporary isolation units prior to patient transfer Retrofit of existing spaces can be accomplished by providing negative pressure, filtration and dilution

HEPA Unit Portable HEPA filter unit can provide required negative pressure and filtration HEPA unit discharge to exterior or to a return grille

Portable Ante Room Additional measures to ensure temporary isolation room operation: Portable ante room Handheld digital pressure gauges Room envelope sealing measures to maintain space pressure relationship

Isolation Cube Existing challenges where individual isolation rooms may not be available Isolation cubes within larger isolation ward Negative pressure environment created at patient bed

Questions? Thank You Oriana Beaudet, DNP(c), RN, PHN, Clinical Consultant, Smith Seckman Reid oriana.beaudet@gmail.com Sheila Cahnman, President, JumpGarden Consulting sheila@jumpgardenllc.com John Alsentzer, Senior Project Manager and Mechanical Engineer, Smith Seckman Reid jalsentzer@ssr-inc.com