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

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

3. Emory University Hospital

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

5. 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

6. 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

7. 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

8. 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

9. 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

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

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

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

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

14. 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

15. 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

16. 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

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

18. Laminar Airflow

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

20. Isolation Exhaust System

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

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

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

24. 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

25. 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

26. 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

27. 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

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

29. 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

30. 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

31. Questions? Thank You Oriana Beaudet, DNP(c), RN, PHN, Clinical Consultant, Smith Seckman Reid Sheila Cahnman, President, JumpGarden Consulting John Alsentzer, Senior Project Manager and Mechanical Engineer, Smith Seckman Reid