title: 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.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine.
authors.forename: Brian T
authors.identifier: 0000-0001-8632-5567
authors.initials: BT
authors.lastname: Garibaldi
authors.affiliation: 2 Department of Emergency Medicine, Johns Hopkins University School of Medicine.
authors.forename: Gabor D
authors.initials: GD
authors.lastname: Kelen
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine.
authors.forename: Roy G
authors.initials: RG
authors.lastname: Brower
authors.affiliation: 3 Facilities Engineering, Johns Hopkins Health System.
authors.forename: Gregory
authors.initials: G
authors.lastname: Bova
authors.affiliation: 4 Department of Nursing, Johns Hopkins Hospital.
authors.forename: Neysa
authors.initials: N
authors.lastname: Ernst
authors.affiliation: 4 Department of Nursing, Johns Hopkins Hospital.
authors.forename: Mallory
authors.initials: M
authors.lastname: Reimers
authors.affiliation: 4 Department of Nursing, Johns Hopkins Hospital.
authors.forename: Ronald
authors.initials: R
authors.lastname: Langlotz
authors.affiliation: 3 Facilities Engineering, Johns Hopkins Health System.
authors.forename: Anatoly
authors.initials: A
authors.lastname: Gimburg
authors.affiliation: 3 Facilities Engineering, Johns Hopkins Health System.
authors.forename: Michael
authors.initials: M
authors.lastname: Iati
authors.affiliation: 3 Facilities Engineering, Johns Hopkins Health System.
authors.forename: Christopher
authors.initials: C
authors.lastname: Smith
authors.affiliation: 3 Facilities Engineering, Johns Hopkins Health System.
authors.forename: Sally
authors.initials: S
authors.lastname: MacConnell
authors.affiliation: 5 Department of Medicine, Johns Hopkins Hospital.
authors.forename: Hailey
authors.initials: H
authors.lastname: James
authors.affiliation: 6 Department of Pharmacy, Johns Hopkins Hospital.|7 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine.
authors.forename: John J
authors.initials: JJ
authors.lastname: Lewin
authors.affiliation: 8 Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital.
authors.forename: Polly
authors.initials: P
authors.lastname: Trexler
authors.affiliation: 8 Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital.
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Black
authors.affiliation: 8 Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Lynch
authors.affiliation: 9 Department of Pathology, Johns Hopkins University School of Medicine.
authors.forename: William
authors.initials: W
authors.lastname: Clarke
authors.affiliation: 9 Department of Pathology, Johns Hopkins University School of Medicine.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Marzinke
authors.affiliation: 9 Department of Pathology, Johns Hopkins University School of Medicine.
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Sokoll
authors.affiliation: 9 Department of Pathology, Johns Hopkins University School of Medicine.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Carroll
authors.affiliation: 9 Department of Pathology, Johns Hopkins University School of Medicine.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Parish
authors.affiliation: 9 Department of Pathology, Johns Hopkins University School of Medicine.
authors.forename: Kim
authors.initials: K
authors.lastname: Dionne
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine.
authors.forename: Elizabeth L D
authors.initials: EL
authors.lastname: Biddison
authors.affiliation: 10 Office of Emergency Management, Johns Hopkins Medicine.
authors.forename: Howard S
authors.initials: HS
authors.lastname: Gwon
authors.affiliation: 2 Department of Emergency Medicine, Johns Hopkins University School of Medicine.
authors.forename: Lauren
authors.initials: L
authors.lastname: Sauer
authors.affiliation: 2 Department of Emergency Medicine, Johns Hopkins University School of Medicine.
authors.forename: Peter
authors.initials: P
authors.lastname: Hill
authors.affiliation: 2 Department of Emergency Medicine, Johns Hopkins University School of Medicine.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Newton
authors.affiliation: 11 Legal Department, Johns Hopkins Medicine, and.
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Garrett
authors.affiliation: 5 Department of Medicine, Johns Hopkins Hospital.
authors.forename: Redonda G
authors.initials: RG
authors.lastname: Miller
authors.affiliation: 12 Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
authors.affiliation: 8 Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital.|12 Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Maragakis
mesh_terms: D019142:Hemorrhagic Fever, Ebola / Q000628:therapy / Q000635:transmission*; D006749:Hospital Design and Construction / Q000379:methods*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008396:Maryland; D008505:Medical Staff, Hospital / Q000193:education*; D010356:Patient Isolation / Q000458:organization & administration*; D062606:Tertiary Care Centers; D057188:Workflow
keywords: Ebola virus disease; biocontainment; infectious diseases