Nebraska biocontainment unit preparing for Ebola
Ten-bed unit has volunteer staff at the ready
Federal public health officials recently contacted clinicians at the Nebraska Biocontainment Patient Care Unit in Omaha to determine if the facility could house Ebola patients if needed as the record outbreak in Western Africa continues. No plans have been set, but the the nation’s first and largest biocontainment unit stands at the ready to handle patients with Ebola and other emerging and deadly infections.
The 10-bed biocontainment facility is located 10 minutes from the Omaha airport and near a military base, making it possible to receive patients from anywhere in the country, notes Angela Hewlett, MD, MS, associate medical director of the Nebraska Medical Center in Omaha, which houses the unit.
Some of the pathogenic agents the unit is qualified to hand include Ebola and other hemorrhagic fevers, plague, anthrax, and smallpox. The biocontainment unit has its own air handling system with negative airflow and HEPA filtration. It also has a pass-through autoclave and specimen decontamination tank, specialized patient transport systems, and personal protective equipment.1
When the biocontainment unit was developed in 2005, the Nebraska health department’s goal was to provide a safe health care environment for working with emerging infections without putting other patients at risk, says Philip W. Smith, MD, professor in the division of infectious diseases at Nebraska Medical Center.
"The unit has 20 air exchanges per hour and can deal with airborne or contact diseases," Smith says. "We are experts in isolation."
National training center
Front-line infectious disease personnel come to Nebraska for training.
"We do drills with military and people from institutions in other states," Smith says. "We even have a mock patient with Ebola. Our staff will put on protective equipment, and we go through full training."
The hospital and unit also provide training for emergency response teams in the community, Hewlett notes.
MERS is a perfect example of a disease the unit would handle because it has a high mortality rate and, while rare, it was brought to the United States this year by travelers returning from Saudi Arabia, Hewlett says.
"We are one of only four of these kinds of units across the country, and one of those was shut down," Hewlett notes. "We’re the largest unit in the U.S., and one of our major assets is our volunteer staff of people."
Since biocontainment is rarely needed, staff volunteers are sought to move over to the unit when a need arises, she explains.
"Health care workers often are afraid to take care of these patients, but we have a completely volunteer staff that is willing to come in and care for these patients when needed," Hewlett says.
"We had a near miss a few years ago where the unit was activated and a call went out to the volunteer staff, and 100% of the health care providers who got the call were willing to come in to the unit," she says. "It was a real time drill for an illness that sounded like viral hemorrhagic fever."
The Nebraska unit’s volunteer staff, consisting of about 30 people, includes a high skill mix of nurses, respiratory therapists, care technicians, and physicians. They work in their own units, but meet monthly to test and drill protocols established for the biocontainment unit, says Kate Boulter, RN, lead nurse of the unit.
"We have drills on the protocols and special equipment, and the staff is very comfortable working in that unit," Boulter adds. "When we all get together we have a huge skill mix and we share knowledge with each other."
The biocontainment unit staff is on call 24/7, but they are only paid for time they work on the unit, she adds.
The unit’s communication system is immediate. When a crisis arises, volunteer staff will receive a page and cell phone call within a one minute period, Hewlett says.
Protocols for the unit are stored on the hospital intranet, available to all hospital staff, Boulter says.
"We’ve had other hospitals contact us and ask for access to our protocols, and we do share," she says.
"We’ve also done just-in-time videos that people can watch," she adds. "Recently I gave a talk to school teachers on bloodborne pathogen training."
The unit also has an active research program and has done work on decontamination, modeling and pathogen trajectory, Hewlett says.
"We study where particles go in the room based on the air handling system, and we study the various types of protective equipment and its safe removal," she explains. "We’ve looked at modalities for screening patients during a pandemic."
- Boulter K, Hewlett A, Schwedhelm S, et al. The Nebraska biocontainment patient care unit. Poster: 10-326. Association for Professionals in Infection Control and Epidemiology (APIC). Anaheim, CA, June 7-9, 2014.
