High-Containment Pathogen Preparation in the Intensive Care Unit

Abstract

The recent Ebola virus disease outbreak highlighted the need to build national and worldwide capacity to provide care for patients with highly infectious diseases. Specialized biocontainment units were successful in treating several critically ill patients with Ebola virus disease both in the United States and Europe. Several key principles underlie the care of critically ill patients in a high-containment environment. Environmental factors, staffing, equipment, training, laboratory testing, procedures, and waste management each present unique challenges. A multidisciplinary approach is key to developing effective systems and protocols to maintain the safety of patients, staff, and communities.

Keywords: Biocontainment unit; High-containment pathogens; Preparedness; Supportive critical care.

Fig. 1

General layout of the Johns Hopkins BCU. Patient rooms and the laboratory have dedicated space for donning and doffing PPE. This space allows unidirectional flow to reduce the risk of cross-contamination. Green indicates clean space, red indicates contaminated space, and yellow indicates doffing rooms. (1) Off-unit area with dedicated elevators, locker room, changing area, and lounge for staff; (2) clean entry and exit space for staff; (3) nurse station; (4) shared donning room for laboratory and patient room 3; (5) laboratory; (6) doffing room for laboratory; (7) patient room 3; (8) doffing room for patient room 3; (9) shared donning room for patient rooms 1 and 2; (10) patient room 1 with 2 ICU headwalls; (11) doffing room for patient room 1; (12) patient room 2; (13) doffing room for patient room 2.

Fig. 2

Timeline of activities caring for patients infected with high-containment pathogens.