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The Creation of a Biocontainment Unit at a Tertiary Care Hospital: The Johns Hopkins Medicine Experience

Originally Published:
2016
Key Point Summary
Key Point Summary Author(s):
Dickey, Andrew
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Key Concepts/Context
Prior to the 2014 Ebola virus disease (EVD) outbreak in West Africa, the United States had only one to three specialized biocontainment units. Once the EVD crisis began, a group of reputable American healthcare institutions worked together to renovate a deactivated clinical space into a functioning biocontainment unit (BCU).
Objectives
This paper describes the design, planning, and construction processes that were involved in the completion of a U.S.-based BCU that was created in response to the EVD crisis.
Methods
Experts in hospital epidemiology, pulmonary and critical care, hospital design, clinical engineering, infectious disease, nursing, and education were assembled to act as a leadership team for the project. An advisory council from the health system in which the BCU would be created was also assembled to ensure the inclusion of key stakeholders. The team visited two other U.S.-based BCUs and attended a seminar in order to gather structural design plans and knowledge concerning EVD. Given the urgency of the outbreak, a fast-track model was used for the project, resulting in close collaboration with a single design contractor. A 7,000-square-foot deactivated clinical unit was chosen as the location due to its distance from other units. Design and construction lasted a total of seven months and cost approximately $5 million ($3.64 million for construction and renovation, $895,000 for capital equipment, $226,000 for staff training, and $226,000 for leadership team salary support).
Design Implications
Multidisciplinary teams including designers, engineers, and healthcare professionals could collaborate during planning and design stages to help ensure that the physical design of particular healthcare spaces like BCUs safely and functionally incorporates the best practices in infection control and biocontainment.
Findings
The end result of the project was a state-of-the-art BCU that utilized features from the previously observed BCUs while also incorporating unique features. Features in common with the previously existing BCUs included secure entry and exit points, an onsite laboratory, an advanced air-handling system for droplet and airborne transmission, a team of highly trained clinicians and nurses, critical care capabilities in all rooms, portable ultrasound and radiology onsite, pass-through autoclaves for waste, and telecommunication capabilities. Features unique to the present BCU included dedicated doffing and donning rooms for all patient care areas, a unidirectional flow of staff through patient care areas, enough physical space to accommodate various obstetrics procedures as well as onsite sterile procedures, and a main patient care room with two ICU headwalls for family care. 
Limitations
This description of a BCU planning, design, and construction process is intended to offer guidance for teams embarking on similar projects in the future. Its guidance may therefore be limited to very rare situations that would require large amounts of funding and coordination to achieve.
Design Category
Building location/site optimization|Furniture, Fixtures & Equipment (FF&E)|Room configuration and layout|Unit configuration and layout|Ventilation and air-conditioning system
Setting
Other healthcare facilities
Outcome Category
Organizational outcomes|Patient health outcomes
Primary Author
Garibaldi, B. T.