1. The Care and Isolation Unit (CIU) at St Patrick Hospital In 2005 the NIH issued a Request for Proposals for the construction and staffing of a patient isolation facility. The facility should be capable of caring for and isolating RML workers and visitors who had either known or potential exposure to, or illness from, work related to laboratory acquired infectious diseases. Must be located within a reasonable distance (75 miles) of the IRF Must be able to provide the full range of standard in-patient care including intensive care Must be able to accept a patient within 8 hours of notification St Patrick Hospital was the only respondent, contract awarded

2. Considerations in Response to the Proposal The primary controls that are in place at RML make an exposure extremely unlikely The risks to the SPH health care force in caring for these individuals is minimal and manageable It is far more likely that a patient with a high hazard infectious disease will present from the community in need of isolation The grant allowed for a significant upgrade of the isolation capacity of the hospital, which is then available for other purposes The training opportunities for HCW have broad applicability to patients from anywhere with anything

3. Components of the CIU Construction needed to comply not only with JCAHO regulations but also the much stricter specifications of the NIH Division of Occupational Health and Safety Controlled access 3 separate stand-alone rooms, each with separate air handling. Designed as single occupancy, could accommodate 2 if needed An anteroom leading into each room with space for donning PPE and a hands-free sink Seamless surface preparations that facilitate topical disinfection of all surfaces Directional air flow from the hallway into the anteroom and from the anteroom into the patient room At least 12 air exchanges per hour in the patient room

4. Components II Air exhausted from the room is HEPA filtered before release to the outside Exhaust air is released into the air 8 feet above the rooftop Each room equipped with private facilities Rooms able to provide all ICU level care Portable radiology capability Separate autoclave in CIU

5. 3 rooms, each with separate air handling Controlled Access New Nurse’s Station Autoclave Lab SICU Controlled Access Directional Airflow

6. Controlled Access

11. Separate Air Handling for Each Room

12. Directional Air Flow

13. Oversized Exhaust Ducts

14. HEPA Filtered Exhaust

16. New Nursing Station

20. Autoclave for Contaminated Items