1. Biocontainment Patient Care Unit--Consensus Standards
Philip W. Smith, MD
University of Nebraska Medical Center
Omaha, Nebraska, USA

3. Nebraska Biocontainment Unit History
Collaborative:
University of Nebraska Medical Center
The Nebraska Medical Center
State of Nebraska Department of Health
Activated by the Chief Medical Officer of the Nebraska Health Department and Medical Director of Unit
July 2004 Construction Began
March 2005 Opened Unit

4. BIOTERRORISM INPATIENT UNIT
UNIVERSITY TOWER LEVEL 7 UNIT II

5. Design Features 10 critical care beds in 5 double rooms
Separate air handling system with no re-circulated air
Negative air pressure – entire unit
HEPA filtration – exhausted air
15 air exchanges in each room
Dunk tank
Pass thru autoclave
Ultraviolet light – surface of fan filter
Decontamination shower on exit
Controlled access and egress

6. Professional Staffing
Registered Nurses -16
Respiratory Care Practitioners – 8
Care Techs - 6
Highly trained- over 80 hours of orientation
Basic and Advanced Disaster Life Support
Adult and Pediatric: CPR, ACLS, PALS
Highly protected
Smallpox vaccine eligible
Hepatitis A & B, Meningococcal & Influenza Vaccines
Staff Competencies
Monthly Meetings
Quarterly drills

8. Community Support Training/Education by staff
Donning and Doffing Procedures
Use of Isopod transporter
Body Sealer System – Contaminated Remains
Basic and Advance Disaster Life Support Classes
EMS, Fire and Police
Staff are a Community Resource
Advance training for pandemic
Just in time training when needed
Participation in local and state biological drills

10. Consensus recommendations: Topic areas
The role of units in overall preparedness
Medical care issues
Infection control issues
Facility issues
Psychological and ethical issues

11. Facility Recommendations-Airflow
Negative air flow with 12 or more air exchanges per hour
Airflow from "clean" to "dirty"
No recirculation of air
Dedicated exhaust at least 25 feet from building openings
High velocity upblast fans with redundancy
HEPA filtered exit air
Wall mounted, digital pressure gauges with alarms
Quarterly airflow testing
Interlocking double door access and egress

12. Other Facility Recommendations
The unit should be separate from other patient care areas if possible
Secured access
Firewalls (1 hour fire separation)
Tornado-proof windows
Standard equipment: pass-through autoclave, dunk tank and decontamination shower
Seamless surfaces for walls and floors
Compliance with local, state and federal life safety codes

13. Infection Control Recommendations:
Personal protective equipment: May have various levels of isolation
Develop a biosafety program
Occupational health program (eg, staff competencies, routine vaccines, vaccinia eligible, fitness for duty evaluations, symptom surveillance)
Waste handling
Cleanable surfaces

14. Infection Control Recommendations: (cont.)
Large equipment disinfection
Patient transport
Integrate with existing hospital policies
Visitors generally not allowed
Anterooms recommended

15. “The times, they are a changing”
Bob Dylan