The Johns Hopkins Hospital Biocontainment Unit

Brian T. Garibaldi, MDAssociate Medical Director, JHHBCU

Assistant Professor of Pulmonary and Critical MedicineJohns Hopkins University School of Medicine

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Financial Disclosures/Unapproved Use

• We have no financial relationships with a commercial entity that are relevant to the content of this presentation.

• JHH has received funding from the Maryland Department of Health and Mental Hygiene (DHMH) and the Assistant Secretary for Preparedness and Response (ASPR)

Objectives

By the conclusion of this talk, you will be able to:

• Describe the critical elements of a biocontainment unit

• Understand the design process of the JHH BCU• Recognize the multidisciplinary nature of BCUs• Describe the mission of the JHH BCU in the

broader context of national and international preparedness

What is a Biocontainment Unit?

Key features of a BCU

• Secure entry and exit points• Advanced air handling system • Highly trained nurse and provider team

including adult, pediatric and obstetrics• Laboratory • Critical Care • Onsite imaging• Waste Management• Infrastructure

Johns HopkinsEbola Preparedness

• Screening/Triage • Education &Training• Supplies• Transportation • Cleaning, Disinfection• Waste Management• Laboratory• Workforce• Ethics• Communications• Designated Units• Biocontainment

Why is this relevant today?

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The Johns Hopkins HospitalBaltimore, MD

The BCU Vision

The BCU Vision

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Key Collaborations

• Emory University• University of Nebraska• NIH• CDC• Colleagues across the world

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• John G. Bartlett– Established the AIDS clinical

service at JHH in 1983

• B. Frank Polk – Pioneering research and

clinical care for patients with HIV

Tackling the fear of contagion

Timeline of the BCU

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BCU Floorplan

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BCU Floorplan

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Patient Room 1

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Patient Room 1

Onsite Laboratory

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Onsite Laboratory

Available Laboratory Tests

Analyte/Panel Instrument Tube Type

Comprehensive Metabolic Panel (CMP)

Abaxis Piccolo Green Top

Electrolytes (Na, K, Cl) Abaxis Piccolo Green Top

Magnesium Abaxis Piccolo Green Top

Phosphate Abaxis Piccolo Green Top

Lactate Abaxis Piccolo Green Top

Heme-8 (CBC w/differential) Sysmex pocH-100i Lavender Top

Arterial Blood Gas w/Co-oximetry

Radiometer ABL90 Blood Gas Syringe

Venous Blood Gas w/Co-oximetry

Radiometer ABL90 Blood Gas Syringe

Ionized Calcium Radiometer ABL90 Blood Gas Syringe

Whole Blood INR Hemochron Signature Blue Top

Plasma equivalent aPTT Hemochron Signature Blue Top

Urinalysis Manual Dipstick Urine Screw Cap

ABO typing Glass Slide Test Lavender Top

Waste Management

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Autoclave – Unit Side

Autoclaves – Clean Side

Radiology

Sonosite Xporte Digital Xray

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Digital Stethoscope

Think Labs One

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Unique Features of the JHH BCU

• Unidirectional flow of staff• Donning and doffing rooms for all patient care areas• Dual Pass-through autoclaves • Physical space for obstetrics procedures• Physical space for sterile procedures, including

limited surgery• Main patient room with two ICU headwalls to provide

care for family • Advanced Telecommunications System

Telecommunications

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Providers

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The Making of the JHH BCU

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• https://youtu.be/oVmCBToWYqc

Tour of the BCU

• https://youtu.be/RzsCk4lm1T8

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The JHH BCU Vision

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PATIENT CARE

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Region 3 Ebola and Other Special Pathogen Treatment Center

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HHS Regional Centers

• Massachusetts General Hospital in Boston, Massachusetts• Bellevue Hospital Center in New York City• Johns Hopkins Hospital in Baltimore, Maryland• Emory University Hospital and Children’s Healthcare of

Atlanta/Egleston Children’s Hospital in Atlanta, Georgia• University of Minnesota Medical Center in Minneapolis,

Minnesota• University of Texas Medical Branch at Galveston in Galveston,

Texas• Nebraska Medical Center in Omaha, Nebraska• Denver Health Medical Center in Denver, Colorado• Providence Sacred Heart Medical Center and Children’s

Hospital in Spokane, Washington

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National Ebola Training and Education Center (NETEC)

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(ASPR), (CDC) Emory University, University of Nebraska Medical Center/Nebraska Medicine & New York Health and Hospitals Corporation, Bellevue Hospital

Training and Education

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Highly Infectious DiseaseTraining

• Quarterly activation drills• Yearly no-notice drills• Monthly staff meetings and activities

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Infection Control Training

• 500 EVS employees have trained on the unit

• Compliance scores have increased across the hospital

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Research

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Research and Innovation

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PPE design and testing

CDC Epicenter Grant

Genomics and infection

FULD Fellow Self-Selector Study

Questions?

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