Neysa Ernst RN, MSN and Mallory Reimers RN, MSN, ACCNS-AG

Transcription

1 B I O C O N T A I N M E N T U N I T Every Nurse a Leader: Nurse Collaborators Build a Biocontainment Unit Neysa Ernst RN, MSN and Mallory Reimers RN, MSN, ACCNS-AG

2 Objectives 1. Lead and collaborate with multiple workgroups utilizing communication, evidenced- based literature, and education. 2. Influence diverse stakeholder groups and contribute to safe delivery and workplace development.

3 National Response 48 national sites designated by CDC Maryland: NIH, UMMC,JHH DC: 3 sites $5.4 billion from Congress for emergency Ebola funding

4 BCU Collaboration The Johns Hopkins Hospital Baltimore, MD

5 Multidisciplinary Effort Department of Medicine Facilities Clinical Engineering Health, Safety and Environment (HSE) Hospital Epidemiology and Infection Control (HEIC) Information Technology Media Relations/Marketing Administration Legal/Risk Management Pharmacy Pathology Social Work Case Management Pastoral Care Materials Clinical Services

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7 The BCU Vision

8 Introduction Establishing a New Biocontainment and Treatment Unit Brian T. Garibaldi, Mallory Reimers, Neysa Ernst, Ron Langlotz, Anatoly Gimburg, Michael Iati, Gregory Bova, Polly Trexler, William Clarke, Elizabeth LD Biddison, Howard S. Gwon, Lauren Sauer, Margaret R. Garrett, Roy G. Brower, Redonda G. Miller, Trish M. Perl, Gabor D. Kelen, Lisa L. Maragakis Johns Hopkins Medicine, Baltimore, MD In response to the current Ebola Virus Disease (EVD) crisis in West Africa, Johns Hopkins Medicine (JHM) created a new biocontainment and treatment unit (BCU) to safely care for patients with EVD and to serve as a site for patient care, education and research for highly infectious diseases. Materials & Methods In September 2014, we identified a recently de-activated clinical unit as the site of the new BCU. Members of the BCU leadership team examined published literature and guidance, visited two existing biocontainment units, and contacted national and international experts to form the design of the physical structure and care activities of the unit. Architects and engineers collaborated with clinicians to redesign the unit and air handling systems to safely accommodate patients with highly infectious diseases transmitted via contact, droplet, airborne or mixed transmission methods. Colleagues from throughout the Johns Hopkins Health System contributed to the development and construction of the BCU and its associated education, research, and patient care protocols. Figure 2. Floor Plan for the JHH Biocontainment Unit Table 1. Unique Features of the BCU 3 Patient Isolation Rooms Dedicated Donning and Doffing Rooms Unique Air Handling System Custom Telemedicine Capabilities Autoclave Waste Management System Vaporized Hydrogen Peroxide Sterilization Room Onsite Biosafety Level-2 (BSL-2) Laboratory Highly Trained, Dedicated Staff Clinicians (33) Nurse s (76) Figure 3. Clinician and Nurse Staffing Figure 5. Vision for the BCU Conclusions The design and construction of the Johns Hopkins Biocontainment Unit represents the highest level of multi-disciplinary collaboration JHH was recently named the Region 3 Ebola and Other Special Pathogens Center by the Office of the Assistant Secretary for Preparedness and Response (ASPR). Table 2. Lab Testing on the BCU References Figure 1. Timeline of BCU Design and Construction Figure 4. Dual Pass-through Autoclave System 1. George FR, Marshall E. Bloom, Nancy PH et al. Preparing a Community Hospital to Manage Workrelated Exposures to Infectious Agents in BioSafety Level 3 and 4 Laboratories. 2010;16: Smith PW, Anderson AO, Christopher GW et al. Designing a Biocontainment Unit to Care for Patients with Serious Communicable Diseases: A Consensus Statement. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science 2006;4: Siegel J, Rhinehart E, Jackson M, Chiarello L. Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings ASHRAE Board of Directors. ASHRAE Position Document on Airborne Infectious Diseases Beam EL, Boulter KC, Freihaut F, Schwedhelm S, Smith PW. The Nebraska Experience in Biocontainment Patient Care. Public Health Nursing 2010;27: Centers for Disease Control and Prevention. Ebola Virus Disease: Information for Laboratories Iwen PC, Garrett JL, Gibbs SG et al. An Integrated Approach to Laboratory Testing for Patients with Ebola Virus Disease. Lab Medicine 2014;45:e146-e Centers for Disease Control and Prevention. Ebola Virus Disease: Ebola-Associated Waste Management Occupational Safety and Health Administration. Safe Handling, Treatment, Transport and Disposal of Ebola-Contaminated Waste

9 BCU Roles 1. Charge Nurse: 2. Primary RN (Patient Room Nurse #1): 3. Secondary RN (Patient Room Nurse #2): 4. Relief Nurse (RN #3) 5. Anteroom Nurse 6. Autoclave/Tasker 7. Physician Provider 8. Nurse Educator 9. HEIC Representative 10. Lab Tech 11. Rad Tech 12. Respiratory Therapist 13. Nurse Manager

10 BCU Staffing Plan Role Staff/shift Shifts Staff /day Nurses 6 on days & 5 Nights Two 12 hour shifts Doctors x 12hour shift 3 Lab Tech 2 1 x 4 hour shift 2 Respiratory Therapist 1-2 per shift 2 x 12 hour shifts 2-4

11 Nursing s Impact

12 Self Selector Home Units

13 BCU Timeline Demolition Begins 10/29/2014 BCU Orientation and Training 2/11/2015 Trip To Emory 2/16/2015 ASPR Grant Submitted 2/3/2015 Nurse Educator Begins 2/23/2015 Arrival of Autoclaves 2/25/ Oct Nov Dec 2015 Feb Mar Apr 2015 Design Construction Provider Team Takes Call BCU Team Training 10/1/2014 Space Identified 10/30/2014 Trips to NIH and Nebraska 11/26/2014 Final Designs Submitted to Contractor 10/1/ /1/2014 4/1/2015 Unit Opening 3/9/2015 "Day in the Life" Training Begins 10/29/2014-4/1/ /16/2014-4/1/2015 2/9/2015-4/1/2015

14 BCU Floorplan

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16 BCU Key Features 3 Patient Isolation Rooms Unique Air Handling System Custom Telemedicine Capabilities Autoclave Waste Management System Vaporized Hydrogen Peroxide Sterilization Room Onsite Biosafety Level-2 (BSL-2) Laboratory Highly Trained, Dedicated Staff

17 Unit Activation The Hospital Epidemiologist (ID attending physician on-call) determines clinical appropriateness of patient Hospital Epidemiologist notifies the Office of Emergency Management Acuity of patient Pathogen patient is potentially exposed or infected with Estimated arrival time of patient Specific type of precautions required. BCU activation protocol will follow the code Yellow Bio workflow.

18 Region 3 Ebola and Other Special Pathogen Treatment Center

19 Personal Protective Equipment

20 Skills Developed on BCU Employee Engagement & Trust Communication: SBAR, Crucial Conversations Multi-D Collaboration Disaster Readiness Training Environmental Safety Training

21 Nurse Self Selectors Need Pre-planned staffing Mirror shifts Continuity Institutional Memory Community

22 Nurse Managers Need ICU Support Clarify Schedule Requirements Window of Time Backfill Plan Return on Investment

23 BCU Draft Schedule operational Assignment hours Resource RN 7:00-19:30 AM HUDDLE HUDDLE Pt Room Nurse 1 7:00-19:30 AM HUDDLE HUDDLE Anteroom Nurse 7:00-19:30 AM HUDDLE 6:45 7:00 7:15 7:30 7:45 Pt Room Nurse 2 8:00-20:30 Pt Room Nurse 3 8:00-20:30 Task Nurse 8:00-20:30 Autoclave Available Staff Nurses in PT Room :00 8:15 8:30 8:45 9:00 9:15 9:30 9:45 10:00 10:15 10:30 10:45

24 Research and Innovation PPE design and testing CDC Epicenter Grant FULD Fellow Self-Selector Study Genomics and infection

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27 From Vision to Reality

28 Questions