Healthcare Design - May 2016 - 54

1: Pass-through lockers in
the biocontainment unit can
be accessed from either
the entrance or exit side.
2: During activation of the
Nebraska biocontainment
unit, a point-of-care lab
was erected in an unused
patient room for quicker
test results. 3: The staff
exit is outfitted with a passthrough shower, allowing
them to "shower out" into
the exit locker room. 4:
Daylit patient rooms with
views to the exterior were
enhanced with the addition
of an exercise bike (not
shown).

patients required 11-14 days of treatment and
were eventually released. The third patient was
critically ill on transfer and eventually succumbed
to the illness after three days.
The unit's activation provided a number of
important lessons in the safe treatment of dangerous diseases, as well as an opportunity for the
design team to revisit the 2004 design and gather
insights from its real-world operation that could
be applied to future projects. To that end, Leo A
Daly met with facility leaders just days after the first
Ebola patient was discharged disease-free in late
September 2014.
Staff reported that the unit performed well in
its primary purpose of safely treating its patients.
However, in the course of use, some tweaks were
made.
Foremost was the installation of a lab within
the unit. Frequent and timely laboratory tests
were needed to make rapid treatment decisions.
Sending samples to the hospital lab took up
valuable time because of the required chemical decontamination of the holding bag via the
dunk tank, so one of the five patient rooms was
repurposed into a point-of-care lab, yielding a
significant reduction in turnaround time.
The large volume of waste produced in the
treatment of Ebola proved a logistical challenge
for staff, as well. A single patient generated
enough waste every day to keep the autoclave
occupied for 12 hours. Even with round-theclock autoclaving, this would limit the unit to
two patients maximum-an eye-opening insight
for future design. It also introduced a storage
challenge, requiring an unused patient room to
be converted into "dirty" storage, with another
patient room transformed into a second "clean"
storage space.
The waste-handling protocol for the unit
required PPE-clad staff to double-bag soiled materials and place them in dirty storage until they
could be autoclaved. Transferring soiled items
from the patient room to the storage area, and

HCDmagazine.com 05.16

then again to the autoclave room, required staff to
walk through a "warm" zone (an area that requires
caution because of the potential for contamination)
while carrying bags of hazardous material. Although
not ideal, the procedures developed by the staff
at Nebraska Medicine were effective in mitigating
this situation. However, future biocontainment units
could be improved by designing a throughput that
avoids the transfer of soiled material through those
areas and creates a separate path for trash, linens,
and autoclave items.
It was realized that nurses, specifically, play a
multifaceted role in this unique environment, too.
Maintenance staff aren't permitted to enter the unit
during activation, so nurses must be jacks-of-alltrades, fixing clogged toilets, replacing light bulbs,
or providing general maintenance, in addition to
cleaning. For example, when a minor repair was
required during the unit's operation, the nursing
staff requested an in-unit maintenance kit and the
associated training to handle simple fixes.
The nightly cleaning regimen of the unit involved
the use of a bleach solution. Although the unit was
designed with sheet-vinyl flooring rated to withstand bleach, the welded seams took some chemical damage that required repair between patients.
The mental health and body strength of the
patient were also areas of concern. In response,
Nebraska Medicine added an exercise bike and
chess board to the room. Staff played chess with
the patients to keep up their morale and mental
acuity, and the exercise bike was used in later
stages of treatment when the patient was capable
of moving around but still confined to the unit.
Finally, during the Ebola outbreak, media interest in the unit was high, leading administrators to
install a security guard at the front of the unit. This
suggests that future biocontainment units should
include space for security personnel.
The next generation
The insights gained during the outbreak have
significant implications for healthcare designers

LEO A DALY

http://www.HCDmagazine.com

Healthcare Design - May 2016

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