Johns Hopkins Hospital unit trains to respond to infectious disease outbreaks, bioterrorism

The Johns Hopkins Biocontainment Unit (BCU) team, which can provide front line care and treatment in the event of highly infectious diseases or bioterrorism attack holds periodic exercises like this one to train and prepare for patients who could otherwise potentially fuel an epidemic. (Jerry Jackson, Baltimore Sun video)

Two medics wearing head-to-toe protective gear carefully wheeled the man on a gurney out of an elevator at Johns Hopkins Hospital.

The public health researcher recently returned from the Democratic Republic of Congo and had symptoms of Ebola — a cough, muscle pain and high fever. Dressed in a dark t-shirt and shorts, the man lay encased in a plastic, bubble-like pod.


Doctors isolated him to prevent the spread of the highly infectious disease, transporting him from the emergency room to the hospital’s biocontainment unit for quarantine until tests could be completed.

The transport conducted Wednesday wasn’t real — it was a training exercise to teach staff how to respond if someone with a deadly disease showed up at the hospital.

The Johns Hopkins Biocontainment Unit is one of 10 regional centers across the country designed to respond to outbreaks of highly infectious diseases or bioterrorism attacks — whether from Ebola or the acute respiratory syndromes SARS or MERS. The unit covers much of the Mid-Atlantic region, including Delaware, Maryland, Pennsylvania, Virginia and Washington.

The unit was opened with federal government funding in 2015 amid an Ebola outbreak in West Africa that caught U.S. hospitals off guard. Two Texas nurses contracted the virus while caring for a Liberian citizen who arrived in the United States with the disease, which is spread through bodily fluids. The nurses were treated and later declared free of the virus.

Johns Hopkins Hospital has built a unit designed to safely care for patients with Ebola and other dangerous pathogens, joining only a handful of institutions with such facilities in the country.

Hospitals want to be ready for whatever the next incident might be.

“We don’t know what the next outbreak will bring, but there is certainly a need for us to be prepared for it,” said Dr. Brian T. Garibaldi, medical director of the Hopkins biocontainment unit.

Part of that preparation is conducting training exercises every few months, like the one Wednesday.

The faux Ebola patient, really the fiance of one of the unit’s medical staff, was taken to a room, where two nurses and a doctor carefully removed him from the “isopod” and lifted him onto a bed. The staff of about 75, all trained in infection control, wore protective gear that included two to three pairs of gloves and plastic shields covering their faces.


The unit is designed to contain airborne pathogens by using specialized air handling systems and negative air pressure. As someone enters, air pushes into the room so that pathogens don’t escape. Medical staff exit through a different door to avoid contaminating hallways and other sterile rooms.

Nurses drew a blood specimen from the patient and took it across the hall for testing at a lab on the unit. Further testing also can be done at a lab run by the Maryland Department of Health, which the doctors work closely with during such emergencies.

“It really is a team that works together concerning these pathogens,” said Dr. David Blythe, the state’s epidemiologist.

Meanwhile, the two medics who brought the patient to the unit headed into an adjacent room to remove their gear. A nurse and infectious disease expert guided each one through a 25-to-30-step process to remove each article of clothing. They removed a layer of gloves and then showed the other team members their hands. They then washed their hands, before moving another layer of gloves. They constantly looked at a mirror for any fluids on their bodies.

A building at Johns Hopkins Hospital was evacuated Thursday due to possible tuberculosis contamination, according to the hospital.

The medics gave each article of clothing to a nurse who placed them into plastic bags. When everything was removed, the bags were placed into red barrels and taken down the hall to a room where the waste was sterilized for disposal.

The clothes were placed into an autoclave that uses extremely high pressure, heat and steam to free them of contaminants before they can be discarded with other medical waste.


While the fake patient was able to leave at the end of the exercise, real patients would remain longer while the Ebola tests or treatments were completed.

The unit is funded by a five-year, $4.1 million grant from the U.S. Department of Health and Human Services’ Office of Preparedness and Response that ends in 2020. Further funding will be needed after that to run the unit, which has an annual budget of about $640,000, Garibaldi said.

“It is going to need capable sustained funding,” Garibaldi said.

Hopkins officials also held the demonstration to let the community know they strive to run the safest facility possible.

“We are always concerned about how we are affecting the community and our neighbors and letting them know we are making sure they are safe,” said Christopher Sulmonte, the unit administrative manager.