Amid panic last fall over the possible spread of Ebola in the United States, Johns Hopkins Hospital began work on a unit designed to safely care for patients with the disease and other dangerous infections, a hospital official said.
With the facility now mostly completed, Hopkins could be designated to care for any patients with Ebola or other dangerous infections across much of the Mid-Atlantic region. Hopkins joins a handful of U.S. institutions with such facilities.
The unit, in Hopkins' East Baltimore hospital complex, includes three patient rooms, each with rooms on either side of it for donning and removing protective equipment, its own lab for testing patient specimens, and a waste management system that can treat linens, protective equipment and bodily fluids on-site. It also is equipped to perform ultrasounds and X-rays without moving patients outside of containment.
The project could bring Ebola patients to Baltimore as health workers continue to battle the virus in West Africa. And in the long run, it could put Hopkins on a short list of institutions prepared to respond in the event of other pandemics.
"A unit like this is obviously important for a disease like Ebola, but it will also be very useful for other emerging infectious diseases," said Dr. Lisa Maragakis, director of infection control for Hopkins Hospital, in a podcast on the Hopkins Medicine website.
Hopkins is already among three hospitals that state health officials designated to care for Ebola patients should any have turned up in the state last fall, when the virus appeared in Texas and New York City. In late October, the state health department tagged Hopkins, University of Maryland Medical Center and MedStar Washington Hospital Center in the District of Columbia, to receive any local Ebola patients.
But the new biocontainment lab puts Hopkins on par with facilities such as the National Institutes of Health Clinical Center in Bethesda, Emory University Hospital in Atlanta and Nebraska Medical Center in Omaha. Those three hospitals have cared for about a dozen Ebola patients, most of whom were flown from West Africa for treatment, in biocontainment labs. There is a fourth U.S. biocontainment unit at Rocky Mountain Laboratories, an NIH facility in Hamilton, Mont.
Currently, a health worker with Ebola is in fair condition at the NIH in Bethesda. The person was flown there from West Africa last month and was briefly in critical condition before improving. In October, Nina Pham, one of two Dallas nurses who contracted Ebola, was transferred there and treated before she was declared free of the virus and released.
At Hopkins, crews began demolition to make way for a biocontainment unit Oct. 29, said Dr. Brian Garibaldi, the unit's associate medical director. That was two weeks after Pham and colleague Amber Vinson contracted the virus from a Liberian man who became sick after traveling to Texas, and when fears over Ebola spreading further in the U.S. were at their peak.
The unit was designed after visits to NIH in Bethesda and Nebraska Medical Center, where Hopkins officials asked experts at those facilities how they designed their units and what they would change if they could, said Garibaldi, who spoke at an Ebola seminar Thursday at Hopkins' Bloomberg School of Public Health.
The unit is designed to contain airborne pathogens, using specialized air handling systems and negative air pressure, he said. It is equipped with systems to sterilize entire rooms using a vaporized hydrogen peroxide solution. And its autoclave waste management system means that waste doesn't have to be contained and shipped elsewhere to be disposed of properly, a process that would cost as much as $500,000 per patient per week, Garibaldi said.
Hospital officials have assembled a team of about 100 doctors and nurses trained to work in the unit, Garibaldi said.
The federal Department of Health and Human Services is planning to establish at least 10 regional centers for treatment of Ebola and other special pathogens, one in each of its designated regions. Maryland's region also includes Delaware, Pennsylvania, Virginia, West Virginia and Washington, D.C. Those centers are intended to be ready within hours to receive a confirmed Ebola patient, and to have "enhanced capacity to care for other highly infectious diseases," according to the department.
Applications are due to the department's Assistant Secretary for Preparedness and Response by April 20. Decisions on the centers will be made after a review, officials said, but they did not provide a timeline.
Christopher Garrett, spokesman for the Maryland Department of Health and Mental Hygiene, said the agency is aware of Hopkins' efforts to become a regional Ebola center.
Maryland received an $11.1 million grant in February for a hospital preparedness program focused on Ebola, and much of that is going to Hopkins, as well as to University of Maryland Medical Center and MedStar Washington Hospital Center, the other two state-designated Ebola hospitals, Garrett said.
The Hopkins unit was built in a location well-known to many Hopkins clinicians, Garibaldi said — a former HIV clinic established by Dr. John G. Bartlett in the early 1980s, where Dr. B. Frank Polk also established an early inpatient clinic for patients with HIV and AIDS.
"I think we're very cognizant of that rich history," Garibaldi said.
U.S. biocontainment units
•National Institutes of Health Clinical Center, Bethesda
•Emory University Hospital, Atlanta
• Nebraska Medical Center, Omaha, Neb.
• Rocky Mountain Laboratories, an NIH facility, Hamilton, Mont.