1
|
Lukowski J, Vasa A, Arguinchona C, ElRayes W, Frank MG, Galdys AL, Garcia MC, Garland JA, Kline S, Persson C, Ruby D, Sauer LM, Vasistha S, Carrasco S, Herstein JJ. A narrative review of high-level isolation unit operational and infrastructure features. BMJ Glob Health 2023; 8:e012037. [PMID: 37423621 DOI: 10.1136/bmjgh-2023-012037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/29/2023] [Indexed: 07/11/2023] Open
Abstract
High-level isolation units (HLIUs) are specially designed facilities for care and management of patients with suspected or confirmed high-consequence infectious diseases (HCIDs), equipped with unique infrastructure and operational features. While individual HLIUs have published on their experiences caring for patients with HCIDs and two previous HLIU consensus efforts have outlined key components of HLIUs, we aimed to summarise the existing literature that describes best practices, challenges and core features of these specialised facilities. A narrative review of the literature was conducted using keywords associated with HLIUs and HCIDs. A total of 100 articles were used throughout the manuscript from the literature search or from alternate methods like reference checks or snowballing. Articles were sorted into categories (eg, physical infrastructure, laboratory, internal transport); for each category, a synthesis of the relevant literature was conducted to describe best practices, experiences and operational features. The review and summary of HLIU experiences, best practices, challenges and components can serve as a resource for units continuing to improve readiness, or for hospitals in early stages of developing their HLIU teams and planning or constructing their units. The COVID-19 pandemic, a global outbreak of mpox, sporadic cases of viral haemorrhagic fevers in Europe and the USA, and recent outbreaks of Lassa fever, Sudan Ebolavirus, and Marburg emphasise the need for an extensive summary of HLIU practices to inform readiness and response.
Collapse
Affiliation(s)
- Joseph Lukowski
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Christa Arguinchona
- Special Pathogens Program, Providence Sacred Heart Medical Center, Spokane, Washington, USA
| | - Wael ElRayes
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Maria G Frank
- School of Medicine, University of Colorado, Denver, Colorado, USA
- Biocontainment Unit, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Alison L Galdys
- Division of Infectious Disease and International Medicine - Department of Medicine, University of Minnesota Medical School Twin Cities Campus, Minneapolis, Minnesota, USA
| | - Mary C Garcia
- Department of Laboratory Services, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Jennifer A Garland
- Department of Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Susan Kline
- Division of Infectious Disease and International Medicine - Department of Medicine, University of Minnesota Medical School Twin Cities Campus, Minneapolis, Minnesota, USA
| | - Caroline Persson
- Biocontainment Unit, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Darrell Ruby
- Special Pathogens Program, Providence Sacred Heart Medical Center, Spokane, Washington, USA
| | - Lauren M Sauer
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sami Vasistha
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sharon Carrasco
- Serious Communicable Disease Program, Emory University, Atlanta, Georgia, USA
| | - Jocelyn J Herstein
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
2
|
Lowe AE, Kraft C, Kortepeter MG, Hansen KF, Sanger K, Johnson A, Grein JD, Martin J, Rousselle R, Garland JA, Spotts J, Lowe JJ, Sauer LM, Kratochvil CJ, Gordon BG. Developing a Rapid Response Single IRB Model for Conducting Research During a Public Health Emergency. Health Secur 2022; 20:S60-S70. [PMID: 35544310 DOI: 10.1089/hs.2021.0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Research is foundational for evidence-based management of patients. Clinical research, however, takes time to plan, conduct, and disseminate-a luxury that is rarely available during a public health emergency. The University of Nebraska Medical Center (UNMC) developed a single institutional review board (IRB), with a vision to establish a rapid review resource for a network focused on clinical research of emerging pathogens in the United States. A core aspect of successful initiation of research during a pandemic or epidemic is the ability to operationalize an approach for rapid ethical review of human subject research and conduct those reviews at multiple sites-without losing any of the substantive aspects of ethics review. This process must be cultivated in anticipation of a public health emergency. US guidance for operationalizing IRB review for multisite research in a public health emergency is not well studied and processes are not well established. UNMC sought to address operational gaps and identify the unique procedural needs of rapid response single IRB (RR-sIRB) review of multisite research by conducting a series of preparedness exercises to develop and test the RR-sIRB model. For decades, emergency responder, healthcare, and public health organizations have conducted emergency preparedness exercises to test requirements for emergency response. In this article, we describe 2 types of simulation exercises conducted by UNMC: workshops and tabletops. This effort represents a unique use of emergency preparedness exercises to develop, refine, and test rapid review functions for an sIRB and to validate readiness of regulatory research processes. Such processes are crucial for conducting rapid, ethical, and sound clinical research in public health emergencies.
Collapse
Affiliation(s)
- Abigail E Lowe
- Abigail E. Lowe, MA, is an Assistant Professor, Global Center for Health Security, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE
| | - Colleen Kraft
- Colleen Kraft, MD, MS, is a Professor, Department of Pathology and Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, and Associate Chief Medical Officer, Emory Hospital, Emory University, Atlanta, GA
| | - Mark G Kortepeter
- Mark G. Kortepeter, MD, is Vice President for Research, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Keith F Hansen
- Keith F. Hansen, MBA, is Co-Director, Center for Preparedness Education, College of Public Health; Co-Executive Director, Association of Healthcare Emergency Preparedness Professionals; and an Instructor, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Kristine Sanger
- Kristine Sanger is Director of Training and Exercise Programs, Center for Preparedness Education, College of Public Health, and Co-Executive Director, Association of Healthcare Emergency Preparedness Professionals, University of Nebraska Medical Center, Omaha, NE
| | - Ann Johnson
- Ann Johnson, PhD, MPH, CIP, is Director, Institutional Review Board and Human Research Program, University of Utah, Salt Lake City, UT
| | - Jonathan D Grein
- Jonathan D. Grein, MD, is Director, Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Julie Martin
- Julie Martin, RN, MEd, CIP, is Assistant Director, Institutional Review Board, Emory University, Atlanta, GA
| | - Rebecca Rousselle
- Rebecca Rousselle, BA, CIP, is Assistant Vice President, Human Research Protection Program, Emory University, Atlanta, GA
| | - Jennifer A Garland
- Jennifer A. Garland, RN-BC, PhD, CIC, is an Epidemiologist and Special Pathogens Clinical Program Manager, Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jessica Spotts
- Jessica Spotts, CIP, is a Senior IRB Education and Quality Improvement Analyst, Cedars-Sinai Medical Center, Los Angeles, CA
| | - John J Lowe
- John J. Lowe, PhD, is Co-Principal Investigator, National Emerging Special Pathogens Training and Education Center (NETEC), a Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health, and Assistant Vice Chancellor for Health Security Training and Education, University of Nebraska Medical Center, Omaha, NE
| | - Lauren M Sauer
- Lauren M. Sauer, MSc, is Director, Special Pathogens Research Network, Global Center for Health Security, and an Associate Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE
| | - Christopher J Kratochvil
- Christopher J. Kratochvil, MD, Associate Vice Chancellor for Clinical Research, University of Nebraska Medical Center, Omaha, NE
| | - Bruce G Gordon
- Bruce G. Gordon, MD, is Assistant Vice Chancellor for Regulatory Affairs, Executive Chairman of Institutional Review Boards, and Professor in the Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE
| |
Collapse
|
3
|
Grein JD, Garland JA, Arguinchona C, Frank MG, Garibaldi BT, Grindle A, Hewlett A, Kline S, Levine CB, Mehta A, Mukherjee V, Sauer LM, Searle EF, Vanairsdale S, Vasa A. Contributions of the Regional Emerging Special Pathogen Treatment Centers to the US COVID-19 Pandemic Response. Health Secur 2022; 20:S4-S12. [PMID: 35483049 DOI: 10.1089/hs.2021.0188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The National Emerging Special Pathogens Training and Education Center (NETEC) was established in 2015 to improve the capabilities of healthcare facilities to provide safe and effective care to patients with Ebola and other special pathogens in the United States. Through NETEC, a collaborative network of 10 Regional Emerging Special Pathogen Treatment Centers (RESPTCs) undertook readiness activities that included potential respiratory pathogens. These preparations, which took place before the COVID-19 pandemic, established a foundation of readiness that enabled RESPTCs to play a pivotal role in the US COVID-19 pandemic response. As initial COVID-19 cases were detected in the United States, RESPTCs provided essential isolation capacity, supplies, and subject matter expertise that allowed for additional time for healthcare systems to prepare. Through the Special Pathogen Research Network, RESPTCs rapidly enrolled patients into early clinical trials. During periods of high community transmission, RESPTCs provided educational, clinical, and logistical support to a wide range of healthcare and nonhealthcare settings. In this article, we describe how NETEC and the RESPTC network leveraged this foundation of special pathogen readiness to strengthen the national healthcare system's response to the COVID-19 pandemic. NETEC and the RESPTC network have proven to be an effective model that can support the national response to future emerging special pathogens.
Collapse
Affiliation(s)
- Jonathan D Grein
- Jonathan D. Grein, MD, is Director, both in Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jennifer A Garland
- Jennifer A. Garland, RN-BC, PhD, CIC, is Special Pathogens Clinical Program Manager, both in Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Christa Arguinchona
- Christa Arguinchona, MSN, RN, CCRN, is Manager, Special Pathogens/Infection Prevention, Providence Sacred Heart Medical Center, Spokane, WA
| | - Maria G Frank
- Maria G. Frank, MD, is a Hospitalist, Division of Hospital Medicine, Denver Health and Hospital Authority, and an Associate Professor of Medicine, School of Medicine, University of Colorado; both in Denver, CO
| | - Brian T Garibaldi
- Brian T. Garibaldi, MD, MEHP, is Director, Johns Hopkins Biocontainment Unit, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Amanda Grindle
- Amanda Grindle, RN, MSN, CNL, CPN, CCRN, is Clinical Program Manager, Special Care Unit, Children's Healthcare of Atlanta, Atlanta, GA
| | - Angela Hewlett
- Angela Hewlett, MD, MS, is an Associate Professor, Division of Infectious Diseases, Department of Internal Medicine; the George W. Orr MD and Linda Orr Chair in Health Security; and Medical Director, Nebraska Biocontainment Unit; all at the University of Nebraska Medical Center, Omaha, NE
| | - Susan Kline
- Susan Kline, MD, MPH, is Executive Medical Director for Infection Prevention, University of Minnesota Medical Center, and a Professor of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota Medical School; both in Minneapolis, MN
| | - Corri B Levine
- Corri B. Levine, PhD, MS, MPH, is Program Manager for Emerging and Special Pathogens Program, University of Texas Medical Branch, Galveston, TX
| | - Aneesh Mehta
- Aneesh Mehta, MD, is an Associate Professor of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Vikramjit Mukherjee
- Vikramjit Mukherjee, MD, FRCP(Edin), is an Assistant Professor, NYU School of Medicine; and is Director, Medical Intensive Care Unit, and Director, Special Pathogens Program, Bellevue Hospital Center; all in New York, NY
| | - Lauren M Sauer
- Lauren M. Sauer, MS, is Director, Special Pathogens Research Network, and is an Associate Professor, Department of Environmental, Agricultural, and Occupational Health, College of Public Health, Global Center for Health Security; both at the University of Nebraska Medical Center, Omaha, NE
| | - Eileen F Searle
- Eileen F. Searle, PhD, RN, CCRN, is Biothreats Program Director, Center for Disaster Medicine, Massachusetts General Hospital, Boston, MA
| | - Sharon Vanairsdale
- Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN, is an Associate Professor, Clinical Track, Nell Hodgson Woodruff School of Nursing, Emory University; Program Director for Serious Communicable Diseases, Emory University Hospital; and Director of Education and Resources, National Emerging Special Pathogens Training and Education Center, Emory University; all in Atlanta, GA
| | - Angela Vasa
- Angela Vasa, MSN, RN, is Director of Isolation and Quarantine Services and Director, Readiness Consultations and Metrics Development, National Emerging Special Pathogens Training and Education Center; both at Nebraska Medicine, Omaha, NE
| |
Collapse
|
4
|
Brett-Major DM, Schnaubelt ER, Creager HM, Lowe A, Cieslak TJ, Dahlke JM, Johnson DW, Fey PD, Hansen KF, Hewlett AL, Gordon BG, Kalil AC, Khan AS, Kortepeter MG, Kratochvil CJ, Larson L, Levy DA, Linder J, Medcalf SJ, Rupp ME, Schwedhelm MM, Sullivan J, Vasa AM, Wadman MC, Lookadoo RE, Lowe JMJ, Lawler JV, Broadhurst MJ. Advanced Preparation Makes Research in Emergencies and Isolation Care Possible: The Case of Novel Coronavirus Disease (COVID-19). Am J Trop Med Hyg 2020; 102:926-931. [PMID: 32228780 PMCID: PMC7204595 DOI: 10.4269/ajtmh.20-0205] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 11/29/2022] Open
Abstract
The optimal time to initiate research on emergencies is before they occur. However, timely initiation of high-quality research may launch during an emergency under the right conditions. These include an appropriate context, clarity in scientific aims, preexisting resources, strong operational and research structures that are facile, and good governance. Here, Nebraskan rapid research efforts early during the 2020 coronavirus disease pandemic, while participating in the first use of U.S. federal quarantine in 50 years, are described from these aspects, as the global experience with this severe emerging infection grew apace. The experience has lessons in purpose, structure, function, and performance of research in any emergency, when facing any threat.
Collapse
Affiliation(s)
| | - Elizabeth R. Schnaubelt
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
- United States Air Force School of Aerospace Medicine,
Dayton, Ohio
| | - Hannah M. Creager
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Abigail Lowe
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | | | - Jacob M. Dahlke
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Daniel W. Johnson
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Paul D. Fey
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Keith F. Hansen
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Angela L. Hewlett
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Bruce G. Gordon
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Andre C. Kalil
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Ali S. Khan
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Mark G. Kortepeter
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | | | - LuAnn Larson
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Deborah A. Levy
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - James Linder
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Sharon J. Medcalf
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Mark E. Rupp
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | | | - James Sullivan
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Angela M. Vasa
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Michael C. Wadman
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - Rachel E. Lookadoo
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | | | - James V. Lawler
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| | - M. Jana Broadhurst
- University of Nebraska Medical Center/Nebraska Medicine,
Omaha, Nebraska
| |
Collapse
|