Making Room For Isolation Patients
The state of Texas, after a visit from the Centers for Disease Control and Prevention last fall, designated Texas Children’s Hospital as a pediatric Ebola treatment center. With a $16 million budget, the hospital’s west campus is now building out an eight-bed isolation unit (as well as 10 beds for acute care) within previously shelled space on the patient tower’s 5th floor.
With a target opening date of October 2015, the design team wasted no time in gathering information and conducting site visits to determine the best way to incorporate the unit in a way that would allow flexibility to use the rooms for non-isolation purposes. Allison Muth, assistant director of facilities planning and development for Texas Children’s, and Brian Walters, senior project manager for Page, described the project in detail during a session at the Healthcare Design Academy in Houston in April.
The unit will care for “normal” isolation patients from across the Texas Children’s system, such as those with measles, influenza, or tuberculosis, while also having the ability to convert to “special” isolation mode for highly contagious infectious diseases such as Ebola. In addition, the unit will be licensed as acute care space, incorporating all eight of the isolation beds and the 10 acute care beds.
The core of the unit will remain largely the same as other patient floors, the speakers explained, to ensure staff familiarity. Some changes include the addition of a biohazard waste area (Muth said you can expect 60 bags of waste in 24 hours for a single isolation patient) and two huge sterilizers to process and clean that waste. The staff locker room is being expanded to include showers. Accommodations for storage of all the equipment necessary for a unit like this were also taken into consideration.
The isolation unit is divided in its containment strategies by zones: green, yellow, and red. The unit as a whole is green—with lots of security and required clearance to enter—with patient rooms at red and the special anteroom designated for doffing of personal protective equipment (PPE) coded at yellow.
The donning, doffing, and disposal of PPE is a critical component of infection containment and the design team spent much time testing the processes for each, having staff go through the protocol in mock-up rooms to ensure the right spaces were designed. Each isolation room is entered through one anteroom (where the donning of PPE takes place) and exited through a separate anteroom for doffing.
To allow for non-isolation usage of the patient rooms when the census requires it, the furniture in each isolation room is all on wheels and can be removed so the room can be sanitized. If, for example, there’s just one Ebola patient, the rest of the rooms could still be used for acute care if necessary; a separate set of security doors can engage to isolate just of couple of rooms in the unit.
In designing the unit, the Texas Children’s team incorporated many of the lessons learned from site visits to the two-bed isolation unit at Emory University Hospital and the five-bed (two if Ebola) biocontainment unit for Nebraska Medicine. Among those lessons:
- Unit flexibility is key for changing functionality.
- Communication between the care team is challenging in full isolation mode and must be considered.
- Protocol for family visitation is also challenging and varies based on situation.