Inside Methodist's new 'Ebola unit'
Indiana University Health unveils its special pathogens unit, designed to fight exotic, highly contagious diseases.
(Photo: Matt Kryger/IndyStar)
The patient sat swathed in protective gear, only her eyes peeking out above her face mask. Nurses swarmed around her, garbed from head to toe in zombie-like suits. Packs on their backs filtered the air they breathed. The patient clutched a pink basin encased in a plastic bag lest nausea overcome her.
The group raced through IU Health Methodist Hospital, down an empty, remote corridor into a locked elevator and up to the sixth floor, where they reached the hospital’s Special Pathogens Unit, thought to be the only such facility in the state.
Born out of the Ebola epidemic two years ago, the unit represents state-of-the-art care for patients who have or are suspected of having highly infectious, relatively rare diseases such as Ebola, Lassa fever, SARS or even bioterrorism. The hospital opened the one-room unit in January 2015 but Tuesday unveiled it to the media and public officials, who watched a drill unfold.
“The idea is to be ready,” said Dr. Douglas Webb, medical director for infection control for IU Health. “This is a result of … trying to prepare for the possibility that any of the major hospitals around the county could see a highly infectious contagious patient.”
In the summer of 2015, the facility saw two patients, each for about three to four days, long enough to ascertain they had malaria, not Ebola, Webb said.
When IU Health started contemplating such a unit in 2014, only four such sites existed nationwide, including one at the National Institutes of Health and one atEmory University Hospital in Atlanta. That's where IU School of Medicine alum Dr. Kent Brantly went to recover after contracting Ebola while working as a medical missionary in Liberia.
Since then, about 40 to 50 hospitals have created units designed to handle such cases. The Centers for Disease Control and Prevention has certified the IU Health unit as an assessment center, but the facility also is capable of treating these diseases, Webb said.
A hospital in Nebraska has the largest such unit, with capacity for 10 patients. Most such units, however, have space for only a few patients, and most sit idle for months or even years between suspected cases.
Renovating the space for Methodist’s unit, where the room is under negative pressure to keep pathogens from escaping, cost hundreds of thousands of dollars, Webb said.
U.S. Rep. Susan Brooks praised IU Health’s efforts Tuesday before watching a drill of how it could operate in a crisis.
For now, IU Health wants to make sure it’s ready, training about 20 staff members in how to handle such concerns.
On Tuesday, the simulation kicked off with the arrival of an actor pretending to be a student suffering symptoms consistent with Lassa fever, a viral hemorrhagic illness that occurs in West Africa. The student had recently returned from Nigeria, which in the past year has seen an outbreak of nearly 275 cases of that disease.
She arrived in an ambulance, and staff whisked her to the unit. Had the drill been real, a team of hospital environmental specialists — also dressed in protective gear — would have swooshed behind, cleaning everything in the patient’s wake. Once the patient entered the room, anyone who went in would have to exit through a rear door.
Red tape on the floor marks the no-return line for those stepping through double doors. The only time both sets of doors open is to allow a patient to enter.
The staff wore suits equipped with air-purifying respirators, mobile air filters that provide the wearer with a constant flow of clean air through a hose.
Everything that could have had contact with the patient’s germs is decontaminated, including the vials that hold the blood the nurses draw to test for disease. The nurses double-bag the vials and wipe the plastic bag with bleach. When the vials reach the lab, the staff don personal protective equipment of their own and study the samples under a special hood.
Nurses tending to the patient will spend no more than two hours at a time encased in the protective suits. Although the suits can be put on relatively quickly, taking them off requires attention and time.
A trained observer watches over video as the two nurses carefully remove the clothing, including multiple pairs of gloves. One missed step could prove fatal.
“It’s like peeling an onion layer by layer,” said Stephen Kitts, a nurse on the unit.
One of the most expensive costs of operating such a unit is disposing of the potentially toxic waste it produces, said Dr. Bryan Schmitt, IU Health clinical pathologist. Little touches abound, such as lining vomit basins with kitty litter-like material so that if the patient is sick, the waste is more solid. The hospital stores the waste until a diagnosis is reached because it must use a special vendor certified to remove the most highly toxic detritus.
Health care workers’ safety is taken into account at every step.
“There’s a need for a unit like this. I don’t think there needs to be a lot of them,” Webb said. “We just want to try to recognize these unusual diseases of having this property of being highly contagious and very lethal.”
Call IndyStar reporter Shari Rudavsky at (317) 444-6354. Follow her onTwitter: @srudavsky.