Capabilities of global high-level isolation units: A pre-workshop survey

Abstract

Objective: To assess experience, physical infrastructure, and capabilities of high-level isolation units (HLIUs) planning to participate in a 2018 global HLIU workshop hosted by the US National Emerging Special Pathogens Training and Education Center (NETEC). Design: An electronic survey elicited information on general HLIU organization, operating costs, staffing models, and infection control protocols of select global units. Setting and participants: The survey was distributed to site representatives of 22 HLIUs located in the United States, Europe, and Asia; 19 (86%) responded. Methods: Data were coded and analyzed using descriptive statistics. Results: The mean annual reported budget for the 19 responding units was US$484,615. Most (89%) had treated a suspected or confirmed case of a high-consequence infectious disease. Reported composition of trained teams included a broad range of clinical and nonclinical roles. The mean number of HLIU beds was 6.37 (median, 4; range, 2–20) for adults and 4.23 (median, 2; range, 1–10) for children; however, capacity was dependent on pathogen. Conclusions: Responding HLIUs represent some of the most experienced HLIUs in the world. Variation in reported unit infrastructure, capabilities, and procedures demonstrate the variety of HLIU approaches. A number of technical questions unique to HLIUs remain unanswered related to physical design, infection prevention and control procedures, and staffing and training. These key areas represent potential focal points for future evidence and practice guidelines. These data are important considerations for hospitals considering the design and development of HLIUs, and there is a need for continued global HLIU collaboration to define best practices.

A narrative review of high-level isolation unit operational and infrastructure features

“…Importantly, costs to construct an HLIU and maintain the physical infrastructure can represent a significant barrier to establishing such units, which can range in the millions of dollars 1 10 12 13. Most HLIUs are in dedicated spaces within hospitals with separate air handling systems; however, a few HLIUs are within private buildings 6 12. HLIUs are generally either dedicated (eg, solely for HCID cases) or designated/flexible (used routinely for non-HCID cases when not activated) 1 6.…”

“…Most HLIUs are in dedicated spaces within hospitals with separate air handling systems; however, a few HLIUs are within private buildings 6 12. HLIUs are generally either dedicated (eg, solely for HCID cases) or designated/flexible (used routinely for non-HCID cases when not activated) 1 6. HLIU biosecurity measures, including secure entry and exit, controlled access, personnel verification and security presence when activated, are essential to managing the risk of HCID exposure to the rest of the hospital and public 1 3 14…”

“…HLIUs have unique and advanced capabilities designed to provide high-quality care while minimising transmission risks through optimal infection prevention and control (IPC) functions 4. HLIUs have played critical roles in response to previous outbreaks of HCIDs or novel infectious diseases, including the 2014–2016 West Africa Ebola virus disease (EVD) outbreak, early weeks of the COVID-19 pandemic when SARS-CoV-2 emerged as a novel pathogen, and sporadic imported cases of other VHFs in the USA and Europe 5–7…”

Challenges and Approaches to High-Level Isolation Unit Staffing and Just-in-Time Training: A Meeting Report

“…Maintaining a cadre of highly trained staff and institutional support for the HLIU program were key challenges discussed in the November 2022 Global Rounds. Although not specifically addressed in this meeting, HLIUs require significant financial investments to sustain capabilities and maintain readiness [ 3 , 13 ]; due to the relative infrequency of HCID events and even rarer HLIU activations, securing and sustaining funding for HLIU operations, including and notably for retaining staff and providing ongoing training, can be particularly challenging for HLIUs. Demonstrating the value of the HLIU program is core to sustaining HLIU staffing; importantly, this value must be highlighted for the individual team member (eg, through research opportunities, professional development, monetary incentives), for the institution (eg, HLIU experts training staff in other hospital departments, conducting and securing funding for research), and for broader local, national, and global health security to sustain funding (eg, supporting HCID surge events across health systems, HCID expertise inherent in HLIU programs).…”

How Should Biocontainment Balance Infection Control With Practice Sustainability?

“…BCUs have the responsibility of designing IPC guidelines to ensure patient and staff safety and containment of highly infectious diseases, and BCU staff conduct regular trainings and annual exercises to test protocols. 6 However, the core requirements of containment care are not designed with sustainability in mind. The increased usage of disposable PPE, waste packaging, and patient personal items that are disposed of or destroyed rather than sterilized or decontaminated is associated with environmentally detrimental BCU policies that are designed to protect HCWs and patients.…”