[MUSIC] The point of this entire course is not to advocate for a biocontainment unit in your facility, but rather, to give you the tools through education to be able to problem solve some of the things that you would need to consider. If you had to care for a patient in your facility, would need a high level biocontainment. It's up to you if you want to invest in the infrastructure of your facility, but we assume that most healthcare facilities cannot do this. But, let's take the next few minutes dedicated to those who do want to invest in their infrastructure and have a biocontainment unit. Here's how Nebraska Medicine selected a particular area of their facility, and what they added to ensure that it would serve as biocontainment unit. >> When we were looking for the location for where the biocontainment unit needed to be, we were quiet fortunate at the hospital, because there was a unit that had previously been used a bone marrow unit for a pediatric patients. It had its own air handling, it was empty at this time, it wasn't being used, and it was almost perfect to just renovate, and change the air handling from a positive pressure to a negative pressure. >> Here is some advice from the experts on where you should locate the patient in your facility to ensure a maximum amount of infection control and containment. >> If I were to give advice to another hospital, I think the couple things that I would really focus them in on is making sure that you have a solid safe structural zone. So, workflows and traffic flow that keeps clean and dirty. Efficient but effective. We had this beautiful unit that was designed that we were able to function within and that created huge amount of safety. But I really think it's no different than out on the front lines today. We have to really always have a team that's mindful of hand washing, personal protective equipment, doing it correctly, because that's how we can injure healthcare workers as if we don't have all those processes in place. >> A very important topic to ensure biocontainment of an infectious disease is waste management. Meticulous care must be used to insure that contaminated waste doesn't cost the spread of the infection, either in the health care facility or beyond. The caregivers at Nebraska Medicine firmly believe that sometimes investing in something an autoclave upfront can actually save a tremendous amount of money down the road. >> So when we think about waste management processes, I think, again, it's a little bit a dichotomy in that we affront spent to have in autoclave put into this biocontainment unit ten years ago. So the upfront cost, and if you were to put that in place today, is probably right around $100,000. Its pretty expensive, if you're going to be in a position where you were, perhaps, rare to ever care for these types of patients with this highly infectious category A waste issue. So, one of those things that it's hard to know how to advice people. But I think if, now, as we're standing up the infrastructure in the country that the places who really are serious about becoming an emerging infectious disease go to location. I think an autoclave is absolutely the way to go. It mitigates risk, you're not moving trash that's contaminated, it just makes it safer for everybody involved. And really the upfront cost of $100,000, you can't compare even with one case, one patient. Over a $1 million for one other organization in the country who needed to use that service. >> But we also need to realize that this may not be possible in most facilities. So, you may have to work with your existing sterilizers, which are typically located in your central supply area of the facility. Our experts have some advice on how to do that. >> And I think what we've seen is that there are places in different states that require, actually their state requires, that they inseminate and decontaminate trash before it's moved anywhere to a landfill. So in those states what we've seen is instead of having autoclaves in their units, they've got a big incinerator somewhere on campus. So, again, it's really helping them to really think about, okay, what's the path you're going to take? How are you going to move trash from A to B? One of the containers, you're going to move that trash in? How do you make sure that all those processes are sound? >> Management of human waste should also be considered in your facility, especially for organisms that are transmitted through the gastrointestinal system, like the Ebola Virus. Here is a short video on how innovative you can get, but the basic principles of containment are what matter. >> When caring for patients who have a highly infectious disease, the proper management of body fluids is essential for that containment of the disease. There have been many discussions related to the proper disposal of human waste generated by the highly infectious disease patient. This video will demonstrate the process used by the Nebraska Biocontainment Unit when disposing of human waste. In the Nebraska Biocontainment Unit, it was determined that all human waste generated by patients will be pretreated with an EPA approved disinfected before being flushed into the public sewer system. It is recommended that local public works departments be included in conversations surrounding human waste disposal. And preparing to dispose of human waste, the healthcare worker should be dressed in the appropriate PPE. Disposable equipment, such as urinals and bedpans, should be limited to single use only. All human waste, such as urine and stool, is pretreated within an appropriate concentration of an approved EPA disinfectant before flushing. In the Nebraska Biocontainment Unit, the disinfectant was allowed to dwell for at least twice the recommended contact time after each patient use. The disinfectant that was selected received ten minutes of dwell time. Instruct the patient not to flush the toilet after use, so that the toilet be treated appropriately. When flushing the toilet, place a tray over the opening if your toilet does not having led to prevent aerosolization. Flush the toilet twice. Wait at least five minutes before remove the tray, and then wipe off the tray with bleach wipes. Following the patient's discharge the trays should be disposed of using established waste removal processes. >> You should be seeing a trend here that all boils down to controlling the movement of potentially contaminated objects. And that means anything that is coming from the immediate patient area. From caregivers, to laboratory specimens, to equipment that maybe contaminated. So you should have a process to ensure that anything coming from the patient's room is moved to a hot, to a warm, and then to a cold environment, or from dirty to clean. [MUSIC]
