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Health & Science

Kids With Ebola Is Not a Happy Thought, But Texas Children’s Hospital Is Ready

The CDC has designated 55 hospitals nationwide as future “Ebola treatment centers.”

  • Workers finish construction on an 8-bed isolation unit at Texas Children's Hospital in Katy.
    Workers finish construction on an 8-bed isolation unit at Texas Children's Hospital in Katy.
  • The high-tech unit will treat children with highly infectious diseases, including Ebola, MERS, and flu.
    The high-tech unit will treat children with highly infectious diseases, including Ebola, MERS, and flu.
  • Dr. Judith Campbell explains how a "pass-through window" will save time in Texas Children's Hospital 8-bed biocontainment unit, currently under construction.  Nurses can deliver supplies and medications to a patient room without having to don and doff the entire protective outfit and hood.
    Dr. Judith Campbell explains how a "pass-through window" will save time in Texas Children's Hospital 8-bed biocontainment unit, currently under construction. Nurses can deliver supplies and medications to a patient room without having to don and doff the entire protective outfit and hood.
  • Texas Children’s has built an entirely new unit, an 8-bed biocontainment wing at its facility in Katy. (Photo Credit: Texas Children's Hospital )
    Texas Children’s has built an entirely new unit, an 8-bed biocontainment wing at its facility in Katy. (Photo Credit: Texas Children's Hospital )
  • Texas Children’s has built an entirely new unit, an 8-bed biocontainment wing at its facility in Katy. (Photo Credit: Texas Children's Hospital)
    Texas Children’s has built an entirely new unit, an 8-bed biocontainment wing at its facility in Katy. (Photo Credit: Texas Children's Hospital)

Almost one year ago, on September 30, 2014, the CDC announced a confirmed case of Ebola in Texas. Thomas Eric Duncan, a Liberian immigrant living at the time in Dallas, was the first person diagnosed with the deadly virus on American soil.

During his stay at Texas Presbyterian Hospital in Dallas, two nurses also fell ill with Ebola. Duncan died, but the nurses survived, as did a handful of Americans who fell ill in West Africa but were transported back to the U.S. for care.

The Ebola outbreak in West Africa, and its spillover into the U.S., launched a national media frenzy and forced hospital officials to take a hard look at their readiness for a serious epidemic.

By February, four months after Duncan died, the CDC had designated 55 hospitals nationwide as future "Ebola treatment centers." Two of them are in Texas: UTMB in Galveston and Texas Children's Hospital in Houston. Many of the hospitals renovated rooms and increased training and simulations for staff.

But Texas Children's has built an entirely new unit, an 8-bed biocontainment wing at its facility in Katy.

"After the case in Dallas a year ago, we knew there would be a need," said Dr. Judith Campbell, medical director for infection control and prevention at Texas Children's. Campbell helped design the isolation unit, which the hospital began planning last fall after Duncan's death.

"A year ago in the United States, there were only twelve beds for the entire country for patients that had a need to be isolated in a biocontainment unit. And not surprisingly, zero of those beds were designated for children," she added.

In the special pediatric unit, each of the eight patient rooms has an antechamber, where doctors and nurses will put on protective gear, gloves and ventilated hoods. After treating the child inside the room, they will leave through a separate door and enter a third room, where they strip the equipment off.

The whole time, nurses will observe through large glass windows.

"So if there's any question they can say ‘Wait, stop. You need to clean your hands again.' Or ‘Wait, stop. Let's take this glove off more carefully,'" Campbell explained.

The unit has its own biosafety laboratory, so infected blood samples never have to be carried to other parts of the hospital. There's also a separate medical waste room, where carts full of used clothing and equipment can be wheeled inside six-foot autoclaves. There's also a locker room with showers. After every shift, medical workers will shower before leaving the unit.

TCH officials say Ebola was the catalyst for the decision to build, but the unit is designed to handle any globe-trotting superbug.

"These rooms are equipped to take care of TB, MERS, pandemic influenza, bird flu and even a pathogen that we might not know what it is yet," Campbell said. "That's why we wanted to build something with the highest level of isolation ability."

Before designing the unit, teams from Texas Children's visited adult biocontainment units at hospitals in Atlanta and Omaha. Dr. Amy Arrington, a pediatric intensive care specialist, said the medical architecture in the new unit is impressive, but none of it will work without proper training protocols and motivated staffers.

The initial training for working on the biocontainment unit included eight hours of general orientation, followed by 12 hours of learning how to don, doff and maneuver in the biocontainment suits.

"I describe it as a space suit," Arrington said. "It's a full-body suit that you put on, that has footies and arm holes and covers you up completely."

Doctors and nurses who volunteered to work on the unit undertook simulations and mock drills, relearning skills such as inserting IVs while wearing the suit.

"When you put three pairs of gloves on, you (can) lose sensation in your hands because they're so tight," said Arrington, "But you really lose that tactile feel that as physicians and nurses is really important in taking care of any patient, let alone a child," Arrington said.

Handling the social and emotional needs of the young patients will be difficult, because parents will probably not be allowed inside the treatment room if their son or daughter has a highly contagious illness.

But Texas Children's is already working with its child-life specialists on strategies. Campbell said the children can use iPads and video chat to talk with their families. One staffer will act as a dedicated liaison between the child and family members, and relatives can see the child through the large glass observation windows.

Campbell also said the hospital is creating a therapeutic teaching doll for younger patients, one that will wear the same biocontainment suit as the doctors and nurses.

"So that when the healthcare providers come in, they understand that yes, we're dressed up a little differently but that their little doll has similar attire on," she said.

The pediatric isolation unit will be ready for patients in late October, with a formal ribbon-cutting expected in November.

 

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