The next outbreak probably won’t be Ebola.
It could be a novel strain of avian or swine flu. It could be a coronavirus like Middle East respiratory syndrome, better known by its acronym, MERS. It could be another viral hemorrhagic fever, like Lassa or Rift Valley.
Whatever it is, Providence Sacred Heart Medical Center officials say they are ready.
The hospital was one of ten in the country chosen by the U.S. Department of Health and Human Services to host a “special pathogens unit,” a special contained ward for people with highly infectious diseases. In the event of an outbreak, Sacred Heart could take patients from Washington, Oregon, Idaho and Alaska.
“The chances of seeing an Ebola patient are very slim, but the chances of us seeing a different patient are higher,” Christa Arguinchona, the assistant nurse manager for the unit.
Congress allocated funding to hospitals following the 2014 Ebola outbreak, which killed thousands of people across West Africa and led to some patients, mostly health care workers, being treated at U.S. hospitals.
The hope was to concentrate resources in designated hospitals “so that not every state has to develop the same redundant capacity,” said Erika Henry, health care preparedness lead for the Washington Department of Health.
Sacred Heart was the sole applicant for the region and received $2.1 million over five years to build the unit, train staff and run ongoing drills.
“We really felt that being a part of this national approach was better than trying to ignore the problem,” said Peg Currie, chief operating officer for Providence Health Care. “We wanted to create an environment for our caregivers where they had an opportunity to learn from the best and the most experienced people on this particular virus.”
Most hospitals, including Sacred Heart, already were equipped to isolate sick patients and prevent contagious diseases from being spread. But Ebola was different.
The disease isn’t especially contagious: it’s spread through blood and bodily fluids and is not airborne. Sit next to an Ebola patient on a crowded bus and you’ll almost certainly be fine, even if they’re very sick.
But Ebola killed roughly half the people it infected during the most recent West Africa outbreak, a fatality rate virtually unheard of for other infectious diseases. It’s far, far easier to catch influenza, but the flu is much less likely to be fatal, so Ebola warrants extra precautions.
“Patient safety and health care worker safety is always our priority, but in this kind of situation it’s just amplified,” Arguinchona said.
Ebola is sometimes nicknamed the “caregiver’s disease” because health care workers, who handle an infected person’s blood and bodily fluids, are more at risk. Ebola is highly infectious, meaning very few virus particles are needed to get someone sick. When they’re sickest, Ebola patients have a very high concentration of virus particles in their blood and other fluids.
Thirty-three nurses, two respiratory therapists and several doctors and lab technicians have volunteered to work on the unit if needed, though they remain assigned to their regular roles in the hospital. Much of the preparation for the special pathogens unit has been setting up procedures to contain diseases while keeping staff safe.
“It’s been very fun for people who have been in nursing for a long time to try something new,” Arguinchona said.
The special pathogens unit is locked and requires an ID badge to enter. The entire unit has negative airflow to prevent disease from spreading out. When a door is opened, either to the unit or to an individual patient room, air flows in rather than out, keeping germs in a designated area.
The unit is 14,000 square feet and equipped to handle up to 10 patients with infectious diseases. It can take up to two Ebola patients: a lower number because of the number of people who would have to be involved in their care. Patients would be housed in the unit’s two critical care capable rooms, which have been stripped of cabinets and other porous surfaces to expidite disinfection.
There’s a lab inside the unit so blood from sick patients doesn’t have to leave. Lab technicians, nurses and doctors caring for patients are required to don personal protective equipment, which varies depending on the seriousness of the disease being treated.
Ebola and similar diseases require the highest level of protection, which Arguinchona demonstrated during a tour of the unit. First, a nurse puts on Crocs over her normal scrubs. The shoes were chosen for a simple reason: “They’re easy to clean,” Arguinchona said.
Next, plastic purple booties go on over her feet. Then, she puts on a helmet with a built-in air filter and face shield. A disposable suit goes over the whole ensemble with a double set of gloves and a final set of booties over the toes. The second glove set is rubber-banded in place.
“You feel like an astronaut,” Arguinchona said.
Staff suiting up will always have an assistant to help them dress and undress. The lab, as well as the two Ebola patient rooms, have “doffing” rooms next door where staff can take off their gear under the eye of another trained practitioner. Waste from the unit is incinerated by a company trained to handle infectious biohazard material.
“There’s drills regularly to ensure that the personal protective equipment is worn properly, is put on properly, is taken off properly,” said Dr. Joel McCullough, Sacred Heart’s medical director of community health and epidemiology.
Spokane may seem like a small city for a multi-state specialized infectious disease unit, but it has a few advantages over larger Seattle hospitals like Harborview.
Sacred Heart has both an adult and children’s hospital, and is equipped to care for both children and adults in the special pathogens unit. The hospital also had space available: a vacant children’s ward that was no longer being used, complete with a colorful African savannah motif on the walls.
Hospital administrators were supportive. Having an Air Force base nearby is also an asset, Currie said, in case patients needed to be flown in from other states without disrupting commercial air travel.
In the event of an outbreak, the hospital would work with the Washington Department of Health and the Spokane Regional Health District, though Sacred Heart always would have the final say about whether they could receive a patient. The hospital has an online portal for employees involved in patient care to monitor themselves for symptoms, like a fever or headache, and enter them every 12 hours.
“Our hope is we’ll never have to use the unit,” said Susan Sjoberg, program manager for communicable disease epidemiology at the Spokane Regional Health District.
When it’s not being used for infectious diseases, it can host overflow patients from other parts of the hospital. Since work was completed earlier this year, some patients recovering from minor surgeries have had short stays. The goal is to keep only short-term patients in the unit so they can be moved out quickly if needed.
Through her work on the unit, Arguinchona has been able to meet with national experts on Ebola, including some of the doctors who were treated in the U.S. after becoming infected caring for West African patients.
When she started preparations, the idea of actually caring for an Ebola patient scared her, she said. But that’s no longer the case.
“I feel really confident about our ability to care for a patient with Ebola,” she said. “I don’t feel scared anymore.”