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Personnel Management and Biosecurity of U.S. High-Level Isolation Units

Herstein, Jocelyn J., MPH; Biddinger, Paul D., MD; Gibbs, Shawn G., PhD; Le, Aurora B., MPH; Jelden, Katelyn C., MPH; Hewlett, Angela L., MD; Lowe, John J., PhD

Journal of Nursing Administration: November 2018 - Volume 48 - Issue 11 - p 553–560
doi: 10.1097/NNA.0000000000000679

OBJECTIVE To describe strategies used by US high-level isolation units (HLIUs) to recruit, train, and sustain a full team of multidisciplinary staff and identify how units are secured.

BACKGROUND Fifty-six US hospitals have been designated HLIUs, capable of providing safe care to patients with highly infectious disease.

METHODS An electronic survey was administered to the 56 HLIUs in spring of 2016. Responses were collected via a fillable PDF and analyzed using descriptive statistics.

RESULTS Thirty-six HLIUs (64%) responded; 33 completed surveys, and 3 reported no longer being a designated HLIU. HLIUs reported large numbers of multidisciplinary staff, primarily consisting of RNs and critical care clinicians. Nearly all HLIUs (94%) required orientation training, although hours varied.

CONCLUSIONS Over a short period, HLIUs recruited and trained significant numbers of staff with little guidance. Costs of ongoing trainings are considerable, and it remains unclear how HLIUs will continue funding these activities.

Author Affiliations: Program Coordinator (Ms Herstein) and Associate Professor (Dr Lowe), Department of Environmental, Agricultural, & Occupational Health; Associate Professor (Dr Hewlett), Department of Internal Medicine; Medical Student (Ms Jelden), University of Nebraska Medical Center, Omaha; Vice Chairman for Emergency Preparedness (Dr Biddinger), Department of Emergency Preparedness, Massachusetts General Hospital, Boston; Associate Professor (Dr Biddinger), Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Professor and Executive Associate Dean (Dr Gibbs) and Academic Specialist (Ms Le), Department of Environmental and Occupational Health, Indiana University School of Public Health, Bloomington; and Director of Research and Development (Dr Lowe) and Medical Director (Dr Hewlett), Nebraska Biocontainment Unit, Nebraska Medicine, Omaha.

The authors declare no conflicts of interest.

Correspondence: Ms Herstein, University of Nebraska Medical Center, 985110 Nebraska Medical Center, Omaha, NE 68198 (

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