How the Special Pathogen Unit plays a crucial role in combatting infectious diseases
UI Health Care’s Special Pathogen Unit ensures safe, expert care for high-risk infections while staying prepared for emerging health threats.
When a dangerous pathogen threatens public health, UI Health Care’s Special Pathogen Unit (SPU) stands ready to respond.
Designed with state-of-the-art infection control and isolation, this unit is able to transform a portion of the Surgical and Neurosciences Intensive Care Unit at our university campus into a secure biocontainment care space equipped to handle highly infectious diseases.
“We’re the only Level 2 SPU in our region,” notes Michael Hartley, emergency management consultant. “That means we have the capacity to care for patients for the duration of their illness. This includes adults, pediatric and neonatal patients, and pregnant women.”
Hartley explains that certified health care facilities are categorized into one of four levels as defined by the National Emerging Special Pathogens Training and Education Center. Each level is based on a facility’s ability to provide specialized care for highly infectious diseases, with considerations for infrastructure, staffing, training, and resources to manage pediatric, adult, or both patient populations.
Level 1 facilities act as regional hubs, offering specialized care for patients with suspected or confirmed special pathogens. They treat patients of all ages and acuity levels for the duration of their illness.
Level 2 facilities like our SPU have the capacity to deliver specialized care to clusters of patients suspected of or infected by a special pathogen and serve as the primary patient care delivery center.
Level 3 facilities provide accessible care, perform basic lab tests, stabilize patients, and coordinate quick transfers to Level 1 or 2 facilities. They can care for patients for 12–36 hours.
All other health care facilities are considered Level 4, which means they identify, isolate, inform, provide stabilizing care, protect staff, and arrange timely patient transport to reduce operational impact.
“The primary goal of the Special Pathogen Unit is to protect health care providers and other patients from exposure while delivering the best possible care to critically ill patients who have or are under investigation for an infection with a special pathogen,” adds Jonathan Simmons, DO, medical director of the unit. “With no vaccines or treatments available for many of these diseases, like Ebola or other hemorrhagic fevers, the focus is on supportive care and preventing the spread of infection.”
Staying ahead of the unexpected
To make such high stakes care possible, Simmons explains that behind the scenes of the SPU are highly trained health care professionals who conduct regular drills to stay prepared for unexpected scenarios, such as recently caring for a patient with Lassa fever.
A special pathogen is a highly infectious agent capable of producing severe disease in humans, according to the U.S. Centers for Disease Control and Prevention (CDC).
During the critical incident, the Hospital Incident Command System (HICS) was activated to coordinate efforts across the university. While the SPU focused on providing direct patient care, a massive support team worked in the background, including pharmacy, infection prevention, epidemiology, pathology, environmental services, administration, maintenance, and Safety and Security, ensuring every aspect of the care process ran smoothly and safely.
“Nurses in the SPU undergo quarterly four-hour training sessions to ensure readiness for high-stakes care,” says Taylor Bentler, MSN, RN, CCRN, nurse manager for the unit. “These sessions emphasize donning and doffing—a specialized process for putting on and taking off personal protective equipment (PPE)—which is a critical skill to protect both the care team and others from exposure. Nurses also practice specialized tasks not typically part of their routine, such as performing x-rays, managing ventilators, and setting up dialysis, all while fully suited in PPE.”
“It's very different doing common care tasks like putting in a line with four pairs of gloves versus one pair of gloves,” says Simmons. “Doctors also must be ready to assist nurses with really anything that they need and because of the strict PPE requirements, team members must rely heavily on each other since quickly entering or exiting the room isn’t an option. The quarterly training is essential because you never know when a situation will arise—it might not happen for another three years, or we could have another case as soon as next month.”
“When our Special Pathogen Unit was first built in 2014, our big focus was on preparing for Ebola,” Hartley adds. “But now, we prepare for any kind of special pathogen, especially after the COVID-19 pandemic. Since its inception, our Special Pathogen Unit has collaborated closely with Level 1 facilities like Nebraska Medicine and Emory University to ensure we’re leveraging the best practices and guidance in handling highly infectious diseases.”
During the Lassa fever incident, UI Health Care worked closely with the CDC, Iowa HHS, the University of Nebraska Medical Center’s Biocontainment Unit, as well as county public health departments.
Ensuring the SPU operates safely and effectively also requires close coordination with many other teams at the university campus—like IT, Safety and Security, and maintenance—who support the specialized in-room team with vital resources such as communication solutions, air handling, and PPE protocols. Their efforts are essential to maintaining the integrity of the unit, which features a range of specialized biocontainment systems designed to support both patient care and safety.
Other key biocontainment features in our SPU include:
- Dedicated exhaust separate from the HVAC supply units to eliminate recirculation of a patient’s exhaled air while also keeping the area under negative pressure
- Decontamination shower for patients and staff to thoroughly clean themselves and dispose of any contaminated PPE
- A pass-through autoclave to treat all contaminated waste. All linens, utensils, medical waste, and garbage goes through the autoclave prior to being handled by housekeeping and nursing staff
Simmons shares that the future goal for the SPU is to continue being a highly capable and effective Level 2 facility, expand the team, and broaden the list of diseases the unit is trained to handle. This includes emerging threats like avian influenza, which could require SPU care if it spreads more widely among humans.
“The bottom line is that people can feel confident knowing we’re equipped to handle these situations safely, without posing a risk to the community, while still delivering the high standard of care that UI Health Care is known for,” says Hartley.
Whatever the case may be, the SPU team is dedicated to staying ahead of public health challenges and ensuring that Iowans continue to receive safe, specialized, and effective care for infectious diseases.