Nebraska Biocontainment Unit

Commissioned in 2005 by the U.S. Centers for Disease Control (CDC), the Nebraska Biocontainment Unit (NBU) is a collaborative project involving UNMC, Nebraska Medicine, and the Nebraska Department of Health and Human Services. It provides the first line of treatment for people affected by bioterrorism or highly hazardous communicable diseases. The NBU is one of only a few biocontainment units in the United States and is the largest, with up to a 10-bed capacity, depending upon the specific infection.

The unit is equipped to safely care for anyone exposed to a highly contagious and dangerous disease. Early isolation of an infected patient is essential–buying time for public health officials and providing the chance to either stop an outbreak or help to contain one. The unit’s location, on the same campus as Nebraska’s Bio-Safety Level 3 Laboratory, allows for timely diagnosis and immediate treatment of patients.

NBU personnel consist of a staff of select physicians, registered nurses, respiratory therapists, and patient care technicians specially trained in high level isolation and biopreparedness. Most work full-time in other areas of Nebraska Medicine but remain on-call to report promptly when the unit is activated.

Philip W. Smith, MD, Founding Medical Director of the NBU

Transcript

Philip Smith: That is the $24,000 question. Why Nebraska? Because it doesn't seem logical, but then when you think about it, it made sense, because—first of all we thought of it, and other people—nobody else really came up with the idea at that point. Things changed after Ebola, I can tell you, but Nebraska's in the center of the US. There were only two other biocontainment units, one in Atlanta, Emory University, and one at USAMRIID. And they were both two-bed units and they were both on the East Coast. We had a number of other things going for us as well. We had the fact that we had both civilian and military airports with dual access to the civilian and to the military casualties that might lead us to activate our units. And Dr. Hinrichs had built a BSL-3 laboratory that was very good and safe and capable of dealing with pathogens like this. So for all those reasons, it just fell into place. And it happened to be it had to be in Nebraska[.]

Shelly Schwedhelm, MSN, RN, Associate Director, Emergency Management and Clinical Operations, Global Center for Health Security

Transcript

Shelly Schwedhelm: It was an old bone marrow transplant unit that had been sort of set aside—a pediatric bone marrow transplant unit. And it had its own air-handling, so that was really a feature that made a lot of sense financially, so we were able to really operationalize it with limited capital and had some support to do that from the state of Nebraska, from those bioterrorism dollars. And then we literally functioned it for 10 years on a shoestring. We had some money from our state health department through hospital preparedness funds that was given to us, I think it was $20,000. [Laughs] And we exercised with our team every three months and most every exercise included personal protective equipment training. We did an exercise like twice a year and then I had a small part of an FTE that was supported to help write protocols, procedures, and the nurse you're going to interview is Kate Boulter, who sort of led on that and just kind of kept things moving for all that time. But we really, we didn't keep supplies on the shelf, we created just in time inventories. So if we literally needed to be activated, we could quickly, you know, within four to eight hours, be good to go.

Steven Hinrichs, MD, Former Director, Nebraska Public Health Laboratory

Transcript

Steven Hinrichs: Well, actually, we had a lab in the unit in the beginning, but they actually needed that space and the actual number of tests that the laboratory in the unit could perform was so minimal it wasn’t worth keeping up anymore. And another interesting thing happened—so the doctors who we originally had interviewed, Dr. Smith—and said what test do you need us to provide. And it was very similar, they were very simple, CBC, smear analysis, that’s all we’re going to ask you to provide when we take care of a patient in the unit. As soon as Ebola actually happened, the doctors said, “If we’re coming into the unit risking our lives, we want as many tests as if this patient was in the ICU of the hospital and don’t tell us you’re only going to give us these five tests. We want every test available.” So now the whole clinical laboratory became involved and we had to develop a method and a process for bringing potentially contaminated samples into the laboratory and running them on automated instruments in the laboratory environment which was not BL3 and how to develop a containment policy and infection control policy, all those sorts of the things was a very significant challenge.

Nebraska Public Health Laboratory

The Nebraska Public Health Laboratory (NPHL) was established in 1997 by the state legislature and governor as a partnership between UNMC, Nebraska Medicine, and the Nebraska Department of Health and Human Services (NE-DHHS). The original focus of testing was to provide support for state-sponsored prevention programs for the detection of sexually transmitted diseases, enteric diseases such as salmonellosis, and respiratory diseases such as influenza. In 1999, testing at the NPHL was expanded through grant funding from the Centers for Disease Control and Prevention (CDC) to include testing for bio-threat agents in environmental samples and the detection of chemical agents in human specimens. This unique arrangement between UNMC and NE-DHHS has resulted in saving millions of tax dollars and has leveraged expertise of existing UNMC personnel and state-of-the-art equipment for the benefit of all Nebraskans.

Management and operation of the laboratory is overseen by individuals within the UNMC Department of Pathology and Microbiology, including Peter Iwen, PhD, director; Tony Sambol, MA, assistant director; and Emily McCutchen, manager. The NPHL has an extensive outreach and education program throughout the entire state and helps facilitate the transportation of specimens to the NPHL.

The Healthcare and Emergency Responder Organization Education Through Simulation Program

Created out of a University of Nebraska Programs of Excellence Grant in 2005, the Healthcare and Emergency Responder Organization Education through Simulation (HEROES) program focuses on providing in-person, statewide instruction and training in a wide variety of preparedness subjects. Led by the UNMC College of Nursing, the program collaborates with the College of Medicine, College of Allied Health Professions, and the Center for Preparedness Education to offer an interdisciplinary approach to biological, chemical, radiological, and natural disaster emergencies. Resources are focused on developing hands-on emergency preparedness trainings across the state as well as training materials that are accessible online.

Among their online resources, HEROES has created informative programming related to the various aspects of caring for Ebola patients. They have also continued to be an active resource for healthcare professionals during the COVID-19 pandemic in relation to PPE usage and infection control. Learn more about HEROES and their educational programs by visiting their website.

Elizabeth Beam, PhD, RN, Assistant Director of Research, Nebraska Biocontainment Unit

Transcript

Elizabeth Beam: [T]he thing that we tried to do, one of the media projects we took on pretty early was not only this donning and doffing and respirators in general, which we kind of had that one in the bag, but we worked on one for the extended use and reuse, because reuse was something that really nobody had anything on, and that was one of our fastest growing videos once it came out. Initially, we kind of tried to do everything and we realized that was like a 30 minute video and nobody watches a 30 minute video. So we focused on that reuse piece, because extended use is pretty much just wear it longer. But if you're going to reuse something, you really have to think about the dance of taking it off gently and putting it somewhere where it can kind of desiccate and dry. And so, helping people understand that was important. And so, we kind of filtered it down to just that part. But all of that, you know, were the things that we could do to help people. And, you know, I had people reach out who had been our long term—long time HEROES, groupies, if you will, who said, “My gosh, thank you. Like, we used your video to make sure everybody was educated on how to wear their respirator” and so on and so forth. And so, I think that's the weird thing about being HEROES is you don't know exactly every story, but like you hear later, whether it was COVID or whether it was Ebola. Like I remember, you know, like I said, I was breastfeeding and other things during that time, but a lot of the groups that went down to like Texas after the Thomas Duncan case to help with education down there that like, “HEROES is amazing. [Laughter] Like, we found so much stuff on there, it was great.” It was just like, it was kind of cool to hear at least secondhand from people that people were finding our content and were really grateful for, not because it was exactly what they were going to do, but at least it was an example and then they could tweak. I remember we went to Denver Health for one of the site visits for NETEC and they were so—they were like, “We get it, we get it. So we’re going to do this part and then we're going to walk a little bit further into the decon shower and take this part off and that part off based on kind of what you did. But our situation is a little different.” Like that's exactly what the education’s designed to do.

Kenneth Bayles, PhD, Vice Chancellor of Research, UNMC

Transcript

Kenneth Bayles: [W]e have unique access to the biomedical portfolio of the DoD, unique access in the country compared to all other institutions, we had this special access. So then the question is how do you take advantage of that? How do you leverage that access? We have a seat at the table with this major department that's a big funding agency. So you got to figure out how to take advantage of that. And we're just kind of like building this plane as it's flying. And we made mistakes along the way, but then we eventually figured out that if we have a funding vehicle that makes it easy for the federal government to send us money, then we better be thinking about things that they want to buy, right? So that's when I started thinking about core capabilities that they might be interested in, and that's where I came up with the idea of the Nebraska Drug Discovery and Development Pipeline. I would go to different DoD labs and pitch this idea, “Come to us. I know you're interested in making different drugs that—” in, you know, in those days I was thinking about—as a microbiologist, I'm thinking about antibiotics and I was pitching this, “use this core capability to make antibiotics that would kill anthrax or that would kill tularemia bacteria or, you know, some of these biological weapons of mass destruction.” That was my pitch. They liked the concept, but there was a group within the DoD that had no interest in antibiotics. They were interested in countermeasures to radiation exposure. And so, they said, “Hey, we can use this core capability, but we want you to help us make radiation counter measures, radiation drugs.” And so, that's what we're doing now. We're making anti-radiation drugs for the federal government.