• Mallory Reimers
  • Jordan A. Hughes
  • Brian T. GaribaldiEmail author


Staffing a facility for bioemergencies is one of the more complicated issues in high containment care. The unique challenges of this environment demand a multidisciplinary team with experience from all aspects of healthcare delivery. At the same time, the goal is to minimize the number of individuals who are potentially exposed to highly infectious pathogens. As a result, the team must consist of engaged individuals who are willing to take on responsibilities above and beyond their normal duties in the hospital. Each healthcare facility must take into account their unique strengths and circumstances when designing a staffing model that is appropriate for that institution. Healthcare worker and patient safety are the ultimate measures of success for a staffing model. Provider engagement in protocol design, training, administration, and team building activities will help to ensure the successful operation of the team during times of activation. Future research and experience with new bioemergencies will continue to inform the practical and ethical issues of staffing units for the care of patients with highly hazardous communicable diseases.


Staffing models Recruitment Retention Safety High containment care Volunteer versus compelled service 


  1. 1.
    Bannister B, Puro V, Fusco FM, Heptonstall J, Ippolito G. Framework for the design and operation of high-level isolation units: consensus of the European Network of Infectious Diseases. Lancet Infect Dis. 2009;9:45–56.CrossRefGoogle Scholar
  2. 2.
    Garibaldi BT, Kelen GD, Brower RG, Bova G, et al. The creation of a biocontainment unit at a Tertiary Care Hospital: The Johns Hopkins Medicine Experience. Ann Am Thorac Soc. 2016;13:600–8.CrossRefGoogle Scholar
  3. 3.
    Sokol DK. Virulent epidemics and scope of healthcare workers’ duty of care. Emerg Infect Dis. 2006;12:4.CrossRefGoogle Scholar
  4. 4.
    Link RN, Feingold AR, Charap MH, Freeman K, Shelov SP. Concerns of medical and pediatric house officers about acquiring AIDS from their patients. Am J Public Health. 1988;78:455–9.CrossRefGoogle Scholar
  5. 5.
    Freedman B. Is there a duty to provide medical care to HIV-infectious patients? Facts, fallacies, fairness, and the future. Can Fam Physician. 1990;36:479–82.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Narasimhulu DM, Edwards V, Chazotte C, Bhatt D, Weedon J, Minkoff H. Healthcare workers’ attitudes toward patients with Ebola virus disease in the United States. Open Forum Infect Dis. 2016;3:ofv192.CrossRefGoogle Scholar
  7. 7.
    Decker BK, Sevransky JE, Barrett K, Davey RT, Chertow DS. Preparing for critical care services to patients with Ebola. Ann Intern Med. 2014;161:831–2.CrossRefGoogle Scholar
  8. 8.
    Smith PW, Anderson AO, Christopher GW, Cieslak TJ, et al. Designing a biocontainment unit to care for patients with serious communicable diseases: a consensus statement. Biosecur Bioterror. 2006;4:351–65.CrossRefGoogle Scholar
  9. 9.
    Kortepeter MG, Kwon EH, Hewlett AL, Smith PW, Cieslak TJ. Containment care units for managing patients with highly hazardous infectious diseases: a concept whose time has come. J Infect Dis. 2016;214:S137–41.CrossRefGoogle Scholar
  10. 10.
    HHS. HHS selects nine regional Ebola and other special pathogen treatment centers. 2015. Available from:
  11. 11.
    Torabi-Parizi P, Davey RT Jr, Suffredini AF, Chertow DS. Ethical and practical considerations in providing critical care to patients with Ebola virus disease. Chest. 2015;147:1460–6.CrossRefGoogle Scholar
  12. 12.
    Johnson SS, Barranta N, Chertow D. Ebola at the National Institutes of Health: perspectives from critical care nurses. AACN Adv Crit Care. 2015;26:6.CrossRefGoogle Scholar
  13. 13.
    Hewlett AL, Varkey JB, Smith PW, Ribner BS. Ebola virus disease: preparedness and infection control lessons learned from two biocontainment units. Curr Opin Infect Dis. 2015;28:343–8.CrossRefGoogle Scholar
  14. 14.
    Al-Dorzi HM, Aldawood AS, Khan R, Baharoon S, Alchin JD, Matroud AA, Al Johany SM, Balkhy HH, Arabi YM. The critical care response to a hospital outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection: an observational study. Ann Intensive Care. 2016;6:101.CrossRefGoogle Scholar
  15. 15.
    Choi WS, Kang C-I, Kim Y, Choi J-P, The Korean Society of Infectious D, et al. Clinical presentation and outcomes of Middle East respiratory syndrome in the Republic of Korea. Infect Chemother. 2016;48:118–26.CrossRefGoogle Scholar
  16. 16.
    Centers for Disease Control and Prevention (CDC). Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). 2011 [cited 24 Feb 2017]. Available from:
  17. 17.
    Fink D, Cropley I, Jacobs M, Mepham S. Febrile illness in healthcare workers caring for Ebola virus disease patients in a high-resource setting. Euro Surveill. 2017;22Google Scholar
  18. 18.
    Dishneau D. App aids monitoring of West Africa travelers for Ebola. Baltimore Sun; 2015.Google Scholar
  19. 19.
    Lenaghan PA, Schwedhelm M. Nebraska biocontainment unit design and operations. J Nurs Adm. 2015;45:4.CrossRefGoogle Scholar
  20. 20.
    Schwedhelm S, Beam EL, Morris RD, Sebastian JG. Reflections on interprofessional team-based clinical care in the ebola epidemic: the Nebraska Medicine experience. Nurs Outlook. 2015;63:27–9.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Mallory Reimers
    • 1
  • Jordan A. Hughes
    • 1
  • Brian T. Garibaldi
    • 2
    Email author
  1. 1.Department of MedicineJohns Hopkins HospitalBaltimoreUSA
  2. 2.Johns Hopkins Biocontainment Unit, Pulmonary and Critical CareJohns Hopkins University School of MedicineBaltimoreUSA

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