Simulation of a Spontaneous Vaginal Delivery and Neonatal Resuscitation in a Biocontainment Unit
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This article describes a large-scale scenario designed to test the capabilities of a US biocontainment unit to manage a pregnant woman infected with a high-consequence pathogen, and to care for a newborn following labor and spontaneous vaginal delivery. We created and executed a multidisciplinary functional exercise with simulation to test the ability of the Johns Hopkins Hospital biocontainment unit (BCU) to manage a pregnant patient in labor with an unknown respiratory illness and to deliver and stabilize her neonate. The BCU Exercise and Drill Committee established drill objectives and executed the exercise in partnership with the Johns Hopkins Simulation Center in accordance with Homeland Security and Exercise Program guidelines. Exercise objectives were assessed by after-action reporting and objective measurements to detect contamination, using a fluorescent marker to simulate biohazardous fluids that would be encountered in a typical labor scenario. The immediate objectives of the drill were accomplished, with stabilization of the mother and successful delivery and resuscitation of her newborn. There was no evidence of contamination when drill participants were inspected under ultraviolet light at the end of the exercise. Simulation optimizes teamwork, communication, and safety, which are integral to the multidisciplinary care of the maternal-fetal unit infected, or at risk of infection, with a high-consequence pathogen. Lessons learned from this drill regarding patient transportation, safety, and obstetric and neonatal considerations will inform future exercises and protocols and will assist other centers in preparing to care for pregnant patients under containment conditions.
This article describes a large-scale scenario designed to test the capabilities of a US biocontainment unit to manage a pregnant woman infected with a high-consequence pathogen, and to care for a newborn following labor and spontaneous vaginal delivery.
Infectious disease outbreaks, such as the Ebola virus disease (EVD) outbreak of 2014-2016, have prompted renewed interest in the development of high-level isolation units—that is, biocontainment units—as well as protocols to provide care for patients with high-consequence pathogens. International travel increases the likelihood that patients infected with pathogens like EVD or avian influenza will present for care in nonendemic areas. In 2014, 68.2 million US citizens crossed international borders, compared with 28.5 million in 2010. The frequency of women traveling during pregnancy is also on the rise. Hence, the US healthcare system must be prepared to treat and manage pregnant women infected with a high-consequence pathogen.
In response to the Ebola outbreak, the Office of the Assistant Secretary for Preparedness and Response (ASPR) funded the creation of a network of 10 Regional Ebola and Special Pathogen Treatment Centers. ASPR stipulated that each of these centers should be prepared to provide care for a pregnant woman infected with a high-consequence pathogen. This mandate requires the capability to provide safe and prompt obstetric care, including treatment of the disease itself as well as commonly encountered acute pregnancy conditions, such as spontaneous vaginal delivery, cesarean section, and spontaneous abortion, in addition to having the capability to resuscitate a newborn post-delivery. Building capacity to care for pregnant patients in this unique situation also necessitates developing a plan for neonatal resuscitation and care if the baby is infected with the high-consequence pathogen or suffers adverse events because of the mother's illness.
Experts in the field of emergency preparedness have called for the identification of a network of obstetricians and pediatricians in advance of public health emergencies to provide the appropriate infrastructure and a timely, efficient response. However, training for such high-risk, low-frequency clinical events represents a logistical challenge. Simulation exercises can provide an optimal tool to improve familiarity, teamwork, communication, and testing of system-based resources to maximize the safe response to real-time events.
This article describes a large-scale functional exercise designed to test the capabilities of a US biocontainment unit to manage a pregnant woman infected with a high-consequence pathogen, and to provide newborn care following labor and spontaneous vaginal delivery.