The Serious Communicable Diseases Unit (SCDU) in Emory University Hospital, where four patients with Ebola virus disease (EVD) were treated in 2014, continues to be of keen interest to infectious disease and public health experts, scientists, military and government officials, and students from here and around the globe.
About 60 groups have toured Emory's SCDU in the past two years, says Allison Klajbor, clinical research coordinator in infectious disease. "We've had ministers of health, members of the US Air Force, and nursing and biostatistics classes," she says. Visitors include delegations from Tokyo, Nigeria, Hungary, Thailand, Japan, England, Vietnam, China, and Canada.
In September, for instance, senior nurse Allison Sykes, of the Newcastle upon Tyne Hospitals NHS Foundation Trust, visited Emory's SCDU as part of a tour of biocontainment units across the US and Europe. "I was the infection prevention and control lead for the development of the high-level isolation unit at our trust during the 2014 Ebola outbreak," Sykes says. "I'm also visiting units at Bellevue, Johns Hopkins, Nebraska, Iowa City, Madrid, Rome, Hamburg, and Berlin." On completion, she said, her report and recommendations will be submitted to the Winston Churchill Memorial Trust, who funded the trip, and shared with other treatment centers in the UK and the national High Consequence Infectious Diseases programme.
Sykes did a walk-through of the SCDU's negative-pressure rooms, lab, and autoclave with SCDU senior administrator Sonia Bell, critical care nurse Jill Morgan, and SCDU medical director Bruce Ribner.
The SCDU has expanded since 2014, and changes have been incorporated in response to lessons learned since that time. For example, as the team told Sykes, as many surfaces as possible in a unit like this should be stainless steel, regular hospital floor tile will be eaten away by continual disinfection, and while patient rooms need to let in natural light, they should also be shielded from view.
"One of the things we didn't anticipate was the public interest," says Ribner. "There were literally helicopters flying overhead to take photos." Blinds couldn't be cleaned properly, so the team settled on opaque film on the outside of the window with enough of an opening at the top for the patients to see "a little sky, while protecting their privacy."
Sykes also was interested in how the unit dealt with patient transport, waste, personal protective equipment, and what medical procedures (such as mechanical ventilation and dialysis) could be performed in the SCDU's rooms.
In June, physician Ian Crozier accompanied a group from the American Society for Microbiology "Microbe 2018" conference as they toured the very unit where he spent 40 days recovering from EVD.
The sickest of the four patients treated at Emory, Crozier remembers only part of his time in the unit--but his successful treatment revolutionized patient care.
"Even after I awoke many weeks later, a few days after my 45th birthday, I wasn't fully aware of how closely I had looked death in the eye," he said. "As a physician, if you had told me during my first week of care that I would develop encephalopathy, respiratory failure, kidney failure, and cardiac arrhythmia, I would have expected my chances of survival to be almost zero. What happened inside those four walls changed the nature of how we treat Ebola patients."
The visitors lined up to take selfies with Crozier, shake his hand, and ask a volley of questions as Morgan, one of Crozier's nurses in the unit, demonstrated the protective PPE outfit, complete with powered air-purifying respirator, double gloves, and booties. "You have to dissect the implications of every action taken in the unit," said Morgan.
Emory's efforts to prepare for future outbreaks have continued through research, improved patient care protocols, and training health care workers and first responders around the country.
"The government has called on Emory to care for patients with special pathogens in the US," says infectious disease physician Colleen Kraft, a member of the original Ebola team. "We would like to take what we learned about preventing transmission of diseases in a biocontainment unit out into every health care interaction."--Mary Loftus | 
