Simulation of a Spontaneous Vaginal Delivery and Neonatal Resuscitation in a Biocontainment Unit

Benjamin K Kogutt; Jeanne S Sheffield; Dianne Whyne; Lisa L Maragakis; Jennifer Andonian; Jade Flinn; Chris Sulmonte; Adam Dodson; Mark Romig; Lauren Sauer; Robert Maloney; Janis Ferrell; Arthur J Vaught; W Christopher Golden; Brian T Garibaldi

doi:10.1089/hs.2018.0090

Simulation of a Spontaneous Vaginal Delivery and Neonatal Resuscitation in a Biocontainment Unit

Health Secur. 2019 Jan/Feb;17(1):18-26. doi: 10.1089/hs.2018.0090.

Authors

Affiliations

¹ Benjamin K. Kogutt, MD, is a Clinical Fellow, Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD.
² Jeanne S. Sheffield, MD, is Division Director, Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD.
³ Dianne Whyne, RN, MS, is Director of Operations, Office of Critical Event Preparedness and Response, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD.
⁴ Lisa L. Maragakis, MD, MPH, is Associate Professor of Medicine, Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, and Senior Director of Infection Prevention, Johns Hopkins Health System, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD.
⁵ Jennifer Andonian, MPH, is Program Manager, Johns Hopkins Biocontainment Unit, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD.
⁶ Jade Flinn, RN, is a Nurse Educator, Johns Hopkins Biocontainment Unit, Office of Critical Event Preparedness and Response, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD.
⁷ Chris Sulmonte, MHA, is Administrative Manager, Johns Hopkins Biocontainment Unit, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD.
⁸ Adam Dodson, NRP, NCEE, is Lead Simulation Specialist, Johns Hopkins Simulation Center, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD.
⁹ Mark Romig, MD, is Assistant Professor, Division of Pulmonary and Critical Care Medicine, and Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD.
¹⁰ Lauren Sauer, MS, is Research Director, Johns Hopkins Biocontainment Unit, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD.
¹¹ Robert Maloney, MS, is Senior Director, Office of Emergency Management for Johns Hopkins Health System, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD.
¹² Janis Ferrell, CT, is Perinatal/Perioperative Clinical Operations Supervisor, Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD.
¹³ Arthur J. Vaught, MD, is Assistant Professor, Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, and Department of Surgery, Division of Surgical Critical Care, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD.
¹⁴ W. Christopher Golden, MD, is Medical Director, Johns Hopkins Hospital Newborn Nursery, Department of Pediatrics, Division of Neonatology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD.
¹⁵ Brian T. Garibaldi, MD, is Director, Johns Hopkins Biocontainment Unit, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD.

Abstract

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.

Keywords: Biocontainment unit; Neonatal resuscitation; Simulation; Spontaneous vaginal delivery.

MeSH terms

Cardiopulmonary Resuscitation*
Containment of Biohazards / methods*
Delivery, Obstetric*
Female
Hospitals
Humans
Infant, Newborn
Infectious Disease Transmission, Patient-to-Professional / prevention & control*
Pregnancy
Pregnancy Complications, Cardiovascular*
Pregnancy Outcome
Simulation Training / methods*

Grants and funding

K12 HD085845/HD/NICHD NIH HHS/United States