August 4, 2020

Five years ago, Texas Children’s Special Isolation Unit (SIU) opened at Texas Children’s Hospital West Campus to provide safe, effective care to patients with highly contagious infectious diseases. The decision to build the SIU came shortly after an unprecedented Ebola outbreak, resulting in the realization that Texas Children’s must always be prepared as an organization to handle any emerging infections that come our way.

Texas Children’s Special Isolation Unit at West Campus – the only one of its kind in Texas and among only a few in the United States – allows our teams to treat pediatric patients who are infected with highly contagious diseases in a state-of-the-art environment. The SIU is fully equipped with all of the latest scientific and technological approaches to biocontainment to assure the safety of the health care team, other patients and their families. The types of highly contagious pathogens that can be treated in the SIU include Ebola, influenza, measles and respiratory illnesses like MERS, SARS and RSV. Today, as many health care organizations face another global health pandemic, the SIU team at West Campus has been busy over the last several months providing care to COVID-19 adult and pediatric patients.

“As a virologist, I always thought in the back of my mind that we would possibly face a pandemic one day whether it be avian influenza or another coronavirus like SARS or MERS,” said Dr. Amy Arrington, medical director of the SIU at West Campus. “But I think until you’re really in that moment, it’s hard to imagine what responding to a pandemic like COVID-19 would be like for our team and the organization.”

Housed on the fifth floor of West Campus, the SIU has eight dedicated beds and up to 18 overflow beds on the fourth and fifth floors to care for COVID-19 patients, with the potential of expanding bed capacity as the need arises. The SIU is activated when patients meet a specific criteria, and in this case, are COVID-19 positive.

“We have nurses and doctors embedded in many clinical areas across our campuses who serve as clinician reservists on standby,” said Denise Tanner-Brown, Assistant Vice President of Nursing of Community and Ambulatory Nursing. “Once we activate them, they are pulled out of their home clinical areas to support the SIU.”

Since the pandemic began in early March, the West Campus SIU has been activated 12 times. The last time the SIU was activated was on May 30 and has remained open since then. As of July 31, 184 patients have been admitted to the SIU and 75 of those patients were admitted in June. West Campus has had 13 COVID-19 positive adult patients admitted to the SIU since it started taking care of adult COVID-19 patients on June 24. In May and June, the SIU saw a 48 percent increase in the average daily census.

Tanner-Brown says the SIU is on the downswing compared to previous months. Texas Children’s has seen a recent decline in COVID-19 admissions which demonstrate that masking protocols are working to curb the spread of the virus. However, the SIU team remains ready to care for increased patient volumes if warranted.

“When we began accepting adult patients in our SIU on June 24, we were a little worried about how they would perceive us as they came into a pediatric hospital setting for care,” Tanner-Brown said. “They have been more than grateful and extremely appreciative of our willingness to take good care of them.”

Since many of the adults who have COVID-19 or who required admission had some underlying disease presence, the SIU team collaborated with education coordinators from Houston Methodist West who provided guidance on general and COVID-19 specific care to ensure the best outcomes for these patients.

View a photo gallery of inside the SIU at West Campus below.

Preparing for a potential second wave

While some school districts are reopening campuses and others are sticking to virtual learning at least for the time being, Texas Children’s is ready and prepared to respond if the Houston area experiences another surge in COVID-19 cases after school starts and into the fall months during flu season.

“We are always in a constant state of readiness and we are not letting our guard down especially with the mounting uncertainty surrounding this unprecedented pandemic,” said Tanner-Brown. “As patient volumes decrease, we have a deactivation strategy where we can temporarily close down units. But we also have an activation strategy in place where we can turn it back on really quickly should the situation change. In general, many people are getting COVID fatigue, and may not feel the need to continue practicing social distancing or taking other safety precautions, so I anticipate that we may see more new cases emerge.”

For the 70 days and counting that the SIU at West Campus has been activated, the recent milestones achieved would not have been possible without the 100 percent collaboration from our team members across the system.

“I think as an organization, we have just really stepped up to the plate to provide good quality and safe care for these patients and our staff,” said Arrington. “It takes a huge village to put this together and to carry this out day after day. And it’s exhausting work, but it is work that is incredibly rewarding too.”

June 22, 2020

Interim Physician-in-Chief Dr. James Versalovic and several other Texas Children’s physicians recently published a paper in the Oxford Academic: The Journal of the Pediatric Diseases Society detailing the clinical course of 57 children with COVID-19 cared for at Texas Children’s at the beginning of the pandemic. Dr. Catherine Foster with Infection Control and Prevention is the lead author of the paper and Dr. Judith Campbell with Infection Control and Prevention is the senior author.

The paper’s overall findings were that most of the children were mildly symptomatic, and only a few patients with underlying medical conditions required hospitalization. System wide, the patient evaluation processes at Texas Children’s allowed for prompt identification and management of patients with COVID-19.

“These outcomes are an affirmation that we were doing what we need to do to provide the best care for patients and their families,” said Campbell, medical director of Infection Control and Prevention. “They tell us that we are identifying patients early and getting them the help they need quickly all while helping to reduce the spread of COVID-19.”

Some key findings of the study, which took place during the first five weeks of the outbreak in Houston include:

Identification process

  • Pre-procedural surveillance testing identified three patients who had no respiratory symptoms
  • The majority (71 percent) of cases presented in the ambulatory setting

Patient demographics

  • Fifty-six percent of all 57 patients were male
  • Median age was 10.7 years (range was 0.1 – 20.2 years)
  • Asthma (12 percent) was the most common underlying condition, followed by sickle cell disease (7 percent)
  • More than half of the cases (54 percent) reported a laboratory-confirmed COVID-19 household contact
  • International travel was reported in two cases (Mexico and Commonwealth of Dominica) and interstate travel in one case (New Jersey)
  • Most patients (83 percent) presented with either fever or cough, including all of the patients who presented to the Emergency Center
  • Fever was reported in 53 percent of ambulatory patients, 90 percent of EC patients, and 25 percent of hospitalized patients

Patient care

  • Six patients were cohorted in the Special Isolation Unit at Texas Children’s Hospital West Campus
  • Half of the hospitalized patients required supplemental oxygen via nasal cannula, and 1 patient was on home bilevel positive airway pressure without supplemental oxygen.
  • No patients required mechanical ventilation
  • The median length of stay was 2 days (range, 1 – 10 days)
  • None of the 57 patients received therapeutic agents to treat COVID-19
  • No patients died

In addition to the data above, the paper evaluated Texas Children’s Hospital’s integrated system approach to the evaluation and management of patients during the COVID-19 pandemic by performing a retrospective assessment of all pediatric patients with COVID-19 cared for through the Texas Children’s system.

COVID-19 was declared a pandemic by the World Health Organization on March 11. As of the beginning of June, the Centers for Disease Control and Prevention reported more than 1.8 million COVID-19 cases and 100,000 plus deaths in the United States. Early reports have provided critical insights on the clinical manifestations of the disease in children. Most children appear to have asymptomatic or mild to moderate respiratory illness, whereas adults, especially the elderly, are more likely to suffer severe respiratory illness and a higher case fatality rate. Given the rapidly evolving nature of the COVID-19 pandemic, data on the epidemiology and clinical course of pediatric patients with COVID-19 in the United States are lacking.

“That’s why it’s so important to document what we are seeing and doing and share these findings with the medical community worldwide,” Versalovic said. “Texas Children’s has been doing this since the onset of the pandemic and will continue to be on the leading edge of scholarship and care of pediatric COVID-19 patients.”

Paper authors include:
Dr. Catherine Foster, Infection Control and Prevention
Dr. Elizabeth Moulton, Infection Control and Prevention
Dr. Flor Munoz, Infection Control and Prevention
Dr. Kristina Hulten, Infection Control and Prevention
Dr. James Versalovic, Interim Physician-in-Chief
Dr. James Dunn, Pathology
Dr. Paula Revell, Pathology
Dr. Tjin Koy, Infection Control and Prevention
Dr. Amy Arrington, Special Isolation Unit
Dr. Lucila Marquez, Infection Control and Prevention
Dr. Judith Campbell, Infection Control and Prevention

May 15, 2018

Texas Children’s recently participated in a large-scale exercise focusing on the transport of an Ebola-positive pediatric patient from a facility in The Woodlands to Texas Children’s Special Isolation Unit at Texas Children’s Hospital West Campus.

As the Centers for Disease Control and Prevention-designated pediatric Ebola treatment center for the southwest region, Texas Children’s was chosen to be a part of the exercise organized by the U.S. Department of Health and Human Services to test the nationwide ability to move patients with highly infectious diseases safely and securely to regional treatment centers.

“Providing safe, high-level care for patients with highly infectious special pathogens, such as the Ebola virus, requires an incredible amount of training and preparation,” said Dr. Amy Arrington, medical director of Texas Children’s Special Isolation Unit. “We do this exceeding well at Texas Children’s Hospital, with a state-of-the-art Special Isolation Unit and incredible team of volunteer health care workers who train regularly to care for these patients. But it is also critical to practice coordinating the transport of these patients as a medical community, between health care facilities.”

More than 50 organizations throughout the nation participated in the exercise, including the Department of State, Department of Transportation, the Regional Ebola Treatment Centers, local and state health and emergency management agencies, hospitals, airport authorities, and non-government organizations.

The exercise focused on moving seven people acting as patients with Ebola symptoms in different regions of the country. At each health care facility, clinical workers simulated the collection and shipment of samples for diagnostic tests to state laboratories, which in turn practiced running the necessary laboratory tests to diagnose the patients with Ebola.

As part of the exercise, each patient received a positive diagnosis. Using appropriate isolation techniques and personal protective equipment, health care workers then took steps to have six of the patients transported by air to designated Regional Ebola Treatment Centers. These patients were placed into mobile biocontainment units for these flights. The pediatric patient was placed into protective equipment and transported by ground ambulance.

“Saving lives during crises requires preparation and training,” said Dr. Robert Kadlec, Health and Human Services Assistant Secretary for Preparedness and Response. “A tremendous amount of coordination, synchronization, and skill is needed to move patients with highly infectious diseases safely. We have to protect the patients and the health care workers caring for those patients. This type of exercise helps ensure that everyone involved is ready for that level of complexity.”

August 15, 2017

The National Ebola Training and Education Center (NETEC) recently partnered with Texas Children’s to host a groundbreaking Pediatric Simulation Conference.

Held on August 10 and 11 at Texas Children’s Hospital West Campus, the conference was the first pediatric simulation course of its kind for the NETEC, which is supported by the Centers for Disease Control and Prevention (CDC) as well as the Office of the Assistant Secretary for Preparedness and Response (ASPR).

The NETEC is comprised of faculty and staff from Emory University, the University of Nebraska Medical Center/Nebraska Medicine and the New York Health and Hospitals Corporation, Bellevue Hospital Center. All three of these health care institutions have safely and successfully treated patients with Ebola and have worked diligently to share their knowledge with other health care facilities and public health jurisdictions.

These adult institutions receive funding to train all of the CDC-funded U.S. Ebola treatment and assessment centers in hospital preparedness. They have hosted successful training and simulation courses but none have been pediatrics based. The NETEC chose to come to Texas Children’s to host its premiere Pediatric Simulation Course because of the knowledge and expertise the health system has honed during the past few years since the most recent Ebola outbreak in 2014.

Less than a year after the outbreak, Texas Children’s built and opened the unique Texas Children’s Special Isolation Unit (SIU) so that the health system would be prepared to handle emerging infections as an institution. As a result, the state and the CDC designated Texas Children’s Hospital as one of several pediatric Ebola treatment centers countrywide.

Texas Children’s SIU is the only one of its kind in Texas and the southwest region, and is among the few in the United States designated just for children. Located on the fifth floor of West Campus, the eight-bed unit is fully equipped to care for any infant or child with a serious communicable disease and has all of the measures available to assure safety of the health care team, other patients and their families.

Children coming to the SIU will receive top notch care from a team of highly-trained staff, led by Dr. Amy Arrington, medical director and nursing leader, Sondra Morris.

“This was a great opportunity to show off our unit, our amazing team and our intuition,” Arrington said. “I am quite proud of how hard the SIU team has worked to make sure everyone at the conference had the best possible experience, and I know they all left here knowing Texas Children’s Hospital is more than prepared for any serious communicable disease in the pediatric population.”

Approximately 35 people from around the nation attended the pediatric simulation conference, which consisted of both lectures and clinical simulations, led by 10 NETEC faculty and 10 SIU course directors. Examples of topics covered included: donning and doffing, nursing care considerations in a pediatric biocontainment unit, ethical concerns, and immersive pediatric simulations held is the SIU.

Barb Craft, a clinical service line director with Kapi’olani Medical Center for Women & Children in Honolulu, attended the conference and said it and Texas Children’s SIU were amazing.

“Your SIU is so well thought out and a model for any isolation unit, be it adult or Pediatric,” Craft said. “I would highly recommend this course and would like more of Dr. Arrington and her staff’s experience shared in future offerings.”

May 5, 2015

5615SIU640

Here at Texas Children’s, we proudly embrace the role of trailblazers to accelerate health care for our patients and their families. Unified in our infinite passion for the mission, we continuously innovate ourselves to meet new medical challenges and situations.

In December, we announced our plan to build an eight-bed special isolation unit at Texas Children’s Hospital West Campus. The unit is designed for children with highly contagious infectious diseases. Similar to the four other biocontainment units in the country, the one at Texas Children’s will be one of the only in the United States designated just for children.

5615SIUinside640“Having the best qualified people running the special isolation unit is key to its success,” said Dr. Gordon Schutze, the unit’s medical director. “Everyone involved will be specially trained in infection control, hospital epidemiology and management of infectious diseases in this special care setting.”

This elite Special Response Team will include physicians, registered nurses, medical technologists and environmental services technicians. The physicians and registered nurses will make up the care team while the medical technologists will perform special specimen testing in a state-of-the-art lab within the special isolation unit. In addition, the environmental services techs will handle waste processing from the unit through an autoclave.

The leaders dedicated to selecting the members of the Special Response Team have begun the process and are asking those who are interested in being a part of this unique and exciting team to raise their hands.

“Being part of this elite team will be an honor and a privilege,” said Dr. Judith Campbell, one of the unit’s associate medical directors.

Dr. Amy Arrington, the unit’s other associate medical director, agreed and said those who are selected to be on the Special Response Team will be getting the chance of a lifetime to impact care delivery. “The care that will be given inside the special isolation unit will be state-of-the art,” she said.

Texas Children’s leaders would like to have the members of the Special Response Team chosen and in place by this summer. At that point, the team will begin a series of ongoing training exercises that will ready them to be deployed to the SIU if it were to be activated.

To learn more about joining the Special Response Team, click here.

About the Special Isolation Unit

Since the decision to build a special isolation unit was made five months ago, members of a multidisciplinary team created specifically for the unit have visited two of the premiere biocontainment units in the country at Emory University in Atlanta and Nebraska Medical Center in Omaha.

Many of the lessons learned by these organizations have been incorporated into the design of the special isolation unit at Texas Children’s and can be seen in a mock-up of the unit that was recently built on the fourth floor of West Campus. Construction of the unit is anticipated to begin in May and the unit should be fully operational in October.

“This unit will help us do what we do best and that is care for children with some of the most serious and complex medical conditions,” West Campus President Chanda Cashen Chacón explained. “The organization’s decision to create a special isolation unit illustrates the level of competency and skill we have here at Texas Children’s.”