We Are Family: Denver Health High Risk Infection Team

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During the West African Ebola Outbreak in 2014, Denver Health & Hospital Authority created the High Risk Infection Team (HITeam) to ensure readiness and preparedness for the hospital and staff. A year later, after a thorough review of its biocontainment facilities by the Centers for Disease Control and Prevention (CDC), Denver Health was designated a Regional Emerging Special Pathogens Treatment Center (RESPTC), able to safely treat and care for patients with highly infectious diseases, by the U.S. Department of Health and Human Services.

The HITeam is staffed by a group of medical doctors, registered nurses, respiratory therapists, medical laboratory scientists, paramedics, and emergency medical technicians who are prepared to identify, isolate, transport, treat, and care for patients. We interviewed two members of this dedicated team about their experience at Denver Health.

Special Pathogens Preparedness: A Team Effort at Denver Health

Adam Sorenson, RN, recalls a seminal moment in his career when he cared for a patient diagnosed with botulism in the pediatric biocontainment unit (BCU) at Denver Health, sparking his interest in rare, high consequence diseases. Like many of the diseases that they see in the BCU, the initial signs and symptoms of botulism are non-specific, making it difficult to diagnose early on. Additionally, botulism is rare and, in pediatric cases, is often the result of consuming honey—but that wasn’t the case in this situation.

Thankfully Dr. Claudia Kunrath, one of the Pediatric Intensivists on the Denver Health HITeam was able to tap into her experience diagnosing and treating botulism. “Many healthcare personnel may never care for a patient with botulism,” says Adam. “The ascending paralysis accompanied by an inability to manage secretions and protect airways requires life support measures such as intubation and a breathing tube. At Denver Health, we are very fortunate to have a diverse work force and, in this case, Dr. Kunrath—who is from and worked in Brazil—had experience with botulism and made the diagnosis.”

The experience underscored for Adam the importance of being able to accurately and efficiently identify rare diseases that can have severe consequences for patients if not treated quickly.

Several years later, he was working in the pediatric ICU when the first cases of Ebola were reported in the United States. Adam recalls several colleagues who had worked in health care at the start of the AIDS epidemic who kept saying it was just a matter of time before Ebola was in their hospital. It was at that point that Adam joined the HITeam. He wanted to be ready for what might be coming to Denver, and the BCU was the perfect place to grow professionally while supporting special pathogens preparedness.

While Denver Health has seen two suspected cases of Ebola since 2015, neither tested positive. However, the unit remains prepared for the next U.S. outbreak of Ebola or any other special pathogen.

As a nurse educator at Denver Health, Adam provides just in time training for volunteers who work in the BCU and leads quarterly drills on protocols like donning and doffing, waste management, and cleaning and disinfection of spaces in the unit. Adam says his favorite thing about the HITeam is the teamwork: “It takes doctors, nurses, laboratorians, respiratory therapists, and paramedics all working together to care for a patient. Preparing and supporting the team is equally important and requires involvement from a lot of people. In the process, we all get to learn about different roles in the hospital, learn new skills, and work with people we might not otherwise get a chance to work with.”

Keeping it Collegial: Family Meetings and the Funky Bug

Jake Fray, MLS (ASCP)CM, is the point of care supervisor in the Biosafety Level 3 laboratory, which means he keeps the lab running: doing quality control checks of instruments, training staff and volunteers, and making sure the lab is ready for activation in case of a special pathogen outbreak. He has worked at Denver Health for seven years and joined the Regional Emerging Special Pathogens Treatment Center (RESPTC) group five years ago. Jake trains a mix of staff, including medical lab scientists with backgrounds in microbiology, molecular diagnostics, chemistry and hematology, on safe practices in a Biosafety Level 3 lab, like donning and doffing personal protective equipment (PPE).

Typically, the HITeam lab serves as a safe space for lab work done for patients in isolation, to avoid contaminating the regular lab with potentially highly infectious diseases. Thankfully those cases are infrequent, but the lab is equipped to test for the Zaire ebolavirus and can package and ship specimens for other highly infectious diseases. Recently they have dealt with a lot of mpox specimens—collecting and sending them out to the state labs.

Whether responding to a potential Ebola case or the mpox outbreak, every activation is an opportunity for the Denver team to test their processes and improve them. A significant benefit of participation in NETEC is learning from their fellow RESPTCs about how they have standardized certain protocols. The HITeam gathers regularly to talk through the examples from other facilities and how they can adjust the processes for the Denver Health setting.

“There’s great value in talking it through. We are working with NETEC to figure out standardization for certain protocols, and it’s useful to have examples from other RESPTCs, but each hospital is different. Our hospital layout, staffing numbers and expertise, and testing capabilities are all different,” says Jake.

These “family meetings” bring together the HITeam coordinators throughout the hospital, from paramedic and emergency department staff to the hospitalists and laboratorians. They meet once a month to discuss topics like workflow from patient pickup to discharge and how to get the patients to isolation without contaminating the entire hospital or scaring other patients. “I really appreciate the family meetings,” says Adam, “because everyone has a voice. It’s not just one person—a lead or charge nurse—making the decisions. We create ‘family rules’ we can all agree on.”

The thread of collegiality runs through HITeam programming. The monthly “Funky Bug” webinars feature presentations from members of the team on the “bug of the month.” The vibe at these sessions is collaborative and conversational. Experts in various subsets of patient care, lab testing, treatment, waste management, and more generously share their knowledge with the wider group of health care professionals in attendance. Questions and conversation are encouraged, and while the subject matter is serious, they clearly enjoy one another’s company.

Join the HITeam: Denver Health Wants YOU!

With the current state of the health care industry—a shortage of workers, burnout among remaining staff, and more—the HITeam faces challenges in recruiting. In an ideal world, the team would include more than 30 nurses; but right now, they have about half that number. Jake estimates that the staff who volunteer fulfill 22 hours of training annually to ensure readiness, security, and competency to work in the biocontainment unit. This commitment takes a toll on the individuals who volunteer and the program. “Our volunteers are being asked to do extra work and we are pulling them off the bench from their full-time jobs,” says Jake.

But ask Jake and Adam and they agree the benefits of joining the HITeam are worth it. “If you want to learn new things and develop new skills, all in a team-oriented environment the HITeam is just that,” says Adam. Volunteers learn critical skills in infection prevention and control, including how to properly use personal protective equipment. Those skills can be transferred to regular duties throughout the hospital and position the volunteer as an expert in special pathogens prevention.

To learn more about the HITeam or to join, visit the Denver Health website or email HITeam@dhha.org.