A Special Program; A Special Professional

Mary Kay Foster
Special Pathogens Unit
Indiana University Health Methodist Hospital

IU Health Methodist Hospital, a pivotal component of the Indiana University Health (IU Health) academic health center (AHC), is highly acclaimed for its myriad of special services, including its status as one of Indiana’s Level I Trauma Centers.  In recent years, IU Health Methodist also has become recognized for its Special Pathogens Unit (SPU).   The evolution and continuing refinement of the SPU is the culmination of the focus and determination of a group of infectious disease /infection control experts. Among these experts is Mary Kay Foster.  A registered nurse since 1985, Mary Kay has been a hospital staff member since 1986.  She joined the infection prevention program in 2012 and was named Special Pathogens Program Manager in 2016.

Mary Kay Foster

Mary Kay Foster

Those who may erroneously assume that infection prevention (and all that it entails) is a snail’s pace, laid back type of specialty, do not know Mary Kay.  In 2014, when the Ebola Virus Disease (EVD) emerged as an international public health crisis, Mary Kay hit the ground running along with Doug Webb, MD, medical director, Infection Control and other IU Health AHC experts, Mary Kay’s mission focused on becoming educated on every aspect of this new world threat. She continues to consistently monitor daily international disease outbreaks and trends, marked by colored pins on the large world map displayed on the wall lining the hallway in the infectious disease offices area at IU Health Methodist Hospital. 

On October 8, 2014, when Thomas Duncan, visiting Dallas from Ebola-laden Liberia, died after being the first person in the United States diagnosed with Ebola, the IU Health infection prevention team decided to act quickly.  The first order of business was to ensure that staff became trained in the appropriate wear of the designated level of Personal Protective Equipment (PPE).  Mary Kay collaborated with infectious disease physicians and decided to solicit volunteers from among the hospital staff who were willing to commit to a model to constantly learn, adapt and grow. Volunteers on-board, the Infection Prevention team’s focus pivoted to determining factors involved in becoming an assessment center – or even a treatment center. Early on, Centers for Disease Control and Prevention (CDC) representatives contacted the IU Health team and inquired if they would like to be a treatment center. While the team believes that they have the commitment and capability to indeed be a treatment center, for now, they are an assessment center.

The path to becoming the highly capable SPU included in-depth dialogue with and learning from expert colleagues from CDC, Emory University and the University of Nebraska’s Ebola Treatment facilities.  The IU Health Board of Directors decided to support and invest in an SPU, which aligns with its mission to improve the health of our patients and community through innovation, and excellence in care, education, research and service.

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Along the road to progress, the IU Health SPU has admitted, monitored and treated patients diagnosed with highly infectious diseases.  (None proved to have the Ebola virus.) While the IU Health Methodist SPU /program is a tremendous asset to the community and the State, Mary Kay is quick to highlight that the program’s success relies heavily on its partnerships with the MESH Coalition, Marion County Public Health Department, Indiana State Department of Health, Indianapolis Emergency Medical Services, other healthcare systems (including other IU Health facilities) and many additional external entities.  “The program won’t work without partner collaboration(s).  We cannot do it alone.”

SPU Set-up and Staffing: 

  Mary Kay’s enthusiasm and pride are palpable as she describes the IU Health SPU.  The SPU / assessment center is designed to house / care for / assess and appropriately diagnose a patient for three to five days, prior to being transferred to a treatment center. The unit is staffed by all volunteers, i.e., staff whose usual / daily positions are in other treatment areas of the hospital.  They are “pulled” from other jobs. Borrowing from a well-known quip, Mary Kay cites that the system “robs Peter to staff Paul.”  Staff engages in rigorous training. All are trained in advanced PPE. 

SPU’s ratio of staff to patient is four to one. Typical staff may include a trained safety officer, two to three Intensive Care RNs or highly skilled Med-Surg RNs and a respiratory therapist.  Training and exercises are regularly conducted and routinely include review of best practices, using hazmat experts and guidelines throughout training.  Mary Kay emphasizes the importance of exercising.  “The work in SPU is not based on muscle memory. When a team member, donned in PPE, is hot, tired, thirsty and hungry, he/she is not at peak performance.” 

Just like a battle line–there is no retreat. 

The SPU suite consists of three rooms:  1.) Patient room; 2.) Doffing room; 3.) Staff prep/storage.  The doors are unidirectional.  Adherence to a checklist is critical.  There are pressure monitors on all doors and monitors throughout the site/area.  “When the light is green for go, and air pressure is at the set parameter, the staff member halts at the red line and must stop and think….’ Am I ready?’   Just like a battle line – once one crosses the line, he is committed to go forward. There is no retreat.  Immediately before suiting up, another step in preparing for battle is hydrating with a quart of Gatorade.


Most Valuable Commodity  

Mary Kay is passionate about conveying that the SPU staff is the most valuable commodity associated with the SPU.  Intense training is required quarterly and is extremely detailed by design.  As Emory University’s staff quickly realized – No one was prepared for the level of detail. Also noted – through lessons of staff that cared for Mr. Duncan in Dallas – it is axiomatic that proper, repetitive and accurate training on PPE be conducted, as it is critical to one’s health and perhaps one’s life.   

Mary Kay assists with donning and doffing

Mary Kay assists with donning and doffing

The evolution of the IU Health SPU at Methodist Hospital has reaffirmed that it takes a village to attain excellence in something so novel and so valuable to the people of Indiana.  In this case, the village includes: Doug Webb, MD; Chad Anspach; Amy Kressel, MD; Elaine Cox MD; Greg Strine RN, Dr. Bryan Schmitt, Dr. Ryan Relich, Mary Kay Foster, RN – and the many volunteers who give of themselves to contribute to the greater good of best practices in highly specialized patient care.

Prior to the arrival of the Ebola virus, the aforementioned professionals were dedicated to their roles of patient care. They would likely all agree that their roles have expanded. Mary Kay Foster is among that group.  An unanticipated side effect of the new found role is that she has become an in-demand speaker, lecturer on SPUs and related lessons.  Over the past year, she has been invited to present at the International Association of Emergency Managers; Indiana regional chapter of American Association of Critical Care Nurses (AACN): Association of Professionals in Infection Control and Epidemiology (APIC); Association for the Healthcare Environment for the American Hospital Association (AHA) and presented a webinar for AHA.  We can’t wait to see what awaits her as the future unfolds!   Mary Kay shares that program development is a continuous process.  “I’m not done yet.”