State infection experts announced plans Monday to visit New Jersey’s four pediatric residential hospitals after a viral outbreak at one facility, in Wanaque, that killed nine medically fragile youngsters and infected at least two dozen people so far.
Teams from the Department of Health will also conduct assessment and training sessions at University Hospital in Newark, the site of an unrelated bacterial outbreak tied to the death of one critically ill infant and infections in three others.
An inspection last week found “major infection control deficiencies” at the Newark facility, the state’s only public acute-care hospital, and resulted in the DOH’s call for administrators to immediately hire an expert adviser on infection protocols.
University Hospital has long been a subject of concern and is currently operating under a state monitor, appointed in July after Gov. Phil Murphy sounded alarms about its financial stability, quality of care, and push to phase out certain pediatric services. In March the hospital received a failing grade on a patient safety report from a national healthcare watchdog, in part for its failure to prevent infections.
Elnahal promises ‘aggressive steps’
“Facility outbreaks are not always preventable, but in response to what we have seen in Wanaque, we are taking aggressive steps to minimize the chance they occur among the most vulnerable patients in New Jersey. Pediatric long-term care facilities such as the Wanaque Center, and University Hospital’s neonatal ICU (Intensive Care Unit), take care of extremely medically fragile infants and children,” health commissioner Dr. Shereef Elnahal said.
On Monday, University Hospital said it “continues to intensify its efforts to improve patient quality and safety,” noting it has hired several clinical executives to help advance better care. “They are spearheading work to bring about a holistic cultural change at the hospital,” the hospital’s statement continued, acknowledging the process is ongoing.
Administrators at the Wanaque Center for Nursing and Rehabilitation have declined to comment on the outbreak, but suspended admissions at the facility last week, when the DOH announced the first few patients had succumbed to the viral infection, caused by the adenovirus type 7. (While this strain is particularly deadly to those with a compromised immune system, the virus usually causes only mild cold-like symptoms in healthy patients and does not pose a public health threat, officials said.)
The state was notified of the first adenovirus diagnosis on October 9 and all patients were infected between then and Oct. 22, the DOH has said; this indicates that the disease is not spreading, but that any cases added since the situation was first announced are a result of that initial period of infection.
The Wanaque center has been cited in recent years by DOH inspectors for some lapses in protocols, including infection control measures, but Elnahal has described these as minor infractions and stressed administrators there are cooperating with the state. The department has installed an on-site monitor and is working with local officials, and federal assistance, to identify the cause of the outbreak — which has now infected 26 people — and how it spread.
Outbreak at University Hospital in Newark
“This is a tragic situation, and our thoughts are with the families who are grieving right now,” Elnahal said. “We are working every day to ensure all infection control protocols are continuously followed and closely monitoring the situation at the facility.”
University Hospital officials have also pledged to collaborate with state officials and move quickly to respond to the outbreak at their facility. “University Hospital takes patient safety, including infection control, very seriously. We have been in regular communication with the Department of Health and continue to work closely with them to address this issue as quickly as possible,” the hospital said in a statement.
DOH officials said they were notified October 1 of the outbreak in Newark — attributed to the Acinetobacter baumannii bacteria, which is not uncommon in hospitals, and primarily impacts those with compromised immune systems — and shared expert guidance with the Newark hospital in the days that followed. But when department teams visited later that month, they found these protocols hadn’t been put in place; inspectors identified problems with hand-washing, personal protective equipment like gowns and gloves, and other cleanliness issues.
Corrective action plan for Newark hospital
On October 23, the state issued a corrective action plan calling for University Hospital to implement the proper infection-control protocols and to hire an outside expert to advise it on these efforts; the DOH said Monday this process is underway. State officials continue to investigate the cause of death of the infant that contracted A. baumannii, who had been transferred from University Hospital to another facility before passing away.
University Hospital officials declined to answer specific questions about the state’s findings and the corrective action plan Monday afternoon. But a spokesman for the facility said it has hired a chief medical officer, plus a head of patient safety and quality, who reports directly to the CEO. The cultural changes they seek “will take diligence and consistent training, oversight, and reinforcement, and we are committed to seeing it through. There are signs of improvement across the hospital and we are using them to remain focused on the work ahead,” the spokesman said.
When the state moved to beef up oversight this summer, president and CEO John Kastanis said the hospital was working hard to shore up its finances to address gaps in care. “The hospital has made changes to its administrative and clinical leadership, and diligently implemented new programs focused on patient safety and quality of care,” he said at the time, and welcomed the assistance from state and local officials to address remaining challenges.
One of the state’s three Level 1 Trauma Centers, University Hospital has nearly 500 beds and serves as a teaching hospital for several Rutgers University programs. It is also slated to receive more than $100 million in state funds this year, including some $46 million in charity care to help pay for the high number of uninsured patients the facility treats. In 2017 hospital officials sought state permission to close some of its pediatric emergency services, triggering concerns among local officials, staff and public health leaders.
New quality control experts
University Hospital has since contracted with several quality control experts, according to Judy Persichilli, the monitor tapped by Elnahal last summer, including Dr. Lawrence Ramunno, the former vice-president and chief medical officer at Sibley Memorial Hospital of Johns Hopkins Medicine, in Washington, DC.
Persichilli, a former hospital executive, nurse and quality care expert, was given broad oversight powers by Murphy and charged with “assessing the level and quality of care provided to the community” by University Hospital, including financial health, and was given full access to records and information to help her understand how care is provided.
In a statement provided through the DOH, Persichilli said infection control is among quality control elements she is now reviewing. She first became aware of the bacterial outbreak on October 8. She has been on site regularly, interviewing staff leaders and executives, and expects to have a report on her findings in the near future. ”Infection control is a component of overall quality and it has been looked at,” she said.
Reviewing proper infection protocols will also be the focus of the DOH team — made up of infection control experts and epidemiologists — that will soon visit the Wanaque Center and the three other long-term care facilities that treat medically complex children — the Voorhees Pediatric Facility and Children’s Specialized Hospital’s sites in Toms River and Mountainside. Visits were set up for November, the department said.
The multidisciplinary infection-control team previously visited the Voorhees facility in May and assessed the work at Wanaque in 2016, according to state epidemiologist and assistant commissioner at the DOH Dr. Tina Tan, both times in response to requests from administrators.
These experts have performed some 160 on-site assessments in the past three years, officials said, checking on hospitals, dialysis centers and outpatient care facilities and hosting webinars and other education programs on infection prevention.