New Precautions Ordered Following 11th Death in Wanaque Viral Outbreak

Lilo H. Stainton | November 19, 2018 | Health Care
Department of Health threatens to impose monetary penalties if reforms aren’t undertaken immediately

Credit: NJTV News
Wanaque center
The virus that has killed 11 medically fragile youngsters continued to spread weeks after a Passaic County pediatric hospital was ordered by the state to implement additional infection control protocols, according to officials who have since insisted on further safeguards to protect patients who have not contracted the disease.

Following new findings that include “egregious” failures to contain the outbreak, the state Department of Health suspended all admissions in all parts of the Wanaque Center for Rehabilitation and Nursing last week and called for the facility to hire several infection-control consultants who are scheduled to start today.

The Passaic County facility — where more than half the pediatric beds are now empty — complied late last week with the state’s demand to properly separate patients, by placing those who are sick or infected apart from those not impacted by the virus, the DOH said. While the separation ideally should have happened sooner, the layout of the Wanaque hospital did not permit this until the patient count dropped significantly, officials said. (The facility also serves elderly residents.)

The spread of the disease has fueled growing concern among state officials and sparked criticism from several staff members and the parents of some patients — including a few who have asserted that administrators at Wanaque have put profits over quality care, according to various media reports.

Labor leaders point to staffing shortages

Labor leaders suggested the problems are tied to staffing shortages. State lawmakers who represent the region have called for family notification of infections to be expedited and for facilities like Wanaque to have clear plans, and the capacity, to safely separate patients and protect them against these kinds of outbreaks. Another senator plans to hold hearings to review the state’s infection-control requirements for residential hospitals with fragile patients.

Credit: NJTV News
Health commissioner Dr. Shereef Elnahal
“I have two young children and the grief and hardship the families are experiencing right now is unthinkable,” said DOH Commissioner Dr. Shereef Elnahal on Friday, when announcing the latest death.

Between September 26 and November 12, 34 individuals at Wanaque have been infected with the Adenovirus Type 7 — which poses little danger to the general public, but is potentially deadly to those with compromised immune systems. The latest case was confirmed three weeks after a surprise inspection by the DOH revealed deficiencies at the hospital.

The Wanaque Center is licensed to care for 92 young patients, many of whom require medical assistance to breathe, eat and perform other daily functions. It also includes a nursing home operation with more than 100 residents, which is now closed to new admissions. Officials there have declined to respond to multiple requests for comment.

The DOH said that, as of last week, there were 42 pediatric patients at Wanaque, including 15 who are infected with the virus (although not all these youngsters still have symptoms.) The decline reflects the impact of the restriction on admissions of any new pediatric patients a month ago and the normal flux in patient census, since many residents require specialty treatments at acute-care hospitals. Eight patients who were infected with adenovirus while at Wanaque are now receiving care elsewhere.

Inability to properly separate patients

A less deadly strain of the same virus also infected eight medically fragile children at the Voorhees Pediatric Facility, a similar hospital in Camden County, in late October. But none have died and the outbreak appears to be contained; the state found no infection control violations at the site and Voorhees was able to separate patients to keep them safe from the virus, the DOH noted.

Elnahal said Friday the fact that Wanaque officials could not do this same separation of patients, which he called “cohorting,” was “among the most major reasons” for the virus’s spread at the Passaic County facility.

The state put out a rare call last week to members of the New Jersey Medical Reserve Corp, a 5,000-member team of trained volunteers that traditionally help county leaders respond to health emergencies, to ensure there were enough experienced individuals available to assist Wanaque staff sort and relocate infected patients. The request was cancelled on Saturday, when Wanaque reported it had completed the process.

Leaders at the Health Professionals and Allied Employees union, which represents about 70 staff members at Wanaque, said staffing issues are part of the underlying problem. “The administration at Wanaque has been unable to adequately staff their facility to effectively contain the spread of the adenovirus infection,” nurse and HPAE president Debbie White said, praising the state’s response to what she said has been a tragedy for the entire community.

Sen. Gerald Cardinale (R-Bergen)
In addition, Sen. Gerry Cardinale (R-Passaic), said plans to safely separate and protect vulnerable patients must be in place in advance. “It’s extremely concerning that they don’t have a plan to prevent a similar outbreak from causing such devastation in the future,” he said, pledging to introduce legislation to address this gap. “Every parent of every patient deserves to know that their children will be safe when entrusted to a pediatric hospital for care, and we’re going to force those facilities to develop plans that provide that assurance.”

In response to the outbreak — which Wanaque administrators first reported to the DOH on October 9 — the health department launched an infection control campaign to emphasize the importance of these protocols to staff and leadership at Wanaque, Voorhees and the state’s other two pediatric specialty hospitals, both run by Children’s Specialized Hospital. The team is also advising University Hospital, in Newark, where a bacterial infection sickened four infants, one of whom later died.

Gaps in care appear to have persisted

While the adenovirus is not considered a public threat, it is not uncommon in crowded residential situations, like college dorms or military barracks. For most, it causes pink eye, mild congestion or other cold-like symptoms; but for those with limited immune systems, the disease can be deadly. A July 2017 outbreak at a drug treatment facility in Cumberland County sent four patients to the hospital, three who died as a result.

At Wanaque, the infection prompted a visit from the DOH team on October 21, which identified what the state has termed “minor deficiencies’ — violations that included multi-second gaps in hand washing protocols, or not changing gloves between adjusting a patient’s feeding tube and breathing apparatus. A department employee was also dispatched to remain onsite and monitor the facility’s operations on a daily basis.

“Strictly enforcing these protocols is really our only tool” to prevent the spread of the virus, Elnahal said. He is also talking to federal officials about potential changes to these protocols in the future.

But gaps in care appear to have remained at the Passaic County facility. In the weeks since the state’s initial crackdown, new cases continued to be diagnosed and the disease claimed additional young lives; while the DOH has not provided personal details, all the Wanaque victims are between toddler and young adult.

According to a November 14 letter from the DOH to Wanaque officials, state inspectors found “evidence of continuing non-compliance” with infection control plans during three separate visits in early November and the problems are “ongoing.” While the letter does not detail the problems, it cites “egregious deficient practices in infection prevention and control which pose an immediate jeopardy and imminent and serious risk of harm to the residents of Wanaque.”

In addition to suspending admissions throughout the site, the letter insists that Wanaque hire an infection control expert, or team, to advise its operations, as well as a physician trained in infection protocols. The DOH said it has already approved the facility’s choice for both roles and the consultants should be in place today. The state also threatened to impose monetary penalties if the latest reforms aren’t in place in the coming days.