Questions about how University Hospital Newark handled the deaths of medically fragile infants infected with a challenging type of bacteria have prompted new state scrutiny, additional legislative review, and calls from Newark’s mayor for new leadership at the beleaguered facility.
The state Department of Health dispatched a team Tuesday to examine why University Hospital administrators who have been tracking the A. baumannii outbreak for nearly two months were not aware of deaths days after they had occurred, what formal notification policies exist and how communication within the Newark hospital can be improved.
The facility was already squarely on DOH’s radar, with a state monitor investigating operational issues and strained finances, and an infection specialist tracking the outbreak, which was first detected in early October. Later that month a department inspection identified “major infection deficiencies” at University Hospital, which is considered the state’s only true public acute-care hospital.
The presence of the bacterium was confirmed in four premature babies in the hospital’s neonatal intensive care unit in October, after one of the children had already died. Two others died during the week of Thanksgiving, according to the DOH, which was notified late Monday. The fourth infant was discharged late last month and no additional cases have been identified, officials said.
All the children had significant medical complications, including limited immune systems, and it is not clear if the bacterium, also known as Acinetobacter baumannii, is what caused their death, officials said. Highly resistant to standard antibiotics, the bacterium is rarely found outside healthcare operations and does not pose a threat to the general public or those in good health.
(Although there are similarities in the outcome and response, the outbreak is unrelated to the deadly adenovirus infection contracted by nearly three dozen vulnerable young people in two long-term care facilities, 11 of whom have died.)
Questions about communication
On Tuesday Health Commissioner Dr. Shereef Elnahal called it “very encouraging” that the infection in Newark now appears under control and said it shows the state’s response at University Hospital is working. “What we are concerned about is are they following protocols for effective notification” internally, he said.
Elnahal said that while the deaths were known to the infection-prevention expert University Hospital hired in late October at the state’s insistence — and that individual notified DOH — the information had not reached the hospital’s own infection-control team by Monday.
“That to me indicated a potential issue,” the commissioner said. So the department dispatched a team in an effort to better understand what the facility’s notification protocol involves, if it was followed, and how it could be improved.
The disconnect also disturbed state Sen. Joe Vitale (D-Middlesex), the longtime head of the Senate health committee, who has pledged to investigate how hospitals and long-term care facilities that house vulnerable patients handle infection control.
“It is wrong and disturbing that the hospital did not even notify their own internal infection control team in addition to the state department of health,” he said.
Vitale said he wants officials from University Hospital to testify before the legislative panel on what they are doing to ensure protocols are followed and “what steps will be taken to correct these deadly deficiencies.” (The committee also wants to hear from administrators at the Wanaque Center for Nursing and Rehabilitation, where the 11 children died, and other facilities, he said.)
Baraka: leadership changes needed
Newark Mayor Ras Baraka said the deaths raise larger questions about the overall safety at University Hospital, which he said is a critical resource for a city like Newark with limited healthcare options and significant needs. Local health officials would continue to work with the state to monitor the outbreak, he added, but additional steps — and major reforms — are needed.
“The deaths of three premature infants with an Acinetobacter bacteria and the infection of a fourth, all cared for at University Hospital, are stark reminders that an overhaul of the quality of care and the leadership of the hospital is urgently needed. The infants had a variety of other medical conditions, but the fact remains that they contracted the bacteria in the hospital’s neonatal ICU,” Baraka said.
In particular, the mayor called for additional state and federal funding, a new board that better represents Newark residents, and for replacing University Hospital’s current president and CEO, John Kastanis, with someone more responsive to the community.
“The time has come for the State of New Jersey and the Newark community to collaborate in setting a new direction for University Hospital,” he said.
Officials at University Hospital declined to respond to the mayor’s comments or address specific question about the notification process or overall safety at the facility. The hospital received a D grade on the latest safety survey from the Leapfrog Group, a national nonprofit watchdog, up from an F in their spring report.
On the lookout for new infections
The facility did release a general statement, attributed to a University Health spokesperson: “We have worked diligently since the Acinetobacter baumannii bacteria was discovered in our neonatal intensive care unit (NICU) to control the outbreak, and there have been no new cases in the NICU since October. We continue to reinforce proper procedures and protocols with our team.”
University Hospital has said it has hired several clinical executives to help promote better care, in addition to the infection specialist required by the state in October, and is making other changes to bring about “holistic change” at the hospital. The facility, which depends heavily on state dollars, has struggled economically, suffered bond-rating downgrades, and struggled to reinvest in its staff and operations, Elnahal has said.
These concerns, and the hospital’s request in the spring to scale back on pediatric emergency care — an important service for Newark residents — prompted Gov. Phil Murphy to call in July for the DOH to appoint a monitor to oversee the operations, regulatory compliance, and financial situation, and to help craft a long-term plan for the facility. Elnahal quickly tapped Judy Persichilli, a nurse and New Jersey Health Care Quality Institute board member, and she is expected to issue a report fairly soon.
In the meantime, the DOH and others will continue to closely monitor the NICU for any additional signs of the A. baumannii outbreak. Unfortunately, it is not yet clear how long they will need to wait to know the facility is in the clear; Elnahal said experts have been tracking the growth of the bacteria in a culture to determine more about its lifecycle and symptoms. “Until then, it is still an area of investigation,” he said.