State Seeks New Infection Protections at Some Long-Term Care Facilities

Lilo H. Stainton | June 7, 2019 | Health Care
After tragic results of viral outbreak at pediatric center last year, Department of Health outlines measures to prevent a repeat

Credit: NJTV News
Wanaque Center for Nursing and Rehabilitation
Responding to last year’s viral outbreak at a Wanaque pediatric facility that contributed to 11 deaths and some three dozen illnesses, New Jersey officials have outlined new measures to prevent such infectious disease outbreaks at certain long-term care hospitals.

The state Department of Health released a report Thursday that called for certain long-term care hospitals to craft specific plans to address such outbreaks, as well as protocols to help keep staff and visitors from introducing disease and to separate healthy patients from those who were infected. The report also identified ways the state can help by revising its own guidelines and expanding infectious-disease training for facility staff.

Some of the changes could require new state funding. Gov. Phil Murphy’s budget proposal for the coming year includes $2.5 million for competitive grants designed to boost the capacity of local health departments, something the report flagged as critical in addressing these types of outbreaks. Other proposals could add another $600,000 in potential public costs, some of which DOH said it could find within its existing funding pools.

Several of the recommendations would require legislative change. And on Thursday, an Assembly panel unanimously approved a bill designed to address these aspects of the DOH report. The sponsors said the measure could not erase the pain for those who lost loved ones in the outbreak last year, but they hoped it could prevent similar situations in the future.

“The way to deal with a tragedy of this magnitude is to take direct action so that it does not happen again,” said Sen. Joseph F. Vitale (D-Middlesex), who chairs the Senate health committee and led a committee hearing on the Wanaque outbreak. He praised the health department and lawmakers for their quick response.

Taking care of ‘our most vulnerable residents’

“Together we will ensure that the facilities taking care of our most vulnerable residents have the proper plans in place to effectively respond to outbreaks,” he said.

The outbreak — sparked by adenovirus type #7 — at the Wanaque Center for Nursing and Rehabilitation, in Passaic County, was eventually tracked back to September, but the DOH was first notified of the situation on October 9. While the virus is likely to cause only mild respiratory symptoms in healthy individuals, it took a far greater toll on some of the children living at Wanaque, who were facing complex medical issues and depended on artificial ventilation and other equipment for daily life functions.

The health department responded in force, deploying its own infection control team to Wanaque and requiring the facility to hire additional experts to be onsite daily; it also contacted similar facilities to review safety precautions. While past federal and state inspections at Wanaque — where about 90 youngsters on ventilators are cared for — had revealed what the state called “minor deficiencies,” larger concerns emerged over the course of additional DOH reviews last fall. The state suspended admissions and insisted Wanaque beef up staffing in order to properly “cohort,” or separate, the patients who were infected from those who were not.

The Wanaque facility — which has declined to speak publicly about the incident and did not respond to a request for comment Thursday — was eventually fined nearly $600,000 by the federal Centers for Medicare and Medicaid Services.

According to reports, CMS blamed Wanaque’s handling of the outbreak for posing “immediate jeopardy” to the health and safety of other youngsters in the affected unit, as well as 150 other residents, including many elderly individuals.

DOH satisfied that problems were resolved

According to the DOH report, another inspection in early January suggested the problems had been resolved and Wanaque was allowed to readmit patients to that unit. A separate report on the epidemiology of the outbreak is still pending.

A second outbreak of adenovirus was discovered later in October at the Voorhees Pediatric Center, in Camden County; but it involved a far-less dangerous strain and infected17 individuals, with no deaths. The state has previously praised that facility’s response to the incident, which was safely contained.

To help avoid similar outbreaks in the future, the DOH report outlined policy and system changes to better support hospital facilities that are addressing respiratory infections like those in Wanaque and Voorhees. These include identifying funding to continue to support a team of state infection control inspectors, as well as respiratory virus experts, both of which had in the past been funded by the federal government. It is also seeking money to beef up lab capacity.

(The DOH is also considering a “call” or request for more pediatric long-term care facilities, as these outbreaks underscored the limited availability of beds for these vulnerable young patients.)

The report also insists all long-term care facilities with ventilator beds, for either children or adults, submit to the state detailed infection control plans to address individual and widespread outbreaks. These would need to include protocols for monitoring visitors and staff to ensure they are not contagious, establishing laboratory and testing systems, and specific plans for safely separating patients.

Importance of family notification

The department is also currently reviewing its guidance for long-term care facilities and has pledged to include elements that ensure facilities have a plan to notify family or caregivers of any outbreak. They will also need to have contracts in place with infectious disease experts, in case of an emergency, and update staff training on the issue. The state will also create an outbreak checklist to help facilities plan, and a training module for their staff.

Credit: NJTV News
Gov. Phil Murphy looked on as Health Commissioner Dr. Shereef Elnahal addressed a hastily arranged press conference on the adenovirus outbreak at Wanaque.
“There is much that our healthcare system can learn to make long-term care more prepared and responsive to outbreaks when they occur,” said Health Commissioner Dr. Shereef Elnahal. “Ensuring that all staff are regularly trained in proper handwashing protocols and other infection control procedures is the best way to prevent the spread of respiratory viruses in long-term care facilities.”

Elnahal thanked lawmakers for their quick response to the situation. The measure (A-5527) approved by the Assembly health committee Thursday adds a statutory requirement that long-term care facilities with ventilator beds file these infection control plans. These must include policies on family notification, staff training and notifying public officials, according to a draft of the bill.

“Although this measure cannot erase [family members] pain, it does put a system in place to ensure that these facilities are prepared and equipped to deal with an adenovirus 7 and other outbreaks,” read a joint statement from the Assembly sponsors, Herb Conaway Jr. MD (D-Burlington), who chairs the committee, Christopher Tully and Lisa Swain (both D-Bergen).

“It specifically mandates that the plan be customized to the facility, meets national standards, and be developed in consultation with an infection control committee at the facility consisting of personnel who are trained, credentialed and experienced in infection control,” they added.

“This legislation gives the public peace of mind that their loved ones in long-term care facilities are being cared for by people who are prepared to respond as quickly and appropriately as possible in the event of this type of health emergency,” the sponsors said.