NJ Lawmakers to Delve Into Deadly Outbreaks Disease at Pediatric Facilities

Credit: Office of Attorney General / Tim Larsen

State Sen. Joe Vitale

State lawmakers plan to hold a hearing at the hospital in the United States of America.

Senate health committee chairman Joseph Vitale said yesterday he wants to gather input from hospital leaders, infection experts and New Jersey Health Commissioner Dr. Shereef Elnahal about the origin of these infections and what state officials can do to reduce the impact of these crises.

In all, the outbreaks of the disease have been reported to be medically fragile patients – and one staff member – at three hospitals in recent months, but did not pose a threat to the public at large, officials have stressed.

As of Monday, 30 patients have been infected with adenovirus at the Wanaque Center for Nursing and Rehabilitation in Pbadaic County, including ten patients who have died. A less severe strain of adenovirus has been reported in the past in the past, but it has not been diagnosed.

In addition, bacteria discovered in the neonatal intensive care unit of Newark's University Hospital have caused symptoms in three medically fragile infants there, and may be linked to the death of a fourth baby. These pathogens would likely cause mild cold-like symptoms in healthy individuals.

Emphasizing infection control

As soon as these situations are investigated, the Department of Health infection-control campaign Wanaque and Voorhees and two facilities operated by Children 's Specialized Hospital, in Mountainside and Toms River.

The DOH also plans to visit University Hospital, which was placed under a state of play last summer when Gov. Phil Murphy raised concerns about the facility's financial stability, quality of care, and its efforts to close certain pediatric units. Recent inspections by separate DOH uncovered teams in Voorhees, Wanaque 's minor problems and what they termed "major infection control deficiencies" at University.

Elnahal said last week that he is now talking to the federal Centers for Disease Control and Prevention about its new infection-control protocols, which are set to be phased in next year, and how to better protect these kinds of patients, many of which depend on ventilators to breathe and feeding tubes for nutrition.

Credit: NJTV

New Jersey Dr. Shereef Elnahal

The comissioner said the existing blanket regulatory standards for long-term care facilities "may be missing the unique needs and risks these patients face," adding that the goal of his team is to "see if there is something we can learn from and move forward . "

Whereas Elnahal said that it could not be inconsistent. "At this juncture, it is more prudent to explore possibilities with stakeholders at all levels," he said.

But Vital – who praised Elnahal's effort to keep it informed on the outbreak "That's like molbades," the senator (D-Middlebad) said, adding, "I wonder if there are other responses or steps we can take" here in the Garden State. He hopes to hold a hearing on December 3, one of only a handful of all legislators are scheduled to be in Trenton before the year's end.

Need for careful surveillance

The New Jersey Hospital Association, which represents acute-care and long-term facilities like the pediatric hospitals, also has a role in this issue, explained Vice President of Communications Kerry McKean Kelly.

The organization partners with the DOH to host a biannual conference on infection protocols, which plays a big role in its ongoing quality-improvement efforts; It also stresses the importance of risk-badessment and careful monitoring of any infections that occur. Similar efforts sepsis, a blood infection that can attack patients in hospital settings.

"It's very much a team-based approach, not just caregivers but housekeeping and other staff members," McKean Kelly said. While this essential training is routine, the NJHA also has specialized training, gloves, gowns and masks – the organization hosted in October.

Although two of the outbreaks have the adenovirus in common, the DOH has stressed that Type 7 – which hit Wanaque – is far deadlier to type 3, which was found in Voorhees. As a result, comparing the response of the two facilities is "in some sense comparing apples and oranges," Elnahal said Thursday.

Wanaque unable to completely segregate patients

That said, there were differences in how the two facilities responded to the crisis. Elnahal said the Voorhees facility, with beds for just over 100 patients, who had symptoms of the virus and who did not. Voorhees officials first notified the patient of the suspected outbreak on October 26, and have stopped accepting new patients, but are taking re-admissions.

But Wanaque, which was unable to completely segregate patients with adenovirus as a result of space constraints, explained Elnahal. That's why it's ok to stop all admissions the outbreak, which was first confirmed on October 9 and reported to the DOH nearly two weeks later; Wanaque officials have declined to respond to multiple requests for comment.

While the ability to quarantine patients is not required for such long-term care facilities, Elnahal said, "In the event of an outbreak, the ability to cohort patients helps significantly."

In addition, when DOH teams visited Voorhees several days after the outbreak was first reported, they found no deficiencies. The October 21 inspection at Wanaque, however, identified a variety of offenses, albeit minor, related to infection protocols. For example, one nurse rinsed her hands for 13 seconds, another touched a breathing tube after removing a hair, and a third caregiver touching her hair while attending a patient , without "performing hand hygiene" before returning to her duties.

Elnahal: '… we can never know the answer'

Elnahal said that while these offenses may seem minor, they could increase the risk for infection. "To the extent to which these quotations can be attributed to the situation at Wanaque is an open question, and one we may never know the answer to," he added.

Maintaining standards is a challenge, the commissioner added, and he said the violations identified at Wanaque do not necessarily reflect the ability of any one staff member. It takes extensive training, regular practice, and institutional support to ensure infection-control measures and other quality-care protocols are truly standard operations, he said.

"This is not easy to do," Elnahal said. "And to do it 100 percent right, for every patient, is the challenge for quality improvement and patient safety programs."