Wanaque NJ Virus Epidemic: Report Details Failures in Handwashing

The state health department carried out the inspection 12 days after the first notification of a "group of respiratory diseases" in the establishment, which takes care of children medically fragile. Four of the six staff members who were observed during this inspection did not meet the standards for "hand hygiene," the report says.

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Two other cases cited in the report, which the Ministry of Health released Tuesday afternoon, concerned licensed practical nurses. One of them used gloves to touch a tube that fed the diet directly into the stomach of a resident and then withdrew it and without getting it. wash hands, touched a tube connecting a fan to the resident's tracheal opening. She then went to another room, opened the window, and made her way to the patient's medicine cart, all without washing her hands.

State officials described the violations as "minor hand washing deficiencies".

A representative from the Wanaque center did not immediately respond to a request for comment on Tuesday night.

The epidemic of type 7 adenovirus, a particularly serious strain of the virus, began on September 26 and sickened 26 children and a staff member. Nine of the children died this month, with the latest death occurring on Sunday. No new cases were reported on Tuesday.

Nine children died as a result of a serious viral outbreak in the ventilation unit of a long-term care facility in Wanaque. (Photo: Kevin Wexler / northjersey.com)

Governor Phil Murphy, questioned about the outbreak at an event in Trenton on Tuesday, said: "We are obviously very worried – we lost nine young lives." Other patients from the Wanaque center "remain disputed," he added. I said.

Health Commissioner Dr Shereef Elnahal said his department was taking "strong action in response to this outbreak. We send infection control teams to all facilities like Wanaque, which deals with medically fragile children, including the Voorhees, Toms River and Mountainside centers.

In addition, a member of the State Communicable Disease Service will remain in Wanaque until the end of the epidemic.

"Every gap we find in these facilities is taken seriously," Elnahal said in an interview. "We are asking for a correction plan and are looking for these defects in future visits."

Source of concern

Deficiencies in infection control are among the most frequently cited problems in all types of health care facilities, he said.

However, the actions of the nurse's aide who went from the removal of the diaper to the fitting of a breathing tube were "certainly worrying," he said.

The Department of Health is also considering whether stricter protocols are needed in an institution such as the Wanaque Center, where patients have a multitude of complex health problems and many rely on ventilators, tracheostomies and feeding tubes. which makes them more vulnerable to infections.

"We will discuss in the coming weeks with CMS [the Centers for Medicare and Medicaid Services, which regulates health care facilities] on federal standards for facilities that care for particularly vulnerable patients, "he said.

The federal government will require long-term care facilities to recruit infection prevention specialists beginning in November 2019. While this development is encouraging, Elnahal said, "we also need to think about the possibility of do more. to protect immunocompromised children, "such as those in central Wanaque.

Hand hygiene standards provide for washing with soap and water for 15 to 20 seconds. Employees are required to wash their hands before touching a patient, whenever their actions go from "a contaminated body site to a clean body site", and after removing the gloves.

A summary prepared by health department staff reported several ways in which Wanaque employees complied with the regulations, including the appropriate use of personal protective equipment such as gloves, blouses and masks.

According to a review of the annual inspection reports from 2015 to this year, this is not the first time that inspectors cite the center for unhygienic practices. The problems identified in these reports were corrected at the time of the next visits, said the health commissioner.

Last August, for example, an inspector saw a nurse take a pill on the floor and give more medicine without washing her hands. An inspector also saw a patient with a urine drainage bag pierced with a hole and pouring into a container. "It happened often," said a nurse to the inspector; "The supplies were not the best and a break in the closed urinary drainage system could result in a potential infection."

Elnahal also described these findings as "findings of" low level "and stated that they had been corrected.

In May 2017, the Wanaque center was cited for several practices that could lead to the spread of infection: Nurses were observed not cleaning, drying, or properly retaining syringes used to administer drugs to patients. Oral patients. A nurse did not clean the medicine trays between sessions with patients. A shovel was left in a powdered amino acid cartridge, potentially exposing it to a bacterium. The tubes of an oxygen bottle that enters the patient's nose were left exposed while the patient was on dialysis while they should have been placed in a plastic bag. A nurse did not properly clean the exterior of a germicide container and a bottle of hand sanitizer after removing the patient's garbage. The nurse was going to put them on a treatment cart before the inspector inquired.

Union claims

Located in the Haskell section of the borough, the Wanaque center is licensed to accommodate 92 children and 135 adults. At the last inspection, 200 patients had been treated.

The unions representing workers at the center have asked for more training and information on the epidemic, but say their demands have been ignored by the center's management. They also asked for mourning advice.

"They are in mourning," said Bridget Devane, director of policy for the union of health professionals and related employees, whose local represents 70 registered nurses and licensed practical nurses at the facility. Some of the patients at the Wanaque center have been cared for by the same nurses and aides for more than a decade, she said.

"They ask for help emotionally while trying to control this infection."

The union would like to hold a candlelight vigil in memory of the dead children as soon as possible, said its president, Debbie White, in a letter to Rowena Bautista, the center's administrator.

Ron McCalla, deputy director of the 1199SEIU division, who represents 136 licensed practical nurses, laundry assistants and food assistants at the center, did not respond to two letters, said a spokesman for Service Employees International. Union.

Assistants are on the front lines in Wanaque and need support and information, writes McCalla, asking nine questions about the epidemic. He asked for "an emergency meeting in service for all staff".

SEIU members have been working at the center without a contract since the new owners bought the facility in 2014, union spokeswoman Bryn Lloyd-Bollard said, and negotiations have been stalled since the spring. Their starting salary ranges from $ 10 to $ 13.50 at the hour.

A large number of SEIU members are holding a second job in other health care institutions because of their high health insurance premiums, he said. This makes indispensable a consistent training on infection control to prevent the spread of the epidemic.

No other outbreak of this virus has been reported in this state, said Elnahal. "It's a subject of vigilance."

Personal Editor Nicholas Pugliese contributed to this article.