A tenth child dies from an adenovirus epidemic in New Jersey

The patients are children with serious medical problems, many of whom need help to breathe and function, at the Wanaque Center for Nursing and Rehabilitation in Haskell, New Jersey.

Confirmed cases became ill between September 26 and October 29, according to the health department. The number of diseases has increased from 18 cases, including six deaths, announced last week by the Department of Health.

"Their ages range from toddlers to young adults," New York Department of Health Commissioner Dr. Shereef Elnahal told reporters last week. "Some have been hospitalized and others are being cared for at this facility."

A staff member was also affected by the outbreak but has since recovered.

The health department also announced Wednesday that four cases of adenovirus have been found in children in a second facility in New Jersey, the pediatric facility Voorhees. However, preliminary tests suggest that it is a strain different from that of Wanaque and that these patients are not in critical condition.

Health officials say that they are stepping up their efforts to strengthen the fight against infections in such establishments in the state. On Monday, the health department announced plans to deploy a team of infection prevention experts later this month to visit the University Hospital and four pediatric long-term care facilities, including Wanaque and Voorhees facilities, where experts will train staff and evaluate how these facilities prevent and control infections.

"Epidemics in institutions are not always preventable, but in response to what we've seen in Wanaque, we are taking aggressive action to minimize the risk of occurrence among New Jersey's most vulnerable patients," Elnahal said. a statement on Monday.

Adenoviruses are often transmitted by touching a contaminated person or surface, or by air while coughing or sneezing. They are known to persist on soiled medical surfaces and instruments for long periods of time. They can not be removed by common disinfectants, but rarely cause serious illness in healthy people. However, US Centers for Disease Control and Prevention have a higher risk of acquiring a serious illness and remain contagious long after recovery.

Symptoms can appear two to 14 days after being exposed to the virus, the State Department of Health said.

The outbreak at the Wanaque plant was caused by a type 7 adenovirus. This type is "most often associated with acute respiratory disease," says the CDC. Other types of adenovirus infections can cause flu-like symptoms, a pink eye and diarrhea.

"We are working every day to ensure that all infection control protocols are constantly monitored and that we are closely monitoring the situation in the facility," Elnahal said.

Could we have done more?

The Wanaque outbreak was caused by a strain of adenovirus known to affect "community living conditions," according to the state's health department – but some wonder if any measures More could have been taken to prevent this, according to interviews with former employees and the mother. of a child who died as a result of the epidemic.

"I am sorry that the children I cared for – who all improved and became stronger and who were learning to walk – were dead," said Javier Guzman, who worked for five years at the center. Wanaque assistant until March 2017, when he announced that several staff members had been fired

"They were so beautiful and so happy, maybe they had a compromised immune system, but they lived a normal life, all they wanted to do was play, sing, and applaud," he said. Guzman.

Former employees told CNN that it had been a shock to hear the news about deaths among young residents of the institution. In some cases, former employees described a facility that required maintenance, as well as unspecified cleaning and infection control practices, including an air cleaner to clean, a leaking ceiling, and a machine to clean. ice collecting what appeared to be mold. . Former employees told CNN that these issues were reported to management.

However, another former employee, who asked not to be named and left the plant to pursue another career, said she had had a positive experience at the Wanaque Center, which she generally found maintenance was receptive. She stated that she thought the facility met industry standards, but that, more generally, these standards were perhaps too low in an industry that 39, she described being understaffed and underpaid chronically.

The facility did not answer CNN's questions regarding comments from my former employees.

Institutional nurses had previously reported a shortage of nurses and supplies, according to a statement last week from the union representing nurses. Health professionals and allied employees said the shortages may have resulted in "poor infection control practices".

The union said it represents 70 nurses working at the Wanaque Center.

On Tuesday, public health officials released the full results of an unannounced inspection on Oct. 21 – after being alerted by the facility and before the health department publicly announced it. deaths. The inspectors found hand hygiene problems in four of the six staff members, but noted that the facility had followed a number of measures in line with existing recommendations, such as the wearing of handpieces. protective equipment outside the rooms and the display of signs indicating the precautions against the adenovirus.

"Now that the report is finalized, some findings raise questions about whether these general long-term care standards are optimal for this vulnerable population of medically-fragile children," Elnahal said in a statement. The statement added that federal regulations will require "on-site preventionist" in places such as the Wanaque Center from November 2019. "We also need to think about the possibility of doing more to ensure that health officials protect immunocompromised children. , such as: those served at the Wanaque Center, "he said.

"Every year in the state, there are hundreds of outbreaks in health facilities," added Elnahal.

In a review done by the Centers for Medicare and Medicaid Services, the Wanaque Center was rated above average in terms of overall quality, but a lower level of health inspection. the average. The rating is based on two years of inspections before November 2017.

The installation has received and corrected other shortcomings in the past. According to an inspection conducted in August, CMS stated that "it was determined that the facility had failed to provide a clean and welcoming physical environment to its residents". The magazine found carpeted areas that "smelled of old carpet and mildew".

In an interview with reporters last week, Health Department Commissioner Elnahal described the deficiencies as "serious and resolving deficiencies" that were subsequently resolved once health inspectors were re-audited. .

A May 2017 inspection report "determined that the facility had failed to ensure that infection control practices were followed." Among the deficiencies cited were improperly stored syringes used to measure liquid medications, as well as poorly cleaned and disinfected medication bedsteads and trays. The deficiencies were corrected a month later and their number was lower than the American average.

In the United States, infection control has become a "more urgent concern" in recent years and consistently ranks among the most common nursing home citations, topping the list from 2010 to 2014, according to a 2015 report. CMS.

"It is rare that during an inspection, an installation produces quotations without quotations," Elnahal said. "If there are a number of quotes, all of low level, we ask for a correction plan.We make sure that the installation works well – and that 's right. did this installation do here. "

"If the conclusions are serious enough that we can take other measures, we will do it," he added.

"I have been there for almost seven years and nothing like that has ever happened," said Christopher Podmayersky, former assistant of the activities of the establishment.

"It's just heartbreaking because I feel it could have been avoided," he said.

& # 39; She is part & # 39;

"She's gone," CNN-affiliated WNC told Kristine Poulos, whose 16-year-old daughter was among those who died in Wanaque. "I can not bring her back, she will not come back."

The daughter of Poulos, who needed to breathe and eat tubes as part of her usual care, was transferred to a hospital with fever, then transferred to a facility in Wanaque, where she died last week, according to the WABC.

Although the full schedule of deaths in the facility remains unclear, the Wanaque facility said it "promptly informed all relevant government agencies when the virus was first identified." According to health department spokeswoman Nicole Kirgan, on October 9, state health officials were informed of a respiratory illness in the facility, which informed the parents ten days later. October 19th.

Poulos told WABC that the adenovirus had been diagnosed in his daughter Elizabeth at least five days before state health officials were informed. "Why do not you bring it back sooner?" she asked.

"We are working side by side with medical experts from the Ministry of Health and the CDC, and we will remain in constant contact with them until this problem is fully resolved," said the center in a statement released on Tuesday. last week. The statement added that staff members "feel a deep sense of loss" and are taking steps to improve safety and comfort, including providing bereavement counseling and a 24 hour hotline. 24/7 for the people concerned.

The property has not responded to several calls and emails for other comments. The facility has been "charged with not admitting new patients until the end of the epidemic and that they are in full compliance," according to the health department of the ########################################################################> 39; State. Public health officials said that the outbreak could only be declared once every four weeks without any other case.

Health experts say that the time needed to respond to a potential outbreak and inform families is variable and may depend on the time they need to investigate an outbreak, grow a virus and confirm their identity.

According to Elnahal, "It can be difficult, if not impossible, to know how the virus has arrived in the institution, what is its source or what is the specific mechanism of spread of the virus, from a person to the 39; another. "

"I just want to know what happened," Poulos told WABC.