Picture credits: Attorney General / Tim Larsen
Senator Joe Vitale
Lawmakers plan to hold a hearing early next month on recent outbreaks at several hospital facilities in New Jersey dedicated to caring for children, including the establishment of Passaic County, where one virus has killed ten adolescents with serious health needs.
Senate Health Committee Chairman Joseph Vitale said yesterday he wanted information from hospital leaders, infection experts and the New Jersey Health Commissioner. Shereef Elnahal, to catch up on the source of these infections and what governments can do to reduce the impact of these crises.
In total, the outbreaks in three hospitals in recent months have sickened more than three dozen young, medically vulnerable patients and one employee, but do not pose a threat to the general public, the authorities have emphasized.
By Monday, 30 people in the Wanaque Center for Nursing and Rehabilitation in Passaic County had been infected with a severe adenovirus strain, including ten deceased patients. A less serious adenovirus strain contracted five patients with complex health needs at the Voorhees Pediatric Facility in Camden County, but none died.
In addition,In the Newborn Intensive Care Unit at Newark University Hospital, three medically fragile infants have caused symptoms and may be associated with the death of a fourth baby. These pathogens would likely cause mild cold symptoms in healthy individuals.
Emphasize infection control
The Ministry of Health has not only directly investigated these situations, but also introduced a broader systemLast week, to review operations in the state's four children's hospitals, including Wanaque and Voorhees, and two facilities that are operated by a children's hospital, Mountainside and Toms River.
The DOH also plans to visit the University Hospital, which was placed under state oversight last summer, when Governor Phil Murphy voiced concerns about the financial stability of the facility, the quality of care and the closure of certain pediatric units. Recent inspections by separate DOH teams have found no violations of Voorhees, minor problems with Wanaque, and what they termed "serious infection control deficiencies" at the university.
Elnahal said last week that he is now talking with the Federal Centers for Disease Control and Prevention about his new infection control protocols, which will be phased out next year, and how the state can better protect this type of critically ill patient. Many depend on respirators for breathing and feeding tubes for nutrition.
New Jersey Health Commissioner Shereef Elnahal
The contractor said that existing blanket regulatory standards for long-term care facilities "could miss the unique needs and risks facing these patients," adding that the team's goal is "to see if there's anything we can do about it can learn and how it goes on. "
The state could impose stricter rules, but Elnahal said it could lead to confusion and inconsistent enforcement. "At this point, it is more prudent to look for opportunities with stakeholders at all regulatory levels," he said.
But Vitale, praising Elnahal's efforts to keep him informed of the outbreaks, said waiting for the federal government could take too long. "It's like molasses," said the Senator (D-Middlesex), adding, "I wonder if there are other reactions or steps we can take" here in the Garden State. He hopes to hold a hearing on 3 December, one of just a few days when all lawmakers will be in Trenton before the end of the year.
Need for careful monitoring
The New Jersey Hospital Association, which represents acute and long-term facilities such as children's hospitals, also has a role to play in combating these outbreaks, said Vice President of Communications, Kerry McKean Kelly.
The organization is working with the DOH to hold a biannual conference on infection protocols that play a major role in their ongoing quality improvement efforts. He also stresses the importance of risk assessment and careful monitoring of infections. Similar efforts have helped institutions reduce rates, a blood infection that can attack patients in hospital settings.
"It's a team-based approach, led by an infection prevention expert, but purchased by employees throughout the facility – not just caregivers, but also cleaners and other staff," McKean Kelly said. While this important training routine is routine, the NJHA also conducts special training as needed, she added, as did the two-day session on personal protective equipment – gloves, robes and masks – the organization hosted in October.
Although two of the outbreaks have the adenovirus in common, the DOH has emphasized that Type 7 – which meets Wanaque – isto medically complex children, type 3, found in Voorhees. The comparison of the reaction of the two plants is therefore "in a sense a comparison of apples and oranges," said Elnahal on Thursday.
Wanaque can not completely separate the patients
However, there were differences in the response of the two institutions to the crisis. Elnahal said the Voorhees facility, with beds for just over 100 patients, had the space and ability to immediately divorce patients who had symptoms of the virus from those who did not. Voorhees officials first informed the DOH of the alleged outbreak on October 26 and stopped accepting new patients but re-briefed.
But Wanaque, which cares for more than 90 pediatric patients, has not been able to completely separate patients with adenovirus due to space constraints, Elahal said. For this reason, the administrators have agreed to cease all approvals, which was first confirmed on October 9 and reported to the DOH nearly two weeks later; Wanaque officials have refused to respond to several requests for comments.
While the ability to quarantine patients is not required for long-term care facilities such as these, Elnahal said, "In the event of an outbreak, the ability to co-ordinate patients will help significantly."
When DOH teams visited Voorhees several days after the outbreak, they saw no shortcomings. The 21st of OctoberHowever, they identified a variety of offenses, albeit minor, related to infection protocols. For example, one sister rinsed her hands for 13 seconds as opposed to the required 20 seconds, another touched a breathing tube after removing a soiled garment from a patient without washing gloves or washing her hands, and a third caregiver She touched her hair while taking care of a patient without performing "hand hygiene" before returning to her duties.
Elnahal: "We may never know the answer"
Elnahal said that while these violations may seem marginal, they could incrementally increase the risk of infection. "To what extent these quotes can be attributed to the situation in Wanaque is an open question that we may never know the answer to," he added.
Compliance with the standards was a challenge, the commissioner added. Wanaque's violations do not necessarily reflect the ability of a single employee. It required extensive training, regular exercises and institutional support to ensure that infection control measures and other quality assurance protocols are truly standard procedures, he said.
"That's not easy," said Elnahal. "Getting 100 percent right for every patient is the challenge for quality improvement and patient safety programs."