Tuesday, April 23, 2019
Home Health NJ waited two weeks after the fatal outburst to inspect the children's...

NJ waited two weeks after the fatal outburst to inspect the children's center. Was that the right call?

The children fell ill on an unusually warm day in late September.

However, it was not until 9 October and after the deaths of two children that the Wanaque Center for Nursing and Rehabilitation reported to the state health department of a viral outbreak at the long-term care facility in northern New Jersey. And then 12 days before state inspectors entered the door.

The devastating outbreak of adenoviruses at the Wanaque Center in Haskell has led to the death of 10 children and has infected 19 more. How the eruption started is unknown.

However, a study of the development and spread of the outbreak raised the question of why state health officials waited two weeks before sending a team to see how Wanaque handled the crisis.

The response from the state will be part of what the Senate Committee on Health, Human Services and Senior Citizens will consider at a hearing on December 3 to discuss the outbreak, said Senate Vice President Joseph Vitale.

Death stalked the center of Wanaque. Nevertheless, they delayed sending children to the hospital

"We will ask as many questions as we can, but this will be one of them," said Vitale, D-Middlesex.

"We want to know when it was reported how the department responded and how the facility responded," said Vitale, adding he wanted to be careful "until we know all the facts."

"No doubt we're all worried about it, and as a layman, I'm saying something is wrong here," he said.

Death stalked the center of Wanaque. Nevertheless, they delayed sending children to the hospital

Wanaque informed the state and local health authorities on October 9 about the post-office outbreak. According to spokeswoman for the health department, Donna Leusner.

"The state has immediately advised the facility on infection control protocols, which should be implemented immediately," said Leusner.

The next day, the Department of Communicable Diseases Department, along with the US Centers for Disease Control and Prevention and the local health department, began work with Wanaque to recommend infection control practices, she said.

The state dispatched two registered nurses from its Health Facilities, Surveying and Field Operations Office on October 21 and conducted a surprise inspection. A state-owned inspection specialist stayed on site.

The state conducted a second surprise inspection on Friday after a report by NJ Advance Media quoted workers at the Wanaque Center. It was alleged that administrators postponed the sending of critically ill children to the hospital for wanting to lose Medicaid funding when a cot became empty.

The decision to wait two weeks before sending state health officials was based on the science of allowing an incubation period to see if Wanaque's treatment of the outbreak was working, Leusner said.

The incubation period of the adenovirus virus is two weeks, the department said.

"It would be impossible to say that an on-site presence before an incubation period could have been useful," said Health Department spokeswoman Dawn Thomas.

"Containing the virus ultimately depends on facility management and clinical staff, who follow these protocols in all circumstances and for every patient, and the Ministry of Health is taking all possible measures to hold the institution accountable," said Thomas.

The profit-oriented owner of Wanaque Center, Continuum Healthcare, who has repeatedly rejected a statement, did not return calls on Friday.

"The Commissioner believes that, given the information we had, the DOH staff responded appropriately at all times," she said.

Adenovirus is actually a group of viruses that are rarely fatal. They mimic the symptoms of the flu and common cold, often attack the respiratory tract, but can also cause gastroenteritis and conjunctivitis. According to the Centers for Disease Control and Prevention, children and children are affected.

The diseases of the virus are usually mild and people usually recover within a few days. However, in some cases, adenovirus infections can potentially be life-threatening, especially in people with weakened immune systems.

All pediatric patients at the Wanaque Center are medically vulnerable. Most need ventilators to help them breathe. Some had serious birth defects and significant health problems.

But why some of them have died remains a mystery to some.

"These children were really fragile, and a serious adenovirus can certainly be deadly," said David Cennimo, epidemiologist at Newark University Hospital and professor of medicine at Rutgers University Medical School. "It's a serious respiratory disease and you can get to a respirator, but these kids already had a respirator and I wonder why they could not help them with it."

He was not directly involved or knew exactly about their cases. He wondered if there were secondary infections. There are many unanswered questions, he added.

"I do not get it, it's a medical facility, these kids are being monitored, I can not explain it," he said.

State health officials, while continuing to investigate, said they may never know how the virus spreads.

"It is impossible for us to know what factors are related to the spread," said Christina Tan, state epidemiologist, in charge of the Department of Communicable Diseases of the Health Department. "There are many factors."

Adenovirus is not a threat from the air. It is not spread through a building's heating and ventilation system, such as legionnaires' disease, Tan said. Rather, the virus moves through respiratory droplets or contact.

The state inspects these facilities every nine to fifteen months, Leusner said.

The Wanaque Center was repeatedly cited before and after the outbreak for hand washing and infection control failures, according to state and federal inspection reports.

At a recent inspection last month, the state indicated that each wing had germicidal disposable wipes, disinfectants, masks, gloves, and clothes, and most of the space was used by staff and visitors before entering the room. According to the report, there were also guidelines for adenoviruses for visitors that were visible in each room, warned visitors, they should not visit when they are ill, and watched as the staff cleaned the rooms with germicidal detergents.

However, the report found deficiencies in hand washing procedures where employees did not wash their hands long enough.

Hand washing is mandatory. No short rinse, but at least 20 seconds. They teach health professionals to sing "Happy Birthday" about twice. In the Wanaque Center, state inspectors found that some nurses had not even survived the first verse in terms of time.

Cennimo said there was a likelihood that the only way to go to bed from bed to bed would be by someone who took care of the children.

"I would be worried that the one who cared for the children was the contact vector between them," Cennimo said.

Vitale, chairman of the Health Committee, said he hopes to find out if the outbreak is spiraling due to human error or systemic weaknesses. Maybe it's both. he said.

"These children are medically vulnerable and depend on other people for survival," added Vitale. "It should not have happened that way, a child gets sick and maybe two, but so many?

NJ Advance Media Staff Writer Spencer Kent has contributed to this report.

Ted Sherman can be reached at tsherman@njadvancemedia.com. Follow him on Twitter @TedShermanSL, Facebook: @ TedSherman.reporter. Find NJ.com on Facebook.

Susan K. Livio can be reached at slivio@njadvancemedia.com. Follow her on Twitter @SusanKLivio, Find NJ.com Politics on Facebook.


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