A ninth child died at the onset of adenovirus in a Wanaque long-term hospital
Scott Fallon, Staff Writer, @NewsFallon
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In one case, a caregiver removed a soiled diaper from a severely handicapped child and then attached a breathing tube to the child with the same pair of gloves.
In another case, after a respiratory therapist put on a breathing mask to a disabled child, took off her gloves and, without washing her hands, went to a second patient room, removed a medical device from the floor and attached it to the foot of the resident , Then she could not wash her hands again before she entered a third patient room.
These and other basic hygiene gaps were covered in an inspection report from a surprise visit on October 21 at the Wanaque Center for Nursing and Rehabilitation, the long-term nursing home where a virus outbreak led to the deaths of nine children this month.
The State Health Inspectorate conducted the inspection 12 days after it was first notified of a "cluster of respiratory diseases" at the facility, which looks after medically ill children. Four of the six employees who were observed during this inspection did not meet the standards for proper "hand hygiene".
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Two more cases, cited in the report released by the Ministry of Health on Tuesday afternoon, were registered nurses. A woman touched a tube with a hand tube that delivered food directly into a resident's stomach, then took off her gloves and, without washing her hands, touched a tube that connected a ventilator to the resident's trachea. Then she went to another room, opened the window, and went to the patient's medicine cart without washing her hands.
Government officials have called the violations "minor hand washing defects".
A representative of the Wanaque Center did not respond immediately to a request for comment on Tuesday evening.
The onset of adenovirus type 7, particularly severe exposure to the virus, began on September 26 and has left 26 children and one employee sick. Nine of the children have died this month, the last death on Sunday. No new cases were reported on Tuesday.
Nine children died as a result of a serious virus outbreak in the respiratory system of a long-term care center in Wanaque. (Photo: Kevin Wexler / northjersey.com)
Gov. Phil Murphy, who was asked at an event in Trenton on Tuesday after the outbreak, said, "This is obviously a deep concern for us – we've lost nine young lives." Other patients at the Wanaque Center "remain in question," he said.
Commissioner for Health, Dr. Ing. Shereef Elnahal said his department "took aggressive steps in response to this outbreak." We send infection control teams to every facility, such as Wanaque, which looks after medically vulnerable children, including centers in Voorhees, Toms River, and Mountainside. In addition, a staff member of the State Service for Communicable Diseases will stay on-site at Wanaque until the outbreak ends.
"Every single shortage we find in these facilities is taken seriously," Elnahal said in an interview. "We ask for a correction plan and look at later visits for these defects."
A cause for concern
Infection control deficiencies are among the most commonly reported problems among all types of health care facilities, he said.
However, the nurse's actions, which involved removing a diaper to place breathing tubes, were "certainly worrisome," he said.
The Department of Health also reviews the need for stricter protocols in a facility like the Wanaque Center, where patients have a variety of complex health problems and many rely on ventilators, tracheostomies, and tubes, making them more susceptible to infection ,
"In the coming weeks, we will be discussing the federal norms with the CMS [the Centers for Medicare and Medicaid Services, which regulates health care facilities]which refer to facilities that provide the most vulnerable patients," he said.
The federal government needs long-term care facilities on site infection prevention specialists from November 2019. Although this is an encouraging Development is, said Elnahal: "We also have to think about whether we can do more … to protect immunocompromised children." Wanaque center.
The standards for hand hygiene require 15 to 20 seconds with soap and water. Employees must wash their hands before they touch a patient whenever a worker's actions go from a contaminated body site to a cleansing body area "and after removing the gloves.  Despite the incidents mentioned in the report, care was taken in the Center of Wanaque was not considered inferior in the end, Elnahal said. "These were subordinate outcomes."
A summary produced by Ministry of Health officials identified ways in which Wanaque employees complied with regulations, including proper ones Use of personal protective equipment such as gloves, coats, and gloves.
This was not the first time that inspectors had quoted the Center for Unsanitary Practices, as a review of the annual inspection reports from 2015 to this year shows eme were resolved at the time of the following visits, said the health commissioner.
Last August, for example, an inspector saw a nurse taking a pill off the floor and moving to spend more medication without washing his hands. An inspector also saw a patient with a urinary drainage bag who had a hole in it and poured it into a jar. "It's happened a lot," one sister told the inspector. "The care was not the best and interrupting the closed urinary drainage system could lead to a potential infection."
Elnahal also referred to these as "low-level findings" and said that they had been corrected.
In May 2017, the Wanaque Center was cited for several practices that could lead to the spread of the infection: Nurses were observed that syringes used for oral administration of patients were not properly cleaned, dried and stored. A nurse did not disinfect the drug shelf between sessions with patients. A spoon was left in a canister of amino acid powder, possibly exposing it to bacteria. The tube from an oxygen tank entering the patient's nose was uncovered while the patient was receiving dialysis when it was to be placed in a plastic bag. A nurse did not properly clean the outside of a germicide container and a bottle of hand sanitizer after taking a patient's waste. The nurse would put her on a treatment cart before the inspector asked.
Demands of the Union
In the center of Wanaque in the Haskell district, 92 children and 135 adults can be cared for. At the time of the last inspection, it had 200 patients.
Unions representing workers at the center have requested more training and information about the outbreak, but say that their demands have been ignored by the Center's management. They also asked for bereavement counseling.
"They are mourning," said Bridget Devane, director of the Health Professionals and Allied Employees union, whose local representation represents 70 registered nurses and licensed practical nurses in the facility. Some of the patients at Wanaque Center have been cared for by the same nurses and staff for over a decade.
"They ask for support as they try to control this infection."  DR. Shereef M. Elnahal is the commissioner of the Health Department of NJ. Tuesday, September 11, 2018. ” width=”540″ data-mycapture-src=”” data-mycapture-sm-src=””/>
Dr. Shereef M. Elnahal is the commissioner of the Health Department of NJ. Tuesday, September 11, 2018. [Photo: Amy Newman / NorthJersey.com]
The union wants to hold a candlelight vigil in memory of the children who died as soon as possible, wrote Debbie White, its president, in a letter to Rowena Bautista, the administrator of the institution.
Two letters to Bautista from Ron McCalla, deputy department head of 1199SEIU, representing 136 certified nurses, laundry and dieticians in the center, were also not answered, a spokesman for the Service Employees International Union said.
The volunteers are at the forefront of Wanaque and need support and information, McCalla wrote, asking nine questions about the eruption. He asked for "an emergency meeting for all employees".
The members of SEIU work without a contract in the center, since 2014 new owners have bought the facility, said the union spokesman Bryn Lloyd-Bollard and the negotiations have stalled since spring. Your starting wage is between 10 and 13.50 USD per hour.
Many members of SEIU work part-time in other health care facilities due to their high health insurance premiums. Therefore, consistent infection control training is essential to prevent the outbreak from spreading.
No further outbreaks of this virus have been reported in the state, Elnahal said. "It's something to watch over."
Employee writer Nicholas Pugliese contributed to this article.
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