Editor’s note: Do you have a family member on the pediatric unit at the Wanaque Center for Nursing and Rehabilitation, or a child who has been affected by the viral outbreak there? NJ.com would like to hear from you. You may reach us at (732) 902-4559, or write to Susan Livio at email@example.com, Spencer Kent at firstname.lastname@example.org, or Ted Sherman at email@example.com.
The state released a new inspection report of the Wanaque Center for Nursing and Rehabilitation in Haskell — where nine children died in a severe viral outbreak and more than a dozen others sickened — finding some deficiencies in handwashing and infection control.
In one case, a nurse performing care of one patient donned gloves, touched the patient’s gastrostomy tube (a tube inserted through the abdomen that delivers nutrition directly to the stomach), re-positioned the resident, but then “removed her gloves, and without benefit of performing hand hygiene, then touched the tubing connected to the resident’s tracheostomy tube and the ventilator machine.”
At the same time, Health Commissioner Shereef Elnahal raised questions over whether the standards set by the Centers Medicare & Medicaid Services for care of patients in settings like Wanaque need review.
“Certain findings raise questions about whether these general long-term care standards are optimal for this vulnerable population of medically fragile children,” said Elnahal. “I will be engaging in collaborative discussions with CMS to assess how we can better align standards for theses pediatric long-term care facilities”
Health officials note that CMS is already moving to require long-term care facilities to have an “infection preventionist” on-site, responsible for infection prevention control programs. That mandate begins in November 2019.
“I am encouraged by this new CMS requirement. We also need to think about whether there is more we can do as healthcare leaders to protect immunocompromised children, such as those served at Wanaque Center,” said Elnahal.
To date, that has been 26 confirmed pediatric cases associated with the adenovirus outbreak at the facility. In addition, a staff member — who has since recovered — also became ill as part of the outbreak.
Those who died, as well as the others who remain sick, were pediatric patients who ranged in age from toddlers to teenagers, many on ventilators with compromised immune systems — some with developmental disabilities or serious health challenges. All became ill between Sept. 26 and Oct. 22, said health officials.
The state said it was notified of the adenovirus outbreak on Oct. 9.
Adenovirus is typically a mild illness that mimics flu- and cold-like symptoms, but can pose serious complications to some people, particularly those with weakened immune systems.
The health department conducted an unannounced inspection of the facility on Oct. 21. According to the report of that visit, a review of medical records for those who died revealed that prior to hospitalization revealed they were being monitored for fever, and medicated with Tylenol alternating with Ibuprofen, and antibiotics administered on a doctor’s orders.
During the inspection, the state confirmed there were germicidal disposable wipes, sanitizers, masks, gloves, and gowns available on every wing, and mostly in every room for the staff and visitors to use prior to entering the room.
The report said there were also guidelines regarding adenovirus for visitors visible in each room, warning visitors not to visit if they are sick, and observed staff cleaning the rooms with germicidal cleaning solutions. A review of the facility’s records showed that there was an Oct. 8 memo that went out, informing all staff on intensive housekeeping and disinfection on the pediatric unit and classrooms.
“In addition, the facility had good communication with physicians and the receiving hospitals,” the report said.
However, the report cited deficiencies in hand washing procedures, where members of the staff did not wash their hands long enough. In another case, a nurse stepped out of a room without first performing hand hygiene and went to another patient’s room to open the window, again without performing hand hygiene, and went to her medication cart.
Elnahal said his department has been working closely with the facility on infection control issues since the outbreak was reported, including having a member of the agency’s Communicable Disease Service onsite at the facility.
“Additionally, in November, we are deploying a team of infection control experts and epidemiologists to conduct training and assessments of infection control procedures at Wanaque and similar facilities,” he said.
Rowena Bautista, adminstrator for the Wanaque Center, did not respond to requests for comment.
The Wanaque Center in northern Passaic County is a 227-bed nursing home, rehabilitation center and a pediatrics center, which offers short- and long-term care.
Licensed for 92 pediatric beds, state officials said the facility has agreed to cease admitting new patients until the outbreak ends. It also has established a 24/7 hotline for families affected. It said the Wanaque Center is also offering professional grief counseling to anyone impacted.
Spencer Kent may be reached at firstname.lastname@example.org. Follow him on Twitter @SpencerMKent. Find the Find NJ.com on Facebook.
Ted Sherman may be reached at email@example.com. Follow him on Twitter @TedShermanSL. Facebook: @TedSherman.reporter. Find NJ.com on Facebook.