POST 95. December 24, 2020. “The Murphy administration may step in to force (New Jersey) hospitals to report COVID-19 outbreaks among staff.”

“One of Virginia’s top health officials is warning medical providers about a growing number of COVID-19 outbreaks in state hospitals.

Health Commissioner Dr. Norman Oliver released a new clinician letter on Friday, writing that reported COVID-19 infections in hospitals have “increased substantially” since August.

“The largest monthly number of hospital COVID-19 outbreaks since the pandemic began was reported in October,” he said. Data from the Virginia Department of Labor and Industry, obtained by the Mercury through a Freedom of Information Act request, shows that more than 10 different hospitals reported COVID-19 cases or hospitalizations among employees between August and October.

Some of those facilities, including Bon Secours St. Mary’s Hospital in Richmond and Sovah Health in Martinsville, were also the subject of employee complaints for not following the state’s emergency COVID-19 safety regulations. Dozens of private health care practices — including dental offices, ear, nose and throat specialists and eye doctors — also reported cases or received complaints.

Sarah Lineberger, manager of the Virginia Department of Health’s health care-associated infections program, said COVID fatigue is likely contributing to the spread in hospitals and health care facilities, which have been on the frontline of the pandemic for months.

“With the increase in community transmission, we think we just really have to get to the basics of infection prevention and control,” she said. “We’re seeing issues with personal protective equipment and the need to remind staff to make sure everyone is social distancing and and following public health guidelines before and after work.”

The fact that many hospital employees were furloughed over the spring and summer and are still getting reacquainted with COVID-19 procedures also complicated efforts to control the virus, Lineberger said. Some hospitals have also relaxed visitor restrictions or may still be operating under emergency protocols when it comes to distributing personal protective equipment…

Oliver called the rise of outbreaks in hospitals especially concerning because the state is also seeing an increase in infections related to multidrug-resistant organisms — bacteria and other germs that don’t respond to antibiotics or other treatments.

“Simultaneous transmission of COVID-19 and multidrug-resistant organisms is occurring in several hospitals and other healthcare facilities across Virginia,” he wrote. Lineberger said that both hospitals and long-term care facilities in Virginia have seen co-occurring outbreaks of the virus and other infections such as Candida auris, a multi-drug resistant fungus that hasn’t been historically common in Virginia.

But recently, the state has been seeing an increasing number of cases, she added — underscoring the need for health care facilities to review and stringently implement infection control procedures.

“We’ve been working with facilities to focus on the basics and make sure they’re thinking about other organisms, not just COVID-19,” Lineberger said. “These are issues that we really tried to drive home with nursing homes and are now coming up in hospitals.”” (A)

“Brigham and Women’s Hospital in Boston is experiencing an outbreak of COVID-19 among patients and staff, which the facility blames partly on lapses in infection control practices by employees.

The hospital, a Harvard Medical School teaching facility, reported on September 28 that, so far, 30 employees and 12 patients tested positive as a result of exposure within the hospital.  The outbreak was first detected on September 22, and cases have risen with increased testing. The hospital said it had tested 488 employees and 581 patients as of September 28…

Brigham and Women’s reported that the outbreak may have started with a presymptomatic employee who had mild symptoms that the worker attributed to seasonal allergies. That worker interacted with a patient. Both the patient — who received an aerosol-generating treatment — and the employee later tested positive.

The hospital said its investigation determined other factors that likely fueled the spread, including that many patients were not masked during clinical care and interactions with staff; that clinicians and health care workers were inconsistent in the use of eye protection during patient encounters; and that staff did not observe physical distancing while eating and unmasked…

Pettis said it is only natural at this point in the epidemic that staff might be less diligent with personal protective equipment and other infection control practices.

“I like to call it PPE fatigue,” she said, noting the difficulty of wearing masks and other PPE throughout a shift.

Infection control specialists at hospitals help gauge the appropriateness and functioning of air handling and filtering and monitor staff on PPE-wearing and other infection control measures because “of that tendency to perhaps let your guard down a little,” Pettis explained.

With the potential for people with SARS-CoV-2 to be asymptomatic or presymptomatic, it is “incredibly difficult to have an absolute risk-free environment,” she said.

“Even if you do everything right, there is the potential for [an outbreak] to happen,” Pettis continued, adding that hospitals are required to report hospital-acquired COVID-19 infections to their local health departments, which then report to state health officials, but there is no national repository of such COVID-19 outbreaks.” (B)

 “Several causes contributed to Covid-19 outbreaks at Mayo University Hospital including a lack of understanding of the virus and the importance of wearing face masks, a report has found.”

“Two outbreaks last April and May occurred on two inpatient wards leading to 75 confirmed cases, 33 among patients and 42 staff….

It conducted an unannounced visit last September to assess Covid-19 related aspects of management. And while it found the hospital to be either compliant or substantially compliant in five of six areas, it raised concerns over its emergency department and addressed the causes of the earlier outbreaks.

“Contributory factors [to the outbreaks] included key information deficits relating to the nature of the Sars-CoV-2 virus at that time, inclusive of the potential for asymptomatic and pre-symptomatic spread, and the importance of mask wearing to prevent cross-transmission,” it found.

Other factors included a delay in turnaround time for tests (subsequently addressed with increased on-site capability), the absence of proper contact tracing, a lack of appropriate isolation facilities, staff crossover between wards and asymptomatic transmission to staff and patients.

During the course of this inspection, Hiqa noted the hospital had implemented several measures to reduce the likelihood of further outbreaks.

However, it said while affected areas of outbreak wards were subsequently closed, “it was of concern” that other areas of the wards remained open to admissions for two weeks afterwards.

Was there an overcrowding problem?

The hospital was found to be non-compliant with standards governing infection prevention and control, specifically relating to overcrowding in its non-Covid emergency department A, where the original outbreak occurred.

“If further outbreaks are to be avoided the hospital must urgently address ongoing risks through improvements in the wider hospital infrastructure, addressing emergency department overcrowding, and through the early closure of outbreak wards to new admissions.” (C)

“On Wednesday, we learned Providence Medical Center in Everett experienced a small COVID-19 outbreak within the hospital.

A hospital spokesperson confirmed “a small number of patients in one unit tested positive for COVID-19 within a few days of each other.”

The spokesperson told KOMO News the first positive test result came roughly two weeks ago.

“At this point, we do not know if these patients may have had a common source of exposure. The investigation is ongoing, and the findings aren’t definitive,” said the hospital statement.

The statement went on say that all visitations were halted within the unit, patients on the unit were discharged, and the unit is currently closed for investigation.

This is just the latest reported outbreak within a hospital in the Puget Sound region.

This week, Multicare Auburn Medical Center confirmed one patient died and eight other patients were infected with COVID-19 last week after a patient tested positive for the virus on a 4th floor unit.

Five employees also tested positive after the hospital tested hundreds of employees that were in the unit within 14 days prior to the first patient testing positive.

“MultiCare is following all public health recommendations and has the PPE we need for our employees to continue to safely care for all of our patients at Auburn Medical Center and throughout our health system.”

In Bremerton, at St. Michael Medical Center, six more people (four patients and two staff members) recently tested positive. This comes after three patients died and more than 70 others were infected during an outbreak in August…

Outbreaks within hospitals have occurred since the start of the pandemic.

According to the latest DOH report, there have been 350 outbreaks within non-long term care healthcare settings. These include hospitals, outpatient settings, behavioral health facilities, supported living facilities, home healthcare, dialysis centers, and independent senior living facilities.” (D)

“At least 100 employees from Ocean Medical Center in Brick Township have been infected with the coronavirus, according to a memo posted on the hospital parent company’s website that attributed the recent outbreak to “colleagues socializing outside of work.”

A spokesman for Hackensack Meridian Health, which owns the 318-bed hospital in northern Ocean County, declined to say Monday specifically how many employees have been affected.

Visits with patients have been suspended with the exception of labor and delivery, end-of-life care, pediatrics and adult patients with special needs, Hackensack Meridian spokesman Benjamin Goldstein said in a statement.

“We continue to have adequate staffing for both COVID-19 cases and elective surgeries, and follow all rigorous safety protocols established by the CDC and the New Jersey Department of Health,” according to Goldstein’s statement…

Ocean Medical Center was treating 68 confirmed COVID-19 patients while 12 others were awaiting test results, according to the Hackensack Meridian Health website data on Monday.

Hackensack Meridian’s 12 acute-care hospitals, Carrier Clinic and its long-term care facilities were treating a total of 737 confirmed COVID-19 patients and 37 other awaiting test results, according to the website.

A rising number of cases can be found throughout the state, as New Jersey has entered the second wave of the pandemic. There were 2,961 patients with confirmed (2,761) or suspected (263) cases Sunday night — including 575 in intensive care, with 332 on ventilators, Gov. Phil Murphy announced on Monday.

Ed Lifshitz, medical director for the Communicable Disease Service at the Department of Health, said during the governor’s briefing he was aware of the outbreak at the hospital, and noted cases are rising at hospitals around the state. Given the nature of hospitals, with patients and staff “coming and going all the time” Lifshitz said it was harder to contain the virus.

Seven of New Jersey’s 71 acute-care hospitals were on “divert status” Monday night but Ocean Medical Center was not among them.

Goldstein, the hospital chain spokesman, stressed that all employees undergo a temperature check and a “comprehensive screening” before they report to work.

“As a result of COVID-19 being widespread in the community, we are also continually reinforcing our safety guidelines with team members to ensure they are maintaining infection prevention practices both inside and outside of the medical center – frequent hand washing, wearing a mask, physical distancing, and staying home when you are sick,” Goldstein’s statement said.” (E)

“As a New Jersey hospital faced a surge of Covid-19 cases in the spring, another deadly foe was quietly spreading among its patients: a drug-resistant bacterial infection.

The superbug outbreak, detailed in a report published Tuesday by the Centers for Disease Control and Prevention, shows how the coronavirus can overwhelm a hospital, straining care and leaving patients vulnerable to other unwanted outcomes.

Carbapenem-resistant Acinetobacter baumanii, or CRAB, is a drug-resistant bacterium known to spread in hospitals, particularly in intensive care units. It can cause pneumonia as well as wound, blood and urinary tract infections, according to the CDC. Carbapenem, a powerful antibiotic, is ineffective at treating the infection.

Not all patients get sick — in some cases, the bacteria can “colonize” the body, but not cause an infection. These patients can still spread the bacteria to others.

The outbreak was first detected in the unnamed New Jersey hospital on May 28, according to the CDC report. Further investigation by the hospital and the state health department identified a total of 34 patients who had caught the superbug from February to July. Typically, the hospital sees up to two cases a month.

The majority of the cases — 82 percent — occurred in March through June, when the hospital was facing a surge of Covid-19 patients, and with it, severe shortages in necessary staff, supplies and equipment.

The bacteria pose a threat to hospitalized patients because they can survive on surfaces for a long time, according to the CDC. Contaminated surfaces must be rigorously cleaned and disinfected to prevent outbreaks.

Such infection control measures, however, took a hit during the hospital’s Covid-19 surge. Personal protection equipment was reused, for example. Fewer screening tests for the bacteria were given to patients, because of staff shortages and higher-need patients.

The report also noted that before the pandemic, key parts of a ventilator were changed every 14 days. To conserve equipment during the surge, however, the hospital switched to replacing these parts only when they were visibly soiled or malfunctioning.

Twenty-five of the 34 patients either infected or colonized with the bacteria were on ventilators at the time.

Twenty of the 34 patients did become infected, including 11 patients with Covid-19. Fourteen developed a form of pneumonia linked to the bacterial infection, four of whom also had bacteremia, a blood infection. A total of 10 patients died, and one remains hospitalized, according to the report.

It wasn’t until late May that the hospital was able to resume normal operations — and with that, CRAB cases fell.” (F)

“The Murphy administration may step in to force hospitals to report COVID-19 outbreaks among staff as legislation requiring the public disclosure remains stalled in the state capital.

Hospitals have so far evaded the same detailed reporting requirements of nursing homes and schools during the pandemic. But with the second wave of the coronavirus threatening to deplete the state’s health care workforce, Gov. Phil Murphy said Monday that he is “100%” in favor of transparency and it is something his staff is working on.

“I can’t promise you executive action,” Murphy said. “That’s something we’re very seriously looking at. Folks have a right to know what’s going on.”

Later Monday, the state hospital association said it would support the now-stalled measure, pending in the Assembly, that “calls for a transparent reporting process for hospital workers infected with the COVID-19 virus.”

Public posting of information about hospital outbreaks will help “residents of this state feel confident seeking medically necessary care at our facilities,” said Cathleen Bennett, president of the association, which represents 71 acute-care hospitals. The association had added its support to A4129, she said.

But to this point neither the state nor hospitals have offered details on recent outbreaks among staff, which generally mean three positive COVID-19 cases that have a “clear link.”

In the past several weeks, outbreaks have sickened more than 100 health care workers at Ocean Medical Center in Brick, sidelined between 30 and 40 employees of Palisades Medical Center in North Bergen and infected hospital workers at Jersey Shore University Medical Center in Neptune.

The Harborage with is part of the Hackensack Meridian Health Palisades Medical Center in North Bergen, N.J. on Wednesday April 22, 2020.

Murphy’s comments came a day after a story by The Record and NorthJersey.com outlining the lack of data on hospital outbreaks, and just hours after unionized health care workers pressed for the passage of a bill to require that hospitals report to the state positive cases, hospitalizations and COVID deaths among staff members.

That bill was introduced shortly after the first wave subsided and passed unanimously in the Senate, but it has made no progress in the Assembly even after the arrival of the second wave of COVID cases this fall…

Hospitals must report some details to the state, such as the number of admitted COVID patients, ventilator use and how many critical care beds are treating COVID patients. That data has helped to show the evolution of the virus and inform decisions by the governor.

As of Monday, there were 3,346 hospitalizations. At the peak of the first wave in the spring there were about 8,300 people hospitalized with COVID, and New Jersey was “at the edge” on hospital capacity, Murphy said.” (G)

“Hospital systems (and other indoor facilities) should focus on a number of provisions in addition to distributing a sufficient supply of masks to all staff and patients. Adequate, well-ventilated, and ideally dedicated space must be provided for breaks from daily work activities and mealtimes for health care workers, with processes in place to ensure that these are staggered to minimize contact and conversation during these higher-risk periods. Shared patient rooms should be avoided when possible, especially when local prevalence of infection is high, because of the possibility that patients might be admitted during the SARS-CoV-2 incubation period and because they must remove their masks to eat. The marginal benefit of universal eye protection should be evaluated, particularly during clinical encounters. Regular, flexible, and convenient testing with short turnaround times and adequate and statutory sick leave should be made available to all health care workers, with systems in place to ensure progression of training for medical trainees. Through these measures, transmission could be further minimized (and perhaps even eliminated), and emerging evidence could continue to direct policies designed to maintain safety in the hospital setting.” (H)

• A.COVID-19 outbreaks are increasing within Virginia’s hospitals, health officials warn, By Kate Masters, https://www.virginiamercury.com/2020/11/09/virginia-health-officials-warn-covid-19-outbreaks-are-increasing-within-hospitals/
• B.Brigham and Women’s Latest to Battle In-House COVID Outbreak, by Alicia Ault, https://www.medscape.com/viewarticle/938215
• C.Contributing factors to Covid-19 outbreaks at Mayo hospital identified, by Mark Hilliard, https://www.irishtimes.com/news/health/contributing-factors-to-covid-19-outbreaks-at-mayo-hospital-identified-1.4439842
• D.Providence Medical Center reports COVID-19 outbreak within hospital, by Patrick Quinn, https://komonews.com/news/coronavirus/providence-medical-center-reports-covid-19-outbreak-within-hospital
• E.Coronavirus outbreak sidelines more than 100 employees at N.J. hospital, By Susan K. Livio, https://www.nj.com/coronavirus/2020/11/coronavirus-outbreak-sidelines-more-than-100-employees-at-nj-hospital.html
• F.New Jersey hospital faced superbug outbreak amid Covid surge, By Sara G. Miller, https://www.nbcnews.com/health/health-news/new-jersey-hospital-faced-superbug-outbreak-amid-covid-surge-n1249559
• G.Murphy indicates he could make info on COVID outbreaks among hospital staff public, by Dustin Racioppi and Lindy Washburn, https://www.northjersey.com/story/news/new-jersey/2020/12/07/covid-nj-hospitals-made-public-phil-murphy-says/6478362002/
• H.Hospital-Acquired SARS-CoV-2 Infection, Lessons for Public Health, by Aaron Richterman, MD1; Eric A. Meyerowitz and Muge Cevik, https://jamanetwork.com/journals/jama/fullarticle/2773128
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