11/14/10 — State releases GlenCare report

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State releases GlenCare report

By Phyllis Moore
Published in News on November 14, 2010 1:50 AM

MOUNT OLIVE -- Glucometers stored together in insufficiently labeled containers, inadequately cleaned or disinfected after use, and claims that medication technicians at GlenCare used devices on more than one patient were all part of a comprehensive report on the assisted living center released by the state Friday.

The nine-page document from the N.C. Department of Health and Human Services, Division of Public Health, followed a nearly month-long investigation into a hepatitis B outbreak at the center that has claimed the lives of five residents to date.

The agency has directed the nursing home to adopt numerous steps to improve safety by Nov. 19 while the investigation continues.

Since August, the total number of cases stands at eight, all hospitalized between Aug. 22 and Oct. 24 although, the report pointed out, two were hospitalized for reasons unrelated to hepatitis B infections.

As of Nov. 9, there have been five hepatitis B deaths of residents at GlenCare.

According to the report, demographics of the eight cases included six males and two females, five blacks and three whites, all with a median age of 70. Seven of the cases were diabetics, and all eight had undergone fingerstick blood glucose testing. One person, it noted, died before hepatitis testing could be performed.

The report indicated that by Nov. 9, testing had been done on 54 residents and is ongoing. Through the testing, it said, one additional acute case of hepatitis infection and one chronically infected resident have been determined. The latter, it pointed out, is not diabetic and does not receive fingerstick procedures.

Further, the report showed that four of those diagnosed had been roommates, while residents of three adjacent rooms also became ill during the outbreak. At least two residents on each of the three hallways in the facility became ill.

The Division of Public Health was first notified by the Wayne County Health Department on Oct. 12. At that time, there were four cases of hepatitis B among residents at the center. Because acute hepatitis B infections in the elderly are uncommon and cause for potential exposure, the report said, the N.C. Division of Health Services Regulations was also advised of the outbreak.

Beginning Oct. 13, the state paid several unannounced visits to GlenCare, reviewing records, interviewing staff and observing practices.

Among their findings:

* Glucometers were stored together in a single compartment in a drawer of the medication cart and were not obviously labeled with resident names.

* A spray bottle labeled "bleach" was on top of the medication cart; date of preparation and concentration was not clearly indicated.

* A medication tech interviewed indicated that glucometers and adjustable lancing devices were not routinely cleaned and disinfected between use, and that, prior to the investigation, they had been used on more than one patient.

* Other employees also told officials they were allowed only one box of gloves per shift and often had to purchase their own.

Several practices have been changed since the initial visit, the report said. On Oct. 26, glucometers were found to be compartmentalized individually and staff indicated the facility planned to discontinue use of adjustable lancing devices in favor of single-use, auto-retracting devices in response to the state's recommendations.

At a press conference on Thursday, GlenCare owners maintained their staff's innocence in any pending allegations that negligence was a factor in the patient deaths. Glenn and Anne Kornegay, president and vice president of the company, respectively, said there are other modes of transmission for the disease -- including sexual contact and drugs, as well as dental and podiatry visits where residents might have contracted the disease.

The state, however, has concluded the cases "most likely" are the result of unsafe blood glucose monitoring practices and person-to-person contact.

"The risk of becoming ill with acute hepatitis B was 15 times higher among persons who were diabetic than among those who were not, and all of those who became ill underwent blood glucose monitoring. Other risk factors associated with diabetes, such as wound care and podiatry, were not statistically significant during our analysis," the report said.

"Based on our investigation, it is not possible to determine how illness entered the facility in the first place. All of the residents with acute hepatitis B in this outbreak were ambulatory to some degree and the facility open to family members and other outside visitors. Because high-risk behaviors such as sexual activity or injection drug use were not well-documented in the facility records, we are unable to evaluate these potential exposures for most residents."

The report also noted that it is a possibility that the virus was first introduced by a resident who was a carrier, who might have died or been discharged before the investigation began.

It further stated that, "Although transmission from staff to residents was considered, this appeared unlikely based on finding that drugs of abuse were not present in the facility and the types of medical supplies used for resident care presented limited opportunities for intentional misuse."

Several recommendations were included in the report, among them the notification of current and former residents at the facility since Jan. 1. They should be alerted to the potential exposure and encouraged to seek testing, the report said.

In addition, all residents at the facility should be offered vaccinations and retested in two to four months and those deemed susceptible should also be monitored for the next six months. Other facilities accepting discharged residents over the next six months were also to be apprised of the situation.

The report is the first of two being released by the state, officials said Friday afternoon.

"It's like a two-pronged look at this," said Jim Jones, spokesman for the Division of Health Services Regulations.

The second report, from the Division of Health Service Regulation, is expected to come mid-week.

"It's still under development or in process," he said. "That's going to get into the rules they may not have followed correctly."

The report will also contain plans of correction for the facility, including fines or sanctions against GlenCare.

Julie Henry, public information officer with the Division of Public Health, said her agency's investigation is "pretty much complete."

"This has been one of the tricky things about this. We're both under Department of Health and Human Services, but we're two separate divisions. We work collaboratively ... but they're two separate investigations," she said. "We would like to think that Stage 1 has already happened. As soon as we observed staff, we talked to them about preventive measures, making sure that not only does each patient have their own fresh needle, but those things that we consider to be proper.

"We have had a good working relationship (with GlenCare). We have been in the facility working with staff. We were notified on Oct. 12 and we were there on Oct. 13."

-The Associated Press also contributed to this story.