Childrens Hospital of Philadelphia Cited in Norovirus Outbreak

By Walter F. Roche Jr.

Nineteen nursing staffers at Childrens Hospital of Philadelphia were stricken with norovirus earlier this year after workers failed to properly sanitize a contaminated patient's room.
The outbreak, which has not previously been made public, triggered an inspection by the state Health Department and  a six-page citation by the agency for violations of state regulations.
According to the health agency report, workers at CHOP "failed to implement appropriate cleaning protocols in accordance with facility policy to ensure care was provided in a safe setting for one nursing unit affected by the Norovirus."
The outbreak, which occurred in late March and early April of this year, struck staffers in 4E/4S, a post surgical unit.
A CHOP spokeswoman said all the staffers recovered. She said some patients also were sickened but did not provide further details.
The state report, which was issued in May, concluded that hospital workers failed to properly sanitize the room with a hospital approved bleach.
In addition state inspectors found that the hospital failed to require that affected workers remain out of work for 48 hours after any symptoms disappeared.
It was not until March 27 that the staffers were directed not to return to work until 48 hours had passed without norovirus symptoms, the report states.
The state found that between March 11 and April 10, 19 CHOP nursing staffers were identified with norovirus symptoms.
Norovirus is highly contagious and results in acute gastroenteritis. Symptoms include diarrhea and vomiting. It can be fatal especially for the young, elderly and those with a compromised immune system.
Disclosure of the outbreak comes amid growing concern about an international outbreak of deadly ebola virus and more contained outbreaks of enterovirus D68. CHOP, in fact, has treated four confirmed enterovirus victims. That number may grow pending test results from the U.S. Centers for Disease Control and Prevention.
Two Texas health care workers, who were involved in the treatment of a now deceased ebola victim, have been diagnosed with ebola.
A CHOP spokeswoman, Rachel Salis-Silverman, said that the Spring outbreak helped the facility in dealing with the current issues.
"This norovirus outbreak among staff taught CHOP that a process needed to be put into place for earlier identification of an outbreak, and additional training on sanitizing patient areas was required. These new processes help support CHOP’s broader preparations underway, which are designed to address the most recent outbreaks," she wrote in an email response to questions.    
CHOP, state records show,  filed a plan of correction following the May inspection in which they stated that staffers had been retrained on proper cleaning methods. That plan was implemented by early July.
More recently CHOP was again cited by state inspectors for giving a patient 10 times the proper dose of morphine.
The seven-page report dated Aug. 8 concluded that staffers failed to follow a series of safety checks before administering by intravenous solution 1.5 milligrams of morphine instead of the 0.15 dose prescribed by a physician.
While the unnamed patient subsequently had decreased respirations, "Naxalone was given with immediate improvement in his respirations."
According to the state records, both inspections were triggered by unidentified complaints.
CHOP also filed a corrective action plan following the overdose incident which included retraining of staff in proper safety checks before administering "high-alert medications."