WOODSTOCK – Valley Hi Nursing Home is working to improve its plans to deal with infection control in the wake of a state investigation that concluded that the plans’ deficiencies led to a scabies outbreak.
The Illinois Department of Public Health report, dated July 20, concluded that not only were residents of the county-run nursing home not isolated despite having rashes, but also that cases of the very contagious disease may have started appearing long before the initial report.
“Based on observation, interview and record review, the facility failed to have an effective infection control program to identify, monitor and contain the spread of a communicable disease between residents and staff,” the report stated. “This failure resulted in the spread of a communicable skin rash to 27 residents.”
Six of the cases as of Thursday morning have been positively identified as Norwegian scabies, McHenry County Department of Health Administration Manager Joseph Gugle said. Norwegian, or crusted, scabies is a severe form of the disease caused by an infestation of the skin by the human itch mite – its victims have thick crusts of skin that contain large numbers of the mites and their eggs. Scabies is spread by both direct person-to-person contact and through contamination of clothing, bedding and furniture.
Valley Hi has until Monday to submit a corrective action plan, and about another month to correct the deficiencies identified in the state report, facility Administrator Tom Annarella said. That will include beefing up its existing policy on infectious diseases.
“The facility is going to review its current infection control policies and procedures, and revise them to include more specific directions on handling skin-related rashes,” Annarella said.
Valley Hi notified the health department June 30 of the issue, and confirmed the first case the following day. Annarella ordered the facility closed to new residents and to visitors, and a treatment plan was implemented for all residents and staff. But the report concluded in part that measures in controlling the spread were inadequate.
Investigators who visited the facility July 1 found that a number of residents with “red rashes and notable itching” were in a dining room eating the evening meal, with one “vigorously scratching her head” while being assisted to eat. What’s more, the state report concluded that scabies may have been a problem weeks or even months earlier.
An unidentified care plan coordinator quoted in the report told investigators that Valley Hi “has had residents with rashes for some time.” A nursing director said that a few residents had been treated before the June 30 report, but that the county health department was not notified because the cases were considered isolated and not an outbreak. A facility log indicated that one resident’s rash started last October.
Annarella said that the epidemiology indicates that scabies likely was introduced to the home in March, but that Valley Hi’s medical director disagrees with the idea that it came any earlier. He also said that the outbreak does not mean that all rashes seen before that point had to be scabies.
Nursing homes, extended-care facilities, prisons and other crowded places where close skin contact is frequent are common sites of scabies outbreaks, according to the U.S. Centers for Disease Control and Prevention. Norwegian scabies is most common with the elderly, the disabled and people with compromised immune systems.
“If the first case happened in October, by the time you hit June, nearly a year later, it would be full-blown across the house,” Annarella said.
But to Cary resident Christy Wagner, whose mother-in-law and uncle live in Valley Hi, the report validated what she said she had reported for weeks prior. She told both the Valley Hi Operating Board and the McHenry County Board that she had alerted staff to her mother-in-law’s rash and terrible discomfort, as well as the apparent scratching of other residents, in early June. Wagner has to wear a gown and gloves to see her mother-in-law, who still is in isolation.
She has called the outbreak a preventable one caused by a “failure to connect obvious dots” and inadequate communication – she alleged that several members of the operating board that oversee the home first learned of the outbreak by reading about it in the newspaper or being turned away.
“It’s our family’s hope that, going forward, there will be much better communication between staff and administration, working together so patient welfare as well as staff health, is a priority. That’s what they’re there for,” Wagner said.
Annarella praised Valley Hi’s staff for its response to the outbreak, and said the home will learn from its mistakes.
“We’ve taken all of the concerns brought forth very seriously, and we’re working on an even stronger program to prevent this from happening in the future,” Annarella said.