Patient care failings cited in Group A strep cluster
Infection control response was prompt, appropriate
State investigators have cited a New York hospital for "inadequate" patient care, but upheld initial findings that its infection control response to a cluster of Group A streptococcus infections that left one patient dead earlier this year was prompt and appropriate.
The strep infections at Strong Memorial Hospital in Rochester, NY, involved three obstetrical patients, including one who died from necrotizing fasciitis after she gave birth by cesarean section. Two health care workers in the unit were colonized with the same strep strain. Infection control measures included re-emphasizing strict adherence to aseptic technique and implementing contact isolation that included private rooms for patients. The newborns of the infected patients were also placed in isolation and were cultured. (See story in Hospital Infection Control, May 1997, pp. 68-70; 75.)
"Although the patient care deficiencies resulted from inadequate treatment of two patients who were infected with Streptococcus bacteria, an earlier investigation concluded that Strong Memorial hospital acted appropriately in dealing with the infectious disease cluster there," the New York State Health Department in Albany stated in releasing the report. "Communicable disease experts, in March [1997], said there were no lapses in infection control practice by Strong Memorial personnel, and once the three cases were identified, the response of the hospital’s infection control staff was prompt and appropriate to prevent further spread of the bacteria."
The state investigation of the cluster, however, determined that the hospital clinically mishandled two of the three cases, including the case of the patient who died.
"While it is not certain that any medical intervention could have saved the life of the first patient [patient No. 1], the hospital failed to recognize the gravity of her condition, and did not begin aggressive treatment soon enough," reported Barbara DeBuono, MD, state health commissioner. "The second patient [patient No. 2] also received inadequate care."
The health department findings regarding deficiencies in the care of patient No. 1 included:
• The hospital failed to begin aggressive treatment of the patient’s Group A streptococcal infection on a timely basis.
• Neither the attending physician, nor anyone from his group practice, saw the patient for 60 hours following her surgery.
• There was no cardiac monitor defibrillator on the postpartum unit when the patient suffered cardiac arrest, and obstetrical service staff were not familiar with the contents of the emergency crash cart.
• Hospital staff at least twice used latex on the patient, despite her known allergy to the material.
The findings on patient No. 2 included:
• Hospital staff failed to take blood cultures or treat the patient with antibiotics soon enough.
• Staff did not follow the hospital’s own policies and procedures that a physician should be called when a patient’s pulse and blood pressure drop below certain levels.
• A first-year resident neglected to write an order for lactated Ringers to treat the patient’s dehydration, even though, in the physician’s medical judgment, the patient needed the treatment.
The health department’s investigation involved comprehensive interviews with hospital staff and a meticulous review of patient records, the hospital’s investigative report and quality assurance findings, and patient care protocols. As a result of the findings, the hospital has signed a legal agreement admitting the deficiencies and agreeing to correct violations. The health department agreed to suspend an $8,000 fine based on the hospital’s acceptable plan of correction, and providing that corrective actions, including submission of quarterly progress reports, are taken, the health department report stated.
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