Morgantown nursing home has largest coronavirus outbreak at a Ky. long-term facility, 51 cases; same owner has Nos. 2 and 3

Morgantown Care & Rehabilitation Center is the only nursing home in Butler County.

This story has been updated with information about Signature HealthCare locations.

The largest outbreak so far of coronavirus cases at a long-term-care facility in Kentucky is at a Morgantown nursing home that is owned by the same company as the one with what is now the second and third largest outbreaks. That company has 42 nursing homes in Kentucky, according to its website.

Signature HealthCare of Louisville said in a press release that Morgantown Care & Rehabilitation Center has 29 residents and 22 employees who have tested positive for the virus.

"Officials said all 29 residents stricken are 'asymptomatic' or have 'mild' cases of the virus," and all are being treated at the facility, in a separate wing, WBKO-TV in Bowling Green reports.

"They are doing a very good job of responding," Gov. Andy Beshear said as he gave numbers of new cases at his daily briefing.

Signature also has Summit Manor in Columbia, where 37 residents or employees were found to have the virus Thursday, and Jackson Manor in Annville, which has had 40 cases overall, the Lexington Herald-Leader reports.

The company said the Morgantown facility “was fortunate enough to obtain enough of the highly sought after and reliable covid-19 tests, and out of an abundance of caution for the protection of our residents, staff and community at large, (that a decision was made) to test the entire facility.”

"Butler County Judge-Executive Tim Flener announced the news in a Facebook post Sunday, identifying the facility as the community’s nursing home," the Bowling Green Daily News reports.

The company said any employees who tested positive would not be allowed to return to work "without special and verified medical clearance," and residents whose cases become more severe will be transferred to hospitals as directed by their physicians.

Besides Morgantown, Columbia and Annville, Signature has Kentucky homes in Albany, Augusta, Bardstown, Beattyville, Bedford, Bowling Green, Brodhead, Calhoun, Calvert City, Carrollton, Danville, Elizabethtown, Georgetown, Glasgow, Harrodsburg, Hartford, Hodgenville, Horse Cave, Lawrenceburg, Lexington (three), Louisville (seven), Liberty, Owensboro (two), Pine Knot, Prestonsburg (two), Radcliff, Taylorsville, Tompkinsville and Winchester.

The Morgantown facility is rated "below average" for inspections and quality of care on the Nursing Home Compare site of the Centers for Medicare and Medicaid Services, but above average for staffing. The Columbia facility is rated average on inspections and staffing but "much below average" for quality of care ("below average" for those staying a short time). The Annville facility is rated much below average on inspections, below average on quality of care and average on staffing.

In the three years ending in mid-2019, the Morgantown facility had three serious deficiences and 33 overall deficiencies, tying for the 22nd most deficiencies in the state during that period, according to a compilation by ProPublica, a national investigative reporting newsroom.

As patient-safety penalties hit hospitals, expert wonders why they aren't improving more; could be eliminated by Obamacare repeal

This is the third year federal government will apply penalties to hospitals that fall short of patient safety standards, leading one Consumers Union leader to wonder why hospitals aren't working harder to eliminate the infections and complications that are causing them to loose money, Trudy Liberman writes in her column for the Rural Health News Service.

“What I am most frustrated about is the lack of urgency in the country and at the agencies for eliminating these infections," Lisa McGiffert, head of the Consumers Union Safe Patient Project, told Liberman. "They are aware of them, but there’s not a sense of urgency to stop them."

"The penalties, along with the entire program to eliminate hospital-acquired conditions, were authorized under the Affordable Care Act," Liberman writes. "They could be in jeopardy if the law is repealed. Some hospitals probably would be happy if they disappeared."

Penalties are levied against hospitals that have a high number of patients with avoidable infections and complications, including blood clots, urinary-tract and surgical-site infections, bed sores and falls. And this year, infections related to antibiotic-resistant infections, like methicillin-resistant Staphylococcus aureus (MRSA) and C. difficile, have been added to the list.

"The federal Agency for Healthcare Research and Quality says there were 3.8 million hospital injuries last year. That translates to 115 injuries per 1,000 patient stays," and "antibiotic-resistant bacteria infect some two million people annually. One quarter of a million cases occur in hospitals," Liberman notes.

Medicare will impose a 1 percent cut in payment to 769 U.S. hospitals who fell short of these patient safety standards in the fiscal year that ended Sept. 30. Eleven Kentucky hospitals were on the list, two more than last year, but five Kentucky hospitals that were penalized last year are not on this year's list.

Since the inception of the penalty program, Lieberman reports, 241 hospitals have been punished in all three years, but 347 that were penalized last year are not on the "bad-guy list."

Critical-access hospitals (by definition, rural) and specialized hospitals that treat psychiatric patients, veterans and children are exempt from the penalties.

"Larger teaching hospitals could lose as much as $1 million or more," Lieberman writes. McGiffert told her that the penalties have gotten the attention of hospital CEOs.

McGiffert said that as recently as 12 years ago, hospitals said infections were not preventable, but, “Now, most people in health care believe most infections are.” She also noted that government agencies have only recently started reporting hospital mistakes and other data to help patients.

McGiffert said patients should use the data to decide where they go for care when they have a choice. She suggested that they look for improvements from one year to the next, which could indicate that that particular hospital' emphasis on patient safety. She also encouraged patients to ask questions if the numbers show a hospital isn't performing as well as it has in the past.

Click here and follow the prompts to learn about Kentucky hospitals. You can compare three at a time. Click on the tab for "complications" to learn more about surgical complications and healthcare-associated infections in each of the facilities.

Lexington will host two health conferences in November: one on immunization, one on health-care associated infections

Lexington will host two health conferences in November, one focusing on immunizations and the other on health-care transparency and patient advocacy.

The 2016 Kentucky Immunization Conference, titled "Educate, Immunize, Protect: Kentucky's Immunization Trifecta," will be held Nov. 2-4 at the Embassy Suites in Lexington.

This conference will feature nationally known speakers who will discuss all areas of immunization from infants to adolescents to adults.

A keynote speaker for this event is Dr. Ari Brown, a pediatrician, childcare advocate and author of the bestselling "411" parenting books. Brown also serves as a medical advisor for Parents magazine and a spokeswoman for the American Academy of Pediatrics.

Another keynoter, Rayna DuBose, is a meningitis survivor who will share her story about overcoming adversity and talk about the importance of vaccination.

This conference is sponsored by the Kentucky Rural Health Association in collaboration with the Kentucky Immunization Program. The cost is $100 through Oct. 15, when it will increase to $150. Continuing education credits will be offered. Click here to register.

Health Watch USA Conference

The annual Health Watch USA Conference for Healthcare Transparency and Patient Advocacy will be held Nov. 4 at the Four Points Sheraton in Lexington. This year's conference is titled, "Full Disclosure and Healthcare Associated Infections."

This conference will focus on the impact and magnitude of adverse events in health care, the importance of creating cultures of safety, patient advocacy, medical device patient safety issues and healthcare associated infections.

Keynote speakers include Dr. Jim Bailey, a fellow in the American College of Physicians and professor of medicine and preventive medicine at the University of Tennessee Health Science Center in Memphis; Dr. Lars Aanning, a medical/surgical consultant; and Dr. Mark Davis, an operating-room safety consultant specializing in reducing injuries from sharps and exposure to blood.

The conference is paid for in part by a grant from the Foundation for a Healthy Kentucky. Click here or call 606-425-7278 to register. The cost to attend is $48. Continuing educations credits are offered.

Drug-resistant infections are a grave threat but are loosely monitored; Ky. health facilities must now report them electronically

By Melissa Patrick
Kentucky Health News

Antibiotic-resistant infections are considered one of the gravest threats to humanity, but such infections and the deaths they cause are not routinely reported, hindering the battle against them, Ryan McNeill, Deborah J. Nelson and Yasmeen Abutaleb report for the Reuters news service.

Reporting on their detailed investigation, they write: "Even when recorded, tens of thousands of deaths from drug-resistant infections – as well as many more infections that sicken but don’t kill people – go uncounted because federal and state agencies are doing a poor job of tracking them."

“You need to know how many people are dying of a disease,” Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy, a Washington-based health policy research organization, told Reuters. “For better or worse, that’s an indicator of how serious it is.”

The report noted many reasons such infections are omitted from death certificates, from poor training in how to fill out the forms to a reluctance of health-care facilities to mention them because "counting deaths is tantamount to documenting your own failures. By acknowledging such infections, hospitals and medical professionals risk potentially costly legal liability, loss of insurance reimbursements and public-relations damage."

The federal Centers for Disease Control and Prevention estimates that about 23,000 people die each year from 17 types of antibiotic-resistant infections and another 15,000 die from Clostridium difficile, a pathogen linked to long-term antibiotic use, but these numbers are "mostly guesswork" based on "few reported deaths from drug-resistant infection," Reuters reports.

Michael Craig, the CDC’s senior adviser for antibiotic resistance coordination and strategy, told Reuters that the agency settled on “an impressionist painting rather than something that is much more technical . . . because of our profound concern about the seriousness of the threat.” They said they are working to improve the estimates.

The numbers of uncounted deaths from drug-resistant infections “speak to what can happen when we don’t allocate the necessary resources to bolster … our public health safety network,” U.S. Sen. Sherrod Brown, D-Ohio, told Reuters. “When we see discrepancies in reporting, are unable to finance a workforce to monitor infections, and can’t even soundly estimate the number of Americans that die from [antibiotic-resistant infections] each year, we know we have a problem.”

Brown recently introduced a bill that would require the CDC to collect more and better data on superbug infections and death rates.

Wide variation in tracking

Reuters did a survey of the nation's health departments and found a wide variation in how seven leading superbug infections are reported, if they are at all.

It found that 17 states report C. difficile infections; 26 states report methicillin-resistant staphlycoccus aureus (MRSA); fewer than half report carbapenem-resistant Enterobacteriaceae (CRE), a family of pathogens that the CDC has deemed an “urgent threat;" and 24 states do not regularly track deaths due to antibiotic-resistant infections. "States that said they do track deaths generally do so for only a few types of drug-resistant infections, and not consistently," Reuters reports.

As of Oct. 1, a new regulation requires Kentucky health-care facilities to report a long list of drug-resistant infections to the Kentucky Department of Public Health electronically. The regulation also requires simultaneous data reporting to the CDC, and allows the agencies to share the data.

"This regulation on encouraging health-care facilities to report is extremely important to track these infections, to learn how to stop these infections and to identify problem areas in the state that need to be addressed," Dr. Kevin Kavanagh, an infection-control activist who leads the Somerset-based watchdog group Health Watch USA, said in a telephone interview with Kentucky Health News.

Kavanagh said proper reporting will allow examination of the methods health-care facilities use to fight these infections and determine whether they are effective or not. He called the matter a "huge, huge issue in nursing homes."

In the Reuters survey, U.S. health departments reported about 3,300 deaths from drug-resistant infections in 2003-2014, but the news service's own analysis of death certificates found 180,000 such deaths during the same time period. More than 20,000 were in California and more than 5,000 were in Tennessee, both states that do not require reporting of deaths linked to such infections.

Reuters found that Kentucky health departments only reported nine deaths related to health care acquired infections between 2003-2014, but Reuter's investigation found 3,027.

Patient-safety advocates petitioned the CDC in 2011 to add a question about hospital-acquired infections to its standard death certificate, which is used by many states, and have been told that it will be considered the next time the CDC revises its certificate.

Little progress made

Over-prescription of antibiotics and their overuse in farm animals has worsened antibiotic-resistant infections. Also, more people are living with weak immune systems and spending more time in health-care facilities, where most most of these infections occur.

Kavanagh said better reporting could indicate whether the overuse of antibiotics in agriculture plays a large part or a small part in the problem.

Reuters reports that in 2001, a task force led by the CDC, the Food and Drug Administration and the National Institutes of Health declared antibiotic-resistant infections to be a grave public health threat and issued an action plan to tame the problem. The plan included creating a national surveillance program and speeding the development of new antibiotics. But little progress has been made toward these goals.

A new national plan to combat this problem was introduced in 2014. Congress followed in 2015 with "a $160 million increase in the CDC’s budget to bolster research, drug development and surveillance of superbugs by the states," Reuters reports. But the news service found that states often come up against strong institutional resistance and laws that shield the health-care industry when it comes to surveillance.

Hospitals can learn from revealing account of the attack of a superbug; sequencing germ's DNA seems to be key

Dr. Tara Palmore, deputy hospital epidemiologist at the
National Institutes of Health Clinic Center, left, and Dr.
Julie Segre, a geneticist with the National Human
Genome Research Institute. Both were integral in
pinpointing the spread of a superbug at NIH.
Associated Press photo by Patrick Semansky.

A candid account of how a superbug was contained at one of the nation's leading research hospitals indicates that fast sequencing of a germ’s full DNA can make all the difference.

Over a six-month period, Klebsiella pneumonia, or KPC, a germ that cannot be treated by most antibiotics, sickened 18 people at the National Institutes of Health. Six of them died and another five, though they survived the effects of the germ, died from the disease that originally brought them to the facility.

Infections at health-care facilities kill about 100,000 Americans each year. But, fearful of lawsuits, hospitals generally don’t reveal to the public when infections outfox control measures, reports Lauran Neergaard for The Associated Press. That changed this week when government researchers published the story of what happened at NIH.

Dr. Julie Segre, a senior investigator at NIH’s National Human Genome Research Institute, was in charge of the “genetic sleuthing that found the bug hiding in sink drains and, most chilling, even in a ventilator that had been cleaned with bleach,” Neergaard reports. A multidrug-resistant strain of Klepsiella bacteria has emerged that spreads easily between patients who are very ill, and it kills half of whomever it sickens.

On June 13, 2011, a research nurse checked the medical records of a study participant who was being transferred from a New York City hospital and was critically ill with a rare lung disease. She found the patient had KPC, prompting the hospital to put her in strict isolation. “Everyone entering her room donned a protective gown and gloves and rigorously washed their hands,” Neergaard reports. “Her medical equipment got special decontamination. All other patients in the intensive care unit had their throats and groins tested regularly to see if the bug was spreading.” All seemed to be clear and the woman was sent home two days later.

But three weeks later, a patient with cancer was found to have KPC, though he was never in the presence of the first patient. Ten days later, a woman with an immune disease also got sick with KPC. Both died from the infection.

Researchers wondered if the cases were related or if the patients were arriving already infected with KPC. Segre turned to DNA for answers. "As bacteria multiply, mistakes appear and are repaired in their genetic codes," Neergaard reports. "Sequencing that genome allowed Segre to follow differences in single genetic letters like a trail of the germ’s transmission and evolution." Using this method, Segre discovered the KPC appearing at NIH was the same strain that came from the New York patient. "Testing bacteria from the 17 additional patients who ultimately caught it shows the KPC was transmitted three separate times from Patient No. 1 and then spread more widely," Neergaard reports.

NIH completely overhauled its decontamination practices, but the bacteria continued to spread. By November, the bacteria appeared in two patients who were not even in intensive care. Finally, the hospital built a new isolation room and all 200-plus patients in the hospital were subject to rectal testing.

The contamination is now contained, but the account of it is giving pause to infection-control specialists around the country. “Absolutely this could happen in any hospital,” said Dr. Deverick Anderson, co-director of a Duke University infection control network. (Read more)

Revealing patient safety issues and medical errors are goals of Facebook page set up by ProPublica

Photo by iStockphoto.com/selimaksan

Interested in creating a venue for those who have been harmed while undergoing medical treatments, ProPublica, the nonprofit, investigative news organization, has set up a Facebook page on the issue.

"Group members have already shared stories of personal disability or the death of a loved one due to surgical mistakes, becoming infected with deadly drug-resistant bacteria and dental mishaps — including cases they claim were not properly addressed by health care providers," Daniel Victor and Marshall Allen report. The page will be moderated by Victor and Olga Pierce.

The page is also open to doctors, nurses, regulators, health-care executives and others interested in discussing medical errors, their causes and solutions. Question-and-answer sessions with experts will be posted, along with links to the latest reports and policy proposals. (Read more)

UK Hospital gets below average marks on patient satisfaction, infections; data on your local hospital are available online

Despite $900 million being invested in expanding the University of Kentucky Chandler Hospital, its patients at do not seem all that happy with the care they receive there.

In an op-ed piece in the Lexington Herald-Leader, Dr. Kevin Kavanagh of Somerset highlights the results of a survey on patients' hospital experiences. That survey ranked UK's hospital below state and national averages in nine of 10 measures. "Especially disturbing, only 66 percent said they would definitely recommend the institution, and only 56 percent stated their room and bathroom were 'always clean'," writes Kavanagh, chairman of Health Watch USA.

The UK hospital also did not fare well when it came to its assessment by the Centers for Medicare and Medicaid Services on hospital-acquired conditions. "UK had the highest reported rate of deadly vascular catheter infections in the state," Kavanagh writes. "UK also had an unacceptably high rate of falls and deep bed ulcers. These latter conditions should be zero."

Kavanagh concluded, "If there are quality problems at UK, it is of paramount importance that they are corrected since not only current patients are at risk but also the quality of the training experience of our future clinicians, which can affect care for years to come." (Read more)

Newspapers can access information about their area hospitals by clicking here. Viewers can choose up to three hospitals and see how they compare to one another in categories like: how well nurses communicate with patients; how quiet the areas around patients are; if patients would recommend the hospital; and if patients always received help as soon as it was wanted.

Newspapers can also see the results of the CMS assessment on hospital-acquired conditions for their area hospitals by clicking here and downloading the Hospital-Acquired Condition Rates zip file (scroll down to Kentucky hospitals). The file contains data on eight hospital-acquired conditions reported between Oct. 1, 2008 and June 30, 2010. Among the conditions reported are air embolism; blood incompatibility; catheter-associated infections; falls and trauma; foreign objects left in the body after surgery; pressure ulcers; uncontrolled blood sugar levels; and urinary tract infections.

CDC hands out $49 million in public health grants; Kentucky gets more than $800k

The Centers for Disease Control and Prevention have issued $49 million in grants to improve public health, $815,000 of which is earmarked for Kentucky.

The Kentucky Cabinet for Health and Family Services will use the funds to expand its epidemiology, lab and health information systems and to detect and prevent healthcare associated infections. Each year, about 100,000 people die nationwide because of these infections, which are often acquired in hospital settings. The funds are meant to help states coordinate HAI prevention, implement multi-facility prevention efforts, improve monitoring of antimicrobial use and enhance electronic reporting.

Every state in the country will receive a portion of the $49 million pot, which is double the size that was handed out in 2010. "This funding will be used to create jobs, enabling the hiring and training of epidemiologists, laboratory scientists and health information specialists in the field of infectious diseases," said Thomas Frieden, director at the CDC. "These grants will also make it easier for health departments to better manage and exchange important information." (Read more)

Kentucky needs system to track hospital infections, doctor says

Kentucky is in need of a single, accurate system that tracks hospital-acquired infections in order to improve health care and receive state and federal funding, an op-ed piece in The Courier-Journal contends. (Hospitals call these "healthcare-associated infections," keeping the HAI acronym but spreading the blame. --Editor)

"The need for accurate data cannot be overstated," writes Dr. Kevin Kavanagh of Somerset. "Data on infections is vital to address epidemics, to direct research, to develop antibiotics and for the state to receive grants and devise prevention protocols."

But Kentucky's reporting system is "duplicative and broken," Kavanagh contends, with no standardized system. "Facilities can make the same report to the Centers for Disease Control and Prevention, the [state] health department and to the hospital's Patient Safety Organization," he said. Though HAIs should be reported in Kentucky, only four outbreaks were conveyed by hospitals last year. "As of December, the definition of an 'outbreak' was not agreed upon, which makes data collection and grant funding difficult," Kavanagh writes.

To combat the problem, 22 states are using The National Healthcare Safety Network run for free by the CDC to collect their data, which Kavanagh advises. He also encourages transparency and commended Norton Healthcare for posting information about treatment of catheter- and ventilator-associated infections. Because of this transparency, the provider received an award from the National Quality Forum. But "the problem of hospital-acquired infections and conditions is too big, too important and has gone on far too long to depend solely upon hospitals to correct the problem," Kavanagh argues. (Read more)