**Lax controls at Scripps cited after infections \| Inspectors say La
Jolla hospital failed to stop exposure to fungus**

The San Diego Union - Tribune; San Diego, Calif.; Mar 29, 2000; Cheryl
Clark;\
\
**Abstract:**\
Seriously ill patients at Scripps Memorial Hospital were exposed to a
potentially lethal fungus because of lax infection controls at the La
Jolla facility, according to state health investigators.\
\
In a 19-page report, the investigators declared the hospital \"failed to
prevent and control aspergillus cases during construction\" and \"failed
to maintain a sanitary environment\" to prevent and control sources of
contamination \"that may have contributed to the increased incidence of
aspergillosis cases.\"\
\
During extensive remodeling at the hospital over a recent three- month
period, inspectors said, 16 patients were found to have the fungus. Six
of the patients died at the hospital. An autopsy, performed on only one,
discovered \"severe aspergillus bronchopneumonia of both lungs.\"

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  **Full Text: Copyright SAN DIEGO UNION TRIBUNE PUBLISHING COMPANY Mar 29, 2000**
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Seriously ill patients at Scripps Memorial Hospital were exposed to a
potentially lethal fungus because of lax infection controls at the La
Jolla facility, according to state health investigators.

In a 19-page report, the investigators declared the hospital \"failed to
prevent and control aspergillus cases during construction\" and \"failed
to maintain a sanitary environment\" to prevent and control sources of
contamination \"that may have contributed to the increased incidence of
aspergillosis cases.\"

During extensive remodeling at the hospital over a recent three- month
period, inspectors said, 16 patients were found to have the fungus. Six
of the patients died at the hospital. An autopsy, performed on only one,
discovered \"severe aspergillus bronchopneumonia of both lungs.\"

\"Without an in-depth medical record review, it could not be determined
if aspergillosis was the primary or contributing cause of death for the
five other deaths,\" the state investigators reported.

Aspergillus is an airborne mold or fungus that is common in the
environment. It is found in decaying vegetation, insulating material and
walls or ceilings, and can be released in dusty environments, especially
during construction.

It is harmless to healthy humans, but when inhaled by people with
weakened immune systems or who are severely ill, it can cause lethal
disease in the lung or other organs.

The Division of Licensing and Certification, a branch of the state
Department of Health Services, compiled its statement of deficiencies
after Scripps officials on Jan. 28 reported a cluster of aspergillosis
cases at the 450-bed acute care hospital.

A team of state inspectors, on behalf of the federal government, spent a
week inside the hospital and detailed numerous infection- control
regulations the hospital failed to meet.

Such inspections are required by state and federal law, and if
corrections are not swiftly made, the hospital\'s ability to receive
reimbursement for Medicare and Medi-Cal patients could be at risk. The
state\'s findings were released along with the hospital\'s plan of
correction.

Scripps\' chief medical officer, Dr. Brent Eastman, yesterday disputed
many of the conclusions in the state report, saying most of the cases
were patients who brought the fungus with them when they were admitted
rather than acquiring the mold inside the hospital. He said that was the
case with the one patient who died. The patient\'s name has not been
released.

Eastman said that all cases mentioned in the state\'s report involved
extremely elderly and sick patients, and those who died did so because
of underlying illness.

Added Chris Van Gorder, Scripps\' chief of health care operations, \"The
hospital has been clean and is always clean, and, frankly, now it\'s
cleaner than it\'s ever been before.\" The hospital notified the state
\"the minute we found we had an increase\" in aspergillosis cases, he
said.

State officials said they reviewed numerous patient records and hospital
reports and discovered 20 patients with sputum cultures positive for
aspergillus exposure between Oct. 28 and Jan. 28. Of those, the state
says only four were determined to have been acquired before the patient
was admitted to the hospital.

For the remaining 16, the first positive sputum culture occurred three
or more days following admission, according to state investigators. Of
the 16, 12 were in the intensive care unit before the first positive
culture and 10 were in the surgical intensive care unit, the state
maintains.

Six of those 16 patients died at the hospital, many perhaps from their
underlying illness.

One common denominator among those who died was that they had been in
Rooms 701 to 723 before the first positive sputum culture, according to
the report.

Chris Cahill, a state infection-control inspector who routinely
investigates hospital outbreaks, said such incidents occur only about
three or four times a year in California. Often, as mysteriously as they
arise, they disappear.

State officials said they discovered many of the problems while the
Scripps La Jolla hospital was engaged in construction and remodeling
projects, and which may have led to the aspergillosis cluster.

Investigators surveying the intensive care unit in early February found
surfaces, including windows, bed frames, emergency resuscitation
equipment and shelves that \"were heavily coated with a layer of white
dust.\"

\"The intensive care unit had white powdery and dusty surfaces
throughout on medical equipment, equipment holders, curtains/drapes,
beds, counters and windowsills. Patient rooms that were \`ready\' to
receive a patient were noted to be dusty,\" the report said. \"The dusty
surfaces were in patients\' rooms, hallways, nurses station and
medication/treatment rooms.

\"On Feb. 1, it was determined that construction was in progress on the
first floor without the use of airtight barriers or HEPA filter
vacuuming to prevent dust and debris contamination.\"

State officials also detailed a problem area between a fire door leading
to the windy helicopter pad and the surgical intensive care unit.

\"This pad was used two to three times a day to deliver trauma patients
to the emergency room and generated large amounts of dust and debris
that could blow into the ICU area through the fire door and open
windows,\" said the report.

And, the report continued, about 500 yards away, \"heavy excavation and
construction was in progress.\"

\"These factors were not investigated by the infection control
practitioner or the hospital epidemiologist to determine what
relationship, if any, these environmental factors influenced the
increased incidence of nosocomial (hospital-acquired) aspergillus
cases,\" the report said.

The state report also concluded that Scripps infection-control officials
neglected to discuss the outbreak officially among themselves until Jan.
20, several weeks after the cluster had become apparent, and neglected
to report the cases to the state until Jan. 28. State regulations
require that such incidents be reported.

The report faulted the hospital for not having an infection- control
official on the construction crew, which would have enabled officials to
monitor areas for construction-related debris that could contain
infectious quantities of mold.

That, said state inspector Cahill, may be the most serious of Scripps\'
deficiencies.

\"They failed to follow their own policies and procedures,\" she said.
If the infection-control official had been present, \"she could have
instructed workers about proper barriers that should have been made when
they have to get into the ceiling or do construction.\"

Scripps officials said they have taken steps to correct every deficiency
mentioned in the state report. And, they emphasized, for whatever
reason, no cases of aspergillosis have been noticed since the end of
January.

Unfortunately, Cahill said, much about the aspergillosis cases may never
be understood.

\"Obviously they had some problem someplace, but what the problem was we
will never, ever know. All we can do is take the appropriate precautions
to make sure people doing construction are doing their job to make sure
infection-control procedures are followed.\"

Credit: STAFF WRITER