DAYTONA BEACH -- Halifax Health Medical Center lacked the policies and procedures needed to combat an outbreak of a potentially deadly hospital-acquired infection, state inspectors concluded after an unannounced visit in June.
A string of infections from July 2010 through May of this year caused by drug-resistant bacteria triggered an investigation by the Florida Agency for Health Care Administration, the department responsible for ensuring providers are in compliance with state and federal regulations.
Halifax Health officials say they are working diligently to address the issue and disputed some of the report's findings.
"From our standpoint, there was no great outbreak," said Ann Martorano, the hospital's chief marketing officer. "It wasn't anything that we couldn't handle. It was more of a documentation issue."
All of the steps Halifax Health outlined to inspectors to resolve concerns "have been approved and accepted," Martorano said.
State inspectors will conduct a follow-up visit to ensure Halifax Health's corrective actions have been implemented, said Shelisha Coleman, a spokeswoman for the Agency for Health Care Administration.
While the state investigation has been closed, it's possible a broader federal investigation could be launched, Coleman said. If federal deficiencies are noted, Halifax Health could be fined or face other sanctions.
Coleman said she could neither confirm nor deny whether Halifax Health will face a federal investigation.
Hospitals nationwide are working to control infection rates. The Centers for Disease Control and Prevention estimate 1.7 million health-care associated infections contribute or cause the deaths of nearly 100,000 people every year.
The bacteria in question can be problematic because infections can be extremely hard to treat and cause or contribute to the deaths of ill patients.
Inspectors wrote in a June 27 report Halifax Health Medical Center was "without any infection control oversight from Jan. 26 to Feb. 21" of this year, a finding hospital officials say is not true. The hospital's chief medical officer was also noted by inspectors as saying there had been "a lack of effective leadership with the problem since 2010."
During that time, Halifax Health was trying to combat an outbreak of Acinetobacter baumannii, a bacteria that can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body. Twenty-one cases of Acinetobacter were reported in 2011 at Halifax Health Medical Center, along with 17 cases from January to May of this year, according to the inspection report.
The hospital's former director of infectious disease didn't find that the bacteria caused any deaths, according to the report.
Acinetobacter typically causes infections in intensive-care units, according to the CDC.
The bacteria's resistance to antibiotics makes it particularly problematic, said Dr. William Schaffner, who chairs the department of preventive medicine at the Vanderbilt University School of Medicine in Nashville, Tenn.
"In hospitals around the country, Acinetobacter infection can be a problem in intensive-care units," said Schaffner, who oversaw infection control at Vanderbilt University Medical Center for three decades. "It has been in my own institution, but we've licked it . . . You have to have absolutely obsessive attention to infection control to curtail the spread of these infections."
Dr. Louis Rice, an infectious disease specialist who chairs Brown University's medical school, said at many hospitals even one or two cases of drug-resistant Acinetobacter in a short span in the same ward are enough to trigger "very aggressive" infection control measures. At Halifax Health, eight cases of Acinetobacter were detected in January.
Infection control measures include culturing patients and staff for the bacteria and isolating infected patients, Rice said.
In an interview with inspectors, the hospital's risk manager said the former director of infectious disease "did not allow surveillance cultures to be taken on new admissions" and stated the hospital "did not have an outbreak of Acinetobacter baumannii," according to the report.
Efforts to reach Dr. Richard Duma, Halifax Health's former director of infectious disease, at his home were unsuccessful.
Stefany Strong, a spokeswoman for the Volusia County Health Department, declined to discuss her department's role containing the outbreak, citing a state statute that allows investigations of communicable disease outbreaks to be kept confidential.
Inspectors and hospital officials gave differing accounts of a transition period earlier this year in the infection control department.
The hospital did not renew the contract of Duma, Halifax Health's longtime director of infectious disease. Hospital officials say he decided to retire and left in May. State inspectors report he left earlier in late January or February.
Inspectors wrote that two other members of the infection control team resigned on Jan. 26, leaving the facility without infection control oversight for nearly a month. In late February, an offsite contractor was employed to handle infection control for Halifax Health, but it was determined at some point she was not performing her contracted duties, according to the report.
At that point, another company was employed to handle infection control, inspectors wrote.
Martorano said a certified infection preventionist was either employed or contracted at all times. One employee was recently hired to handle infection control in house, and hospital officials are in the process of filling another position, she said.
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