Report: Woodstock nursing home failed to control scabies outbreak

Valley Hi Nursing Home's lack of effective infection control procedures contributed to a scabies outbreak at the Woodstock facility, a state health inspection has determined.

The McHenry County-operated nursing home did not have a care plan for addressing several residents' skin rashes, according to an Illinois Department of Public Health report completed July 20. Residents with visible rashes were found in common areas of the facility rather than in isolation, and some employee statements suggest potential scabies cases began months before the outbreak was reported.

Those findings resulted in Valley Hi receiving a federal citation for infection control.

“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,” which resulted in the spread of a skin rash to 27 residents, the state report says.

Valley Hi Administrator Thomas Annarella said the management and staff are in the midst of drafting a more detailed protocol for handling such outbreaks, including training and treatment procedures. The nursing home must submit a plan of correction to the health department by Aug. 8 and correct deficiencies by Sept. 3. State health officials will then determine their next steps, such as whether to fine the nursing home.

“We had policies and procedures in place to address the infections,” Annarella said. “That policy needs to be broadened to include more specific language related to the rash.”

The outbreak

The scabies outbreak was first reported June 30 to the McHenry County Department of Health, which is also conducting an investigation. Administration Division Manager Joseph Gugle said five cases have been clinically confirmed as Norwegian, or crusted, scabies, a highly contagious infestation of the skin caused by the human itch mite.

Dozens of other residents and several staff members were reported to have rashes that have not been clinically diagnosed as scabies, though all rashes were treated as such, said Dawn Redner, Valley Hi director of nursing. Treatment, which continues for some, has been given to residents and staff members across the facility, she said.

“From the time that we had the confirmation, I believe with the medical director's help, we were on top of (the outbreak),” Annarella said, adding the nursing home followed Centers for Disease Control and Prevention guidelines.

But Larry Vincent, whose mother is a Valley Hi resident, said he doesn't believe the management responded appropriately. His mother had a skin rash in January that continued until she was officially diagnosed with scabies June 30, he said. And once the outbreak was confirmed, he said, he wasn't notified of his mother's treatment plan.

“I agree with everybody; let's clear it up first and then look for blame,” Vincent said. “But at the same time, how can (scabies) be very common in a nursing home and you don't have anything in place to correct it?”

Reviewing procedures

The McHenry health department did not receive any notification of skin rashes before June 30, Gugle said. State health code requires all nursing and immediate care facilities to report “all incidents of scabies and other skin infestations.”

The state report showed some instances in which residents may have had rashes before the outbreak was confirmed. A facility log titled “Scabies Line List,” for example, listed Oct. 19, 2015, as the onset date for one resident's rash.

Some staff members also reported noticing residents with rashes last year, according to the report, and an employee identified as the “director of nursing” said the facility treated a few residents for scabies before June 30.

Annarella said administrators and medical professionals began monitoring residents with rashes starting in February but “we were not aware of it as scabies” at the time.

After reviewing the chain of events, he said, officials now believe scabies were first brought into the facility in March. Annarella also said it's unlikely the disease was in the facility last year because “if you have an outbreak in October, by the time you reach July, it'd be a full house,” Annarella said.

County board member Chuck Wheeler, also on the Valley Hi operating board, said communication needs to be improved among the staff, management, medical professionals and board members, who were not immediately told of the outbreak.

“That concerned me, but that issue has been addressed, and it will not happen in the future,” he said. “Valley Hi is an excellent facility. ... This is just a minor blip, and I'm confident the management of Tom Annarella and his staff will do the right things to get us back on track.”