Six residents tested positive for strep

Six residents at Carson City's Evergreen Mountain View Health Care had positive lab cultures and symptoms consistent with Group A streptococcus infections, a state health official said Wednesday

Three of those individuals died and another four residents had similar symptoms, but did not have lab results to confirm the presence of an invasive Group A strep.

Those were the findings of a study concluded Tuesday following an outbreak between late November and Dec. 15, said State Epidemiologist Dr. Randall Todd.

The study was a joint effort between the Nevada State Health Division and the Centers for Disease Control and Prevention in Atlanta.

"We don't see any evidence after that date of additional or probable Group A strep," Todd said. "The facility was already implementing our recommendations and the fact they aren't seeing additional cases indicates they've been working to make things better. Apparently, they're succeeding."

Problems began at Mountain View on Dec. 9, when four patients died of a "flu-like" illness. In the days that followed, two were found to have Group A strep. The organism was also found in other Mountain View residents that were admitted to Carson-Tahoe Hospital, but officials have not determined whether flu or another viral infection was involved in the deaths.

"Influenza may have set up conditions so these residents were susceptible to strep," he said. "But without more lab evidence, it would be difficult to prove."

Two of the residents who died were embalmed before appropriate cultures could be taken. They had to be eliminated from the study. Only one of the remaining two tested positive for influenza, Todd said.

Group A streptococcus is a common bacterium found in the throat and on the skin. Most infections are relatively mild illnesses, like strep throat or impetigo. On rare occasions the bacteria can cause other severe diseases, especially in people with chronic illnesses like cancer and diabetes and in people on kidney dialysis.

To prevent outbreaks in the future, the Centers for Disease Control recommends:

n Improve respiratory related infection control.

"Staff and residents with respiratory illness must be separated," Todd said. "When that's not possible, masks should be available for people who are ill.

He said the facility also needs to provide more opportunities for staff and residents to wash their hands.

"They need to consider waterless hand gel containers on the wall between rooms," he said.

n Enhance illness surveillance.

"It's important to identify the illness as soon as possible so proper treatment can be initiated. A delay in rapid test results from the laboratory was identified as one of the barriers," Todd said. "The staff needs to know what they're dealing with sooner rather than later. With vulnerable populations, antiviral medications can reduce flu-related morbidity."

n Enhance vaccination.

"The proportion of residents and staff immunized was not that high prior to the outbreak," Todd said. "We know there was at least a possibility that a viral illness like flu was circulating."

n Enhancement of visitor screening.

"Introducing illness into a residential home can do a lot of harm," Todd said. "I think Mountain View needs to reiterate that more frequently, and make masks available."

Todd said the Centers for Disease Control will be doing more extensive studies on the charts and staff interviews, but he doesn't expect the results or recommendations to change.

"A lot was learned from the study. There are far-reaching implications," Todd said. "These are basic recommendations any facility should take to heart."

Contact Susie Vasquez at svasquez@nevadaappeal.com or 881-1212.