Failure to Report Norovirus Outbreak and Incomplete Legionella Water Management Program
Penalty
Summary
The facility failed to notify the Centers for Disease Control and Prevention (CDC) of an outbreak of Norovirus, as required by both facility policy and the Maine CDC Notifiable Diseases and Conditions List. The Infection Preventionist was responsible for reporting confirmed cases of state-specific reportable diseases, including any cluster or outbreak of illness with potential public health significance. Despite several residents exhibiting symptoms consistent with Norovirus, including nausea, vomiting, and diarrhea, the CDC was not notified at the time of the survey. The Director of Nursing confirmed that no testing for Norovirus had been conducted and that the CDC had not been contacted regarding the outbreak during the initial interviews. Additionally, the facility's Legionella Water Management Program was found to be incomplete. The program lacked evidence of established testing protocols, acceptable control measure ranges, documentation of testing results, and corrective actions for when control limits are not maintained. There was also no evidence that the effectiveness of the program was being validated through water testing for Legionella or other water-borne pathogens. These deficiencies were identified during a review of the program with facility leadership.