All of St. Joseph's fungal meningitis patients received steroid injections at Michigan Pain Specialists in Brighton, a physician-owned pain clinic roughly 26 miles from the hospital. Michigan Pain Specialists was one of four clinics in Michigan to receive contaminated shipments of steroids, Casalou said, and the lot that arrived in the Brighton area seems to have been more highly contaminated than others.
“The clinic received one of the 'hot lots,' ” Casalou said, using a term that has been used to describe lots of the drug that have been linked to large numbers of infections. “Some of the lots had higher concentrations than others.”
About 620 patients received a total of about 750 contaminated steroid injections at Michigan Pain Specialists, according to figures cited by the hospital.
In the first week of October, just after Tennessee health officials first reported a cluster of fungal meningitis cases, St. Joseph began to identify patients with the disease, said Dr. Lakshmi Halasymani, the hospital's chief medical officer.
As the hospital quickly became known as one of the few that had some degree of familiarity with the infection, St. Joseph officials decided to gather and treat all affected patients from the region at their facility.
“It became clear very early on that this population was going to need very consistent care delivery and care management,” Halasymani said. “We're dealing with a period of real clinical uncertainty, and it helped to have a centralized approach.”
As part of becoming the region's go-to facility for the outbreak, St. Joseph initiated its emergency preparedness plan, which allowed it to increase staffing levels and more easily coordinate with other hospitals in the region, Casalou said. The incident command center has now been operational for nearly two months. “Disasters usually have a defined time period, and we quickly realized we were going from a sprint to marathon,” he added.
In the rush to prepare the hospital for the influx of serious, high-acuity patients, St. Joseph's opened 16 additional beds that were at the time licensed but offline. Those beds were opened in less than a week, Casalou said.
Trinity Health, St. Joseph's parent health system, stepped in, too. The Livonia, Mich.-based system sent nurses from multiple locations, including its hospitals in Pontiac, Mich., and Columbus, Ohio.
State officials granted licenses to out-of-state nurses in just 24 hours, Casalou said. They also approved an emergency certificate of need for an additional MRI machine and granted a license request for another operating room in just one day.
To ensure treatments that were deemed effective were put into practice right away, Trinity helped to build order sets for the health system's electronic health record that corresponded with protocols identified by St. Joseph clinicians and by the Centers for Disease Control and Prevention, said Dr. Donald Bignotti, Trinity Health's senior vice president and CMO. “We now have evidence-based treatments,” he said.
Trinity also added clinical decision-support alerts into the EHR that help physicians identify which patients are at risk of fungal meningitis.