The U.S. Food and Drug Administration Friday released a report of its observations from an inspection of the New England Compounding Center, the Framingham, Mass., facility tied to a nationwide fungal meningitis outbreak.
So far, 331 cases of fungal meningitis have been found in 18 states, including 25 deaths, according to the Centers for Disease Control and Prevention. The newest state to report an infection was South Carolina, and the latest death was reported in Tennessee. Seven other peripheral joint infections from injections given to joints such as the knees, hips, shoulders and elbows, have also been linked to the outbreak.
During an FDA inspection of the facility on Oct. 2, 2012, investigators found 83 vials out of a bin containing 321 vials of preservative-free methylprednisolone acetate -- the injectable steroid tied to the outbreak -- contained a "greenish black foreign matter." Another 17 vials in the same bin contained a "white filamentous material." Fifty of the vials were sent by the FDA to a lab and tested, and all 50 confirmed the presence of microbial growth.
While the firm's worksheets said raw materials it used to manufacture drugs were sterile, the investigation notes the firm used non-sterile active ingredients, with the exception of sterile water, to formulate its preservative-free methylprednisolone acetate injections. The New England Compounding Center also provided no evidence to support the effectiveness of its steam autoclave used to ensure sterile materials, the report found.
During an Oct. 4 investigation of the facility, the FDA found condensation and discoloration on the autoclave which had been used to sterilize the steroid injections as well as other drugs. That is the final sterilization step in the process for making these products, the FDA said.
Investigators also found a greenish yellow lining on the viewing lens of one of two autoclaves used to steam equipment. Condensation and discoloration was also observed on the other autoclave.
What's more, investigators found a parking area shared by a facility that recycles mattresses and plastics produced airborne dust particles 100 feet from the firm's HVAC system. Dark particulate along with white filamenteous substances were found covering the louvers of air conditioning behind the autoclave in the firm's middle room.
The CBS News Investigative team reported this week that there have been local complaints about the recycling center's smell and accumulation of debris outside the business. A large fire outside the recycling business in September 2009, captured in this YouTube video shows large clouds of black smoke billowing up from the back of the building that also held the compounding center.
During the course of its investigation, the FDA also observed different colored residues lining different weigh station hoods, which are used to weigh active ingredients and other raw materials used to make sterile drug preparations.
They also found issues in the firm's prep room, used to sterilize equipment before filling with drugs, including discoloration on surfaces and a leaky boiler and standing water approximately 30 feet from the entrance to the prep room. A mat at the entrance to the prep room was "brown and soiled."
The report also details "problems with NECC's ability to maintain its Clean Room" during the inspection. The clean room is an enclosed space that is designed and maintained to have a controlled environment with low humidity, proper temperature and low levels of airborne particles and surface contamination.
Besides finding bacteria and mold on multiple surfaces locations in the clean room, the investigation noted the air conditioning in the clean room was turned off from 8:00 p.m. to 5:30 a.m. nightly.
Having the air conditioning turned off nightly "is not a typical practice for a clean room," Steven Lynn, director of the Office of Manufacturing and Product Quality, Office of Compliance, Center for Drug Evaluation and Research at the FDA, said during the press conference.
There was also presence of a dark, hair-like discoloration in a transition room between the clean room and where products are filled.
The report also shows tests of surfaces taken by the New England Compounding Center itself. While the company's own tests of equipment as far back as January 2012 indicated samples of bacteria and "overgrowth" of mold -- think of a plant growing out of control, the FDA said -- the agency did not find documentation of corrective actions taken by NECC to address the contamination.
The FDA notes these observations only reflect a "snapshot in time" and its investigation is not final. Massachusetts state health officials announced earlier this week plans to revoke the firm's license.
The FDA's "483" form that details its investigation can be found on its web site.