Infection Malpractice

Brien Roche

Infection, according to The Center for Disease Control, is the cause of upwards of 100,000 deaths per year in hospitals.  In looking at an infection case from a medical malpractice point of view  there are many things to do. You must identify the type and origin of the pathogen. You must be able to state the mode by which it moves. Were required steps taken to prevent the growth and movement of the bug. Finally did the doctor see and treat the problem.

Infection Malpractice Prevention Procedures

A study based in Michigan of 108 intensive care units found that catheter related blood stream infections could be decreased to zero. Five procedures were implemented. Those procedures were hand washing, using full barrier precautions during insertion of central nervous catheters, cleaning skin with chlorhexidine, avoiding femur site if possible and removing catheters that were not needed.  Where these techniques are used infection is controlled.

Many doctors take a somewhat laid back approach to the risk of post-surgical infection. This is seen in the failure to give preoperative antibiotics. It is also seen in the failure to give proper postoperative antibiotics. Finally it is seen in improper discharge of a patient with a draining wound.

Where an infection is seen questions should be asked. Did the providers react to it properly. Were cultures ordered along with an infectious disease consult. Call, or contact us for a free consult.

Health Care Can Be Dangerous

Hospital infection is common. The fact is that hospitals are dangerous places. This likewise applies to doctors’ offices, clinics and other health care settings. A bacteria that is on the rise in these places is called clostridium difficile. It is also known as C. diff. This bacteria causes chronic diarrhea, abdominal pain and intestinal inflammation.

Antibiotic Resistant Infections

The people most at risk are those in a hospital setting that are being treated with antibiotics. Antibiotics kill the harmful bacteria. They also destroy good bacteria. This allows the C. diff to gain a foothold.

This bacterium is evolving into an ever aggressive strain that resist drug treatment.

Within our intestinal system there are a multitude of bacterium. Some of these are needed to digest food. The growth of these is promoted by what are called probiotics. These consist of such things as yogurt. Yogurt promotes the growth of helpful bacteria.

Doctors believe that our sterile environment weakens our ability to produce these helpful bacteria.

Infection Cases Constituting Medical Malpractice

In August of 2012 the National Institute of Health disclosed through a journal article that the bacteria known as Klebsiella pneumoniae had run unchecked through their hospital in Bethesda, Maryland. It resisted antibiotics. It caused at least six deaths. This bacteria has a mortality rate of up to 50 percent.

A number of states have laws that require hospitals to report such infections. That way there is a public record of the presence of these superbugs.

When the doctors at NIH were stumped on how to deal with this new strain of bacteria they turned to an old but dangerous drug:  colistin.

According to a Washington Post article of August 25, 2012 colistin was discovered in Japan in 1949. It is dangerous because it causes kidney damage.

Drug Makers Withdrawing

The large drug makers have withdrawn from the field of coming up with new antibiotics. There is not that much money in it. At least when compared with other drugs. The FDA has made it tough for drug makers to get new antibiotics approved. Between 1945 and 1968 drug makers brought 13 new categories of other drugs onto the market. During this same time there were only two new categories of antibiotics brought to market.

Congress has tried to create some incentives. An additional five years of market exclusivity has been granted for antibiotic drugs. In other words this means there would be no challenge from generics. Call, or contact us for a free consult.

Deadly Hospital Bugs

Three types of hospital acquired infections that can cause devastating injury, yet are preventable, are:

1. Bloodstream infections contracted within 48 hours after a central line is placed.

2. Surgical site infections that occur at or near the incision site within 30 days or within one year if an implant is left in place. What is required is the use of preventive antibiotics. In addition hair removal should be avoided unless needed. Finally if the surgery is heart surgery then the glucose levels must be managed during the immediate post-op care. Antibiotics should be given within one hour before the incision.

3. Infections of the lungs that develop within 48 hours after ventilation through endotracheal or tracheostomy tubes. Simple things that can be done are keeping the head of the bed in a semi upright tilt if the condition allows such. In addition weaning the patient off sedation in order to better judge the patient’s breathing. Hastening extubation can also be helpful. In addition the hospital staff need to observe good hand hygiene. The patient should be given antiseptic oral care. The airway should be aspirated continuously. Finally the equipment must be cleaned and maintained.

Hospital Rules

You should obtain the hospital’s rules as to prevention of hospital acquired infections. Such rules are required by the Joint Commission. You should learn what system that hospital uses to support these rules. Also how that is documented.

Infection cases from the medical malpractice point of view are tough. The defense will contend that everything may have been done right but the infection may still have taken hold. The plaintiff’s retort is the defendant’s conduct increased the chance of infection. That is the probable cause of this infection. This has some appeal to a jury. The role of the health care provider is to not unnecessarily expose the patient to such risk.

Infections Can Be Good

In 1989 17,414 British school children were studied by an epidemiologist. He concluded that those who had grown up with more siblings, thereby presumably more germs, were less likely to have allergies and eczema.

It is well-known that our immune systems need bacteria. Through exposure to these infections early in life, the immune system learns what is harmful. Also it learns what is not harmful. As a result it produces antibodies to fight the bad bugs that enter the body. Call, or contact us for a free consult.

“Clean” May Not Always Be Good

The rise of asthma and diseases of inflammation over the last 50 years suggest that our focus on “clean” may be hurting the fight against so-called “bad germs”.

Studies suggest that growing up on a farm can protect children from allergies and other immune system problems. However these studies admit that it is tough to know whether it is the farm that is having the good effect or other factors.

A 2012 study did indicate that children that grow up on farms had significantly lower rates of asthma, hay fever and eczema.

Rich Man’s Disease

One of the diseases that had been a big threat to children was Polio.  Polio is, at least in part, what is called a fecal-oral virus.  That is, feces somehow enters the body. In most cases this through poor bathroom hygiene. They enter the central nervous system resulting in either paralysis, respiratory problems or death.

Polio was referred to as the “rich man’s disease”. This is because the lower classes may have had poor bathroom hygiene. However their bodies quickly adapted to the polio bug. They produced antibodies to fight it.  In contrast the upper classes did not produce these antibodies. As a result, when someone within the upper social strata used poor bathroom hygiene fecal material entered the body. It had deadly results.  It is thought that may have been the origin of Franklin Roosevelt’s polio.  He was a member of the upper class. His class was thought not to produce the antibodies to fight off the polio virus.

Our current focus on “clean” is not to be shunned. It needs to be tempered with the thought that an antibiotic is not needed for every infection. Sometimes a little bit of dirt may be a good thing.  To some extent this can be included in diet. Yogurt which is filled with bacteria and is a probiotic has a helpful effect of replacing bacteria in the intestines. This is needed after bacteria has been destroyed through the use of antibiotics.  When you take an antibiotic, that antibiotic kills not only the bacteria that is causing the infection, but also other bacteria in your system.

Infection Malpractice-Sepsis

Sepsis develops when chemicals are released into the bloodstream to fight off an infection. They set off inflammatory responses throughout the body.  As a result there may be damage and organ failure. That can be fatal. The most common infections that set off the process are pneumonia and infections in the urinary tract, skin or gut.

There is no specific test for sepsis.  The symptoms can vary.  That means that it often is not seen by the doctor. Muhammad Ali and Jim Henson both died of sepsis.  Although that has brought some focus to the problem, much is still not known.

Infection Malpractice-Knowing the Signs of Sepsis

According to MedStar Georgetown MD approximately 1.7 million adults develop sepsis each year in the U.S. This leads to an estimated 270,000 deaths.

You’ve undoubtedly heard the term “sepsis”. But do you really know what it is?

According to Brendan Furlong, MD, Chief of the Emergency Department at MedStar Georgetown University Hospital, the definition of sepsis is evolving. It’s best thought of as your body’s reaction to infections.  Your immune system releases chemicals into your blood to protect you against bacteria, viruses and other infections.  When this fails, your body can become overwhelmed by your immune system’s response. This can damage your tissues and organs.  Sepsis can also lead to death.

Even seemingly ordinary infections like urinary tract infections and the flu can lead to sepsis.  Different factors such as the type of organism, the amount of time it has been in your body and the state of your general health each play a factor in whether your infection will lead to sepsis.  Also the people at highest risk of sepsis are those either under 12 months or over 65 years old, people with weakened immune systems or those with chronic health conditions.

Signs & Symptoms

Hospital procedures can also put your body into the position where sepsis can become a possibility.  Having a medical device implanted into your body can increase the risk of local and/or bloodstream infections.  Here are the symptoms and signs of sepsis that Dr. Furlong of MedStar says to be aware of:

• General weakness, body aches and/or shaking chills;
• confusion, sleepiness and/or a lack of alertness;
• a temperature greater than 101° or less than 96.8°;
• elevated heart rate;
• difficulty breathing or breathing unusually fast or slow;
• any symptoms associated with the inciting infection.

Also according to Dr. Furlong, sepsis is a condition that should be treated immediately.  Treatment can include IV fluids and antibiotic, antiviral or antifungal medications.  Other treatment including breathing tube, dialysis, blood transfusions or medication to treat dropping blood pressure can also be necessary. Also at times surgery is necessary to remove the direct source of the infection.

Lowering the Risks

Dr. Furlong recommends these ways to lower your risk of sepsis:

• Taking good care of chronic health issues;
• getting all your recommended vaccines;
• washing your hands thoroughly and often and keeping cuts and abrasions clean;
• if you have or suspect an infection and feel the above signs or symptoms, immediately go to an Emergency Room.  Don’t hesitate to mention that you’re concerned you may have sepsis.

Infection Malpractice-Urinary

Urinary infections are the most common of all bacterial infections.  As many as 80% of women will get at least one such infection.  They can be caused by sexual activity, the use of certain spermicides, the use of diaphragms, the use of catheters and the presence of diabetes.

After age 50, men tend to get urinary infections at about the same rate as women.  It is the E. coli bacteria that is most often the culprit.

Symptoms may include a strong urge to urinate, pain during urination or cloudy or bloody urine.

Preventing Urinary Infections

A tactic to employ in order to prevent these is to drink plenty of water to flush the bacteria out. Another measure is to urinate when the urge arises.  Do not try to hold it in.  Getting the urine out of your system is good.  Finally urinating after sexual activity can likewise help flush out any bacteria that might have entered during sex.

If you think you have been injured by the medical malpractice of a health care provider in regards to an infection issue, contact us.
Also for more information about infectious diseases see the site maintained by the Center for Disease Control.
In addition for more information on infections see the pages on Wikipedia.