Hospital Infection

Fairfax Injury Lawyer Brien Roche Addresses Hospital Infection Cases

Brien Roche

Infection, according to the 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  it is necessary to identify the type and origin of the pathogen, identify the mode by which that pathogen is typically transmitted, determine whether the providers took adequate precautions to prevent the presence and transmission of the pathogen and then finally determine whether the provider recognized the infection and treated it properly.

Hospital Infection Prevention Procedures

A study based in Michigan involving 108 different intensive care units determined that the occurence of catheter-related blood stream infections was reduced to zero as a result of five procedures being 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 unnecessary catheters.  What this study exemplifies is that where proper procedures are implemented infection can be controlled.

Many physicians take a somewhat lackadaisical approach to the risk of post surgical infection.This can be seen in the failure to administer preoperative antibiotics, failure to administer proper postoperative antibiotics and improper discharge of a patient with a draining wound.

Where an infection has been identified questions frequently arise as to whether the providers reacted to it properly by having laboratory cultures obtained and reporting and securing prompt involvement of infectious disease experts.

Hospital infection is fairly common. The fact is that hospitals can be dangerous places. This likewise applies that doctors’ offices, clinics and other health care settings. A particular type of bacteria that has been found to be on the rise in these environments is called Clostridium difficile also known as C. diff. The infection can cause chronic diarrhea, abdominal pain and intestinal inflammation.

Antibiotic Resistant Infections

The people most at risk are those who are in a hospital setting that are being treated with antibiotics. Antibiotics not only kill the harmful bacteria but they also destroy protective bacteria that exist within our system. This allows the C. diff to gain a foothold.

A Washington Post article of December 17, 2013 addressed this issue.

This particular bacterium has been evolving into an increasingly aggressive strain that can resist drug treatment.

Within our intestinal system there are a multitude of different types of bacterium, many of which are helpful and necessary in order to properly digest food. The growth of these types of bacteria can be promoted by what are called probiotics. Probiotics consist of such things as yogurt which promote the growth of this helpful bacteria.

Doctors believe that our increasingly sterile environment may be actually weakening our ability to develop 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 and proved to be antibiotic resistant resulting in at least six deaths that are directly attributable to the bacteria. This particular bacteria has a mortality rate of up to 50 percent. Such hospital acquired

An issue has also arisen as to whether or not NIH should have disclosed to patients and also to local authorities the presence of this superbug. This is especially true with an institution like NIH which deals only with the sickest of the sick.

At this point, a number of states have passed laws requiring that hospitals report hospital borne infections so that at least 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 known as colistin.

According to a Washington Post article of August 25, 2012 colistin was discovered in Japan in 1949. It was quickly identified as being a rather dangerous drug because it causes kidney damage.

The ominous aspect of what happened at NIH is that the Centers for Disease Control and Prevention, a federal agency, reported 10 years ago that there were 1.7 million annual hospital borne infections in the U.S. which caused nearly 100,000 deaths.

The large pharmaceutical companies have retreated from the field of inventing new antibiotics because there is not that much money in it compared to other drugs. Inventing new antibiotics is extremely challenging and the FDA has made it extremely difficult for these companies to get new antibiotics approved. In fact, in this same Washington Post article, it is reported that between 1945 and 1968 drug companies brought 13 new categories of antibiotics onto the market but between 1968 and 2012 there are only two new categories of antibiotics that have been brought to the market.

Congress has endeavored to create some incentive for the large pharmaceutical companies to come back into the antibiotic field granting an additional five years of market exclusivity to antibiotics drugs. What this means is that there would be no competition from generics for companies that invent new antibiotics.

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

1. Bloodstream infections contracted within 48 hours after having a central line placed are almost always due to the central line.

2. Surgical site infections that occur at or near the incision site within 30 days of the procedure or within one year if an implant is left in place can be dramatically reduced through the timely administration of prophylactic antibiotics, avoiding hair removal at the surgical site unless absolutely necessary, and if the surgery is heart surgery then managing the glucose levels during the immediate post-operative care. As to the administration of antibiotics, typically these must be administered within one hour before the incision and should be documented in the chart.

3. Infections of the lungs that develop within 48 hours after a patient begins receiving mechanical ventilation through endotracheal or tracheostomy tubes can also be prevented. Simple procedures such as maintaining the head of the bed in a semi-upright position for the patient assuming the medical condition otherwise allows such. Weaning the patient off continuous sedation in order to better evaluate the patients ability to breathe independently and to hasten extubation can also be helpful. In addition the hospital staff need to observe good hand hygiene, provide the patient with antiseptic oral care, aspirate the patients airway continuously and insure that the respiratory equipment is disinfected, sterilized, and properly maintained.

In pursuing a claim under any such circumstances as these it is necessary to obtain the hospitals rules regarding the prevention of hospital acquired infections which are required by the Joint Commission and then further to determine what system that hospital used to support these criteria and how that is documented.

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

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Hospital Infection

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