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.
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 to 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.
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.
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.
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.
Infection cases from the medical malpractice perspective are very difficult because the defense can present an impressive showing that the doctor or facility may have done everything right but the infection may still have taken hold. The plaintiff’s retort to that is the defendant’s conduct unnecessarily increased the patient’s exposure to infection and is the probable cause of this infection. This latter argument has some appeal to a jury in that the role of the health care provider is to not unnecessarily expose the patient to such risk.
In 1989 17,414 British school children were studied by an epidemiologist and he concluded from them that those who had grown up with more siblings and, thereby presumably more germs, were less likely to have allergies and eczema.
It is well-known to physicians and epidemiologists that our immune systems need bacteria and so-called “bugs”. Indeed many parts of our system function on bacteria; in particular the small intestines.
Through exposure to these types of antigens and infections early in life, the immune system learns what is harmful and what is not harmful and then can develop the necessary antibodies to fight any invading antigens that enter the body.
As reported in a Washington Post article of March 26, 2013, the prevalence of asthma and diseases of inflammation of the last 50 years suggest that our obsession with cleanliness may well be having an effect on the ability of all of us to fight off so-called “bad germs” or antigens.
As reported in the same Washington Post article there are studies that likewise suggest that growing up on a farm can protect children from allergies and other immune system-related conditions. These studies however acknowledge that it is difficult to determine whether or not it is the presence of the farm that is having the beneficial 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.
Historically one of the diseases that has been most threatening to young children was that of Polio. Polio is, at least in part, what is called a fecal-oral virus. That is, feces somehow enters the body, typically through poor bathroom hygiene and then impacts the central nervous system resulting in either paralysis, respiratory difficulties or death.
Polio at one point in time was referred to as the “rich man’s disease” because the lower economic classes may have had poor bathroom hygiene, but their bodies quickly adapted to the polio invasion by developing antibodies or immunities to fight it off. The wealthier classes however did not develop those antibodies and as a result, when someone within the upper social strata exercised poor bathroom hygiene thereby introducing fecal material to the body it sometimes had devastating results. It is speculated that is the origin of Franklin Roosevelt’s polio. He was a member of the upper class and his class was thought not to have developed the necessary antibodies to fight off the polio virus.
Although our current obsession with cleanliness is not necessarily to be shunned, it probably needs to be tempered with the recognition that it is not necessary to obtain an antibiotic every time someone has an infection and also the simple recognition that sometimes a little bit of dirt may be a good thing. To some extent this philosophy can be incorporated into diet also in that yogurt which is filled with bacteria and is sometimes referred to as being a Probiotic has a very helpful effect in terms of replenishing bacteria in the intestines in particular after the bacteria has been destroyed through the use of antibiotics. Keep in mind that when you take an antibiotic, that antibiotic kills not only the bacteria that is causing the particular infection, but may well kill all the bacteria in your system. That bacteria needs to be replenished. One way to do that is through the consumption of yogurt.
Sepsis destroys tissue. Sepsis develops when chemicals are released into the bloodstream to fight off an infection and they set off inflammatory responses throughout the body. As a result of those inflammatory responses there is damage and organ failure that may occur throughout the body. 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 misdiagnosed. Muhammad Ali and Jim Henson both died of sepsis. Although that has brought some attention to the condition, much is still not known about it. Classic symptoms of sepsis are decreased body temperature, elevated heart rate, high respiratory rate and white blood cell counts that either are too high or too low.
Sepsis destroys the tissue in the body thereby causing organ dysfunction. As a result of that it can be fatal.
Sepsis is most common among older people or the very young or those with compromised immune systems. People that have been through chronic diseases such as AIDs or have had surgery are more susceptible to sepsis.
One of the biggest hurdles in terms of treating sepsis is first identifying it. It must be identified quickly. Because sepsis destroys, the condition can rapidly advance to septic shock where blood pressure drops so low that the blood simply cannot be pumped.
Aside from the above, the typical warning signs that may exist are either decreased temperature or increased temperature or low blood pressure. If sepsis is suspected then one of the first things to do is to address the low blood pressure by administering fluids. Ideally this will increase the pressure so the blood will circulate to all organs. If the fluids do not accomplish the goal then it may be necessary to begin I.V. drugs to constrict the blood vessels and thereby raise the blood pressure.
Some of the more troubling symptoms may be a combination of intense pain and mental confusion that worsens very quickly. All of these symptoms must be addressed quickly as the condition itself can be life-threatening.
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.
A tactic to employ in order to prevent urinary infections is to drink plenty of water in order to flush the bacteria out of your system. Another preventive measure 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 the urethra during intercourse
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.