Acquiring an Infection
Most medical procedures carry risks of acquiring an infection. Indeed, about 1 in 10 patients admitted to hospital will acquire an infection during their admission.
The most common infection experienced during a hospital admission involves staphylococcus aureus. This organism is carried in the noses of about 30% of normal, healthy people. When staphylococcus aureus causes an infected wound following surgery, it is normally considered likely that the infection came from the patient’s own nose or skin (endogenous infection). In a minority of cases, the organism comes from the skin of a member of staff or from the hospital environment (exogenous infection).
As infection can have devastating consequences for patients, hospitals are required to provide an environment which minimises the risk of infection to patients, healthcare workers and visitors.
This requires the establishment and implementation of an adequate infection control programme which will include the establishment of an appropriate and qualified Infection Control Team within the hospital, the production of detailed infection control policies, the education of staff in best infection practice, the surveillance and audit of infection when it occurs and the deployment of adequate resources and facilities to ensure adequate standards of practice are followed. Even with the best facilities and practice, infections still occur because no preventive measures are 100% reliable.
Accordingly, the acquisition of an infection during a period of hospitalisation is not necessarily evidence of negligence and will not be so if an adequate infection control programme was in place and had been adequately implemented in the circumstances under consideration.
There is a particularly serious form of infection known as MRSA (methicillin resistant staphylococcus aureus) which is an organism from the staphylococcus aureus family but which is resistant to most forms of antibiotics.
In the United Kingdom and Ireland, MRSA is very uncommon in the general population and is almost always acquired in hospitals or in other healthcare facility as a result of cross-infection.
Hospital staff can become colonised with MRSA due to their work in the hospital environment and the most common route of transmission of MRSA to patients is from the hands of staff members. For this reason, the most effective form of control of MRSA is considered to be hand washing or hand disinfectant by healthcare workers before any patient contact.
Surgical site infection
Surgical site infection generally occurs when an infected organism is introduced into the surgical site during the operation. The occurrence of a surgical site infection with MRSA or some other organism indicates a breakdown of proper infection control procedures. However, surgical site infections are also an inherent risk of any surgery and occur from time to time even when best practice guidelines have been followed.
Accordingly, surgical site infections are not of themselves indicative of negligence.
The risk of infection varies between patients and the type of procedure performed and there is general consensus among surgeons of the rates of infection which are considered to be reasonable in respect of different types of procedures. It may be negligent for a surgeon to continue operations if infection rates are known to be above the generally acceptable threshold for that surgery or if an unusual infection occurs which indicates a potential significant infection control issue that might place future patients at risk.
An adequate infection control programme includes adequate surveillance of infections so that where unexpected infections occur, adequate investigations are undertaken with a view to identifying and eradicating their likely source.
Our Legal Expertise
Ivor Fitzpatrick & Company has investigated many cases of infections acquired in hospitals to identify whether their occurrence was the result of substandard infection control practices, poor operative performance and/or hygiene practices or the result of inadequacies in the post-operative after care.
Infection cases are often difficult and complex because they can occur without any inadequacies in the standard of care and it is therefore necessary to prove precisely how the infection occurred in order to demonstrate that it would have been prevented if adequate care had been provided.
We have successfully negotiated settlements in cases of post-operative infections, often where other deficiencies in the care and management afforded to the patient have allowed inferences to be drawn that adequate infection control procedures were unlikely to have been followed.
These cases require the close involvement of experts in the fields of microbiology and infection control and very detailed examinations of the policies and practices of the health institution concerned are essential. In some cases, the past history of the surgeon and the institution concerned are important sources of evidentiary material which can demonstrate a failure to respond adequately to earlier cases of a similar nature.