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Newsletter Issue: 
Eighteenth Edition
Newsletter Date: 
Spring 2010

HOSPITAL AQUIRED INFECTIONSA large percentage of the calls we receive are from people who have suffered a hospital-acquired infection. Often these infections develop into very serious problems for the patient involving extended hospital stays, re-operations, home health care, IV antibiotics, and tremendous physical and emotional pain and suffering. Not surprisingly, they are associated with huge additional medical expenses and extended loss of income.  

Up until the past few years, the general rule for evaluating infection cases has been that most of the time acquiring the infection in the hospital is not negligent, but failure to timely diagnose and treat the infection can be negligent. It is still true that delay in diagnosis and treatment of an infection can form the basis of a viable malpractice claim. If the doctors and nurses stick their heads in the stand and fail to realize and properly interpret the signs of a serious infection, it can make things much worse for the patient.

However, in recent years much work has been done by infectious disease doctors and hospital quality and safety research groups demonstrating clearly that infections in a hospital setting can be prevented quite easily. This work has also demonstrated that different hospitals have much different infection rates which can be traced to whether they have adopted a culture of attentive hygiene.

The CDC estimates that approximately 1.7 million hospital-associated infections cause or contribute to 99,000 deaths each year in the United States. These infections are commonly transmitted when hospital officials become complacent and hospital personnel do not practice correct hygiene regularly. Common infection sites are the urinary tract, the lung, and surgical sites, often spreading into the blood stream.

The CDC estimates that 31,000 people a year die from hospital-acquired blood stream infections following catheter insertion. The conclusion of the extensive work that has been done out of Johns Hopkins Hospital in Baltimore is that this can be stopped. Hospital infections are not like a disease for which there is no cure. Incredibly, their work led them to develop a very simply and common check list of routine hospital hygiene which has resulted in the reduction of infection rates after catheter insertion from 11 per 1,000 to nearly zero. Here is the simple check list:

  • Wash your hands
  • Clean your skin with chlorhexidine
  • Try to avoid placing catheters in the groin
  • Cover the patient and yourself while inserting the catheter
  • Keep a sterile field and ask for every procedure if the benefits of catheterization exceed the risk.

This relatively simple template has carried over to other areas of the hospital as well. In the surgical intensive care unit, Hopkins developed a check list that included making sure that infection-preventing supplies such as disinfectant and drapery were near and handy. They observed that these items had been stored in many different places in the hospital and in an emergency, hygienic steps were skipped. They gathered all the necessary materials and placed them together on an accessible cart. They assigned someone to be in charge of the cart and to make sure it was stocked. They also instituted independent safeguards to make certain the check list was followed.

Most importantly, the nurses were empowered to make sure the doctors followed all the steps on the hygiene check list, including telling the doctors to wash their hands. Not surprisingly, that created some culture shock within the hospital, but in four years they reduced their ICU infection rates to almost zero.

The implication of this work for the evaluation of hospital-acquired infection cases is potentially significant. The traditional negligence cost/benefit analysis applies directly. The benefit of reducing infections is tremendous. The cost is almost nothing. All it takes is simple common sense forethought and the daily effort by the hospital to make sure everyone complies with the simple requirements.

This obviously does not mean that every hospital-acquired infection is the result of negligence. However, it does mean that in a case where hospital acquired infection has caused severe harm, it may be well worth investigating whether the hospital had any of these common sense infection control protocols in place, and more importantly, whether there was a concerted effort made to strictly comply with the protocols on a daily basis.

If someone calls you with an infection case, please don’t hesitate to call me. I will always make the time to discuss this with you.

  • Claims numbers continue to be down across the board. This includes auto, workers’ compensation and medical malpractice. They have been going down for the last 6-7 years. No one seems to have a primary explanation for this trend, but it continues to impact the practice of law.
  • Check out our new redesigned website at It should be up and running within the next 3-4 weeks.
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