NosocomiaL infection~ is it our fault?

.......السلام عليكم ورحمة الله وبركاته

"My 9-year-old daughter was recently released from the hospital after what was supposedly an uneventful tonsillectomy. Three days after her release, she had to be rushed back to the hospital from complications from a staph infection that I am sure she picked up from the hospital. Can I bring a medical malpractice suit against the hospital for the ensuing costs to treat this infection?"

I found this question from a medical malpractice website. Maybe many question like this has been rose before. When a patient is admitted to the hospital, he or she expects to receive treatment and emerge healthier than when they entered. However, oftentimes patients are exposed to certain conditions in which they can be subject to acquisition of an infection.

What the patient described may be a NOSOCOMIAL INFECTION, which is also known as a hospital-acquired infection. This type of hospital-acquired infection is typically absent during time of admission but diagnosed within the first 48 hours of course of stay in the hospital, or 30 days after their release.

The infection may be developed from the hospital admission, but we have to make things clear. There are 2 forms of nosocomial infections:

i) Endogenous /auto infection- the causative agents comes from the patients and the infection develop during the stay in the hospital as a result of patient’s decrease resistance. ii) Cross infection – the patients comes into contact with new infective agents and soon develops infection.

some classified it to be 3forms

MAIN ROUTES OF TRANSMISSION......
Route	Description
Contact transmission	The most important and frequent mode of transmission of nosocomial infections.
Droplet transmission	Occurs when droplets are generated from the source person mainly during coughing, sneezing, and talking, and during the performance of certain procedures such as bronchoscopy.
Airborne transmission	Occurs by dissemination of either airborne droplet nuclei (small-particle residue {5 µm or smaller in size} of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time) or dust particles containing the infectious agent. Microorganisms transmitted by airborne transmission include Legionella, Mycobacterium tuberculosis and the rubeola and varicella viruses.
Common vehicle transmission	Applies to microorganisms transmitted to the host by contaminated items such as food, water, medications, devices, and equipment.
Vector borne transmission	Occurs when vectors such as mosquitoes, flies, rats, and other vermin transmit microorganisms.

Contact transmission is further divided into two subgroups: direct-contact transmission and indirect-contact transmission.

Routes of contact transmission
Route	Description
Direct-contact transmission	Involves a direct body surface-to-body surface contact and physical transfer of microorganisms between a susceptible host and an infected or colonized person, such as occurs when a person turns a patient, gives a patient a bath, or performs other patient-care activities that require direct personal contact. Direct-contact transmission also can occur between two patients, with one serving as the source of the infectious microorganisms and the other as a susceptible host.
Indirect-contact transmission	Involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, needles, or dressings, or contaminated gloves that are not changed between patients. In addition, the improper use of saline flush syringes, vials, and bags has been implicated in disease transmission in the US, even when healthcare workers had access to gloves, disposable needles, intravenous devices, and flushes.

Factors predisposing a patient to infection can broadly be divided into three areas

• People in hospitals are usually already in a poor state of health, impairing their defense against bacteria – advanced age or premature birth along with immunodeficiency (due to drugs, illness, or irradiation) present a general risk, while other diseases can present specific risks - for instance, chronic obstructive pulmonary disease can increase chances of respiratory tract infection.

• Invasive devices, for instance intubation tubes, catheters, surgical drains, and tracheostomy tubes all bypass the body’s natural lines of defence against pathogens and provide an easy route for infection. Patients already colonised on admission are instantly put at greater risk when they undergo an invasive procedure.

• A patient’s treatment itself can leave them vulnerable to infection – immunosuppression and antacid treatment undermine the body’s defences, while antimicrobial therapy (removing competitive flora and only leaving resistant organisms) and recurrent blood transfusions have also been identified as risk factors
  

What I want to emphasis here, the infection is not solely arise from the hospital fault. However, the following steps taken by hospital personnel and guests can help in preventing the spread of infection and maintain a sanitary environment:

1. Proper sterilization of medical tools, dressings, and uniforms
2. Isolate patients with especially contagious illnesses
3. Frequent and proper hand washing
4. Use aprons and gloves at all times
5. Proper sterilization of all surfaces
6. Make sure to use alcohol rubs and antimicrobial agents when possible

Despite the best safety precautions, patients still may be infected when staying at a hospital. The thing is, if the infection is due to the negligent behavior of others, they may be entitled to financial compensation following a civil lawsuit. The hospital administration, staff and maintenance crews have a responsibility to provide optimal care to patients. If this does not happen and reckless behavior occurs, they should be held accountable for their actions. A medical malpractice lawyer can offer advice to patients injured by hospital acquired infection, regarding their rights to pursue a lawsuit against the hospital for all damages.

Therefore, it is critical that hospital staff take all appropriate measures to minimize the chance of an infection being allowed to spread amongst patients. Additionally, doctors and other hospital staff must be cognizant of symptoms occurring in patients in order to provide proper treatment early enough to prevent injury to the patient.

pic: infection at the surgical site


Resources:
1) Lecture note “Nosocomial Infection” by dr. Hera Nirwati, M. Kes
2) Medicalmalpractice.com
3) Nosocomial-Infections