Hospital or Nursing Home Acquired Infections

There are two hospital or nursing home acquired infections that are frequently considered for potential malpractice cases, Methicillin resistant Staphylococcus Aureus (MSRA) and Clostridium difficile-associated disease (CDAD or CDI).

MRSA cases are extremely difficult cases because the defense does its best to tell a jury that one can contract this infection anywhere. It is often referred to as a community acquired infection. Therefore, even if one can prove that the hospital had other cases of this type of infection, the argument is still made that the patient could have acquired it anywhere-the gym, the office, at home. Many hospital have implemented guideline whereby a nasal test is performed at admittance to determine the existence of infection or susceptibility to infection, thereby requiring antibiotic treatment before any procedures are performed. Although an attorney can discover in deposition testimony whether the hospital had sanitary procedures in place, actually followed the sanitary procedures, took isolation precautions for known infections, conducted adequate in house surveillance procedures to uncover and treat infections, required the use of gowns and gloves, and followed guidelines for using antiseptics properly; nevertheless, the MRSA cases remain difficult at best.

On the other hand, CDI cases have risen dramatically in the last several years. CDI confines itself to the bowels. Normal disinfectant procedures in hospital do not take care of CDI spores. They can be on any dry surface and a bleach product is all that will remove it. These cases now rival MRSA cases as the most common acquired infection cases related to health care organizations such as hospital or nursing homes. CDI can lead to longer hospital stays and, if not treated promptly and appropriately, to death. CDI can develop after anti bacterial or anti microbial use. It can come days or weeks after stopping antibiotics. It usually starts with abdominal cramping and diarrhea. In the second stage, the diarrhea becomes watery and fever often presents itself as well. The can be a loss of appetite and dehydration.

The problem with diagnosing CDI is that the tool usually used is a stool sample. Unfortunately it takes a couple of days to get a positive result and that might be too long to begin interventional techniques. The treating doctor should immediately institute a course of vancomycin or metronidazole if there is a suspicion of possible CDI. If that is not done, CDI can lead to multi system failure and death. There may be a need to perform a cholectomy immediately to remove the infection.

Physicians are frequently prescribing immodium for CDI which is directly contrary of what should be ordered. Products like immodium compound the problem because the bowel does not clean out as quickly and it allows the toxin to be even more rampant. Prescribing narcotics is also contra indicated as it slows down the mobility in the bowel which is not what one needs to do. That allows the infection to fester and grow.

Often, by the time the results of the tests come back the patient has already been discharged and falls between the cracks. There is inadequate documentation of lad/doctor notification and doctor/patient notification. Many laboratories do not have good procedures for immediate notification of a physician when results fall within certain well known alert or critical ranges.