A clean sweep


A clean sweep

With the advent of drug-resistant bacteria, hospital-acquired infections are a growing threat to patient safety. They can also result in costly lawsuits. What is the best way to fight the problem? HRMR investigates.

According to the Centers for Disease Control and Prevention (CDC), about one in 20 hospital patients will get a hospital acquired infection (HAI). While for many this will be a short-lived problem, an unfortunate minority face more serious, even life-threatening, consequences. The growing prevalence of antibiotic-resistant superbugs means that HAIs are an issue that risk managers cannot afford to ignore—not only because of the threat to patient safety but also because of the growing risk of lawsuits relating to infections.

The main reason for legal action is to deal with the outstanding medical bills that can arise from multiple days in the ICU, or the use of high cost medications to treat the infection. A single day in the ICU can add $5,000 to the overall healthcare cost of a patient—plus expensive antibiotics.

“It’s almost impossible to prevent all HAIs,” says Pamela Popp, executive vice president and chief risk officer for Western Litigation. “But remember that just because an infection is considered a HAI, it does not mean that there is negligence or malpractice—simply that it developed while the patient was in the hospital.”

Nevertheless, a short trawl of the Internet reveals plenty of plaintiff attorneys willing to take on cases relating to HAIs, helped in some cases by new genetic testing techniques which can help identify an infection.

An experienced personal injury attorney can undertake a review of medical records and launch an investigation of the hospital’s disinfection, sanitation and prevention practices to learn if the facility was in compliance with standard practices in the industry. A hospital infection lawyer will enlist experts in the field to assess the particular situation and help determine whether medical malpractice or mistakes occurred.

“There’s more risk of litigation if there’s a really bad outcome, such as death or necrotizing fasciitis that might result in loss of a limb,” says Nancy Lamo, clinical risk consultant and assistant vice president at Lockton. “Another key point is whether it’s unexpected; in other words, if your primary illness seems entirely unrelated to the infection—for example, if someone comes in with a cardiac issue and in the course of his treatment he has an intravenous (IV) drip and then develops a serious bacterial infection at the site of the IV. In that case the cause of the infection seems to be unrelated to his underlying illness.”

The resulting medical malpractice case could be brought on the grounds of lack of proper sterilization of equipment; failure to diagnose the infection in a timely fashion so that it can be aggressively treated; and failure to advise the patient at the informed consent process that an infection (and the consequences) could result during the treatment or surgery.

“The only criteria for filing a medical malpractice claim/lawsuit are the duty between the provider and patient, a perceived breach of that duty, and an injury of some type (this can be financial rather than physical),” says Popp. “These criteria are necessary for there to be a finding of negligence—but only if the injury/damage is directly caused by the breach of duty by the providers.

“Experts then debate whether the presence/development of infection could have been anticipated, was recognized in a timely fashion, and was treated appropriately. The presence of an infection alone does not equal negligence on its own. There has to be a breach of the duty for there to be a finding of negligence.”

The good news, adds Popp, is that most infections do not result in a poor outcome. Such cases are less likely to come to the attention of the risk manager. Instead, the quality manager is likely to be tracking each and every infection to determine whether it needs to be reported to the CDC or elsewhere, or if there are care process changes that need to happen—such as stronger sterilization compliance—to decrease infections in the future.

However, Lamo advises, it is wise for risk managers to have the issue of HAIs on their radar, even if it’s simply a matter of making sure you have an infection prevention committee and that you go to some of their meetings to stay on top of their work.

“I would want to have an awareness of the infection control measures that the hospital is engaging in. Depending on the size of the hospital, how it’s structured and the kind of care they deliver that can look different,” she says. “I would want to make sure that the infection control folks are including the frontline caregivers (because everyone’s responsible), that there is an awareness of the issue of HAIs, and that there are initiatives and control methods for a variety of infections.

“You should also make sure there some kind of antimicrobial stewardship, meaning that someone should be looking at the use of antibiotics and ensuring there’s not the ongoing overuse or abuse of antibiotics that results in the development of drug-resistant organisms.”

Lamo agrees that raising awareness is key. A really simple thing to look at is hand-washing. “The single most important thing that can be done to reduce the problem of HAIs is to encourage hand-washing, and patients need to know that it’s okay to ask caregivers whether they have washed their hands,” she says.

Patient education should also extend to educating them about the risks of infection from any treatment or procedure, says Popp. “Only then can they make an informed decision that they wish to go forward with the care/treatment (unless it’s an emergency, of course). Just because an infection occurs does not mean that the ultimate medical outcome will be bad—it could just be delayed, or maybe not even delayed. In other situations it could affect the outcome, from just a little, to a lot.” 

Drug-resistant bacteria, hospital acquired infections, HAIs