Hospital-Acquired Infections Are on the Rise

On Oct. 16, 2007, the Centers for Disease Control and Prevention (CDC), in Atlanta, issued a press release stating that, for the first time, Methicillin-resistant Staphylococcus auereus (MRSA) was killing more people than AIDS.

With such publicity, questions arose. What is MRSA? Can medical facilities really be held responsible when inpatients contract the illness during treatment? And is failure to timely diagnosis and treat MRSA a valid basis for a medical malpractice claim?

What Is MRSA, and Who Contracts It?

MRSA is a bacterial infection (more specifically, a staph infection) resistant to antibiotic medication. It is often found in hospital intensive care units and dialysis wards. It is always serious, and sometimes can cause permanent injury or death.

In order to properly litigate a MRSA case, the attorney must understand its different types and its different causes. MRSA infections are generally broken down into three categories: 1) hospital-acquired (or health-care acquired); 2) community-acquired; or 3) epidemic MRSA (an epidemic occurs when new cases appear in a cluster at substantially above the expected rate, or when three or more cases are associated with a particular person, time or place). Categorization of MRSA into any of these three categories is essentially a clinical diagnosis, made by the treating infectious disease specialist. Therefore, although we have microbiological testing available to us that can identify a particular strain of MRSA, the categorization is generally made through history and medical course.

Generally speaking, hospital-acquired MRSA is a stronger strain than community-acquired, for obvious reasons. It is living in an environment where there is necessarily a lot of antibiotic medication available, yet it is still resistant to the medication.

Critically ill patients and immuno-compromised individuals are the most susceptible to contracting MRSA. Other individuals at a statistically higher rate for contracting the infection include patients with a tracheostomy or gastrostomy tube, central line, PICC (peripherally inserted central catheter) line or urinary catheter. MRSA is known to be pervasive at the sites of one of these lines. Nonetheless, anyone and everyone is at risk to contract MRSA when exposed, even otherwise healthy health care workers who have been exposed to the bacteria.

Sanitation for Prevention

A universally accepted minimum protocol that should be employed at all medical care facilities to guard against the spread of MRSA employs preventative measures that include hand washing, the wearing of sanitary gloves, safe handling of linens, and appropriate environmental cleaning.

It is widely accepted that hand washing is the single most effective way to prevent the spread of MRSA. All caregivers must regularly wash their hands after every hand-to-hand (skin-to-skin) contact with a patient. Unfortunately, while most doctors and nurses understand the need to wash their hands after each and every patient contact, the support staff will not always be as diligent. It is imperative that medical care facilities train each and every employee (such as certified nursing assistants, orderlies, physical therapists, occupational therapists and speech therapists) on proper hand-washing procedures. Otherwise, contamination may occur when, for example, the physical therapist works with a patient with traumatic orthopedic injury and fails to consider the possibility of an MRSA infection.

In addition to hand washing before tending to each patient, contact with certain patients requires a heightened level of precaution, including the wearing of gloves. MRSA can be particularly pervasive in areas of sores, wounds or the mucous membranes of a patient. As a result, each and every time a health care worker has direct contact with a sore, open wound or mucous membrane of a patient, sanitary gloves must be worn. This should be done whether or not the patient is displaying signs of a MRSA infection because the patient may merely be a carrier. Furthermore, the medical care facility should keep all lesions covered whenever feasible.

For patients with urinary catheters, the medical care facility should be diligent in changing them whenever necessary to prevent clogging, as blockage increases the risk for infection. In addition, staff changing the drainage bags should keep the bags off of the floor. When patients have a cough or runny nose, all tissues they use should immediately be placed into the trash can, not onto a countertop to be disposed of later.

Although not as prevalent as direct person-to-person contact, bed linens, towels, pajamas, dishes, etc. can all carry MRSA and, in turn, transfer MRSA to people. Therefore, medical care facilities must implement daily routine cleaning procedures for all rooms and surfaces. This must include the use of disinfectants registered with the EPA to adequately fight MRSA. Dishes and utensils should be disposable.

Because of the high prevalence of MRSA in the intensive care and dialysis units of medical care facilities most medical care facilities have special precautions in place specific to these units. And some medical care facilities take the additional precaution of keeping infected and/or colonized patients in the same room to further prevent the spread of MRSA.

The maintenance staff also needs to be instructed in the appropriate sanitation procedures. Employees handling trash and soiled linens should wear gloves. Furthermore, employees handling trash should not separate it, seeking recyclable materials.

Next month we will look at roadblocks to successful suit, and discuss some case preparation tips.

Brandon Swartz, a member of this newsletter's Board of Editors, is a founding partner of Swartz Culleton PC in Newtown, PA. His practice focuses on all types of personal injury cases including wrongful death and medical malpractice.

On Oct. 16, 2007, the Centers for Disease Control and Prevention (CDC), in Atlanta, issued a press release stating that, for the first time, Methicillin-resistant Staphylococcus auereus (MRSA) was killing more people than AIDS.

With such publicity, questions arose. What is MRSA? Can medical facilities really be held responsible when inpatients contract the illness during treatment? And is failure to timely diagnosis and treat MRSA a valid basis for a medical malpractice claim?

What Is MRSA, and Who Contracts It?

MRSA is a bacterial infection (more specifically, a staph infection) resistant to antibiotic medication. It is often found in hospital intensive care units and dialysis wards. It is always serious, and sometimes can cause permanent injury or death.

In order to properly litigate a MRSA case, the attorney must understand its different types and its different causes. MRSA infections are generally broken down into three categories: 1) hospital-acquired (or health-care acquired); 2) community-acquired; or 3) epidemic MRSA (an epidemic occurs when new cases appear in a cluster at substantially above the expected rate, or when three or more cases are associated with a particular person, time or place). Categorization of MRSA into any of these three categories is essentially a clinical diagnosis, made by the treating infectious disease specialist. Therefore, although we have microbiological testing available to us that can identify a particular strain of MRSA, the categorization is generally made through history and medical course.

Generally speaking, hospital-acquired MRSA is a stronger strain than community-acquired, for obvious reasons. It is living in an environment where there is necessarily a lot of antibiotic medication available, yet it is still resistant to the medication.

Critically ill patients and immuno-compromised individuals are the most susceptible to contracting MRSA. Other individuals at a statistically higher rate for contracting the infection include patients with a tracheostomy or gastrostomy tube, central line, PICC (peripherally inserted central catheter) line or urinary catheter. MRSA is known to be pervasive at the sites of one of these lines. Nonetheless, anyone and everyone is at risk to contract MRSA when exposed, even otherwise healthy health care workers who have been exposed to the bacteria.

Sanitation for Prevention

A universally accepted minimum protocol that should be employed at all medical care facilities to guard against the spread of MRSA employs preventative measures that include hand washing, the wearing of sanitary gloves, safe handling of linens, and appropriate environmental cleaning.

It is widely accepted that hand washing is the single most effective way to prevent the spread of MRSA. All caregivers must regularly wash their hands after every hand-to-hand (skin-to-skin) contact with a patient. Unfortunately, while most doctors and nurses understand the need to wash their hands after each and every patient contact, the support staff will not always be as diligent. It is imperative that medical care facilities train each and every employee (such as certified nursing assistants, orderlies, physical therapists, occupational therapists and speech therapists) on proper hand-washing procedures. Otherwise, contamination may occur when, for example, the physical therapist works with a patient with traumatic orthopedic injury and fails to consider the possibility of an MRSA infection.

In addition to hand washing before tending to each patient, contact with certain patients requires a heightened level of precaution, including the wearing of gloves. MRSA can be particularly pervasive in areas of sores, wounds or the mucous membranes of a patient. As a result, each and every time a health care worker has direct contact with a sore, open wound or mucous membrane of a patient, sanitary gloves must be worn. This should be done whether or not the patient is displaying signs of a MRSA infection because the patient may merely be a carrier. Furthermore, the medical care facility should keep all lesions covered whenever feasible.

For patients with urinary catheters, the medical care facility should be diligent in changing them whenever necessary to prevent clogging, as blockage increases the risk for infection. In addition, staff changing the drainage bags should keep the bags off of the floor. When patients have a cough or runny nose, all tissues they use should immediately be placed into the trash can, not onto a countertop to be disposed of later.

Although not as prevalent as direct person-to-person contact, bed linens, towels, pajamas, dishes, etc. can all carry MRSA and, in turn, transfer MRSA to people. Therefore, medical care facilities must implement daily routine cleaning procedures for all rooms and surfaces. This must include the use of disinfectants registered with the EPA to adequately fight MRSA. Dishes and utensils should be disposable.

Because of the high prevalence of MRSA in the intensive care and dialysis units of medical care facilities most medical care facilities have special precautions in place specific to these units. And some medical care facilities take the additional precaution of keeping infected and/or colonized patients in the same room to further prevent the spread of MRSA.

The maintenance staff also needs to be instructed in the appropriate sanitation procedures. Employees handling trash and soiled linens should wear gloves. Furthermore, employees handling trash should not separate it, seeking recyclable materials.

Next month we will look at roadblocks to successful suit, and discuss some case preparation tips.

Brandon Swartz, a member of this newsletter's Board of Editors, is a founding partner of Swartz Culleton PC in Newtown, PA. His practice focuses on all types of personal injury cases including wrongful death and medical malpractice.