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When the sick get sicker in the hospital: people go to the hospital to get better, but they may develop an infection while there that worsens their condition. If this happened to your client, you need to know how to trace the path of the infection to find out what, and who, caused it.

Article Excerpt
If you dedicate your practice to representing the injured, you probably have met or will meet clients whose stay in a hospital was complicated--sometimes catastrophically-by a health-care-associated infection. Infections can cause serious injuries, including disfiguring scarring, amputations, and severe neurological impairments, as well as death.

Commonly called nosocomial or hospital-based infections, these complications are a widespread problem. The Centers for Disease Control and Prevention (CDC) estimates that, in U.S. hospitals alone, an estimated 1.7 million such infections occur, leading to 99,000 deaths, each year. (1)

Medical science has established that certain infections, and the injuries associated with them, are preventable. For example, a 2006 study demonstrated that, with five simple precautions, catheter-induced bloodstream infections can be eliminated. (2) If medicine has done away with certain infections by using simple, published precautions, it seems fair to infer that the occurrence of such an infection must be the result of some failure to take proper preventive measures.

When one of your clients has suffered an injury as a result of a nosocomial infection, you must determine whether the injury was preventable in the exercise of proper care. To answer that question, you need to

* identify the type and origin of the pathogen that caused the infection

* familiarize yourself with the pathogen's mode of transmission

* determine whether the providers and facility in question took proper precautions to prevent the presence and spread of the pathogen

* determine whether the health care providers recognized the infection and took proper steps to treat it.

These lines of inquiry should help you determine if a patient has a valid claim and, if so, prove its merits.

Identification of the pathogen sets up further lines of inquiry. Generally, laboratory studies can identify the culprit. You need to find out what type of pathogen (such as bacterial, viral, or fungal) caused the infection. To determine the precise strain, scour the medical record for all information regarding the pathogen, including reports from cultures and DNA or chromosomal studies.

Cultures and other studies performed on pathogens are frequently omitted from the medical records produced in response to a patient's or attorney's first request. Omission from initial copying and production does not mean that these records do not exist. Repeat requests will usually turn them up. ff the infection was fatal and an autopsy was performed, a specimen of the pathogen may have been preserved and may be subjected to testing.

Identifying which strain caused the infection helps you determine where the bug came from. For example, hospitals are known repositories for drug-resistant bacterial strains, including the most notorious, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). (3) But some strains of MRSA are found primarily in the community. (4)

The patient's history and clinical presentation play a key role in determining where the infection originated. Patients who present with no...

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