Hospital-acquired infection is common, perhaps the greatest hazard from inpatient admission. The (now-diminishing) power of antibiotics has in some circumstances led to less concern with aseptic surgical and nursing technique. Nevertheless, aseptic technique must be scrupulous in high-risk situations, such as injection steroid medications into joints.
It is not possible completely to sterilise the skin and mucous membranes (linings of body orifices) prior to surgery, and the patient's own normally harmless germs are the origin of many postoperative infections. Scrupulous regular cleaning reduces but does not remove contamination of hospital surroundings by bacteria resistant to many antibiotics.
In the present state of knowledge and practice, the large majority of postoperative infections are not prevented by standard care.
Virtually all surgical procedures have a predictable wound infection rate, resulting in trivial to lethal consequences in a small minority of patients. Debilitation and compromised immune defences are demonstrably the major factors in determining who gets surgical infections.
Nevertheless, a frequent medicolegal question is whether substandard care also contributed in a particular case. Considerations include presence of an anatomically remote focus of infection, cross-infection by caregivers (hand-washing), inadequate air conditioning, and prolonged blood-vessel catheterisation. Proven remediable factors comprise duration of preoperative hospitalisation and of operation, preoperative bathing and hair removal, and use of electrocautery and surgical drains.
Features which occasionally point to negligent causation are the identity of the micro-organisms and the antibiotic-sensitivity profile of causative bacteria. These details are particularly helpful in mini-epidemics, such as may occur with inadequate sterilisation of arthroscopy instruments, .
Clues to negligent factors:
1. overlooked preoperative infection
2. avoidable surgical delays
4. antibiotic-resistance patterns
Delay in diagnosis, and misdiagnosis of the seriousness of an infection, are often raised and rarely proven. This is an area where academic recommendations are not necessarily reflected in community practice.
After prompt and correct diagnosis, insufficient dosage or length of course of antibiotics can sometimes be implicated as contributory negligence in severe or chronic infection. With the development of powerful antibiotics, however, some of the traditional guidelines on length of intravenous or intramuscular treatment are not supported by empirical evidence.
Copyright © 2008 Electronic Handbook of Legal Medicine