Medical malpractice related to nosocomial MRSA infection, comment


After reading the posts regarding MRSA acquired during the hospitial stay and how this is a legal issue makes me think of one thing. Nurses need a law degree before stepping foot in a hospital. Well, that may be a little overboard. I see this everyday. Practicing medicine while keeping in mind that we can be sued. We order extra lab work, radiology, ultrasound, MRI, and swabs for MRSA so we cover all the bases and avoid going to court. I can understand the MRSA swabs that may need to be done in order to avoid a lawsuit, but we would have to swab everyone. We really don’t know if the history we are obtaining is inclusive. Is this done in other countries? Are people “sue happy”? This is a foriegn concept to some friends and family that visit the US. Maybe we can invent a body scan that will take photographs head to toe to cover wounds, swab every orifice, lower the beds to 1 foot off the ground, and make it mandatory to wear special non-slip shoes to avoid falls. Again, the above example is out of frustration that we are not only caring for patients, but always are adding new things to do in order to avoid a lawsuit. I wish it were different, but we all know it will only get worse.

Original Post

January 16, 2007

Title: Medical Malpractice Related to Nosocomial MRSA Infections

The media and government have educated the public in the “super bugs” some patients become infected with in the hospital environment. The most widely known “super bug” is methicillin resistant staphylococcus aureus (MRSA). In June 2006 there was a case brought to court regarding the death of patient who had been in the hospital for a knee joint replacement. Since the patient had not been screened for MRSA prior to hospitalization it could not be proved if he picked up the MRSA during the hospital stay. With the documented community acquired MRSA he could have had the bacteria dormant in his body when he was admitted for the planned surgery. The doctor and hospital were not found negligent in this case.

Many hospitals are fearful of similar lawsuits based on nosocomial infections. Some hospitals are now culturing high-risk patients prior to hospital admission to determine if they are colonized. There is now a nasal swab test that has a turn around time of two hours to identify MRSA. Certainly this can be helpful so that colonized patients coming in for elective procedures can have this treated and also be isolated from non-colonized patients. Patients that test positive for MRSA can be cohorted with like patients or put in private rooms. There are multiple hospitals in Europe starting to follow this intervention with positive outcomes in their nosocomial rates.

It would seem to me the hospital administrators would prefer paying for the MRSA culture versus facing the potential of law suits from patients who develop nosocomial MRSA infections while inpatient. If I had a family member going to the hospital I would much prefer they be tested for MRSA prior to a surgery as “knowledge is power” Having the knowledge of colonized MRSA prior to surgical intervention can allow for adjustments that lead to positive outcomes for the hospital, surgeon and patient. I can visualize hospitals even being forced to do it to allow them better leverage in the court system by being able to say, “this person was colonized with MRSA” prior to hospital admission. From the epidemiology stand point it would also allow the opportunity to keep the more virulent strain of community MRSA from entering the hospital environment.

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