At Sands White & Sands, we are regularly contacted by persons who have suffered through a health care associated infection, also known as an “HAI.” An HAI is any infection acquired in a health care setting, which includes not only traditional hospital settings but also outpatient surgical centers, nursing homes, rehabilitation centers and community clinics. These infections are caused by a wide variety of viruses, bacteria and fungi, including Methicillin-resistant staph (MRSA). In the year 2002 alone there were approximately 1.7 million HAIs in the United States and 98,987 associated deaths. While substantial progress has been made in HAI prevention in the last decade, the Centers for Disease Control (CDC) estimates that 1 in 20 patients still get an infection each year while receiving medical care.
It is not unusual for persons who have contracted an HAI to feel resentment toward the health care facility and to wonder whether a legal case can be brought for their damages. Although not all HAIs can be prevented, these cases deserve close scrutiny to determine whether the health care facility did all it should have done to prevent the infection. If you or your loved one has suffered what you believe was an HAI resulting in significant permanent injuries or economic damages, please call us to discuss your case.
How do HAIs typically occur?
The majority of HAIs fall into one of the following five categories:
- Central line associated bloodstream infections -- Central line catheters are like the IVs with which most people are familiar but instead of being inserted in the arm or hand they are typically placed in large veins in the chest, neck or groin and can remain in place for extended periods of time. They are commonly used in intensive care units to deliver medication or fluids. If contaminated, they can become a source of infection.
- Catheter associated urinary tract infections -- Urinary tract infections are reportedly the most common type of health care associated infection reported to the CDC’s National Health care Safety Network. Roughly 15%-25% of hospitalized patients receive urinary catheters during their hospital stay and approximately 75% of all urinary tract infections acquired in hospitals are associated with the use of a urinary catheter.
- Ventilator associated pneumonia – Ventilator associated pneumonia describes any bacterial infection transmitted to the lungs through the medium of a ventilator. It is very common in intensive care units and has been estimated to affect 10%-20% of all patients undergoing ventilation, with the percentages decreasing in more recent estimates presumably because of infection control measures. In part because patients using ventilators are already at risk, the mortality rate may exceed 10%.
- Surgical site infections-- As recently as the mid-1990’s, surgical site infections were the most common hospital associated infection among post-surgical patients. Of these infections, approximately two-thirds were confined to the incision and one-third involved organs or spaces accessed during an operation.
- Clostridium difficile infections-- Clostridium difficile, also known as “C-diff”, is a bacillus that can be accidentally ingested in a health care facility. It then resides in the intestinal tract and can cause severe diarrhea when competing bacteria have been eradicated by antibiotics. Its main symptoms are watery diarrhea, fever, loss of appetite, nausea and abdominal pain. The elderly and the chronically ill are at increased risk for infection as well as patients receiving antibiotics, using proton pump inhibitors and undergoing gastrointestinal surgery. The bacillus is spread by feces so any surface that comes into contact with feces may serve as a medium of transmission. The most common mode of transmission is via the hands of health care personnel.
What is being done by health care facilities to prevent HAIs?
Over the years several guidelines have emerged on the prevention of HAIs. Guidelines have been published by the CDC, the Society for Health Care Epidemiology of America, the Infectious Diseases Society of America, the Institute for Health Care Improvement and the Health Care Infection Control and Prevention Advisory Committee. These comprehensive guidelines include recommendations specific to particular types of procedures and general recommendations with regard to the maintenance of sanitary conditions. Hospitals and other health care facilities have implemented these recommendations to varying degrees in their own standard procedures. It has become increasingly difficult for a hospital or other health care facility to simply ignore these standards without risking liability for HAIs that could have been prevented if the guidelines had been adopted.
What can you do to help prevent am HAI?
The CDC recommends that patients and their loved ones consider 10 steps to help prevent health care associated infections:
- Talk to your doctor about any worries you have about your safety and ask them what they are doing to protect you.
- If you do not see your providers clean their hands, ask them to do so. Also remind your loved ones and visitors. Washing hand can prevent the spread of germs.
- Ask if you still need a central line catheter or urinary catheter. Leaving a catheter in place too long increases the chances of getting an infection
- Ask your health care provider if there will be a new needle, new syringe and a new vial for the procedure or injection. Health care providers should never reuse a needle or syringe on more than one patient.
- Be careful with medications. Avoid taking too much medicine by following package directions. To avoid harmful drug interactions, tell your doctor about all of the medicines you are taking.
- Get smart about antibiotics. Help prevent antibiotic resistance by taking all of your antibiotics as prescribed and not sharing your antibiotics with other people. Remember that antibiotics don’t work against viruses like the ones that cause the common cold.
- Prepare for surgery. There are things you can do to reduce your risk of getting a surgical site infection. Talk to your doctor to learn what you should do to prepare for surgery. Let the doctor know about other medical problems you have.
- Watch out for C. diff. Tell your doctor if you have severe diarrhea, especially if you are also taking an antibiotic.
- Know the signs and symptoms of infection. Some skin infections, like MRSA, appear as redness, pain or drainage at an IV catheter site or surgical incision site, and a fever. Tell you doctor if you have any of these symptoms.
- Get your flu shot. Protect yourself against the flu and other complications by getting vaccinated.
Can health care facility charges for HAI treatment be disputed?
Medicare and Medicaid no longer reimburse hospitals for 11 categories of preventable hospital-acquired conditions including catheter associated urinary tract infections, vascular catheter-associated infections and surgical site infections associated with certain surgeries, namely, coronary artery bypass graft procedures, bariatric surgery for obesity, and orthopedic procedures involving the spine, neck, shoulder or elbow. Moreover, Medicare and Medicaid policy also prevents facilities from passing the costs of these “never events” on to patients. A number of private insurers, such as Aetna, have followed Medicaid and are incorporating Medicaid’s policy into their own contracts with facilities.
Regardless of whether you are a Medicare or Medicaid patient, if a facility is charging you for treatment of an infection acquired at the facility, you should consider disputing the charges and demanding that the facility bear this expense on its own. You may well find that the facility relents and withdraws these charges from your billing statement in an attempt to avoid litigation.