Healthcare-Associated Infections: Not Only a Clinical Burden, But a Forensic Point of View

Author(s): Marco Di Paolo, Luigi Papi, Paolo Malacarne, Federica Gori, Emanuela Turillazzi *.

Journal Name: Current Pharmaceutical Biotechnology

Volume 20 , Issue 8 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

Background: Healthcare-associated infections (HCAIs) occur when patients receiving treatment in a health care setting develop an infection. They represent a major public health problem, requiring the integration of clinical medicine, pathology, epidemiology, laboratory sciences, and, finally, forensic medicine.

Methods: The determination of cause of death is fundamental not only in the cases of presumed malpractice to ascertain the causal link with any negligent behavior both of health facilities and of individual professionals, but also for epidemiological purposes since it may help to know the global burden of HCAIs, that remains undetermined because of the difficulty of gathering reliable diagnostic data. A complete methodological approach, integrating clinical data by means of autopsy and histological and laboratory findings aiming to identify and demonstrate the host response to infectious insult, is mandatory in HCAIs related deaths.

Results: Important tasks for forensic specialists in hospitals and health services centers are the promotion of transparency and open communication by health-care workers on the risk of HCAIs, thus facilitating patients’ engagement and the implementation of educational interventions for professionals aimed to improve their knowledge and adherence to prevention and control measures.

Conclusion: HCAIs are a major problem for patient safety in every health-care facility and system around the world and their control and prevention represent a challenging priority for healthcare institution and workers committed to making healthcare safer. Clinicians are at the forefront in the war against HCAIs, however, also forensic pathologists have a remarkable role.

Keywords: Healthcare-acquired infection, forensic issues, litigation, autopsy, patient information, disclosure of HCAIs risks.

[1]
Meier, B.M.; Stone, P.W.; Gebbie, K.M. Public health law for the collection and reporting of health care-associated infections. Am. J. Infect. Control, 2008, 36(8), 537-551.
[2]
Raja Danasekaran, G.M.; Annadurai, K. Prevention of healthcare-associated infections: Protecting patients, saving lives. Int. J. Community Med. Public Health, 2014, 1, 67-68.
[3]
Henderson, D.K.; Palmore, T.N. Critical gaps in knowledge of the epidemiology and pathophysiology of healthcare‐associated infections. Infect. Control Hosp. Epidemiol., 2010, 31(Suppl. 1), S4-S6.
[4]
Ewans, T.M.; Ortiz, C.R.; LaForce, F.M. Prevention and control of nosocomial infection in the intensive care unit. In: In: Intensive Care Medicine. 4th Ed;; , Irwin; , Cerra; , Rippe, Eds.; New York: Lippincot- Ravan,, 1999; pp. 1074-1080..
[5]
European Centre for Disease Prevention and Control. Healthcareassociated infections acquired in intensive care units. In: ECDC. Annual epidemiological report for 2015. Stockholm: ECDC,; , 2017.
[6]
European Centre for Disease Prevention and Control.. ECDC Surveillance Report Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals 2011-2012. http://www.ecdc.europa.eu/en/publications/Publications/healthcare-associated - infections - antimicrobial -use-PPS.pdf (Accessed July 28, 2018).
[7]
Manoukian, S.; Stewart, S.; Dancer, S.; Graves, N.; Mason, H.; McFarland, A.; Robertson, C.; Reilly, J. Estimating excess length of stay due to healthcare-associated infections: A systematic review and meta-analysis of statistical methodology. J. Hosp. Infect,, 2018,.S0195-6701(18)30317-7.
[8]
De Angelis, G.; Murthy, A.; Beyersmann, J.; Harbarth, S. Estimating the impact of healthcare-associated infections on length of stay and costs. Clin. Microbiol. Infect., 2010, 16(12), 1729-1735.
[9]
Kaier, K.; Wolkewitz, M.; Heister, T. Estimating the attributable costs of hospital-acquired infections requires a distinct categorization of cases based on time of infection. Am. J. Infect. Control, 2018, 46(6), 729.
[10]
Ehrenkranz, N.J.; MacIntyre, A.T.; Hebert, P.R.; Schneider, W.R.; Hennekens, C.H. Control of health care-associated infections (HAI): winning both the battles and the war. J. Gen. Intern. Med., 2011, 26(3), 340-342.
[11]
Umscheid, C.A.; Mitchell, M.D.; Doshi, J.A.; Agarwal, R.; Williams, K.; Brennan, P.J. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect. Control Hosp. Epidemiol., 2011, 32(2), 101-114.
[12]
Pascall, E.; Trehane, S.J.; Georgiou, A.; Cook, T.M. Litigation associated with intensive care unit treatment in England: An analysis of NHSLA data 1995-2012. Br. J. Anaesth., 2015, 115(4), 601-607.
[13]
MindMetre Research. Healthcare Associated Infections – litigation and reputation. 2014.Available at:. www.mindmetreresearch.com/.../MindMetre-HCAI-Litigious-Re (Accessed: July 30, 2018).
[14]
Pacella, F.; Collini, S.; Angelucci, F.; Agostinelli, E.; Guzzo, A.S.; Cerza, C.; Pacella, E. Infections in hospital departments. What is hospital responsibility? Clin. Ter., 2017, 168(4), e266-e270.
[15]
Goldenberg, S.D.; Volpé, H.; French, G.L. Clinical negligence, litigation and healthcare-associated infections. J. Hosp. Infect., 2012, 81(3), 156-162.
[16]
Guinan, J.L.; McGuckin, M.; Shubin, A.; Tighe, J. A descriptive review of malpractice claims for health care-acquired infections in Philadelphia. Am. J. Infect. Control, 2005, 33(5), 310-312.
[17]
Steinbuch, R. Dirty Business: Legal Prophylaxis for Nosocomial Infections, 97. Kentucky Law J., 2009, 97, 505.
[18]
Khoury, L.; Iokheles, M. Factual causation and healthcare-associated infections. Health Law J., 2009, 17, 195-228.
[19]
Kachalia, A.; Gandhi, T.K.; Puopolo, A.L.; Yoon, C.; Thomas, E.J.; Griffey, R.; Brennan, T.A.; Studdert, D.M. Missed and delayed diagnoses in the emergency department: A study of closed malpractice claims from 4 liability insurers. Ann. Emerg. Med., 2007, 49(2), 196-205.
[20]
Gilbert, G.L.; Cheung, P.Y.; Kerridge, I.B. Infection control, ethics and accountability. Med. J. Aust., 2009, 190(12), 696-698.
[21]
Solomon, R.C. Ethical issues in medical malpractice. Emerg. Med. Clin. North Am., 2006, 24(3), 733-747.
[22]
Moralejo, D.; El Dib, R.; Prata, R.A.; Barretti, P.; Corrêa, I. Improving adherence to Standard precautions for the control of health care-associated infections. Cochrane Database Syst. Rev., 2018.2CD010768.
[23]
Erasmus, V.; Daha, T.J.; Brug, H.; Richardus, J.H.; Behrendt, M.D.; Vos, M.C.; van Beeck, E.F. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect. Control Hosp. Epidemiol., 2010, 31(3), 283-294.
[24]
Parmeggiani, C.; Abbate, R.; Marinelli, P.; Angelillo, I.F. Healthcare workers and health care-associated infections: knowledge, attitudes, and behavior in emergency departments in Italy. BMC Infect. Dis., 2010, 10(10), 35.
[25]
Beauchamp, T.L.; Childress, J.F. Principles of Biomedical Ethics, 7th ed; Oxford Press, 2012.
[26]
Marschang, S.; Bernardo, G. Prevention and control of healthcare-associated infection in Europe: A review of patients’ perspectives and existing differences. J. Hosp. Infect., 2015, 89(4), 357-362.
[27]
Klevens, R.M.; Edwards, J.R.; Richards, C.L., Jr; Horan, T.C.; Gaynes, R.P.; Pollock, D.A.; Cardo, D.M. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep., 2007, 122(2), 160-166.
[28]
van Mourik, M.S.M.; Perencevich, E.N.; Gastmeier, P.; Bonten, M.J.M. Designing surveillance of healthcare-associated infections in the era of automation and reporting mandates. Clin. Infect. Dis., 2018, 66(6), 970-976.
[29]
Eggimann, P.; Pittet, D. Infection control in the ICU. Chest, 2001, 120(6), 2059-2093.
[30]
Vincent, J.L. Nosocomial infections in adult intensive-care units. Lancet, 2003, 361(9374), 2068-2077.
[31]
Safdar, N.; Dezfulian, C.; Collard, H.R.; Saint, S. Clinical and economic consequences of ventilator-associated pneumonia: A systematic review. Crit. Care Med., 2005, 33(10), 2184-2193.
[32]
Nanomedicine. Report of the European Science Foundation, 2005.
[33]
McGuire, A.R.; DeJoseph, M.E.; Gill, J.R. An approach to iatrogenic deaths. Forensic Sci. Med. Pathol., 2016, 12(1), 68-80.
[34]
Santurro, A.; Vullo, A.M.; Borro, M.; Gentile, G.; La Russa, R.; Simmaco, M.; Frati, P.; Fineschi, V. Personalized medicine applied to forensic sciences: New advances and perspectives for a tailored forensic approach. Curr. Pharm. Biotechnol., 2017, 18(3), 263-273.
[35]
Di Sanzo, M.; Cipolloni, L.; Borro, M.; La Russa, R.; Santurro, A.; Scopetti, M.; Simmaco, M.; Frati, P. Clinical applications of personalized medicine: A new paradigm and challenge. Curr. Pharm. Biotechnol., 2017, 18(3), 194-203.
[36]
La Russa, R.; Fineschi, V.; Di Sanzo, M.; Gatto, V.; Santurro, A.; Martini, G.; Scopetti, M.; Frati, P. Personalized medicine and adverse drug reactions: The experience of an Italian teaching hospital. Curr. Pharm. Biotechnol., 2017, 18(3), 274-281.
[37]
Borro, M.; Gentile, G.; Cipolloni, L.; Foldes-Papp, Z.; Frati, P.; Santurro, A.; Lionetto, L.; Simmaco, M. Personalised healthcare: The DiMA clinical model. Curr. Pharm. Biotechnol., 2017, 18(3), 242-252.
[38]
Pomara, C.; Riezzo, I.; Bello, S.; De Carlo, D.; Neri, M.; Turillazzi, E. A pathophysiological insight into sepsis and its correlation with postmortem diagnosis. Mediators Inflamm., 2016.20164062829
[39]
Lucas, S. The autopsy pathology of sepsis-related death. Curr. Diagn. Pathol., 2007, 13, 375-388.
[40]
Tsokos, M. Postmortem diagnosis of sepsis. Forensic Sci. Int., 2007, 165(2-3), 155-164.
[41]
Marshall, J.C.; Reinhart, K. International sepsis forum. Biomarkers of sepsis. Crit. Care, 2009, 37, 2290-2298.
[42]
Al-Tawfiq, J.A.; Tambyah, P.A. Healthcare associated infections (HAI) perspectives. J. Infect. Public Health, 2014, 7(4), 339-344.
[43]
Calfee, D.P. Crisis in hospital-acquired, healthcare-associated infections. Annu. Rev. Med., 2012, 63, 359-371.
[44]
Zingg, W.; Holmes, A.; Dettenkofer, M.; Goetting, T.; Secci, F.; Clack, L.; Allegranzi, B.; Magiorakos, A.P.; Pittet, D. Hospital organisation, management, and structure for prevention of health-care-associated infection: A systematic review and expert consensus. Lancet Infect. Dis., 2015, 15(2), 212-224.
[45]
Pronovost, P.J.; Weast, B.; Bishop, K.; Paine, L.; Griffith, R.; Rosenstein, B.J.; Kidwell, R.P.; Haller, K.B.; Davis, R. Senior executive adopt-a-work unit: A model for safety improvement. Jt. Comm. J. Qual. Saf., 2004, 30(2), 59-68.
[46]
Bittner, M.J.; Routh, J.M.; Folchert, M.D.; Woessner, N.E.; Kennedy, S.J.; Parks, C.C. Hand hygiene among health care workers: Is educating patients and families a feasible way to increase rates? WMJ, 2017, 116(2), 79-83.
[47]
Lent, V.; Eckstein, E.C.; Cameron, A.S.; Budavich, R.; Eckstein, B.C.; Donskey, C.J. Evaluation of patient participation in a patient empowerment initiative to improve hand hygiene practices in a Veterans Affairs medical center. Am. J. Infect. Control, 2009, 37(2), 117-120.
[48]
McGuckin, M.; Taylor, A.; Martin, V.; Porten, L.; Salcido, R. Evaluation of a patient education model for increasing hand hygiene compliance in an inpatient rehabilitation unit. Am. J. Infect. Control, 2004, 32(4), 235-238.
[49]
World Health Organization. WHO Guidelines on hand hygiene in healthcare, 2009.
[50]
Gudnadottir, U.; Fritz, J.; Zerbel, S.; Bernardo, A.; Sethi, A.K.; Safdar, N. Reducing health care-associated infections: Patients want to be engaged and learn about infection prevention. Am. J. Infect. Control, 2013, 41(11), 955-958.
[51]
Møller, T.; Borregaard, N.; Tvede, M.; Adamsen, L. Patient education--a strategy for prevention of infections caused by permanent central venous catheters in patients with haematological malignancies: A randomized clinical trial. J. Hosp. Infect., 2005, 61(4), 330-341.
[52]
McCarthy, D.M.; Engel, K.G.; Buckley, B.A.; Forth, V.E.; Schmidt, M.J.; Adams, J.G.; Baker, D.W. Emergency department discharge instructions: Lessons learned through developing new patient education materials. Emerg. Med. Int., 2012.2012306859
[53]
Pittet, D.; Panesar, S.S.; Wilson, K.; Longtin, Y.; Morris, T.; Allan, V.; Storr, J.; Cleary, K.; Donaldson, L. Involving the patient to ask about hospital hand hygiene: A National Patient Safety Agency feasibility study. J. Hosp. Infect., 2011, 77(4), 299-303.
[54]
Ottum, A.; Sethi, A.K.; Jacobs, E.; Zerbel, S.; Gaines, M.E.; Safdar, N. Engaging patients in the prevention of health care-associated infections: A survey of patients’ awareness, knowledge, and perceptions regarding the risks and consequences of infection with methicillin-resistant Staphylococcus aureus and Clostridium difficile. Am. J. Infect. Control, 2013, 41(4), 322-326.
[55]
Seale, H.; Chughtai, A.A.; Kaur, R.; Crowe, P.; Phillipson, L.; Novytska, Y.; Travaglia, J. Ask, speak up, and be proactive: Empowering patient infection control to prevent health care-acquired infections. Am. J. Infect. Control, 2015, 43(5), 447-453.
[56]
Campbell, F.A.; Goldman, B.D.; Boccia, M.L.; Skinner, M. The effect of format modifications and reading comprehension on recall of informed consent information by low-income parents: A comparison of print, video, and computer-based presentations. Patient Educ. Couns., 2004, 53(2), 205-216.
[57]
McGuckin, M.; Waterman, R.; Shubin, A. Consumer attitudes about health care-acquired infections and hand hygiene. Am. J. Med. Qual., 2006, 21(5), 342-346.
[58]
Bahadori, M.; Teymourzadeh, E.; Ravangard, R.; Nasiri, A.; Raadabadi, M.; Alimohammadzadeh, K. Factors contributing towards patient’s choice of a hospital clinic from the patients’ and managers’ perspective. Electron. Physician, 2016, 8(5), 2378-2387.
[59]
Victoor, A.; Delnoij, D.M.; Friele, R.D.; Rademakers, J.J. Determinants of patient choice of healthcare providers: A scoping review. BMC Health Serv. Res., 2012, 12, 272.
[60]
Mosadeghrad, A.M. Patient choice of a hospital: Implications for health policy and management. Int. J. Health Care Qual. Assur., 2014, 27(2), 152-164.
[61]
Guinan, M.; Fu, A.; O’Neill, L.; Tsang, R.; McGuckin, M. Choosing a Hospital and Physician-Does the Public Really Care About Infection Rates and Being Informed?; APIC: Washington, DC, 2005.
[62]
Council of Europe. Council Recommendation (2009/C 151/01): on patient’s safety, including the prevention and control of healthcare associated infections. Strasbourg, France: 9th June (2009). http://ec.europa.eu/health/patient_safety/docs/council_2009_en.pdf (Accessed (July 28, 2018).
[63]
Hostiuc, S.; Molnar, A.J.; Moldoveanu, A.; Aluaş, M.; Moldoveanu, F.; Bocicor, I.; Dascalu, M.I.; Bădilă, E.; Hostiuc, M.; Negoi, I. Patient autonomy and disclosure of material information about hospital-acquired infections. Infect. Drug Resist., 2018, 11, 369-375.
[64]
Soltner, C.; Lassalle, V.; Galienne-Bouygues, S.; Pottecher, J.; Floccard, B.; Delapierre, L.; Jungfer, F.; Sargentini, C.; Alberti, C.; Beydon, L. Written information that relatives of adult intensive care unit patients would like to receive--a comparison to published recommendations and opinion of staff members. Crit. Care Med., 2009, 37(7), 2197-2202.
[65]
Abbate, R.; Di Giuseppe, G.; Marinelli, P.; Angelillo, I.F. Patients’ knowledge, attitudes, and behavior toward hospital-associated infections in Italy. Am. J. Infect. Control, 2008, 36(1), 39-47.
[66]
Merle, V.; Van Rossem, V.; Tavolacci, M.P.; Czernichow, P. Knowledge and opinions of surgical patients regarding nosocomial infections. J. Hosp. Infect., 2005, 60(2), 169-171.
[67]
Merle, V.; Tavolacci, M.P.; Moreau, A.; Dubreuil, N.; Dollois, B.; Gray, C.; Kerleau, K.; Théry, S.; Czernichow, P. What factors influence healthcare professionals’ opinion and attitude regarding information for patients about hospital infection? J. Hosp. Infect., 2007, 66(3), 269-274.
[68]
Seale, H.; Novytska, Y.; Gallard, J.; Kaur, R. Examining hospital patients’ knowledge and attitudes toward hospital-acquired infections and their participation in infection control. Infect. Control Hosp. Epidemiol., 2015, 36(4), 461-463.
[69]
Bo, M.; Amprino, V.; Dalmasso, P.; Argentero, P.A.; Zotti, C.M. Written versus verbal information for patients’ education on healthcare-associated infections: A cross-sectional study. J. Hosp. Infect., 2015, 91(4), 358-361.


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 20
ISSUE: 8
Year: 2019
Page: [658 - 664]
Pages: 7
DOI: 10.2174/1389201020666190618122649
Price: $58

Article Metrics

PDF: 10