Staphylococcal Infection in Hospital RoommatesAuthor(s): Harry C. Nottebart, Jr.Source: Infection Control, Vol. 1, No. 2 (March/April 1980), pp. 105, 108Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiologyof AmericaStable URL: http://www.jstor.org/stable/25702644 .

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Staphylococcal Infection in Hospital Roommates

There are only a few cases involving hospital liability for nosocomial infections. These are the ones always cited when discussing responsibility for hospital-acquired infections. One of these cases is Helman v. Sacred Heart

Hospital 381 P.2d 605 (1963). In this case the plaintiff, George E. Helman, sued Sacred

Heart Hospital for injuries alleged to have occurred as a result of a staphylococcal infection acquired while Mr. Helman was a patient in the defendant hospital and as a result of the hospital's negligence.

Mr. Helman was injured in an automobile accident in Idaho on July 4, 1957, sustaining a crushed chest, a dislocated left hip, and multiple fractures of the left pelvis. Sometime near the end of July he was transferred to Sacred Heart Hospital in Washington for hip surgery.

At Sacred Heart Hospital Mr. Helman was placed in a

semi-private room. His roomate, Mr. Hagerup, had been

admitted on July 9, 1957 with a fractured back and was

paraplegic. On August 1, 1957, Mr. Helman had an extensive

operation on his left hip; he then returned to his room. On

August 2, he developed what was called a "spiking septic fever." On August 13 his surgical wound opened, discharging a large amount of purulent material. A culture of this material grew Staphylococcus aureus.

Subsequently the infection required that hip be fused

surgically. The hip fusion was done on October 28, and Mr. Helman was not discharged from the Sacred Heart

Hospital until March 14, 1958. On August 9, 1957 Mr. Helman's roommate complained

of a boil under his right arm. The boil was treated with hot compresses. On August 10, the boil began to drain

purulent material and a culture was taken. On August 13, culture of the drainage was reported to be growing Staphylococcus aureus and the patient was transferred to an isolation ward.

There was evidence that the hospital personnel moved from one patient to the other without washing their hands and failed to follow hospital procedure to prevent the

spread of infection. This evidence was apparently uncontroverted and thus stands as a fact.

The other medical fact in question was whether the

Staphylococcus aureus from the roommate's boil was the

same organism as the Staph, aureus from Mr. Helman's

hip. If these organisms were the same, and there was evidence that the hospital personnel went from one

patient to another without washing their hands or

observing other sterile techniques required by hospital procedure, then there was a chain of causation linking the roommate's infection to Mr. Helman by way of hospital personnel. If true, then the hospital did not meet its duty and was negligent.

Since the trial court found as a matter of fact (as opposed to law) that the S. aureus from the roommate was identical to the S. aureus from Mr. Helman, the appellate court

would normally accept this as fact and would not consider the factual matter further. However, in appellate opinion on this case the court devoted four pages to discussing this

question. Neither organism was phage typed at the time, so the court had to rely on the antibiotic sensitivities of the two organisms. The following chart simplifies the one that appears in the court's opinion:

Roommate Mr. Helman

Chloromycetin 0 ++

Bacitracin ++ +++

Polymyxin B 0 ++ Erythromycin 0 +++

Neomycin ++++ +++

Furadantin ++++ +++

Novobiocin 0 ++++

Oleandomycin +++ 0

The appellate court even reviewed the testimony of the

physicians, the pathologist and the professor of microbi

ology, all of whom testified that the differences in the antibiotic sensitivity patterns of the two organisms indicated that they were different strains. In opposition

was the head of the bacteriological laboratory for the Idaho Department of Health. His position was that antibiotic sensitivities were only to guide the thera

peutic use of antibiotics in treating infections and not for distinguishing between different strains of organisms.

Since there was a conflict in the expert testimony the

jury could accept either view of what the antibiotic sensitivities meant as to whether the S. aureus was the same organism in each patient. The jury accepted the view that the S. aureus organisms were identical in spite of the different antibiotic sensitivities. The theory accepted by the trial court and affirmed on appeal was that the nurses

(continued on page 108)

INFECTION CONTROL/Volume 1, Number 2 105

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(The Law and IC continued)

and other personnel taking care of the roommate carried the S. aureus to Mr. Helman sometime between August 10,

when the boil began to drain purulent material, and

August 13, when Mr. Helman's surgical wound opened and began discharging pus.

Since the personnel had not washed their hands between

caring for the two patients, and had not complied with other hospital procedures to prevent the spread of infection (not specified in the court's opinion) the

hospital had not followed its duty to the plaintiff, Mr. Helman, and this failure to perform its duty was the direct result of his infection. The hospital was negligent and Mr. Helman was awarded $67,839.97 by the jury; this was affirmed on appeal.

What can the infection control practitioner learn from this case? What sort of lessons are taught here?

First and foremost is the issue related to following established hospital policy. In establishingcertain policies the hospital is assuming certain duties. If the hospital, acting through its employees, fails to follow its own

procedures, then there is a failure to perform its duties. If the failure is the direct cause of injury to a patient, then the

hospital is negligent and may be required to pay damages to the injured party.

In this case, the hospital personnel should have washed their hands between caring for patients. Apparently the

hospital personnel also failed to carry out other proce dures that would have limited the spread of an infection from one patient to another. Procedures adopted by a

hospital need to be reasonable, achievable standards and the compliance with these hospital procedures needs to be

zealously enforced. Visionary or idealized procedures may look impressive on paper, but they must be workable and

they must be followed all the time. Otherwise the hospital will have assumed duties that it cannot hope to fulfill.

What can the hospital and the infection control

practitioner do about the other major problem in this case?the identification of the two S. aureus organisms involved here? Should every S. aureus isolated by the

bacteriology laboratory be phage typed? Impossible. Should every S. aureus involved in a nosocomial infection be phage typed? This would be a more manageable task but probably is not practical. Perhaps all organisms (S. aureus or otherwise) from nosocomial infections should be saved in case further testing is needed in the future (for the purpose of litigation defense). In a hospital with a nosocomial infection rate totaling 2-5% of all patients discharged this could add up to a sizable number of stored

organisms in one year. But if the specimens were being saved for possible future litigation they would have to be

kept for at least the number of years required by the Statute of Limitations for the laws of the state. The laboratory could end up storing a large number of organisms saved

only for this purpose. Most laboratories would be hard

pressed to find space for another hundred cultures, much less several hundred. Therefore, this possibility also is too burdensome for practical purposes.

Perhaps the solution is not to save every possible organism, or to phage type every S. aureus, but to apply judgment rather than a rigid rule. If an organism has been involved in a serious nosocomial infection (life threaten

ing, or causing prolonged hospitalization, procedures, or

complications) then it should be saved, or at least identified or phage typed, depending on the organism, as far as the hospital procedures allow and perhaps even as far as the hospital's reference laboratory can identify it.

If a case such as this ever goes into litigation the attorney defending the hospital can use all the background data and current literature that the infection control practition er can provide. It would also be hoped that the infection control practitioner and the other hospital personnel could testify that the hospital's procedures for isolation and prevention of the spread of pathogenic organisms are

always followed and were followed in the case in question.

Harry C. Nottebart, Jr., J.D., M.D. Medical College of Virginia

School of Medicine

Richmond, Virginia

108 The Law and IC Nottebart

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