HIQA has reported on the wholesale failure of staff in Beaumont hospital to wash their hands. (A pdf of their report is available here) The staff knows, in theory, about the germ theory of disease but like everybody else they experience its apparent refutation. We are surrounded by bacteria, we live in a sea of bacteria and few of us are seriously damaged by them. Why, then, is it unacceptable to fail to wash your hands?
The answer lies in the special environment of a hospital. Hospitals are, by definition, unhealthy places. Unhealthy people congregate there. They are encouraged to do so. If they are unhealthy because they have been attacked by unusual bacteria, pathogens, they have brought those pathogens to the hospital. Not only that, the living arrangements of the hospital facilitates the infection of other patients with the pathogen.
Consequently, there are diseases that are so closely associated with hospitals, it is unlikely a person would be infected elsewhere. These diseases are known as “nosocomial” diseases. This is of interest to lawyers.
Section 12 of the Safety, Health and Welfare at Work Act 2005 decrees:
“12.—Every employer shall manage and conduct his or her undertaking in such a way as to ensure, so far as is reasonably practicable, that in the course of the work being carried on, individuals at the place of work (not being his or her employees) are not exposed to risks to their safety, health or welfare.”
This places a duty squarely on the hospital to effectively preclude a patient being infected with a nosocomial disease.
C. Difficile is, almost exclusively, a nosocomial disease. The bacterium exists in two states; an active state and as a spore. It is very difficult to cultivate in a laboratory in its active state (which difficulty is reflected in its name) and it is very difficult to kill in its spore state.
It is a serious disease, but can be suppressed by suitable antibiotics. Unfortunately, it is the use of antibiotics that creates the opportunity for it to proliferate in a patient. It is normally kept in check by the other bacteria of the human gut. These are killed by a typical course of antibiotics and C. Difficile then takes their place. It produces two toxins which attack and damage the colon.
Patients whose original complaint or illness involved their colon are at very serious risk from a C. Difficile infection. The chances of them dying are increased considerably.
There is no known case where a court decided a medical negligence claim against a hospital on the basis that the plaintiff contracted a nosocomial disease. The plaintiff will have to adduce more and other evidence of the negligence of the hospital in the infection of the plaintiff.
This, on one view, is difficult. It is very unlikely that a plaintiff can pin-point the act of negligence that infected him or her but there are other approaches to solving the problem.
In the case of a hospital, it is more likely that it is responsible for a C. Difficile infection, not by a positive act, but by a systemic failure.
Every hospital is obliged to have in place a written protocol for the staff to follow so that patients are kept safe. Beaumont hospital undoubtedly has such a protocol. Thanks to the HIQA report we know that it is not followed. Beaumont hospital, like all hospitals, is obliged to monitor the staff and ensure that protocols are followed. Clearly, it has failed and is failing, to do this.