Hundreds of thousands of patients acquire infections in U.S. hospitals each year that were not present on admission. Central line-associated bloodstream infections, catheter-associated urinary tract infections, surgical site infections, and C. difficile infections are among the most common and most preventable. When a hospital's failures in hand hygiene compliance, sterilization protocols, or device maintenance cause or contribute to a serious HAI, the resulting harm can include prolonged hospitalization, permanent injury, and death. The medical-legal case begins with the same question as every malpractice case: what did the standard of care require, and where did the facility fall short?
Establishing the Standard of Care for Infection Prevention
The standard of care for infection prevention is extensively documented. The Centers for Disease Control's Healthcare Infection Control Practices Advisory Committee publishes evidence-based guidelines for preventing specific types of HAIs, including the CLABSI, CAUTI, and SSI prevention bundles that are the operational standard for hospital infection control programs. The Joint Commission accredits hospitals in part on the basis of infection control practices and maintains National Patient Safety Goals that address infection prevention. The Society for Healthcare Epidemiology of America publishes practice recommendations for healthcare-associated infections. These sources collectively define what a reasonable hospital's infection control program does.
An expert in infection control or hospital epidemiology should be retained to evaluate whether the specific infection in your case was caused by a failure of these protocols. The expert must identify the specific failure — inadequate central line insertion technique, failure to perform PICC line care according to the bundle, failure to remove unnecessary urinary catheters , and explain how that failure enabled the organism to cause the infection. General assertions that infection prevention could have been better will not survive a Daubert challenge; the causation opinion must specify the breach and the mechanism.
The Records That Expose the Failure
Infection control cases require records beyond the standard medical chart. The hospital's internal infection surveillance records track HAI rates by unit, by procedure, and by time period. If the unit where your client was infected had an elevated CLABSI or CAUTI rate in the period surrounding the infection, that data is evidence of a systemic failure in the infection control program.
The central line insertion checklist, if one was used, documents whether the procedure followed the required steps: full barrier precautions, chlorhexidine skin prep, verification of proper draping. Gaps or absent entries in the checklist are evidence of breach. The nurse's documentation of daily central line care , line site assessment, dressing changes, flushing protocol , should be consistent with the bundle requirement. Document discrepancies between what the care protocol requires and what the flowsheets reflect.
Request the facility's infection control policies and procedures, their surveillance data for the relevant unit and time period, their hand hygiene compliance monitoring data, and any quality improvement corrective action documents relating to HAI rates in the period surrounding your client's infection. Quality improvement documents are often protected by state peer review statutes, but the underlying data used to generate them may be separately discoverable. Research the specific scope of your state's peer review protection carefully before structuring the discovery request.
Causation: Organism and Breach
Proving causation in an HAI case requires establishing both that the organism causing the infection was hospital-acquired and that the hospital's breach of the standard of care enabled the infection to occur. The first element is established by the clinical record: the admission cultures that were negative, the fever and infection signs that developed after admission, and the positive culture identifying the organism. Many hospital systems document HAIs according to CDC surveillance definitions, which specify the criteria for classifying an infection as healthcare-associated.
The second element, that the breach enabled the infection, requires expert testimony connecting the specific failure to the specific organism. A central line-associated bloodstream infection caused by a skin commensal organism like Staphylococcus epidermidis is consistent with a breach in line insertion or maintenance technique that allowed skin flora to enter the bloodstream. A surgical site infection with an organism matching what was present in the operating environment may support a different breach theory. The expert must explain why the breach enabled this infection, not just why infection control matters in general. For additional resources on building complex hospital malpractice cases, see our coverage at medical malpractice. Settlement patterns in serious HAI cases are covered in our case law and settlements section.
Using Quality Improvement Data Without Running Into Peer Review
Many hospitals generate quality improvement reports, infection surveillance dashboards, and corrective action plans as part of their infection control programs. These documents may be protected from discovery under state peer review or quality assurance statutes if they were created primarily for quality improvement purposes. However, the underlying data used to generate those reports, the raw infection counts, the surveillance records, and the compliance monitoring data, is often separately discoverable. Structure discovery requests to separately seek the underlying data from the derivative quality reports, and be prepared to litigate the scope of the peer review protection if the hospital asserts it blanketly. Courts in most jurisdictions draw the line between the protected deliberative process and the underlying factual data, and the factual data is generally accessible.