can lead to a lawsuit!!

Yes, according to a news article, a medical malpractice lawsuit filed late last month accuses nurses and health care providers of negligence by giving the patient “an IV tainted with streptococcus pyogenes” — bacteria commonly associated with strep throat. Click here for more info.

The harm – following the removal of the IV catheter, plaintiff’s arm became severely red, tender, and swollen at her IV site, and she was readmitted to the hospital on April 2, 2010, the complaint states. “Blood cultures taken from the plaintiff revealed that the plaintiff’s blood was positive for streptococcus pyrogenes. “Due to the infection in her blood acquired, the plaintiff underwent, among other procedures, a right knee aspiration and washout, a venectomy of her cephalic vein from her shoulder to below her antecubital fossa, as well as the placement of a subclavian catheter for long-term antibiotic infusion,”

The lawsuit – The first count of the malpractice suit claims the hospital owed a duty to provide the plaintiff with “clean, bacteria free medical equipment, such as IV needles, catheters, and medications,” as well as “a clean environment where simple procedures … may take place without unreasonable risk of an easily avoidable infection.” The complaint claims the hospital breached the standard of care by providing the plaintiff with an IV tainted with streptococcus pyogenes, failing to ensure proper infectious disease controls were implemented, enforced and adhered to, nor made sure employees involved in the patient’s care wore gloves, masks or washed their hands.

I agree – we don’t really know the whole story about this case and the details about the patient’s IV access but the complaint identifies hospital workers who “handled, flushed, injected fluids into, or otherwise specifically acted in some way upon the plaintiff’s IV site which became infected during her stay  between March 28 and March 31, 2010. Yup, this could happen and could involve anyone of us… although none of us would deliberately do “anything” to intentionally harm a patient or compromise the patient’s venous access.

So what do we remember about Streptoccocus pyogenes? (From Todar’s Online Textbook of Bacteriology) 

• Streptococcus pyogenes (Group A streptococcus) is a Gram-positive, nonmotile, nonsporeforming coccus that occurs in chains or in pairs of cells.
• Streptococcus pyogenes is one of the most frequent pathogens of humans. It is estimated that between 5-15% of normal individuals harbor the bacterium, usually in the respiratory tract, without signs of disease. As normal flora, S. pyogenes can infect when defenses are compromised or when the organisms are able to penetrate the constitutive defenses. When the bacteria are introduced or transmitted to vulnerable tissues, a variety of types of suppurative infections can occur.
• Streptococcus pyogenes owes its major success as a pathogen to its ability to colonize and rapidly multiply and spread in its host while evading phagocytosis and confusing the immune system.
• Acute diseases associated with Streptococcus pyogenes occur chiefly in the respiratory tract, bloodstream, or the skin. Streptococcal disease is most often a respiratory infection (pharyngitis or tonsillitis) or a skin infection (pyoderma). Some strains of streptococci show a predilection for the respiratory tract; others, for the skin. Generally, streptococcal isolates from the pharynx and respiratory tract do not cause skin infections.
• Infection with Streptococcus pyogenes can give rise to serious nonsuppurative sequelae: acute rheumatic fever and acute glomerulonephritis. These pathological events begin 1-3 weeks after an acute streptococcal illness, a latent period consistent with an immune-mediated etiology
•  Transmission via respiratory droplets, hand contact with nasal discharge and skin contact with impetigo lesions are the most important modes of transmission. The pathogen can be found in its carrier state in the anus, vagina, skin and pharynx and contact with these surfaces can spread the infection  The bacterium can be spread to cattle and then back to humans through raw milk as well as through contaminated food sources (salads, milk, eggs); however, cattle do not contract the disease. Necrotizing fasciitis is usually because of contamination of skin lesions or wounds with the infectious agent

It is very unfortunate this happened to this patient and it would be interesting to know the outcome of this case. What I do know and believe is – no nurse or healthcare worker would intentionally cause harm to a patient. With our vigilance in implementing and adhering to infection control practices, we will continue to protect our patient’s safety.