An infectious disease expert witness opines on a case happened in Hawaii where a patient suffers a severe surgical wound infection resulting in lower limb amputation following inadequate sterilization of medical equipment. This case involves a sixty-one-year-old female who presented to the hospital with a past medical history of osteoarthritis. Due to the severity of her condition, the patient underwent left ankle arthrodesis to relieve the chronic pain she was experiencing. The procedure took place without incident and the patient was discharged from hospital following an uneventful post-operative course. Three weeks following the surgery the patient returned to her primary care physician’s office for suture removal. A medical assistant employed by the physician removed the patient’s sutures using unsterilized forceps. Additionally, the medical assistant claimed that the utensils used for suture extraction were “exposed all day long” through multiple patient encounters. Two days following her visit to the physician’s office the patient developed a serious wound infection requiring hospitalization. She required constant medical care and multiple incision and drainages of the wound site, antimicrobial therapy (requiring a PICC line), skin grafts, and ankle hardware removal. The wound remained unhealed and the patient is left with an open hole on the medial aspect of her ankle. She then underwent a flap surgery, which later failed. Finally, the patient had to undergo a below-the-knee amputation (BKA) due to unsuccessful attempts to eradicate the infection.
Question(s) For Expert Witness
- Is it possible for a patient to contract this type of infection following a surgical procedure with unsterilized equipment?
Expert Witness Response E-004446
It is possible that the infection could have resulted from unsterilized equipment, especially if the equipment was re-used several times during the day on several patients with no sanitation in between uses. Since the patient had no signs of infection when she presented for suture removal this would suggest that the pathogen was introduced after the visit to the physician’s office. However, on the hand, there are all kinds of bacteria that live on the skin, and on the sutures, etc. It is possible that these bacteria could have been the causative pathogens in this case. So part of the answer depends upon what organism caused the infection – what is one that naturally colonizes the skin or was it an “alien” pathogen introduced to the wound through poor sterile techniques. It would also be very pertinent to investigate the patient’s medical history further. To fully assess the situation one would need to know whether or not the patient suffered from any co-morbidities such as vascular disease, obesity, etc that would affect her healing process. For example, diabetes mellitus is a known cause of poor wound healing.