Hospital-acquired infections: Alfred Nel v Guy’s & St Thomas’ NHS Foundation Trust

Hospital-acquired infections continue to be a perennial problem. In addition, unfortunately, it continues to be very difficult for patients to get redress via litigation. This article considers a fascinating, yet disturbing, case that involved 20 people being infected with Pseudomonas aeruginosa – a hospital infection that is not well known to the public. It also considers the adequacy of the present system for reporting hospitalacquired infections to Public Health England, formerly the Health Protection Agency. Alfred Nel’s claim against Guy’s & St Thomas’ NHS Foundation Trust was both fascinating from a lawyer’s perspective, especially evidentially, and appalling. It was a brutal example of the consequences of failings that are easily avoidable and involved the persistent problem of hospital-acquired infections. The issues reached far beyond the case itself – issues that affect all of us, as patients. Mr Nel almost died as a result of an outbreak of P. aeruginosa, a bacteria found in water which infected him and 19 others at Guy’s Hospital, London, in November 2005. A young woman, aged 21, died as a result of the same outbreak. I only acted for Mr Nel. The surgical unit at Guy’s Hospital was closed for a period of time after the outbreak became apparent. P. aeruginosa can spread by the transfer of bacteria on medical equipment such as breathing equipment, intravenous lines and catheters, as a result of contact with contaminated water. It is probably untreatable in most cases. It is prevented by hand hygiene and good infection control measures, such as medical equipment washers and disinfectors. Mr Nel was an exceptionally strong, rugby-playing South-African plumber, who was aged 38 at the time of the incident. He worked extremely hard and loved physical activity. He was robust and the type of man who did not complain about pain or illness. Mr Nel had a history of kidney stones, which had never caused him much trouble and which had been treated routinely in the past. He would usually return to work very soon after the treatment. Mr Nel had a recurrence of kidney stones in October 2005 and was treated for these at Guy’s Hospital on 1 November 2005. The procedure involved inserting an endoscope (a long tube with a light and camera at the end) up his ureter so that his kidney could be inspected. The kidney stones were treated, and the following day, a stent that had been inserted was removed. All seemed fine and he was discharged. A few hours later, Mr Nel became extremely unwell and had severe pain in his kidney area. He started showing signs of serious and extensive infection. The pain became unbearable and spread over his body, arms and legs until his entire body felt in agony. His wife called an ambulance, and he was taken to Luton & Dunstable Hospital. He was pyrexial, septic and unstable. Mr Nel needed emergency treatment. The doctors performed a percutaneous nephrostomy, which involved puncturing the skin to create a pathway for a tube to drain the infection. He was also given antibiotics. However, he deteriorated as the antibiotics failed to combat the infection. On 4 November 2005, he was admitted to Intensive Care. He was critically ill, vomiting blood and fighting for his life. Tests revealed that he had become infected as a result of contracting P. aeruginosa. Studies have shown that patients such as Mr Nel, who have become septic as a result of P. aeruginosa, have only about a 20% chance of survival. He was very lucky to survive. We were the second firm to act for Mr Nel. Our investigations showed that there were serious and avoidable failings in the washer-disinfector cleaning equipment used to sterilise the endoscope that had been inserted into Mr Nel’s ureter during surgery.