Devon and Exeter Medico Legal Association Event

Chris Thorne of Foot Anstey with Derek Butler and the Chair of DEMLA,
Christopher Gardner-Thorpe

On the 10th January MRSA Action UK members Derek Butler, Maria Cann, John Galvin and Susan Spratt attended the Devon and Exeter Medico Legal Association (DEMLA) meeting to take part in the debate about healthcare associated infections and the legal and moral dilemma faced by staff and patients when things go wrong.

The event was well attended by professionals from the medical and legal profession. Alaric Coleville from Royal Devon and Exeter Hospital Trust gave an interesting presentation on the history of MRSA and the challenges facing healthcare providers in preventing healthcare associated infections. Bacteria are found on the skin of all of us, healthcare workers, patients, visitors all had a part to play. MRSA was not the only infection, and although the Trust had achieved considerable success in reducing the numbers of MRSA bacteraemia to zero, there was still more to do to reduce other infections, including the high numbers of Clostridium difficile.

Derek presented a summary of cases of people who had been affected by contraction of healthcare associated infections, and not surprisingly because of the nature of bacteria colonising skin, it was all age groups that had been affected. Anyone receiving healthcare is at risk if the proper systems and procedures are not followed.

Healthcare settings are obliged to meet the requirements set out in The Health and Social Care Act 2008, Code of Practice on the prevention and control of infections and related guidance. Trusts have a duty under the Health and Safety at Work Act to protect staff and service users from pathogens, including bacteria that can be found in the environment, on medical devices, and the biggest transmitter, the hands of healthcare workers.

A retired orthopaedic surgeon said that when he was practising, attention was paid to asepsis, as the skin of the surgeon and the patient was viewed as high risk. There was no prophylaxis, isolation was used for high risk operations and patients did not contract infections. He believed the mix on wards was contributing to more infections. His argument was comparable to that of one used by our President, Professor Hugh Pennington. Staphylococcus aureus was a known problem back in the late 1860s and early 1870s. In 1884 the surgeon William MacEwen reported his series of 804 antiseptic limb-bone operations at Glasgow Royal Infirmary. Only 8 became infected, and only 3 died, one of pneumonia, one of tuberculosis, and one of diphtheria. Methods turned out to be risky with the use of carbolic soap which eventually affected the health of the surgeons, but mortality and infections in orthopaedic surgery was not as it is seen now.

Maria raised the thorny issue of staff not washing their hands between patients. Alaric said that staff didn't mind being asked, and if patients thought handwashing was not happening it was likely alcohol gel was being used. Maria said that patients who were unconscious couldn't ask, and patients who are vulnerable are unlikely to feel they can challenge, it's difficult when you are in that situation. Alcohol gel is not a panacea; it doesn't work on organic material, such as human faeces, vomit. And sometimes this may not be visible to the naked eye on hands.

Medical practitioners are responsible; patients shouldn't have to remind them. Causation is mainly through the poor practice of medical practitioners, although legally it is often difficult to prove. Post infection review and route cause analysis will often show the likely cause of an infection. If staff are not properly trained or they are not following procedures correctly then this can usually be identified.

Derek had highlighted the case of Kitty Cope where COSHH regulations were used. Although the case settled out of court for what is believed to be far in excess of the compensation quoted in the press, it was the hospital not following its procedures that made it possible to take the case forward through the COSHH regulations.

Preventing infections save lives and is everyone's business, but ultimately it is the medical practitioners who, if they follow aseptic practice, including good hand hygiene, should have preventing infections well within their grasp.

If you or someone you care about has been affected by a healthcare associated infection and you wish to discuss this with us, please contact us at

The information on this website is for general purposes only and is not a substitute for qualified medical care, if you are unwell please seek medical advice.

(c) MRSA Action UK 2013