Management of the Medico-Legal Dispute of Healthcare-Related SARS-CoV-2 Infections: Evaluation Criteria and Case Study in a Large University Hospital in Northwest Italy from 2020 to 2021

Rosario Barranco (), Isabella Caristo, Filippo Spigno, Marta Ponzano, Alessio Trevisan, Alessio Signori, Antonio Di Biagio and Francesco Ventura
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Rosario Barranco: Department of Legal and Forensic Medicine, Health Science Department (DISSAL), University of Genova, 16132 Genova, Italy
Isabella Caristo: Department of Legal and Forensic Medicine, Health Science Department (DISSAL), University of Genova, 16132 Genova, Italy
Filippo Spigno: Department of Legal and Forensic Medicine, Health Science Department (DISSAL), University of Genova, 16132 Genova, Italy
Marta Ponzano: Department of Health Sciences, Section of Biostatistics, University of Genova, 16132 Genova, Italy
Alessio Trevisan: Transfusion Medicine, Policlinico San Martino Hospital, 16132 Genova, Italy
Alessio Signori: Department of Health Sciences, Section of Biostatistics, University of Genova, 16132 Genova, Italy
Antonio Di Biagio: Infectious Diseases Unit, Policlinico San Martino Hospital, 16132 Genova, Italy
Francesco Ventura: Department of Legal and Forensic Medicine, Health Science Department (DISSAL), University of Genova, 16132 Genova, Italy

IJERPH, 2022, vol. 19, issue 24, 1-13

Abstract: Healthcare-related SARS-CoV-2 infection is an issue of particular concern during the pandemic. It has important repercussions on the National Health System, which represents a source of medical-legal health disputes. In the healthcare context, there are reports of negative screening at hospital admission (via nasopharyngeal swabs) and subsequent diagnosis of SARS-CoV-2 infection during hospitalization. Such cases cannot be considered a priori of healthcare-related infections but require extensive in-depth evaluation. In this study, we propose an empirical classification to frame cases of SARS-CoV-2 infection diagnosed in the hospital (first negative admission swab, with subsequent positive test during hospitalization). The classification is based on five categories: nosocomial, probably nosocomial, indeterminate, probably community, and community cases. We analyzed patients who died after testing positive for SARS-CoV-2 during hospitalization (with initial negative screening) in the largest hospital in Northwest Italy from February 2020 to 31 December 2021. A total of 383 cases were tracked and are listed as follows: 41 cases (11%) were classified as nosocomial (i.e., 3.2% of COVID-19 deaths). In contrast, 71 cases (19%) were classified as probably nosocomial, 69 (18%) were indeterminate (i.e., the clinical, radiological, and laboratory characteristics did not provide information on the genesis of the infection), 166 (43%) were classified as probably community cases, and 36 (9%) were defined as community cases. Deceased patients with nosocomial SARS-CoV-2 infection constituted the following: 3.23% (41/1266) with respect to the total number of COVID-19 deaths, 1.1% (41/3789) with respect to those who entered the hospital with a negative swab and 0.82% (41/4672) with respect to the total of deaths from any cause of death. In this paper we discuss the topic and issues of nosocomial COVID-19 in hospitalized patients and address the medicolegal implications.

Keywords: SARS-CoV-2; healthcare-related SARS-CoV-2; medico-legal disputes; legal medicine; COVID-19 (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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