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Management of MRSA infection following surgery (11HDC01438)
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(11HDC01438, 21 June
Plastic surgeon ~ Breast reduction surgery ~ Information
~Informed consent ~ Post-operative care ~ MRSA ~ Care coordination
~ Documentation ~ Rights 4(1), 4(2), 4(5), 6(1)(f)
A woman consulted a plastic surgeon to discuss breast reduction
surgery. She told the plastic surgeon of her concerns about
post-operative infection. The plastic surgeon allayed all of her
fears and gave her confidence that she would have nothing to worry
about, and she proceeded with the surgery.
Post-operatively, the woman developed infections in her wounds.
She telephoned the plastic surgeon's clinic and advised a nurse
that she was nauseous and feeling hot and cold. The plastic surgeon
instructed the woman to discontinue her antibiotics. The woman
continued to feel ill and became increasingly concerned. She
presented at the clinic and consulted with either the plastic
surgeon and/or his nurse on five occasions over a two week period.
During that time, the woman was prescribed an oral antibiotic, an
antibiotic ointment, and swabs of her wounds were taken.
The swabs cultured Methicillin Resistant Staphylococcus aureus
(MRSA) and Staphylococcus aureus. There is no evidence that the
woman was informed that she had MRSA, or that her general
practitioner was informed. The woman presented at the clinic the
following week, and the plastic surgeon reviewed her wound and
instructed her to return in three weeks' time. When the woman
phoned the clinic two and a half weeks later, she was told that the
plastic surgeon was not available, and she was referred to the
District Nurse. The District Nurse was also not advised that the
woman had MRSA.
It was held that it was more likely than not that the woman and
the plastic surgeon discussed the risk of infection at the first
consultation. However, in attempting to allay the woman's concerns
about the procedure, it appears that the plastic surgeon may have
understated that risk. He did not take sufficient care to ensure
that the woman's expectations in that regard were appropriately
managed, particularly given her experience and expressed concerns
in relation to infection. It was recommended that he review his
practice and take greater care in the future when discussing the
risks of surgery with patients.
The plastic surgeon should have reviewed the woman more closely
when it was known that her wound swab had cultured MRSA. He did not
provide post-operative services to the woman with reasonable care
and skill, and breached Right 4(1).
The plastic surgeon breached Right 6(1)(f) for failing to inform
the woman of the results of the swabs and that she had MRSA. He
also breached Right 4(5) for failing to inform her general
practitioner and the district nurse that the woman had MRSA, which
was information they required to ensure her ongoing care was
The plastic surgeon's record-keeping in this case was incomplete
and inadequate, and a breach of Right 4(2).