This article, the first in a series that will explore the legal implications of hospital infection control, outlines the basic legal principles applicable to infection control. Future articles will discuss the issue of confidentiality and apply general principles to the specific issues surrounding AIDS.

In order to succeed in a medical malpractice action, the plaintiff must demonstrate by a preponderance of the evidence that: (1) the defendant(s) had a duty to act in a particular manner; (2) the defendant(s) negligently breached that duty; (3) the plaintiff suffered some “harm” or injury; and (4) the harm suffered by the plaintiff was causally related to the breach of duty.'

Physicians and hospitals have a duty, once a patient care provider relationship has been created, to provide care to the best of their skill, training, and experience.' A significant aspect of that duty for hospitals is the creation and maintenance of an environment that is safe from unnecessary risk of infection or harm.

The genus Bacillus is a diverse group of gram-positive, spore-forming aerobic bacilli. B anthracis, the agent of anthrax, is primarily an animal pathogen but is capable of causing human infection, most commonly of the skin or lungs. B cereus, a well-recognized cause of gastroenteritis, may occasionally cause epidemics in health institutions. Both B cereus and other Bacillusspecies are increasingly recognized as opportunistic pathogens in the hospitalized patient. This report is intended as a comprehensive review of the bacteriology, clinical features, and therapy of Bacillus spp infections. Nosocomial epidemics and transmission will be highlighted.

As the consumers and regulators of health care have become more concerned with quality of delivered services, interest has focused on hospital- and physician-specific mortality rates as an index of quality. Mortality rates have several characteristics that promote their use as a performance indicator. The numerator, death, is generally (but perhaps incorrectly) accepted as an adverse outcome of health care. Death is thought to be easily measured, and is recorded in several locations, including the medical record abstract and death certificates, where the information is accessible without provider consent. The denominator, persons or patients, is also available from several public sources. The desirability of mortality data is further enhanced by the wide variety of statistical methods to manipulate and compare rates and proportions. The conceptual validity of mortality rates as reflecting quality is supported by a long tradition of using mortality rates at the “macro” level to compare the quality of national health care delivery systems (eg, infant mortality rates) and at the “micro” level to compare the outcome of different therapies (eg, thrombolytics for acute myocardial infarction). However, despite face validity, ease of measurement, and widespread acceptance in other areas, hospital-specific mortality rates, as calculated from current data sources, have a variety of potential problems.This article will explore the clinical, administrative, and information-based difficulties in using mortality rates as an indicator of the quality of medical care delivered by specific hospitals or physicians.

The goal of diagnostic testing is to identify patients with a particular disease. Often, it is just as important that the test not mistakenly identify healthy persons as having disease. For example, a new test for the acquired immunodeficiency syndrome (AIDS) might identify 99.99% of all patients infected with the human immunodeficiency virus (HIV). However, if the test is positive in large numbers of persons who are not infected, its usefulness may be overshadowed by the harm caused by false positive results.