HOSPITAL INFECTIONS.

Fortunately, I have many friends and acquaintances who are doctors in various specialisations, and this topic sometimes comes up in conversation. However, it is something that affects everyone as patients, especially whenever we undergo medical or hospital treatment. With regard to healthcare-associated infections (HAIs), i.e. those that occur at least 48 hours after admission to hospital and up to a maximum of three days after discharge, the Supreme Court has consolidated a precise division of the burden of proof in a recent order of the Supreme Court No. 17145 of 2025.

The patient seeking compensation for damages has the burden of proving the causal link between the onset of the infection and the healthcare service, according to the “more likely than not” criterion. Such proof may also be provided on a presumptive basis, using serious, precise and consistent evidence. Case law has identified the main presumptive elements as temporal (onset of infection from the third day of hospitalisation), topographical (location of the infection at the surgical site) and clinical (type of microorganism).

last update October 2025

Once the patient has fulfilled this burden of proof by demonstrating the likely nosocomial origin of the infection, the burden of proof shifts to the healthcare facility. In order to exclude its liability, the facility must demonstrate that it has fulfilled its duty of care by proving that it has adopted and effectively applied all necessary measures to prevent infection. As specified by the Court of Cassation, the facility must document the effective implementation of protocols relating, for example, to the disinfection of environments, the sterilisation of materials, waste management, air quality and microbiological surveillance. The mere preparation of general protocols is not sufficient if their application to the specific case is not proven.

On the other hand, however, it has been stated that, according to the principle of proximity of evidence, incomplete medical records cannot result in prejudicial evidence for the patient.

Everyone must do their best, both as patients and, above all, as healthcare facilities, in the hope that such cases occur as rarely as possible.