ETHICAL ISSUES ABOUT NOSOCOMIAL INFECTION S

Ethical issues about nosocomial infections have to be considered in tw o fields: the daily practice and the doctors participation in the inst itutional or suprainstitutional committees, involved in various admini strative, strategic or financial measures aiming at the control and th e prevention of nosocomial infections. In daily practice the ethical r ules are founded on the principles of individual good: regarding nosoc omial infection the principle of non maleficence is the most relevant. Physicians, nurses or other health professionals may have a part of r esponsibility in a nosocomial infection. However there are many impedi ments to their acknowledgement of their own moral responsibility. The most important impediments may be: a) the more and more collective app roach of care in many hospital wards; b) the fact that the consequence s of a nosocomial infection in one patient can extend to patients in o ther structures and, thus, can remain ignored by those who are respons ible for this infection; c) paradoxically enough, the high attention p aid to the theoretical issues concerning nosocomial infection. It must be kept in mind, too, that the ethical issues concerning nosocomial i nfections include the necessity for providing the patients with adequa te and truthful information about the risks of nosocomial infection, i n every hospital or ward, and - if it happens - about the nosocomial n ature of an infectious complication. There is also some concern about the fact that the various modalities of legal responsibility and indem nification for a nosocomial infection, that the law has already specif ied or could define in a near future, may have a negative influence on the capacity of many care providers to keep a feeling of their moral responsibility. In the official committees devoted to decide administr ative, strategic or financial measures able to help scientific researc h and to induce better practice in the surveillance and the prevention of nosocomial infections, the ethical principles at use are not only those of good but also those of justice. The balance between these eth ical principles is delicate, however, for doctors, the main concern sh ould be to avoid any distortion of the debate which could result from their confusing use of the principles of good. (C) 1998 Elsevier, Pari s.