Patients with methicillin-resistant Staphylococcus aureus (MRSA) can contaminate ED environments, according to the authors of a recent study.1 Researchers examined 42 adult ED patients with evidence of MRSA colonization. They obtained cultures from patients and then gathered cultures from up to 16 surfaces in ED rooms. This occurred after patient discharge, but before disinfection of the rooms. Of the 25 rooms occupied by patients with MRSA, 19 contained one or more MRSA-contaminated environmental surfaces.

This raises the question: What if an ED patient acquired a MRSA infection from a contaminated surface? It might seem like a successful lawsuit against the hospital would be imminent. However, David Talan, MD, FACEP, FIDSA, is unaware of a single case with this fact pattern.

“There’s evidence that MRSA exists in the ER, and there’s a small chance patients could acquire a nosocomial infection even during their short stay in the ED,” notes Talan, chair emeritus of the department of emergency medicine and faculty in the division of infectious diseases at Olive View-UCLA Medical Center in Sylmar, CA. Still, making a malpractice lawsuit out of that is surprisingly difficult. “It is theoretically possible, but it is virtually impossible to prove,” Talan says. “I have never seen it come up in a case involving ED care.”

There are many hurdles to overcome to prevail in a med/mal lawsuit with this fact pattern. A plaintiff attorney would need to subpoena the hospital’s infection control records and would have to find evidence that there were known outbreaks of MRSA infections in the ED. The attorney would need to prove the plaintiff contracted MRSA from the ED and not someplace else, a virtually impossible task.

“People can come in contact with bacteria from all sorts of mechanisms outside the hospital,” Talan says. “You’d need epidemiologic proof.”

The plaintiff attorney would need to discover a cluster of patients in a certain amount of time who were in a certain room in the ED, who all had open wounds, and contracted MRSA. Molecular techniques could be used to tell what type of MRSA the plaintiff contracted and whether it was an identical strain to the patient who was in the room before. This is a labor-intensive, costly, and farfetched scenario. “There are so many things that you’d need to piece together that it never happens,” Talan concludes. “It would be super difficult.”


  1. Liang SY, Jansson DR, Hogan PG, et al. Emergency department environmental contamination with methicillin-resistant Staphylococcus aureus after care of colonized patients. Ann Emerg Med 2019;74:50-55.