Nel v Guy’s and St Thomas’ NHS Foundation Trust [06.04.12]

Claimant received damages of £541,000 after he contracted infection during endoscopic surgery to remove kidney stones; allegation of faulty washer-disinfector and in the alternative, reliance on res ipsa loquitor - the infection could not have occurred without negligence.


This case highlights the importance of Trusts having clear protocols and policies in place to deal with cross infection control measures, and the need for adequate staff training to assist with the prevention of the spread of infections. The unusual nature of the allegations, which were directed at those responsible for the operation and maintenance of the washer-disinfector, rather than those involved in the clinical treatment of the Claimant, highlights the need for such training to be given to all Trust staff, and not just those in a clinical role.

The Claimant also criticised the Trust for failing to apply lessons learned following a similar outbreak in the past. This further illustrates the value of an effective risk management regime and the importance of Trusts putting in place mechanisms to address earlier concerns.


The Claimant was treated for kidney stones at a hospital of the Defendant Trust in November 2005. A cystoscopy and ureterorenoscopy were performed - both procedures using an endoscope to investigate the bladder and kidney via the urethra.

The Claimant became unwell a few hours after discharge. He was taken to a hospital where it was noted that he was pyrexial, septic and unstable. He underwent a percutaneous nephrostomy, a procedure to insert a tube to drain infection from the kidney. However, he continued to deteriorate despite being given antibiotics and was admitted for intensive care.

Blood cultures revealed the Claimant became infected as a result of pseudomonas aeruginosa - a bacterium found in water and skin flora.

The Claimant alleged the Defendant was negligent in having

  1. Failed to apply lessons learned following a previous similar outbreak in 2008;
  2. Failed to train or adequately train staff in relation to the operation and maintenance of the washer-disinfector 
  3. Failed to install or adequately install a system for ensuring the water supply to the washer-disinfector was reasonably safe
  4. Failed to test the bacterial endotoxin level in the water

Alternatively, the Claimant relied on the doctrine of res ipsa loquitur in that the infection could not have occurred without negligence.

Liability was admitted.