{"id":869709,"date":"2026-05-09T14:16:57","date_gmt":"2026-05-09T12:16:57","guid":{"rendered":"https:\/\/kohenavocats.com\/infection-nosocomiale-indemnisation-charge-preuve-2026\/"},"modified":"2026-05-09T14:16:57","modified_gmt":"2026-05-09T12:16:57","slug":"infection-nosocomiale-indemnisation-charge-preuve-2026","status":"publish","type":"post","link":"https:\/\/kohenavocats.com\/tr\/infection-nosocomiale-indemnisation-charge-preuve-2026\/","title":{"rendered":"Infection nosocomiale : indemnisation et charge de la preuve apr\u00e8s les arr\u00eats de 2026"},"content":{"rendered":"

Le 7 janvier 2026, la premi\u00e8re chambre civile de la Cour de cassation a censur\u00e9 une cour d’appel qui exigeait du patient la preuve d’un lien direct et certain entre son infection et les soins prodigu\u00e9s par la clinique. Le 25 f\u00e9vrier 2026, le Conseil d’\u00c9tat a suivi le m\u00eame raisonnement dans une affaire impliquant l’ONIAM. Ces deux d\u00e9cisions confirment une r\u00e8gle majeure : d\u00e8s lors qu’une infection est qualifi\u00e9e de nosocomiale, le poids de la preuve bascule sur l’\u00e9tablissement de sant\u00e9. Ce retournement juridique conditionne directement la strat\u00e9gie que doit adopter tout patient ou famille confront\u00e9 \u00e0 une infection contract\u00e9e en milieu hospitalier.<\/p>\n

Qu’est-ce qu’une infection nosocomiale au sens juridique ?<\/h2>\n

L’article R. 6111-6 du code de la sant\u00e9 publique (texte officiel<\/a>) dispose que \u00ab les infections associ\u00e9es aux soins contract\u00e9es dans un \u00e9tablissement de sant\u00e9 sont dites infections nosocomiales \u00bb. Le Conseil d’\u00c9tat est venu pr\u00e9ciser cette d\u00e9finition r\u00e9glementaire. Il a jug\u00e9 qu’une infection pr\u00e9sente un caract\u00e8re nosocomial. Elle doit \u00ab survenir au cours ou au d\u00e9cours de la prise en charge d’un patient \u00bb. Elle ne devait \u00ab ni \u00eatre pr\u00e9sente, ni en incubation au d\u00e9but de celle-ci \u00bb. Cette pr\u00e9somption peut toutefois \u00eatre renvers\u00e9e. L’\u00e9tablissement doit alors prouver que l’infection a \u00ab une autre origine que la prise en charge \u00bb (CE, 23 mars 2018, n\u00b0 402237 (d\u00e9cision<\/a>)), motifs : \u00ab doit \u00eatre regard\u00e9e comme pr\u00e9sentant un caract\u00e8re nosocomial […] sauf s’il est \u00e9tabli qu’elle a une autre origine que la prise en charge \u00bb.<\/p>\n

La Cour de cassation a align\u00e9 sa jurisprudence sur celle du juge administratif. Elle retient d\u00e9sormais la m\u00eame d\u00e9finition extensive. Ni le caract\u00e8re endog\u00e8ne du germe, ni l’\u00e9tat ant\u00e9rieur du patient, ni son comportement ne permettent d’\u00e9carter cette qualification. Seuls le crit\u00e8re temporel et l’absence d’incubation \u00e0 l’admission sont pris en compte.<\/p>\n

La pr\u00e9somption de responsabilit\u00e9 de l’\u00e9tablissement de sant\u00e9<\/h2>\n

L’article L. 1142-1 du code de la sant\u00e9 publique (texte officiel<\/a>) \u00e9tablit un r\u00e9gime de responsabilit\u00e9 sans faute : \u00ab Les \u00e9tablissements, services et organismes susmentionn\u00e9s sont responsables des dommages r\u00e9sultant d’infections nosocomiales, sauf s’ils rapportent la preuve d’une cause \u00e9trang\u00e8re \u00bb. L’\u00e9tablissement ne peut donc pas se contenter de d\u00e9montrer l’absence de faute dans son organisation. Il doit prouver que l’infection proc\u00e8de d’une cause \u00e9trang\u00e8re \u00e0 la prise en charge.<\/p>\n

Parall\u00e8lement, l’article L. 1142-1-1 du code de la sant\u00e9 publique (texte officiel<\/a>) pr\u00e9voit une indemnisation au titre de la solidarit\u00e9 nationale lorsque le dommage atteint un seuil de gravit\u00e9. Ce r\u00e9gime s’applique lorsque la responsabilit\u00e9 de l’\u00e9tablissement n’est pas engag\u00e9e ou lorsque le taux d’atteinte permanente \u00e0 l’int\u00e9grit\u00e9 physique d\u00e9passe 25 %, ainsi qu’en cas de d\u00e9c\u00e8s.<\/p>\n

Les arr\u00eats de 2026 : l’incertitude ne suffit plus \u00e0 exon\u00e9rer<\/h2>\n

La Cour de cassation renverse la charge de la preuve<\/h3>\n

Dans un arr\u00eat du 7 janvier 2026, la Cour de cassation est revenue sur une d\u00e9cision de la cour d’appel de Paris qui avait rejet\u00e9 la demande indemnitaire d’un patient. La cour d’appel estimait que l’expertise m\u00e9dicale laissait planer un doute sur l’origine de l’infection. Elle en avait d\u00e9duit que le patient n’apportait pas la preuve du lien causal entre les soins et son dommage.<\/p>\n

La Cour de cassation a censur\u00e9 ce raisonnement au visa de l’article L. 1142-1 du code de la sant\u00e9 publique. Elle a pr\u00e9cis\u00e9 la r\u00e9partition de la charge de la preuve.<\/p>\n

\n

\u00ab Dans le cas d’une infection consid\u00e9r\u00e9e comme nosocomiale, c’est \u00e0 l’\u00e9tablissement de sant\u00e9 qu’il incombe d’apporter la preuve que la contamination ne s’est pas produite lors des soins qu’il a prodigu\u00e9s au patient et proc\u00e8de ainsi d’une cause \u00e9trang\u00e8re \u00bb<\/p>\n<\/blockquote>\n

(Cass. 1re civ., 7 janvier 2026, n\u00b0 24-20.829 (d\u00e9cision<\/a>)), motifs : \u00ab dans le cas d’une infection consid\u00e9r\u00e9e comme nosocomiale, c’est \u00e0 l’\u00e9tablissement de sant\u00e9 qu’il incombe d’apporter la preuve \u00bb. La simple incertitude de l’expert ne constitue pas une preuve de cause \u00e9trang\u00e8re.<\/p>\n

Le Conseil d’\u00c9tat confirme la pr\u00e9somption en contentieux administratif<\/h3>\n

Dans un arr\u00eat du 25 f\u00e9vrier 2026, le Conseil d’\u00c9tat a \u00e9t\u00e9 saisi d’un pourvoi de l’ONIAM contre un arr\u00eat de la cour administrative d’appel de Nantes. L’Office contestait le caract\u00e8re nosocomial d’une infection contract\u00e9e par un patient hospitalis\u00e9 au CHU de Nantes. Le patient avait bri\u00e8vement quitt\u00e9 l’\u00e9tablissement avant de pr\u00e9senter les premiers sympt\u00f4mes. L’ONIAM arguait que cette sortie non autoris\u00e9e pouvait constituer une cause \u00e9trang\u00e8re.<\/p>\n

Le Conseil d’\u00c9tat a rejet\u00e9 le pourvoi. Il a jug\u00e9 que la cour d’appel avait souverainement appr\u00e9ci\u00e9 les faits. Elle avait relev\u00e9 une incertitude. Celle-ci concernait \u00ab la possibilit\u00e9 qu’il ait contract\u00e9 l’infection \u00e0 l’occasion de sa br\u00e8ve sortie de l’h\u00f4pital \u00bb. Cette incertitude ne permettait pas de regarder l’ONIAM comme apportant la preuve d’une autre origine (CE, 5\u00e8me et 6\u00e8me chambres r\u00e9unies, 25 f\u00e9vrier 2026, n\u00b0 499381 (d\u00e9cision<\/a>)), motifs : \u00ab l’Office ne pouvait \u00eatre regard\u00e9 comme apportant la preuve que l’infection avait une autre origine que sa prise en charge par le centre hospitalier \u00bb.<\/p>\n

Comment obtenir l’indemnisation : CCI, tribunal ou ONIAM<\/h2>\n

Le patient dispose de plusieurs voies pour faire reconna\u00eetre son droit \u00e0 r\u00e9paration. Le choix de la proc\u00e9dure d\u00e9pend de la gravit\u00e9 du dommage, de la nature de l’\u00e9tablissement et de l’issue de la proc\u00e9dure amiable.<\/p>\n\n\n\n\n\n\n\n
Voie de recours<\/th>\nJuridiction comp\u00e9tente<\/th>\nD\u00e9lai<\/th>\nSeuil de gravit\u00e9<\/th>\nQui indemnise<\/th>\n<\/tr>\n<\/thead>\n
Commission de conciliation et d’indemnisation (CCI)<\/td>\nAmiable<\/td>\n10 ans apr\u00e8s consolidation<\/td>\nAIPP > 24 % ou d\u00e9c\u00e8s<\/td>\nONIAM ou assureur de l’\u00e9tablissement<\/td>\n<\/tr>\n
Tribunal judiciaire<\/td>\nJuge civil<\/td>\n10 ans apr\u00e8s consolidation<\/td>\nAucun<\/td>\nAssureur de l’\u00e9tablissement ou m\u00e9decin<\/td>\n<\/tr>\n
Tribunal administratif<\/td>\nJuge administratif<\/td>\n10 ans apr\u00e8s consolidation<\/td>\nAucun<\/td>\n\u00c9tablissement public ou ONIAM<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

La saisine de la CCI est gratuite et ne n\u00e9cessite pas d’avocat. L’expertise m\u00e9dicale est organis\u00e9e par la commission. Pour en savoir plus sur la contre-expertise m\u00e9dicale et les d\u00e9lais de recours<\/a>, consultez notre analyse d\u00e9taill\u00e9e. Si l’avis de la CCI reconna\u00eet le caract\u00e8re nosocomial de l’infection et retient la responsabilit\u00e9 de l’\u00e9tablissement, l’assureur de celui-ci dispose de quatre mois pour pr\u00e9senter une offre d’indemnisation. \u00c0 d\u00e9faut, l’ONIAM peut se substituer.<\/p>\n

Lorsque le dommage atteint le seuil de 25 % d’atteinte permanente \u00e0 l’int\u00e9grit\u00e9 physique ou entra\u00eene le d\u00e9c\u00e8s, l’indemnisation rel\u00e8ve de la solidarit\u00e9 nationale. L’ONIAM pr\u00e9sente alors directement une offre. Le bar\u00e8me d’\u00e9valuation du pr\u00e9judice suit les r\u00e8gles expos\u00e9es dans notre article sur le pr\u00e9judice esth\u00e9tique et le calcul de l’indemnisation en 2026<\/a>. Le patient conserve n\u00e9anmoins la possibilit\u00e9 d’engager une action en justice si l’offre est insuffisante ou si une faute m\u00e9dicale est all\u00e9gu\u00e9e en compl\u00e9ment.<\/p>\n

Infection nosocomiale \u00e0 Paris et en \u00cele-de-France : juridictions comp\u00e9tentes<\/h2>\n

\u00c0 Paris, le tribunal judiciaire est comp\u00e9tent pour les litiges concernant les \u00e9tablissements de sant\u00e9 priv\u00e9s. Le tribunal administratif de Paris conna\u00eet des contentieux impliquant les h\u00f4pitaux publics de l’Assistance publique \u2014 H\u00f4pitaux de Paris (AP-HP). Les cours d’appel de Paris et de Versailles exercent un contr\u00f4le sur les d\u00e9cisions de premi\u00e8re instance selon le lieu de survenance de l’infection.<\/p>\n

La CCI d’\u00cele-de-France instruit les dossiers de patients ayant \u00e9t\u00e9 pris en charge dans les \u00e9tablissements de la r\u00e9gion. Le d\u00e9lai moyen d’instruction est de huit \u00e0 douze mois. Il est conseill\u00e9 de constituer un dossier complet d\u00e8s la saisine : compte-rendu d’op\u00e9ration, r\u00e9sultats de pr\u00e9l\u00e8vements microbiologiques, courriers de sortie, et tout document attestant de l’absence d’infection \u00e0 l’admission.<\/p>\n

Questions fr\u00e9quentes<\/h2>\n

Une infection survenue plusieurs semaines apr\u00e8s l’intervention peut-elle \u00eatre qualifi\u00e9e de nosocomiale ?<\/strong><\/p>\n

Oui. Le crit\u00e8re temporel s’appr\u00e9cie au cas par cas. Le Conseil d’\u00c9tat et la Cour de cassation retiennent la notion de \u00ab d\u00e9cours \u00bb de la prise en charge. Une infection du site op\u00e9ratoire apparue dans les quatorze jours suivant l’intervention est classiquement regard\u00e9e comme nosocomiale. Le d\u00e9lai peut \u00eatre plus long pour certaines infections li\u00e9es \u00e0 des implants.<\/p>\n

Le patient doit-il prouver que l’h\u00f4pital a commis une faute d’hygi\u00e8ne ?<\/strong><\/p>\n

Non. Le r\u00e9gime de l’article L. 1142-1 du code de la sant\u00e9 publique est un r\u00e9gime de responsabilit\u00e9 sans faute. La victime n’a pas \u00e0 \u00e9tablir une carence dans les protocoles d’asepsie. Elle doit seulement d\u00e9montrer que l’infection r\u00e9pond \u00e0 la d\u00e9finition juridique du caract\u00e8re nosocomial.<\/p>\n

L’ONIAM peut-il refuser d’indemniser au motif que l’origine de l’infection est incertaine ?<\/strong><\/p>\n

Non. Les arr\u00eats de 2026 ont pr\u00e9cis\u00e9 que l’incertitude sur l’origine de l’infection ne suffit pas \u00e0 exon\u00e9rer l’\u00e9tablissement ou l’ONIAM. C’est \u00e0 l’\u00e9tablissement de prouver une cause \u00e9trang\u00e8re. \u00c0 d\u00e9faut, la pr\u00e9somption de responsabilit\u00e9 ou l’indemnisation au titre de la solidarit\u00e9 nationale s’appliquent.<\/p>\n

Le refus de soins du patient peut-il diminuer l’indemnisation ?<\/strong><\/p>\n

Non. La Cour de cassation a tranch\u00e9 cette question. Le refus d’un patient victime d’une infection nosocomiale de se soumettre \u00e0 des traitements m\u00e9dicaux ne peut entra\u00eener la perte ou la diminution de son droit \u00e0 indemnisation. Ce refus rel\u00e8ve de son droit au consentement \u00e9clair\u00e9 pr\u00e9vu \u00e0 l’article L. 1111-4 du code de la sant\u00e9 publique.<\/p>\n

Peut-on agir contre le m\u00e9decin en cas d’infection nosocomiale ?<\/strong><\/p>\n

La responsabilit\u00e9 de l’\u00e9tablissement de sant\u00e9 est engag\u00e9e de plein droit. Celle du m\u00e9decin ne peut \u00eatre recherch\u00e9e qu’en cas de faute personnelle d\u00e9montr\u00e9e. La Cour de cassation a toutefois pr\u00e9cis\u00e9 que la responsabilit\u00e9 du praticien demeure engag\u00e9e si une faute m\u00e9dicale distincte est \u00e9tablie, ind\u00e9pendamment de la prise en charge par l’ONIAM.<\/p>\n

Besoin d’un avis rapide sur votre dossier<\/h2>\n

Vous ou un proche avez contract\u00e9 une infection apr\u00e8s une hospitalisation ou une intervention chirurgicale ? Notre cabinet vous propose une consultation t\u00e9l\u00e9phonique en 48 heures avec un avocat sp\u00e9cialis\u00e9 en droit m\u00e9dical et dommage corporel. Nous analysons votre dossier, v\u00e9rifions le caract\u00e8re nosocomial de l’infection et d\u00e9terminons la voie d’indemnisation la plus adapt\u00e9e.<\/p>\n

Contactez-nous au 06 89 11 34 45<\/a> ou via notre formulaire de contact<\/a>.<\/p>\n

Cabinet Kohen Avocats \u2014 Paris et \u00cele-de-France<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Les arr\u00eats de 2026 confirment que l’incertitude sur l’origine d’une infection nosocomiale ne suffit pas \u00e0 exon\u00e9rer l’\u00e9tablissement de sant\u00e9.<\/p>\n","protected":false},"author":232070755,"featured_media":4725,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_crdt_document":"","_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_kj_source_type":"","_kj_official_id":"","_kj_official_url":"","_kj_judilibre_id":"","_kj_jur":"","_kj_lieu":"","_kj_chambre":"","_kj_rg":"","_kj_date":"","_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[6995,58543],"tags":[],"class_list":["post-869709","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-decryptage","category-droit-medical"],"yoast_head":"\nInfection nosocomiale : indemnisation et charge de la preuve apr\u00e8s les arr\u00eats de 2026 - 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