In some states, urinary tract infections that may have been present at
admission and surgical site infections are among the various health care-
associated infections that must be reported to state authorities.

One reason that health-care associated infections (HAIs) may be classified as
a ‘never event’ on some lists but not on others is that the genesis of the
infection is not always known. Health care providers are working to identify
infections and colonizations that are present in the patient at admission,
which allows preemptive treatment and minimizes transmission to other
patients.

If a patient is admitted with an unknown infection, or if we do not suspect
that they have an infection, then we do not isolate them and, in turn, risk
spreading that infection to other inpatients.

The HAI issue that has caused a lot of controversy, particularly in
Pennsylvania, involves urinary tract infections (UTIs). Because we are testing
for them now, we are discovering them when the patient is in the hospital.
Reality says that some significant percentage of patients, particularly
elderly patients, has a low-grade UTI most of the time, which we are just
identifying and treating as they come into the hospital. Yet, since UTIs are
considered serious events in the state of Pennsylvania, a lot of time and
energy is devoted to the paperwork that comes with identifying and treating
these UTIs.

The HAI issue is a controversial point when it comes to ‘never events.’ HAIs
can include surgical site infections, of which some are readily treated and
others are not. Newspapers have featured several recent reports about
professional athletes who have surgical site infections, particularly from
knee surgeries.

Tom Brady (first-string quarterback for the New England Patriots) was one such
athlete who ended up in the news, and there are a couple of other people who
are headlining now because of infections. Therefore, these infections can
affect everyone and are an ongoing problem.

In an effort to reduce these infection-related issues, the physician needs to
talk to the patient at or before admission and before a procedure. Patients
should be warned that they may develop an infection, and some of these
infections arise from microorganisms that are already residents on the
patient’s skin.

Patients must be prepared for the possibility of acquiring an infection, and
must be educated as to how and why these infections occur and how they are
treated. Using this approach, patients may not be so surprised when they
receive a letter disclosing that he/she acquired an infection during
hospitalization.

Reference:
Kathleen Hale, RN, BSN, MHSA, and Richard P. Kidwell, JD Never Events: Health-
Care Associated Infections – Part 2.

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