I'm responding to the article "Preventing surgical site infection" (November 2005). I'm pleased the author (and your publication) has addressed this important issue. The article was well written, following quality measures established on evidence-based research.

The Association for Professionals in Infection Control and Epidemiology's policy on healthcare-associated infections (HAIs) emphasizes prevention and promotes zero tolerance for HAIs and other adverse events. However, more education/clarification is necessary to give the reader a more complete picture of how and why HAIs occur, as it's inevitable that some patients will have an infection, regardless of their care.

The severity of illness in a patient is an independent factor in the probability of an adverse outcome (infection) during the natural course of a disease or condition, regardless of the patient's environment. Many organisms that cause infections are normally present in healthy individuals, and we each have different susceptibilities to these organisms at different times.

Generally, hospitalized patients already have a stressed immune system, which makes them more susceptible to any organism, intrinsic or extrinsic. The patient's immune system is often even more stressed with treatment, including invasive devises that allow an organism to become a pathogen (for example, the patient's skin flora) even with the most optimal care.

I'm afraid the public may erroneously believe there should be no infections in patients in healthcare settings. This is an unrealistic belief, and I feel we do a disservice if we neglect to educate correctly, causing unrealistic expectations.