HEALTH service politicians have at last recognised the frequency, human misery, mortality and costs of hospital-acquired infections, but, as yet, have failed to understand the underlying problems.

True, personal hygiene (eg hand washing) and its enforcement is important but to ascribe the rise in acquired infection to the over use of antibiotics is too simplistic.

The range of conditions treated and the number of immunocompromised patients receiving irradiation, cytotoxic drugs or steroids has increased; so too has the presence of virulent and resistant organisms within hospitals.

Health ministers, such as David Davies, are wrong in supposing that infection control officers (usually a senior bacteriologist) are not present in all NHS hospitals.

They have a fourfold task: random sampling in wards, operating theatres, etc; investigating outbreaks; advising (in effect commanding) which antibiotic should be used in the presence of resistant organisms; and ensuring that organisms causing Legionnaire's Disease do not get into the hot water supply.

But these measures are secondary to primary prevention. In the past, ward sisters had a regular staff of nurses and cleaners responsible for their ward. Control of cleaning has been taken over by the domestic service manager and sisters have to complain or request what is needed indirectly through them.

In some hospitals, cleansing services have been privatised and administrators can only make changes through an intermediary. Secondly, financial stringency and shortage of supplies to wards has meant the reuse of disposable instruments.

Thirdly, administrators, to beautify wards, have often replaced linoleum with carpets providing a nidus for infection and a haven for house mites and dust exacerbating asthma and allergic conditions.

Lastly, more care is needed in the disposal of soiled materials. All these changes came about during the previous administration, but have continued.

A recent development is the replacement of ward sisters by ward managers, covering two or three wards, with junior sisters limited to shift work. It is up to health ministers to reverse these trends.

EDMUND CRITCHLEY, Merlin Road, Blackburn.