The State Journal's front page article on staff infections known as MRSA on April 15 was balanced but not as complete as it might have been.

MRSA is but one cause of health care associated infections (HAI). Indeed the new "community acquired " MRSA is more virulent than one we have known about in hospitals for more than 40 years. Other multiply drug resistant organisms (MDRO) also need continuing attention.

Our efforts need to be on the elimination of all preventable HAI. Based on my 40 years ' experience in the field of prevention and control of HAI some thoughts:

Nonsense No. 1: Universal screening of all Veterans Administration patients for nasal carriage of MRSA.

This program was introduced nationwide in all VA hospitals last year at an annual cost of $23 million. There is no scientific evidence that this program will reduce the spread of MRSA in the VA hospitals. In the meantime, the Centers for Disease Control, the one federal program where there is expertise on HAI, has a paltry $2 million a year to spread around the country in grants to learn the best practices necessary to prevent HAI.

The feds have it backwards. Let the VA have $2 million to test their unproven theories about MRSA on a random sample of patients and let the CDC have the $23 million to make a big difference in the elimination of

all

HAI.

Nonsense No. 2: State-mandated reporting of rates of HAI and MRSA.

Wisconsin has so far ducked these pernicious ideas. The laws require reporting HAI incidence data. The same idea has been legislated in some states for reporting MRSA infections of any kind. The public should only be given good data that everyone collects in the same way. Again, there is no credible scientific evidence that this mandatory reporting reduces infections or helps people choose the "best " hospitals.

Sense No. 1: Use CDC expertise and fund it.

The CDC has a panel of experts, appointed by the Health and Human Services secretary, to advise the government and all health care providers on solid evidence-based guidelines for the prevention and control of HAI.

This Healthcare Infection Control Advisory Committee is the best place for carefully reviewed evidence on our knowledge in this area. The committee provides the best information on preventing MDRO, MRSA, and all other preventable HAI. You would think the VA would at least follow the CDC committee advice. They did not.

Sense No. 2: Wisconsin already has some useful voluntary programs.

Fortunately the Wisconsin legislators I know who are interested in this area would like more evidence and would like a national set of definitions and guidelines before going forward with any legislation. The Wisconsin Hospital Association already collects a great deal of data about proven processes designed to prevent HAI reported from most hospitals in the state.

Good hand hygiene is task No. 1 for all of us in health care. There is much to be done. It would be wonderful if we could direct our federal funding and our collective energies in the most productive direction.

Scheckler is a hospital epidemiologist at St. Mary 's Hospital in Madison.