Dáil Éireann debate -
Wednesday, 7 May 1997

Vol. 478 No. 7

Adjournment Debate. - MRSA Monitoring Unit.

Mr. B. O'Keeffe

The Minister is aware that the super bug, MRSA, is rampant in acute hospitals. I am aware of cases where people died after they contracted MRSA in acute hospitals. People are afraid that they will contract this disease, which can be fatal, after they are admitted to acute hospitals.

I understand a number of operations have been postponed in an acute hospital in Dublin. It is extremely costly to deal with MRSA because wards must be isolated and patients who contract the bug require great care and attention. I bring this to the Minister's attention because it is a bug for which there is no known cure. I understand also that, in many instances, it is contracted through open wounds, particularly by those who have had operations and who are susceptible to it.

I have been informed by people in University Hospital in Cork that, at any given time, there could be ten to 20 people within that hospital suffering from this bug, a problem which manifests itself in all acute hospitals nationwide.

While the Department has issued guidelines, some of the difficulties to which this infection gives rise are only now becoming apparent. For example, this week I was contacted by the family of a terminally ill person who contracted this MRSA in an acute hospital. The hospital discharged the person to a nursing home where the medical staff discovered that the patient had contracted this super bug. It is extremely expensive for a nursing home to deal with somebody who has contracted MRSA, isolation being part and parcel of the treatment. Therefore, it will clearly be seen that financial difficulties attend the care of such a patient in a nursing home.

Over and above all of this, I have now discovered that nursing homes are not anxious, and some are unwilling, to accommodate people suffering from this bug on their premises. Within the Southern Health Board area, while the patient about whom I speak was admitted to a nursing home, medical staff of the Southern Health Board visited the nursing home and suggested it was not appropriate for that patient to be cared for there because of the danger of spreading the bug within the home itself: therein lies the dilemma.

Having spoken to nursing home proprietors I know they are particularly concerned about possible litigation in the event of a spread of MRSA within a nursing home. No doubt this will lead to an increased dilemma as owners of nursing homes become aware of the problematic nature of this bug and will be unhappy to receive patients who have contracted it.

The dilemma for the Minister and acute hospitals is that, since these patients must receive medical care in isolation, they will have to remain in acute hospitals much longer than necessary to deal with the complaint for which they were originally admitted.

My question relates to the establishment of a national surveillance monitoring unit. The Minister will have had a report on his desk on it for well over 12 months. The relevant study group recommended its immediate establishment. This is important for the control of this super bug, establishment of the numbers suffering from it, its impact on the operations of acute hospitals in addition to monitoring the extent of meningit is and other diseases of that nature.

I do not want to raise unnecessary fears. I have been informed by medical people that, by and large, the bug which can be fatal in some cases, and can be less than harmful in many others. Therefore, it is crucial that the Department establish this national surveillance monitoring unit immediately to restore confidence among staffs in nursing homes and in patients' medical care, demonstrating that some pertinent action is being taken in an endeavour to establish the origins of this bug and effectively control it.

Minister of State at the Department of Education (Mr. Allen)

I am replying to this Adjournment Debate on behalf of the Minister for Health who is anxious to ensure that all necessary measures be taken to control and reduce the prevalence of methicillin-resistant staphylococcus aureus or MRSA. In September 1993 a committee, comprising representatives of the Department of Health, consultant microbiologists, specialists in public health medicine, general practice and the Infection Control Nurses Association, was established to identify the extent to which MRSA was a problem in our health system and to identify priorities for its control. The committee recommended a comprehensive set of guidelines covering procedures for the management of MRSA in acute hospitals, in other health care settings and produced guidelines and information for patients and health care staff.

In 1995 the Minister published national guidelines which were endorsed by a wide range of professional bodies involved in the control of MRSA, widely circulated nationwide, giving invaluable advice on preventing its spread. These guidelines represent an important step in promoting awareness of the dangers it poses. Indeed the measures taken for control of MRSA will ensure an even safer environment for the care of the sick both in hospital and within the community.

The Minister is also committed to ensuring that future trends in the prevalence of MRSA continue to be closely monitored and has accepted the need for a national communicable disease surveillance unit which will provide a comprehensive broad-based approach to the prevention of disease. The organisational and structural issues involved are being considered by the Department of Health in conjunction with the relevant agencies and professional interests.

However, when making a decision on the organisational and structural issues involved it will be essential to take account of developments in a number of other bodies, such as the Institute of Public Health, the Office for Health Gain, the Food Safety Board and the Virus Reference Laboratory, all of which are at development stage or under review and will have to have links with the unit. Therefore, the intention is to work on the detailed arrangements for the unit, in conjunction with the ongoing work on these bodies during the coming year, with a view to its establishment in 1998.

The Minister reassures the House of his continuing commitment to address the issue of hospital-acquired infection, including MRSA, in the context of his Department's strategy for effective health care in the 1990s —"Shaping a Healthier Future"— which emphasised quality of service as one of its key principles. He is confident widespread awareness of the guidelines for its control and the development of surveillance systems will prove valuable weapons in the fight to make our hospitals as safe as possible an environment for the care of the sick. To that end he has asked his Department to reissue the 1995 guidelines stressing the necessity for hospitals to adhere to them to ensure best practice in the control of MRSA.