Vol. 519 No. 6
20 Mr. Shatter asked the Minister for Health and Children if there is a possibility that new variant CJD could be transmitted through hospital instruments or appliances; the measures taken to date to address this problem; and if patients are at risk.
Creutzfeldt-Jakob disease – CJD – is one of the prion diseases which occurs in humans and certain other animal species. There are a number of categories of CJD, including variant CJD – VCJD – which is linked to the Bovine Spongiform Encephalopathy – BSE – agent in cattle. Worldwide, there are documented cases of CJD being transmitted accidentally to patients via contaminated medical instruments or contaminated pituitary hormones prepared from human cadavers. These are known as iatrogenic infections. No cases of iatrogenic CJD infection has been notified to the Department of Health and Children in Ireland.
The emergence of VCJD has led to considerable scientific research into the nature of transmission of this condition. The nature of VCJD means that it is possible for transmission through hospital instruments or appliances although no case of transmission by this means has been identified.
The CJD advisory group was established in September 1996 to advise the Minister for Health and Children on all issues relating to CJD and to provide advice on particular issues referred by the Minister to the group from time to time. Included in the terms of reference of the advisory group is the surveillance of CJD in Ireland, the assessment of scientific developments, both nationally and internationally with regard to the risks to public health concerning Transmissible Spongiform Encephalopathy agents – TSEs – and CJD and the provision of advice on research strategies for BSE-CJD.
Additional InformationThe chairman of the group is Professor William Hall, virologist, virus reference laboratory, University College, Dublin, and the group currently consists of experts in, inter alia, public health, neuro-pathology, haematology, food safety and veterinary science.
At meetings in 1998 and 1999 the advisory group considered the recently published UK guidance, Transmissible Spongiform Encephalopathy Agents: Safe Working and the Prevention of Infection – prepared by the joint working group of the advisory committee on dangerous pathogens – ACDP – and the spongiform encephalopathy advisory committee – SEAC – on safe working and the prevention of infection relating to TSEs. The guidance deals with the risks from exposure to TSE agents that may arise as a result of work activities and it provides advice and recommendations on the minimisation of such risks and other related matters. It also addresses concerns about hospital infection control procedures and safe working in clinical settings.
On the advice of the advisory group a copy of the guidance was circulated to the chief executive officers of the health boards and the chief executive officers of the voluntary hospitals from the Chief Medical Officer of my Department last year. The CJD advisory group continues to keep abreast of scientific developments in this area.
Will the Minister confirm that no special sterilisation arrangements or equipment are currently available in this country with regard to medical equipment or appliances available in our hospitals to ensure that new variant CJD is not transmitted through hospital instruments or appliances? Has the Minister or any other Minister in the Department of Health and Children met any consultants to discuss this issue and are there are any proposals emanating from his Department to put into place equipment of the nature now being installed in the United Kingdom to address this issue? Why is this issue not being treated with any sense of urgency in the context of risks that it may pose currently and in the future to patients?
It is being treated very seriously and the chairman of the group is Professor William Hall, virologist, virus reference laboratory, University College, Dublin, and that group currently consists of experts in, inter alia public health, neuro-pathology, haematology, food safety and veterinary science. They have looked at the situation as it pertains in the United Kingdom and at a meeting in 1998 and again in 1999, the advisory group considered the recently published UK guidelines, Transmissible Spongiform Encephalopathy Agents: Safe Working and the Prevention of Infection, as prepared by the joint working group of the advisory committee on dangerous pathogens – ACDP – and the spongiform encephalopathy advisory committee – SEAC – on safe working and the prevention of infection relating to TSEs. The guidance deals with the risks from exposure to TSE agents that may arise as a result of work activities and it provides advice and recommendations on the minimisation of such risks and other related matters. It also addresses concerns about hospital infection control procedures and safe working in clinical settings. The ideal situation would be to have all disposable equipment. As the Deputy knows, there were some problems before with endoscopic procedures even in this country. There is not any problem with sigmoidoscope, rectoscopes and instruments like that. I do not see a major problem in the future with having disposable equipment as a preventative measure in preventing transmission of CJD.
Could the Minister address the issue of non-disposable instruments and appliances used on more than one occasion on more than one patient? Will the Minister of State answer the question? Has he or any of the other Ministers in the Department met any person to discuss the issue? What is available to ensure it is properly addressed? Has the Minister of State received recommendations from the group to which he referred as to what should be done about it? Does the Department have ideas of its own about how it should be addressed, apart from formulating consultative groups which sit endlessly contemplating all aspects of practically every issue which falls under its aegis? Has there been a meeting with anyone about the issue? Is action being taken in the context of non-disposable instruments and appliances in our hospitals? Can the Minister of State guarantee that no patient will contract new variant CJD through the use of instruments or appliances in any hospital in the State?
There is no accurate risk assessment based on scientific research on the transmission of CJD through hospital instruments or appliances.
The Minister of State knows nothing.
Worldwide there are documented cases of CJD being transmitted accidentally to patients via contaminated medical instruments or contaminated pituitary hormones prepared from human cadavers—
Does the Minister of State know anything about the specific issue I have raised?
The Deputy should allow the Minister of State to continue without interruption.
The Minister of State has no information.
The Deputy was not interrupted. He should allow the Minister of State to reply without interruption.
This is outrageous. Will we have a tribunal in ten year's time to examine what went wrong in this area?
The Deputy was not listening. In every hospital throughout the country there is an infectious disease control committee. The Minister is being advised by a group chaired by Professor William Hall, virologist, virus reference laboratory, UCD, and comprising Mr. Albert Costello, deputy chief veterinary officer, Department of Agriculture, Food and Rural Development—
Does the Minister of State have any information? He is making a farce of Question Time. He is reading out a list of committee members in reply to a substantive question.
That is not true.
The Deputy is making a farce of it.
There must be order in the House. I ask Deputy Shatter to behave in the Chamber. I ask the Minister of State to resume his seat because we are moving to Question No. 21 as the six minutes have been used up, mainly by Deputy Shatter.
They have been used up mainly by the Minister of State who failed to reply to a serious question.
