MRSA, methicillin-resistant staphylococcus aureus, is a resistant form of staphylococcus aureus. The Health Protection Surveillance Centre, HPSC, collects data on MRSA bacteraemia, also known as bloodstream infection or "blood poisoning", as part of the European Antimicrobial Resistance Surveillance System, EARSS. At national level, MRSA bacteraemia is now included — since 1 January 2004 — in the revised list of notifiable diseases under the infectious diseases regulations and therefore laboratories are now legally required to report cases of serious MRSA infection to the Departments of Public Health and to the HPSC. The reporting process for MRSA bacteraemia remains the same for now, that is, direct reporting to the HPSC via the EARSS protocol which is done on a quarterly basis. As MRSA bacteraemia is a laboratory diagnosed disease, notification is done per clinical laboratory rather than on a hospital by hospital basis. Provisional figures for 2004, the most recent period for which data are available, indicate that 533 cases of MRSA bacteraemia were notified last year.
International experience shows that the number of MRSA bloodstream infections seen in an individual hospital is generally proportional to the size of the hospital and the complexity of illnesses seen at that hospital. Thus larger hospitals treating sicker patients are more likely to see cases of MRSA bloodstream infection compared to smaller hospitals. As can be seen from the overall number of cases reported, hospitals reporting cases of MRSA bloodstream infection will report more than one case in each quarter and this is in keeping with surveillance data from other countries.
In order to address the issue of antimicrobial resistance, including MRSA, the Strategy for the Control of Antimicrobial Resistance in Ireland, SARI, was launched in June 2001. Since then, approximately €20.5 million in funding has been made available by my Department under the strategy; of this, approximately €4.5 million has been allocated in the current year. This SARI funding is in addition to normal hospital funding arrangements in relation to infection control.
In 1995, a Department of Health committee comprising representatives from my Department, consultant microbiologists, specialists in public health medicine, general practice and a representative from the Association of Infection Control Nurses produced a set of guidelines for the management of MRSA in acute hospital wards, including specialist units. The implementation and operation of these guidelines in acute hospitals is a matter for those hospitals in the first instance. These guidelines have been widely circulated and include an information leaflet for patients. The infection control sub-committee of the National SARI Committee recently prepared draft guidelines in relation to the control of MRSA in Irish hospitals and community health care settings. The key recommendations cover such areas as environmental cleanliness, bed occupancy levels, isolation facilities, hand hygiene, appropriate antibiotic use and protocols for the screening and detection of MRSA. These draft guidelines, based on the best evidence available internationally, are a key component in the response to MRSA in Ireland. The recommendations, when signed off by the National Hospitals Office of the HSE, will replace the guidelines issued in 1995 in relation to MRSA.
Effective infection control measures, including environmental cleanliness and hand hygiene, are central to the control of hospital acquired infections, HAIs, including drug-resistant organisms such as MRSA. The HSE and hospital managers have corporate responsibility for infection control. Infection control, including hand hygiene, is a key component in the control of MRSA. The SARI infection control sub-committee released national guidelines for hand hygiene in health care settings during 2004 — these guidelines have been widely circulated by the HPSC and are available on the HPSC's website, www.hspc.ie. The ten point plan for accident and emergency services, which I announced in November 2004, includes provision for dedicated cleaning services; this recognises the importance of hospital cleanliness.
The NHO of the HSE has identified the auditing and targeting of infection control initiatives and the enhancement of cleanliness of hospitals as priorities in its service plan for 2005.