I thank the committee for the invitation to come before it. I understand that members have received a document from us, which I will briefly go through because it contains a considerable amount of detail, which I am sure members have already read.
The first three or four pages of our document deal with the general issues surrounding health care associated infection. As we noted at our previous meeting, although most of the discussion has focused on MRSA, we are concerned about the much wider area of health care associated infection and antimicrobial resistance. This document sets out some of those issues.
On page 2, members can see how people are significantly affected by being infected while they are in hospital. Infection significantly increases their chances of further illness, of enduring extended stays in hospital and of dying as a result of such stays. The health services have always known that this is one of the most significant problems we face and one of the major clinical risks faced by hospitals and the health care system. We face the challenge of trying to prevent and reduce the impact of health care associated infection.
Ireland is not unique in experiencing problems with health care associated infections. Every hospital throughout the world has a problem with these infections. Some of the earliest cases about which people are aware in this regard date back 200 or 300 years and involved women dying after childbirth as a result of nurses or doctors not washing their hands in between dealing with patients. This problem was identified and changes took place. Matters of this nature have become more complex.
The level of MRSA in Ireland is shown on page 3. There has been an increase in the number of cases of MRSA but there has also been a much larger instance of infection with staphylococcus aureus among members of the population. This demonstrates that we are getting better at identifying this problem and seeking to do something about it.
This problem is not unique to Ireland. However, the distribution of it throughout the country is unique. The map shows that Ireland resembles the UK and some countries in southern Europe but differs from countries in northern Europe. The problem does not solely concern MRSA and staphylococcus aureus. The graph on page 4 demonstrates the extent of infection with e.coli, another bacteria with which people are familiar. There is an increasing possibility of resistance to e.coli, which must be addressed. This is where the issue of antimicrobial resistance is very important.
I will now deal with what works, based on international experience. The points heard by the committee at our previous meeting are very clear. Active surveillance and screening, availability of isolation facilities, appropriate levels of infection control staffing, staff use of various precautions and hand hygiene and lowering levels of antibiotic use all help to prevent and reduce hospital acquired infection. The HSE undertook a survey in 2003 to identify where we needed to take action, which we are now acting upon. Some of the results are pinpointed in our document. Our previous meeting with the committee came just after we published the results of the first national audit of hygiene. Members can see some of these results in our document. We are now in the throes of the second hygiene audit, which began in February 2006. The results should be due sometime in the summer, with the first report to the national hospitals office, I hope, appearing in June 2006.
We are also in the process of finalising our national standards for infection control and cleaning. These standards have gone through an extensive process with the help of the Irish Health Service Accreditation Board and are being piloted in a number of hospitals. The results of these pilot projects will give us the final standards in infection control and hospital hygiene and cleaning.
We have also examined the very important issue of training for staff and how it should be carried out. We have identified a clear need for us to provide training for professional clinical staff and other staff within the system. Section 7 on page 8 details some of the measures we have examined to provide this training to staff in hospitals.
Another issue of great importance to us is ensuring that products, be they cleaning agents, chemicals or laboratory tests, are appropriate to prevent and reduce the impact of hospital acquired infections. We are, therefore, establishing a group to examine how this can be done in order to ensure that we obtain good products that are clearly evidence-based, work and are cost-effective within our system.
Public communication and publicity are very important. We have had the "Clean Hands Save Lives" campaign and the publication of a number of documents indicating what needs to be done. We will address the need for us to undertake a much larger publicity campaign this year. We also recognise that we must carry out similar measures within our system for our staff. Aside from training, we must increase people's awareness and understanding of what needs to be done. Those are some of the issues we intend to address.
In parallel, we have accepted that the issue of visiting may have an impact on what is happening. The National Hospitals Office has undertaken a cross-system review of visiting procedures and made proposals on a new standard national visiting policy. This document is still in consultation but it will hopefully be published shortly. It is hoped that the policy will allow visiting in a compassionate way but will also meet the needs of a modern health care system by ensuring that hospitals are not so overrun that it will be difficult to provide safe care for patients.
We are involved with our colleagues in the United Kingdom in a major study on the prevalence of health care associated infection. This study, undertaken under the auspices of the professional organisation of consultant microbiologists and infection control staff, is being carried out in all four parts of the United Kingdom and we have agreed to participate. The study will be important because it will one day give us exact information on how much hospital acquired infection is in our system. It is not a routine study but the information will allow us to see the full scale of the problem in order that we can determine what to do. Due to the way in which the study is being carried out, we will be able to compare Ireland to the four parts of the United Kingdom. Consequently and because of other studies in the United Kingdom, we will be able to see some of the economic and social impacts, as we will be able to extrapolate them from our database and what we know of the United Kingdom's data.
We met the MRSA and Families group in February and arranged to meet with it twice a year, in the months of May and November. Dr. Hynes and I have just received a communication from Professor Drumm in which he indicated that he will join us at one of those meetings in the near future because he would like to meet the families.
Much of the discussion beyond this room has been on the level of resources required to deal with the issue. In the Estimates voted to the HSE this year, nothing was specifically given to deal with this problem. However, the HSE believes it is an important issue that must be attacked and in respect of which something must be done. In the processes we undertook, which have culminated in recent days, it was agreed that €5 million, taken from elsewhere in the system, be set aside this year to deal explicitly with the problems of MRSA and hospital acquired infections. In addition, a directive has been sent to the rest of the system to the effect that when people are engaged in other developments in the clinical area, they must put in place infection control measures that will improve the system, particularly where it is expanding. This is the up-to-date position.