JOINT COMMITTEE ON HEALTH AND CHILDREN debate -
Thursday, 16 Nov 2006

MRSA: Motion.

Senator Browne

I move:

That the Joint Committee on Health and Children calls on the Minister for Health and Children to bring forward amendments to update sections 29, 30, 31, 39 and 52 and-or other relevant sections of the Health Act 1947 to take account of modern hospital-acquired infections, including MRSA; and the joint committee renews its call for the appointment of a national director of infection control, as agreed at the joint committee meeting of 5 October last.

I am delighted to move this motion. As Deputy Connolly pointed out, more than just MRSA is involved in this matter. It is shocking that in 2006, a person who goes to hospital with a minor ailment risks leaving with an acquired infection, or not leaving at all, due to the hospital's lack of hygiene and other issues rather than through any fault of his or her own.

There are 557 known cases of MRSA in hospitals, but I have examined the 2005 figures. I appreciate that some of the 572,000 inpatients in public hospitals were repeat customers, as it were, but we were officially told that the rate of MRSA incidence is 0.5%. Roughly calculated, that suggests more than 2,860 cases. These figures are open to debate, but the number of cases is under-reported. I cannot prove the exact figure but in light of how many inpatients are dealt with by the health system every year and the minimum percentage rate of MRSA incidence, the figure is higher than we know.

The most shocking aspect of the issue is that patients are not informed that they have the bug, be it clostridium difficile or MRSA. In many cases, their families find out later. Some people are lucky enough to have relatives in the health service who might by chance notice that vancomycin is on the patients' charts and who subsequently ask the health providers about the matter. Often, this is how patients find out that they have MRSA.

One in 20 patients has an infection as a consequence of his or her time in hospital. Of this total, 0.5% has an MRSA infection. This is the official figure, but I contend that it is actually higher. My colleague, Deputy Twomey, has referred to the need for a new hygiene audit to combat the MRSA problem, a matter on which I am sure he will speak later.

We must examine a number of issues. There is one nurse for every 12 patients whereas the recommended ratio is 1:4. In the public health system, there is one public health nurse for every 5,000 people in the community. When patients are discharged from hospitals, there is no back-up for them in their communities. MRSA affects everyone and is not just a hospital bug. For example, Deputy James Breen contracted MRSA in his doctor's surgery. It seems that acute hospitals, nursing homes and dischargees have no backup.

Given that there were 6,000 more beds in the public health system 26 years ago, our considerable bed occupancy levels pose a problem. Other countries have levels of 85% and have some hope of dealing with infectious diseases, but that is impossible in Irish hospitals. In 2003, the number of isolated beds in acute hospitals was 6%, but the recommended target is 50%.

Section 52 of the Health Act must be updated because it refers to the old health board system, which has been abolished and replaced by the Health Service Executive. I would prefer the situation outlined during the week, namely, a patient safety authority independent of the HSE taking cases against employees in some instances. Employees have a duty of care, but they also have the right to work in a safe environment. They should not be at risk of contracting MRSA while working.

The chosen sections relate to the general duty to take precautions against infecting others with diseases. One section's provision for a fine of £50 is clearly out of date. No employee has ever been fined for breaches of hygiene that could lead to a worsening of a patient's condition. Section 31 relates to the prevention of the spread of an infectious disease and section 39 refers to a health authority's burial of a person who died from an infectious disease.

Recently, the Dublin coroner had a few comments to make on this issue. He wanted MRSA to be cited on people's certificates of death. While it is important to note that patients do not necessarily die from MRSA, they certainly die with MRSA. Last month, the coroner, Dr. Brian Farrell, stated that cases must be reported if patients die from MRSA resulting from environmental factors in a hospital or cross-infection or if the death was unexpected or unexplained.

I hope my motion will be accepted. I realise that a great deal of work is involved, but it is important that the Department of Health and Children update the Act. At our last meeting, we agreed that a national director of infection control should be appointed, but unless the Act is updated, the director would have an impossible job.

Chairman

The motion is not controversial and it reflects the committee's policy.

Deputy McManus

I support this well conceived and timely motion. Recently, I raised the issue of C. difficile or clostridium difficile, a superbug that is not notifiable, via parliamentary question. In this country, there is a significant lack of information on and understanding of C. difficile. The motion's approach recognises that there are serious problems and it would be helpful to promote its progress as much as possible. I compliment Senator Browne on his work on the motion.

Deputy Devins

Most of us would agree with the sentiments expressed in the motion. On a point of clarification, I have read sections 29, 30, 31, 39 and 52 of the Health Act 1947, but I am puzzled about why we need to make these amendments. Section 29(1) states: "The Minister may by regulation specify the diseases which are infectious diseases". Section 52, which applies to the old health boards according to the Senator, refers to a "health authority", which could be the whole country under the HSE. Do we need to go through this process or could we ask the Minister to include these diseases by regulation?

Deputy Connolly

I support the motion, but we sometimes fall into the trap of not mentioning clostridium difficile and vancomycin resistant enteroccocci, VRE, when we discuss MRSA despite them having the same deadly result. For many, the possibility of contracting MRSA leads to a genuine fear of hospitals. We know of adverse incidents in hospitals, the chances of which are one in 30. Every day, this equates to one person per ward receiving the wrong treatment or contracting one of the above diseases.

The considerable information deficit is problematic. If someone contracts an infection there should be a moral obligation on the doctor to inform the patient and the relatives. A cloak of secrecy covers the process at present, which is not helpful. Deputy Breen has suggested sending a letter to the patient's general practitioner as soon as MRSA or other diseases are discovered. We should improve our reporting system to provide for mandatory reporting.

Senator Henry

I support the motion. We should clarify that we refer to blood borne MRSA infections. Sometimes under reporting may be due to difference between blood borne infection and other types. Clostridium difficile is becoming a major problem. A friend contracted it recently in one of the most important hospitals in the United States.

I have frequently called for a campaign by the Department of Health and Children or the HSE on the abuse and overuse of antibiotics. There is great demand from patients for antibiotics. The Sub-Committee on the Adverse Side Effects of Pharmaceuticals has considered the direct advertising to the public by pharmaceutical companies. This places more pressure on GPs to supply antibiotics when they may be of little value.

Senator Glynn

I support the points made by Deputy Devins. I support the motion. We are anxious to eliminate the scourge of MRSA and related infections. It is a relatively new phenomena and one must ask how it came about. The old practice was that disposal of human waste was a nursing duty. Does every hospital have an infection control officer? Senator Henry has identified the problem — the use and abuse of antibiotics. I remember a doctor who would not give an antibiotic unless he sent a sample for culture and sensitivity testing. It is a useful practice but is not always followed. We must do all in our power to eliminate MRSA and related infections. Perhaps this could be rectified by regulation.

Deputy Twomey

Given Deputy Breen's personal circumstances I will give way to him.

Deputy J. Breen

It gives me no pleasure to sit here and state that I am a victim of MRSA and that it has done permanent damage to my body. I fear that if I have to undergo surgery again, MRSA lying dormant in my body will take my life.

I appeal for a director of infection control. I appeal to the Minister for Health and Children to display notices in hospitals advising those entering and leaving to wash their hands. At the time of foot and mouth disease there was a notice at my farm advising people to disinfect their boots entering and leaving the farm. When one enters a hospital there is no such sign. Visitors should be told to wash their hands using the antibiotic gel in each ward. If we put simple measures in place we can combat this deadly bug. MRSA and the antibiotics pumped into my body as a result have done permanent damage. People tell me I look fine but I live in fear of what will happen if I undergo further surgery. I did not contract MRSA in a hospital; it was at a doctor's surgery. Perhaps the HSE should inspect doctors' surgeries.

Deputy Twomey

I support the motion. Fine Gael and the Labour Party's idea of a patient safety authority fulfils much of what is proposed here. Regarding hygiene, Fine Gael and the Labour Party call for a chain of responsibility in hospitals and support the return of the old style matron. The problem in our hospitals is the absence of a chain of responsibility. Who is responsible for hygiene and infection control? The health system needs a flying squad comprising infection control and hygiene experts who can inspect hospitals correctly. An antibiotics policy for every hospital is not all that is needed. We must change the ethos in hospitals. Infection control is poor because it is not given the required priority.

Some contributors have suggested that regulation will have the same effect as legislation. The Health (Nursing Homes)(Amendment) Bill, in which the HSE suggests a 5% charge on the value of elderly patients' homes, is being debated by the Dáil because the Attorney General advised that regulations are not as strong as legislation. Following this logic, regulations are not as strong as legislation in respect of MRSA and infectious diseases. This is the basis of Senator Browne's motion. We can strengthen the legislation to control infection.

We must change the ethos in hospitals regarding infection control and hygiene. The best way for this committee to proceed is to make a recommendation to the Minister for Health and Children to introduce legislation. She can then make proposals to change the ethos in the health system.

Senator Browne

In reply to Deputy Devins, the Health Act 1947 is remarkably up to date in view of its age. Some aspects of it are out of date and some parts of it may need to be changed. No employee in the health service has been prosecuted for breaches in duty of care. If one was to be found guilty the maximum fine is £50. That is not good for patients or employees. I am not satisfied with the idea that the HSE could prosecute itself for breaches of care. It should be done by a different body, a public safety authority.

Half of inpatients are over 65 years of age and these are most at risk of blood infection. Rates of MRSA infection need not be as high as they are. In Wales the rate has been reduced by 60%, in Norway there were four cases of bloodstream infections of MRSA in 2005 and in Denmark, 11. In Ireland, there were 592 such cases. This is crazy and it should not be the case. The Netherlands has an aggressive search and destroy policy that has led to great results in the reduction of MRSA rates.

In one case, a pregnant woman had a scan while she had a wound in her ear. Unfortunately, during the scan she contracted MRSA. She could not take antibiotics because this might harm the unborn baby. Not taking antibiotics put her at risk and the baby could have been born with MRSA. I know of a man in his mid-30s who broke his leg. He contracted MRSA and was out of work for one year. A man in his mid-50s was involved in a car crash through no fault of his own. He broke his hip and it had to be operated on three times because of an MRSA infection on the first occasion. The danger is that it can affect any of us in this room. At the very least, in 2006 patients should be able to have confidence that they will not leave hospital in a worse state than that in which they entered due to negligence.

Chairman

I thank Senator Browne. His motion is supported by the committee and rightly so. When representatives of the MRSA group were before the committee we made it clear we would promote the introduction of legislation and the appointment of a national director. We will forward the motion to the Minister for Health and Children.

Question put and agreed to.