Dáil Éireann Debate, Thursday - 2 December 2004
23 Mr. Murphy asked the Tánaiste and Minister for Health and Children her views on a report (details supplied) that MRSA is present in many hospitals and in nursing homes here; and if she will make a statement on the matter. [31811/04]
View answer24 Mr. Coveney asked the Tánaiste and Minister for Health and Children the amount of funding she has allocated to prevent the spread of MRSA and other hospital bugs; and if she will make a statement on the matter. [31812/04]
View answer79 Mr. Allen asked the Tánaiste and Minister for Health and Children if she will report on her efforts to combat the spread of MRSA in public hospitals and nursing homes; and if she will make a statement on the matter. [31809/04]
View answer135 Dr. Twomey asked the Tánaiste and Minister for Health and Children her concerns on a report (details supplied) which revealed that Ireland has significantly higher levels than a number of EU countries of MRSA; and if she will make a statement on the matter. [31814/04]
View answer171 Mr. Durkan asked the Tánaiste and Minister for Health and Children the number of fatalities recorded that have occurred arising from MRSA infection; the action taken to address the issue; and if she will make a statement on the matter. [31971/04]
View answer172 Mr. Durkan asked the Tánaiste and Minister for Health and Children if in the case of the reported incidents of MRSA, action was taken to identify the cause or causes and to prevent a recurrence; and if she will make a statement on the matter. [31972/04]
View answer173 Mr. Durkan asked the Tánaiste and Minister for Health and Children to indicate the number of reported incidents of MRSA in the past five years; if such incidents occurred in the same hospital or institution more than once; the action taken to prevent a recurrence; and if she will make a statement on the matter. [31973/04]
View answerI propose to take Questions Nos. 23, 24, 79, 135, and 171 to 173, inclusive, together.
Staphylococcus aureus is a bacteria commonly carried on the skin or in the nose of healthy people. Occasionally, "staph" can cause infections — such bacteria are one of the most common causes of skin infections. Over the past 50 years, treatment of these infections has become more difficult because bacteria have become resistant to various antibiotics — antimicrobials. MRSA, methicillin-resistant Staphylococcus aureus, is a resistant form of Staphylococcus aureus. The proportion of Staphylococcus aureus bacteraemia caused by MRSA in Ireland in 2002 was 42.7%.
The National Disease Surveillance Centre, NDSC, collects data on MRSA bacteraemia, also known as bloodstream infection or "blood poisoning", as part of the European antimicrobial resistance surveillance system, EARSS. Ireland has the highest level of participation of any country involved in EARSS and EARSS data in Ireland represent at least 95% of the population; thus the EARSS data for Ireland approximate the true total number of cases of MRSA bacteraemia in Ireland. In 2003, there were 477 cases of MRSA bacteraemia reported here. The total number of cases of MRSA bacteraemia notified for the first two quarters of 2004 is 274; it should be borne in mind that the number of laboratories notifying cases has increased in 2004.
The level of antibiotic resistance in Ireland in relation to MRSA is one of the highest in Europe. Two of the reasons for this, and the responses to date, are as follows. The first reason is that one of the common strains of MRSA in Ireland is highly contagious and it is particularly difficult to control its spread. This strain is also seen in the UK and that partially explains the reason both the UK and Ireland have such high rates.
The second reason relates to the overuse of antibiotics in hospitals. The SARI hospital antibiotic subcommittee has completed draft guidelines for hospitals on promoting prudent use of antibiotics. Many of the regional SARI committees have also appointed clinical pharmacists to individual hospitals to improve antibiotic prescribing habits. A pilot project on promoting more rational use of antibiotics has been funded by my Department, through the SARI national committee, and has commenced in the Midland Health Board region.
In 1995, my Department prepared a set of guidelines in relation to MRSA; these guidelines have been widely circulated and include an information leaflet for patients as well as guidelines for use in acute hospitals, district-community hospitals and nursing-residential homes. The infection control sub-committee of SARI has recently issued draft recommendations in relation to the control of MRSA in Irish hospitals and community health care settings for consultation; these draft recommendations update and are intended to replace the 1995 guidelines referred to above. It is assumed that the report referred to by the Deputies is in fact the new draft recommendations. The document concerned has been issued for consultation and is currently in draft format. The key recommendations cover such areas as environmental cleanliness and overcrowding, isolation facilities, hand hygiene, appropriate antibiotic use and early detection of MRSA. These draft guidelines, based on the best evidence available internationally, are a key component in the response to MRSA in Ireland.
In 1999, my Department asked the NDSC to evaluate the problem of antimicrobial resistance in Ireland and to formulate a strategy for the future. The NDSC gave detailed consideration to these issues and drew up a Strategy for the control of Antimicrobial Resistance in Ireland, SARI. This report contains a wide range of detailed recommendations to address the issue of antimicrobial resistance. The SARI recommendations can be grouped into five main categories, as follows: surveillance of antimicrobial resistance; monitoring of the supply and use of antimicrobials; development of guidance in relation to the appropriate use of antimicrobials; education of health care workers, patients and the general public; and infection control in the hospital and community setting.
SARI was launched in June 2001. Since then, approximately €16 million in funding has been made available by my Department to health boards under the strategy; and, of this amount, approximately €4.5 million has been allocated in the current year. It is at the discretion of each health board CEO, in consultation with their respective regional SARI committee, to prioritise measures to be taken in their region to implement the recommendations of the SARI report.
The strategy recommended that a national SARI committee be established to develop guidelines, protocols and strategies in relation to antimicrobial resistance. This committee was established in late 2002 and as part of its remit provides advice to the regional SARI committees in each health board area which were established as a result of the strategy's recommendations. The national SARI committee is comprised of a wide range of experts in the field.
I assume by "incidents of MRSA" the Deputies are referring to cases of MRSA infection. MRSA tends to be a recurring problem in most hospitals not just in Ireland but in most countries in Europe, North America and elsewhere; however, it is acknowledged that Ireland has a relatively high incidence of MRSA infection in international terms. Even in countries with very low levels of MRSA infection, such as Scandinavia, recurrent infections are seen over time in individual hospitals. The fact that a hospital sees multiple cases of MRSA infection over time is to be expected from international experience and may reflect the type of patient seen at that hospital, rather than implying some lapse in infection control practice. No country has ever succeeded in completely eliminating MRSA; even countries such as the Netherlands and Denmark, which have very low MRSA rates, still see MRSA infections and have to deal with MRSA outbreaks from time to time.
At national level, MRSA bacteraemia is now included — since 1 January 2004 — in the revised list of notifiable diseases of the infectious diseases regulations, so laboratories are now legally required to report cases of serious MRSA infection to health board departments of public health and to the NDSC. The reporting process for MRSA bacteraemia remains the same for now, that is, direct reporting to the NDSC via the EARSS protocol which is done on a quarterly basis, as this has proven extremely effective; as MRSA bacteraemia is a laboratory diagnosed disease, notification is done per clinical laboratory rather than on a hospital by hospital basis.
MRSA infection is generally confined to hospitals and, in particular, to vulnerable or debilitated patients — these include patients in intensive care units and on surgical or orthopaedic wards. MRSA does not generally pose a risk to hospital staff, unless they are suffering from a debilitating disease, or family members of an affected patient or their close social or work contacts. MRSA does not harm healthy people, including pregnant women, children and babies. MRSA can affect people who have certain long-term health problems. Visitors to patients with MRSA infection should be advised by the local nursing-medical staff to wash their hands thoroughly after visiting patients so as to avoid spreading MRSA.
Infection with staphylococcus aureus, including MRSA bacteria, can be prevented by practising good hygiene, that is: keeping hands clean by washing thoroughly with soap and water; keeping cuts and abrasions clean and covered with a proper dressing, namely, a bandage, until healed; and avoiding contact with other people's wounds or material contaminated by wounds.
Infection control, including hand hygiene, is a key component in the control of MRSA and the SARI infection control subcommittee has just released national guidelines for hand hygiene in health care settings; these guidelines have been widely circulated by the NDSC and are available on the NDSC's website.
Each health board-authority region has a regional SARI committee and it is the responsibility of each health board CEO, in consultation with the regional committee, to identify and prioritise the appropriate measures required to implement the SARI strategy in his or her region.
It is not possible, outside of detailed research settings, to determine the exact number of fatalities due to MRSA. This is because many, if not most, people who die with an MRSA infection die from their underlying disease rather than the MRSA infection. To routinely measure the number of deaths directly related to MRSA infection would be extremely difficult and would still only result in an estimate, given the complexities involved. For this reason few, if any, countries try to routinely measure deaths directly related to MRSA.
However, the NDSC has advised that international research shows that patients with MRSA bloodstream infection are, on average, approximately twice as likely to die as patients with bloodstream infections caused by sensitive strains of Staphylococcus aureus, that is, those that respond to antibiotics. The attributable mortality from hospital-acquired bloodstream infections, including bloodstream infections caused by MRSA, is about 20% to 30%. Thus, MRSA bloodstream infection is serious and potentially life-threatening.
One other key factor in transmission of infections in hospital is hospital bed occupancy. Basically it is difficult, if not impossible, to effectively control infection if a hospital is running at close to 100% bed occupancy. This both promotes transmission of infection and also further contributes to the bed crisis by causing beds to be blocked or closed as a result of infection. The steps taken to address the current bed crisis will also benefit the control of infection.
My Department will await the final version of the recently issued draft guidelines which will then be evaluated in conjunction with the Health Service Executive.
