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Hospital Acquired Infections.

Dáil Éireann Debate, Tuesday - 21 June 2005

Tuesday, 21 June 2005

Questions (35, 36, 37, 38, 39, 40, 41, 42, 43, 44)

Gerard Murphy

Question:

56 Mr. G. Murphy asked the Tánaiste and Minister for Health and Children if the guidelines of 1995 dealing with the control of MRSA in acute hospitals have been implemented in each hospital; and if she will make a statement on the matter. [20930/05]

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Olivia Mitchell

Question:

62 Ms O. Mitchell asked the Tánaiste and Minister for Health and Children the person who is responsible for the cleanliness, hygiene and infection control in each acute hospital; the name and position of these persons; and if she will make a statement on the matter. [20907/05]

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Gerard Murphy

Question:

108 Mr. G. Murphy asked the Tánaiste and Minister for Health and Children the reason MRSA and other contagious diseases are not coming under control in hospitals; and if she will make a statement on the matter. [20908/05]

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Liz McManus

Question:

109 Ms McManus asked the Tánaiste and Minister for Health and Children if her attention has been drawn to the recent figures produced by the Irish Patients Association showing that Ireland has the highest rate of MRSA infection in Europe; her views on these figures; if she intends to introduce legislation or regulations providing for the mandatory reporting of MRSA; and if she will make a statement on the matter. [20813/05]

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Pádraic McCormack

Question:

125 Mr. McCormack asked the Tánaiste and Minister for Health and Children if she requested the HSE to ask each acute hospital to submit a report on issues regarding hygiene and infection control before the HSE began its audit of these issues; and if she will make a statement on the matter. [20896/05]

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Paul Nicholas Gogarty

Question:

140 Mr. Gogarty asked the Tánaiste and Minister for Health and Children her views on the latest report that shows that Ireland has the worst rates of MRSA in Europe; the progress made to date in dealing with the MRSA problem; the cost to date; and if she will make a statement on the matter. [20942/05]

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Jim O'Keeffe

Question:

148 Mr. J. O’Keeffe asked the Tánaiste and Minister for Health and Children the efforts she is making to curb the spread of MRSA; and if she will make a statement on the matter. [20881/05]

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Bernard J. Durkan

Question:

241 Mr. Durkan asked the Tánaiste and Minister for Health and Children if she has issued guidelines to hospitals on hygiene policy to combat the MRSA bug; if same has been monitored in hospitals; if there is any feedback on same; and if she will make a statement on the matter. [20960/05]

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Bernard J. Durkan

Question:

313 Mr. Durkan asked the Tánaiste and Minister for Health and Children the number of cases of MRSA reported to date; the action taken arising from such reports; and if she will make a statement on the matter. [21286/05]

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Bernard J. Durkan

Question:

314 Mr. Durkan asked the Tánaiste and Minister for Health and Children the reason it has not been possible to address the issue of MRSA in view of the fact that the cause or causes are well known and simple to remedy; and if she will make a statement on the matter. [21287/05]

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Oral answers (15 contributions) (Question to Minister for Health)

I propose to take Questions Nos. 56, 62, 108, 109, 125, 140, 148, 241, 313 and 314 together.

Prevention and control of hospital acquired infections is a priority for me and for the Health Service Executive. The director of the national hospitals office has engaged external consultants to carry out an independent hygiene audit of every hospital this summer. The results of the audit will be made public and will ensure that the issue of hygiene is taken more seriously by hospitals than has been the case in the past.

Every hospital will know that the public will have access to the results of the hygiene audit and this will encourage hospitals to perform better to tackle MRSA and help to ensure that the matter is taken seriously. I am not happy with the standard of hygiene in hospitals and it is one of the first things I asked the new national hospitals office to deal with. I am determined that our hospitals are run to the highest possible standards. There is no excuse for low standards when huge money is being spent on cleaning programmes involving both in-house cleaning and outside contracts.

We need an all out national effort to deal with MRSA. Anything that requires to be done will be done, by way of reporting, getting correct data published and changing practices in hospitals. We will also make money available for public awareness campaigns targeted at people visiting hospitals so they are fully informed about best hygiene practices.

I am aware of the recent report published by the Irish Patients Association on hospital acquired infections, HAIs. Since 1 January 2004, MRSA is included in the revised schedule of infectious diseases under the infectious diseases regulations. Under these regulations the Health Protection Surveillance Centre, HPSC, must be notified of persons suffering from any of the diseases set out in the schedule to the regulations. The HPSC also collects data on MRSA bloodstream infection as part of the European antimicrobial resistance surveillance system.

The number of MRSA cases reported in Ireland for 2004 was 553. The provisional figure for the first quarter of 2005 is 145. According to the HPSC, the rates of MRSA observed in Ireland is high and compares with the United Kingdom, France and southern European countries. The lowest rates are seen in the Netherlands and Scandinavia, although those rates are rising.

A SARI infection control sub-committee has recently updated the national guidelines for the control and prevention of MRSA in hospitals and in the community. 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 guidelines are with the Health Service Executive for finalisation and should be published in the coming weeks.

Will the Tánaiste find out who is responsible in each hospital for hygiene and cleanliness? What sanctions has the Tánaiste prepared for a hospital that fails in this regard? I am surprised the Tánaiste is carrying out an audit through a UK-based company rather than an Irish-based one.

Does the Tánaiste have the authority to find out what is happening in the 37 acute hospitals under her control? Does she accept that MRSA is fast becoming another litigation nightmare in respect of the health care services because simple protocols have not been followed since 1995 and this will lead to at least 200 cases coming to court in the foreseeable future? Has the Tánaiste received correspondence from the Health Service Executive or an equivalent organisation on MRSA and its presence in hospitals, especially in the past 12 years, and what has gone wrong or what is being done to try to stop it?

Will the Tánaiste explain why a meat factory or a hotel, which has a significant public health responsibility, is raided by environmental health officers, whereas a hospital is not? Does she see merit in my proposal to set up a flying squad of experts, such as clinical nurses and quality control experts who would raid hospitals, which should be the safest places in the country? A flying squad could carry out an independent audit of hospitals without warning throughout the year.

The Tánaiste referred to septicaemia of MRSA in hospitals but that statistic is not broken down by hospital. It is done at laboratory level. Septicaemia of MRSA is a good indicator of how out of control MRSA is in a hospital. Publishing those figures for each hospital would provide a ready answer as to where the problem lies.

These are simple questions that have nothing to do with the audit or extra money but with who is responsible and what we can do that will work for the future. Studying markers such as septicaemia will better indicate what is going, or has gone, wrong.

The English company won the contract. We are obliged under public sector recruitment procedures to go to tender. The company has significant experience in this area. The audit will be done during July and August for every hospital and will give us strong base information.

The Health Service Executive recently held the first conference of all the persons responsible for cleaning hospitals. The responsibility lies with people at different levels in each hospital. International best practice suggests that when a senior clinician has responsibility for hygiene in the hospital the standards are higher. It may be that a microbiologist should have overall responsibility for hospital hygiene.

I said recently that when I held my previous portfolio I visited meat factories and other places of work where hygiene standards were much higher than they are in health care. We would not allow food to be produced in the kind of hygiene environment in which patients are treated. That is not acceptable and that is why I have made this matter a priority. I have had many discussions with the national hospitals office on this issue.

One of the main tasks of the new information and quality authority will be to set standards. We must have standards and enforce them. There is merit in the Deputy's suggestion about a hit squad but unless the squad were to do the cleaning it would not achieve much. There is significant variation in what people believe to be the appropriate standards. That is why the conference took place and why the audit is important. As a result, each hospital will be told what is and is not acceptable.

I want to see greater transparency in reporting and I accept the Deputy's point that this is not done hospital by hospital. I am discussing this with the medical team in the Department and the Health Service Executive. One of the issues that arises is that there is greater laboratory surveillance now than there was in the past. That is not an excuse because it does not give the full answer but it may explain the higher incidence as we now have data which we did not have previously. That, however, does not excuse the fact that there were 105 cases of MRSA in the first quarter of this year.

Does the Tánaiste accept that this problem affects not only hospitals but also other institutions such as nursing homes? There is a terrible irony in the fact that teams are sent into workplaces to check whether somebody is puffing a cigarette while MRSA is rampant through the hospital sector. Collecting data and carrying out surveillance does not ensure action on this terrible infection.

Would the Tánaiste consider extending the powers of the Health and Safety Authority as a simple way to ensure enforcement? MRSA could be made a notifiable disease and the Health and Safety Authority could, if necessary, work with public health doctors to investigate hospitals and nursing homes which are workplaces but where the risk to patients is greater than to staff. Surely the Tánaiste could do this straight away? Providing such a capability to enforce best practice and levy penalties on those who did not comply would transform the situation. Instead of finding out who is in charge in a hospital the Tánaiste could make it clear that there is a requirement on hospitals to meet hygiene standards and if they do not they will incur serious penalties.

Is the Tánaiste preparing a legal defence against those litigants who are taking legal action with the encouragement of a Government Deputy? What is the Government's position? Will it fight every case?

I presume that if litigation arises it will involve the institutions concerned, namely, hospitals, which have their own insurance policies. The Health and Safety Authority has a specific remit in regard to the health and safety of workers. It does not have the expertise for this job which is a clinical matter. This is not a matter of basic cleanliness, in which we are all expert. One must go behind the scenes to ensure that everything in the hospital is run to the highest standards. The consultancy that won the contract has significant expertise in this area and will provide a good measure of the situation.

Following the audit, discussions will take place in each hospital to ensure a senior person, hopefully at microbiologist level, will take responsibility for this area. That is already the case in some hospitals.

Standards will be part of the remit of the health information and quality authority to ensure that patients receive treatment of the highest possible standard, including the hygiene standard. That Bill will come before the House later this year. It is recruiting its chief executive officer and other experts in that area.

While some aspects of an investigation into this issue may be complicated, does the Tánaiste recognise that generally the cause or causes are simple? Since taking up office has the Tánaiste, or anybody in the Department of Health and Children, sent a directive or circular to each hospital and nursing home in the country outlining the basic cause or causes of this infection and requesting that immediate steps be taken to deal with it?

I presume the Tánaiste is also aware, notwithstanding the expertise of the consultants — of whom we have seen many in recent years — that in the United Kingdom, whence this company comes, there is also a serious problem in regard to this infection. The company may derive its expertise from its experience in the United Kingdom.

Would it be beneficial for the Tánaiste to give readily available information in the House? Dr. Twomey said we could get a reply to most questions a month or two later because they are referred to the Health Service Executive. That is totally unsatisfactory. Previously, when the old health boards still existed, a directive was given instantly and a reply expected within 24 hours.

I said that the HSE is in the process of putting in place a parliamentary affairs division that will be fully resourced. The intention is that, by the autumn of this year, Members of the Oireachtas and others will have very speedy access to responses such as the one that the Deputy seeks from me.

The earlier part of the Deputy's question concerned what I have done since taking up office regarding hygiene. At my first meeting with Mr. Pat McLoughlin after his appointment as head of the national hospitals office, I raised the matter as a priority issue. I made money available in the Estimates for hygiene related initiatives. Mr. McLoughlin felt that the most appropriate way to proceed was to have a hygiene audit so that we could see the state of play. That had to go to public tender.

However, that is not the only initiative, since there have been many discussions with individual hospitals and a conference at which those responsible for hygiene have heard what is expected of them, and there will be many more efforts of that nature. Making the information publicly available will in itself act as pressure on those with responsibility in the area to act quickly. I said this in another forum, and I do not mind repeating it here. When the nuns were running the hospitals, they were always spotless.

Simplicity.

Some things are basic, but with others one must be in the back office ensuring that everything is run to the highest possible standard, and that is what we intend to ensure.

Has that instruction been issued?

Only last week I heard of the case of a gentleman who was admitted with a heart attack to an intensive care unit. His son-in-law told me the skylight above his bed was covered with cobwebs. Hygiene simply does not exist in some of our hospitals. The Tánaiste and Minister for Health touched on the point that, in the old days, when we had no money and no Celtic tiger, our hospitals were spotless. Now that we have the money, we have private companies in — more privatisation, which the Tánaiste favours — and many hospitals are filthy. I have visited some lately and the problem is simply appalling. The question has once again been asked what action will be taken. Will we continue to rely on private companies to do the cleaning in our hospitals?

The Tánaiste touched on the appropriate use of antibiotics. What action is taken against general practitioners who simply hand out antibiotics as if they were Smarties, sometimes under pressure from pharmaceutical companies? Many are not at all careful in the way that they hand them out. Can anything be done about such GPs? I stress that many GPs are responsible, but many are not.

I have listened to several of the Tánaiste's responses. Given the seriousness of the MRSA issue and the threat that it poses, will she would consider a proactive campaign? Lives are at risk and it could be hers. What is her opinion on such a campaign of public awareness to encourage co-operation regarding anonymous reporting if it is the preference of the in-patient, out-patient or visitor?

We must recognise that the appointment of a hygiene standards officer, irrespective of the seniority required to carry weight and make demands, will require 100% co-operation from all who work in or use services at every hospital site if it is to succeed. What is the Tánaiste's position in that regard and concerning the seeking of public participation in outlining what people have witnessed and believed to be negligent? That is the only way that we will ultimately root out the problem.

Yes, there will be a proactive campaign, beginning with the hygiene audit during July and August of every hospital in the country. The results will be published and we will also have a public awareness campaign, mainly but not exclusively around the hospitals. I hope that we will also be able to provide for a mechanism whereby people can bring it to the authorities' attention if they are unhappy with hygiene standards in a given hospital setting, such as that mentioned by Deputy Gormley. Finally, a senior person in every hospital will have to take responsibility for hygiene. If companies are being paid to perform a cleaning job and are not doing it, other companies will have to be found. It is not good enough and it is not a resource issue.

What about the antibiotics?

My apologies. Later this year we will be updating the Medical Practitioners Act 1978. As the Deputy is aware, the medical profession is self-regulated with statutory backing. We will have an opportunity to debate what may or may not happen. If people have specific complaints, it is a matter for the Medical Council. It is not a matter for political intervention regarding clinical decisions. Clinicians have autonomy in our system, as they do in other countries. The Medical Council polices and enforces that.

Written Answers follow Adjournment Debate.

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