Simon Coveney
Question:90 Mr. Coveney asked the Minister for Health and Children if she is satisfied that MRSA is coming under control; and if she will make a statement on the matter. [6222/07]
View answerTuesday, 20 February 2007
Questions (17, 18, 19, 20, 21, 22, 23, 24, 25)
Billy Timmins
Question:125 Mr. Timmins asked the Minister for Health and Children the number of staff diagnosed with MRSA in the past 12 months; and if she will make a statement on the matter. [6225/07]
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Bernard J. Durkan
Question:175 Mr. Durkan asked the Minister for Health and Children the extent to which she, her Department or the Health Service Executive have studied or implemented the best international practice for combating MRSA; if she will produce evidence to re-assure patients or potential patients that the issue is under control; and if she will make a statement on the matter. [6175/07]
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Olwyn Enright
Question:191 Ms Enright asked the Minister for Health and Children if she is satisfied that hospital acquired infections are coming under control; and if she will make a statement on the matter. [6224/07]
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Paul Nicholas Gogarty
Question:196 Mr. Gogarty asked the Minister for Health and Children the reason her strategy to combat MRSA is not working; the cost of implementing this strategy; and if she will make a statement on the matter. [6300/07]
View answerOlwyn Enright
Question:199 Ms Enright asked the Minister for Health and Children the rate of blood-borne MRSA in hospitals here; and if she will make a statement on the matter. [6223/07]
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Kathleen Lynch
Question:206 Ms Lynch asked the Minister for Health and Children the number of cases of MRSA in each of the past three years and to date in 2007; the number of fatalities attributable to MRSA; the steps being taken to reduce the incidence of MRSA; the measures to improve facilities and tackle overcrowding in hospitals that have been made to deal with MRSA; and if she will make a statement on the matter. [6258/07]
View answerBernard J. Durkan
Question:367 Mr. Durkan asked the Minister for Health and Children the action taken to prevent the spread of MRSA throughout the hospital network; and if she will make a statement on the matter. [6522/07]
View answerBernard J. Durkan
Question:368 Mr. Durkan asked the Minister for Health and Children the number of incidents of MRSA confirmed to date; the number of hospitals affected to date; the action taken arising therefrom; and if she will make a statement on the matter. [6523/07]
View answerOral answers (5 contributions)
I propose to take Questions Nos. 90, 125, 175, 191, 196, 199, 206, 367 and 368 together.
While it is an unfortunate fact that health care associated infections are not preventable in all cases, I assure the House that every effort is made to minimise the incidence of such infections. The Health Service Executive has appointed an assistant national director of health protection as the lead person nationally to address the issue of MRSA. Since its establishment, the health protection group has concentrated on a number of key issues, including the development of a three-year action plan and overseeing its implementation, as well as putting a high quality governance structure in place.
The Health Service Executive is also appointing a number of new infection control nurses, surveillance scientists and antibiotic pharmacists. These staff will strengthen specialist support for infection control and facilitate the development of the national surveillance system. Some posts have already been filled and the remainder are currently being recruited. The Health Service Executive has also initiated a number of other actions, including a two-year national publicity campaign on health care associated infections and antibiotic resistance which will use the full range of media at national and local levels, the development of a national surveillance system, a national infection control education programme, information for patients and the public, a new hygiene assessment scheme, a GP education initiative on antibiotic prescribing and measures to tackle overcrowding.
I have asked the Health Service Executive to set up a national helpline through which patients and their families can report incidents of poor infection control in our hospitals. If, for example, patients are unhappy that a hospital staff member is not disinfecting his or her hands between patients, they or their family members can call the helpline if they feel they are not in a position to raise the matter directly with staff in the hospital. This is not about blaming people, but about helping all of us, including patients, visitors and health care staff, to play our part in improving patient care.
Although MRSA is not a notifiable disease, the health protection surveillance centre of the Health Service Executive collects data on it as part of the European antimicrobial resistance surveillance system. The European surveillance system collects data on the first episode of blood stream infection per patient per quarter. The Irish data from the European surveillance system which are published on a quarterly basis by the Health Service Executive show there were 445 cases in 2002, 480 in 2003, 553 in 2004, 592 in 2005 and 435 up to the end of the third quarter of 2006. It is difficult to identify the number of fatalities attributable to MRSA as many people also have significant co-morbidity factors.
In 2006 Ireland participated in the Hospital Infection Society's prevalence survey of health care associated infection in the United Kingdom and Ireland. The survey which included 45 Irish acute adult hospitals, including eight private hospitals, provides accurate and comparable data for the prevalence of health care associated infections, including MRSA. Preliminary results of the study are now available. The overall prevalence of health care associated infection in the United Kingdom, excluding Scotland and Ireland, is 7.9%. The figures for England, Wales, Northern Ireland and the Republic of Ireland are 8.2%, 6.3%, 5.5% and 4.9%, respectively.
No figures are available for the number of staff diagnosed with MRSA. Routine screening of staff is generally not recommended because staff colonisation with MRSA is rarely implicated in MRSA transmission. Compliance with good practice, including the wearing of protective clothing and hand hygiene measures, should minimise the risk of cross-infection.
A primary element of the fight against health care associated infections involves changing practices and procedures and the manner in which many health care staff go about their daily work. Accordingly, it is unrealistic to try to isolate the overall cost of implementing such a strategy. The reduction in the incidence of such infections will both improve patient care and generate savings in the cost of service delivery. While accepting that many health care associated infections are not preventable, I am satisfied that significant steps are being taken to reduce the rates of infection and treat them promptly when they occur.
This reply is not good enough. I told the Minister at last Thursday's meeting of the Oireachtas Joint Committee on Health and Children that in the event of a pandemic of avian flu, there was a plan. The plan starts with putting the Minister for Defence, Deputy O'Dea, in charge and consists of a book, approximately two inches thick, on what to do in the event of avian flu affecting the population.
Ireland has an epidemic of MRSA. Professor Drumm's comments in this respect are important because they lead on to the question. When I asked him how many front-line staff in our hospitals had been swabbed for MRSA, he replied:
We have not swabbed staff at large in the hospitals . . . If we swabbed everybody in the system for MRSA, how many staff would immediately be taken out of the system?
The Minister has just stated it does not matter whether staff have MRSA. At the same joint committee meeting Professor Drumm stated that simply shaking hands could spread MRSA. While a plan for MRSA is desperately needed, is it true the HSE has only got as far as drawing up draft guidelines on how it will deal with MRSA in hospitals? Professor Drumm has no idea of the number of staff affected. Subsequently, he stated that when one did swab staff——
A debate on Question Time is not in order.
This question is important, as the Minister has no idea. She should confirm these figures. Professor Drumm stated: "It looks like up to 40% of isolates from staff in this country may be multiply resistant." Is it true that of the staff being swabbed, 40% have MRSA or some variant thereof? Is Professor Drumm wrong when he claims it can be spread by shaking hands? The Minister has stated it is not spread by staff.
There is serious concern in respect of MRSA in Ireland. Members want to know who will be in charge and what is the plan. There are no clear guidelines as to how the Minister will deal with this issue, apart from talking about public campaigns and raising issues in respect of prescribing. While Members are aware that these are the key issues, they want to know whether the Government has a clear plan. This is particularly true when one considers the enormous number in the community and who work in the health care services whom Professor Drumm is afraid to swab because of the possible consequences.
The Government has a plan. I understand Fine Gael recently held a meeting that was addressed by my good friend, Dr. Maurice Nelligan, who told the audience that half of them had MRSA. Deputy Twomey is a doctor and knows that one can swab people's hands and they may have it and one can swab their noses and they do not, or vice versa.
The action plan is being led by Dr. Doorley, Dr. Kelleher and Dr. Hynes of the HSE's medical team, with others. I met them two weeks ago to discuss the plan and I have mentioned some of its requirements such as the recruitment of specialist nurses and surveillance scientists and antibiotic pharmacists. It involves an education programme with general practitioners and the public because, as the Deputy is aware, the main reason for the increased incidence of MRSA is the over-prescription of antibiotics. This has been shown worldwide and the countries that do best are those that have in place an active programme with general practitioners and patients. It involves a helpline to assist patients to draw the attention of the authorities to matters about which they are unhappy, rather than expecting patients or their families to complain at local level, which the Government understands can often be difficult.
The plan also involves the swabbing of staff. Will we swab visitors? A host of measures are involved and the statistics I cited regarding the comparison between Ireland and England, Wales and Northern Ireland demonstrate we are better. I do not boast about this because an incidence of 4.9% is still not good enough. I would prefer to see Ireland reach the levels that obtain in the Scandinavian countries or Holland in which the rates are substantially lower. While that is the target we must set for ourselves, it will take us some time to reach it.
There is a major programme of training under way within the HSE in respect of this issue. I refer to the general practitioner programme and the recruitment of staff. In addition, there is the entire issue of hygiene. As the Deputy is aware, the standards of hygiene that apply when one visits a food production or pharmaceutical company are substantially higher than those in hospitals. I visited a company recently in which one was obliged to cover one's hair, shoes and so on. We probably need to reconsider the standards that apply to those of us who visit hospitals, particularly those of us who visit seriously ill patients.
Written Answers follow Adjournment Debate.