I propose to take Questions Nos. 147, 329, 330 and 331 together.
Tackling all Health Care Associated Infections (HCAIs), including MRSA and C. difficile, continues to be a priority for the Government and the Health Service Executive (HSE). The HSE launched a National Infection Control Action Plan in March 2007. An Infection Control Steering Group is responsible for overseeing the implementation of the plan. This Steering Group is supported by eight Local Implementation Teams which ensure that all local facilities are focused on achieving the national targets. The HSE aims over the period of the plan to reduce HCAIs by 20%, MRSA infection by 30% and antibiotic consumption by 20%. Achievement of these targets will benefit all patients who are at risk.
A new National Surveillance System has been established to collect data and provide information based on four key areas in order to monitor HCAIs in our health system:
1. Staphylococcus bacteraemia (bloodstream infection);
2. Antibiotic consumption;
3. Alcohol gel use;
4. MRSA Surveillance in Intensive Care Units, from 2008 onwards.
This data (excluding MRSA in ICUs) has been compiled and published for 2006 and 2007. This report represents a significant step forward in terms of providing essential data that will serve as a benchmark for assessing progress in the future. This is the first report providing information on a hospital by hospital basis. The number of hospitals in this report which did not return any cases of MRSA was seven. I firmly believe that you cannot manage what you do not measure. We have now with this system begun a very useful measurement process. The results so far show some improvement in 2007 over 2006. The overall S. Aureus bloodstream infection rate was lower in 2007 (0.36) compared to 2006 (0.37). The overall proportion of MRSA was also lower in 2007 (38.5%) compared to 2006 (42.4%). The number of MRSA blood stream infections for the past five years are — 477 cases in 2003, 550 cases in 2004, 586 cases in 2005, 589 cases in 2006 and 533 cases in 2007.
Ireland participated in the Third Prevalence Survey of Health Care Associated Infections in acute hospitals in 2006 which surveyed a number of hospitals in Ireland, England, Northern Ireland and Wales. This study revealed that the Republic of Ireland was shown to have the lowest prevalence rate of both HCAIs and MRSA when compared with England, Northern Ireland and Wales. In European terms, the rates of MRSA for Ireland are better than many of the South European countries but not as low as some of the Scandinavian countries. Since May 4th of this year, C. difficile has become a notifiable disease and all cases now have to be reported to the relevant Department of Public Health. The range identified in the Third Prevalence Survey of Health Care Associated Infections in acute hospitals in 2006 was 0.5% of patients studied. The information available to date is the number of cases reported up to the 13th September 2008 which is 956 and is consistent with the results of the 2006 survey.
Other measures taken to reduce the incidence of HCAIs include the appointment of additional infection control staff, education campaigns for healthcare staff and the general public around the prudent use of antibiotics and the use of designated private beds for isolation purposes where required for patients who contracted HCAIs. In addition, new environmental building guidelines to inform infection control policy in all new builds and refurbishments are expected to be published shortly by the HSE.
In relation to hygiene standards and best practice, the Health Information and Quality Authority (HIQA) undertook a comprehensive review of hygiene in our acute hospitals in 2007 and published its report last November. This review was based on hygiene standards which were accredited by the International Society for Quality in Healthcare. The report represents a thorough assessment of how hygiene services are provided and managed in 51 HSE-funded acute care hospitals. HIQA is following up on this review to ensure that deficits identified during that process are rectified and the Authority has already commenced a further national review this month.
In addition, HIQA is due to publish Infection Prevention and Control Standards later this year. These standards are consistent with international best practice. When finalised, these, along with the National Hygiene Standards, will provide a comprehensive framework to control infection in all healthcare settings. While accepting that not all HCAIs are preventable, I am satisfied that significant steps are being taken to reduce the rates of HCAIs generally and to treat them promptly when they occur.