I would like to thank Deputy Martin for raising this issue.
Hospital-acquired patient infections continue to be an issue in hospitals worldwide. Many of these infections are difficult to treat as they involve antimicrobial resistance (AMR), where the infectious agent is resistant to a treatment to which it was previously sensitive. Current evidence shows that while antimicrobial resistance in MRSA has continued to decline. Over the last five years MRSA infection among people with the infected agent has declined from 40% to 23.5%. However, resistance in other organisms, such as E Coli, is rising. In relation to the incidence of infection, there has been a decrease in central IV line infection and a decrease in C. difficile infection. There has been a minimal increase in peripheral line infection.
A national clinical programme, under the Royal College of Physicians in Ireland (RCPI) and the HSE, is in place to address this issue. This will be run through a multidisciplinary clinical advisory group under RCPI governance, with joint working groups on prevention of surgical site infection and critical care and hospital-acquired infection. An HSE implementation group will be chaired by the National Director for Patient Safety, Dr Philip Crowley, and the programme operated under the Regional Directors of Operations. The issue is also being addressed outside the acute system, through initiatives in primary and long term care. The programme aims to ensure that healthcare workers focus on three areas every time they care for patients. These are:
- Hand hygiene compliance
- Appropriate use of antimicrobials
- Prevention of medical infections associated with medical devices such as intravenous lines and urinary catheters.
Because treatment of these infections is complicated by antibiotic resistance, emphasis is being placed on better antimicrobial use and on hygiene-related measures in hospitals, with compliance in this area audited on a regular basis. The most recent data shows that compliance with certain measures are at appropriate levels, and that increased effort is needed in other areas. For instance, hand hygiene compliance has improved, with the most recent hand hygiene compliance audit (June/July 2012) indicating an increase to 81.6% (below the 2012 target of 85%). Nursing/midwives scored the highest (86%) with medical staff the lowest (69%). I recognise that there is a need for further improvement in this area and in particular in relation to aseptic tasks, such as inserting an intravenous (IV) line, where compliance is at a sub-optimal rate of 80%.
I am very much aware of this issue, and will continue, as will my department, to monitor measures being taken by the HSE and the compliance audits of these measures. While this issue requires ongoing clinical vigilance, I am satisfied that current measures are having a positive effect, as is evident from a decrease in incidence of infection and decline in AMR in relation to MRSA.