Dáil Éireann Debate, Tuesday - 25 February 2014
696. Deputy Brendan Griffin asked the Minister for Health if he will provide an update on the MRSA problem in hospitals here; the most recent statistics for hospitals over the past five years; the number of deaths that have been linked to MRSA in each of the past five years and where these occurred; and if he will make a statement on the matter. [8754/14]
View answerThe prevention of Healthcare Associated Infections (HCAIs) and colonisation/infection of our patients with antimicrobial-resistant organisms (AMR) such as MRSA is one of my priorities in protecting patient safety. HCAIs represent a major cause of preventable harm and increased healthcare costs.
The prevalence of MRSA has dropped considerably in recent years. There has been a decrease of 59% in reported cases of MRSA from 2006 to 2012. Provisional data for the first three quarters of 2013 indicates that the reduced rates are holding (see table below).
The Health Protection Surveillance Centre (HPSC) collates information from hospitals on healthcare associated infections and antimicrobial resistant organisms such as MRSA. Information is also published on an ongoing basis for overall S. aureus blood stream infections (BSI) and MRSA infection within that grouping – published quarterly to hospital level since 2007. Detailed information on MRSA rates per hospital is available on the HPSC website (www.hpsc.ie).
Notably, there has been a decrease in reported S. aureus BSI from 1,412 cases in 2006 to 1,060 cases in 2012 (24.9% decrease). The decrease in MRSA cases as a percentage of overall bloodstream infections saw a greater decrease in this time however - a reduction from 41.9% in 2006 to 22.8% in 2012 (last full year statistics to date). To the end of Quarter 3 2013, (provisional) 180 (21.3%) of overall BSI cases were due to resistant S. aureus (MRSA) and in actual cases of MRSA reported, a 59% drop was observed:
|
Year |
No. of MRSA cases |
Decrease |
|
2006 |
592 |
- |
|
2007 |
536 |
- |
|
2008 |
439 |
- |
|
2009 |
355 |
- |
|
2010 |
305 |
- |
|
2011 |
263 |
- |
|
2012 |
242 |
59% decrease on 2006 figures |
|
2013 |
180* |
* Data provisional to the end of Q3 2013 |
While not all HCAIs are due to AMR a significant proportion are. HCAIs are not an inevitable consequence of healthcare - recent evidence suggests that up to 70% of HCAIs can be prevented depending on the type of infection and the baseline rate. The approach to prevention and control of HCAIs is similar irrespective of whether or not it is caused by an antibiotic resistant bacteria. Therefore, the Health Service Executive (HSE) has a dual focus:
- implementing measures to prevent and control HCAIs including those caused by AMR such as MRSA
- implementing specific measures for AMR including MRSA:
- These are outlined in national guidelines which have been recently updated
- Monitoring infections caused by AMR as outlined later in this response.
The HSE has implemented a number of national initiatives in this field for many years, including:
- SARI 2001-2010 (The Strategy for the Control of Antimicrobial Resistance in Ireland) which specifically outlined the national strategy for prevention of AMR and was launched by the Minister of Health in 2001.
- HSE ‘ Say No to Infection’ which focused on both HCAIs and AMR, launched in 2007
- The RCPI & HSE National Clinical Programme for the prevention and control of HCAIs and AMR which commenced in late 2010.
Public reporting of HCAIs and AMR in Irish acute hospitals:
- HCAIs Prevalence Study 2006 and 2012
- S. aureus bloodstream infection (reported quarterly since 2007) – this includes public reporting of MRSA rates per hospital
- Alcohol hand rub consumption (reported bi-annually since 2007)
- Antibiotic consumption (reported bi-annually since 2007)
- Hand hygiene compliance (reported bi-annually since 2011)
The overall aim of the National Clinical Programme for the prevention and control of HCAIs and AMR is that every healthcare worker and all parts of the healthcare system recognise that the prevention and control of HCAIs and AMR is a key element of clinical and non-clinical governance. Our healthcare systems have processes in place to ensure safe healthcare is reliably delivered irrespective of the healthcare setting. The programme focuses on getting three basic practices right every time we care for our patients, these are hand hygiene, using antimicrobials appropriately (antimicrobial stewardship) & preventing medical device-related infections i.e., IV lines/drips, urinary catheters. If the above three measures are applied consistently and reliably every time healthcare workers care for their patients/residents/client then a significant proportion of HCAIs, including that caused by AMR will be prevented.
While I welcome the reducing trend in reported rates of MRSA in Ireland, MRSA rates are comparably high with other countries. We must systematically build our actions and processes to continue to reduce the prevalence of MRSA in Ireland.
In relation to the Deputy's question about the number of deaths that have been linked to MRSA, routine data is not available on deaths from hospital acquired infections (HCAIs). In certain cases such infections may be a contributing factor to a particular death but not the primary cause, hence the difficulty in giving definitive statistics on the issue.
In December last I launched and endorsed the second National Clinical Guideline, Prevention and Control Methicillin-Resistant Staphylococcus aureus (MRSA). This National Clinical Guideline provides practical guidance on prevention and control measures for MRSA to improve patient care, minimise patient morbidity and mortality and to help contain healthcare costs. The guideline has been developed for all healthcare staff involved in the care of patients, residents or clients who may be at risk of or may have MRSA in acute hospitals, obstetrics and neonates, nursing homes/long stay residential units and the community.
I might add that I have ensured that Patient Safety has been made a priority within the HSE's Annual Service Plan through specific measures focused on quality and patient safety including HCAIs, Medication safety and implementation of Early Warning Score systems. My officials meet the HSE each month on the Service Plan and patient safety is a standing item on that agenda.
