The prevention of Healthcare Associated Infections (HCAIs) and colonisation/infection of 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 62.5% in reported cases of MRSA from 2006 to 2013. However, there are concerns about the rates of resistance of other organisms as detailed in the EARS- Net Report referred to below.
The Health Protection Surveillance Centre (HPSC) collates information from hospitals on healthcare associated infections and antimicrobial resistant organisms such as MRSA,Clostridium difficile etc. The most recent European Antimicrobial Surveillance System Report (EARS - Net) for Quarter 4, 2013 was published on March 27th. The full Report is available at http://www.hpsc.ie/hpsc/A-Z/MicrobiologyAntimicrobialResistance/EuropeanAntimicrobialResistanceSurveillanceSystemEARSS/EARSSSurveillanceReports/2013Reports/.
The HSE has implemented a number of national initiatives in the control and prevention of HCAIs for many years, including:
o 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.
o HSE ' Say No to Infection' which focused on both HCAIs and AMR, launched in 2007
o The RCPI & HSE National Clinical Programme for the prevention and control of HCAIs and AMR which commenced in late 2010.
o 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 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.