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Hospital Acquired Infections

Dáil Éireann Debate, Tuesday - 1 July 2014

Tuesday, 1 July 2014

Questions (529)

Peter Mathews

Question:

529. Deputy Peter Mathews asked the Minister for Health in respect of the World Health Organization's report on the overuse of antibiotics, if vigorous and urgent actions are in place in Ireland as well as in conjunction with other countries to deal with this threat. [28235/14]

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Written answers

The rise in antimicrobial resistance (AMR) is universally recognised at global, European and national levels as one of the greatest potential threats to human and animal health with possible serious consequences for public health. The emergence of resistance is a normal biological phenomenon, but the extensive use, misuse and overuse of antimicrobials (antibiotics) in both human and animal health have increasingly raised levels of antimicrobial resistance – in all countries and in patients of all age groups; with increasing travel and trade, drug resistance can spread rapidly. The societal and financial costs of treating antimicrobial-resistant infections places a significant burden on society and patients infected with drug-resistant organisms are more likely to remain in hospital for a longer period of time and to have a poor prognosis.

Ireland welcomes and has supported the leadership and work of the WHO over many years in addressing the impact of the overuse of antibiotics, specifically the work of the WHO Strategic and Technical Advisory Group on Antimicrobial Resistance which recommends that the WHO should lead the development and coordination of a global action plan on antimicrobial resistance and the publication in April 2014 by the Organisation of its first global report on antibiotic resistance: Antimicrobial Resistance Global Report on Surveillance 2014. Ireland and the EU fully supported the passing of the AMR Resolution at the WHO's 67th World Health Assembly in May 2014 which stressed the need for global action under WHO leadership.

In Ireland the prevention and control of healthcare associated infections (HCAIs) and AMR has been a significant patient safety and public health priority for the Department of Health for several years. A wide range of initiatives has been put in place in the Irish health system over several years including improved surveillance of infections and prescribing, infection prevention and control processes, antimicrobial stewardship initiatives, public and professional awareness raising and with a significant emphasis on the education and training of healthcare professionals.

The HSE has implemented a number of national initiatives in the control and prevention of Health Care Associated Infections (HCAIs) (which arise in part from the overuse of antibiotics) for a number of 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 (Royal College of Physicians of Ireland) & HSE National Clinical Programme for the prevention and control of HCAIs and AMR which commenced in late 2010 to provide expert advice nationally

- 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)

Ireland reports to the European Antimicrobial Resistance Surveillance System (EARS-Net) and to ESAC, the European Surveillance of Antimicrobial Consumption in Europe. All Irish hospital labs participate in EARS-Net, representing 100% coverage of the population.

The overall aim of the National Clinical Programme for the prevention and control of HCAIs and AMR, referenced above, 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.

As I have stated in the House on previous occasions, the prevention HCAIs and colonisation/infection of patients with antimicrobial-resistant organisms 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 and the downward trend appears to be holding for the first quarter of 2014 (figures are provisional).

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. It must be noted that there are concerns about the rates of resistance of other organisms and ongoing high antimicrobial consumption. The most recent European Antimicrobial Surveillance System Report (EARS - Net) for Quarter 1, 2014 was published on June 25th. The full Report is available at http://www.hpsc.ie/hpsc/A-Z/MicrobiologyAntimicrobialResistance/EuropeanAntimicrobialResistanceSurveillanceSystemEARSS/EARSSSurveillanceReports/2014Reports/.

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. A third national Guideline on Surveillance, Diagnosis and Management of Clostridium difficile Infection in Ireland was launched in June 2014.

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.

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