To put in context the issue of hospital acquired infection, particularly MRSA, which is the central one that has gained currency recently, we must recollect that there have been a number of advances in medicine in recent decades. These advances have improved greatly the range and safety of the procedures that can be offered within the modern health care system. With less invasive surgery and advances in anaesthetics, there is an increasing ability of the hospital system to treat many more patients, particularly on a day care or outpatient basis.
However, advances in medical technologies and treatment which have led to the survival of sick and vulnerable patients have also, unfortunately, contributed to the emergence of resistant strains of bacteria. In our complex health care environment a certain level of infection will occur, despite the best efforts of those providing care. However, we equally recognise that there are many infections which occur in this environment which are preventable by reference to and use of well recognised and evidence-based practices and procedures within hospitals and other health care institutions.
On the issue of antimicrobial resistance, while antimicrobials have saved the lives of many patients and eased the suffering of many millions of people during recent decades, they have also contributed significantly to major gains in life expectancy. These gains are now jeopardised by another related development, the emergence and the spread of microbes that are resistant to cheap and effective first choice or first line drugs. Infections caused by resistant microbes fail to respond to treatment resulting in prolonged illness and greater risk of death. Treatment figures also led to longer periods of infectivity which increase the numbers of infected people moving in the community and thus expose the general population to the risk of contracting a resistant strain of infection.
Specifically regarding MRSA, the bug, staphylococcus aureus, is a bacteria which resides in the skin and other parts of the body of many people within the community who are perfectly well while they carry this organism. If the resistant strain, however, gains access to deep tissues such as broken skin on a surgical site, wound infections or the bloodstream, infections can occur. The early penicillin antibiotics, with which we are all familiar, were effective in the treatment of such infections, but from the late 1960s onwards many strains have become and remained resistant.
MRSA has been prevalent in Irish hospitals since the 1970s and, as members are aware, it continues to be prevalent. Ten years ago, in 1995, the Department of Health and Children prepared a set of guidelines on MRSA, which was widely circulated and included an information leaflet for patients, as well as guidelines for use in hospitals, district community hospitals and nursing and residential homes.
In 1999, a comprehensive survey of MRSA was done on a North-South basis between ourselves and our colleagues in the Northern Ireland health services. This identified the prevalence of MRSA within our hospital system. It also identified a number of areas for development and improvement in the provision of facilities for the control of MRSA in hospitals. Subsequent to that study, it was decided to update and revise the guidelines previously produced by the Department. In 1999, the Department asked the national diseases surveillance centre, which is now the health protection and surveillance centre from which Dr. Cunny comes, to evaluate the problem of resistance, including MRSA, in Ireland and to formulate a strategy for the future. The result of this has been the strategy for antimicrobe resistance in Ireland which was launched in 2001. This report, in addition to many other initiatives, updated the 1995 guidelines.
I have set out the areas in which SARI recommendations are based. I will not go through them individually but there are five particular categories. Over the last number of years, a stream of funding from the Department has gone into the health system to support activities under this strategy.
I also deal with the reporting of MRSA cases. One of the central tenets of good public health action in respect of the prevention and control of infectious and communicable diseases is that the problem needs to be accurately and comprehensively identified and described. That in turn requires active and effective surveillance.
I also deal with how MRSA is reported within the health care system and how the surveillance system describes and identifies the nature and extent of the problem. In 2001, there were 337 reported MRSA bloodstream infections and that has increased to over 500 in 2004. There were 314 in the first six months of 2005. We note, however, that the increase in the total number of reported MRSA cases may be due to the increased surveillance as a result of many more laboratories participating in the reporting process. It may be marginal but I think it is important to mention that.
The percentage of resistant staphylococcus aureus observed in Ireland is high and is on a par with some other European countries. Rates are lower in the Netherlands and Scandinavia, but these countries are now reporting significant increasing trends, although at a low level.
Effective infection control measures have been identified over the years. These include environmental cleanliness and hand hygiene. Improving standards of cleanliness in hospitals is now a priority. I am sure that later in the presentations, the hygiene audit issue will be discussed.
The Health Service Executive recently published updated guidelines on hand hygiene and guidelines on the control of MRSA for hospital and community settings. These two significant documents give clear policy and practice guidance to healthcare workers on the control of hospital acquired infections.
As I mentioned, the national hygiene audit has been published and we will deal with that. The HSE will soon publish infection control standards and cleaning standards. Where previously standards may have depended on the approach of a particular hospital in a particular area, the HSE's national remit will ensure every hospital and institution will share and meet the same high standards of cleanliness and infection control. That is the case in terms of environmental cleanliness as well as the structures, personnel and processes that are required to inform and maintain infection control standards in hospitals. The situation is complex and multifaceted.
Last year, to demonstrate the worldwide nature of antibiotic resistance, the World Health Organisation established an international patient safety alliance under the chairmanship of Sir Liam Donaldson from the UK. In the 2005-06 period, the global patient safety challenge for the WHO's member states, including Ireland, is entitled "clean care is safer care". The focus of this initiative is on preventing infections associated with health care and the core message is that simple measures can save lives.
We recognise that the public, patients and their families demand and need to have confidence in the safety and effectiveness of the healthcare system. At the very least, they should not be injured by preventable infections while under the care of our hospitals or any other institutions. The nature and extent of, and many of the solutions to, these problems have now been described. There is an onus on all of us within the healthcare system to push forward with implementing these solutions. The presentation from our HSE colleagues will deal in some detail with their plans and objectives in moving forward to establish the structures, processes and resources to deal with this situation.
With the permission of the Chairman, I will ask Dr. Kelleher to introduce his presentation.
