Dáil Éireann Debate, Thursday - 2 December 2004
3 Mr. Gormley asked the Tánaiste and Minister for Health and Children the steps she intends to take to implement the recommendations of the latest report on MRSA; the likely costs of implementing this; and if she will make a statement on the matter. [32006/04]
Amharc ar fhreagraMRSA is one of a number of antimicrobial resistant organisms of public health concern in the health care sector. The infection control sub-committee of SARI recently issued draft recommendations in respect of the control of MRSA. These recommendations update and are intended to replace earlier 1995 guidelines. I assume this is the document to which the Deputy refers. It has been issued by the experts for consultation and currently is only in draft form. The strategy, which was issued in 2001, contains a wide range of detailed recommendations to address this issue. Since this document was launched, approximately €16 million in funding has been made available to health boards to implement the strategy. Of this, in the region of €4.5 million has been allocated in the current year. Implementation of the strategy is ongoing.
A national committee comprised of a wide range of experts was established in 2002 to develop guidelines, protocols and strategies in respect of this matter. The National Disease Surveillance Centre collects data from hospitals on MRSA bacteria as part of the European antimicrobial resistance surveillance system. Ireland has the highest level of participation of any country involved in this system. In 2003, 477 cases were reported in Ireland. The NDSC has advised that the total number of cases notified for the first two quarters of 2004 was 274. It should be borne in mind that the number of laboratories notifying cases increased in 2004.
Hand hygiene is a key component in the control of MRSA. The SARI infection sub-committee has just released national guidelines for hand hygiene in health care settings. Chief executive officers at hospital and health board level have corporate responsibility for infection control.
My Department will await the final version of the recently issued draft guidelines which will then be evaluated. Costs arising in this context will be discussed at that stage. I want MRSA to be a priority issue for the new health information and quality authority when it becomes operational. Cleanliness and hygiene in hospitals are a concern I intend to address through the accident and emergency package of measures we are going to put in place next year.
I thank the Minister for her reply. Unfortunately, it was reminiscent of those provided in 1998 by the then Minister, Deputy Cowen, and in 2001 by her immediate predecessor, Deputy Martin, when I previously raised this issue. The first committee was established in 1993.
A question please, Deputy.
Does the Tánaiste agree that the situation has worsened since 1993 when the first committee was established? Does she also agree that antibiotics continue to be handed out like Smarties by general practitioners and others and that we have not dealt with this problem? Will she explain why, in Ireland, MRSA has been shrouded in secrecy? The Tánaiste may be aware of stories about people being identified as MRSA patients but this fact has not appeared on their death certificates. Why is it that only recently we were informed that deaths from MRSA are uncommon in Ireland? It emerged earlier today that the deaths of six patients at the Mater were linked to MRSA. Why is it that there is evidence that up to one in ten deaths in the UK are linked to MRSA, while we in this country have been told that such deaths here are uncommon? How many people in this country have died from MRSA? A league table is being introduced in Britain in respect of MRSA deaths. Would the Tánaiste favour the introduction of such a table here?
First, the reply I gave earlier was not the same as those previously received by the Deputy. The question may be the same but the reply is not.
I said it was reminiscent of those previously provided.
It is even different from that I provided to the Deputy on the previous occasion I answered questions on this matter.
League tables have their uses. However, I do not want a situation to develop where the more proactive hospitals will lose out because they are taking more precautions. We must be careful in respect of that matter.
I stated on the previous occasion that it is extraordinary that the main cause of MRSA is the failure of so many people in hospital environments to observe basic rules relating to hand hygiene and other forms of hygiene. If this matter involved the putting in place of high technology, we would probably have done so long ago or there would have been many calls for us take action in that regard. However, it involves something rather simple. I am extremely concerned about this matter.
I am informed by the medical advisers in my Department that people who contract MRSA mainly die because of the underlying causes connected to the original illness which led to their being in a hospital environment. I do not have statistics or figures at my disposal regarding the number of people who died purely as a result of MRSA. I am strongly advised that it is the underlying condition rather than MRSA which causes death.
I am not happy with the situation and we intend to give the new quality authority a strong role in respect of standards. Hygiene is one of the obvious standards. We need a standards body so that basic hygiene, both in terms of the activities of personnel and the cleanliness of buildings and their surroundings, is observed to the highest possible standard. As stated previously, we pay a great deal of money for these services and we need to ensure that we get what we pay for.
The Tánaiste stated that people are not dying from MRSA but that their deaths result from underlying causes. We know from what is happening in Britain, however, that this is not the case. Does the Tánaiste agree that we can only tackle this problem if we are honest about it and categorically state that people are dying in our hospitals because of MRSA? Does she further agree that, in addition to hygiene, the terrible conditions and overcrowding in our hospitals are fundamental causes of difficulties with MRSA?
We must proceed to the next question.
One of the recommendations in the report is that there should be less overcrowding in our hospitals. Does the Tánaiste agree that this should be the case? Will she promise the House that from now on she will insist that MRSA be listed as a cause of death? Will she do that much at least?
Basic hygiene is not related to numbers. The fact that a medical professional washes or fails to wash his or her hands has nothing to do with the number of people in a particular environment. Hygiene is a basic requirement. I would like to think that a heightened awareness campaign could be put in place in hospitals in respect of this matter. People must be aware, from the time they first enter a hospital, as to what they should or should not do. It would be a matter for medics and not for me to decide cause of death.
The Minister is——
That clearly must be done on the basis of medical advice. It cannot be done at political direction.
They want to hide it. The Minister is refusing to do it. She is washing her hands of the matter.
I do not believe they want to hide it.
