I propose to take Questions Nos. 9, 10, 32, 40, 42, 57, 63, 64, 78 and 101 together.
Tackling Healthcare-Associated Infections (HCAIs), including MRSA is a priority for the Government and for the Health Service Executive. Recently-published studies show that in Ireland, the overall rate of HCAIs, which includes MRSA, is lower than our UK counterparts. However, it is generally accepted that MRSA infection rates in the UK and Ireland are higher than our European counterparts. Excessive antibiotic prescribing is a key cause of these higher rates.
The Health Service Executive has recently developed a National Infection Control Action Plan including governance and performance management. The plan has clear targets for all hospitals, clear hygiene and infection control standards, an improved physical environment, initiatives on reducing antibiotic consumption and education of the public and of health professionals, including the current T.V. and media campaign. Achieving these targets is a priority for the HSE so that patients can be assured that in the future their chances of contracting an infection will be reduced to the minimum level possible. To achieve this, there is a corporate commitment throughout the HSE and services generally. Evidence-based guidelines, clear responsibility and accountability and the recognition that the public also has a role to play in preventing HCAIs is vital to achieving improvements.
In addition, the HSE is currently appointing a number of new infection control nurses, surveillance scientists and antibiotic pharmacists. These staff will strengthen specialist support for infection control and facilitate the development of the national surveillance system.
I have asked the HSE to set up a national helpline which patients and their families can call to report incidents of poor infection control in our hospitals. If, for example, patients are unhappy that a member of staff is not disinfecting his or her hands between patients, they or a family member can call the helpline if they do not feel in a position to raise the matter directly with staff in the hospital. This is not about blaming people, it is about helping all of us, patients, visitors and health care staff, to play our part in improving patient care.
I have also instructed the HSE that designated private beds should be used where isolation facilities are required for patients who contract a HCAI or MRSA.
In relation to the issue of overcrowding in hospitals, focused efforts under the Winter Initiative scheme have achieved a reduction in the numbers waiting for admission on trolleys in A&E and a reduction in the time those patients spend waiting. Admission lounges have been put in place in a number of hospitals to ensure that patients are treated with dignity while awaiting admission. A number of new A&E Departments commissioned in 2005/06 have provision for minor injury clinics, including Connolly Hospital, Blanchardstown, Cork University Hospital, St. Vincent's Hospital and St. James's Hospital. In 2006, over 1,000 additional extended care places were provided through privately contracted arrangements. In relation to 2007, the HSE has developed proposals to contract a further 450 beds in private nursing homes throughout the country. There are also proposals for an additional 450 beds within the public system. Additional home-care packages have been put in place to facilitate discharge from hospital to the patient's own home. It is important that people do not remain in hospital any longer than is medically necessary.
MRSA is not a notifiable disease but the Health Protection Surveillance Centre of the HSE collects data on MRSA as part of the European Antimicrobial Resistance Surveillance System. The European Surveillance system collects data on the first episode of blood stream infection per patient per quarter. The Irish data from the European surveillance system, which is published on a quarterly basis by the HSE shows that there were 445 cases in 2002, 480 cases in 2003, 553 cases in 2004, 592 cases in 2005 and 435 cases up to the end of the third quarter of 2006. There are no figures available to date in relation to 2007.
It is difficult to identify the number of fatalities attributable to MRSA as many people also have significant co-morbidity factors.
In 2006, Ireland participated in the Hospital Infection Society's "Third Prevalence Survey of Health Care Associated Infection" in the United Kingdom and Ireland. The survey, which included 44 Irish acute adult hospitals, including 8 private hospitals, provides data on the prevalence of health care associated infections (including MRSA). The overall prevalence of healthcare-associated infection in the UK, excluding Scotland and Ireland is 7.9%. The figure for England is 8.2%, 6.3% for Wales, 5.5% for Northern Ireland and 4.9% for the Republic of Ireland. 10% of HCAIs were MRSA related in the Republic of Ireland.
A primary element of the fight against healthcare-associated infections involves changing practices and procedures and the way in which many health care staff go about their daily work. Hygiene is a significant issue in our hospitals. It impacts hugely on inspection rates. Hand hygiene is the most important form of hygiene in this regard, but hygiene in general is important.
It is unrealistic to try to isolate the overall cost of combating HCAIs. Indeed, reducing the incidence of these infections will not alone improve patient care but will also generate savings in the cost of service delivery. Minor capital priorities have been identified and are being addressed (€10m this year and €10m next year) by the National Hospitals Office following the two previous national hygiene audits. In the medium- to long-term, capital funding will be committed to increase the number of single rooms and isolation facilities in keeping with best international practice in hospital design.
While accepting that not all healthcare-associated infections are preventable, I am satisfied that significant steps are being taken to reduce the rates of infection and to treat them promptly when they occur. The Department of Health and Children will be monitoring and evaluating the progress being made by the HSE in the management of this issue.