Pat Gallagher (Donegal South West, Fianna Fail)

I apologise to the House on behalf of the Minister for Health and Children, Deputy Harney, who is unable to be present and I thank Deputies Timmins and Doyle for raising this important matter.

Like the Deputies, I express my sympathy to any patients and families who have been affected by this issue. I share the Deputies' concerns about MRSA, C. difficile and health care associated infections generally. I take this opportunity to reiterate the Minister's commitment to ensuring that high-quality care is made available to all patients and to the further development of our health services and, in particular, the issue of patient safety.

The House will recall that the Tánaiste dealt with this matter in considerable detail earlier today during Leaders' Questions. Health care associated infections, HCAIs, are not new. For centuries they have been a side effect of medical treatment, especially in hospitals. There are a number of types of HCAI, including MRSA and Clostridium difficile, C. difficile. The more medical care a person requires, the more likely he or she is to develop a health care associated infection. These infections are, therefore, more common among people with serious illnesses or at high risk such as patients with a weakened immune system.

The extent to which hospitals are affected by HCAIs such as MRSA and C. difficile varies with the type of hospital. In the 2006 prevalence survey of health care associated infections, the prevalence of MRSA was 0.5% in tertiary-regional and general hospitals, and was zero in specialist hospitals. The survey found that 36 patients had C. difficile representing 0.5% of patients studied. However, C. difficile was not, up to now, a notifiable disease and, as a result, it was difficult to quantify the extent of infection in the health care system generally. In March 2008, the Minister instructed the HSE to make C. difficile a notifiable disease and I am happy to inform the House that from 4 May all cases will have to be notified to the relevant department of public health.

The Department understands that the 16 cases referred to by the Deputies were the subject of recent communications between the Dublin County Coroner and the HSE. Some of the patients are reported to have had MRSA and others C. difficile infections at the time of death. Most such instances involve significant co-morbidity factors and while the HSE will deal with the issues raised by the coroner, the Minister wants to assure the House that she is fully aware of the problems posed by health care associated infections and the stress they cause. This is an issue facing health services worldwide.

Tackling these infections remains a priority for the Government and for the Health Service Executive. The HSE has established a national infection control action plan. It has put in place an infection control steering group, chaired by Dr. Pat Doorley, national director of population health, to oversee the implementation of the plan. Over the next three to five years the HSE aims to reduce HCAIs by 20%, MRSA infections by 30% and antibiotic consumption by20%. These targets will be achieved through the development of national and local level action plans to reduce the potential for spread of infections in health care settings. The steering group is supported by eight local implementation teams which will ensure that all local facilities are focused on achieving the national targets.

The availability of microbiology services in the hospital setting is an absolute necessity. However, it is not feasible or practical to have a full consultant microbiologist position in every location. Currently, consultant microbiologist advice is accessed by St. Columcille's from St Vincent's Hospital. The Minister has been informed that funding has been earmarked for the provision of dedicated consultant microbiologist sessions at St. Columcille's Hospital, Loughlinstown. However, the post has been advertised on a number of occasions and it has proved difficult to get the necessary expertise.

The availability of isolation facilities is another important factor in the overall solution to this issue. In that context, the Minister has agreed with the HSE that designated private beds should be used where isolation facilities are required for patients who contract MRSA and this policy has been adopted by the HSE. New environmental building guidelines have also been developed by the HSE to inform infection control policy in all new builds and refurbishments.

Improvements on hygiene are critical to effective infection control. The Health Information and Quality Authority, HIQA, undertook a comprehensive review of hygiene in our hospitals in 2007. The report represents a thorough assessment of how hygiene services are provided and managed in 51 HSE-funded acute care hospitals. Hospitals generally performed well on hygiene in the service delivery area. Most hospitals achieved either extensive or exceptional compliance with the standard in the service delivery section of the report. HIQA is currently working with managers and clinicians to develop national standards for infection prevention and control. When completed these, along with the national hygiene standards, will provide a comprehensive framework to help reduce the spread of infection throughout the entire system and improve the quality of our health care.

A national surveillance system has recently been established by the HSE to collect data and provide information on four key areas, to monitor health care associated infections, HCAIs, in our health system. One of these areas is antibiotic consumption which is an important factor in the emergence of more virulent strains of C. difficile resulting from the over-use of antibiotics.

While accepting that not all HCAIs are preventable, the Minister is satisfied that significant steps are being taken to reduce the rates of HCAIs generally and to treat them promptly when they occur.

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