John Moloney (Laois-Offaly, Fianna Fail)

If the Deputy took some time to read recent reports on the success of the health service he would realise the age profile of people in this country has far outgrown that of many of our European colleagues. For the record, the Minister, Deputy Harney, with whom I have had the honour of working during the past year, is honest, decent and courageous. I could think of many more adjectives to describe her hard work and, most important, her caring position as Minister for Health and Children. However, I do not expect the Deputy to apologise. That would be far too much to ask.

At the outset, I wish to express my apologies to the patients and their families who have been affected by the outbreak of clostridium difficile. I share the Deputies' concerns in relation to C. difficile and healthcare associated infections,HCAIs, generally. Since the beginning of October, there have been 22 confirmed cases of C. difficile at the hospital. There are currently ten confirmed cases. All confirmed cases were initiated on appropriate treatment for C. difficile and the majority of patients have responded to these treatments. In the same period a further 30 patients were symptomatic. Most of these patients have since improved. However, 11 patients remain symptomatic. There are currently 99 beds closed at Our Lady of Lourdes Hospital, Drogheda.

C. difficile is a well recognised HCAI. National guidelines for the surveillance, management and control of C. diff icile-associated disease are implemented on an ongoing basis in Our Lady of Lourdes Hospital in order to minimise the impact of an outbreak on all patients, staff and the general public. They include guidance on the prescribing of certain antibiotics to prevent infection, case finding, risk assessment of symptomatic patients, isolation of patients who pose a potential or actual high risk of infection to others, mandatory hand hygiene and other infection control measures.

The C. difficile outbreak in Our Lady of Lourdes Hospital was reported on 28 October. I have been assured by the HSE that all appropriate infection control procedures and practices have been put in place. These include the following: an outbreak committee has been convened in accordance with the national guidelines; a renewed emphasis on medication prescribing with increased restrictions on the use of certain antibiotics, laxatives and other drugs in line with expert advice available to the committee; three wards in the hospital were identified and used to implement stringent isolation and control measures; there has been targeted emphasis on mandatory hand hygiene and other infection control measures; ongoing education of all grades and disciplines of staff to update on the status of the outbreak and measures that staff can take to care for the patients affected and minimise the further spread to unaffected patients and contain the outbreak.

The outbreak committee has sourced specialists to assist with deep cleaning of affected wards and hospital equipment. Specialist engineers have been drafted in to decontaminate most of the affected areas of the hospital and these measures will continue on an ongoing basis.

C. difficile is a notifiable disease which means that a doctor is legally bound to notify the coroner in all cases where a person has died who may have been exposed to or contracted a C. difficile infection. The coroner is responsible for determining if C. difficile was the cause of and-or contributory factor to a person's death.

Since 6 November, in consultation with the Louth county coroner, the HSE's clinical director has agreed that all deaths occurring at the hospital during the escalation phase of the outbreak will be notified to the coroner as a matter of routine. Prior to 6 November two deaths involving C. difficile as a suspected contributory factor were notified to the coroner and since 6 November, there have been a further four deaths at the hospital which have all been notified to the coroner. The HSE expects that a number of these cases will not be attributable to C.difficile. The families of the deceased have been contacted and have been offered appointments to meet with the treating clinician.

Restrictions remain in place at the hospital and general practitioners and ambulance services have been requested to refer adult patients, with medical complaints to other appropriate hospitals. Members of the public are asked to attend the emergency departments at the hospital only in the case of a genuine emergency and to contact their GP or out-of-hours service in the first instance. Visiting restrictions remain in place and where visitors are permitted they are being advised of the need for appropriate hygiene protocols including thorough hand washing.

For the moment all elective medical and surgical procedures have been cancelled. Measures have been put in place to deal with all priority 1 endoscopy procedures, namely, urgent endoscopes for diagnostic or therapeutic purposes. Arrangements have now been put in place to provide an orthopaedic and hip fractures service within the three North Dublin hospitals as a result of a C. difficile outbreak which was called in Navan on 13 November. There are two confirmed cases of C. difficile at Our Lady's Hospital Navan.

Surgical services continue to be provided across the Louth Meath Hospital Group. Elective day case surgery continues to be provided in Our Lady's Hospital and Navan and Louth County Hospitals and is being managed on the basis of individual patient needs. Contingency arrangements are in place in Beaumont Hospital for level 2 and level 3 surgery, for example, acute surgical or urgent elective. Through proactive management of clinically discharged patients at both hospital sites, capacity has been developed to deal with the requirement for patients in Louth County Hospital. As the outbreak continues all of the above are being reviewed on a daily basis and all appropriate measures will be taken to ensure timely access to quality safe services in line with patient need.

The World Health Organisation declared a global flu pandemic in June 2009. Since then my Department and the HSE have implemented plans to deal with the pandemic in Ireland. HSE national and crisis management teams are meeting regularly to co-ordinate HSE preparedness and response to issues such as the pressures being placed on the acute hospital system during the pandemic. A mass vaccination programme is underway through general practitioners and through public mass vaccination clinics which have been established all over the country.

I am satisfied that both the C. difficile and swine flu issues are being managed appropriately.

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