Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Question 84: To ask the Minister for Health and Children the measures she is taking to ascertain the true extent of serious infections and fatalities from MRSA; the further measures she will take to tackle this crisis in hospitals here; and if she will make a statement on the matter. [35573/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Health Protection Surveillance Centre, HPSC, collects data on MRSA as part of the European Antimicrobial Resistance Surveillance System, EARSS. This system collects data on the first episode of bloodstream infection per patient per quarter. The Irish data showed that there were 445 cases in 2002, 480 cases in 2003, 553 cases in 2004, 586 cases in 2005 and 285 reported cases in the first half of 2006.

This year Ireland participated in the Hospital Infection Society's prevalence survey of health care associated infections, HCAIs, in the United Kingdom and Ireland. The survey provides accurate and comparable data on the prevalence of health care associated infections including MRSA in acute hospitals in Ireland and can also be compared to similar data being obtained in England, Scotland, Wales and Northern Ireland. Preliminary results of this study are now available. The overall prevalence of health care associated infection in the UK and Ireland study, excluding Scotland, is 7.9%. The individual figures are England, 8.2%; Wales, 6.3%; Northern Ireland, 5.5%; and the Republic of Ireland, 4.9%, the lowest.

Active recruitment is ongoing within the HSE nationally to employ essential infection control staff, such as infection control nurses, hospital liaison pharmacists, surveillance scientists and clinical microbiologists. The HSE will shortly publish a three-year action plan which will set targets in this important area.

It is difficult to identify the number of fatalities attributable to MRSA as many people also have significant co-morbidity factors. All medical practitioners have an ethical responsibility to complete death certificates as accurately as possible and this includes recording MRSA infection. Discussions are ongoing between the HSE and the coroner's office as to how best to ensure the accuracy of death certification can be improved.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The organisation MRSA and Families continues its work of collating the incidence of MRSA arising from hospitalisations in this State and will hold its second annual conference this weekend in Waterford. Is the Minister aware that the incidence of MRSA is increasing? Is she aware of the recent shocking case of a woman who presented at one of our hospitals for the removal of a kidney stone? She contracted MRSA through bed sores in her ankles and left hospital with both legs amputated. That is an astonishing fact. Does the Minister agree these are all preventable tragedies? What we require is proper hygiene and supervision and the implementation of the guidelines laid down as far back as 1995. Yet we see the alarming increase in infections and deaths being recorded. The Minister made a point about the coroner's office. Has she noted the requirement stipulated recently by the Dublin City Coroner for doctors to report to him all cases of death from MRSA prior to signing the death certificate? Does she accept this demonstrates the need for proper recording of these deaths? I believe this reflects the serious and growing concern among the public that the true extent of MRSA infection and its role as a primary or contributory secondary factor of deaths in our hospitals is not being recorded in all cases. While the Minister may show comparisons with neighbouring countries, as she did in her initial response, the truth is, as indicated by the concerns raised by the Dublin City Coroner, that the problem is much worse than the statistics suggest.

Will the Minister initiate action with her colleague, the Tánaiste and Minister for Justice, Equality and Law Reform, Deputy McDowell to insist that all coroners emulate the action of their Dublin city colleague? I am just looking at a number of particular points I believe are essential. For instance, will the Minister establish a national directorate for the inspection, prevention and control of MRSA? Will she expand the role of the Health Information and Quality Authority as regards MRSA? Does the Minister agree that these are specific actions that could aid the objective of reducing the incidence of MRSA to the maximum possible extent?

I accept the Minister is aware and appreciates the great frustration, hurt and pain of families who have lost loved ones to MRSA as well as those people who have had the harrowing experience of the loss of both legs as a result of being infected while in hospital merely for the removal of a kidney stone. I know she must share the same feelings. Will she now take on board the call of the MRSA and Families network for a public inquiry into the non-implementation of the 1995 guidelines? We need to see the guidelines for the control of MRSA implemented. Will she consider the example of a redress board, which the network has demanded, for the victims of MRSA in our hospitals?

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Deputy has a number of questions. The survey among different countries was a sample study of some 75,000 patients, 10% of whom were Irish. It was significant that our rates were much lower. I am not boasting about that, but simply pointing out that this is not often the message we hear. The Deputy asked whether I agreed that these matters were preventable. Unfortunately, they are not. There is no such thing as an environment where people will not contract hospital-related infection. The main reason we have higher figures for MRSA now is that there is more data available. In the past this was not measured. Nowadays there is much more measurement and that will reveal the type of data that was not available in the past.

The over-prescribing of antibiotics is a crucial factor worldwide, not just in Ireland. At the last general election in Britain, Mr. Tony Blair set a target of reducing MRSA and other hospital-acquired infections by a third over an eight-year period. Many would say that is a very low target, but it is nonetheless extremely difficult to achieve because of the difficulties involved in trying to eliminate hospital-acquired infection. The most common infection acquired in hospital is a urinary tract infection. That relates mainly to people who have a catheter-related infection, with the percentage being 56.2%. A large proportion of patients with pneumonia, some 18.5%, get ventilatory-related infections and so on.

We must have a hospital and health care environment which operates to the highest possible standards of cleanliness. The hygiene audit has proven successful. Second, we should have people in every health care setting who have responsibility for infection control. The hospitals that do best are those which have some senior person in charge of this. That is why we gave the HSE additional resources this year to recruit specialist nurses and microbiologists in this area. That is the only way of having the expert staff to ensure we have an appropriate environment within the hospital.

We should have more single rooms. On my two-day visit to the United States, the big issue there and in every other country is whether we should move entirely to single-bed rooms for infection control reasons. With these, the capacity of patients to acquire an infection is minimised, particularly for very sick patients in an environment where there is much sickness and people are extremely vulnerable.

We should not be complacent as we have much to do. The HSE is having discussions with the coroner, and I will pursue the matter with my colleague, as the Deputy suggested.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I thank the Minister for her reply. We all agree the kernel of the issue is hygiene and vigilance. The absence of same is the real contributory factor to the problem. Would the Minister not agree that hygiene issues arise for a number of reasons? Part of it can also be attributable to overcrowding and understaffing in our hospitals. Does the Minister believe there is a correlation and connection between both of these factors, which are very obvious and identifiable in many of our hospitals? They must also be tackled if we are truly to grapple with the issue of MRSA.

The Minister cited a number of countries for comparison. Is she aware of other countries with better results? I point her in the direction of the Netherlands as one example, as the Minister is probably aware of the success there. We should be comparing with best practice, not the sadder reality under Prime Minister Blair's Administration.

While accepting that the Minister has indicated she will look at the ideas mooted by the Dublin City Coroner, what we really need is accurate information, as well as real and concerted action. We require accurate information to establish the true picture. I am very much of the view that we are not seeing the full extent of either the primary or contributory factors of MRSA indepth in our hospital sites around this country.

With regard to concerted action, I made some points to the Minister in my opening contribution, which I will reiterate as the Minister did not respond. One was to establish a national directorate for the inspection, prevention and control of MRSA, and whether the Minister saw a role for the Hospital Information and Quality Authority in addressing MRSA. There were also two points raised by the MRSA and Families network with regard to a public inquiry and the establishment of a redress board.

The Minister has had to address such issues with other matters that have arisen with regard to hospital sites in this State. We are both very much aware of those. I do not believe for one moment that the issue of MRSA is going to quietly go away, or be suffered indefinitely by people without taking a serious stand. That is already apparent.

It is incumbent on the Minister, the Department and the Government to act now in a responsible fashion on this matter for all the right reasons, and not only because of the prospect of action by people who have suffered and lost loved ones from MRSA.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Hygiene has a factor to play in all of this, but the biggest contribution is made by the over-prescription of antibiotics. We must not forget that, as all the very strong evidence suggests, this is what has made our immune system so vulnerable to acquiring all kinds of infections, particularly in the developed world. Hygiene is still a factor and hospitals should be run to the highest possible standards. We have made major efforts over the past year with good and interesting results. The newest hospitals or those with most resources did not necessarily do best. In many cases old hospitals did well as a result of management. One of the first tasks of the Health Information and Quality Authority, HIQA, is to examine the matter of hospital acquired infection, particularly MRSA. I agree with the Deputy that HIQA is the appropriate body to do this.

The National Hospitals Office is headed by Mr. John O'Brien. He has a number of staff and is considering the recruitment of additional personnel for infection control. Staff are reporting to him on this matter and in time there may be a director at this level. One must consider who should be responsible in each health care setting, which is more important in the first instance.