Billy Timmins (Wicklow, Fine Gael)
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I wish to share time with Deputy Andrew Doyle.

Jan O'Sullivan (Limerick East, Labour)
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Is that agreed? Agreed.

Billy Timmins (Wicklow, Fine Gael)
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In the two terms plus one year I have been a Member of the Dáil, this is one of the most outrageous and regrettable incidents I have come across. Also, while I acknowledge the presence of the Minister of State, Deputy Pat the Cope Gallagher, it is regrettable the Minister for Health and Children, Deputy Mary Harney, has chosen not to attend the House this evening.

It was Florence Nightingale who said "The very first requirement in a hospital is that it should do the sick do no harm." I want to extend my sympathy to the families, relatives and friends of the 16 people who lost their lives in 2007 in St. Columcille's Hospital, Loughlinstown.

It is regrettable that it was the county coroner who sought to push this issue up the agenda. There were 16 deaths in total, ten of which related to C. difficile. In five of these cases C. difficile was the direct cause of death. Some six deaths were related to MRSA. In October 2007, Dr. Crowe called for the appointment of a consultant microbiologist. This has not happened to date. The coroner, Mr. Kieran Geraghty, made recommendations in January 2007 but it cannot be established if these were implemented. I hope the Minister of State can tonight give us some explanation for these deaths. The situation is totally unacceptable. I do not know if people died from C. difficile or MRSA 50 or 100 years ago but I know they have died in St. Columcille's Hospital, Loughlinstown, in the past year. It is a terrible indictment on the HSE and the health service and ultimately the buck stops with the Minister. We can talk all day about a consultant microbiologist. I go into several hospitals not only Tallaght Hospital. I visited Whitfield Clinic outside Waterford at Christmas. It was very hygienic. The disinfectant was inside the door and it was spick and span. Most of our hospitals, which are under the control of the State, are in a terrible condition. Basic cleaning is not actually being done in the hospitals.

It is regrettable that I find myself in a position where if somebody told me in the morning he or she was trying to get into Loughlinstown, I would have to advise against going there at present. Our local councillor, John Ryan, was on the national airwaves this morning in regard to this issue. I want the Minister to be able to tell me there is no infection in that hospital and that it is safe to go in there.

Why did this happen? What measures are being put in place to ensure it will not recur? Can the Minister of State give a guarantee to the House that it is safe for patients to go into St. Columcille's Hospital, Loughlinstown? I would like to be able to tell them it is safe but I am not so sure.

Andrew Doyle (Wicklow, Fine Gael)
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I am somewhat confused because yesterday's article in The Irish Times stated "Minister Harney says HSE unable to fill the post of microbiologist". I tabled a parliamentary question in November about the infection control policy in St. Columcille's Hospital, Loughlinstown, and the way in which the absence of a vital staff member, that is, a microbiologist was going to be addressed as a matter of urgency. The response I received from the HSE on 7 November was to the effect that specific policies are in place for the control and treatment of MRSA and C. difficile at St. Columcille's Hospital which are compliant with national infection control policies. There is an infection control committee in place and there is one whole-time permanent specialist infection control nurse. Consultant microbiology is available on request, when required.

Yet Dr. Donal O'Shea, whom the Tánaiste quoted earlier today, had acknowledged that there were improvements. We acknowledge there have been improvements. The challenge in St. Columcille's is that the building is 200 years old and it was built as a workhouse. It is the one hospital of that age that remains in what was the old Eastern Health Board area.

When a councillor from 1999 to 2004, I sat on a hospital review committee which recommended that this hospital be knocked and rebuilt either on the existing site or a new site, depending on other issues. That appraisal has not taken place. The HSE and the Department have concentrated on putting all their resources into a couple of major hospitals. That is the hospital for Wicklow people and the people of Shankill, Killiney, Ballybrack and Loughlinstown. It is unacceptable in this day and age that the staff who work hard are left with the challenge of trying to address MRSA without the help of a microbiologist. The manger, the consultant endocrinologist and the county coroner have all called for such a post. We need answers.

Pat Gallagher (Donegal South West, Fianna Fail)
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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.