Ciara Conway (Waterford, Labour)
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During the summer a report was published which outlined huge failings by a number of health care providers in hospitals throughout the country with regard to hygiene. Last week Dr. Tracey Cooper from HIQA appeared before the Oireachtas Joint Committee on Health and Children. She stated hand hygiene good practice did not require monetary investment. It is not often we hear that improving outcomes for patients does not require money. What it does require is cultural change and leadership. Some of those best paid from the public purse are hospital consultants and they should be the leaders and drivers of change in culture in hospitals. However, basic issues such as hand hygiene standards are not adhered to.

During an unannounced visit to Waterford Regional Hospital in June, 45 hand hygiene opportunities were observed by the relevant person but only 20 were taken, of which only 19 were compliant. This is a serious breach of trust between the public and care providers. Over the weekend I had the misfortune of having to attend the local accident and emergency department with a family member. We received wonderful service and were tended to very efficiently by the staff. On our way in I observed there was no signage to tell members of the public to clean their hands. We had to seek hand gel. This is very basic. We have an issue with trying to change the culture in hospitals and this issue needs to be examined. It does not require monetary investment, but we know from evidence and best practice throughout the world that it is the single most effective way to ensure we prevent health care associated infections.

I have spoken to people who have tragically lost family members to health care associated infections. What recourse will there be with regard to hospitals in breach of such basic hand hygiene standards? HIQA's role is to monitor and work with hospitals to try to improve hand hygiene, but there are no consequences for public hospitals which continuously fail to meet basic hygiene standards. It is our wish that we will never have to impose sanctions on hospitals for failing to meet hygiene standards, but it is imperative that we act to ensure hospitals are encouraged and supported to meet them. I am sure other public representatives have also come across people who are afraid to go to hospital because they fear they may become sicker, rather than getting better. The public has a huge role to play in adhering to hospital visiting policies. We also need leadership within the hospital system and must ensure those in positions of authority and leadership lead on very basic matters such as hygiene, particularly hand hygiene.

Kathleen Lynch (Cork North Central, Labour)
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I am taking this matter on behalf of the Minister for Health and thank the Deputy for raising it.

I just asked the Minister for Finance when the Crimean war occurred and he told me that it was around 1880. That was when Florence Nightingale decided washing one's hands and being clean were important to prevent infection. Perhaps we should call this the Florence Nightingale campaign and remind people that washing our hands is important. I wonder how many of those who work in hospitals would cook their dinner at home without washing their hands.

The prevention and control of health care associated infections, HCAIs, is one of the Minister's priorities in protecting patient safety. HCAIs represent a major cause of preventable patient harm and increased health care costs. Since late 2012, the Health and Information Quality Authority, HIQA, has been carrying out a monitoring programme against the national standards for the prevention and control of health care associated infections, 36 of which have been completed. The Minister and the Department welcome the publication of HIQA's reports and note the concerns raised in these and previous reports about hand hygiene practices, particularly among medical staff. With regard to hand hygiene, the findings of the authority suggest hand hygiene best practice needs to become more operationally embedded at all levels.

Improving patient safety is foremost about achieving a culture of patient safety, rather than the imposition of sanctions, which may be counterproductive. Achieving this culture of patient safety, in which best practice in hand hygiene is embedded, requires actions at all levels.

It is the responsibility of management and clinical leadership to make this a priority and ensure that the correct conditions to allow for the improvements in hand hygiene compliance are in place.

It must be emphasised that it is of vital importance that health care workers recognise their personal responsibility to protect patients by maintaining their own good hand hygiene. I am extremely disappointed to note that, despite the Health Service Executive's initiatives to develop an organisational culture of hand hygiene, a significant number of health care staff, including doctors, are still not adhering to the basic principles of hand washing. I very much support the HSE's ongoing work through its national programme of activity to raise awareness among staff, monitor compliance with national standards and take action to reduce HCAIs in hospitals. A key element of this programme is the HSE's continuing biannual hand hygiene audits, which occur both in the acute sector and in the long-stay area. Additionally, from July of this year it has become mandatory for all staff to receive hand hygiene training as part of staff induction, and an education programme that will take place every two years is being established.

The HSE audits have shown an encouraging improvement in hand hygiene compliance, with the most recent figure of 84.3% compliance overall at October 2012. This figure represents a significant increase from June-July 2012, when it was at 81.6%, and was just below the target of 85% for 2012. The Minister will be studying the statistics from the latest hand hygiene audits which took place earlier this year when they are published in the near future. I hope the compliance rate will have improved and will be closer to the HSE's target rate of 90% for 2013.

I am also reassured to note that MRSA rates are at their lowest level in seven years. The number of cases of MRSA has fallen by 59% between 2006 and 2012 - from 592 to 242 - and the downward trend is holding per statistical returns to date. However, there is no cause for complacency as there continues to be significant room for improvement, particularly among medical staff. With this in mind, the Chief Medical Officer of the Department of Health has written to the chair of the Health and Social Care Regulatory Forum asking that the forum consider the matter and submit proposals as to how it might adopt a common approach to raise awareness of hand hygiene, in particular, and support and reinforce compliance with this very important patient safety issue.

Finally, the licensing of health facilities Bill, which will provide for a mandatory system of licensing for public and private health service providers, will further strengthen and reinforce the actions that are being taken to ensure a culture of patient safety. The proposals are designed to improve patient safety by ensuring that health care providers do not operate below core standards, which are applied in a consistent and systematic way. Standards and other requirements will be enforceable through inspection and imposition of sanctions as necessary. Again, it is incredible that people would have to be told all of this.

Ciara Conway (Waterford, Labour)
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The Minister of State might be right about calling it the Florence Nightingale campaign. Now that we have secured the Rosie Hackett bridge, maybe we can ensure we will have clean hands, and that will be thanks to another woman.

It is incredible and a little disappointing that the HSE's target figure for compliance for last year was only 85% and for this year it is only 90%. Surely its target should be 100% for something as basic as hand hygiene. I welcome the indication that some of these standards will be enshrined in the licensing of health facilities Bill. The Minister of State might be able to give some indication as to when that Bill is likely to be published and taken on the floor of the House.

It is incredible that some of the most highly paid professional people in this country, who are paid from the public purse and who also get huge resources in terms of the education they receive, cannot do something as basic as washing their hands. As a mother, I taught my daughter from a very early age the importance of hand hygiene, yet we consistently have failure by some of the most educated people in this country to do something as basic as washing their hands.

As the Minister of State said, this endeavour goes back to the time of the Crimean War, when it was discovered that if people washed their hands, maternal death rates plummeted. This is something hospitals all over Europe struggle with in terms of controlling hospital infections. I think it incumbent on those in leadership positions in hospitals to embed a culture of change. When one is in a hospital facility, one often sees medical people coming out in their scrubs or uniforms to go for their coffee or lunch. That kind of practice needs to stop to ensure we have clean and safe hospitals for the public.

Kathleen Lynch (Cork North Central, Labour)
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Sometimes the most difficult changes to make are cultural and attitude changes - they are not the most expensive but they are often the most difficult. A few years ago, we were all encouraged, as patients - which I am sure we all will be at some stage of our lives - to ask clinicians whether they had washed their hands. However, it is not quite that simple when a patient is solely reliant on that clinician for his or her care. There must be a cultural shift in terms of hand hygiene. As I said earlier, which one of us would start to prepare our food without washing our hands? When talking about an area where, by its very nature, there is a risk of infection, we have to be far more careful.

In regard to the legislation, we are trying to have the domestic legislation front-loaded in the next session because we feel it is important given all the work that had to be done in regard to the financial mess in which we found ourselves. We are trying to front-load the domestic legislation and I hope this Bill will be taken as well.

Finian McGrath (Dublin North Central, Independent)
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The Government is great at washing its hands.