Dáil debates
Thursday, 15 November 2018
Saincheisteanna Tráthúla - Topical Issue Debate
Infectious Diseases
4:15 pm
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context | Oireachtas source
Is oth liom go bhfuil orm é seo a ardú sa Dáil mar tá an t-ábhar chomh tromchúiseach sin. I regret having to raise this matter. I wish I was asking about when the new hospital will be built or the extraordinarily long waiting lists. However, it has been brought to my attention that a patient with active tuberculosis, TB, was admitted to hospital in Galway. Of course, that can happen. However, in this case the patient was not suitably isolated and another patient contracted TB as a result, as did approximately 12 or 13 staff who have been diagnosed with latent TB and are undergoing treatment with antibiotics. Some have suffered adverse reactions to the antibiotics.
I am obliged to raise the matter because it should have been dealt with efficiently and effectively. The patient should have been isolated and other relevant protocols immediately enacted. It seems that did not happen quickly enough and the patient who came in with active TB and had a history of active TB was not isolated for several weeks, during which time the patient was resident on multiple wards and several people were exposed. Contagious diseases are a risk in the helping professions for nurses and doctors and for patients. However, we need a system that anticipates such risks and rolls out appropriate protections. That does not seem to have happened.
The infected staff, who include nurses and care assistants, do not feel that the system has looked after them. For example, they had to attend their GPs for treatment and pay for those attendances. They had to make a case to be granted sick leave. Having suffered the trauma of contracting latent TB, they must also deal with the feeling that they are not being cared for and are expected to just get on with it.
The staff were not tested in a timely manner. One of those to whom I spoke asked to be tested and was told that tests are not carried out willy-nilly and that he or she was only exposed to the patient for a short time. Subsequent testing of other care staff indicated they had contracted latent TB as a result of a short exposure. The staff member in question had to again request a test, fill out a form for a second time and was then diagnosed with latent TB and all the consequences thereof.
I am disappointed that the Minister, Deputy Harris, is not here to address this issue, although that is no reflection on the Minister of State, Deputy Catherine Byrne, whose attendance I appreciate. This is a very serious matter involving an infectious disease and an apparent failure to urgently roll out the proper protocol and procedures in order to protect staff and patients.
Catherine Byrne (Dublin South Central, Fine Gael)
Link to this: Individually | In context | Oireachtas source
The Minister, Deputy Harris, asked me to pass on his apologies for not being present to take this Topical Issue. On his behalf, I thank the Deputy for raising the matter. I will read the script and then respond to some of Deputy Connolly's concerns.
I wish to assure the Deputy that the incidence of tuberculosis in Ireland is low. The World Health Organization categorises Ireland as a low incidence country, with less than ten cases per 100,000 population. The annual notification rate of TB in Ireland has declined since 2007 when the rate was 11.3 per 100,000, or a total of 480 cases. In 2010 and 2011, the annual TB notification rates were 9.2 per 100,000 or 420 cases in 2010 and 424 cases in 2011, which were the lowest rates recorded since surveillance of TB began in the 1950s when up to 7,000 cases were recorded per year.
Tuberculosis is a preventable and curable disease. It can be contracted by breathing in the bacteria mycobacterium tuberculosiswhich may be sneezed or coughed by a person who has TB in his or her lungs. However, although it is contagious, the HSE has advised that TB is not very infectious: close, prolonged contact with a sick person is usually required to become infected.
On the specific case referred to by the Deputy, the HSE has advised that a small number of cases of tuberculosis are identified in Galway University Hospital each year. That is within the expected range for the population size served by the hospital. When a case of TB is diagnosed, the hospital works with the HSE department of public health to provide screening for the family and for patients and staff who had close contact with the person, in line with best medical practice. This is called contact tracing and may involve a skin test, blood test or chest X-ray. Infection with the TB bacteria may not lead to developing the TB disease. Most people exposed to TB are able to overcome the bacteria. The bacteria become inactive, but remain dormant in the body and can become active later. This is called latent TB infection. People who have it do not feel unwell and cannot pass TB on to others. They may develop TB disease later in life and are offered up to six months' treatment to prevent that.
Staff can be exposed to TB in any healthcare setting. A patient suspected to have TB is isolated and the necessary precautions are put in place. If other patients or staff are exposed to TB, the department of public health follows up in regard to patient contacts while the department of occupational health deals with staff exposure.
On the specific case referred to by the Deputy, several staff in Galway University Hospital are being followed up by the departments of occupational health and public health following exposure to a patient earlier this year. It was not initially known that the patient had TB. The patient was admitted as an inpatient and subsequently found to be infectious. A review of the case will take place under our quality and safety processes. Education sessions have taken place for staff and the hospital is currently reviewing operating procedures for the management of TB.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context | Oireachtas source
I acknowledge the Minister of State delivered a prepared reply. She read out ten or 11 paragraphs but only the final one dealt with my question.
I live in Claddagh in Galway and am fully aware of the background to TB, that it is treatable and that patients with active TB attend hospitals. All of that is accepted. I ask the Minister of State to please address the question as to whether the appropriate protocols and procedures were followed in this case. Why was a patient with active TB resident on at least two wards without being isolated? How could the TB be undiagnosed when the patient had a history of TB?
The Minister of State confirmed that a review will take place. The patient was admitted early this year. Why has a review not yet taken place? Surely, a review should have taken place immediately to determine why the TB was not diagnosed, why the patient was not isolated and why a significant number of staff on different wards contracted latent TB. Those questions should have been answered by the Minister of State. Was there an internal review? If not, why not? Did the hospital not realise the importance of this matter?
I do not want to have to raise such issues in the House. I am very proud of Galway. I want a public health system of which we can be proud. However, events of this nature keep occurring and it is only when the matter is raised in the Dáil that a review is carried out. That does not engender confidence in our health system. I want to build confidence in it. I want the hospital in Galway to function. It has many problems relating to a lack of staff and so on and I fully support it in that regard. However, the Minister of State should be able to tell me whether a review of this matter was carried out, what was learned and what action was subsequently taken.
I should be hearing that a care package was provided for the staff in a caring manner. I should not be hearing comments to the effect that tests are not carried out willy-nilly.
4:25 pm
Catherine Byrne (Dublin South Central, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I apologise to the Deputy if she feels that the answer I read was not adequate. However, I cannot answer the specific questions she asked. All I can do is read the material I have been given. It does not set out the specific pattern of what exactly happened in this case. I have taken note of a number of the concerns raised by the Deputy and I will bring them back to the Minister. I will ask for more comprehensive information on the individuals who have been affected by this case of TB, particularly staff members, to be given to Deputy Connolly as soon as possible. If I had the relevant information in front of me to enable me to answer the questions asked by the Deputy, I would give that information to her. I just do not have it. There is no point in me pretending that I have it because I do not have it. I will ask the Minister and his officials to contact the Deputy to outline the exact information they have received from the hospital in respect of the cases that have been mentioned.
Catherine Connolly (Galway West, Independent)
Link to this: Individually | In context | Oireachtas source
I thank the Minister of State.