Fergal Browne (Fine Gael)

I move:

"That Seanad Éireann notes that there were 285 recorded cases of MRSA hospital acquired blood infections in Irish hospitals for the first six months of 2006, that there have been recent findings in coroner's courts that MRSA was the cause of death and a factor in people dying, and that MRSA has reached endemic proportions in our health system; calls on the Government to follow the example set in the Netherlands where they have the lowest percentage rate of MRSA in Europe in their hospitals by:

reducing the overall use of antibiotics;

screening and isolation of patients suspected of having MRSA when first admitted to hospitals;

screening of staff persons who have been in contact with patients who have tested positive for

MRSA and the taking of appropriate steps thereafter; and

having proper cleaning techniques and management of hospitals.

Further calls on the Minister for Health and Children to:

ensure that when patients test positive for MRSA that they and/or their family are informed immediately so that appropriate steps are taken to aid their full recovery;

indicate how many of the additional fifty two infection control staff announced recently by the HSE have been appointed; and

explain the reason funding has been given to a research project concerning infection control as announced by the Health Research Board on Friday 18th last considering that lack of knowledge on the subject is not the problem but rather putting the existing knowledge and expertise into practice; and

inform the Senate on what progress being made to update the 1947 Health Act, as requested recently by the Joint Oireachtas Committee on Health and Children.

I welcome the Minister to the House and apologise in advance if I call her Tánaiste during my speech. Deputy Twomey keeps doing it, so old habits die hard.

This may well be the last time we have a debate on MRSA in the lifetime of this Seanad. It is important to record the large amount of work that has been done by the MRSA and Families group, which first highlighted the issue. I am proud to say that I attended the first public meeting on the matter, approximately two years ago in Kilkenny. I knew the group was being formed and had heard complaints about hospital hygiene and people not being treated as they should be. I was gobsmacked to discover a large crowd at the meeting and was even more surprised when I heard the people's stories there. One that stuck in my head concerned a patient who only realised she had MRSA when the contract cleaners shouted to each other not to use a particular mop because one lady in a four-bed ward had MRSA, so a different mop had to be used. That is how the lady found out she had contracted MRSA and it really brought the situation home to me.

The motion is quite detailed. Last week, I spent a day in Holland, a country that has led by example and now has the lowest rate of MRSA in Europe. That did not come about by coincidence. The Netherlands has been aggressively reducing the use of antibiotics for over 20 years and has a tough policy of screening hospital patients on arrival.

I am not sure if the Minister is aware of the fact that there is a link between pig farmers and MRSA. Anyone involved in the Dutch pig industry will immediately be put into isolation when first admitted to hospital, as well as being screened and tested. If the results are positive, hospital staff who have come into contact with that patient are also screened. If such patients share a ward with others, the other patients are screened as well. The Dutch authorities are constantly managing and monitoring the situation. In addition, Dutch hospitals employ a different system of cleaning. We must re-examine the use of contract cleaners in Irish hospitals. We should introduce the cleaning department as a career route within hospitals, whereby people would be accountable, rather than going in for just a few hours a day with no one feeling part of a team.

Last September, I visited Cardiff and saw at first hand how they reduced MRSA rates by60%. The message I got from that trip was the idea of collective responsibility — everyone was in it together, there was an atmosphere of teamwork, and no one was trying to blame anyone else. From the hospital manager down to the cleaning staff everyone had a role to play and they were not trying to scapegoat each other. Unfortunately, nobody seems to be in charge here, however, and patients are suffering.

The Minister is correct to refer to the overall use of antibiotics but we have seen no action from the Government on that issue. We need to start reducing the overall use of antibiotics which, doubtless, is affecting people's resistance to infection and leading to the rise in MRSA. We also need to introduce screening for hospital staff. From the outset I have stressed the need not only to care for patients but also to look after hospital staff. This is a health and safety issue. All employees are entitled to work in a safe environment. However, if hospital staff are coming into contact with patients who have MRSA, they in turn are being put at risk. We need to examine the MRSA issue in a collective manner.

Patients should be informed as soon as it is known that they have contracted MRSA. I am fed up hearing that patients only discover later that they have MRSA and are not told when in hospital, although I accept that is changing. At a meeting with the Minister last year, I kept stressing the point that patients should be informed that they have MRSA so that appropriate steps can be taken. I have come across cases of people who only discovered they had MRSA after leaving hospital and their families members were not advised to take extra precautions. That should be done automatically.

It is regrettable that the amendment to the motion contains waffle to the effect that the Government "acknowledges the entitlement of all patients to be informed in a sensitive manner of any diagnosis of MRSA". That procedure should include any other blood infections such as clostridium difficile and VRA, which is another bug. The Joint Committee on Health and Children passed a motion about updating the 1947 Health Act, and also called for the appointment of a national director of infection control. It is regrettable that the Minister will announce that only 20 of the proposed 52 infection control staff have been appointed, which shows some tardiness in the Department's viewpoint.

I acknowledge, however, that there has been some progress on this matter. It is great to hear people talking all the time about MRSA. It was mentioned by Seán O'Rourke on "The Week in Politics" programme last week, and it was the number one issue when American pollster, Frank Luntz, did a survey of people's concerns. The Sunday Independent recently did a vox pop about MRSA in which people recognised what was involved and expressed their opinions. The matter is coming up continually, which was not the case two years ago. That is mainly due to the voluntary MRSA in Families group, which has been pushing the issue.

MRSA rates vary greatly around the world. For some reason, in Norway and Sweden the rate is less than 1%, while Ireland has rates of 40% in some cases. Bulgaria has MRSA rates of between 7% and 18%. While rates vary geographically, the data show that other countries are getting to grips with the problem and are taking steps to reduce it. While it is terrifying to read newspaper headlines about MRSA, it is good to see that it is receiving the prominence it deserves. Recently, a leading microbiologist, Dr. Maureen Lynch, described MRSA as being endemic in Irish hospitals. We are now beginning to see MRSA listed as a cause of death, whereas until recently it was not even cited on death certificates. I have numerous newspaper clippings which indicate that the situation is changing. When I questioned Professor Drumm with regard to patients being informed about MRSA, his reply was that if we told them about that, we would have to tell them about everything else as well. His answer did not inspire confidence.

I accept that clostridium difficile is probably a bigger killer of people than MRSA and that other infections also occur in hospitals. However, all blood infections can be controlled. It is worth noting that Welsh hospitals have reduced by 60% the number of MRSA cases. This took much work but it is noteworthy that very few health personnel are required to deal with MRSA in Wales, although I would have thought a large number were involved. This demonstrates it is possible to get excellent results with a few dedicated people.

The most serious problem in Irish hospitals relates to the rate of bed occupancy, which is close to 100%. The Netherlands has a search and destroy policy in which wards are closed down. Our problem is that we could not do this as we have patients on trolleys in accident and emergency units and in corridors. If we were to close wards, it would cause further chaos. I cannot understand why the Minister continues to state we do not need 3,000 extra beds in the health system when it is clear they are needed.

We need far more isolation beds, a point which came across clearly on my trip to Amsterdam. It is not possible to isolate an infection when infected patients are in wards with other patients. The ideal is that 50% of hospital beds should be isolated, whereas just 6% of hospital beds in Ireland are isolated at present. We should aggressively aim to have at least a quarter of beds in single-bed wards in order that hospital staff have some hope of controlling the spread of infection.

I have put down numerous parliamentary questions on this issue and have raised it with the Minister at the Joint Committee on Health and Children. In 2004 there were 553 cases despite €1 million having been spent on vancomycin, which is a drug used to treat MRSA. The Minister acknowledged to me that people with diabetes have a higher rate of MRSA.

Has the Minister asked the Minister for Social and Family Affairs to acknowledge that people with MRSA have a long-term illness? Has she plans to include the condition on the long-term illness list in order that it can be considered for social welfare purposes? I know one person who unfortunately contracted MRSA and was out of work but he had grave difficulty getting social welfare payments. The Minister admitted we have just 44.1 clinical infection nurses in the country at present whereas there are more than 300 in the Netherlands.

The most worrying aspect relates to the Health Act 1947. In some respects that Act is amazingly in-date and accurate, and refers to duty of care, looking after patients and not making a patient worse than when that person entered hospital. However, I discovered through the parliamentary questions system that not one person working in the health system has ever been fined or prosecuted for failure to adhere to proper hygiene standards, which obviously does not reflect the reality given there are so many cases of MRSA in hospitals. This can be contrasted with the area of food hygiene, where one can be fined €15,000 if standards are breached. The health service seems to have fallen behind. We seem to put more emphasis on abattoirs and the production of food than we do on the health of human beings.

I am sure the Minister will refer to hygiene audits. These have not been as successful as they should have been. Patients and staff are still not routinely screened and there is concern that the Health Information and Quality Authority will not be able to audit all hospitals annually. We need an external body to monitor independent external hygiene. There is a data deficit in terms of collecting comparable data on health care associated infections. Professor Drumm admitted at the Joint Committee on Health and Children in March 2006 that to give the figure for how many died from MRSA would be "almost unfair and would frighten people".

Fine Gael has proposed a patient safety authority which would have far more teeth and power than what the Government is planning. The strategy for the control of antimicrobial resistance in Ireland has been launched. I cannot understand why the Minister has not acted on it, although she recently announced a grant of €1.5 million to a multi-disciplinary research team. The question is not the lack of knowledge but rather putting the knowledge into effect.