Brendan Smith (Cavan-Monaghan, Fianna Fail)

I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I thank Senator Fitzgerald for raising this very important issue.

I wish to express my sympathy to any patients and families who have been affected by this matter. I share the Senator's concerns regarding health care associated infections. I reiterate the Minister's commitment to ensuring high quality care is made available to all patients and to the further development of our health services, in particular the issue of patient safety.

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. The more medical care a person requires, the more likely he or she is to develop a health care associated infection. These infections, therefore, are more common among people with serious illnesses or who are at high risk such as patients with a weakened immune system.

The extent to which hospitals are affected by HCAIs such as MRSA and Clostridium difficile varies with the type of institution. 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 Clostridium 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. In March 2008, the Minister instructed the Health Service Executive to make Clostridium difficile a notifiable disease and I am pleased to inform the House that from 4 May all cases will have to be notified to the relevant public health department.

I am aware that the Dublin County Coroner has written to Professor Drumm, the chief executive of the HSE, recently regarding the 16 cases referred to by the Senator. I understand some of the patients are reported to have had MRSA and other Clostridium difficile infections at the time of death. Most such instances involve significant co-morbidity factors and I have no doubt the HSE will deal with all the relevant issues raised by the coroner. Officials of the Department of Health and Children have been in touch with the HSE and have requested the relevant information to be made available to the Minister at the same time, who will then give due consideration to the issues involved. In this context I reassure the House that the Minister is fully aware of the problems posed by HCAIs and the stress they cause. This is an issue facing health services worldwide. Tackling these infections remains a priority for the Government and the HSE.

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 by 20%. These targets will be achieved through the development of national and local level action plans to reduce the potential for the spread of infections in health care settings. The steering group is supported by eight local implementation teams which will ensure all local facilities are focused on achieving the national targets.

The availability of microbiology services in the hospital setting is a 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 Hospital 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. When the HSE sought to fill this post before, it proved difficult to get the necessary expertise. However, I am assured a further advertisement will be placed in the very near future.

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 HCAIs, and this policy has been adopted by the HSE. New environmental building guidelines have 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. Its 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. The HIQA is 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 been established recently by the HSE to collect data and provide information on four key areas, to monitor HCAIs in our health system. One of these areas is antibiotic consumption which is an important factor in the prevention and control of infection.

While accepting that not all HCAIs are preventable, the Minister is satisfied that significant steps are being taken to reduce the rates generally and to treat them promptly when they occur. I assure Senator Fitzgerald that I will bring the contents of her contribution to the Minister's attention tomorrow morning.