Seanad debates

Wednesday, 14 February 2007

4:00 pm

Photo of Pat MoylanPat Moylan (Fianna Fail)
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I welcome the Minister for Health and Children to the House and call on Senator Browne to move the motion.

Fergal Browne (Fine Gael)
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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.

Photo of Maurice CumminsMaurice Cummins (Fine Gael)
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I second the motion and support the many valid points made by my colleague, Senator Browne. There is no doubt MRSA is reaching proportions of a modern epidemic and is a widespread problem in hospitals throughout the country. It is a pitiful and pathetically sad day when many patients are forced to worry about what infection they will contract during their stay in hospital in addition to the reason behind their hospitalisation in the first place, a point made on the other side of the House just last week. It is an even greater injustice that many people in our hospitals contract MRSA and are not informed about it immediately. The situation in our hospitals is dire, with people exposed to this infection on a widespread basis. This issue needs to be urgently addressed.

The level of the problem of MRSA in Ireland is vast and with 285 recorded cases of MRSA hospital-acquired blood infections during the first half of 2006, the problem is clearly not abating. The situation is particularly stark when compared to other European countries. The European antimicrobial resistance surveillance system, EARSS, is one of the most reliable sources of information on the subject and monitors levels of MRSA in a number of countries across Europe on an annual basis.

A recent report on MRSA examined trends in 30 European countries between 1999 and 2005 and found that Ireland has one of the highest rates of MRSA in Europe, with levels consistently reaching more than 40% during the period. In contrast, countries such as Iceland, Norway, Sweden, Estonia, the Netherlands, Denmark and Finland reported proportions below 3% during the same timeframe. If it is possible for some of our European counterparts to keep proportions of MRSA below 3%, it is outrageous that we are faced with a crisis MRSA situation with levels more than ten times greater than this figure.

Not only are some countries capable of maintaining very low levels of MRSA infections, EARSS has also highlighted that France and Slovenia have shown a consistent decrease in MRSA levels in the past five to six years, and levels in Slovenia have dropped from 21% in 1999 to 10% in 2005. These trends support the conclusion that MRSA is not an irreversible development and may be dealt with effectively by focusing on control efforts.

The Health Research Board recently announced it has awarded a €1.5 million grant to help tackle health care infections such as MRSA, to which reference was made by Senator Browne. The research will examine a number of areas such as enhanced cleaning processes, the clinical usefulness of the rapid detection of MRSA and more intensive efforts to improve hand hygiene. It appears ridiculous to invest time and money in researching the need to improve hygiene and cleaning practices when it is evident that investment would be far better placed in actually implementing strategies in hospitals to bring the situation under control. Surely it would be a better idea to focus efforts elsewhere and examine the practices adopted by countries maintaining low levels of MRSA infections or those countries which have actively brought levels of infection under control in the past five years.

The HSE recently announced it was appointing 52 additional infection control staff. How many of these have been appointed and what kind of impact are they having on the system? We need urgent action to rid hospitals of MRSA, not promises of additional staff. The HSE must adopt an urgent and effective strategy, based on best practice in other European countries, to deal with the MRSA situation.

There is a worrying indication that the high level of MRSA infections in Ireland may be linked to the over-prescribing of antibiotics. Two recent cases of MRSA emerged as a result of a reduced effectiveness of antibiotics. While our overall level of prescription of antibiotics is close to the European average, there are significant regional, seasonal and socioeconomic variations in the prescription of antibiotics. It is thought this contributes to a resistance to MRSA infection. We need to address this urgently and bring about a change in prescription practice to reduce the overall use of antibiotics.

It is clear that a multifaceted approach is urgently required to address the MRSA issue. Not only do we need rapid action from the HSE to bring about a real and effective change in hospital hygiene practices, we need to inform and train those coming into contact with MRSA patients on how to deal with the situation appropriately. We must also tackle the high levels of antibiotic prescribing in the community.

It is unacceptable that patients do not receive an adequate response from the health service in tackling this issue. The HSE must account for its inadequate approach to this crisis and provide patients with some reassurance that the current situation will not continue.

The health system's use of contract cleaners rather than employees who know their job and responsibilities and who are accountable to a manager within the hospital is another contributory factor to the spread of MRSA. When we learn of the personal circumstances of families whose loved ones have died as a result of an MRSA infection, we realise this major problem, which affects so many people, needs urgent action. We must rid our hospitals of this scourge. I look forward to the Minister's response.

Photo of Camillus GlynnCamillus Glynn (Fianna Fail)
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I move amendment No. 1:

To delete all words after "Seanad Éireann" and substitute the following:

"welcomes the Government's commitment to promoting patient safety and high-quality health services and in particular to the setting up of the commission on patient safety and quality assurance;

supports the objective of the commission to develop clear and practical recommendations to ensure that quality and safety of care for patients is paramount within the health care system;

welcomes the appointment of an assistant national director of health protection as the lead person nationally for MRSA in the HSE supported by senior representatives of the National Hospitals Office, PCCC and Risk Management as well as senior clinicians who have set a number of targeted-national initiatives to reduce the prevalence and impact of HCAIs;

welcomes the recruitment of key staff including 20 infection control nurses, 20 antibiotic liaison pharmacists and ten surveillance scientists in the coming months as part of a national strategy on HCAIs;

acknowledges the upcoming television and radio campaigns to increase awareness of the importance of hand hygiene among hospital staff, visitors and patients;

welcomes the continued education and training of health care workers on HCAIs;

recognises the problems associated with large influxes of visitors as a complicating factor in maintaining hospital hygiene and controlling HCAIs and supports the HSE in its efforts to enforce its policy on visiting;

supports the important role of the Irish Health Services Accreditation Board and its work in applying accreditation standards to ensure safety and continuous quality improvement;

acknowledges that the HSE has put in place management structures at both corporate and hospital level with responsibility for ensuring quality and minimising risk;

acknowledges that hospital cleanliness is vital in fighting the spread of HCAIs;

notes the results of the second hygiene audit which showed significant improvement on the first hygiene audit in almost every hospital;

notes that the Irish Health Services Accreditation Board, IHSAB, is due to carry out a third hygiene audit this year;

welcomes the development by the IHSAB of the hygiene services assessment scheme at the request of the Department of Health and Children. This scheme is a set of standards which the hospitals assess themselves against;

welcomes the Bill to establish an independent Health Information and Quality Authority;

acknowledges the entitlement of all patients to be informed in a sensitive manner of any diagnosis of MRSA;

welcomes the Health Research Board's study on health care acquired infection. The outcome of this research will be a valuable tool in progressing the fight against health care acquired infections at both strategic and operational level; and

notes the request of the Oireachtas Committee on Health and Children regarding the updating of the Health Act 1947, which is being considered in the context of the HSE implementing an accompanying reporting system."

I welcome the Minister for Health and Children, Deputy Harney, to the House. The words "methicillin resistant staphylococcus aureus" do not seem to register with many people, but the abbreviation "MRSA" strikes fear into the heart of almost everyone. Difficulties pertaining to MRSA in society and our hospitals are nothing new. Back in 1995 or 1996, the then Minister for Health and Children had to answer questions on the surveillance of these types of infection.

Fergal Browne (Fine Gael)
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The guidelines brought in then were never implemented.

Photo of Camillus GlynnCamillus Glynn (Fianna Fail)
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I will be honest that I am firmly on the side of the consumer in this regard. The Minister and the Government are endeavouring to tackle the situation as the current position is unacceptable. I am delighted the Fine Gael motion advocates the control of visitors. I recall a time when my local hospital in Mullingar controlled the number of visitors to a patient. The hospital might have let two visitors visit a close relative, but rarely three and if visitors were not close relatives, they might not have been let in at all, rather the hospital staff would convey the visitors' good wishes to the patient. We have become lax on the issue of visitors.

I have never been convinced that the use of contract cleaning services in hospitals was the right way to go. Hospitals are places where, as expected, we find many sick people with varying degrees of infection, many of which are contagious, whether by droplet infection or direct contact. It is imperative therefore to minimise movement. Formerly, even when training nurses to make beds, minimum movement was advocated to prevent the spread of infection. The disposal of human and other waste such as blood, urine, faeces, pus, etc. was always deemed a nursing duty because these wastes were a source of infection.

We could take the co-operation that existed among Seán and Mary citizen during the last outbreak of foot and mouth disease as an example to follow. We must commend the Minister and Ministers of State at the time, Deputies Walsh, Davern and Brendan Smith, on the manner in which they advanced the need for vigilance. The Government, the Minister and all Members are endeavouring to get the message across that MRSA can only be eradicated or kept to a minimum with the co-operation of everybody.

I agree with the suggestion that we introduce a policy to test patients at source. In an effort to reduce the incidence of MRSA, one Galway hospital has introduced a policy of testing all patients for the bug and informing them of the result. Among the first things that should be done in a doctor's surgery is to inform the patient of a definitive diagnosis, since it is a human right to know.

Unfortunately, I have much more to say on this subject but lack the time. I welcome the appointment of nurses with responsibility for infection control, since a single case of MRSA is one too many. I ask the Minister to give sympathetic consideration to those who have contracted MRSA and assist them and their families in any way possible, especially those who contracted the scourge in hospital.

I compliment Senator Henry on stressing the role of antibiotics at a recent meeting of the Oireachtas Joint Committee on Health and Children. It is not rocket science to know that if someone is admitted to hospital with a throat or eye infection or an open, pus-covered wound, a culture should be taken to test sensitivity. Reaching for a prescription pad without knowing the organism that has caused the infection or its sensitivity to a given antibiotic is not the right way to treat a patient. I commend Senator Henry on her remarks in that regard.

Mary Henry (Independent)
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I thank Senator Glynn for his kind words on exactly the area I wish to address. I welcome the Minister for Health and Children, Deputy Harney, to the House. I have frequently heard her speak on this issue and am well aware that she realises its seriousness. Florence Nightingale said that when the sick enter hospital, they should not become sicker as a result. We have got into an unfortunate situation where people going into hospital are very afraid that they will become infected by antibiotic resistant bacteria and that it will be the end of them. However, thanks to my friend, Dr. Fred Faulkner, the chief microbiologist at St. James's Hospital, I have a report from the standing medical advisory committee to the Department of Health in London. It was written in 1959 and addresses staphylococcal infections in hospitals and antibiotic resistance. We are not dealing with a new problem but with one that has now got seriously out of hand.

If the Minister read this report, she would find that many of the summary conclusions and recommendations are exactly the same as our own. The first is that the control of staphylococcal disease depends largely on the application of aseptic methods, in other words, cleaning up. The use of antibiotics, either for treatment or for prophylaxis, is by itself unreliable. We have a terrible idea nowadays that there is a pill for every ill and that we can solve everything that way. The area I wish to address is the seventh recommendation, namely, that in all suspected cases of staphylococcal disease, it is desirable to confirm the diagnosis by bacteriological investigation. We have not put enough emphasis or exerted enough effort on this situation.

Initially we had bacteria resistant to one antibiotic. MRSA initially stood for methicillin resistant staphylococcus aureus. However, MRSA rapidly became multiply resistant staphylococcus aureus, and the current situation is that we have not just staphylococcus aureus but many other bacteria resistant to the most common antibiotics, with nothing else coming down the line to take over from them.

Bacteria have been here for billions of years. They are far more successful than human beings, who have been around only for a few million years.

Photo of Brendan RyanBrendan Ryan (Labour)
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They are tougher too.

Mary Henry (Independent)
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They are a great success, managing to change their little jackets overnight so that whatever affected them yesterday has no effect on them today. New antibiotics are being introduced only to be defeated within a few days. We have not put enough emphasis on the role of the laboratory, which can be the key to diagnosis and surveillance in acute hospitals in particular. We must know what the mechanisms are in these changing bacteria so that we might have some idea of the best way to make progress. Only in the laboratory will we manage to find out anything about suitable prescribing, in the hospital and outside.

I very much regret that 100% of our cervical smear tests now go to Dallas in the United States, since it has a terrible effect on morale in Irish laboratories conducting such screening. What will happen to the training of medical scientists if we outsource all our specimens? The international privatisation of specimens from hospitals would be a terrible mistake and I hope that the Minister can rectify that problem as soon as possible.

The resistance of many bacteria is probably under-diagnosed owing to insufficient surveillance in hospitals, never mind what is happening in the community where we frequently have very little idea what is occurring. There have been cases where we do not know what mechanism caused the bacteria to change and we must know that because genes coded for resistance emerge in one strain only to be transferred to others. That DNA change means that various mechanisms can be used by the bacteria to defeat an antibiotic.

That can make a difference to how one directs one's next line of treatment. For example, if the enzyme b-lactase is produced, it breaks down the b-lactam ring in penicillin, and that is the anti-bacterial part. If one knows that the bacterium is using that mechanism, one will not try a cephalosporin since the same thing will happen, moving on instead to a different type of antibiotic such as a tetracycline.

This can also happen with gram-negative bacteria, including e.coli, and there are other methods that the bacteria can use, such as altering the penicillin's binding proteins so that it cannot work. One needs to know exactly what they are doing, and our laboratories are not receiving sufficient investment in the area. It must be done countrywide and not just in research laboratories. It is terribly important that we get at it as quickly as possible if the problem of multiple drug resistance is not to worsen further.

It is only if we take such steps that microbiologists will be able to advise surgeons, physicians and junior hospital doctors of the next best antibiotic rather than allowing the scattergun approach seen in far too many hospitals. Part of our problem is that medical scientists are not being encouraged enough or given enough finance to investigate the area.

Senator Glynn noted that I raise this constantly, and I heard the Minister speak on it on the radio, namely, the education of the public into desiring antibiotics where they are not strictly necessary. I see from the text of the amendment that the Government parties acknowledge the upcoming television and radio campaigns to increase awareness of the importance of hand hygiene among hospital staff, visitors and patients. What about a campaign on expectation and the feeling that if one visits a general practitioner and does not come away with a prescription for an antibiotic, the consultation has been a failure? Most upper respiratory tract infections are viral and many of the pneumococci are resistant to antibiotics, yet 40% of antibiotic prescriptions are for upper respiratory tract infections.

The Government must invest in educating not only the public but GPs and hospital doctors. Pharmaceutical companies are now relied on to hold medical seminars and so forth, but they will hardly suggest that people cut down their use of antibiotics. The Government will have to get involved and carry out trials of different treatments. One would be as well to put one's head over a bowl of friar's balsam and inhaling. The Government must get involved in such trials because no one else will be able to do so. Antibacterial wipes, which are advertised on television, are lethal and should not be allowed at all.

I must refer to the abuse of antibiotics in the food chain, particularly among poultry and pigs who are brought up in factory farms. Although these are called growth enhancers in their food, they are antibiotics. They may not be used by humans, but they are encouraging resistance among animals and poultry. There is far too casual an attitude about this and it should be discouraged.

This is a matter of surveillance and investment in our laboratories, and education of patients and doctors as to the appropriate use of antibiotics.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I welcome the opportunity to make a statement in this House on MRSA. I reiterate my 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.

At the outset, I want to assure Senators that the vast majority of patients in Ireland receive effective and safe treatment. However, international studies suggest that a minority of patients can be harmed through their care, either in hospital or in the community. I do not wish to minimise in any way the effect on patients and their families of contracting infections in hospitals and other health care facilities, and I acknowledge and regret the pain caused to patients and their families. It is a problem in all health care systems but one which I am determined to control in the Irish health care system.

MRSA is not a new problem and it is unique to Ireland. Health care associated infections, HCAIs, including MRSA infection, are in many Irish hospitals and MRSA is increasingly being seen in community health care units such as nursing homes. The impact of these infections is considerable. At a human level the impact on patients and their families can be debilitating. It is in everybody's interest to keep infections out of our hospitals, out of nursing homes and out of all settings where people are vulnerable.

The control of health care associated infections, including MRSA, continues to be a priority for the Health Service Executive. Measures to control the emergence and spread of health care associated infections are necessary because there are fewer options available for the treatment of resistant infections, as Senator Henry acknowledged, and because these strains spread among vulnerable at-risk patients.

Acute hospitals collect information on health care associated infections at a local level. It is my intention that this information will be collected, both locally and at a national level. We need to be able to measure data and compare it.

Among the recommendations in the strategy for antimicrobial resistance in Ireland is the appointment of infection control nurses, surveillance scientists and antibiotic pharmacists necessary to commence a national surveillance programme. The HSE is currently in the process of recruiting these staff and they should be in place in the coming weeks and months.

The HSE has appointed a small group, led by an assistant national director of health protection, to take the lead on MRSA. The group has concentrated on a targeted number of issues including the development of a three-year action plan and overseeing its implementation, as well as putting a high quality governance structure in place. It has always been my experience that if everybody is responsible then nobody is ultimately responsible. It is therefore vital that there is clarity around this issue.

There is an increasing body of evidence of what are the best and most effective practices to reduce the impact of HCAIs. The HSE will take measures including: a public education campaign; directed action on specific health care associated infections; initiatives on the appropriate prescribing of antibiotics, particularly working with general practitioners; a national surveillance system for HCAIs; a health care worker educational and training programme; and the implementation of a standardised approach to antimicrobial susceptibility testing.

A number of projects have been continued or started over the last year. These include recruitment of key staff including scientists, infection control nurses, antibiotic liaison pharmacists and surveillance scientists while good practice guidelines on control and prevention of MRSA were implemented. A hand-washing poster campaign, "Clean Hands Save Lives", took place in October 2005. I note that this campaign is not in operation in some health care settings I visit and that is a cause of considerable concern.

I acknowledge what has been stated here about other industries. In my previous job, where I had responsibility for visiting many settings including the semi-conductor and pharmaceutical sectors, the standard of hygiene required of visitors included covering hair, covering shoes and covering all clothing by wearing a white coat or other such garment. In vulnerable places in hospitals, particularly intensive care units and such areas, we need to learn quickly from what is happening in other sectors.

The projects to which I referred also include the following: antibiotic stewardship guidance to guide professionals on the appropriate use of antibiotics is being developed; existing systems on data collection on community and hospital antibiotic consumption are being enhanced to provide a more detailed and wider range of information on antibiotic prescribing while the HSE is planning to create a suite of education and training programmes on HCAIs for approximately 4,000 health care workers.

On the development of a public education programme, a two-year national publicity campaign on HCAIs and antibiotic resistance which will use the full range of media, at both national and local levels. On information for patients, the Health Protection Surveillance Centre has information for the public on HCAIs on its website. The HSE will ensure that the availability of this information is brought to the attention of all hospital managers and consultants. It will be made as widely available as possible within the hospital for distribution to patients and members of the public.

The HSE and the Department of Health and Children sponsored the Irish Patients' Association in organising a clean hospital summit in January 2006. This brought together over 200 HSE staff with a key role to play in promoting hospital hygiene in their workplace. A further summit is planned for the spring of this year.

I have met with representatives of the MRSA and Families group. It is a responsible group of citizens who have been badly affected, either directly or through their families, as a result of acquiring infections in a health care setting. The HSE has also held constructive meetings with them and further meetings and discussions are planned.

Visiting hours and associated problems with the influx of visitors has been seen as a possible complicating factor in maintaining hospital hygiene and in controlling infection. A national visiting guidelines document has been produced by the HSE. I would ask all visitors to hospitals, in so far as is possible, to respect hospital visiting times and also to be vigilant in using the facilities available to ensure that their hands are not carrying infection to patients.

A project plan for the development of a GP educational initiative to run from early this year until 2009 has been developed. This will include the recruitment of 20 continuing medical education groups, the establishment of a surveillance system on antibiotic prescribing and the development of guidelines and the education of GPs.

It is difficult to identify the number of fatalities attributable to MRSA as many people also have significant co-morbidity factors. Last year Ireland participated in the Hospital Infection Society's "Prevalence Survey of Health Care Associated Infections" in the United Kingdom and Ireland. The survey provided accurate and comparable data on the prevalence of health care associated infections, including MRSA, in acute hospitals in Ireland and can also be compared with similar data being obtained in England, Scotland, Wales and Northern Ireland. Preliminary results of this study are now available and the final results will be available shortly. The overall prevalence of health care associated infection in the UK and Ireland study — these figures exclude Scotland — is 7.9%. The figures are 8.2% for England, 6.3% for Wales, 5.5% for Northern Ireland, and 4.9% for the Republic of Ireland.

As I mentioned earlier, the prudent use of antibiotics underpins any approach to the control of antibiotic-resistant bacteria, including MRSA. This, together with good professional practice and routine infection control precautions, such as hand hygiene, constitute the major measure in controlling and preventing health care associated infection, including that caused by MRSA, both in hospital and in community health care units.

Hospital cleanliness is also vital in fighting the spread of HCAIs. To date, two national hygiene audits have been carried out in acute hospitals. The first audit was carried out in mid-2005. The second audit was conducted in early 2006. The results of the second audit showed that significant work had been done at hospital and national level. Almost every hospital had increased its overall score since the first audit, with some of the most significant improvements being shown by those hospitals that recorded poor scores in the first audit.

A national cleaning manual has been issued to support hospitals in maintaining good hygiene and the Irish Health Services Accreditation Board, IHSAB, is due to carry out a third hygiene audit this year. Well managed hospitals will be ready at any stage for an audit.

The board also developed the hygiene services assessment scheme at my request. This was officially launched in November 2006 and is a four stage process involving self-assessment, peer review, award and report. The IHSAB initiated the self-assessment process in all acute hospitals in January with the peer review visits commencing in April and the final report in August 2007. The ethos behind this type of scheme is that for hygiene to become an inherent part of daily operations within a hospital staff must take ownership of the process and self-assessment is the driving tool to do this.

All medical practitioners have an ethical responsibility to complete death certificates as accurately as possible and this includes recording methicillin resistant staphylococcus aureus, MRSA, infection. The attending doctor must sign the death certificate and determine cause of death. In November 2006, a coroner's court recorded what is believed to be the State's first verdict of death by MRSA infection. The coroner ordered that deaths due to hospital infections must be reported to the coroner and other reporting bodies so that statistics could be gathered. This is the first time this has occurred in Ireland and members of the central council representing the families involved have welcomed the ruling and I share their response.

Last month, I welcomed the announcement by the Health Research Board, HRB, of the establishment of a multi-disciplinary research team that will investigate and help tackle health care associated infections. The research will look at three specific areas: enhanced cleaning processes and their impact on infections, the clinical usefulness of the rapid detection of MRSA and more intensive efforts to improve hand hygiene to achieve near 100% compliance with best practice.

The HRB funded research team will then use state of the art molecular technology to determine the relationship between environmental contamination with health care associated infections and the incidence of such infections.

The organisation of health services is complex in any country and for any population. As in any large organisation, this complexity challenges us to find a radical simplicity that guides our work and decisions. Many procedures are in place to protect the well-being of patients and to secure the best medical outcome possible, however, as with any system, these safeguards are not completely error proof. I would like all of us in health care to unify around one very basic promise to patients before all else, namely, that they will be safe. I would like this simple promise to drive everything it possibly can in health care — policy, practice, organisation of hospitals, organisation in hospitals, individual and group behaviour, resource allocation, recruitment, training and education. There is virtually no area of health care that a patient safety agenda cannot and will not positively influence.

A modern health care system accepts that each person can play a central role in his or her own treatment and recovery. It recognises that each individual plays a critical and essential role in the assessment of his or her own needs and that quality of care is inextricably linked to the involvement of the user in determining his or her health care.

Patients and their advocates must be also encouraged to play their part in embedding safe care in our systems. Patients, their relatives and carers must be central to our efforts to minimise harm and we must develop mechanisms which empower them to point out any possible errors or care deficiency without fear of the consequences.

To this end I have asked the Health Service Executive, HSE, to set up a national help line which patients and their families can call to report incidents of poor infection control in our hospitals. If, for example, patients are unhappy that a member of the hospital staff is not disinfecting his or her hands between patients, they or a family member can call the helpline if they do not feel in a position to raise the matter directly with staff in the hospital. This is not about blaming people, it is about helping all of us, patients, visitors and health care staff, to play our part in improving patient care.

In addition, I recently established a Commission on Patient Safety and Quality Assurance. Membership of the commission is made up of medical and nursing representatives, management representatives and representatives of patients and carers. The overall objective of the commission is to develop clear and practical recommendations to ensure that quality and safety of care for patients is paramount within the health care system.

The commission will develop proposals for ensuring clear responsibility, among senior management and clinical leaders within the health system, for performance in relation to quality and patient safety. It will also make recommendations on more effective reporting of adverse clinical events and complaints and a clearer role for patients and carers in feeding back on care received. It is intended that the commission will report back within 18 months.

Finally, I would like to refer to the importance of the establishment of the independent health information and quality authority to progress the safety and quality agenda. This is provided for in the Health Bill 2006, which I hope this House will have the opportunity to debate in a matter of weeks.

In 2005 I reaffirmed Ireland's commitment to enhancing the safety of patients by signing up to the Global Patient Safety Challenge. This is a major initiative, undertaken by the World Health Organisation, WHO, which aims to address significant aspects of risk to patients receiving health care. During 2006 and 2007, the Global Patient Safety Challenge will be to identify, develop, test and evaluate strategies for the implementation of the WHO guidelines designed to assist countries in improving patient safety and saving lives by reducing the burden of health care associated infections.

Photo of Brendan RyanBrendan Ryan (Labour)
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Cuirim fáilte roimh an Aire. Ní ró-mhinic a chímid anseo í anois, but the Minister for Health and Children, Deputy Harney, visits us fairly regularly and she is very welcome.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I will be back here next week, I believe.

Photo of Brendan RyanBrendan Ryan (Labour)
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We are always glad to welcome the Minister. In her early days as a Minister of State the Minister for Health and Children was one of the first to begin the practice of introducing legislation in this House. She had the double burden of introducing major legislation and dealing with a large, significant and domineering senior Minister simultaneously but she did both competently.

Photo of Mary O'RourkeMary O'Rourke (Fianna Fail)
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She disposed of him.

6:00 pm

Photo of Brendan RyanBrendan Ryan (Labour)
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This is too serious an issue for me to make the sort of speech I usually make because I could beat the Minister over the head about the delays. I think it is a pity we may well end up trying to reinvent the wheel on this matter. I would have loved to have heard in the Minister's speech why her Department thinks the incidence of MRSA is so much lower in places like the Netherlands and Sweden. Have we sent people there to find out why? Have we identified a list of things which indicate why?

Who could argue with any of the things presented in the Minister's speech? However, what evidence exists indicating that the things presented in her speech are the things we actually need to do? I am sure there is some evidence but are all of these things being implemented in other countries? If so, and if they are successful, why did it take us so long to come to them?

I do not want to go back over other issues to do with the health service, but why are our hospitals not as clean as they should be? I find it astonishing that we must launch a personal hygiene campaign directed at people working in hospitals. When our children were small, and we were dealing with bottles at one end and nappies at the other, every one of us understood, without a huge public campaign, the possibility of infection if we did not operate to high levels of hygiene. I must assume, therefore, that it is not that doctors and nurses do not realise the risks; it is a lack of the necessary time, opportunity and freedom to operate best practice because they are under such pressure. I cannot prove this and I will not launch into a big speech on the matter. I must assume that the things obvious to every parent dealing with children at their most vulnerable are obvious to those working in health care.

I have heard a great deal of talk about quality assurance in this country and I have seen it in operation in third level education where it focuses entirely on the minions, the teachers. There is no quality assurance system for senior management in third level education. Real quality assurance starts at the top, as any textbook on quality assurance will tell you. It is the example of those at the top that convinces others of the value of quality assurance and changes it from being a weapon of management to make life difficult, as it is perceived, to a necessary part of doing a job as well as it can be done.

There is a great panoply of quality assurance measures relating to academic work and none relating to management. I must assume the same applies to the health service. No process of quality assurance applies to the work of middle managers and those who are somewhat higher in the public health service. If it did, we would know who is responsible, who is being paid a salary to take charge and who has tried to organise the relevant programme. One will never find out who is responsible for what in the hospital system but one will find out a lot about cross-over infections being carried by overworked nurses and doctors. What should be the subject of collective responsibility is turned into an adversarial set of circumstances in which those who deal with the dirty job of hygiene continually feel that what they are being asked to do is not remedying the problem. They are asked to fill out more forms and produce more procedures to which they do not believe those above them are committed.

Let us consider the issue of over-use of antibiotics. I am not a doctor and do not know much about this matter but I know some antibiotics are infection specific and others are broad spectrum. The recommended method of prescription is to identify the particular micro-organism causing the infection and prescribe a specific antibiotic. If my general practitioner, who is very good, wants to do this, he must have the test done in some laboratory. If he takes blood samples or other samples from me, I must bring them to the laboratory myself to have them analysed. There is no procedure whereby a general practitioner in Cork city can send samples to a laboratory to have them analysed. Nobody collects them so the patient must bring them. In the name of heaven, does anybody seriously believe a busy general practitioner like mine will go through the process of sending every sample he takes to the laboratory to have it identified to determine which antibiotic should be used? He will do the simple thing and write a prescription for a broad-spectrum antibiotic, which is guaranteed to increase the possibility of the evolution of antibiotic-resistant micro-organisms.

I do not know a lot about this matter but it seems that if we want to use antibiotics only when they are needed and use only those that are specific to certain infections, we must have a system that ensures that general practitioners, who are at the front line, can have samples analysed appropriately. Similarly, hospitals with large numbers of old people and public and private nursing homes should have such a system in place. Where an older person has a chest infection, for example, it is important to know what prescription is appropriate. As Senator Henry stated, there is not much point in prescribing antibiotics for a viral infection. However, if an infection requires an antibiotic, it should be known what type is required.

I am somewhat intrigued by the Health Research Board's research programme but I may well be wrong about it. Some countries have managed to curtail or reduce dramatically the incidence of health care associated infections. The Health Research Board is to research "enhanced cleaning processes and their impact on infections". If one asked the public about this, they would wonder why such research is required. The board is also to examine the "clinical usefulness of the rapid detection of MRSA". Are we suggesting it might not be clinically useful to detect it rapidly? The only reason for doing research is to determine whether an alternative procedure can be adopted. The board is also to consider "more intensive efforts to improve hand hygiene to achieve near 100% compliance with best practice". This means we will get people to use materials of the best quality when washing their hands. This is what everyone wants to do.

Photo of Camillus GlynnCamillus Glynn (Fianna Fail)
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If we could get them to wash their hands, we would be on a winner.

Photo of Brendan RyanBrendan Ryan (Labour)
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When we were changing babies' nappies and preparing their bottles, we knew about enhanced hand hygiene. The Health Research Board's press release states it "will then use state-of-the-art molecular technology". What has this to do with washing one's hands. Somebody fed a good bit of jargon to the Minister who is, incidentally, a very intelligent woman. I am not sure what any of this means and I am more than a little confused by it, to put it mildly.

I have the good fortune to work in an area that trains people to work in the pharmaceutical industry. Most, but not all, of the pharmaceutical companies in Cork produce a range of drugs. Between the production of one drug and the next, a process of cleaning is required so there is no possibility of a drug being contaminated. The companies do this efficiently and successfully. Contrary to what the Minister says, it appears one can be 100% successful in this regard. In the 25 years in which there has been a pharmaceutical industry in Cork, I have never heard of a product becoming contaminated by another that was produced previously.

Let us not set our standards by saying something will always go wrong. The pharmaceutical industry, with all its faults, can do what I have described. It does so by employing a steady methodology and because it is utterly terrified of the US Food and Drug Administration. It is afraid because it knows it must meet high standards. Management is responsible for the achievement of high standards. It teaches others and is responsible and accountable. When this principle is injected into the health service, not just in respect of MRSA but more broadly, we will make progress.

The problems that exist are not the fault of doctors or nurses. They arise because there is a layer of management that has never accepted that the job of management is to take responsibility, which is what it is paid for.

Photo of Ann OrmondeAnn Ormonde (Fianna Fail)
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I welcome the Minister of State, Deputy Seán Power, and thank the Minister, Deputy Harney, for attending to listen to the first half of this debate.

I seldom agree with Senator Ryan but I was nodding quite a lot regarding points he made. He made practical suggestions, which I thought about making myself, on how best to overcome the problem of MRSA. It is a serious problem and our task is to determine how it can be kept out of hospitals. This is a fundamental question.

In a way I am glad Fine Gael tabled this motion but I hope it will acknowledge that every effort is being made to tackle the problem. It is a matter of how best we can come together to solve it. We need joined-up thinking rather than having everyone separated into little boxes, each doing his own thing. We have enormous numbers of staff in hospitals, all stretched to their potential to try to give a service. At the same time there is this awful infection that seems to be creeping into hospitals, nursing homes and other vulnerable areas in society. What can we do to alleviate this?

I welcome the Minister. I also welcome the range of initiatives she has introduced towards preventing the spread of MRSA in hospitals and vulnerable areas. The task of the new commission will be to put forward clean, clear and practical recommendations on performance, the reporting of adverse clinical events and complaints, a clearer role for patients and carers concerning feedback on care received, ways to ensure health care practice based on what has been seen to work in other countries and a statutory system for licensing public and private providers of health care. The last is especially interesting and I would welcome a prompt move on that.

The Minister has appointed the assistant national director of health protection within the HSE to lead this campaign against MRSA. She needs to have the support of all the interested bodies that work in hospitals, the joined-up thinking I referred to, because without an integrated workmanship style to counteract MRSA, we will not get it right. It will mean one body overlooking others and nothing effective will be done to clear up the mess.

I was very interested in the Minister's reference to a public awareness campaign. At that point I began to reflect on whether this bug existed in hospitals 20 years ago. As we know, there were hospital matrons in the past, particularly nuns, and I wonder whether they had a style of management which ensured everything was meticulously clean and there were no suggestions of slovenly workmanship in any shape or form. As a result of such management norms being replaced over time, workmanship, administration and so on has become slovenly.

Should there be better screening systems for visitors? I have visited patients in hospitals, wandering in outside visiting times, and very seldom have I been stopped. I do not want to compare the incidence of MRSA with the threatened onset of foot and mouth disease in the country some years ago. However, one can learn from the way that crisis was managed and how the screening process was so meticulous that the disease was wiped out before it ever caught hold. Perhaps the list which the Minister has itemised is the way forward. I repeat what she said about national visiting guidance:

Visiting hours and associated problems with the influx of visitors has been seen as a possible complicating factor in maintaining hospital hygiene and controlling [HCAIs]. A national visiting guidelines document has been produced by the HSE. I would ask all visitors to hospitals, in so far as is possible, to respect hospital visiting times and also to be vigilant in using the facilities available to ensure that their hands are not carrying infection to patients.

There is a significant problem of how to stop this infection. Very often infection is brought in from outside rather than emanating from within the hospital. I am more concerned about this rather than what is happening within the hospital. Perhaps sufficient attention is not being paid to hand washing and how professionals administer their duties to patients.

The Minister has started to introduce measures, however. I welcome the fact that Fine Gael tabled the motion to highlight what is being done and how important it is for the public at large to be made aware of the problem. People do not realise the danger until they have a patient from within their own family and are confronted with the horrors of MRSA. The might think it all emanates from inside the institutions and blame everybody, the consultants, the doctors, or nurses, when it might come from a vulnerable area within the community. Everyone has a responsibility in this. Nobody is to blame. It needs a collective approach as the only way to introduce proper hygiene measures and standards within hospitals and the community.

I welcome the Minister. She has given us a list and guidelines on how she proposes to move forward. She has started it and I know that she will be successful. However, we all have a role to play. If everyone addresses their responsibilities in this regard, we will achieve the necessary standards in hospitals.

Photo of Frank FeighanFrank Feighan (Fine Gael)
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I welcome the Minister to the House on a very emotive issue. I wonder whether we ever get matters right in Ireland. Many years ago we had probably the most lax hygiene standards in Europe. From a food viewpoint we did not know what a health worker was. In pubs the standard of cleanliness in toilets, behind the counter and in restaurant areas was very poor. Not that many people died, however.

In any event, we have introduced what is perhaps the most draconian legislation in Europe. There are 37 different offences under food legislation with health officers closing pubs, restaurants, abattoirs, small businesses and butchers. It is quite clear that matters have gone over the top but in Ireland, we do not do things by half. We must go over the top regardless of what is being introduced. If the same standards were introduced in public sector hospitals or nursing homes, I have no doubt we would not be having this debate about MRSA in the House.

Fergal Browne (Fine Gael)
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Hear, hear.

Photo of Frank FeighanFrank Feighan (Fine Gael)
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This Government has always stooped to facilitate vested interests. When we had the opportunity under benchmarking to ensure that people did the work for which they were responsible, we shirked the responsibility. I attribute the incidence of MRSA to the fact that despite doctors, nurses and hospital staff working very hard, nobody is responsible, no one has been sacked and nor will they be even though people are dying from this disease. That is the problem we face in this country.

I first encountered MRSA when a woman came to my office. She had to go into hospital and she was genuinely concerned. She was afraid to go in case she contracted MRSA. I was not too sure what MRSA was at the time and neither was anyone else. Neither were we too sure how the disease could be contracted.

Photo of Camillus GlynnCamillus Glynn (Fianna Fail)
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It was discovered 32 years ago.

Fergal Browne (Fine Gael)
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How many years ago?

Photo of Camillus GlynnCamillus Glynn (Fianna Fail)
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It was discovered in 1975.

Photo of Frank FeighanFrank Feighan (Fine Gael)
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Not all of us have worked in the health service. Many people have died from having contracted MRSA. I am sure there has been a cover-up in that the death certificates of people who have died from MRSA record that they died from other diseases. People have called to my constituency office expressing their concern about contracting this virus. The Government has done nothing to allay the fears of the public about the spread of this virus or to implement the necessary measures to contain it. I do not want to be political but something must be done now.

Hospital staff are very busy individuals and the staff simply leave work to go home, at which point there is no hygiene supervision in place. If they have a baby at home or cook at home, they will probably take more care sterilising a bottle or cleaning around a cooker than they take in what they do in the hospital. That is not a reflection on the hard-working staff in the hospital but on the health service. Money is being thrown at it. The attitude is there is no need to worry because nobody will pay.

If I had a shop in which there was an ice cream machine and the environmental health officer, on inspecting the premises, found hygiene standards were not being met in terms of the area around the sink, the ice cream machine or the water quality, that shop would be closed. A court injunction would be taken to close it. The prevalence of MRSA has been discussed for many years but has anybody in a senior position been sacked?

Fergal Browne (Fine Gael)
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No.

Photo of Frank FeighanFrank Feighan (Fine Gael)
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No senior worker or administrative staff member who is responsible for the running of a hospital has been sacked. We can talk all we want about this problem but we have not yet tackled it in the way we should have.

A total of 8,000 patients tested positive for superbugs in Irish hospitals in 2005 and 6,000 patients in more than 30 hospitals were infected by MRSA. That is incredible. Between 1999 and 2002 the incidence of MRSA increased steadily from 38.8% to 42.7%. What are people working in the hospitals and nursing homes doing in this respect?

Photo of Ulick BurkeUlick Burke (Fine Gael)
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What is the Minister responsible doing?

Photo of Paddy BurkePaddy Burke (Fine Gael)
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I wish interrupt the Senator to welcome a former distinguished Leader of the House, Deputy Cassidy, and the Mullingar west delegation to the Visitors Gallery.

Photo of Camillus GlynnCamillus Glynn (Fianna Fail)
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Hear, hear.

Photo of Frank FeighanFrank Feighan (Fine Gael)
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I also welcome the delegation. There is one rule for the private sector and no rule for the public sector. The sooner we get our act together the better. People must take responsibility and to achieve this, a benchmarking measure should be included. Otherwise, we will continue to fight a losing battle against the problem of MRSA. We are all involved in tackling this. Senator Ormonde rightly pointed out that it is a serious problem and it must be addressed. People in administrative posts must take responsibility in this respect. The Government has thrown vast sums of money at the health service.

We have all attended conferences and I am sure some Members have visited Holland. There they searched for and destroyed MRSA. It now has the lowest incidence of MRSA in Europe. We should learn from its experience. We can learn all we want about it but we know what causes it and how to stop the spread of it. If we and administrative staff in all the hospitals and nursing homes do not have the will to tackle it, we will lose the battle.

Superbugs are spread through poor hygiene and the failure to implement proper cleaning and sterilising practices. Such bugs are largely preventable. Effective cleaning procedures and good hygiene practices can eliminate the spread of almost all of them. What is required is not rocket science but simply proper cleaning and housekeeping practices.

It is incredible that we are debating the serious problem of the incidence of MRSA which has been prevalent for many years.

Photo of Ulick BurkeUlick Burke (Fine Gael)
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Hear, hear.

Photo of Frank FeighanFrank Feighan (Fine Gael)
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We should be ashamed of the fact that we oversaw it but we must do everything now to address it. I do not want any person who has to go hospital for an investigative procedure to call to my constituency office in the coming years expressing concern that he or she may contract MRSA. This virus has caused huge anxiety among the public and we must now address this problem.

Margaret Cox (Fianna Fail)
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I wish to speak about my experience when I was a member of the former Western Health Board. A number of the hospitals in the Western Health Board region which are old and have poor facilities are open territory to allowing the spread of MRSA or encouraging it to develop even further. Merlin Park Regional Hospital, the acute orthopaedic hospital for the region, was built in the early 1930s or 1940s at which time it treated TB patients. The facilities have not been improved since the hospital was built. Private and semi-private rooms and wards in the hospital do not have ensuite bathroom facilities. In the long wards or even private rooms, where patients are isolated if MRSA is detected, patients have to use the toilet facilities available or a commode, in which case they have to wait for it to be taken away, emptied and disinfected. To tackle the problem of MRSA, it is vital to identify the accident blackspots in terms of facilities in our hospitals and to put in place a radical plan immediately to address these needs.

While I am only familiar with the facilities in Merlin Park Regional Hospital, I am sure there are many other hospitals with similar facilities where commodes are used and a cleaning and disinfectant regime is in place. The facilities in such hospitals need to be upgraded as a matter of urgency and from a health and safety perspective not only for the staff but most especially for the patients. The Minister said it is important to ensure that people do not go into a hospital and become sicker in hospital than they were before they went in. It is within our remit to deal with that and to ensure patients are treated properly and this bug is contained.

Examples of best practice in other places on the Continent and in the UK were mentioned and there are many lessons to be learned. I had a conversation only yesterday evening with a person who is working at the coalface in a hospital. This person spoke about the difficulty of dealing with MRSA, managing cleaning and, importantly, the huge burden on staff of paperwork involved in the carrying out of hospital audits. Staff spend increasingly more time dealing with paperwork. There is more paperwork, plans and fancy words but hospitals are not any cleaner and we are not eradicating the bug. Therefore, we are not solving the problem.

From a cost point of view, the focus in hospitals over the past ten to 15 years has been on outsourcing non-essential and non-core activities. Cleaning has been outsourced to cleaning companies. We are attracting many non-nationals, many of whom do not have good English, and many of them work for contract cleaning companies where the rate of pay is quite low. This is the only type of work many of them can find to survive. These people often do not understand the instructions they are given, the importance of the work they must do and the fact that they are operating in a life-threatening environment if they do not do their work properly.

The Patient Focus website provided some advice on MRSA. It stated that if there is dust or dirt under a person's bed, that person should ask for the area to be cleaned. The problem is that patients are dependent on the people around them and they can feel very vulnerable. It is very difficult for them or their visitors to request that areas be cleaned around them. They do not want to be seen as moaners by the nursing staff. It is difficult to have the courage to say to the nurse that the area around one's bed is filthy and disgusting or that the bathroom is just not clean enough. It is difficult to deal with that situation and we must push the responsibility back to the providers of the service, be they the internal management or the contractors if it is outsourced. They are responsible for the quality and they must ensure it is 100% all of the time.

It will also be necessary for the Health Service Executive to provide a central training budget for the training and education of people working in this area, especially those who provide the service and clean the floors. Nobody can work on a building site without a FÁS Safe Pass. No cleaning contractor or staff employed directly by the HSE should be allowed to provide a cleaning and hygiene service in a hospital without having undergone a certified training course similar to the Safe Pass. In this way, they would understand the implications of not doing the job properly. If people knew that not doing their job properly could cause the death of a person, they would recognise their responsibility. If we do not show people their responsibility, we cannot expect them to understand how important it is that they do their job to the highest standards.

As the Minister said, the focus must be on education but also on training and development for those doing the job. We all agree it is about hygiene and cleanliness. I was recently in the Mater Hospital and there were gel containers everywhere for cleaning one's hands. However, I felt at one stage that I was the only person using them as I went from one department to another. It certainly did not seem as if they were being used by the porter staff, the nursing staff, the contractors or the people delivering the food. I spent up to three hours sitting in the outpatients department with someone, and this opened my eyes to the inattention that people displayed to the possibility of cross-infection.

We have a big job to educate the public, patients and management within hospitals. We also need to give them resources because they cannot do anything otherwise. Providing resources is vital in controlling and limiting this disease. If lessons are to be learned from best practice abroad, we need to learn them. There is no point in re-inventing the wheel.

Photo of Ulick BurkeUlick Burke (Fine Gael)
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It is unfortunate that the Minister for Health and Children came to the House and delivered the usual jargon. However, it is clear from what she said that the Government has abdicated its responsibility in tackling this urgent and infectious outbreak in our hospitals. The Minister said she reaffirmed Ireland's commitment to enhancing the safety of patients by signing a global patient safety challenge. That indicates her complete misunderstanding of the reality. There is something wrong in the hospitals and she has failed to take action. She must take responsibility because the HSE is not doing its work.

To blame nurses for the lack of cleanliness in hospitals is wrong. The nurses have a professional duty and they carry that out to the highest standards possible. She spoke about national initiatives in her speech. What are they? She mentioned a public education programme, initiatives in appropriate prescribing of antibiotics, national surveillance and health care worker education and training programmes. That would be fine if we were not dealing with something that needs immediate action. She also failed to point out that she is not providing the funding for the cleaning of hospitals. If we had clean hospitals like those of 30 or 40 years ago when we did not have this problem, it might then be fine to suggest those initiatives to deal with problems that may occur in the future. However, she has failed to realise that the infection is rampant in our hospitals. Many patients who leave hospital go to other care facilities such as nursing homes and they are now being infected.

As long as this Minister believes that training programmes can solve the problem without an urgent cleaning of hospitals, then the infections will continue. I could show Members of this House a photograph of a ward in University College Hospital in Galway. This 26-bed ward has a chain and a padlock on the door from Friday evening to Monday morning, yet we are still told there are no facilities for the isolation of patients with the MRSA infection. This is occurring all year round. I monitored the situation for six weeks as I was visiting someone regularly in the hospital. Each Friday evening, a lock and a chain was put on that facility. I was told it was locked because there are six day care beds in that facility. That is not the case.

We were always told that when the nuns ran the hospitals there was never a dirty ward, which is true to some extent. When a matron went around the wards every day, we did not have these problems. Practical steps are needed, as are resources.

I am sure the Minister is getting consultants to prepare a glossy magazine that will outline the HSE's new initiatives in the western region and other areas. The glossy magazine will provide details of the HSE's initiatives. Hundreds of thousands of euro will be used to pay consultants and to produce the glossy magazine that will lie on a shelf or be dumped in a bin, without any notice being taken of it. If such resources were used to do certain jobs, we would have a better service.

My colleagues have cited figures which underline the increases in the incidence of MRSA. The tragedy is that many people have died. A support group has been established to help the families who have been affected by MRSA. The group is begging the Minister to acknowledge the extent of this crisis. Her comments in this House indicate clearly that she does not understand the problem. She does not want to interfere other than to express her sentiments in the form of jargon.

It seems that no individual is ultimately responsible for the hygiene level in a given hospital. We will not make progress until somebody with the appropriate responsibility gets somebody in to solve the problem. We have heard on many occasions about the problems in one of the main hospitals in Dublin. We have seen headlines to that effect in the national newspapers. A patient in that hospital had to take the initiative to highlight what she encountered there. She spoke about the dirt and grime in the hospital's toilets and other facilities. There is no need for me to say anything further about it.

Who will take responsibility for this problem? I do not think it is the duty of nurses because they are professional people who need to concentrate on bringing patients to good health once more. Somebody else needs to be responsible. Some officials from the HSE's western division spoke this morning about what they intend to do. They gave a list of people with responsibilities in various areas. The same sentiments were expressed by public representatives across the board, without political distinction. It was agreed that nobody was taking responsibility for the delivery of the service.

I am sure Senators Glynn and Leyden, as former members of health boards, will agree that if these problems had been encountered when the health board structure was still in place, the public representatives who were members of the boards would have taken the initiative and highlighted the matter at local level. That opportunity is now gone, however. This problem would not have deteriorated to the current extent if the health boards were still in existence. Somebody within that structure was always prepared to take responsibility at local level.

Photo of Camillus GlynnCamillus Glynn (Fianna Fail)
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The Senator's party could not get rid of the health boards quickly enough.

Photo of Ulick BurkeUlick Burke (Fine Gael)
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Who actually got rid of them? Who set up the present system? Is Senator Glynn blind to reality? The House encountered a case of ministeritis when the——

Photo of Camillus GlynnCamillus Glynn (Fianna Fail)
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The Senator is suffering from convenient amnesia.

Photo of Ulick BurkeUlick Burke (Fine Gael)
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If the Senator's party carries on in that manner, the public will give it the answer it deserves in due course.

Photo of Camillus GlynnCamillus Glynn (Fianna Fail)
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Facts are facts.

Photo of Ulick BurkeUlick Burke (Fine Gael)
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When the health boards were in place, there was some local responsibility. Somebody could be identified as being responsible for any given matter. That is no longer the case, however. If the Government is disappointed with what is happening, the Minister needs to take action. We have a national MRSA crisis in our hospitals because she has failed to take action. I am sad to say that the Minister and the HSE are aware of the ongoing problems. People are suffering extensively — some families are grieving as a consequence of bereavements — but nobody is taking responsibility for this problem. The Minister listed the initiatives she proposes to take in areas such as education and training and spoke about global responses to patient care. How much more out of touch with reality will she go? The Minister's proposals are not sufficient to address the urgent crisis in our hospitals.

Photo of Terry LeydenTerry Leyden (Fianna Fail)
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I welcome the Minister of State, Deputy Brian Lenihan, back to the House. The worthwhile and well-worded motion before the House highlights the MRSA crisis in this country without making any election promises.

Photo of Ulick BurkeUlick Burke (Fine Gael)
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That would have given Government Senators an excuse.

Photo of Terry LeydenTerry Leyden (Fianna Fail)
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It does not say that MRSA will be eliminated if the rainbow coalition gets back into power. It is clear that this problem cannot be eliminated with a simple sleight of hand. There is no magical solution to it.

Photo of Ulick BurkeUlick Burke (Fine Gael)
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That is precisely what we are saying.

Photo of Camillus GlynnCamillus Glynn (Fianna Fail)
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Some 32 years have passed since MRSA was discovered in our hospitals.

Photo of Terry LeydenTerry Leyden (Fianna Fail)
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I agree there is a need to reduce the overall use of antibiotics. That would be very worthwhile.

Photo of Ulick BurkeUlick Burke (Fine Gael)
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There is a need to clean the hospitals.

Photo of Camillus GlynnCamillus Glynn (Fianna Fail)
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When Deputy Michael Noonan was Minister for Health in 1995, he announced that MRSA had been discovered here 20 years earlier.

Photo of Ulick BurkeUlick Burke (Fine Gael)
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I am concerned about the hospitals.

Photo of Camillus GlynnCamillus Glynn (Fianna Fail)
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It is true. I have documentary evidence of it if Senator Ulick Burke would like to see it.

Photo of Terry LeydenTerry Leyden (Fianna Fail)
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I agree that patients who are suspected of having MRSA should be screened in isolation when they are first admitted to hospitals. Staff who have been in contact with patients who have tested positive for MRSA should also be screened and appropriate steps should be taken thereafter. Proper cleaning techniques should be introduced by the management of hospitals. The points which have been made in the motion before the House are quite commendable and reasonable. This debate gave the Minister, Deputy Harney, an opportunity to come to the House to express her concerns in this regard.

There was a detailed discussion of MRSA on a recent edition of the "The Late Late Show" with Mr. Pat Kenny. I was concerned by the lack of impatience and urgency shown by the HSE representative on that programme.

Photo of Ulick BurkeUlick Burke (Fine Gael)
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Hear, hear.

Photo of Terry LeydenTerry Leyden (Fianna Fail)
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The man's lackadaisical approach — he said the HSE intended to deal with this now and that then — did not reassure me that he was doing very much about the issue. I understand there is a way of detecting the presence of MRSA in hospitals. A piece of equipment can be used to ascertain the level and extent of the infection within a hospital.

We should use this debate to remind the Minister, the Department and the HSE that, rightly or wrongly, there is widespread concern about MRSA throughout the community. When people go into hospital for procedures such as hip operations which require serious involvement with surgeons, they worry about MRSA. We all have a role in this regard. It is clear that the standard of hygiene in our hospitals must be maintained at the highest possible level. While I have some regard for contract cleaners, the standard of hygiene was much higher some years ago when matrons were responsible for the cleaning system in county hospitals. The results of the use of modern techniques such as contract cleaning, which have not improved hygiene in hospitals, are starting to become evident.

I would like to speak about the methods which have been proposed, the issue of hand washing and the provision of facilities in our hospitals. I am not sure that the hand washing guidelines are being adhered to in hospitals. When I visited a ward in the Sacred Heart hospital in Roscommon recently, I was told by a nurse that I should be very careful because the hospital had MRSA. I was told to wash my hands, which was fair enough. I question the decision that was made to transfer large numbers of vulnerable and elderly patients to the hospital in question from the county hospital. When MRSA is detected, patients should be placed in isolation. They should not be transferred to another institution because that might cause the infection to be spread. This is something with which people in management positions should concern themselves.

The question of allowing visitors to hospitals is a serious one. I suggest that the presence of MRSA should lead to a curtailment of visitor numbers. Visitors should be made aware that they can carry MRSA without suffering from it. One should avoid visiting vulnerable patients, in particular, unless one is absolutely sure one is not carrying MRSA. I am not sure whether there is any technique or procedure for testing people for MRSA.

We all feel we have a duty to visit family members, friends and political contacts when they are in hospital, but we might not be doing them any great favours by doing that. I have spoken to constituents, including a member of a local authority who is in the Mater Hospital, about this issue. I told the man in question I would not feel comfortable going to visit him while he was laid up if I were worried I would contribute to his illness in any way.

People should bear in mind the danger that they may bring MRSA into a hospital and infect a vulnerable patient. I was a member of a health board and I know of instances where patients may have had ten visitors at a time. Patients would be worn out trying to explain their illness and how they were. Everyone was having a party and eating the grapes but they were not doing the patient much good. This was the case with very vulnerable patients. It led to a situation where visitors were not especially welcome, could only come by arrangement and visiting was confined to family members. This is one of the recommendations made by the Minister on the control of visitors.

The control system in hospitals is very lax. People do not go to the reception desk, do not visit by appointment and wander through the hospital without any great control. The HSE and the management of hospitals need to impose control so that areas where vulnerable patients are accommodated such as near operating theatres should not be open to visitors. Patients recovering from serious operations should only be permitted visits from close relations. These might seem draconian measures but we are fighting a serious and unseen enemy in MRSA.

Senator Ormonde and others referred to the fight against foot and mouth disease and the action taken by our Government which prevented the spread of the disease from North to South. This was a very successful campaign. Foot baths were positioned at the entrances to all buildings and this campaign was led by the then Minister, Deputy Walsh, and the Minister of State, Deputy Davern. I commend them and their co-operation with the Northern Ireland Minister.

It may not be a comparison of like with like but foot and mouth was a very infectious disease, as is MRSA. The Minister referred to the recruitment and training of key staff, including scientific infection control nurses, antibiotics liaison pharmacists and surveillance scientists. There has been an over-prescription of antibiotics which has resulted in MRSA defeating some of the strongest antibiotics. People have been fed antibiotics as they are present in chicken, pork and other food products in the food chain. In the case where medical practices also own a pharmacy, it is beneficial to the medical practitioner to keep prescribing as much antibiotics as possible because they have a share in the pharmacy. They do not prescribe generic drugs which are cheaper.

This is a combined effort of all parties, public representatives and health care workers because we are in this together. Nobody has any magic wand. This is a serious fight and we should endeavour to allay public fears. When members of the HSE or their public relations advisers are in discussions on radio programmes, they should be able to express the urgency of the situation. The best spokespersons who can explain the actions being taken by the HSE and hospital management to eliminate MRSA, if it can be eliminated, should speak on programmes such as the "The Late Late Show".

I do not think any hospital in the western world has eliminated MRSA. The Netherlands seems to have a great success story and its success should be studied in detail by the HSE. We should all be united in our approach. I hope that the combined motion and amendment to it would be agreed. The Government amendment to the motion is positive and it should be agreed without division in the House. A division is of no use in the fight against MRSA.

7:00 pm

Fergal Browne (Fine Gael)
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I welcome the Minister of State, Deputy Brian Lenihan, to the House. In my closing contribution on the motion, I refer to points made by Senator Leyden about the elimination of MRSA. I do not think it is a question of eliminating MRSA but, instead, recognising we have it, that we can reduce the incidence of it as other countries have done, and that it must be managed, which is key. MRSA will stay with us because, as Senator Henry pointed out, bacteria have been here for a lot longer than we have and will be here for a lot longer after we have gone. People are over-using antibiotics, doctors may be over-prescribing them and the bacteria are building up an immunity to the antibiotics.

The US Food and Drug Administration, FDA, has approved a rapid 24-hour test for MRSA. This test has been approved by Canada. We should be researching the benefits of this test instead of reinventing the wheel. My colleague, Senator Feighan, raised the issue of the food industry. The fines in the food industry can be up to €1,500 per offence and six months in jail. A total of 37 offences are listed under the legislation governing food. Why is the health system so backward and why is more emphasis put on food and animal welfare than on patients in hospitals? There seems to be no accountability and no modern management techniques. This issue has been raised by many people.

Private hospitals are far from clean and they can be worse than public hospitals. The issue of nursing homes is significant. Last week my colleagues visited a nursing home in Amsterdam. Patients in nursing homes are elderly, they may have Alzheimer's disease and can be more difficult to control and keep in isolation rooms. These issues should be examined.

Senator Ormonde referred to hand washing. It is not necessarily a question of hand washing as this can be a means of spreading the infection. It is a question of using alcohol gel. This was brought home to me during our trip to Holland.

The Department of Agriculture and Food has 30 information websites available with regard to avian flu, yet no bird has tested positive for this infection. However, 600 people have MRSA and there are no comparable websites in the health system. We seem to be well able to provide information about foot and mouth disease, avian flu and food hygiene but we fail miserably on the issue of patient safety in hospitals.

There is an issue about compensation due to patients. I recommend that anyone going into hospital should insist on being swabbed on admission and tested for MRSA and they should be tested and swabbed again on their departure. If the tests prove that they did not have MRSA on admission to hospital but had the infection when leaving the hospital, they should be compensated. It is unfortunate but it will take litigation and compensation before the authorities sit up and take notice. That is the history of our country and it is regrettable that this is what it will take.

In Holland hospital uniforms are cleaned in the hospital. There is no such practice of staff going home with them on and wearing them while feeding babies and going shopping. The staff undressed at the hospital and the uniforms were all cleaned. This is another method for eliminating the spread of MRSA. The sum of €1.5 million given last January to help tackle MRSA is mind-boggling. We are reinventing the wheel. All it takes is a visit to Dr. Hussein in Cardiff or to Deventer in Holland where best practice can be observed and which can be replicated quite easily.

While much in the Minister's contribution was welcome, she spoke mainly in the future tense. For example, she indicated that the commission on patient safety and quality assurance would report back in 18 months. A new Government and, in all likelihood, a new Minister for Health and Children will be in office at that stage. As Senator Leyden, a Government Member, noted, the lack of urgency is worrying.

The amendment is disappointing, especially its lack of clarity regarding the simple, basic right of patients to be informed if they have MRSA. While it acknowledges that patients have such an entitlement, it does not state they should be informed.

Any of us could end up in hospital tomorrow. I know of a 16 year old who broke his leg playing rugby and contracted MRSA while in hospital for treatment. If patients contract MRSA, so be it, but it is not asking too much to require that they be informed in order that they, their families and members of staff can take precautions.

Considerable work has been done on the MRSA problem over the past two years. I compliment the MRSA and family group on its work on the issue, including the public meetings it held, and my local radio station, the first media outlet to allow someone to air a view on the issue. The widespread coverage of MRSA since the programme in question was broadcast shows the power of local radio, without which the national media may not have provided a forum for discussing the issue.

I also compliment some members of the press who have consistently written about MRSA. While it is good that the issue has received prominence in newspapers and on television recently — it has been discussed twice on "The Late Late Show" and was covered in an episode of the "Prime Time Investigates" programme — it is worrying that it is still a topic for discussion and little progress has been made in addressing it. Much more work needs to be done. My party will vote against the Government amendment because it is disingenuous and does not treat the MRSA problem with the urgency it demands.

Amendment put.

The Dail Divided:

For the motion: 27 (Eddie Bohan, Cyprian Brady, Michael Brennan, Margaret Cox, Brendan Daly, John Dardis, Timmy Dooley, Liam Fitzgerald, Camillus Glynn, John Gerard Hanafin, Brendan Kenneally, Tony Kett, Michael Kitt, Terry Leyden, Don Lydon, Martin Mansergh, John Minihan, Paschal Mooney, Tom Morrissey, Pat Moylan, Francis O'Brien, Mary O'Rourke, Ann Ormonde, Kieran Phelan, Eamon Scanlon, Jim Walsh, Mary White)

Against the motion: 19 (Paul Bradford, Fergal Browne, Paddy Burke, Ulick Burke, Paul Coghlan, Noel Coonan, Maurice Cummins, Frank Feighan, Michael Finucane, Brian Hayes, Mary Henry, Joe McHugh, David Norris, Joe O'Toole, John Paul Phelan, Shane Ross, Brendan Ryan, Sheila Terry, Joanna Tuffy)

Tellers: Tá, Senators Minihan and Moylan; Níl, Senators Browne and Cummins.

Amendment declared carried.

Motion, as amended, put and declared carried.