Wednesday, 30 April 2008
I thank the Cathaoirleach for facilitating me to raise in the Senate the need for the Minister for Health and Children, Deputy Mary Harney, to outline what action she intends to take following the deaths of 16 people in St. Columcille's Hospital, Loughlinstown, County Dublin, as a result of hospital-acquired infections and whether the Government intends to order an investigation into this matter.
The Minister for State at the Department for Health and Children, Deputy Brendan Smith, may have seen or heard about the "Panorama" programme about this problem in England where many people have died from this hospital-acquired infection. So successfully has C. difficile taken hold in English hospitals that it now contributes to the deaths of four times as many people as MRSA. We must be careful and vigilant with regard to this infection. It is extremely disturbing that 16 people have died in St Columcille's Hospital and we must ask how many people around the country have died from this infection. It is critical that we put in place the best possible mechanisms at national and regional level in every hospital to prevent the spread of this infection.
The "Panorama" programme was terrifying. There are timely lessons from the investigation that was done in the UK regarding the outbreaks in Maidstone and Tunbridge Wells Trust. The programme makers interviewed nurses and other people who had been working in those places under very difficult conditions. Wards were overcrowded and staff were under pressure, very similar conditions to what we have in hospitals here. I would be most concerned that we are not taking this infection seriously enough and that we are not putting in place enough mechanisms and cleanliness routines to deal with the spread of this infection. It is different to MRSA and it needs a different approach, although there are some similarities in the preventive steps we have taken concerning MRSA.
Since I became a Senator I commissioned a study in MRSA. What is clear is that we have a very high rate of infection in this country and that we must have a stronger search and destroy policy in order to beat this infection. The facts that have emerged regarding St Columcille's suggest that there was no microbiologist in place. Why has it taken so long to fill the position of microbiologist at that hospital? Will there be an investigation into what happened there so that we can learn from it? We can then ensure that we do not have a similar situation in other hospitals in the country resulting in the deaths of people from this infection. It is imperative that we put in place the sort of safety standards needed if this is not to be repeated in other hospitals.
We are paying for the failure of the Department to put in place comprehensive enough plans to tackle hospital acquired infection. It is clear that we need more isolation rooms and a search and destroy policy and we must learn from other countries, particularly from the Netherlands which has managed to deal with this infection. I look forward to hearing what the Minister of State has to say on this matter.
I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I thank Senator Fitzgerald for raising this very important issue.
I wish to express my sympathy to any patients and families who have been affected by this matter. I share the Senator's concerns regarding health care associated infections. I reiterate the Minister's commitment to ensuring high quality care is made available to all patients and to the further development of our health services, in particular the issue of patient safety.
Health care associated infections, HCAIs, are not new. For centuries they have been a side-effect of medical treatment, especially in hospitals. There are a number of types of HCAI, including MRSA and Clostridium difficile. The more medical care a person requires, the more likely he or she is to develop a health care associated infection. These infections, therefore, are more common among people with serious illnesses or who are at high risk such as patients with a weakened immune system.
The extent to which hospitals are affected by HCAIs such as MRSA and Clostridium difficile varies with the type of institution. In the 2006 prevalence survey of health care associated infections, the prevalence of MRSA was 0.5% in tertiary-regional and general hospitals and was zero in specialist hospitals. The survey found that 36 patients had Clostridium difficile representing 0.5% of patients studied. However, C. difficile was not up to now a notifiable disease and, as a result, it was difficult to quantify the extent of infection in the health care system. In March 2008, the Minister instructed the Health Service Executive to make Clostridium difficile a notifiable disease and I am pleased to inform the House that from 4 May all cases will have to be notified to the relevant public health department.
I am aware that the Dublin County Coroner has written to Professor Drumm, the chief executive of the HSE, recently regarding the 16 cases referred to by the Senator. I understand some of the patients are reported to have had MRSA and other Clostridium difficile infections at the time of death. Most such instances involve significant co-morbidity factors and I have no doubt the HSE will deal with all the relevant issues raised by the coroner. Officials of the Department of Health and Children have been in touch with the HSE and have requested the relevant information to be made available to the Minister at the same time, who will then give due consideration to the issues involved. In this context I reassure the House that the Minister is fully aware of the problems posed by HCAIs and the stress they cause. This is an issue facing health services worldwide. Tackling these infections remains a priority for the Government and the HSE.
The HSE has established a national infection control action plan. It has put in place an infection control steering group, chaired by Dr. Pat Doorley, national director of population health, to oversee the implementation of the plan. Over the next three to five years the HSE aims to reduce HCAIs by 20%, MRSA infections by 30% and antibiotic consumption by 20%. These targets will be achieved through the development of national and local level action plans to reduce the potential for the spread of infections in health care settings. The steering group is supported by eight local implementation teams which will ensure all local facilities are focused on achieving the national targets.
The availability of microbiology services in the hospital setting is a necessity. However, it is not feasible or practical to have a full consultant microbiologist position in every location. Currently, consultant microbiologist advice is accessed by St. Columcille's Hospital from St Vincent's Hospital. The Minister has been informed that funding has been earmarked for the provision of dedicated consultant microbiologist sessions at St. Columcille's Hospital, Loughlinstown. When the HSE sought to fill this post before, it proved difficult to get the necessary expertise. However, I am assured a further advertisement will be placed in the very near future.
The availability of isolation facilities is another important factor in the overall solution to this issue. In that context, the Minister has agreed with the HSE that designated private beds should be used where isolation facilities are required for patients who contract HCAIs, and this policy has been adopted by the HSE. New environmental building guidelines have been developed by the HSE to inform infection control policy in all new builds and refurbishments.
Improvements on hygiene are critical to effective infection control. The Health Information and Quality Authority, HIQA, undertook a comprehensive review of hygiene in our hospitals in 2007. Its report represents a thorough assessment of how hygiene services are provided and managed in 51 HSE-funded acute care hospitals. Hospitals generally performed well on hygiene in the service delivery area. Most hospitals achieved either extensive or exceptional compliance with the standard in the service delivery section of the report. The HIQA is working with managers and clinicians to develop national standards for infection prevention and control. When completed, these, along with the national hygiene standards, will provide a comprehensive framework to help reduce the spread of infection throughout the entire system and improve the quality of our health care.
A national surveillance system has been established recently by the HSE to collect data and provide information on four key areas, to monitor HCAIs in our health system. One of these areas is antibiotic consumption which is an important factor in the prevention and control of infection.
While accepting that not all HCAIs are preventable, the Minister is satisfied that significant steps are being taken to reduce the rates generally and to treat them promptly when they occur. I assure Senator Fitzgerald that I will bring the contents of her contribution to the Minister's attention tomorrow morning.
I would be grateful if the Minister of State were to do that, as it is important. I am concerned, however, that there are not yet national standards for infection prevention and control. Until we have those and hospitals have the resources they need in this regard, it will be very difficult for them to attain the standards they must reach to prevent the spread of infections. Perhaps the Minister of State might convey that view to the Minister as well.
Senator Fitzgerald's point is important. The putting in place of the infection control steering group chaired by Dr. Pat Doorley is a very important development. It is one I hope will bring rapid progress in this crucial area.