Cecilia Keaveney (Fianna Fail)
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I thank the Cathaoirleach for allowing me to raise this most important issue. I raise the issue of MRSA not to indict hospitals or, in this case, dentists, but just to flag the issue and request some information. I do it with no intention other than this. I thank the Minister of State, Deputy Haughey, for being here to respond.

Coinciding with my decision to ask about MRSA auditing in dentists, we went through quite a traumatic experience locally in Donegal in which babies were diagnosed with MRSA in Letterkenny General Hospital. This links to what I was going to say. It can be seen that a number of measures were taken, including specialist cleaning followed by testing of areas within the unit to ensure they were free of MRSA, and screening of patients and staff in the maternity unit in Letterkenny to prevent further cases. However, the mother of one of the infected babies, who also has three other children, wondered whether the control measures had been put in place as a result of the cases and whether they could have been introduced sooner. That is the main reason I have raised this matter.

We all know that MRSA is a difficult name to pronounce: methicillin-resistant Staphylococcus aureus. I prefer to call it the superbug. The bacterium is responsible for difficult-to-treat infections in humans and is especially troublesome in hospital-associated infections. It is resistant to some antibiotics but not all drugs. The greatest risk is to patients with open wounds or weakened immune systems or who have been fitted with invasive devices. Improper sanitary procedures may transfer bacteria from patient to patient. These are facts with which most people are familiar at this point. I am interested in prevention strategies, which include patient screening upon hospital admission; surface sanitisation and the use of appropriate disinfectants; the use of personal protective clothing such as gloves, surgical masks and eye protection; the isolation of MRSA-positive patients; hand washing and alcohol-based hand rubs, and the availability of adequate facilities and supplies that encourage workers to practice good hygiene. These are aspects of what we are familiar with in terms of the hospital location.

However, the difficulty with MRSA is that is it not confined to hospitals but is found in every community. In this instance I wish to draw attention to its presence in dentists' surgeries, outpatient settings and health care facilities — anywhere a high degree of hygiene is necessary. That is why I am raising this. Some people are concerned about whether aerosols and spatter generated during dental treatment can spread MRSA, and whether dentists are provided with the same resources as hospitals to allow them to institute infection control procedures. Some issues of simple hygiene are mentioned quite often in the Seanad; for example, do dentists wear their uniforms outside the dentist's office? What about other people working within the system?

The Dental Council of Ireland has a code of practice for infection control in dentistry, which states: "If recommended infection control procedures are followed and accidental inoculation by sharps is avoided, there is minimum risk of transmission of serious infectious diseases during dental treatment". Are we pursuing guidelines similar to those which operate in the USA under the American Dental Association? In 2003, these guidelines included educating and protecting dental health care personnel; preventing transmission of blood-borne pathogens; hand hygiene; personal protective equipment; attention to contact dermatitis and latex hypersensitivity; sterilisation and disinfection of patient care items; environmental infection control; attention to dental unit water lines, biofilms and water quality; and other special considerations, such as the use of dental hand-pieces and other devices, radiology, parenteral medications, oral surgical procedures, and dental laboratories.

We currently have audits for hygiene in hospitals. These are keeping our hospitals under pressure to ensure the best standards. We do have an issue with MRSA and other superbugs. If we know how to minimise the potential for the spread of this disease, has the HSE started or does it intends to open up audit facilities for dentists? I know it intends to introduce them for nursing homes and so on. This is not in any way an attack on any individual dentist. I am talking about the implementation of standard procedures and hygiene quality assurance so people can have the confidence in other health professionals that they should have in their local hospitals.

Returning to the original point I made, I trust that those who have contracted MRSA in recent times in any of our hospitals will be given personal follow-up in their cases to try to get them over it. I also trust that we will minimise the number of people in the future who might contract such a dangerous and invasive super bug.

Seán Haughey (Dublin North Central, Fianna Fail)
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I will be taking this Adjournment on behalf of my colleague the Minister for Health and Children, Deputy Harney. I am happy to have the opportunity to address the important issues raised by Senator Keaveney.

It is important to recognise that it is the job of each and every member of the dental team, whether in a public or private dental surgery, to play a role in implementing safe and realistic infection control procedures. I wish to reassure Senator Keaveney that the issue of controlling infection is a high priority within the dental surgeries of the public dental service of the Health Service Executive. Within the public dental service, there are four principal dental surgeons who have lead responsibility for quality and audit, health and safety and dental radiology. Under this remit, their work involves continually updating the knowledge within the public dental service of emerging issues, research and other relevant advancements in terms of infection control. They are also responsible for monitoring and enforcing overall health and safety standards in keeping with Dental Council of Ireland code of practice, and health and safety legislation. They and their other principal dental surgeon colleagues throughout the public dental service actively follow best practice in the prevention of infection.

While the responsibility to prevent infection lies, in the first instance, with each individual staff member, the Health Information and Quality Authority has the right to externally review the dental services provided in the public dental services under the Health (Amendment) Act 2007.

The Dental Council of Ireland takes a strong interest in conditions pertaining in private dental surgeries. The Dental Council of Ireland has developed a code of practice relating to infection control in dentistry which it issues to all registered dentists. This code of practice is updated by the Dental Council of Ireland based on expert opinion as necessary. Under this code dentists have a duty to take appropriate precautions to protect their patients and their staff from the risk of cross-infection. In addition, it also advises them that failure to provide and use adequate decontamination, disinfection and sterilisation facilities may lead to proceedings for professional misconduct before the fitness to practice committee of the Dental Council of Ireland.

Under the Safety, Health and Welfare at Work Act 2005, employers have a legal responsibility to ensure that all their employees are appropriately trained and proficient in the procedures necessary for working safely. All dental practices are required to display a safety statement and all staff should be familiar with this statement. Employers also have a responsibility to protect staff, patients and others attending their practices. While at work, employees are required by the Act to take reasonable care for their own and others' health and safety and to comply with the health and safety requirements of their employers.

I take this opportunity to inform the House of an important related development initiated by the Minister for Health and Children, Deputy Harney, who announced last year that she plans to bring forward a new national oral health policy. This new oral health policy, the first such policy in 13 years, is being undertaken by the Department of Health and Children, in conjunction with the HSE. The development of this new policy will allow a critical examination of the many challenges and issues currently facing the dental sector in Ireland.

As part of this process of policy development, the Department of Health and Children have been examining the regulatory regime which governs the dental sector in Ireland. This examination will include consideration of a strengthening of the legal mechanisms which can be put in place to improve inspection of dental premises and ensure compliance with standards across a wide range of issues, including infection control. The development of the national oral health report will also consider the recommendations of the recent report of the commission on patient safety and quality assurance.

The Dublin Dental School and Hospital is one of only seven institutions in Ireland which has been accredited by HIQA as demonstrating excellence in patient health and safety. The dental hospital also has an innovative water-line sterilisation unit which ensures that water used during patient treatment is of the highest quality in international terms. Finally, the Department of Health and Children is committed to developing and maintaining a culture of vigilance in regard to preventing infection and to create the conditions whereby all dental surgeries are operated in line with best international practice in preventing infection.