Richard Bruton (Dublin North Central, Fine Gael)
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Question 297: To ask the Minister for Health and Children the incidences of hospital infections of different kinds in the major Dublin hospitals; if she will provide an indication of the trend in these infection incidences since reporting began; and the extent to which she is satisfied with the progress to date in meeting the targets for containing this problem. [3656/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I would like to assure the Deputy that tackling all Health Care Associated Infections (HCAIs), including MRSA and C Difficile, continues to be a priority for the government and for the Health Service Executive (HSE).

MRSA is not a notifiable disease. However, the Health Protection Surveillance Centre of the HSE collects data on MRSA. In 2007, 43 Irish laboratories serving 64 acute hospitals (public and private) participated in their data collection system representing an estimated 98% coverage of the Irish population. At present we do not have the relevant statistics for each individual hospital. However the total number of MRSA cases recorded over the last five years was 445 cases in 2002, 480 cases in 2003, 553 cases in 2004, 592 cases in 2005, 588 cases in 2006 and 432 cases by the end of the 3rd Quarter in 2007.

Clostridium difficile, which is another significant HCAI, is not a notifiable disease and, as a result, it is difficult to quantify the extent of infection in the health care system. However, Clostridium difficile infection was examined in the Third Prevalence Survey of Health Care Associated Infections (HCAIs) in acute hospitals in 2006. The survey found that thirty-six patients had Clostridium difficile representing 0.5% of patients studied.

The extent to which hospitals are affected by HCAIs such as MRSA varies with the type of hospital. In the 2006 prevalence survey of healthcare associated infections, the prevalence of MRSA was 0.5% in tertiary/regional and general hospitals, and was zero in specialist hospitals.

A National Surveillance System has recently been established by the HSE to collect data and provide information on a quarterly basis on four key areas, to monitor HCAIs in our healthcare system:

1. Staphylococcus bacteraemia;

2. Antibiotic consumption;

3. Alcohol gel use;

4. MRSA surveillance in Intensive Care Units.

The data for 2006 is currently being finalised and a report will be released by the Health Protection Surveillance Centre in the near future. This report will include rates of MRSA bloodstream infection, listed by individual hospital. Data for 2007 will be available in early 2008 and MRSA bloodstream infection rates for all publicly funded hospitals will be published quarterly thereafter. All of this will greatly assist in the monitoring of improvements in infection control.

The HSE launched a National Infection Control Action Plan in March 2007. An Infection Control Steering Group, chaired by Dr. Pat Doorley, National Director (Population Health) is responsible for overseeing 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%. Achievement of these targets will benefit all patients who are at risk. These targets will be achieved through the development of national and local level action plans to reduce the potential for spread of infections between persons in healthcare settings, and, in addition, will focus on reducing antibiotic use in Ireland. The Steering Group is supported by eight Local Implementation Teams which will ensure that all local facilities are focused on achieving the national targets.

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 against hygiene standards developed by the Irish Health Services Accreditation Board. HIQA published its report, the National Hygiene Services Quality Review, on 13th November, 2007. The 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. However, the results were poor on governance. While the good hygiene practice of front line staff highlighted in the report is vital, real improvement in this whole area also depends heavily on good leadership and a system of governance. HIQA is currently 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 and improve the quality of our health care.

The availability of isolation facilities is an important factor in the overall solution to the issue of reducing incidence of infection. I have instructed the HSE that designated private beds should be used where isolation facilities are required for patients who contract MRSA and this policy has been adopted by the HSE. New environmental building guidelines are being prepared by the HSE to inform infection control policy in all new builds and refurbishments and the HSE is committed to ensuring that such facilities are in line with international best practice including the provision of adequate numbers of single units.

While accepting that not all HCAIs are preventable, I am satisfied that significant steps are being taken to reduce the rates of infections and to treat them promptly when they occur.