Kathleen Lynch (Cork North Central, Labour)
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Question 97: To ask the Minister for Health and Children her views on establishing an official register to record deaths from hospital acquired infection; if such a register is in place; if there are proposals to set up a register; her views on whether such a register would allow for accurate data to be compiled to assist in controlling this problem; and if she will make a statement on the matter. [5893/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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At present I do not have any plans to establish a new register specifically for recording deaths from hospital acquired infections. However, the monitoring and control of Healthcare Associated Infections (HCAIs) is a priority for this Government and the HSE. A HCAI is an infection that someone may get after a stay in hospital or after receiving medical treatment. Such infections are most often linked to treatment in hospitals but can happen after treatment in outpatient clinics, nursing homes and other health care settings. The more medical care a person requires, the more likely they are to develop an infection and HCAIs are most common in people with serious illnesses or risk factors, such as patients who require a long period of stay in a health care setting or patients with weakened immune systems.

It is not currently possible to identify the number of fatalities attributable directly or solely to HCAIs as most cases involve significant co-morbidity factors. 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. The proposed Coroners Bill 2007 now defines MRSA as a reportable death. 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 health 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.

Clostridium difficile, which is another significant HCAI, is not at present 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 in acute hospitals in 2006. The survey found that thirty-six patients had Clostridium difficile representing 0.5% of patients studied. My Department, in conjunction with the HSE, is actively considering the addition of a small number of diseases including Clostridium Difficile to the list of notifiable diseases. This will be finalised as soon as the EU issues a new list of case definitions. In the meantime I am arranging that Clostridium Difficile be included as an organism which is notifiable under the category acute infectious gastroenteritis. This will in effect make Clostridium Difficile notifiable in the short term.

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 health care 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. 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.