Michael Ring (Mayo, Fine Gael)
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Question 202: To ask the Minister for Health and Children the breakdown, on a hospital and county basis, of the number of cases of MRSA that have been reported in each hospital in the period from 1 January 2007 to 31 December 2007 and from 1 January 2008 to date in 2008; and if she will make a statement on the matter. [19280/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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At a European level, the European Antimicrobial Resistance Surveillance System (EARSS) was established in 1999 in response to the growing threat of antimicrobial resistance in Europe. EARSS comprises a network of over 800 microbiological laboratories serving some 1,200 hospitals in 30 countries that collects routinely generated antimicrobial susceptibility testing data on invasive infections caused by seven important bacterial pathogens. As of January 2008, all 44 microbiology laboratories in Ireland serving 65 acute hospitals (public and private) participate in EARSS representing 100% coverage of the Irish population.

Under the case definition for EARSS, data are collected on the first bloodstream isolate of Staphylococcus Aureus per patient per quarter. The table provides an extract of the relevant information as requested by the Deputy, taken from the recent report of the Health Protection Surveillance Centre. The table which relates to 2007 includes the number of MRSA isolates by hospital. Most of the variation in reported numbers of S. aureus bloodstream infections between hospitals can be explained by differences in hospital size, activity and patient populations. At present there is no way to adjust the data to allow for these differences and hence direct comparisons between hospitals are not possible.

There are limitations on the data provided. The EARSS case definition does not distinguish between clinically significant and non-significant bloodstream isolates, so some isolates may be contaminants (e.g. bacteria on the patient's skin), rather than true bloodstream infections. The definition only includes bacteria isolated from blood cultures, and does not include other types of infection caused by Staphylococcus Aureus such as wound infections, pneumonia etc. The standardised method for surveillance of antimicrobial resistance includes the first isolate of Staphylococcus Aureus from each patient in each three month period. This could mean that if a patient has more than one episode of MRSA in a three month period then only the first episode is reported and alternatively some duplicates may occur as Staphylococcus Aureus (either MRSA or MSSA) can be isolated from the same patient over two or more quarters.

It should also be noted that if a patient is diagnosed with a bloodstream infection at a given hospital it does not indicate that the infection was acquired at that hospital. Many bloodstream infections are acquired in the community, but only diagnosed upon admission to hospital. A patient may either have acquired the infection in one hospital, but the infection may be diagnosed on transfer to another hospital. The frequency with which blood cultures are taken depends on the numbers and types of patients being treated at that hospital and access to laboratory services. Hospitals that have a high frequency of taking blood cultures are more likely to diagnose bloodstream infections, but are also more likely to detect contaminated blood cultures.

The report of the Health Protection Surveillance Centre which includes this data together with information on antibiotic consumption and alcohol-based hand rub usage in both 2006 and 2007 is the first of its kind and forms part of the HSE action plan to guide infection control. While the data in the report comes with multiple caveats, it does nonetheless represent a significant step forward in terms of providing essential data that will serve as a benchmark for assessing progress in the future. While we don't have information yet on 2008, it is intended that similar data will be published quarterly from now on. I am glad to note that the trend so far is downward both in terms of the overall level of MRSA and the proportion of S. Aureus that is methicillin resistant, although the improvement is not statistically significant. While accepting that not all HCAIs are preventable, I am satisfied that significant steps are being taken to reduce the rates of HCAIs generally and to treat them promptly when they occur.