Denis Naughten (Roscommon-South Leitrim, Fine Gael)
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Question 330: To ask the Minister for Health and Children the steps being taken to address the issue of hospital acquired infection; the number of such cases in each hospital in the past 12 months of suspected or confirmed infection; and if she will make a statement on the matter. [27082/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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Tackling all Healthcare Associated Infections (HCAIs) continues to be a priority for the Government and the Health Service Executive (HSE).

The HSE launched a National Infection Control Action Plan in March 2007. An Infection Control Steering Group is responsible for overseeing the implementation of the plan. Over the next five years, the HSE aims to reduce HCAIs by 20%, MRSA infection by 30% and antibiotic consumption by 20%. Achievement of these targets will benefit all patients who are at risk. The Steering Group is supported by eight Local Implementation Teams which will ensure that all local facilities are focused on achieving the national targets.

A new National Surveillance System has 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: Staphylococcus bacteraemia (blood stream infections); Antibiotic consumption; Alcohol gel use; MRSA Surveillance in Intensive Care Units, from 2008 onwards.

This data (excluding MRSA in ICUs) has been compiled and published for 2006 and 2007. I attach in table format an extract of the relevant information for the Deputy, taken from the recent report of the Health Protection Surveillance Centre. The table gives the number of MRSA bloodstream isolates by acute public hospital for 2007. 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.

It should 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.

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. I firmly believe that you cannot manage what you do not measure. We have now with this system begun a very useful measurement process.

The results so far show some improvement in 2007 over 2006. The overall S. Aureus bloodstream infection rate was lower in 2007 (0.36) compared to 2006 (0.37). The overall proportion of MRSA was also lower in 2007 (38.5%) compared to 2006 (42.4%). The overall acute in-patient antibiotic consumption rate is marginally up in 2007 over the 2006 rate by 2.4%. The overall alcohol gel use is up by a significant 50%. The results provide a good benchmark to enable us to measure the progress of each hospital. From now on, this data will be available on a quarterly basis.

In March 2008, the Chief Medical Officer of my Department instructed the HSE to make C. difficile a notifiable disease and since May 4th all cases are required to be notified to the relevant Department of Public Health. The number of cases reported to date is within the range identified in the Third Prevalence Survey of Health Care Associated Infections in acute hospitals in 2006, 0.5% of patients studied.

The Health Protection Surveillance Centre (HPSC) published Guidelines for the Surveillance, Management and Control of C. difficile-associated disease on 22nd May 2008. They give national guidance and deal with the isolation of C. difficile ribotype 027 for the first time in Irish hospitals. They will be a valuable resource in assisting in the prevention, management and control of this infectious disease. The HSE is considering the report at present to decide on its implementation and I have asked to be kept informed of progress on this matter.

Since 2006, over 30 new staff in posts of Senior Pharmacists, Senior Infection Control Nurses and Surveillance Scientists have been appointed specifically to enhance infection control. I have instructed the HSE that designated private beds should be used for isolation purposes where required for patients who contract HCAIs. New environmental building guidelines to inform infection control policy in all new builds and refurbishments are expected to be published by the HSE later this month.

The Health Information and Quality Authority (HIQA) undertook a comprehensive review of hygiene in our acute hospitals in 2007 and published its report last November. The report represents a thorough assessment of how hygiene services are provided and managed in 51 HSE-funded acute care hospitals. This allows individual hospitals identify strengths and areas for improvement. HIQA is following up on this review to ensure that deficits identified during that process are rectified and the Authority will be undertaking a further national review this Autumn. In addition, on 3rd June HIQA published draft Infection Prevention and Control Standards for public consultation. When finalised, these, along with the National Hygiene Standards, will provide a comprehensive framework to control infection in all healthcare settings.

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.