Update: Hospital Bug and Infection Prevention – Health 30th September, 2014

QUESTION NO:  470

 
  *  To ask the Minister for Health the steps taken or needed to be taken to prevent hospital bugs and infections throughout the public health sector; the extent, to which comparisons have been made with the private sector in this regard; and if he will make a statement on the matter.

                                                                                         Bernard J. Durkan T.D.

 
REPLY.
The prevention of Healthcare Associated Infections (HCAIs) and colonisation/infection of  patients with antimicrobial-resistant organisms (AMR) is one of my Department’s priorities in protecting patient safety.  HCAIs represent a major cause of preventable harm and increased healthcare costs.

As the Deputy will be aware, the prevalence of MRSA has dropped considerably in recent years.  There has been a decrease of 62.5% in reported cases of MRSA from 2006 to 2013; first-quarter returns for 2014 see a minor rise compared to quarter 1 of 2013 but it must be  stressed that these figures are provisional.  There are, however, concerns about the rates of resistance of other organisms as detailed in the EARS- Net Report referenced below.  While the reducing trend in reported rates of MRSA in Ireland is welcome, MRSA rates are comparably high with other countries and we must systematically build our actions and processes to continue to reduce the prevalence of MRSA in this country.

The Health Protection Surveillance Centre (HPSC) collates information from acute public and private hospitals on healthcare associated infections and antimicrobial resistant organisms such as MRSA, Clostridium difficile etc.   The most recent European Antimicrobial Surveillance System Report (EARS – Net) for Quarter 1, 2014 was published on June 17th.   The full Report is available at http://www.hpsc.ie/hpsc/A-Z/MicrobiologyAntimicrobialResistance/EuropeanAntimicrobialResistanceSurveillanceSystemEARSS/EARSSSurveillanceReports/2014Reports/ .

The HSE has implemented a number of national initiatives in the control and prevention of HCAIs over many years, more recently the HSE’s National Clinical Programme for the prevention and control of HCAIs and AMR which commenced in late 2010 and is supported by the national RCPI/HSE Clinical Advisory Group on HCAIs which provides expert guidance and leadership to the health system.  The overall aim of the National Clinical Programme is that every healthcare worker and all parts of the healthcare system recognise that the prevention and control of HCAIs and AMR is a key element of clinical and non-clinical governance.  The programme focuses on getting three basic practices right every time patients are cared for; these are hand hygiene,  using antimicrobials appropriately (antimicrobial stewardship) & preventing medical device-related infections i.e., IV lines/drips, urinary catheters.  If the above three measures are applied consistently and reliably every time healthcare workers care for their patients/residents/client then a significant proportion of HCAIs, including that caused by AMR will be prevented.
Public reporting of HCAIs and AMR in Irish acute hospitals includes:

• HCAIs Prevalence Study 2006 and 2012
• S. aureus bloodstream infection (reported quarterly since 2007) €“ this includes public reporting of MRSA rates per hospital.  Arrangements have now been made for monthly collection of new cases of C. Difficile and Staphylococcus bloodstream infection rates which will inform future HSE Service Plans
• Alcohol hand rub consumption (reported bi-annually since 2007)
• Antibiotic consumption (reported bi-annually since 2007)
• Hand hygiene compliance (reported bi-annually since 2011)

In December last my predecessor launched and endorsed the second National Clinical Guideline, Prevention and Control Methicillin-Resistant Staphylococcus aureus (MRSA).   This National Clinical Guideline provides practical guidance on prevention and control measures for MRSA to improve patient care, minimise patient morbidity and mortality and to help contain healthcare costs.  The guideline has been developed for all healthcare staff involved in the care of patients, residents or clients who may be at risk of or may have MRSA in acute hospitals, obstetrics and neonates, nursing homes/long stay residential units and the community.  
The Department is ensuring that Patient Safety remains a priority within the HSE’s Annual Service Plan through specific measures focused on quality and patient safety including HCAIs, Medication safety and implementation of Early Warning Score systems.  My officials meet the HSE each month on the Service Plan and patient safety is a standing item on that agenda.

There are no comparative statistics for the private sector regarding initiatives to prevent hospital infections; reporting of HCAIs to the HPSC covers all acute hospitals, both public and private, in Ireland.