Dáil Éireann - Volume 591 - 28 October, 2004

Written Answers. - Infectious Diseases.

  73. Mr. Stanton asked the Tánaiste and Minister for Health and Children the number of MRSA cases currently in hospitals in the State; [495] the assistance given or available to families and the method of applying for such help when a family member contracts MRSA in a hospital; and if she will make a statement on the matter. [26357/04]

  Ms Harney: Staphylococcus aureus, often referred to simply as “staph”, are bacteria commonly carried on the skin or in the nose of healthy people. Occasionally, “staph” can cause infections — such bacteria are one of the most common causes of skin infections. Most of the infections are minor, such as pimples or boils and most can be treated without antibiotics. However, these bacteria can also cause serious infections, such as surgical wound infections and pneumonia. In the past, most serious “staph” infections were treated with antibiotics related to penicillin. Over the past 50 years, treatment of these infections has become more difficult because “staph” bacteria have become resistant to various antibiotics, antimicrobials. MRSA, Methicillin-Resistant Staphylococcus aureus, is a resistant form of Staphylococcus aureus. The proportion of Staphylococcus aureus bacteraemia caused by MRSA in Ireland in 2002 was 42.7%.

I note that the Deputy has asked for the number of MRSA cases. This is a somewhat misleading term, as MRSA is not a disease but rather a bacteria that can cause a wide range of infections. Indeed, most people who acquire MRSA do not develop any infection and simply carry the bacteria without any symptoms. To try to routinely measure all of the various types of infection that can be caused by MRSA and to determine whether or not they are clinically significant would be an enormous undertaking; even if an attempt were made to try to measure all MRSA cases, there are no comparative data as this is not something that is routinely done at a national level in most countries.

MRSA bacteraemia is used as a measure for two reasons: first, it is a reliable indicator of significant MRSA infection and, second, it is the same standardised measure of MRSA infection that is used by most other countries, for example, the UK, the USA, etc.

The National Disease Surveillance Centre, NDSC, collects data from hospitals on MRSA bacteraemia, also known as bloodstream infection or blood poisoning, as part of the European Antimicrobial Resistance Surveillance System, EARSS. Ireland has the highest level of participation of any country involved in EARSS and EARSS data in Ireland represent at least 95% of the population; thus the EARSS data for Ireland approximates the true total number of cases of MRSA bacteraemia in Ireland. In 2003, there were 477 cases of MRSA bacteraemia reported in Ireland.

The strategy for the control of antimicrobial resistance in Ireland, SARI, was launched in June 2001. Since then, approximately €16 million in [496] funding has been made available by my Department to health boards under the strategy. Much of this funding is designated for improving hospital infrastructure for control of infection and for appointing the additional microbiologists, infection control nurses and other health care professionals required for effective control of infection in hospitals.

At national level, MRSA bacteraemia is now included in the revised list of notifiable diseases of the infectious diseases regulations, so hospitals are now legally required to report cases of serious MRSA infection to health board departments of public health and to the NDSC. The reporting process for MRSA bacteraemia remains the same for now, that is direct reporting to the NDSC via the EARSS protocol, as this has proven extremely effective.

MRSA infection is generally confined to hospitals and, in particular, to vulnerable or debilitated patients. These include patients in intensive care units and on surgical or orthopaedic wards. MRSA does not generally pose a risk to hospital staff, unless they are suffering from a debilitating disease, or family members of an affected patient or their close social or work contacts. MRSA does not harm healthy people, including pregnant women, children and babies. MRSA can affect people who have certain long-term health problems. Visitors to patients with MRSA infection should be advised by the local nursing-medical staff to wash their hands thoroughly after visiting patients so as to avoid spreading MRSA.

Infection with Staphylococcus aureus or MRSA bacteria can be prevented by practising good hygiene, namely, keeping hands clean by washing thoroughly with soap and water; keeping cuts and abrasions clean and covered with a proper dressing, that is, bandage, until healed; and, avoiding contact with other people’s wounds or material contaminated by wounds.

Hand hygiene is a key component in the control of MRSA and the SARI infection control sub-committee has just released national guidelines for hand hygiene in health care settings. These guidelines have been widely circulated by the NDSC and are available on the NDSC’s website. The SARI national committee has set the implementation of these guidelines as a priority for the coming year.

Each health board-authority region has a regional SARI committee and these committees have been developing regional interventions to control hospital infection, including MRSA.

In 1995, my Department prepared a set of guidelines in relation to MRSA. These guidelines have been widely circulated and include an information leaflet for patients. The SARI infection control sub-committee is currently updating national guidelines on the control of MRSA in health care settings. A draft version of these guidelines is being distributed for consultation in the coming week and will also be available on the [497] NDSC website. The key recommendations cover such areas as environmental cleanliness and overcrowding, sufficient isolation facilities, hand hygiene, appropriate antibiotic use, early detection of MRSA through surveillance and laboratory detection of MRSA. The implementation of these guidelines will require further essential staff and improved hospital infrastructure, as outlined in the SARI report, and an acceptance of corporate responsibility for infection control at senior hospital and health board level.

Question No. 74 answered with Question No. 22.