In the UK, hospitals are banning ties, long sleeves and even doctors' traditional white coats in an effort to curb the spread of hospital-acquired infections. But what's being done in Ireland? Hélène Hofmanreports
Last week's second annual Clean Hospital Summit renewed calls for immediate action to substantially reduce rates of health-acquired infections (HCAI), particularly MRSA.
According to figures from the Health Protection Surveillance Centre (HPSC), there were 587 cases of MRSA reported in 2006, just five fewer than in 2005, and the Irish Patients' Association (IPA), which organised the conference, wants the Government to speed up efforts to bring down this figure.
In Britain, efforts to tackle MRSA - or Methicillin Resistant Staphylococcal Aureus - were boosted last week when the British Department of Health announced its intention to introduce a "bare below the elbows" dress code. From next year, hospitals will ban staff from wearing ties, jewellery, watches and even long-sleeved white coats after it was found that they could all potentially carry infections.
Commenting on the move at the Clean Hospital Summit, Minister for Health Mary Harney said it was important to look at examples from other countries. "I think we need to look at all these issues and we need to learn from what's happening elsewhere and we don't need to be slow to introduce the changes here that we know will deliver a higher quality of care for patients that are in our care, particularly in a hospital environment," she said.
In the meantime, the HSE has recruited 40 nurses, pharmacists and scientists to examine ways to reduce rates of HCAIs from this month. The National Infection Control Steering Committee, set up earlier this year, aims to reduce the prevalence of MRSA by 30 per cent and rates of antibiotic prescribing, which are above the EU average, by 20 per cent in the next three to five years.
"These targets might not look that ambitious at face value, but they are. These infections have been around for years and this problem won't be solved overnight," says Dr Patrick Doorley, the national director for population health with the HSE.
Next month the National Infection Control Steering Committee will publish a set of targets on tackling HAIs to be circulated to healthcare facilities around the country. The targets concern a number of areas including educating staff and the public, promoting better hand hygiene and preforming prescription practices. Looking at improving facilities is also an issue as, Doorley says, it is difficult to segregate infected patients because of a lack of single rooms. "This is one of the ways the HSE is doing harm to patients and although we can't get rid of the healthcare-acquired infections altogether, it is now top of the HSE agenda," he says.
According to Dr Robert Cunney, consultant microbiologist with the HPSC, there are a number of interconnected criteria which healthcare facilities will need to adhere to in order to control and curb infection. "A study of 204 hospitals in 32 European countries looked at countries who succeeded [ in controlling infection] and compared what they were doing to countries who had not succeeded. What they found was that there were five key areas and to control and tackle infection you need to look at them all," says Cunney.
"Firstly, you need a really good surveillance and screening in place; you need a minimum level of trained infection-control staffing; you need the physical facilities, which means having enough single rooms and a low enough bed capacity to be able to use those rooms efficiently; you need to ensure that hospital staff take infection-control precautions; and finally [ you need to ensure] that antibiotics are appropriately used. All of those need to be put in place," he says. "It will take a long time to catch up on other countries in Europe but we're moving in the right direction."
The IPA's Stephen McMahon agrees that progress is being made. For example, the second national audit of hospital hygiene found that 80 per cent of hospitals were achieving international best standards compared with less than 10 per cent in the first audit. However, he believes that patients themselves have a part to play: "When someone sees something is wrong it should be raised so that it is addressed and resolved. Too often people wait for the person responsible to take notice.
"Hygiene is first and foremost and can have a huge effect on minimising the risk of contracting hospital-acquired infections for patients. We all have to be more vigilant and that's part of a constructive partnership," says McMahon.
He is also concerned about levels of antibiotic prescribing. "Patients shouldn't rate the quality of their consultation on their prescription. What it should depend on is the doctor prescribing what's right and appropriate for the patient and that may not be antibiotics," he says.
Together with the MRSA and Families group, the IPA has called for more transparency in the system. Last October, Dublin City Coroner Dr Brian Farrell asked doctors to report cases where a patient died of MRSA.
Margaret Dawson, whose husband Joe contracted MRSA, says this is a significant development but she is still concerned for other patients. "We're being told that there have been improvements, but I don't think so. We're still very much at the bottom of the ladder and there's no point saying we're not," she says. Dawson has also expressed concerns about other HCAIs, particularly Clostridium difficile, or C-diff, which in its most serious form can lead to life-threatening complications. In 2005, more than 1,200 patients in Irish hospitals were diagnosed with C-diff.
"There is still a wall of silence and in many cases people don't know what's going on. I had to learn from what they call a 'whistleblower' about my husband and that's not right," she says.
Martin Cormican, professor of bacteriology at NUI Galway, says that although improvements have been made in the past few months, sustained effort is essential to combating HCAIs and it will be some time before any significant results emerge.