Mary Harney said it all, really. She was flabbergasted at the notes she had been given by her officials in order to answer a Dáil question last October, writes Mary Raftery.
The question was about MRSA, the antibiotic-resistant infection found in hospitals, and what measures were being taken to control it.
Her background notes told her that medical staff were being encouraged to wash their hands. "It seems incredible, but we had to issue guidelines on hand hygiene recently. When I saw this in my briefing note, I had to check whether it was correct," the Minister for Health said.
MRSA is a scandal simmering away at the heart of the Irish health service. We have the second-highest rate of infection in Europe, with the figures increasing every year.
It is an infection which lives primarily only in hospitals and it targets the sickest of patients. As illnesses go, it is relatively unique in that it is the hospital which gives it to you, and it is hospital which can, if the necessary steps are taken, prevent you from getting it. The primary route of transmission is from the dirty hands, clothing and equipment of medical personnel.
And yet, in Ireland, MRSA is something of a phantom disease. Stories abound of patients and their relatives not being told that MRSA was involved, not knowing why extra precautions were being taken around their cases. There are no figures available for MRSA deaths and each hospital's incidence of the infection remains secret. All we are allowed to have is the overall figure, which tells us that there were 477 MRSA cases in 2003.
This is in stark contrast to the UK. They are so alarmed by their MRSA figures that they have introduced league tables comparing each hospital's incidence of the infection. Crucially, they also include MRSA information on death certificates. It is now estimated that the death rate from hospital-acquired infections in the UK may be as high as 5,000, or about one in 10 of hospital deaths.
All of this information has put considerable pressure on the British government to act. Without the openness and honesty regarding the scale of the MRSA problem, things would have trundled on much as they were, or indeed much as they still do, in Ireland.
Here, doctors say that it is not fair to compare hospital data on MRSA, as patients may have contracted the infection elsewhere, before a transfer, for example. They also say that it is so difficult to be sure that MRSA was the actual cause of death (as opposed to the underlying illness) that you cannot include it on most death certificates. All of these arguments were made in the UK, but they did not cut much ice. There, a decision was taken that the public had a right to know what their hospitals were doing to them.
Earlier this year British patients were actively encouraged to ask every doctor and nurse if they had washed their hands before touching them. All very well, but such a question could certainly be perceived as offensive, as an implied criticism of the professionalism of medical staff.
Hand-washing is so basic a precaution against the spread of infection that one assumes that doctors, of all people, would be aware of it. However, in one of the most damning studies ever undertaken of Irish medics, it was discovered earlier this year that almost half of hospital doctors do not, in fact, wash their hands between patient examinations. Of those who did wash, less than half used disinfectant. Fewer than one in 10 cleaned their stethoscopes once a day (only 2 per cent after each patient). Almost two-thirds wore the same unwashed white coat for longer than a week.
There is absolutely no excuse for this degree of outright negligence. Department of Health guidelines on MRSA as far back as 1995 targeted the need for medical personnel to wash hands and equipment between each patient. This was repeated in a 2001 report on a range of antibiotic-resistant infections which stated that these have the potential to reach "catastrophic proportions" within our hospitals.
Also ignored have been the repeated calls for additional infection control staff in hospitals, particularly microbiologists. These currently stand at less than half the number considered necessary to control infection. The mid-western region, for instance, still does not employ a single consultant microbiologist, leaving a major hospital such as the Limerick Regional without the necessary protection.
So where, you might ask, are the courts in all of this, why is no one suing? So far, one result of the secrecy around MRSA is that hospitals have remained safe from legal action. If you don't know what you have or what killed your relative, you can't take anyone to court. So, while the costs of the infection are enormous, they are still largely hidden.
It is difficult to escape the conclusion that until someone makes the health service pay up in the courts for its negligence in failing to control the spread of MRSA, a significant number of patients will continue to be gravely harmed, or even (secretly) killed, by their stay in hospital.