Infection Control

December 20, 2008

Ireland’s first National Isolation Unit was opened yesterday by the Minister for Health, at the Mater Hospital in Dublin.  The unit has 12 beds in total and will be used for patients who contract highly infectious diseases such as tuberculosis, SARS and pandemic influenza.  It will also be used to treat patients with other infections including HIV, hepatitis B & C, meningitis, MRSA and malaria. This all sounds pretty good until you stop to think about it more deeply.

hospital-hygiene

Firstly, I was amazed to learn that this highly specialised ‘state-of-the-art’ facility with it’s own infectious diseases multidisciplinary team, is actually the first of it’s kind in the whole country. Six of the isolation beds in this new unit will  be under negative pressure to help prevent airborne transmission of infection by microscopic droplets. Two of the isolation rooms will have different air handling systems to enhance infection control. It begs the question as to what has been happening with highly infectious patients up until now? I know that some of bigger public hospitals already have isolation units which are used to hoard all the MRSA infected patients together but they do not have any specialised facilities.

And secondly, with healthcare associated infections (HCAI) such as MRSA and C. diff now endemic in Irish hospitals, it strikes me that it might make more sense to use the isolation units for the patients who are clear of HCAI’s, to keep them free from contamination?


Spread The Word

October 10, 2008

Tomorrow, Saturday, a health protest is due to take place in Dublin and I’m in need of your help.

The main objective of the MARCH & RALLY is to have a large gathering of trade unionists, patients, health campaigners and the general public to demand:

an end to privatisation of the Health Service

an end to cutbacks

a first-class, equitable Health Service

The protest has been organised by the Public Health Service Campaign (PHSC) group which is an alliance of the Dublin Council of Trade Unions, the Youth Committee of the Irish Congress of Trade Unions and Patients Together. The campaign is supported by the Health trade unions and a wide range of patients, hospital and medical campaigners.

In the run up to the imminent budget, the campaign aims to put a stop to the underfunding of our Health Service. In recent years, we’ve seen chaos in our A&E Departments, a shortage of hospital beds, reduced services for the elderly, cutbacks in funding for disability services, the misdiagnosis of cancer patients, and an alarming rise in the rate of hospital acquired infections such as MRSA and C. difficile.

On October 11, we will demand not only that the cutbacks end, but that we get the first class health service we deserve. The PHSC is calling on all trade unions, patient and hospital campaigns, community organisations and the general public to get out on the streets on the day, to achieve the loudest possible protest,” said Patients Together spokesperson, Janette Byrne.

YOUR HEALTH – YOUR PROTEST.

Assemble 2.00 pm, Saturday, 11th October 2008.
Garden of Remembrance, Parnell Square, Dublin, 1.

Speakers at the rally will include:

Prof John Crown, Consultant Oncologist
Liam Doran, Irish Nurses Organisation General Secretary
Janette Byrne, Spokesperson for Patients Together,
Conor Seville, brother of Beverly.
Kevin Callinan, National Secretary, IMPACT
Audrey Deane, Social Policy Advisor, St. Vincent de Paul Society,
Peadar McMahon of the Health Services Action Group and the Monaghan Hospital Community Alliance,
Louise O’Reilly, National Nursing Official, SIPTU,
Dr. Teresa Graham, (SIN) Stop Infections Now Campaign, (MRSA),
Walter Cullen, Unite Trade Union

Live music will be provided by ASLAN members and other artists.

Please spread the word about this protest and if you can support the march & rally, all the better.

Now, this is where I need your help.  What wording do you think I should use on my placard?

UPDATE: No placard was needed as I joined-up with the S.I.N. (Stop Infections Now) campaigners who had produced their own teeshirts and placards for the march and rally. I am very proud to be a SINNER!

This peaceful protest was better organised than the last one in March but I suspect the numbers were down by comparison.  For me personally, the highlight of the day was to witness two consultant doctors represent the rights and interests of patients and advocate for a better health service. I admire them both hugely for publicly taking this stance and for not being afraid to speak out about the faults within the system. If only their colleagues would follow suit.  


Knowledge is Power

September 8, 2008

I wrote a post recently lamenting the lack of information available to the public on MRSA and suggested that a well-orchestrated campaign was needed to correct this deficit.  Well, now my wishes have come true with the launch of a new campaign group called  S.I.N. (Stop Infections Now). Would you like to consider becoming a SINNER?

Did you realise that members of the public get most of their knowledge about the measures needed to prevent MRSA from the media?  The information given to patients who have acquired MRSA in hospital can be insufficient or sometimes, even non-existent.  The result is that there are some thousands of patients being discharged from our acute hospitals every year with MRSA (in wounds, in bones or in their respiratory systems) and with very sketchy knowledge on how to prevent the spread of the infection to others.

Health Care Acquired Infections (HCAIs) such as MRSA and C. Diff, are a major problem in the Irish health system and many people have been affected.  These infections often result in prolonged stays in hospitals, sometimes with permanent disability or even death occurring.  The human and financial costs are enormous. Appeals to the Minister for Health, the HSE and hospital managements have proved ineffective in preventing HCAIs, so a campaign has been set up to approach the problem from a different angle i.e. people power.

The SIN Campaign has been established to do the following:

– provide information to the public (and to health care staff) about HCAIs, their causes and what is needed to prevent them.

– outline what can be done by a prospective patient before he/she goes into hospital to help prevent infection.

– what to do if an infection is acquired, the questions to ask, and the appropriate responses to demand.

– how to complain in a non-confrontational manner, and the options open if satisfaction is not achieved.  These options include legal action.

This information is contained in a Patient Information Kit which includes a leaflet, flyer and a CD.  Thus informed, it is hoped that people will simply refuse to accept a service which, while being excellent in some respects, is severely sub-standard as far as these infections are concerned. The SIN Campaign will also include research into the social and psychological effects of HCAIs from the point of view of patients and health care workers.

The campaign group is asking for help from individuals and from companies. This help can be in the form of:

– donations or sponsorship of any size to help with the information kits and the research,

– becoming a patron so your name can be used,

– helping with fund raising or introductions to others who can help.

S.I.N. is the brainchild of Dr.Teresa Graham (formerly of MRSA and Families Network) and the Campaign and Patient Information Kit will be officially launched next Wednesday, 10th September in Dublin.  I’ve already become a SINNER by registering my personal details with the campaign group and I’m very much looking forward to attending the public launch and meeting the people behind this worthy campaign.

If you’d like any further information on this campaign, you can contact:

Dr. Teresa Graham at 051 386651 or  tvgraham@gofree.indigo.ie




Salmonella Agony

August 21, 2008

The latest figures for the recent outbreak of salmonella agona show that some 132 people have now been infected with the bug and it’s already spread to 5 countries within the European Union. The genetic fingerprint of the microbe has been linked to a particular production line at Dawn Farm Foods in Naas, Co. Kildare. The company has decided to close the entire plant for a week and has contracted the expertise of Limerick company OMC Scientific, to decontaminate the entire production facility. How times have changed.

Many years ago when holidaying in Connemara, our holiday plans came to an abrupt end when the friends who’d been staying with us, had to return home following the sudden death of a relative. Our little holiday cottage felt very empty with just my husband, myself and our young son rattling around in it so to cheer ourselves up, we decided to treat ourselves to lunch in a local hotel. Later that evening, I became violently ill with nausea, vomiting and diarrhoea which continued relentlessly all night. I still felt very unwell the following day so we decided to give up on the holiday and return home. I shall never forget that 6-hour car journey with awful nausea, every mile was agony. My husband and son luckily were unaffected and sang songs together all the way home to help pass the time. As far as I can remember, I recovered within a few days but a week or so later, I again became increasingly nauseated until the whole unpleasant episode started all over again.  I consulted my doctor who prescribed medication to ease the symptoms. This pattern repeated itself every few weeks until eventually about two months later and two stone lighter, I was admitted to hospital for investigation and treatment. This is when it emerged that I had a dangerous form of infective diarrhoea and the bacteria was linked back to the piece of chicken I’d eaten for lunch on that fateful day in Connemara. My infection was officially notified to the Food Safety Authority and that was the last I ever heard of the sorry tale. I’ve often wondered since how many other poor souls suffered the same fate after eating food from that kitchen and I have to admit, I still to this day shudder whenever I pass by the doors of that hotel.

The HSE is presently in talks with OMC Scientific to consider using it’s technology in Irish hospitals, to reduce the incidence of hospital-acquired infections (HCAI’s) such as MRSA and clostridium difficile. OMC’s bio-decontamination service is already used in a number of British, French and American hospitals. A study published in the Journal of Hospital Infection found that this technology is 66 times more effective than manual cleaning in removing hospitals superbugs. It’s estimated it would cost the HSE about €14 million a year to cover all 52 acute hospitals in the country but this would lead to a reduction in the prevalence of superbugs which is thought to cost the HSE about €200 million a year. Now there’s a cutback worth considering!


Tighten your Belt

July 8, 2008

Well, it’s finally happened. The economic downturn is upon us, our public finances are under severe pressure and major cutbacks in healthcare spending are anticipated. Our already ailing health service is set to suffer even further and it almost goes without saying that patient care will be compromised.

Brendan Drumm, the HSE chief, believes that in the present economic environment, the health service could face five years without any extra funding. He also believes that there is no reason why the standard of health service provision should suffer as a consequence. Our Minister for Health, Mary Harney has warned that hospitals must operate within budget and must do so without impacting on patient care. We’re told that the way our hospitals are being run is both ineffective and inefficient. I turned on the news last night to hear that hospitals across the country are facing a scaling back of services with staff cuts and ward closures. One hospital has already accused the HSE of gross neglect of patients and claims that the cutbacks are being done at the expense of patients. A spokesperson for the HSE insisted that patient care will not be compromised by the cutbacks. Who do they think they’re fooling?

My biggest fear is that patient’s lives will be put at risk by these further cutbacks in spending. There is already a serious problem in our hospitals with the level of healthcare associated infections (HCAI’s) such as MRSA and Clostridium difficile. Poor cleaning, overcrowding, inadequate facilities, lack of infection control staff, poor management and a lack of accountability have all contributed to unacceptable levels of infection and death within our health system. There is also growing public disquiet. We are constantly promised that improvements are “planned” or “under way” but how can this be so when cutbacks in basic front-line services are being simultaneously requested. This is not the time to talk about cutbacks and the necessity of hospitals staying within budgets. The HSE has lost sight of the needs of the patients. It increasingly prioritises bureaucracy and finance rather than health, with numbers and budgets taking precedence over real people and care.

We are once again being asked to tighten our belts. Brendan Drumm says that it is the duty of everybody, including the health service, to use taxpayers’ money more effectively. This is all very well and good but could someone please explain why this situation has arisen after a whole decade of unprecedented economic growth? Is there any Government accountability left in the area of healthcare?

UPDATE: In case anyone ever thinks I’m exaggerating about the state of our health service, have a look at this post which can also be found over at Irish Election. It details the experience of bringing a child to A&E and is a classic example of how the system is failing to provide emergency care. This post completely mirrors my thoughts.


Value for Money?

June 4, 2008

A new set of draft standards for infection prevention and control, has been published by the Health Information and Quality Authority (HIQA). HIQA was established in May 2007 as an independent Authority, with broad ranging functions and powers, reporting to the Minister for Health. It was set up to drive safety, quality, accountability and the best use of resources in our health and social care services. Our present health service is neither efficient nor cost effective, it swallows up vast sums of money with poor return. HIQA aims to correct this imbalance and deliver value for your money.

The new standards once finalised, will provide a national framework to improve the performance of healthcare settings in order to reduce healthcare associated infections (HCAI’s). These standards are a key component in ensuring quality and safety. As Eithne Donnellan reports in the Irish Times today, “the standards cover accountability, hand hygiene, reducing infection from medical instruments, surveillance of infections, having appropriate multidisciplinary infection-control teams in place which reflect the size and specialities of a facility, informing patients immediately of their infection status, and management of outbreaks“. HIQA now wishes to consult with interested parties and the general public before drawing up a final set of standards to be published later this year. Everyone has a right to have their view considered and submissions can be made online here to the Authority until the 18th July, 2008. HIQA envisages having the standards finalised and ready for ministerial approval by September.

I’m really pleased to see that the Department of Health is taking infection prevention and control extremely seriously but I’m not convinced that we’re getting value for money. You see, I’m aware that the HSE published an updated set of comprehensive guidelines back in 2005, called “A Strategy for the Control of Antimicrobial Resistance in Ireland ( SARI)” but these guidelines, which have a marked similarity to the new standards drawn up by HIQA, were never implemented. It was publicly acknowledged by the HSE at the time that the guidelines failed because of inadequate resources, sub-optimal infrastructure and a lack of access to relevant expertise locally. Has anything changed in the interim, I ask? Forgive me if I’m wrong, but it seems to me that there’s very little new about the report published yesterday other than the change of name. I’d love to know how much it’s cost to date. Meanwhile, the health service continues to struggle on with it’s inadequate resources and sub-optimal conditions. HIQA faces a hard task ahead.


So Dat’s Dat!

May 6, 2008

After ten years, ten months and ten days in office, Bertie’s finally gone! You cannot but wonder if Mary Harney will soon be following him. Brian Cowen, our Taoiseach-in-waiting, is due to receive his seal of office tomorrow and will announce his new cabinet shortly afterwards. Will he show Mary the door?

I had to laugh when reading about the HSE in the Sunday Indo yesterday. “A bloated system”. “HSE belt tightening is a fat lot of good”. “The HSE like everyone else needs to tighten the belt, to cut a little fat”. “The HSE will soon resemble a hippopotamus in bondage gear”. I”ll give you one guess as to what stimulates this sort of language from newspaper columnists. You’re right! Our present Minister for Health is no advert for healthy living and after three and a half years in the job, she’s definitely looking the worse for wear. Harney took on this role in September 2004 with promises to reform the health service. During her time in office, she is credited with achieving a reduction in A&E waiting times, putting a new cancer control programme in place, reducing operation waiting times and the introduction of hygiene audits.

A recent report provided by the HSE, showed that in the first two months of this year 44 per cent of patients in hospital emergency departments awaiting admission, had to wait longer than the official maximum target period of 12 hours. The report also revealed that the number of patients waiting more than 24 hours for admission increased by 57 per cent over the same period last year. The only thing that has improved is the HSE’s daily fiddling of the figures to make it look like there is a reduction in the numbers on trolleys.

As regards the cancer control programme, Mary Harney secured at enormous cost, the appointment of a top cancer specialist, Prof Tom Keane. His mission is to restructure cancer care in this country with the introduction of 8 new centres of excellence. According to John Crown, a medical oncologist, none of the four centres planned for Dublin will be comprehensive. “The plan is that colon cancer is treated in one place, lung cancer in some other place. That is not excellence in care. It is a system based on compromises which are in turn based on medical politics”. Under the new plan, there will be no centre of excellence located north of a line between Dublin and Galway. This system is already doomed to failure.

Waiting lists for operations have been reduced but at a huge cost. Surgeons and their operating teams in our public health system are frequently left twiddling their thumbs when their operating lists are cancelled because of the shortage of beds for elective admissions. Meanwhile the HSE is paying top dollars to the private hospitals via the National Treatment Private Fund (NTPF) to have public patients treated in the private system. This madness is Mary’s solution to the long waiting lists. Talk about false economy.

And finally the hygiene audits. Mary Harney promised back in 2005, to tackle health care associated infections (HCAI) and said that the target over the next three to five years would be to reduce hospital-acquired infections by 20 per cent and MRSA by 30 per cent. The numbers of patients becoming infected with MRSA fell only slightly last year. Newly released figures show there were 533 cases of bloodstream MRSA infection reported last year, compared with 588 in 2006, a reduction of less than 10 per cent. Overcrowding, poor cleaning, haphazard hand hygiene, infrastructural defects, and lack of infection-control staff particularly microbiologists, is favouring the spread of the hospital superbugs. Our Minister for Health is more interested in budget control than infection control and patients remain at serious risk of infection.

New official figures have shown that the HSE is now €95 million over budget for the first four months of the year. The HSE has drawn up a series of controversial proposals to claw back on the financial overrun. These include hospital bed closures, the curtailment of A&E services and new restrictions on the issuing of medical cards and drug-cost reimbursements. There is also a proposal to divert the €185 million earmarked for the development of services for the disabled, older people and those in palliative care. We ain’t seen nothing yet in terms of cutbacks and the impact this will have on patient care.

There is increasing unrest amongst those working in the health service and patients too, are fast losing patience. Mary Harney’s credibility has been badly damaged by a series of cock-ups and system failures during her tenure in office. The failure to get the new consultant’s contract up and running has been a major blow to her plans. Her promises to reform the health service, have not materialised. The question remains. Will Brian Cowen take the easy route and leave Mary Harney to continue to take the flak or will he have the courage to show her the door?