HC Deb 21 July 2004 vol 424 cc347-50W
Andrew Mackinlay

To ask the Secretary of State for Northern Ireland in what circumstances hospitals in Northern Ireland are required to provide strict isolation for MRSA sufferers; and if he will make a statement. [184775]

Angela Smith

The Government recognise that the emergence of Methicillin Resistant Staphylococcus Aureus (MRSA) over the last twenty years represents a serious threat to the prevention, control and successful treatment of infection. It is committed to taking forward a wide range of actions to reduce the emergence and spread of MRSA and its impact on the treatment of infection.

In Northern Ireland, the Chief Medical Officer has issued guidance to health and social service trusts on MRSA and the management and control of hospital infection, and on resistance to antibiotics and other antimicrobial agents, in 1999 and 2000, respectively.

The guidance requires hospitals to carry out a risk assessment on a patient found to be colonised or infected with MRSA. The result of the assessment determines how the patient is managed and the type of isolation required, if any.

Andrew Mackinlay

To ask the Secretary of State for Northern Ireland what surveillance has been undertaken by hospitals in Northern Ireland in respect. of MRSA; and if he will make a statement. [184776]

Angela Smith

It has been a mandatory requirement for acute trusts to report MRSA bacteraemia rates since 2002 to the Communicable Disease Surveillance Centre, Northern Ireland. The Healthcare Associated Infection Surveillance Centre (HISC) based at the Royal Victoria Hospital in Belfast since 2001 was formed to assist acute trusts in Northern Ireland to undertake nosocomial infections surveillance at local level. HISC commenced its work on orthopaedic surgical site infections and is developing further modules.

Andrew Mackinlay

To ask the Secretary of State for Northern Ireland how many MRSA eases were recorded by the Northern Ireland equivalent of the Public Health Laboratory Service in each year from 1983; and if he will make a statement. [184778]

Angela Smith

Information on MRSA infection in Northern Ireland has only been available from 2001 when a pilot exercise on bacteraemias was undertaken prior to the introduction of the mandatory reporting system in April 2002. The following numbers of patient episodes of such MRSA infection were recorded:

Number
2001–02 228
2002–03 218

Andrew Mackinlay

To ask the Secretary of State for Northern Ireland what independent inspections are undertaken of hospital hygiene management programmes in Northern Ireland; and if he will make a statement. [184779]

Angela Smith

The responsibility for cleaning and inspection of hospital hygiene lies with each of the Trusts and information relating to independent inspections is not held centrally on behalf of the Department of Health, Social Services and Public Safety (DHSSPS). However DHSSPS is aware that some Trusts do carry out internal inspections on their hygiene management programmes. Hospital hygiene management programmes in Northern Ireland are not inspected independently on behalf of DHSSPS.

Andrew Mackinlay

To ask the Secretary of State for Northern Ireland what assistance has been given since 19 March 1997 to the(a) development and (b) use in hospitals in Northern Ireland of new (i) paints and (ii) cleaning products able to kill known microbes; and if he will make a statement. [184780]

Angela Smith

The responsibility for refurbishment and cleaning of hospitals in Northern Ireland lies with each of the hospital trusts. The Department of Health, Social Services and Public Safety does not hold information on the use of paints and cleaning products able to kill known microbes centrally.

New build facilities are however constructed to the standards specified in the NHS Estates, Health Building Notes, which provide for anti-microbial paint finishes in specialist sterile areas such as operating theatres.

Andrew Mackinlay

To ask the Secretary of State for Northern Ireland what action has been taken in Northern Ireland to implement the guidelines for combating MRSA set out in the report of the working party headed by Mr. G. Duckworth since its publication in 1990; and if he will make a statement. [184781]

Angela Smith

The 1990 guidance, revised in 1998, is followed in Northern Ireland. A combined working party made up of the British Society for Antimicrobial Chemotherapy, the Hospital Infection Society and the Infection Control Nurses Association are currently revising the guidelines.

On receipt of the revised guidelines, the Department of Health, Social Services and Public Safety will take forward the development of appropriately revised local protocols.

Andrew Mackinlay

To ask the Secretary of State for Northern Ireland what measures he proposes to introduce to tackle MRSA in nursing homes in Northern Ireland; and if he will make a statement. [184782]

Angela Smith

The Department of Health, Social Services and Public Safety issued guidelines for residential and nursing home staff for the management of residents with MRSA in 1996. These are in the process of being revised and updated. The Department's Regional Advisory Committee on Communicable Disease Control is currently considering a report commissioned on an infection control nursing strategy for Northern Ireland. It deals with the service to the statutory sector including community and secondary care services, the independent sector including nursing homes, and primary care.

Andrew Mackinlay

To ask the Secretary of State for Northern Ireland which hospitals in Northern Ireland stock antibiotics against strains of MRSA; and if he will make a statement. [184783]

Angela Smith

All acute hospitals in Northern Ireland have access to antibiotics effective against strains of MRSA.

Andrew Mackinlay

To ask the Secretary of State for Northern Ireland which antibiotics are deemed by his Department to be effective against strains of MRSA; and if he will make a statement. [184784]

Angela Smith

The majority of MRSA strains are sensitive to the following antibiotics: vancomycin, teicoplanin, linezolid, synercid, rifampicin, fucidin and the tetracyclines.

Andrew Mackinlay

To ask the Secretary of State for Northern Ireland what the percentage change in the incidence of MRSA was in Northern Ireland in each year since 1989; and if he will make a statement. [184785]

Angela Smith

Information on the incidence of MRSA bacteraemias in Northern Ireland is available only from 2001. These figures showed a reduction of 10 cases, 4.4 per cent., between 2001–02 and 2002–03. Figures for 2003–04 are not yet available.

Andrew Mackinlay

To ask the Secretary of State for Northern Ireland what guidance he gives to the Ambulance Service in Northern Ireland on(a) combating MRSA and (b) infection control generally; and what additional resources he plans to make available for this purpose. [184786]

Angela Smith

The Northern Ireland Ambulance Service developed a protocol for the management of MRSA patients during transportation, which was agreed by the relevant local specialists in infection control and local hospitals. The protocol was issued to all staff in 1999.

Training in general precautions and management of MRSA patients during transportation is provided to all operational staff during their basic training and as appropriate and necessary during their regular post proficiency training. The Northern Ireland Ambulance Service is currently reviewing this training and its compliance with the recently published Controls Assurance Standards for the Control of Infections.

The funding for this training is provided from within the Northern Ireland Ambulance Service annual training budget.

Andrew Mackinlay

To ask the Secretary of State for Northern Ireland how many and what percentage of deaths in Northern Ireland were caused by MRSA, or had MRSA as a contributing factor, in the last year for which figures are available, broken down by hospital; and if he will make a statement. [184787]

Angela Smith

The latest year for which figures are available is 2003. The number and percentage of deaths contributed to by MRSA in Northern Ireland, for this year are given in the following table. Information broken down by hospitals is not provided to prevent the possible disclosure of information on individuals. Work is under way to introduce specific codes for antibiotic resistance in conjunction with the World Health Organisation. Active efforts to automate mortality statistics also continue.

Number of registered deaths where the death certificate mentioned MRSA
2003 (provisional data)
All deaths 14,462
MRSA 30
Percentage of deaths which mention MRSA 0.21

Andrew Mackinlay

To ask the Secretary of State for Northern Ireland whether the isolation procedures set down by the Department of Health to combat MRSA in England and which were operative as at 19 March 1997 are operative in Northern Ireland; when the procedures were last brought to the attention of hospitals; and if he will make a statement.[184788]

Angela Smith

The isolation procedures used to combat MRSA in England are also in use in Northern Ireland. The most recent Departmental guidance (HSS(MD)9/2000), "the Management and Control of Hospital Infection", was issued to the Health and Personal Social Services in Northern Ireland in April 2000.

Andrew Mackinlay

To ask the Secretary of State for Northern Ireland what measures he has instigated with the Chancellor of the Exchequer to ensure that(a) there is correct and consistent reporting of deaths caused by MRSA, or where it is a contributory factor, in Northern Ireland, and (b) death certificates in Northern Ireland are completed as directed by the Government. [184790]

Angela Smith

In the UK, the International Classification of Diseases (ICD) is used to classify causes of death. ICD does not have a specific code for Methicillin Resistant "Staphylococcus aureus" (MRSA) but statistics on deaths where MRSA was a contributing factor can be obtained. This is done by identifying all deaths with specific ICD codes likely to be linked with MRSA and then manually checking the cause of death written on the death certificate. This is consistent with the approach taken in England and Wales.

Doctors are required to complete the cause of death medical certificate to the best of their knowledge and belief. Guidelines on completing death certificates are included at the front of every book of certificates. Certificates are not available without these instructions. Medical students receive training in their final year on completion of death certificates.