MRSAMinister for Health Mary Harney's plan to tackle MRSA in hospitals is bound to fail because it does not address the underlying problems that are contributing to the spread of the infection, a public health specialist has warned.
Dr Anthony Staines, a senior lecturer in epidemiology in UCD, after spending three days as a patient in St Vincent's Hospital, experienced first-hand the scale of overcrowding in hospitals which he says is the issue that must be tackled in reducing MRSA infection.
"Over the course of one day alone there were three different people in the bed beside me," he said. "And St Vincent's is not by any means the most overcrowded hospital in Dublin."
Dr Staines contracted MRSA five years ago. He has been in various hospitals on seven occasions over the past five years after getting a rare form of cancer.
"What worries me at the moment is that everybody is blaming MRSA on the staff. And fine, staff should wash their hands more, but Mary Harney's project does not go far enough," he said.
Dr Staines pointed out that OECD guidelines recommend a maximum of 85 per cent bed occupancy. Ireland has the highest bed occupancy rates in the OECD. Figures from the Department of Health show that in 2002 the level in major acute hospitals was 95 per cent. "Not one hospital was below the maximum recommended level of 85 per cent, and one unfortunate hospital reached 123 per cent - a figure I found hard to believe. This is a disaster," he said.
Under these conditions, infection would spread despite the best efforts of staff. "The more you crowd people together the more infectious diseases you get. There is evidence that overcrowding directly leads to the spread of MRSA," he said. In addition, because there are not enough isolation wards in our hospitals, many MRSA patients are still nursed on general wards.
MRSA, or methicillin-resistant staphylococcus aureus, is a bacterium found on the skin which is resistant to most of the commonly-used antibiotics. It can cause many different symptoms and can be fatal. Dr Staines said it was also a problem that "no really reliable figures" were available on the number of infections.
Dr Staines stressed that he only recovered from MRSA five years ago because he received "world-class" quality of care. "But the problem is people are providing world-class care in third-world surroundings."
He worked in the NHS in Britain for seven years before returning to Ireland and pointed out that the NHS is now aiming for a bed occupancy rate of 82 per cent. He said a recent UK public accounts committee report on hospital-acquired infection stated explicitly that while hygiene was important in controlling infections, so too were adequate numbers of isolation facilities and lower bed occupancy rates.
Dr Staines said Ms Harney, in focusing solely on hygiene, was not addressing the problem of overcrowding. "I would say her heart is in the right place but I don't think she will succeed in tackling MRSA or the A&E crisis because no-one has grasped the nettle of the scarcity of resources, and the resources that are needed to make a difference are huge. Depending on how you do the sums we are short of between 1,000 and 3,000 beds."
What the system needed was the equivalent of three large acute hospitals, and people had to ask themselves if they were willing to pay more tax for a decent health service.
Private money was not the answer because the private medical sector in Ireland was only viable with a huge public subsidy. While Ms Harney's solution was to get the private sector to provide 1,000 beds to free up beds in public hospitals, there had been no mention of putting a budget in place to run these additional beds. "Also the private sector costs the public sector money in terms of staff training and because if something goes wrong public hospitals have to fix it," he said.
He said Ms Harney's 10-point A&E plan would actually make matters worse by increasing bed occupancy.
Blaming staff for not washing their hands was "an excellent way for the Government and people generally to evade responsibility", Dr Staines said.