Say No to Healthcare Infection

In March 2007, the HSE launched a strategy to reduce the spread of infection in all our Health Facilities and Hospitals.

Say No to Infection established a National Infection Control Steering Group to take charge of reducing Health Care Associated Infection (HCAI) levels.

Read the following topics related to the HSE's work to reduce Health Care Associated Infection:

The Strategy - No to Infection

The Infection Control Steering Group is chaired by Dr Pat Doorley, National Director, Population Health, and is responsible for reducing infection levels in Ireland's health care facilities by:

  1. Reducing the spread of infection and
  2. Reducing and altering antibiotics usage

Over the next five years the Steering Group will:

  • Reduce Health Care Associated Infections by 20%
  • Reduce MRSA infections by 30%
  • Reduce antibiotic consumption by 20%

The Steering Group is supported by eight Local Implementation Teams which are working to ensure that all local facilities are focused on achieving national targets, standards and protocols and report results back to the Steering Group.

Dr Doorley emphasises: 'Without understating the significance we are placing on addressing these infections, it is really important that we put this issue in perspective and patients and their families are not unduly alarmed.

'Ninety per cent of hospital patients do not have any type of health care associated infection and 99.5% of people in hospital do not have MRSA. Health care infections have been around for decades and the rates of infection in Ireland are relatively low when compared with many other countries.

'What we need to do in health care facilities, like hospitals and nursing homes where people are generally more vulnerable, particularly elderly people and those who receive regular care, is limit the transfer of infections from people who are carrying it harmlessly on their skin, to people who are vulnerable.

'The single most effective way to stop this transfer is for everyone who passes over the threshold of a health care facility to clean their hands properly and regularly. In tandem with this we will be seeking to reduce and alter antibiotic use, support the development of better infection control capabilities and promote better local infection control Governance and Performance Management.'

Dr Doorley stresses that while hospital hygiene is clearly important, 'evidence shows that hand hygiene is the single most effective defence against the spread of MRSA from one person, where it may reside harmlessly, to someone for whom it could cause problems.'

'Everyone has a really simply but important role to play - hospital hygiene alone cannot tackle the problem. With the Steering Group and with the commitment of all health professionals across the country, our objectives are very achievable'.


The problem with the over use of Antibiotics

Because of the increasing use of antibiotics during the past 30 years some bacteria have built up a resistance to them.  It has therefore become increasingly difficult to treat the infections caused by bacteria that are resistant to antibiotic.

When compared to other European countries, the USA and Australia, Ireland's Health Care Associated Infection rates are relatively low.   However, when compared with some European countries, such as Norway, Sweden and the Netherlands, Ireland has a higher proportion of Health Care Associated Infections that are MRSA related.  This is because in Ireland the MRSA causing bacteria has built up a resistance to antibiotics and is more difficult to eradicate. Explaining that the main issue in Ireland is the relatively high proportion of Health Care Associated Infections, which are antibiotic resistant, Dr Doorley pointed out that:

'In countries such as the Netherlands, Norway, Sweden, Finland and Iceland, less than five per cent of certain bacteria are antibiotic resistant, so that as a proportion of Health Care Associated Infections, MRSA in these countries is low. The reasons for this difference can be tracked back to the early 1990s when these countries implemented very strict antibiotic prescribing protocols and guidelines both in hospitals and in the community.'

Read Health Care Associated Infection and Antimicrobial Data for Irish Hospitals, 2006-2007.pdf (size 97.8 KB)

Public Information Campaigns

An important part of the HCAI strategy, Say No to Infection, is to provide the public with information on HCAI and to use information messages that promote good hand hygiene habits in patients, visitors and healthcare workers.

'Clean your hands - say no to infection'
The HSE in March 2007 launched a major public information campaign aimed at imparting key messages to the public ensuring that they are aware of essential hygiene standards in all hospitals and healthcare settings. This campaign aired through both broadcast and print media from 19th March, 2007. The campaign was targeted at the general public and healthcare professionals, and highlighted that good hand hygiene is the single most important way to reduce the spread of healthcare associated infections.

Results of an independent evaluation of this information campaign showed that having seen the information, 9 in 10 people would clean their hands before entering a hospital or health facility.

'Have you cleaned your hands?'
The second phase of public information on this topic was launched in January 2008, when the HSE invitied patients to ask their healthcare workers if they have cleaned their hands before treating them. The HSE advert wass based on questions - and when someone is unwell or in hospital, they have lots of questions for their carers - like, Do I need an operation?, When can I go home?, How long 'til I'm back to normal? The message of this campaign was that patients should also ask one important and easy question of their healthcare workers - Have you cleaned your hands? There is no question that when one is unwell, and vulnerable, that this might seem like a difficult or challenging question.  But, since good hand hygiene does so much to halt the transfer of infection from patient to patient, no health worker would object to reassuring the people in their care that they are getting the clean pair of hands they deserve.

Results of an independent evaluation of this campaign showed that having seen the information, nearly 7 in 10 people would ask a health care worker if they had cleaned their hands.

Have you cleaned your hands? - read about this campaign, view the TV ad, listen to the radio ad

Monitoring Health Care Associated Infection and other Data

Surveillance and monitoring the levels of infection, the use of antibiotics, and use of alcohol gels in health facilities is an important part of this strategy. The HSE's Health Protection Surveillance Centre has taken responsiblity for publishing this data for all Irish hospital. The first publication of this information was in May 2008, and you can read or download the report here -

Third Survey of Infections in Acute Hospitals
Ireland has emerged with the lowest rate of healthcare associated infections in a 2006 independent comprehensive survey of hospital infections (in Ireland, Northern Ireland, England and Wales).  Over 7,500 patients were surveyed in 44 acute Irish hospitals with the overall figure of MRSA infection emerging as under 0.5% - significantly lower than their UK level of 1.5%.

The overall rate of Health Care Associated Infection (HCAI) which includes MRSA related infections) was also significantly lower in Irish hospitals. While the UK hospitals recorded an overall figure of 7.6%, Irish hospitals recorded an overall figure of 4.9%.  The results are from the Third Prevalence Survey of Healthcare-Associated Infections in Acute Hospitals, carried out by the UK and Ireland based Hospital Infection Society between February and May 2006.

During that four month period, specialist Infection Control Staff carried out the survey, standardised methods of training were used and the US Centres for Disease Control and Prevention (CDC) definitions of infection were used.

Ireland's overall HCAI figure of 4.9% compares favourably with recent figures for other countries:

  • Australia  6% 
  • France  6-10%
  • Norway  7% 
  • Netherlands  7%
  • Spain  8%
  • USA  5-10% 
  • Denmark  8%
    Source: Winning ways - Working together to reduce healthcare associated infection in England (Department of Health, 2003)

The HIS survey shows that in Ireland:

  • Of the 7,518 patients surveyed, 0.5% (37) had MRSA related HCAI
  • Of the 28 General Hospitals surveyed, 68% of the hospitals had no patients with MRSA related infections
  • Of the ten Regional/Tertiary Hospitals surveyed, 35% of the hospitals had no patients with MRSA related infections
  • Of the six Specialist Hospitals surveyed 100%, had no patients with MRSA related infections

'This survey has provided important detailed information on the prevalence of HCAI in Irish acute hospitals.  Although Irish hospitals have participated in previous surveys of HCAI, and many hospitals carry out regular surveillance of HCAI, this was the first opportunity to collect detailed information and compare it directly with that from other Irish hospitals as well as with data from the UK. This Survey and the individual hospital results provide an important baseline for our new national Steering Group as we move forward', concluded Dr Doorley.

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Last updated on: 12 / 04 / 2008