Second Opinion: Ireland has one of the highest rates of MRSA in Europe, ensuring that healthcare-associated infections (HCAI) are at the top of the health agenda.
The Health Service Executive's guidelines for tackling infection are the right first step in reducing incidence rates.
Some countries such as the Netherlands have managed to reduce HCAI rates significantly over the past few years. The 1,200-bed Erasmus Medical Centre in Rotterdam provides aexample - it recorded 70 MRSA cases in 2002 but eliminated the infection completely by 2004.
So if good guidelines have been issued and we can look to other countries for proven solutions, what's the problem? Let's use the Dutch experience as an example. Why don't we simply replicate their approach, where their "search and destroy" strategy, involving early detection and containment of infection, has been so successful?
Unfortunately for Ireland, the Dutch strategy requires free beds (average bed occupancy in Dutch hospitals is 80 per cent) and beds are not available to the same extent in Ireland, where high occupancy rates and A&E pressures make separation and isolation of potentially MRSA-infected patients impracticable.
The challenge facing Irish hospitals is not what changes to make but how to implement the changes using existing resources and without affecting other priorities such as waiting times and financial balance.
From work that PA Consulting Group has undertaken with the UK department of health and the National Health Service, we believe that targeting improvement efforts at high-risk areas makes the best use of scarce hospital resources in reducing healthcare-related infections.
Using the HSE guidelines as a base, three ongoing activities are required: a risk-based approach to targeting infection; sharing analysis and best practice across hospitals; and prediction of infection behaviour and incidence.
These strategies require data. In Ireland, the MRSA data that has been collected, shared or published is insufficient to drive such improvement activities.
It has been suggested that the reluctance to collect data and publish simple league tables of hospital MRSA infection rates is because it would provide an unbalanced picture. Large acute hospitals are more likely to have higher infection rates than smaller, less acute hospitals because of the number of patients treated and the types of service offered.
This may be overcome, however, if a weighting system is introduced for hospitals, taking into account the number of beds, the nature of the illnesses treated, the number and range of procedures performed, and so on.
Improved MRSA infection surveillance may be needed to generate data on where infection risk is greatest. Analysis of cause, origin, speciality, ward, procedure and patient characteristics highlights the priority areas for improvement.
The source of MRSA is identifiable in up to 90 per cent of cases and a diagnostic tool developed by PA has shown that each individual hospital tends to have two or three main causes of infection, allowing staff to direct their efforts where it is most likely to yield benefit.
This is important because while there are many ways to prevent and manage infection, no one tactic can control MRSA - a package of measures is needed. Few hospitals have the resources to implement and monitor such changes across the whole organisation at once, so knowing where to start makes improvement possible.
MRSA incidence varies for a variety of reasons, not least size and type of services provided. But our work with healthcare providers has shown clearly that cross-hospital infection control can yield dividends. Collating and analysing data from different locations provides comparative information on the sources and trends in infection, which may then lead to a nationally adopted solution.
A longer term view of infection risk requires hospitals to review internal and external events that may lead to changes in the likely incidence pattern of healthcare-associated infections. Predictable events, such as a seasonal increase in patients particularly vulnerable to infection, can expose a hospital to increased infection risk.
Knowing what should be done is only the beginning. Hospitals need to identify and target high-risk areas with solutions that can work in Ireland if infection rates are to be reduced. Given Ireland's position near the top of the European MRSA league table, it is imperative that Irish hospitals share their knowledge.
Sile Ryan is a principal consultant with PA Consulting Group's health practice. PA supported the design and implementation of the UK department of health programme to tackle MRSA.