The closure of a cancer unit at St James's Hospital in Dublin in September provided a dramatic example of the damage that can be done to the health system by drug-resistant microbes.
To deal with the outbreak of infection by a Vanomycin-resistant microbe, the hospital has had to close down the unit - and the bone marrow transplant unit it contains - for months, during which time it has been refurbished. It will reopen in the middle of this month.
As a result of the closure, 10 patients so far have had to be sent abroad for bone marrow transplants. In a way, St James's was lucky: the outbreak was confined to one unit and did not affect the wider hospital.
Hospital infections have, of course, become part of folklore. Everyone, it seems, knows someone who went to hospital and picked up an infection.
Levels of infection by resistant bugs in Irish hospitals are high compared to other northern European countries. According to a report by the National Disease Surveillance Centre (NDSC), as many as 42 per cent of samples of one bug, Staphylococcus aureus, are resistant, compared to 7.2 per cent in Germany and 0.2 per cent in the Netherlands.
The purpose of the NDSC report is to recommend ways to get our levels of infections down to those northern European levels.
Achieving this is not just a matter of changing what happens in hospitals, although it is clear that changes are needed. For example, the report recommends that messages about the importance of staff washing their hands or using wipes (like baby wipes) need to be reinforced and that there needs to be better compliance by staff with these simple measures.
Simple up to a point, that is. If there aren't hand-washing facilities or tissue dispensers dotted around wards, it is very difficult indeed for staff to comply with these requirements and get through a busy shift.
It is going to cost money to make even simple protective measures feasible in many hospitals. Hospital workers also need more education on infection control. The appointment of specialists, such as infection control nurses (of whom there are few), is another necessity.
Hospital staff can wash their hands all day and all night, but that in itself will not reduce the number of resistant bugs that live in everyone's systems. Usually, these bugs do us no harm - it is only when we have an operation or are very weak that they can overwhelm our defence systems, make us very sick and prolong our stay in hospitals.
The very nature of the patient population is changing in ways which make it more vulnerable, according to Prof Hilary Humphreys of Beaumont Hospital in Dublin. With more people surviving car crashes and cancer treatments and more people having operations, the hospital population is becoming increasingly vulnerable to the damage that can be done by these infections.
Resistant bugs are a natural phenomenon. We have been using antibiotics for 60 years or so now. These work by attacking a particular part of a microbe (a cell wall, for instance). If a microbe evolves through a genetic mutation and is able to survive an attack on the cell wall, then that microbe can replicate and thrive while its less adaptable fellows die.
Penicillin is one of the great magic bullets of our time. By the 1960s, however, some microbes had evolved that were resistant to penicillin. In recent times, tests by three health boards have found that about 17 per cent of samples of Streptococcus pneumoniae are resistant to penicillin. This particular bug causes pneumonia, bacterial meningitis and sinusitis.
The more antibiotics we use, the more we are going to kill off the bugs that are susceptible to antibiotic treatment - and the more the "tough guys" which can survive what we throw at them are going to multiply.
The "tough guys" are also encouraged by the habit some of us have of not completing a course of antibiotics as soon as we feel better. By stopping treatment once it has killed off enough microbes to get rid of our symptoms, we leave the tougher ones alive to replicate and gather strength. For this reason, health authorities encourage doctors to prescribe antibiotics only when necessary.
That's easier said than done. Many of us, when we feel the first twitches of illness, trot off to our GP to get a prescription for an antibiotic (or, even more unwisely, borrow leftover antibiotics from a relative or friend). GPs are thus key figures in reducing the availability of antibiotics and in holding back the tide of resistant microbes.
But it's not as simple as just saying no. Suppose, for instance, that Dr Smith will not give you antibiotics for a cold on the grounds that they won't cure it, and that, indeed, Dr Smith is generally reluctant to lash out such prescriptions. Suppose you also know that Dr O'Morain is accommodating in this respect. Dr Smith may be a hero of the public health system, but Dr O'Morain will get more business.
AS confirmation of this, a paper in the NDSC report, prepared by Prof Colin Bradley of University College Cork on behalf of the Irish College of General Practitioners, states: "It has been shown that doctors who prescribe fewer antibiotics have fewer patients attending with minor respiratory infections." Further evidence that we don't really need all the antibiotics we demand comes from a study, cited by Prof Bradley, which shows that if patients are given a prescription but advised to hold off filling it for a few days, as many as one-third never actually bother to use it. Saying no is a skill which, oddly enough, many GPs don't seem to be good at. A major cause of unnecessary prescribing of antibiotics, according to Prof Bradley, is pressure exerted by patients on GPs. UCC is about to introduce a pilot programme to teach GPs the gentle art of saying no.
In the meantime, those who are concerned about holding back the tide of drug-resistant microbes would do well not to pressurise GPs into saying yes. And when antibiotics are prescribed, we should all finish the full course of treatment.
pomorain@irish-times.ie