No evidence HSE has superbug under control, scientist warns

A scientist overseeing the Health Service Executive’s fight against a dangerous superbug warned last year there was no evidence it had any greater control over the problem than when it was first declared an emergency.

Prof Martin Cormican, HSE national lead for healthcare-associated infection and antimicrobial resistance, made his observations last September after the Department of Health had raised the possibility of declaring an end to the public-health emergency for the superbug Carbapenemase Producing Enterobacteriaceae (CPE).

Concern about the growing threat posed by the superbug, which is resistant to most antibiotics, led to Minister for Health Simon Harris declaring CPE a public-health emergency in October 2017.

Records show Prof Cormican drafted a letter highlighting his concerns about declaring the emergency over after the issue was raised by officials from the department at a meeting of the National Public Health Emergency Team (NPHET) in September 2018.

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In the document, obtained by under freedom of information legislation, Prof Cormican observed: "Transmission of CPE to patients in the healthcare system in Ireland has not been interrupted and has not substantially declined."

The number of patients with CPE has increased steadily in recent years and went from 433 in 2017 to 537 last year. A total of 307 new cases have been confirmed in the first half of 2019.

Outbreaks

There were 27 new outbreaks of CPE recorded in acute hospitals in 2018 compared with 15 the previous year. In the first six months of 2019 there have been 10 reported outbreaks.

The latest figures show there were 211 patients in 28 hospitals with CPE in June, of whom nine were not accommodated in an en-suite single room as recommended.

Over 24,000 patients are currently being screened by hospitals every month for the infection.

In his letter to NPHET, Prof Cormican said CPE differed greatly from past infectious diseases that resulted in public-health emergencies being declared as it was primarily concentrated in acute hospital settings.

“If the response to CPE is delayed until there is a larger number of people with serious illness that response will almost certainly be too late to be effective,” he warned.

Prof Cormican added: “If CPE becomes firmly established in the vulnerable sections of the population it is likely to be practically impossible to control or eradicate it.”

Prof Cormican also expressed concern that the frequency of meetings of NPHET had gone from weekly at the start of the emergency to about once every two or three months.

There hasn’t been a meeting of the committee this year but one is scheduled next month.

Although the cost of implementing screening for CPE was modest, Prof Cormican said it seemed nobody had the authority to speedily approve such funding, despite the issue being a public-health emergency.

“It is difficult to reconcile the scale of the additional resources provided ... with the priority and urgency implied in the declaration of a public health emergency.”

Asked about officials seeking to declare the CPE emergency over last September, a spokesperson for the department said they had noted that many NPHET actions had been closed at that point and it was recognised that its work was “moving toward a structured, enhanced operational phase”.

The department said funding of €5 million has been allocated for antimicrobial resistance controls in hospitals and community care settings this year.

HSE director general Paul Reid has warned antibiotic-resistant superbugs could become an irreversible problem for the Irish health service.

Mr Reid said if the numbers of CPE cases continued to increase on current levels, the health service was moving closer to “a tipping point beyond which effective control is impossible”.