Medical experts fear that continued HSE cutbacks are leading to relaxed attitudes to the diagnosis and treatment of the fatal superbug MRSA, writes Lorna Siggins, Western Correspondent
THE HEALTH Service Executive (HSE) West has sought to allay concerns about the impact of current financial cutbacks on laboratory testing for MRSA.
Prof Martin Cormican, clinical director of laboratory medicine at Galway University Hospitals (GUH), said he was more concerned about the impact of these restrictions on laboratory testing for other conditions, such as atypical pneumonia, farmer's lung and a series of uncommon infectious diseases.
Prof Cormican was responding to concerns raised about treatment of MRSA swabs referred to the GUH laboratory. Swabs were "not being stockpiled" he said, and both doctors and hospital clinicians have the opportunity to make a case if new MRSA testing regulations are impacting on patient care.
Restrictions on testing for the MRSA superbug have been imposed as part of State-wide HSE stringencies since September last. This reflects a "far too casual" approach to an infection which is "endemic" in Irish hospitals and claims the lives of about 350 patients here annually, according to Dr Teresa Graham of the MRSA and Families Network.
Last July the HSE confirmed that it was recruiting just over 50 staff as part of an action plan to reduce healthcare-associated infection rates by 20 per cent.
Dr Patrick Doorley, chairman of the National Infection Control Steering Committee, told The Irish Times then that the reduction target for MRSA was 30 per cent, along with cuts in the prescription of antibiotics, regarded as a major contributor to drug-resistant infection.
However, less than two months later, the HSE imposed a series of cost cuts which had a direct impact on laboratory staffing levels.
In a letter, seen by The Irish Times, issued to management and general practitioners at GUH, dated September 8th, 2007, Prof Cormican identified a series of "service restrictions" which he said were "intended to be temporary" and would "return to normal on restoration of staffing levels".
"Faced with reduced staffing and demands for higher quality, it is not possible to sustain existing levels of service" within the pathology directorate, the letter stated, and "together with all of this, the directorate has also been requested to find additional savings in non-pay expenditure".
The service restrictions imposed as of September 17th, 2007 included taking MRSA swabs "ONLY" (sic) from hospital inpatients and approved "pre-assessment clinics" (such as orthopaedic and cardiothoracic) and other sources "where the details on the form specify that the patient is 'pre-operative' or 'pre-admission'".
Further restrictions imposed included no processing of eye swabs, apart from ophthalmology, no processing of sputa from outside of the hospital except for M. tuberculosis and no skin and nail fungal culture, apart from dermatology.
The virology department was directed to cut serological testing for atypical pneumonia, for Aspergillus antibodies or "farmer's lung" antibodies, which were normally sent to an external reference laboratory, for herpes simplex virus and for a range of other "uncommon" infectious disease serologies which would normally be sent to external laboratories.
Asked by The Irish Times to comment on the letter, Prof Cormican said he would be very concerned about the impact that financial cuts - still in place - were having on lab work.
The new testing system had allowed for more efficient testing of MRSA, he said, but restrictions on other tests were of more concern as these were clinically valuable. Had he the financial freedom, he would restore all of the virology tests which had been cut, and most of those in microbiology, but he believed that there had been "too much checking of MRSA" previously.
Last month, Fianna Fáil TD Michael Finneran (Roscommon/South Leitrim) expressed concern about the level of priority given to MRSA samples by laboratories in Galway. "Given that health spending has risen by 370 per cent over the last 10 years, the HSE must explain why it doesn't have the resources to pay for this vital service," he said.
In response, HSE West said laboratory resources were "limited" and it was "important that these resources are used as much as possible" to undertake tests "that matter most to a high-quality standard".
"The laboratory has policies to try to target the resource available to deliver the most benefit to patients," HSE West said. "Doctors are always welcome to contact the laboratory medical staff to discuss individual cases, where an exception to the general policy is required for a particular reason," it stressed.
Dr Graham said that, in her view, MRSA had become "so endemic" that the HSE felt it would cost too much to try to reduce its incidence.
The current HSE target of reducing it by 30 per cent over five years was too small, given that nine hospitals in Wales had achieved a 70 per cent reduction over five years.
Dr Graham said there appeared to be no political will because there was a mistaken belief that MRSA affected the old and those who were already ill. "Even if it did only affect these categories, what does it say about our society that we should tolerate something that is potentially fatal, when we have the knowledge and expertise to prevent it?" she asked.