The health service is facing a €40 million annual bill due to an escalating threat from a potentially lethal superbug, according to Health Service Executive (HSE) director general Tony O'Brien. Carbapenemase-producing enterobacteriaceae (CPE) are carried harmlessly in the gut, but have become resistant to antibiotics. They represent a threat if they invade the bloodstream of already ill hospital patients.
About 40-50 per cent of patients with a CPE bloodstream infection die. CPE is not untreatable but it is a challenge as antibiotic combinations or older, more toxic drugs have to be used. However, just two per cent of cases detected in the Republic have been invasive; the remainder, who carry the bacteria in their bowel, do not become ill but can infect other people.
The resistant bug has caused operations to be postponed and wards to be closed. In Italy, it led to the suspension of bone marrow transplantation programmes. The World Health Organisation has labelled carbapenem resistant bugs a "critical priority" for which new antibiotics are needed.
Researchers have linked a money-saving decision to stop routine Sunday hospital cleaning in Tallaght Hospital to the CPE outbreak there. Overcrowding due to reduced bed capacity is also a key factor; it is difficult to access certain areas for cleaning when additional beds have been squeezed into wards and corridors. Other factors were too few staff, an insufficient number of single rooms and inadequate IT systems.
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CPE live in hospital kitchen sinks, hand wash basins and on toilets. The decision to halt routine Sunday cleaning in Tallaght occurred in 2015. To what extent the cleaning budget was curtailed because of overall budgetary pressures in the hospital must now be clarified.
Although expert opinion is that the HSE is still in a position to contain the CPE outbreak, it must respond urgently. And there is certainly no place in the health service for the kind of short-term and counter-productive thinking that led to arbitrary cuts to the cleaning budget at one of Dublin’s teaching hospitals.