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Morgan: Tackling hospital acquired infections

Speech to the National Assembly for Wales.

"Minister, I welcome this statement and thank you for the fact that this work builds on the publication of the report into how hospitals should be combating hospital-based infections, which was published, as I understand, in 2004.

We are pleased that the data is being collected by the national public health service, and we note the figures that have been published up until the end of 2005. According to the NPHS, in 1999 there were 1,488 reported cases of Clostridium difficile, which rose last year to 2,136—although that figure has not been confirmed figures as yet.

Can you confirm the accuracy of those figures, and can you also confirm the figures up until the mid point of this year? While I am aware that the figures tend to be ever changing, due to reports coming through, are more recent figures available, taking this year into account?

Secondly, we know for a fact that Clostridium difficile is resistant to most disinfection methods and that it is very difficult to eradicate. Therefore, what discussions have you had with NHS trusts about the strategies that they have put in place to deal with patients who have been identified with this bacterium? That is important, bearing in mind how quickly it could spread.

Thirdly, you pointed out that surveillance work is being done with regard to patients over the age of 65. Is there any scope to widen the surveillance to patients below the age of 65?

I know that you said in your statement that we anticipate that only a small number of people below the age of 65 could be classed as having the infection, but it might be useful, in future years, for the NPHS to widen the scope of the surveillance to include people under the age of 65.

The data that has been published by the NPHS forms part of one of the recommendations of the report that was published in 2004. What future work is being planned by the NPHS, bearing in mind that this is the first publication of a set of data that was recommended by the chief medical officer and the chief executive of the NHS in their report, called 'Healthcare Associated Infections: a Strategy for Hospitals in Wales'?

In your statement you mentioned that type 027 has been detected in Wales at very low levels, as you announced in July 2006. What is the level of detection, because you said that, in terms of hospital-acquired infections, we have an overall detection of around 6.3 per cent, but that 15 per cent of that is classed as MRSA?

What proportion of that 6.3 per cent of the detection rate of hospital-acquired infections is Clostridium difficile, compared with the rates of MRSA? You have not been clear in the report as to the rate of Clostridium difficile as a proportion of the rate of hospital-acquired infections.

On the crucial part of your report, which mentions education being a key factor, chapter six of the report that was published by the chief medical officer and the chief executive of the NHS, said that there were several process indicators that would be valuable in the context of intervention and performance indicators.

One of those was the percentage of staff trained in infection control. Are you now able to tell us, since the publication of that report in 2004, how many staff have been trained in infection control, specifically in relation Clostridium difficile?

One of the other recommendations, or suggestions, in the report was that the use of outcome measures as performance indicators would be strongly recommended, but that there were problems with this.

One problem was that we had a weak evidence base in terms of the rates of infection that might be anticipated in a hospital, and that, as a result, it would be difficult to see outcome indicators as targets, because they could be seen as speculative, simply because of the weakness of the evidence base.

I accept that the national public health service published its data from 2005 for the first time, but I would like an assurance that more work will be done by the NPHS in publishing outcome data on hospital infections. Unless we get the outcome data from the NPHS, it will be difficult to satisfy one of those key recommendations in the joint report from the chief medical officer and the chief executive of the NHS.

There is a huge amount of work to be done, although I welcome the fact that we are making some progress. However, we need further clarity as to the exact numbers of patients who have been recorded as having Clostridium difficile, and on how Clostridium difficile compares as a proportion of overall hospital infection rates, compared with other hospital infections, such as MRSA."

"Weinidog, croesawaf y datganiad hwn a diolchaf ichi am y ffaith bod y gwaith hwn yn adeiladu ar y broses o gyhoeddi'r adroddiad ar sut y dylai ysbytai fod yn trechu heintiau a geir yn yr ysbyty, a gyhoeddwyd yn 2004, fel y'i deallaf. Yr ydym yn falch bod y data yn cael ei gasglu gan y gwasanaeth iechyd cyhoeddus cenedlaethol, a nodwn y ffigurau a gyhoeddwyd tan ddiwedd 2005.

Yn ôl y Gwasanaeth Iechyd Cyhoeddus Cenedlaethol, roedd 1,488 o achosion o Clostridium difficile wedi'u cofnodi yn 1999, a gododd y llynedd i 2,136—er nad yw'r ffigur hwnnw wedi'i gadarnhau hyd yma. A allwch gadarnhau cywirdeb y ffigurau hynny, ac a allwch hefyd gadarnhau'r ffigurau hyd at ganol y flwyddyn hon? Er fy mod yn ymwybodol bod y ffigurau'n tueddu i newid yn barhaus, o ganlyniad i adroddiadau newydd, a oes ffigurau diweddarach ar gael, sy'n ystyried eleni?

Yn ail, gwyddom am ffaith fod Clostridium difficile yn gwrthsefyll y rhan fwyaf o'r dulliau diheintio a'i bod yn anodd iawn cael gwared ar yr haint. Felly, pa drafodaethau a gawsoch ag ymddiriedolaethau'r GIG ynglyn â'r strategaethau a roddwyd ar waith ganddynt i ymdrin â chleifion y nodwyd bod ganddynt y bacteriwm hwn? Mae hynny'n bwysig o gofio pa mor gyflym y gallai ledaenu.

Yn drydydd, bu ichi sôn bod gwaith arolygu yn mynd rhagddo o ran cleifion dros 65 oed. A oes unrhyw le i ehangu'r gwaith arolygu hwn i gleifion sy'n iau na 65 oed? Gwn ichi ddweud yn eich datganiad ein bod yn rhagweld mai dim ond nifer fach o bobl o dan 65 oed y gellid eu dosbarthu fel pobl â'r haint hon, ond gallai fod yn ddefnyddiol, yn y dyfodol, i'r Gwasanaeth Iechyd Cyhoeddus Cenedlaethol ehangu cwmpas y gwaith arolygu i gynnwys pobl o dan 65 oed.

Mae'r data a gyhoeddwyd gan y Gwasanaeth Iechyd Cyhoeddus Cenedlaethol yn rhan o un o argymhellion yr adroddiad a gyhoeddwyd yn 2004. Pa waith a gaiff ei gynllunio gan y Gwasanaeth hwn yn y dyfodol, o gofio mai hwn yw cyhoeddiad cyntaf cyfres o ddata a argymhellwyd gan y prif swyddog meddygol a phrif weithredwr y GIG yn eu hadroddiad, 'Heintiau sy'n Gysylltiedig â Gofal Iechyd: Strategaeth i Ysbytai yng Nghymru'?

Yn eich datganiad, soniasoch fod math 027 wedi'i ganfod yng Nghymru ar lefelau isel iawn, fel y cyhoeddwyd gennych ym mis Gorffennaf 2006. Pa lefel a ganfuwyd, oherwydd bu ichi ddweud, o ran heintiau a geir yn yr ysbyty, fod gennym gyfradd ganfod gyffredinol o tua 6.3 y cant, ond bod 15 y cant o'r gyfradd honno wedi'i dosbarthu fel MRSA?

Pa gyfran o'r 6.3 y cant honno o gyfradd ganfod yr heintiau a geir yn yr ysbyty sy'n Clostridium difficile, o gymharu â chyfraddau MRSA? Nid ydych wedi bod yn eglur yn yr adroddiad o ran cyfradd y Clostridium difficile fel cyfran o gyfradd yr heintiau a geir yn yr ysbyty.

O ran y rhan hollbwysig o'ch adroddiad, sy'n sôn am y ffaith bod addysg yn ffactor allweddol, dywedodd pennod chwech o'r adroddiad a gyhoeddwyd gan y prif swyddog meddygol a phrif weithredwr y GIG fod nifer o ddangosyddion proses a fyddai'n werthfawr yng nghyd-destun ymyriad a dangosyddion perfformiad. Un o'r rheini oedd canran y staff a hyfforddwyd ym maes rheoli heintiau.

A allwch ddweud wrthym yn awr, ers cyhoeddi'r adroddiad hwnnw yn 2004, faint o staff a hyfforddwyd ym maes rheoli heintiau, yn arbennig mewn perthynas â Clostridium difficile?

Un o'r argymhellion, neu'r awgrymiadau eraill yn yr adroddiad oedd y câi'r defnydd o fesurau canlyniadau fel dangosyddion perfformiad ei argymell yn gryf, ond bod problemau gyda hyn. Un broblem oedd bod gennym sylfaen dystiolaeth wan o ran cyfraddau'r heintiau y gellid eu rhagweld mewn ysbyty, ac o ganlyniad, byddai'n anodd gweld dangosyddion canlyniadau fel targedau, oherwydd gellid ystyried eu bod yn ddamcaniaethol, yn syml oherwydd bod y sylfaen dystiolaeth yn wan.

Derbyniaf fod y gwasanaeth iechyd cyhoeddus cenedlaethol wedi cyhoeddi ei ddata o 2005 am y tro cyntaf, ond hoffwn gael sicrwydd y bydd mwy o waith yn mynd rhagddo gan y gwasanaeth hwnnw o ran cyhoeddi data ar ganlyniadau heintiau mewn ysbytai. Oni fydd y Gwasanaeth Iechyd Cyhoeddus Cenedlaethol yn rhoi'r data ar ganlyniadau inni, bydd yn anodd bodloni un o'r argymhellion allweddol hynny yn yr adroddiad ar y cyd gan y prif swyddog meddygol a phrif weithredwr y GIG.

Mae swm aruthrol o waith i'w wneud, er fy mod yn croesawu'r ffaith ein bod yn gwneud rhywfaint o gynnydd. Fodd bynnag, mae angen rhagor o eglurder o ran yr union nifer o gleifion y cofnodwyd bod Clostridium difficle arnynt, ac ar y modd y mae Clostridium difficile yn cymharu fel cyfran o gyfraddau cyffredinol heintiau mewn ysbytai, o gymharu â heintiau eraill mewn ysbytai, megis MRSA."

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