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Methicillin Resistant Staphylococcus Aureus

Mr. Flynn: To ask the Secretary of State for Health what estimate he has made of the number and percentage of patients who have contracted (a) MRSA and (b) other infections in hospitals in each of the past five years. [4662]

Mr. Horam: The Department has made no such estimates. Data on the incidence of methicillin resistant staphylococcus aureus compiled by the Public Health Laboratory Service from numbers of isolates for which hospitals have requested specialist typing show a total of 2,286 confirmed reports from hospital incidents in 1992, 4,592 in 1993, 10,818 in 1994, 17,063 in 1995 and 21,272 until the end of October 1996. These figures represent the number of patients affected by MRSA, not the number infected, as about 80 per cent. of people who acquire MRSA, carry it harmlessly and do not suffer infection. An incident is three or more patients with the same strain in a month from the same hospital.

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The results of the "Second National Prevalence Survey of Infection in Hospitals," published earlier this year, showed an overall prevalence rate for all types of hospital acquired infection of 9 per cent., compared with 9.2 per cent. in 1980. The survey, undertaken jointly by the Hospital Infection Society, the Public Health Laboratory Service and the Infection Control Nurses Association, was conducted between May 1993 and June 1994 and covered 37,000 patients across 23 specialties in 157 hospitals in the United Kingdom and Eire. There have been no published national studies on the incidence of hospital acquired infection, but the incidence rate is generally thought likely to be around half the prevalence rate.

Mr. Flynn: To ask the Secretary of State for Health what plans he has for making MRSA a notifiable condition; and if he will make a statement on the reliability of current statistics on MRSA infection and deaths. [4663]

Mr. Horam: MRSA infection can take the form of many different diseases from trivial skin infections to pneumonia or septicaemia. It would be wholly

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impracticable to make all these diseases notifiable. Appropriate measures to control MRSA do not depend on it being notifiable.

MRSA does not have a distinct code within the revision of the International Classification of Diseases used for encoding death registration data at the Office for National Statistics. Consequently, there are no centrally held statistics on deaths from this cause. The Public Health Laboratory Service publishes aggregate data on numbers of cases of certain severe infections, some which are due to MRSA which are voluntarily reported to it by hospitals. It also publishes data derived from isolates of MRSA sent to it for specialist typing. Although these data give helpful indications of trends, it is not possible from either of these data sets to identify the total number of cases of MRSA infection.

Mr. Flynn: To ask the Secretary of State for Health what assessment he has made of the use of antibiotics in (a) the spread of methicillin resistant staphyloccus aureus and meningitis and (b) resistance to anti-malaria drugs and to anti-TB drugs; and if he will make a statement. [4665]

Mr. Horam: Bacteria have the ability to develop resistance to antibiotics which are normally effective against them through exposure to these drugs. The emergence of some resistant bacteria such as MRSA is therefore a consequence of the necessity of antibiotic treatment in modern medical practice. Prevention of the spread of existing MRSA is dependent on effective infection control arrangement. In the case of tuberculosis, there is good evidence to relate the emergence of drug resistant tuberculosis to inadequate treatment of initially drug sensitive tuberculosis. In the United Kingdom, standard protocols have been in use for the treatment of tuberculosis for many years and the incidence of drug resistance is very low. New guidance issued this year aims to keep it this way.

Recently published research conducted in Gloucester into general practitioner antibiotic prescribing and meningitis has produced some interesting observations--including a possible link between meningitis and the high use of one particular type of antibiotic in towns in Gloucestershire in 1987. Such a hypothesis is, however, speculative and the findings need to be tested in other areas. The Public Health Laboratory Service will be asking its meningococcal working group for its recommendations on further work.

Drug resistance of Plasmodium falciparum malaria to the anti-malarial drug cholroquine has increased in both intensity and geographical distribution over the last few years, and resistance to the newer antimalarial, mefloquine, is now a problem in parts of south-east Asia. These facts have to be borne in mind when considering an appropriate malaria prevention strategy for travel to endemic areas.

Refugees

Mr. Corbyn: To ask the Secretary of State for Health what estimate he has made of the expenditure by each London borough on support for refugees and their families under the terms of the National Assistance Act 1948 as amended by subsequent legislation. [4669]

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Mr. Burns: Special grant report No. 22 relating to the persons from abroad children's grant was debated on Wednesday 6 November. First claims for funding will be submitted by 31 December. Officials are in close contact with local authorities with regard to estimates of the cost of supporting childless adult asylum seekers under the National Assistance Act.

Edgware General Hospital

Sir John Gorst: To ask the Secretary of State for Health how many (a) 999 emergencies, (b) general practitioner referred emergencies and (c) self-referred emergencies have been received at Edgware general hospital in each month of 1996. [3514]

Mr. Malone [holding answer 12 November 1996]: The information requested on attendances at the Edgware hospital accident and emergency department in 1996 is as follows:

Month	GP referrals	Self- referrals	999 referrals	Other(35)	Total
January	655	1,877	572	671	3,775
February	609	1,795	447	649	3,500
March	695	2,041	498	718	3,952
April	614	2,154	483	703	3,954
May	577	2,180	530	802	4,098
June	551	2,315	565	993	4,424
July	610	2,361	632	905	4,508
August	539	2,144	562	694	3,989
September	473	2,000	549	858	3,880
October	465	2,042	668	814	3,939
Total	5,788	20,909	5,506	7,807	40,010

(35)Other--patients who may be referred by a number of other routes including police, schools, employers, dentists, opticians etc.

Kidney Patients

Mr. Churchill: To ask the Secretary of State for Health what guidance he has given to NHS dialysis centres in respect of the re-use of blood lines and dialysers; what assessment he has made of the compliance of NHS staff with manufacturers' recommendations; and if he will make a statement. [4913]

Mr. Horam: No specific guidance has been issued to national health service dialysis centres on this issue; however, general guidance on the re-use of medical devices supplied for single use was provided to the NHS in a device bulletin, DB 9501, published by the Medical Devices Agency in January 1995. Copies will be placed in the Library.

The Medical Devices Agency has issued general guidance advising users to read the manufacturer's instructions for use before using any device.

Mr. Churchill: To ask the Secretary of State for Health what funds are currently made available to provide patients suffering kidney failure with (a) disconnect systems, (b) EPO drug treatment for anaemia and (c) reimbursement of the additional cost of overnight dialysis for those who work. [4914]

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Mr. Horam: There is no specific funding for patients suffering kidney failure. Health authorities are given general allocations for hospital and community health services to purchase health care services for their resident population. It is for individual health authorities in consultation with the provider of services to decide the level and type of work of services purchased, taking account of local circumstances and national policies and priorities.

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Correspondence

Mr. Thurnham: To ask the Secretary of State for Health when he plans to reply to the letter of 9 August from the hon. Member for Bolton, North-East concerning care homes in the north-west. [4976]

Mr. Burns: A reply was sent on 18 November 1996.

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