BECAUSE it emerged last week that the family of Valentine Ryan (74), from Cork, will bring the first case heard before the courts in relation to contraction of MRSA.

An inquest last November into the pensioner's death was the first to bring in a verdict that death was due to MRSA infection.

The minister for health, the Health Service Executive (HSE) and the Mercy University Hospital (MUH) in Cork are being sued by the family. "By taking this action, we hope to pave the way for others. Hopefully, it will make a significant dent in the hospital's purse strings so they'll implement simple guidelines to stop the spread of MRSA in all hospitals, " said Mark Worth, Mr Ryan's son-in-law. "We're not interested in retribution. We want to see a change."

The Ryan action will prove a test case for MRSA liability. The family claim the pensioner died after contracting the superbug through contributory negligence. Ryan died on 25 April 2002 after protracted treatment, first in MUH and then Cork University Hospital (CUH).

At his inquest, Cork coroner Myra Cullinane warned that detailed information on such infection deaths was now "urgently required". The inquest was staged four years after Mr Ryan's death despite the fact the hospital where he was being treated did not immediately notify the coroner's office.

No post-mortem examination was ever conducted but the inquest still endorsed a death certificate ruling that Mr Ryan died from MRSA septicaemia or blood poisoning. A secondary cause of death was renal failure.

How much might the state have to fork out to other families?

Millions. Ian Simon of Brian Lynch & Associates in Galway, solicitor for the MRSA & Families Network, told the Taoiseach recently he was taking about 200 cases on behalf of MRSA victims or their families who have lost their lives, mobility or occupation after contracting the superbug.

Many other solicitors around the country are taking cases on behalf of victims.

Each case will be treated individually and compensation will be calculated depending on how a person was affected in terms of dehabilation, age, earning power and dependent family members. Cases can be taken against the hospital, HSE and Department of Health.

What is MRSA and what is its incidence in Ireland?

MRSA stands for Methicillin-Resistant Staphylococcus Aureus. It is resistant to a range of antibiotics, including penicillin.

MRSA first appeared in 1961 and has spread widely in many countries since. It has been particularly associated with hospitals and other healthcare facilities. The infection can permanently damage your health and can sometimes be fatal.

There were 589 reported MRSA bloodstream infections in 2006 and 592 in 2005, according to Maurice Kelly of the Health Protection Surveillance Centre. Contraction of MRSA does not necessarily result in death . . . many people are left needing fulltime care for the rest of their lives.

Is legal action the only option for victims?

Yes. The MRSA & Families Network were optimistic about the prospect of a redress board to compensate victims of the MRSA superbug but this option was ruled out unequivocally by the Taoiseach when he met with the group two weeks ago. Ahern made it clear a redress board was out of the question but seemed open to the possibility of funding an advocacy support service for MRSA survivors and their families.

The group was extremely disappointed with the Taoiseach's attitude and maintains that hundreds of victims and their families cannot afford, or do not want to, go down the legal road. "It is discrimination.

It costs about 3,000 to take a case and many people don't have that kind of money, " according to Dr Teresa Graham, spokeswoman for the group. "Many people have been left severely injured and bereaved and have no redress whosoever. When the cases start going before the courts, perhaps the government will have a rethink. A redress board would save the state a lot of money and heartache for the families. It's bad enough to lose someone to MRSA, but then to have to go through the courts to get recognition is very difficult."

What is the recourse for MRSA sufferers in other countries?

Legal action seems to be the only option for people worldwide. Britain has recently seen a number a civil cases being settled before they hit the courts.

Are poor hygiene standards in hospitals responsible in part for MRSA?

Definitely . . . and this fact is acknowledged by the HSE. "No, we are still not fully happy with the hygiene standards in hospitals.

There have been significant improvements but there is still a fair amount of work to be done, " according to Kevin Kelleher, assistant national director for population health at the HSE.

To date, the HSE has not compiled statistics on the number of people who lost their lives to MRSA. "We're still looking at whether we can do that and if it would be of any value, " he added. Previously, MRSA was not put on a person's death cert and hundreds of families never knew that that was what caused a loved-one's death as the hospitals were not always forthcoming with information, according to Teresa Graham. A HSE audit in 2006 found that 40% of hospitals had unacceptable hygiene standards. The year before, 60% of hospitals had "poor standards" of hygiene.

Research carried out in 2005 showed that doctors were the worst culprits when it came to not washing their hands to minimise the risk of spreading infection. Staff were monitored before and after a sixweek education campaign that involved the placement of a hand rub next to each patient's bed. The study found that only 31% of doctors were following the rules before the campaign and just 55% showing compliance afterwards. Nursing staff fared better . . . half were washing their hands in the pre-campaign phase and 89% did so afterwards.

What is the HSE doing to combat MRSA?

The Health, Information and Quality Authority (HIQA) has been established to tackle infection control. The body is in the process of developing hygiene standards that should be in place by the end of the year.

In the interim, the HSE has developed guidelines that they "expect people to abide by", according to Kelleher. At the moment, policy in relation to infection varies widely from hospital to hospital, which is of grave concern, according to Graham. "A uniform policy cannot be introduced quickly enough. It's a matter of life and death."