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Monitoring infection rates at local level, for example by ward, clinical specialty or hospital, is the responsibility of each NHS board.

The independent review of the Vale of Leven hospital will examine the adequacy of local systems and practices that were in place there. The recommendations to be made by the review team may have implications for local systems and practices that operate elsewhere.

A range of national mandatory healthcare associated infection surveillance systems are in place to assist NHS boards in this exercise and all NHS boards are required to follow the NHS Quality Improvement Scotland Healthcare Associated Infection standards and the NHS Scotland Code of Practice. Cases of outbreaks of infections are reported to Health Protection Scotland who provide expert support, advice and guidance.

The cause of the outbreak in October 2007 could not be determined. The Outbreak Control team is currently reviewing the circumstances of the most recent outbreak at the Victoria Infirmary and a full report will be compiled. Six patients were affected in October 2007 and I understand that a further five patients were affected in the most recent outbreak, one of whom died on 24 June 2008. We are advised by NHS Greater Glasgow and Clyde that clostridium difficile was a contributory factor in the patient''s death.

The following is the original answer (published on 8 July 2008); see below

The cause of the outbreak in October 2007 could not be determined. The Outbreak Control team is currently reviewing the circumstances of the most recent outbreak at the Victoria Infirmary and a full report will be compiled. Six patients were affected in October 2007 and I understand that a further six patients were affected in the most recent outbreak, one of whom died on 24 June 2008. We are advised by NHS Greater Glasgow and Clyde that clostridium difficile was a contributory factor in the patient''s death.

Twenty-two patients of the 55 patients we are now aware of have died. Of these, clostridium difficile was recorded on nine death certificates as being the likely underlying cause of death, and was recorded as a possible contributory factor in a further nine deaths.

Although the chief executive is ultimately accountable for ensuring that all the appropriate policy and procedures aimed at preventing outbreaks of healthcare associated infection are in place at the NHS board, it has been a consistent message that “infection control is everyone’s business” within NHSScotland. It also has to be acknowledged that a significant number of C.difficile cases come into hospital from the community. The issue of hygiene and infection control is raised in annual reviews and was raised with NHS chairs at my meeting with them on 30 June.

It would not be appropriate for me to comment until the independent review announced by me on 18 June 2008 has examined all the circumstances surrounding the clostridium difficile cases at the Vale of Leven Hospital. The review team’s report is due to be published by the end of July 2008.

The clostridium difficile outbreak in October 2007 was managed by the local Outbreak Control Team who isolated the six patients affected in a temporary cohort isolation facility. In dealing with this outbreak, the board followed the procedures set out in Annex 4 of the 2003 guidance document Managing Incidents Presenting Actual or Potential Risks to the Public Health: Guidance on the Roles and Responsibilities of Incident Control Teams, which can be accessed at:

http://www.scotland.gov.uk/Publications/2003/01/16243/17308.

As a consequence of this outbreak, I am advised that NHS Greater Glasgow and Clyde put a range of actions in place and ordered a deep clean of affected ward areas, implemented its rapid response team and put additional resources into surveillance. More generally, all NHS boards must comply at all times with the national cleaning standards, the hand hygiene monitoring, the prudent prescribing of antibiotics procedures, appropriate infection control precautions (e.g. isolation) and rapid accurate diagnosis procedures.

The approach taken by the Scottish Government’s Healthcare Associated Infection (HAI) Task Force is to encourage higher standards of hand hygiene by NHS staff, patients, visitors, and members of the public through a range of actions including a national poster campaign in main hospital thoroughfares (these posters are routinely refreshed), the provision of the Chief Nursing Officer and Chief Medical Officer’s five top tips which visitors and patients should be made aware of, the availability of alcohol hand gels at every acute bed and ward area for patients and visitors to routinely use and monitoring of compliance of NHS staff by local hand hygiene co-ordinators against an audit tool produced by Health Protection Scotland. The latest health protection quarterly monitoring report reveals that compliance in Scotland has increased from 68% in the first audit in February 2007 to 88% now.

Alongside the NHS element of the hand hygiene campaign, our national TV and media advertising campaign Germs - Wash Your Hands of Them, which ran for six weeks in early 2007 and again in early 2008, carried the clear message to the general public that regular hand hygiene will help them avoid catching and spreading infections. To get the message across to young children and their families, we issued hand hygiene information packs and a DVD to all primary schools and nurseries in Scotland in September last year. On a local level, it is for each infection control team at NHS boards to decide how their visitors are best encouraged to wash their hands and make use of the alcohol hand gels.

I refer the member to the answer to question S3W-14657 on 4 July 2008. I also announced on 18 June 2008 that an independent review would be held into the circumstances surrounding the clostridium difficile cases at the Vale of Leven Hospital. The review team’s report will be published at the end of July 2008.

All answers to written parliamentary questions are available on the Parliament’s website, the search facility for which can be found at http://www.scottish.parliament.uk/webapp/wa.search.

A robust structure is already in place. All NHS boards employ infection control managers who are managerially accountable for ensuring implementation and monitoring of national healthcare associated infection (HAI) strategy. Every hospital has access to a team of infection control professionals to help manage outbreaks and incidents of HAI. The ward sister or charge nurse is professionally responsible for ensuring that their ward is a clean, safe environment, and a structure is in place to ensure that these staff complete the cleanliness champions training programme.

All NHS boards are expected to follow the guidance set out in Annex 4 of the 2003 guidance document Managing Incidents Presenting Actual or Potential Risks to the Public Health: Guidance on the Roles and Responsibilities of Incident Control Teams. This document is currently under review and an updated version of Annex 4 will be issued shortly. All NHS boards must also follow the guidance in key documents such as the NHS Quality Improvement Scotland Healthcare Associated Infection (HAI) Standards, the NHS Scotland Code of Practice; the Standard Infection Control Precautions and the Transmission Based Precautions model policy and the prudent antibiotic prescribing guidance documents published in 2005 and 2008.

It is for NHS board chief executives to ensure that all the appropriate policy and procedures in relation to HAI are in place. They were reminded of this responsibility in a letter of 27 June 2008 from the Director-General of the Scottish Government Health Directorate and Chief Executive of NHSScotland. Managerial responsibility for effective implementation and monitoring of the procedures set out in the above guidance documents rests with the infection control managers. Professional advice in the prevention and management of outbreaks rests locally with the infection control doctor and infection control nurses and responsibility for ensuring that the ward is a clean and safe environment primarily rests with the ward sister/charge nurse.