NHS Quality Improvement Scotland (QIS) has confirmed the report will be published on its website by end June 2009.

I refer the member to the statement I made to Parliament on 22 April 2009 when I confirmed that there will be a Public Inquiry into the Clostridium difficile outbreak at the Vale of Leven following the conclusion of on-going police and Health and Safety Executive (HSE) investigations.

I refer the member to the answer to question S3W-23027 on 5 May 2009. 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/Apps2/Business/PQA/Default.aspx.

Clostridium difficile spores represent the main source of cross infection with the organism and their containment is, therefore, a top priority. Health Protection Scotland (HPS) issued guidance in October 2008 titled Guidance on Prevention and Control of Clostridium difficile Associated Disease (CDAD) in Healthcare Settings in Scotland which details the measures to be taken to prevent the spread of clostridium difficile, such as isolation of symptomatic patients, hand hygiene, environmental cleaning, personal protective equipment and the safe management of linen and waste.

This guidance can be found on the HPS website at:

http://www.documents.hps.scot.nhs.uk/hai/sshaip/guidelines/clostridium-difficile/guidance-cdad-2008-10.pdf.

Products which receive the recommendation of the Health Protection Agency''s Rapid Review Panel (RRP) will be automatically considered for possible use in NHS Scotland by the HAI Commodities Advisory Group. This is a strategic group hosted by National Procurement, which meets six monthly but operates an e-mail discussion group between meetings. The group oversees the use of HAI related commodities within NHS Scotland and brings the process of review and procurement of products together through the application of a single national systematic approach and process.

NHS Lothian has confirmed that there has been no recent incident of Clostridium difficile at the Western General Hospital. NHS Lothian has an upper control limit of two cases in one ward per week. Any breaches of the upper control limit triggers investigation by the Infection Control Team. Between October 2008 and March 2009 there were no breaches of the upper control limit. As an additional precaution, however, the Infection Control Team investigated eight incidences between October 2008 and March 2009 where wards reported above two cases in one calendar month. No incidences of cross infection were identified in any of these investigations.

On 3 February, the Scottish Government was notified of an outbreak of Clostridium difficile in NHS Orkney (NHSO). Seventeen patients, including one member of staff, had been confirmed as Clostridium difficile positive since the start of January 2009. This compared to a total of 26 cases for the whole of 2008. Seven cases were identified in the community, 10 in hospital. Of the 17, three have died, with Clostridium difficile recorded on two of the death certificates, in both cases as a contributory cause of death.

Immediately the situation became known, the Chief Nursing Officer (CNO) asked Health Protection Scotland (HPS) to visit to fully explore the circumstances and to provide support, which they did on 6 February. The CNO, supported by members of the Scottish Government HAI team and HPS also visited the board on 10 February, and an action plan was produced. Through weekly monitoring, I am being kept informed of progress.

The detail of the Clostridium difficile outbreak was reported publicly through local media and the NHS Orkney, HAI Reporting template (HAIRT), and the HAIRT was discussed at the NHSO board meeting on 19 February 2009. A copy can be accessed through the NHSO website using the following link http://www.ohb.scot.nhs.uk/images/pdf/OHB114%20Orkney%20HAI.doc.

I spoke to the Chair of NHS Orkney on 5 February and met him on 4 March. He reassured me that the outbreak was contained and the action plan was in place, and I have asked that NHS Quality Improvement Scotland (QIS) review the clinical governance arrangements in place across NHS Orkney, which is consistent with their remit to provide advice and guidance on effective clinical practice.

A further review of infection control arrangements will also be undertaken by HPS by the end of September 2009.

Health Protection Scotland (HPS) advise there is no intention to distinguish between samples taken in hospitals, community settings or nursing homes for the national surveillance of Clostridium difficile Associated Disease (CDAD).

HPS will carry out validation studies with individual NHS boards to establish where CDAD cases are arising to best focus efforts to reduce the risk of developing the infection.

Antimicrobial prescribing is the biggest single risk factor for CDAD and in that context it is assumed that all cases are healthcare associated.

This information is not routinely collected or held centrally. The transfer of patients would be considered by local infection control teams if relevant to the investigation or the management of any incident or outbreak.

Learning and information about prescribing antibiotics is shared with GPs at a local level through education and feedback sessions organised by the NHS boards prescribing advisers. As part of the Scottish Antimicrobial Prescribing Group''s education work stream, NHS Education for Scotland is currently developing a learning resource for primary care on managing common infections, which will include appropriate use of antimicrobials. The NHS board''s antimicrobial management team is tasked with ensuring the implementation of such educational programmes.