NHS Greater Glasgow and Clyde has advised that in addition to induction training as previously outlined, a training session dedicated to Clostridium difficile was provided for nursing staff at the Vale of Leven Hospital in May 2007.

Since May 2007, 73 staff from the hospital have also registered for cleanliness champion training.

Three two-hour sessions a day are also being held for the next two weeks at the hospital. This commenced on Monday 15 September 2008 with 48 staff (all staff groups) attending on the first day.

Other training to have taken place at the Vale of Leven Hospital includes a Clostridium difficile care bundle education session on 28 August 2008, infection control training for domestic staff on 27 August 2008, hand hygiene audit tool training on 5 September 2008, infection control for physiotherapists on 5 June 2008 and training on statistical process charts on 8 September 2008.

A critical issue in the surveillance of Clostridium difficile cases is in identifying when the number of cases in any one ward breaches an agreed control level in a defined period of time, which would indicate the need for an outbreak control team to be established. Until May 2008 and including the period between January to April 2008 when there was a peak in the new Clostridium difficile cases at the hospital, although daily monitoring of Clostridium difficile prevalence was in place, there was no agreed upper levels to alert local staff of an excess of new cases over a period.

The monthly reports will be published on the board''s website.

NHS Argyll and Clyde and NHS Greater Glasgow and Clyde were both visited during 2004-05 as part of the Healthcare Associated Infection (HAI) standards peer review programme. The Vale of Leven Hospital was part of NHS Argyll and Clyde Acute Hospitals Trust at this time.

NHS Quality Improvement Scotland (NHS QIS) standards are considered for revision and updating every three years. The most recent standards were published in March 2008, and future arrangements for performance assessment against the standards are in development. Further information is available on the NHS QIS website at:

http://www.nhshealthquality.org/nhsqis/controller?p_service=Content.showandp_applic=CCCandpContentID=4099.

The NHS QIS review process is just one of the ways in which we monitor NHS board performance against HAI Targets, and given the importance of hand hygiene compliance, I have requested that Health Protection Scotland (HPS) move from three to two monthly reporting on NHS boards compliance from January 2009. I have also increased the target of 90% compliance by November 2008 to 95% compliance by April 2009.

As noted in the independent review team report no routine monitoring was undertaken within the dates requested.

Guidance on Prudent Antimicrobial Prescribing: The Scottish Action Plan for Managing Antibiotic Resistance and Reducing Antibiotic Related Clostridium Difficile Associated Disease was issued under cover of CEL30(2008) on 8 July 2008. This guidance recommends that all NHS boards should immediately establish an antimicrobial management team (AMT) which should cover primary and secondary care prescribing activities. A key role for the AMT Board is the implementation and compliance monitoring of a local antimicrobial policy.

The Scottish Government has no plans to do so. This would be a matter for the independent review team.

Guidance on the control of Clostridium difficile associated disease (CDAD) was first issued in the early 1990s by the then public health laboratory services and evidence has shown that this guidance has remained relevant.

Specific Scottish guidance on surveillance of CDAD has been available since the start of the mandatory CDAD surveillance programme in September 2006 and this was updated in October 2007.

A range of CDAD documents have been produced by Health Protection Scotland for NHS boards. These include the standard infection control precautions model policies which have been available since September 2006, with supporting education materials for hand hygiene and personal protective equipment also available, transmission-based precautions model policies, including contact precautions policy with Clostridium difficile specific hand hygiene and cleaning guidance, which was launched April 2008, the CDAD care bundle which was launched in March 2008 and a checklist for preventing and controlling CDAD was circulated for comment on 19 June 2008 to all infection control managers.

Health Protection Scotland is drafting new overarching national guidance to draw together the above publications and the Scottish Government''s HAI Task Force has been advised that a final draft will be provided to them in September 2008.

I refer the member to the answer to question S3W-15681 on 10 September 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.

Engaging with patients and relatives who had been affected by Clostridium difficile was a key specification given by me to the independent review team. It was therefore always the intention of the independent review team to involve patients and relatives in the review process.

The Independent Review Team was specifically tasked with reviewing the events that took place at the Vale of Leven Hospital and Health Protection Scotland staff were consulted as part of the review. Any wider implications from the findings in the review are being taken forward in the national action plan.