Meeting of the Parliament

Meeting date: Tuesday, May 7, 2013

Official Report 878KB pdf

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Topical Question Time

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Clostridium Difficile

1. To ask the Scottish Government what action it is taking to address the recent emergence of a new strain of Clostridium difficile. (S4T-00341)

This is the first published report of Clostridium difficile ribotype 332 in the United Kingdom and worldwide, though new strains have occurred frequently over the past 10 years. On 23 April, Health Protection Scotland alerted clinicians and laboratory staff across the national health service to the emergence of the new strain, and a reference was published in its weekly report on 1 May.

Health Protection Scotland advises that the identification of a novel ribotype does not require any immediate changes to surveillance or in the antibiotics that are used to treat CDIs. There is no evidence to suggest that the identification of the ribotype poses a greater health risk to the public than other known strains. The same infection prevention, control and treatment measures apply to CDI caused by ribotype 332 as they do to any other form of CDI.

The healthcare associated infection task force national advisory group has been asked to consider the emergence of the new strain as part of its on-going remit to develop responses to emerging new infections.

I thank the minister for that answer, in light of the scientific advice that he has received. Does he agree that, although the latest figures from Health Protection Scotland show that C diff infections in people over 65 are at their lowest levels since recording began, patients in Scotland must have confidence in the quality of care and the treatment that they will receive in hospitals and that that should not be undermined by fear of contracting an infection?

The member rightly recognises the significant progress that has been made in reducing C difficile infections in NHS Scotland. Since January to March 2007, there has been an 82 per cent drop in the number of C difficile infections among patients over 65. We must build on that. Announced and unannounced inspections by the Healthcare Environment Inspectorate ensure that there is robust evidence of action being taken by individual health boards in their healthcare settings to make sure that there are proper prevention control measures in place. Alongside that, Scottish Government officials review the HEI inspection reports, together with boards’ improvement plans to establish whether and be assured that progress is being made. The HEI task force is also kept informed, where appropriate, of inspection outcomes to identify any additional polish measures that may be needed to improve patient safety and patient care environments.

Although the overall quality of infection prevention and control in Scotland’s hospitals is good, what further steps will the Scottish Government take to implement the HEI’s finding that the frequency of environmental cleaning in nine hospitals did not meet the NHS Scotland national cleaning services specification?

It is right to recognise that significant improvements have been made to how our healthcare environments are inspected and the quality of the hygiene in them. Although good progress has been made, as I said in my earlier response it is essential that we build on that progress. We review the HEI reports so that we are assured that health boards are taking action where there have been indications of a deficiency in their processes. Boards are in no doubt about the Government’s commitment to address the issue and our desire to see improvement.

To assist our boards, we have provided £5 million annually to allow them to employ several hundred additional cleaners to assist with the cleaning of our hospitals and other healthcare facilities. That allows us to ensure that the environments are kept to the highest possible hygiene standards.

Does the minister agree that concern about new strains of C diff has sometimes been fuelled by a public suspicion that is often born out of a lack of candour, and that the Government’s response should always be, on the one hand, to be calm, measured and factual but, on the other, to be candid in the advice that it gives?

I agree. When it comes to such issues, there is the potential for the release of partial information to be misinterpreted as a desire to withhold information. The member is alluding to the concerns that were expressed about how Health Protection Scotland announced the identification of the new ribotype. As I have mentioned, the strain does not raise any further safety issues regarding treatment, surveillance or any action necessary to deal with the infection. There are more than 500 different C difficile ribotypes.

On reflection, I think that it is clear that Health Protection Scotland could have been more proactive in making information available from the outset, to balance patient confidentiality issues with the need to reassure the public. The proactive approach that NHS Fife then took helped to address concerns that might have arisen as a result of the information that HPS had made available.

I offer my condolences to the three families who have lost loved ones in the new outbreak of C diff. I am sure that all members’ thoughts are with them at this time.

I understand the rationale for withholding the names of the hospitals concerned to protect the families, who are our first concern. However, I hope that a dual intention was not to protect the besieged Victoria hospital in Kirkcaldy, which has been the subject of numerous complaints from patients and staff in recent months. A nurse recently accused the hospital’s management of redeploying staff to deceive visiting inspectors.

In 2008, following the dreadful C difficile outbreak at Vale of Leven hospital, where hygiene standards were found to be lacking, the then cabinet secretary said that there would be a zero tolerance to non-compliance with hand hygiene practice. Will the minister say how many reprimands for poor hygiene there have been over the past five years, in pursuit of the zero tolerance approach? Will he also say what sanctions exist for non-compliance?

The effect of the zero tolerance approach is illustrated by the significant progress that has been made—I mentioned the 82 per cent reduction in the number of C difficile cases in patients who are over 65.

We have an on-going programme of HEI inspections, which we introduced to drive up standards, and we continue to make progress in that regard. We also have an annual programme of work with staff to reinforce the importance of hand hygiene in the context of hospital-acquired infections, and there is on-going auditing work to identify further measures in NHS Scotland to improve the situation.

That succession of measures demonstrates the zero tolerance approach that this Government has taken since 2007 to address healthcare associated infections. The marked reduction in the number of cases clearly reflects the strong measures that the Government has taken forward.

The member asked about individual reprimands in health boards. I am sure that he recognises that the issue is not the tally of reprimands that have been issued but the creation of a culture in which a robust system of hand hygiene is in place, so that staff do not think twice about hand hygiene but act automatically. We are aiming for such a culture in NHS Scotland, which is why we have seen such a marked reduction in the number of hospital-acquired infections over the past six years.

I, too, express my condolences to the bereaved families.

The minister is aware of a new mechanical device, which uses ultraviolet radiation, and which it is claimed will eradicate C difficile. The device is being used in Stoke Mandeville hospital and in other English hospitals. Will he consider trialling the Xenex machine in ward conditions, in this difficult situation?

I am aware of the new technology. NHS Scotland is always keen to consider how to apply new forms of technology, to improve patient safety and the healthcare environment. No doubt NHS Scotland will consider the issue as part of its on-going improvement work around addressing hospital-acquired infections.

My thoughts, too, go out to the families who are involved.

I think that the people of Fife will want to know that they can rest assured that their hospitals are as safe as possible. Might there be a place for a particular reporting mechanism in NHS Fife in the months ahead, to assure people that the instances of C diff are being taken very seriously and that everything that can be done is being done to avoid such instances in future?

NHS Fife is no different from any other NHS board in seeing a marked reduction in the number of C difficile infections in its hospitals. As I said in my earlier response, although this new ribotype has been identified, that does not mean that any treatment, surveillance or preventative measures that are being taken have to be changed. That is why we have also referred the matter to the healthcare associated infection task force, which is the national advisory group that will consider the emergence of this new strain.

I stress that this new ribotype is one of several hundred that are out there and that it is sensitive to the antibiotics used to treat C difficile infections. On that basis, NHS Fife has, as any board would do, set up a problem assessment team in partnership with Health Protection Scotland to look at whether it can take further measures to reduce healthcare associated infections such as C difficile. It is important to recognise that NHS Fife has made significant progress and that a process is in place to evaluate whether it can take any further measures to reduce infection rates. However, this new ribotype does not change the way in which we treat, manage and prevent CDIs in our hospitals.