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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.

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.

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.

NHS Orkney introduced a draft antimicrobial policy in February 2009 and this was formally adopted in April 2009. An antimicrobial team has been established to audit compliance with the policy, and an antimicrobial pharmacist is in post and has the responsibility for ensuring day to day delivery of the policy.

There were six cases ribotyped, broken down as follows:

Ribotype	Cases
015	1
027	4
078	1

 

Ribotyping is not available for the other cases because the sample was either culture negative or no culture was grown.

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

National guidance requires the setting of local trigger thresholds for each clinical area. Following the recent outbreak these are now in place across NHS Orkney and have been set at two cases for each ward within any 30 day period.

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.

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.