Health and Well Being Secretary Nicola Sturgeon
Statement on C-Difficile cases in Dunbartonshire
Scottish Parliament
Wednesday, June 18, 2008
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I would like to begin by conveying my sincere condolences to the families of all those who died at the Vale of Leven hospital as a result of C-difficile.
I hope that my statement today will assure them - and the other patients who, over the past six months, contracted C. difficile at the Vale of Leven - that the government treats this issue extremely seriously.
I am deeply concerned that the 54 cases that occurred between December 2007 and June 1, 2008 - and the 16 deaths that are included in that figure - came to light only as a result of a retrospective investigation by the health board.
This raises very serious questions about the robustness of both the surveillance systems and the infection control procedures in operation at the hospital.
I will outline later in my statement what action NHS Greater Glasgow & Clyde has taken to address these deficiencies and what further action I propose to take.
Firstly, however, let me set out the timeline of events since Greater Glasgow & Clyde became aware of cases of the 027 strain of C.difficile.
- May 2 - the national Reference Laboratory alerted the Vale of Leven to 2 cases of C.difficile identified as the O27 strain
- May 21 - the Infection Control Team became aware that since August 2007 there were a total of 6 cases of the O27 strain identified from recent and historical samples across the Clyde area, and that three of these had a common link to the Vale of Leven. The incident review team at its meeting that day set in train a range of actions to improve infection control. Health Protection Scotland and the Scottish Government were informed of the situation and I was subsequently briefed by officials
- May 22 - NHS GG&C issued a press release confirming its investigation of the three linked cases of 027 and that one of the patients involved had died in March
- May 28 - the Infection Control Team met again to ensure that action to improve infection control at the Vale of Leven was being taken forward
- June 6 - a local Dumbarton newspaper advised me that it intended to report a possible five deaths from C.difficile at the Vale of Leven. As I have already outlined, the Infection Control Team were implementing a range of actions at that time. A review of lab data to establish the number of C.difficile cases was also underway
- June 10 - the Scottish Government was advised by NHS Greater Glasgow & Clyde that, in addition to the other actions it was taking, a full look back review had been conducted. That review had identified a total of 54 cases of C.difficile infection from December 2007, including 8 deaths with C.difficile as the main cause of death and another 8 cases where it was a secondary cause
- June 10 - the Outbreak Control Team met
- June 11 - NHS Greater Glasgow & Clyde updated the public by press release
- June 13 - I received an interim report on the situation from NHS GG&C
- June 17 I received a further report.
Presiding Officer,
The reports that I have received from NHS Greater Glasgow and Clyde raise serious cause for concern. They suggest that the surveillance systems in place at the hospital were inadequate and did not alert the Board to the number and pattern of cases.
They also make clear that a physical examination of the hospital by the Infection Control Team identified serious issues about infection control. It found that:
- throughout the hospital in both clinical and patient toilet areas there was a lack of dedicated hand hygiene basins
- many commodes were not fit for use and required to be replaced
- personal protective equipment like gloves and aprons were not readily available
- bed spacing throughout the hospital fell short of health and safety recommendations
The Infection Control Team was also informed that these issues had been raised by staff over a number of years.
Presiding Officer, the reports also set out a range of actions that the Board is taking to address these issues. These actions include:
- stepping up local surveillance systems and infection control procedures throughout the hospital to bring them into line with current NHS GG&C standards
- a concerted drive towards improving hand hygiene compliance, led by the Board's hand hygiene co-ordinator and top-level medical and nursing staff
- the opening of an additional ward to improve bed spacing and access to hand washing facilities
- an urgent review of the use of antibiotics which are known to reduce the body's natural defences against C-difficile, and staff training to highlight awareness of infection control interventions
- a commitment by GG&C to refurbish and upgrade the facilities at the hospital
The Board has also invited Health Protection Scotland to review its infection control procedures to ensure that they meet national standards.
Presiding Officer, while I am pleased that these steps have now been taken and to have the board's commitment to refurbishing and upgrading facilities at the hospital, it is nevertheless my view that the case for an independent review is overwhelming.
The public need to know why the surveillance systems and infection control procedures did not work as they should have done.
They are also entitled to assurances that the actions being taken are adequately addressing the key problem areas and don't fall short in any way.
I also think it is vital to have a thorough investigation to ensure that any good practice recommendations are picked up by other Boards and adopted nationally so that we can reassure other patients in other parts of the country that their safety is being protected as fully as possible.
I can therefore announce today that an independent review will be held:
- to examine all of the circumstances surrounding the 54 C.difficile cases
- to review the adequacy of the surveillance systems and infection control measures that were in place in the Vale of Leven
- to review the adequacy of facilities, procedures and systems now in place at the hospital
The review will be led by Professor Cairns Smith, Professor of Public Health at Aberdeen University. He will be assisted by Professor Mary Henry, Nurse Director of NHS National Services Scotland and Dr Gabby Phillips, a Consultant Medical Microbiologist at NHS Tayside.
I have asked for a full report and recommendations to be finalised - and made public - by the end of July.
This review is, of course, without prejudice to the statutory responsibilities of the Lord Advocate under the Fatal Accidents and Sudden Deaths Inquiry (Scotland) Act 1976.
Presiding Officer, the situation at the Vale of Leven raises wider questions about the surveillance of C.difficile within the NHS. A series of further actions are therefore being taken.
Firstly, all Infection Control Managers are being asked to review their own C.diff data over the past 6 months and to report their findings back to Health Protection Scotland and to the Scottish Government as soon as possible.
Second, my officials have contacted all other Boards to check on their local surveillance systems to make sure that they are fit for purpose.
It is vital that we make sure that these systems are able detect any increase and that we look at linking up surveillance data with data on deaths.
Third, Health Protection Scotland, in collaboration with my officials, is preparing new national guidance on C.difficile which will stipulate clear requirements for local surveillance monitoring and ensure a consistency of approach.
Taken together with the results of the review, this further action will allow us to determine how procedures could and must be improved across Scotland.
Presiding Officer, the position at the Vale of Leven is deeply concerning. I expect the highest standards of surveillance, infection control and care to prevail everywhere in our NHS and I hope that my statement today shows that we are willing to face up to the challenges of delivering them.
The safety of our patients is paramount. A thorough review will take place over the coming weeks to identify the circumstances that led to the situation at the Vale of Leven and I am determined to ensure that the lessons to be learned from this exercise will help us to drive C.diff infection rates down and reduce the risks to patients.