The independent review into the cases of C. difficile associated disease (CDAD) at the Vale of Leven Hospital was published today by the University of Aberdeen’s Department of Public Health.

It found that the facilities at the hospital were “inadequate for effective patient isolation and infection control” adding that there were “frequent patient transfers between wards and other hospitals during this period.”

It continued: "The facilities were inadequate in terms of hand washing facilities, single room accommodation with sufficient toilets, appropriate spacing between beds, clinical and storage space to facilitate effective infection control practices.

"There was no active monitoring of the implementation of antibiotic policies or feedback on usage to clinical staff."

The report made a series of recommendations to ensure good infection prevention and control procedures are in place at the hospital, which it said should be adopted “as a matter of urgency.” In particular it recommended that a review of current infection control policies and procedures to ensure current best practice guidelines with respect to the prevention and control of C. difficile infection are implemented and monitored, including relevant training and education for all staff, and said that the current process for communication with patients over infection control issues should be improved in consultation with patient representatives.

However, the review also said that the uncertainties over the longer term future of the hospital had led to lack of investment in the upgrading and maintenance of the hospital, and stressed that it is important to view the events at the Vale of Leven Hospital in the context of an increasing problem affecting hospitals across Scotland.

Another report into the outbreak, which was also published today by Health Protection Scotland (HPS) found that 3174 cases of CDAD were reported from all acute hospitals 1 December 2007 to 31 May 2008, of which the majority occurred in the 50-64 age group.

It recommended that a combination of both local and national surveillance, infection prevention and control procedures were needed to reduce numbers of cases of CDAD. As part of this it said that consideration should be given to extending the national surveillance system for CDAD to those aged between 15 and 64 years. HPS also said that it will produce a framework for local surveillance that will include guidance on definitions, methods and how to identify triggers and monitor improvement.

Cabinet Secretary for Health and Wellbeing Nicola Sturgeon said the picture painted by the independent report was “appalling and unacceptable” and gave a guarantee that both reports’ recommendations will be accepted in full.

She said: "The Independent Review and the HPS reports confirm the C.difficile mortality rate at the Vale was significantly higher than the national average. There were peaks in cases that should have triggered investigative action - but no effective local surveillance was in place.

"The picture painted by the independent report of the facilities and procedures at the Vale of Leven is appalling and unacceptable and there should be no doubt NHS Greater Glasgow & Clyde owe the patients and the families concerned an unconditional apology.

"I would like to thank all the families involved for their open and constructive contribution to the work of the Review team.  Their messages stand out clearly, and I can assure them we are listening and acting."

Sturgeon said she has also has the Healthcare Associated Infection (HAI) Task Force, which is chaired by the Chief Nursing Officer, to ensure that a robust approach in infection control is implemented across Scotland through a comprehensive action plan.

She added: "We must ensure greater emphasis on the development of standardised local surveillance which is robust, sensitive and reliable in identifying situations which require further investigation.  All Boards will now produce two monthly reports checked against a standard national template.

"NHS Boards should be in no doubt - leadership, governance and accountability are the means by which patients and the families can have confidence in our hospitals."

However, Labour's Public Health spokesman Dr Richard Simpson today called for a full judicially-led public enquiry.

Simpson said: 

"Today's reports are a useful start to finding out the extent and scale of the Clostridium difficile problem across the country but they reveal more questions than answers. 

"The only way we are to both get to the bottom of what happened at the Vale and stop the rise of C diff across the country is to have a full public inquiry in front of a judge. 

"The scale of C diff in Scotland is concerning and the fact that the Cabinet Secretary failed to follow the lead shown by the NHS in England, which updated its mandatory web-based surveillance system for the infection in January 2008, shows an alarming complacency. "

He said that while C diff went down by 33 per cent over the last year in England, iIn Scotland rates are up 16 per cent over the last quarter. 

He added: "The surveillance systems at the Vale were inadequate compared to similar hospitals such as the Victoria where the emergency infection control team intervened rapidly. It is clear that had the Cabinet Secretary insisted that both surveillance and antibiotic policies were effectively implemented, then lives would have been saved.  

"Nicola Sturgeon should order a full public inquiry so the families can get the answers they deserve."

You can view the independent review here: http://www.abdn.ac.uk/public_health/cdad/

The Health Protection Scotland report is available here: http://www.documents.hps.scot.nhs.uk/hai/sshaip/publications/cdad/cdad-review-2008-07.pdf