Infection controls slammed at C Diff hospital

Infection-control facilities at a hospital where Clostridium difficile was linked to 18 deaths were "inadequate", a report said today.

A total of 55 people were affected by the outbreak of C diff at the Vale of Leven Hospital in Alexandria, West Dunbartonshire.

The infection was the primary cause of death in nine patients, and was also a contributory factor in another nine.

In June, Health Secretary Nicola Sturgeon announced an independent review into the C diff outbreak.

Today that independent review team made a series of recommendations.
The report said: "The facilities at the Vale of Leven Hospital were inadequate for effective patient isolation and infection control."

Chief Executive of NHS Greater Glasgow and Clyde (NHSGGC), Tom Divers, apologised to patients and families affected by the C-diff outbreak.

He said:"There are clearly lessons that have been learned and a clear need for me now, on behalf of NHS Greater Glasgow and Clyde, to apologise to the families affected by C-diff at the Vale of Leven Hospital."

"I recognise the concerns of relatives of patients that they were not properly informed every step of the way of the infection and how to help protect themselves and others from the risk of infection. I have instructed infection control teams and senior managers to take action on these valid complaints."

Mr Divers recognised as key areas for immediate attention the report's criticisms of the poor standards of certain facilities in particular the insufficient access to hand washing facilities.

"I have already instructed immediate remedial improvements – and many of those are already underway – these include improved hand washing facilities and better bed spacing.

"A further key issue raised by the report is the lack of an effective local hospital surveillance system for infections at the start of the outbreak. As part of a planned programme we had already introduced a new system for more effective surveillance of infections across all our hospitals. This will enable doctors, nurses and infection control teams to identify higher than normal levels of infections in any of the wards of Greater Glasgow and Clyde hospitals to take swift control measures to protect patients and the spread of any infection.

"We have already made some initial changes to the management arrangements in Clyde resulting in the Clyde structure now being fully integrated with the rest of Greater Glasgow. As a result of today's recommendations we will take forward further actions to reinforce leadership, accountability and empowerment both at the ward and hospital level and ensure clear lines of communication and responsibility to the Board's Medical and Nurse Directors. Locally our Charge Nurses will be given extra support, authority and the ability to access the resources to be able to deliver on HAI responsibilities.

"We will also carry out a full review of our infection control structures to address the recommendations of the IRP report. All of this work will form part of our detailed action plan to ensure all the key recommendations made by the panel are fully addressed and monitored on a regular basis. We will ensure that the families concerned, as well as other patient representatives, are invited to be represented in this process.

"The uncertainty over the future of this local hospital has undoubtedly been a factor in the lack of major modernisation investments. I can today give a commitment that this Board will bring forward proposals in August and September that will set out a clear vision for the future of the Vale of Leven site that can then be the subject of public debate over the next few months."

Dr Syed Ahmed, NHSGGC's Consultant in Public Health Medicine and Chair of the Vale of Leven C-diff Outbreak Control Team, said: "The Vale of Leven certainly had more cases of C-diff than one would expect during the first six months of 2008 … sadly C-diff is a germ that is in the community and there will always be sick and vulnerable patients – especially among the elderly – who will develop C-diff associated diseases.

"Another factor in this particular outbreak was the prevalence of the more virulent 027 type strain of C-diff amongst the patients affected.

"From an infection control point of view it is clear more could have been done to identify the risks earlier and potentially reduce the spread of infections.

"We believe that better infection surveillance and control measures might have resulted in fewer cases of C-Diff. However we are still working with Health Protection Scotland to investigate the reasons why there were a higher than expected number of deaths amongst those who became affected.

"Cleaning and hand hygiene are a crucial part of our fight against the spread of C-diff but equally important is the prudent use of certain antibiotics for certain types of patients. The public health team are working closely with acute hospital infection control teams and microbiological experts to radically review and implement a new system-wide antibiotics prescribing policy. Staff education programmes are already underway.

"Whilst we already have printed leaflets and other information available for families and patients on the wards we recognise we need to do more to ensure more effective understanding of infection protection measures."

Tom Divers, concluded: "Recent months have been difficult for the families of patients. Local staff at the hospital have also been put under strain. The staff at the hospital are dedicated and caring professionals with only their patients' best interests at heart and the Board and I will support them as we go forward."

Health Secretary Ms Sturgeon said the independent review of the C diff outbreak at the Vale of Leven made "disturbing reading".

She said: "With regard to the state of facilities and procedures at the Vale of Leven, let me be clear that the picture painted by the review team report is appalling and completely unacceptable.

"As the report makes clear, it is a picture of a hospital suffering the
consequences of 10 years of uncertainty about its future."

She said she has apologised to families on behalf of NHS Greater Glasgow and Clyde and expects the board to offer an apology to patients and families.

She said that, in response to calls for a public inquiry, she has passed the report to the Lord Advocate, who has asked the procurator fiscal for Argyll and Clyde to consider whether any further action should be taken.

She said: "A few years ago a relative of mine died in hospital after contracting C diff.

"In this instance I do have more of a personal insight into how they feel.

"I understand why they are calling for a public inquiry and I think that call deserves to be properly considered and that's why I'm taking the step of passing the report to the Lord Advocate because, in doing that, that will be properly considered in the context of the Lord Advocate deciding whether further action is necessary."

She called on NHS Greater Glasgow and Clyde to give a clear commitment on the future of the hospital.

She said: "I am determined to ensure that that hospital does not continue to suffer death by a thousand cuts."

Referring to the Health Protection Scotland review of C diff cases in all hospitals in Scotland, she said the extent of C diff was still unacceptable.

She has published an action plan to tighten up infection control through measures such as a zero-tolerance approach to hand hygiene, new reporting obligations on all health boards and the extension of mandatory surveillance of C diff.