Scottish Executive

Hospital-Acquired Infection

Jackson Carlaw (West of Scotland) (Con): To ask the Scottish Executive, further to the outbreak of clostridium difficile at the Victoria Infirmary in Glasgow in October 2007, what steps were taken to prevent a fresh outbreak.

Nicola Sturgeon: The clostridium difficile outbreak in October 2007 was managed by the local Outbreak Control Team who isolated the six patients affected in a temporary cohort isolation facility. In dealing with this outbreak, the board followed the procedures set out in Annex 4 of the 2003 guidance document Managing Incidents Presenting Actual or Potential Risks to the Public Health: Guidance on the Roles and Responsibilities of Incident Control Teams, which can be accessed at:

http://www.scotland.gov.uk/Publications/2003/01/16243/17308.

As a consequence of this outbreak, I am advised that NHS Greater Glasgow and Clyde put a range of actions in place and ordered a deep clean of affected ward areas, implemented its rapid response team and put additional resources into surveillance. More generally, all NHS boards must comply at all times with the national cleaning standards, the hand hygiene monitoring, the prudent prescribing of antibiotics procedures, appropriate infection control precautions (e.g. isolation) and rapid accurate diagnosis procedures.

Jackson Carlaw (West of Scotland) (Con): To ask the Scottish Executive who is being held accountable for the outbreaks of clostridium difficile at the Victoria Infirmary in Glasgow in October 2007 and June 2008.

Nicola Sturgeon: Although the chief executive is ultimately accountable for ensuring that all the appropriate policy and procedures aimed at preventing outbreaks of healthcare associated infection are in place at the NHS board, it has been a consistent message that "infection control is everyone’s business" within NHSScotland. It also has to be acknowledged that a significant number of C.difficile cases come into hospital from the community. The issue of hygiene and infection control is raised in annual reviews and was raised with NHS chairs at my meeting with them on 30 June.

Jackson Carlaw (West of Scotland) (Con): To ask the Scottish Executive what guidance is given to hospitals to prevent outbreaks of clostridium difficile and other hospital-acquired infections and who is responsible for ensuring that this guidance is rigorously enforced.

Nicola Sturgeon: All NHS boards are expected to follow the guidance set out in Annex 4 of the 2003 guidance document Managing Incidents Presenting Actual or Potential Risks to the Public Health: Guidance on the Roles and Responsibilities of Incident Control Teams. This document is currently under review and an updated version of Annex 4 will be issued shortly. All NHS boards must also follow the guidance in key documents such as the NHS Quality Improvement Scotland Healthcare Associated Infection (HAI) Standards, the NHS Scotland Code of Practice; the Standard Infection Control Precautions and the Transmission Based Precautions model policy and the prudent antibiotic prescribing guidance documents published in 2005 and 2008.

It is for NHS board chief executives to ensure that all the appropriate policy and procedures in relation to HAI are in place. They were reminded of this responsibility in a letter of 27 June 2008 from the Director-General of the Scottish Government Health Directorate and Chief Executive of NHSScotland. Managerial responsibility for effective implementation and monitoring of the procedures set out in the above guidance documents rests with the infection control managers. Professional advice in the prevention and management of outbreaks rests locally with the infection control doctor and infection control nurses and responsibility for ensuring that the ward is a clean and safe environment primarily rests with the ward sister/charge nurse.

Jackson Carlaw (West of Scotland) (Con): To ask the Scottish Executive who is being held accountable for the outbreak of clostridium difficile at the Vale of Leven Hospital between December 2007 and June 2008.

Nicola Sturgeon: I refer the member to the answer to question S3W-14657 on 4 July 2008. I also announced on 18 June 2008 that an independent review would be held into the circumstances surrounding the clostridium difficile cases at the Vale of Leven Hospital. The review team’s report will be published at the end of July 2008.

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/webapp/wa.search.

Jackson Carlaw (West of Scotland) (Con): To ask the Scottish Executive how many of the 54 patients who contracted clostridium difficile at the Vale of Leven Hospital between December 2007 and June 2008 subsequently died and how many of these deaths were attributed to clostridium difficile.

Nicola Sturgeon: Twenty-two patients of the 55 patients we are now aware of have died. Of these, clostridium difficile was recorded on nine death certificates as being the likely underlying cause of death, and was recorded as a possible contributory factor in a further nine deaths.

Jackson Carlaw (West of Scotland) (Con): To ask the Scottish Executive what plans it has to place a named individual in direct control of enforcing guidelines aimed at preventing the outbreak and spread of hospital-acquired infections in every ward in every hospital.

Nicola Sturgeon: A robust structure is already in place. All NHS boards employ infection control managers who are managerially accountable for ensuring implementation and monitoring of national healthcare associated infection (HAI) strategy. Every hospital has access to a team of infection control professionals to help manage outbreaks and incidents of HAI. The ward sister or charge nurse is professionally responsible for ensuring that their ward is a clean, safe environment, and a structure is in place to ensure that these staff complete the cleanliness champions training programme.

Jackson Carlaw (West of Scotland) (Con): To ask the Scottish Executive what plans there are to make it compulsory for hospital visitors to wash their hands with alcohol gel before they are allowed to enter hospital wards.

Nicola Sturgeon: The approach taken by the Scottish Government’s Healthcare Associated Infection (HAI) Task Force is to encourage higher standards of hand hygiene by NHS staff, patients, visitors, and members of the public through a range of actions including a national poster campaign in main hospital thoroughfares (these posters are routinely refreshed), the provision of the Chief Nursing Officer and Chief Medical Officer’s five top tips which visitors and patients should be made aware of, the availability of alcohol hand gels at every acute bed and ward area for patients and visitors to routinely use and monitoring of compliance of NHS staff by local hand hygiene co-ordinators against an audit tool produced by Health Protection Scotland. The latest health protection quarterly monitoring report reveals that compliance in Scotland has increased from 68% in the first audit in February 2007 to 88% now.

Alongside the NHS element of the hand hygiene campaign, our national TV and media advertising campaign Germs - Wash Your Hands of Them, which ran for six weeks in early 2007 and again in early 2008, carried the clear message to the general public that regular hand hygiene will help them avoid catching and spreading infections. To get the message across to young children and their families, we issued hand hygiene information packs and a DVD to all primary schools and nurseries in Scotland in September last year. On a local level, it is for each infection control team at NHS boards to decide how their visitors are best encouraged to wash their hands and make use of the alcohol hand gels.

Jackson Carlaw (West of Scotland) (Con): To ask the Scottish Executive what steps it is taking to ensure that the errors that led to the outbreak of clostridium difficile at the Vale of Leven Hospital (a) are not repeated at that hospital, (b) are not being made in other hospitals and (c) will not be repeated at any other hospital in future.

Nicola Sturgeon: It would not be appropriate for me to comment until the independent review announced by me on 18 June 2008 has examined all the circumstances surrounding the clostridium difficile cases at the Vale of Leven Hospital. The review team’s report is due to be published by the end of July 2008.

Legislation

Mike Rumbles (West Aberdeenshire and Kincardine) (LD): To ask the Scottish Executive how many new regulations have come into force since May 2007, broken down by ministerial portfolio.

Mike Rumbles (West Aberdeenshire and Kincardine) (LD): To ask the Scottish Executive how many regulations have been repealed since May 2007, broken down by ministerial portfolio.

Bruce Crawford: The information is not held centrally. Details of all Scottish Statutory Instruments are published on the Office of Public Sector Information website.

The Scottish Government is determined to ensure effective regulation in Scotland while minimising the unnecessary cost and bureaucracy sometimes associated with compliance and inspection.

NHS Staff

Ross Finnie (West of Scotland) (LD): To ask the Scottish Executive what progress NHS 24 made towards achieving the Efficient Government sickness absence target of 4% by end of March 2008.

Nicola Sturgeon: NHS 24 is working well in partnership with its workforce to support employee wellbeing and has several work streams in place aimed at promoting attendance and managing sickness absence. The target for most health boards was to achieve a sickness absence rate of 4% by March 2008, but the agreed target for NHS 24 was actually 6%, in recognition of a particularly challenging set of circumstances affecting that particular board. NHS 24 has clearly explained to the Scottish Government the plans it has in place to make sustained progress in reducing its absence rates.

The yearly average absence rate for NHS 24 at March 2008 was 9.06%, a year earlier the same measure showed a rate of 9.88%. The monthly rate for March 2008 was 9.3% and the corresponding rate for March 2007 was 10.7%.

National Health Service

Karen Gillon (Clydesdale) (Lab): To ask the Scottish Executive what guidance it gives to the NHS to support improved recycling, reduction and reuse of waste from NHS facilities.

Nicola Sturgeon: The Scottish Government Health Directorates provides operational support and guidance on waste management issues to NHSScotland through Health Facilities Scotland, a Division of NHS National Services Scotland. Guidance is available on the safe management and disposal of clinical and other healthcare waste, waste minimisation, training requirements, transport of dangerous goods and the impact of the Waste Electrical and Electronic Equipment Directive on NHSScotland.

This guidance is currently under revision to provide support to NHSScotland in the implementation of the Waste Management in NHSScotland Action Plan 2007, a response to recent Audit Scotland reports on waste management in Scottish hospitals.

As part of this guidance revision, Health Facilities Scotland is preparing a model sustainable recycling policy which NHS boards can use as a basis for developing their own specific policies including recycling policies.

The Scottish Government is also promoting further waste minimisation and recycling activity within NHSScotland in partnership with delivery partners such as Waste Resource Action Group (WRAP), REMADE, Scottish Waste Awareness Group (SWAG), Scottish Environment Protection Agency (SEPA) and the Scottish Industrial Symbiosis Programme (SISP).

Karen Gillon (Clydesdale) (Lab): To ask the Scottish Executive what targets it has set for year-on-year reduction of waste from NHS facilities.

Nicola Sturgeon: The Scottish Government has not set specific targets for the year-on-year reduction of waste from NHS facilities but has set overall national targets for recycling and composting of municipal waste of 40% by 2010 and 70% by 2020.

NHSScotland is bound to national targets through the implementation of the Scottish Government Health Directorates Environmental Management Policy for NHSScotland [NHS HDL(2006)21] which requires all NHSScotland Bodies to comply with all statutes, legislation and policies which impact in their environmental performance. The policy also imposes a mandatory requirement that each NHS board "must include targets for the reduction of clinical, special and other waste arisings and identify, where practicable, re-use, recycling and recovery opportunities".

There is within NHSScotland an internally-accepted target of a 2% annual reduction in "waste arisings" set for all NHSScotland boards, together with an understanding that individual boards will set their own targets in respect to waste and recycling, as required by NHS HDL(2006)21. These targets are also a requirement of the NHSScotland Waste Management Action Plan 2007, a response to the Audit Scotland 2005 follow-up report on waste management on Scottish hospitals.