Chamber and committees

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.

Health Protection Scotland (HPS) advise there is no intention to distinguish between samples taken in hospitals, community settings or nursing homes for the national surveillance of Clostridium difficile Associated Disease (CDAD).

HPS will carry out validation studies with individual NHS boards to establish where CDAD cases are arising to best focus efforts to reduce the risk of developing the infection.

Antimicrobial prescribing is the biggest single risk factor for CDAD and in that context it is assumed that all cases are healthcare associated.

The appropriate use of antimicrobials is an important clinical governance issue. The NHS board''s Antimicrobial Management Team (AMT), which is a sub-group of the board''s Area Drug and Therapeutics Committee, covers both primary and secondary care sectors. Their key role is the development, implementation and compliance monitoring of the board''s antimicrobial policy. The AMT feeds back to the board''s clinical governance and risk management teams.

All labels on antibiotic prescriptions should have standard labelling “ Complete the Course. Pharmacists in hospital and primary care settings also counsel patients on how to take their medicine including taking at regular intervals, requirements to take before and after food and completing the course.

Good prescribing practice for any treatment should also involve discussion with the patient of potential risks and benefits as appropriate on an individual basis.

The benefit of using an antibiotic to treat an infection in a patient over 65 years must be balanced against the potential for predisposing them to Clostridium difficile. Prescribers must weigh up these risks and decide on an individual basis what is clinically appropriate.

All staff have a responsibility for infection control, including GPs. Guidance developed by the HAI Task Force covers all NHS services, including the Primary Care Sector, and there is GP representation on the national HAI Task Force.

Each NHS board has an evidence-based primary care antimicrobial prescribing policy which provides guidance on when to prescribe antibiotics and which antibiotic should be used to treat each common infection. This policy is issued to GPs either electronically or in hard copy.

I refer the member to answer to question S3W-20028 on 28 January 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 answer to question S3W-20313 on 9 February 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.

Learning and information about prescribing antibiotics is shared with GPs at a local level through education and feedback sessions organised by the NHS boards prescribing advisers. As part of the Scottish Antimicrobial Prescribing Group''s education work stream, NHS Education for Scotland is currently developing a learning resource for primary care on managing common infections, which will include appropriate use of antimicrobials. The NHS board''s antimicrobial management team is tasked with ensuring the implementation of such educational programmes.