NHS boards swamped by guidance on hospital infections

Published on Monday 29 June 2009 21:29

HEALTH boards have been left confused by a blizzard of paperwork about a potentially deadly hospital bug, a report has warned.

Quality watchdogs found a "widespread lack of clarity" about how national guidance and documents on the bacteria Clostridium difficile should be applied in the three health boards they studied.

This lack of clarity applied at all levels, from the ward to the boardroom, said NHS Quality Improvement Scotland, after a study of NHS Grampian, NHS Highland, and NHS Orkney.

It said the national approach to tackling C diff was correct and the actions set out in the documents issued nationally were necessary.

"However, issuing guidance is only part of improving practice, and subsequent implementation needs to be supported and monitored," the report stated.

"Our visits highlighted confusion and lack of implementation around even some relatively basic components within the national approach."

And the report warned: "This appears to be due, at least in part, to the perceived large volume and complexity of the national documentation, and suggests we now need to focus on ensuring reliable infection control."

The report followed visits by the watchdog body to learn lessons from C diff outbreaks in each area – at Dr Gray's Hospital in Elgin in the case of Grampian, and at Caithness General Hospital in the case of NHS Highland.

"We found widespread lack of clarity at all levels within the organisation, from ward to board, around the status, uses and application for the large number of documents, tools, and guidance produced at nation level," said the report.

For C diff alone, these included: guidance by Health Protection Scotland , a "bundle/checklist", a "trigger tool," a "severe case investigation tool", protocols for mandatory national surveillance and C diff targets.

On top of this is more general guidance and policies on matters such as hand hygiene and antibiotic prescribing.

Among the areas suffering a lack of clarity was the definition of what constitutes an outbreak, and whether a second C diff- related condition in a patient after 28 days was a recurrence of the disease or a new case.

Health secretary Nicola Sturgeon said:

"The reports confirm that where problems arise it is not with the policy and guidance but in their application."