Failure to adopt “prudent” antibiotic prescribing practices and ignoring government guidelines contributed to the deaths of 34 hospital patients from Clostridium difficile infection, according to the conclusions of an independent inquiry released on 24 November 2014.
Antibiotics were prescribed unnecessarily to some patients, the Vale of Leven Hospital Inquiry into the outbreak of C difficile at the hospital found. In other cases, antibiotics were prescribed even after laboratory tests showed the infection would be resistant to them.
The inquiry report
criticises the hospital, run by NHS Greater Glasgow and Clyde, for failing to adopt Scottish government antibiotic prescribing guidelines and failing to appoint an antimicrobial pharmacist to audit the use of antibiotics and ensure that good prescribing practice was followed.
But it also hit out at the Scottish government for not introducing an inspection system to ensure that its antibiotic prescribing guidelines were being adopted by hospitals, a failure described in the report as “surprising and regrettable”.
Lord Maclean, author of the report and chairman of the inquiry, said he was unable to prove claims made to him during the inquiry that hospitals across Scotland were failing to follow government antibiotic prescribing guidelines. “What was perfectly apparent to me was what I describe as a mismatch between expectation and implementation,” he writes.
The report identifies “serious personal and systemic failures” which contributed to the death of the 34 patients during the C difficile outbreak at the hospital in Alexandria between 1 January 2007 and 31 December 2008, when 143 patients tested positive for the hospital-acquired infection.
The Scottish government has accepted all of the report’s 75 recommendations, including that health boards implement any changes in government antibiotic prescribing policy or guidance “without delay” and that the Scottish government should monitor implementation of any guidelines within specified time limits.
NHS Greater Glasgow and Clyde apologised to the families and patients affected by the C difficile outbreak following publication of the report. Its chairman Andrew Robertson confirmed in a statement that the board had taken steps to “improve prudent antibiotic prescribing” in all its hospitals since 2008.
In a separate statement, Scottish health secretary Shona Robison said the government was setting up an implementation group to ensure the report’s recommendations were introduced countrywide.
Robison said she was also writing to all Scottish health boards to ask them to review their services against the findings and recommendations of the inquiry report, and report back to her within eight weeks.
 The Rt Hon Lord MacLean. The Vale of Leven Hospital Inquiry Report. APS Group Scotland on behalf of The Vale of Leven Hospital Inquiry. November 2014. SG/2014/211 (available at www.valeoflevenhospitalinquiry.org).