A BBC investigation has learned of potentially deadly failings in basic infection control in many of Scotland's hospitals.
By Samantha Poling
BBC Scotland's news website
Inadequate facilities, ineffective surveillance and organisational failure.
Combined, they spawned the perfect environment for Scotland's worst outbreak of a deadly hospital infection.
C.diff affected dozens of patients at the Vale of Leven Hospital
Earlier this year, the bug Clostridium Difficile or C.diff, was allowed to spread through the Vale of Leven Hospital in Dunbartonshire, largely unnoticed for six months. In total, 58 patients were infected and 18 died.
An independent investigation confirmed what most already knew - 10 years of chronic underfunding had left the Vale hospital in a state of abject misery.
I should know. It had been my local hospital for many years and I had entered its doors as a patient often.
I had seen first-hand how the gradual decay of neglect had eaten its way through more than just the fabric of the building.
Each visit presented a staff more overwhelmed than the last - a system sinking deeper under the pressure.
Against such a background, I don't think many people were surprised when news of the outbreak broke. I certainly wasn't.
What did surprise me though, was the sheer magnitude. How could a bug have been allowed to stalk the wards for as long as it did?
For the last five months I've been investigating what really happened at the Vale of Leven hospital. I've spoken with frontline staff, families of those who died in the outbreak as well as experts in the field.
I've also had access to leaked documents which suggest the outbreak itself should have been identified much sooner.
During my research, it became obvious that staff had been under severe pressure at the time of the outbreak
I've also investigated the wider picture - whether such a serious outbreak could happen again, at another Scottish hospital.
I began my investigation by meeting with a dozen families of Vale patients who died with C.diff. What emerged very quickly was a picture of a hospital in crisis.
One of the patients who lost their lives in the outbreak was 93-year-old Ellen Gildea, from Bonhill in Dunbartonshire. She was admitted with a stroke but then placed into the old bed of a C.diff patient, in a room with C.diff patients.
Her granddaughter, Kim McGarrity, told me how the patients had to share toilet facilities: "The commodes used to get passed from pillar to post, there was only one auxiliary going between my gran and this woman who had C.diff which we think was quite appalling."
Unsurprisingly, considering the environment into which she was placed, Mrs Gildea soon contracted C.diff herself and died on 7 March.
During my research, it became obvious that staff had been under severe pressure at the time of the outbreak, and that the hospital lacked enough single rooms to deal with so many infected patients.
Alister Johnston, from Helensburgh, was 66 when he contracted C.diff. He had been admitted to the Vale with a chest infection. He was put in a two-bedded area within the ward.
HEALTH BOARD STATEMENT
It has already been acknowledged that there were some ocassions when it was not possible to isolate patients because of a shortage of single rooms
It is common practice for nurses to have to provide care to both patients with and without infections
NHS Greater Glasgow and Clyde has a strict policy for the cleaning of isolation rooms after an infectious patient has been discharged or transferred
Transfers to the Vale of Leven happen routinely for a number of reasons as part of agreed clinical pathways across Greater Glasgow and Clyde
An internal investigation was undertaken by three senior managers prior to the external investigation by Prof Smith and his team
For the full statement from the health board, clickhere
His daughter, Sheila Chandler, remembers being concerned about the hospital's isolation procedures. Shortly after her father was diagnosed with the bug, she went to visit him, and found her mother, already there, wearing a plastic apron.
She said: "My mum was sitting with a plastic apron on and I, I just sort of laughed. I said, 'What are you dressed up as?'.
"She said, 'apparently he's got a bug and this is him in isolation, but unfortunately, a poor guy here has been brought in with chest pains and they'd nowhere to put him'.
"So, they put him in the bed opposite my dad. So he wasn't, in fact, in isolation."
Alister Johnston died on March 9th, after battling the bug for more than six weeks.
The failings which caused the Vale of Leven outbreak to take hold so dramatically were addressed by an independent review commissioned in June this year.
The report was critical of the fabric of the hospital, the high number of transfers between wards and poor infection control. But the review team was only given five weeks to carry out their work.
Professor Cairns Smith was the lead author. He admitted the report had failings: "We didn't get to the bottom of every aspect and that was really unrealistic in terms of the timescale."
Professor Smith said the team was commissioned to do a very "focused" piece of work, designed to fix what went wrong at the Vale of Leven, quickly.
I gave the report to the UK's leading patient safety specialist so it could be reviewed.
I think it's very reasonable to suppose yes that more than 18 people died at the Vale. It may be a substantial more
Professor Hugh Pennington
Professor Brian Toft, a patient safety specialist with Coventry University, was very critical. He condemned the report as "not fit for purpose" and said it gave little help to other Scottish hospitals hoping to avoid a similar serious outbreak.
He said: "It certainly gives me some concern I must say.
"The level of generality is so high that it would be impossible to know whether or not I had beaten the problem."
We also discovered the official death toll of 18 at the Vale may have been seriously underestimated. C.diff is sometimes missed off death certificates even when a patient has been infected with the bug.
Scotland's leading epidemiologist, Professor Hugh Pennington, said the practice can lead to a distorted view of infection rates.
"C.diff should appear on a death certificate more often than it does, I think it's very reasonable to suppose yes that more than 18 people died at the Vale. It may be a substantial number more."
Between December and June, more than 3,000 people were infected with C.diff in Scotland's hospitals and almost 300 died.
We decided to see whether the same failures which happened in the Vale of Leven hospital, were being repeated in other Scottish hospitals.
We asked every acute hospital in Scotland whether basic infection control measures were in place.
The results are staggering.
C.DIFF DEATH VICTIMS
Sarah McGinty, 67
Alister Johnston, 66
Ellen Gildea, 93
Almost half of hospitals which responded said their cleaning budgets had gone down in real terms this year, and two thirds of their building maintenance budgets had also gone down in real terms.
We also asked them about bed spacing. Scottish guidance dictates a space of 2.4m should be left from the middle of one bed to the next in shared accommodation. Yet beds in more than a third of hospitals are too close together, raising the risk of infection.
Only four hospitals told us they had trained all their staff in infection control in the last year.
And just 20% of beds in all Scotland's hospitals are in single rooms.
In a statement, Greater Glasgow and Clyde Health Board said it could not discuss individual cases.
It said the hospital has a strict cleaning policy and domestic cleaning hours have not changed for two years and that isolation rooms are cleaned with chlorine after an infectious patient leaves, leaving no need to delay the next admission.
It added that transfers of patients between hospitals and wards are standard practice to meet patients' medical needs.
Although the board accepts the outbreak should have been identified in January, it rejects claims it carried out a "witch hunt" of staff.
"Death on the Wards: the Truth about Scotland's Hospitals", was broadcast on Wednesday, 19 November on BBC One Scotland.
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