RCPE Press Release

02 February 2010

A leading international infection control expert will warn doctors gathering in Edinburgh today (2 February 2010), at a conference organised by the Royal College of Physicians of Edinburgh (RCPE), that “extraordinary resources” and enhanced infection control measures are likely to be required to prevent the spread of Clostridium difficile (C.difficile) infections which are thought to have led to a significant increase in related deaths in Scotland in recent years.

The warning, coming a day after the preliminary public inquiry hearing into the deaths of 18 patients at the Vale of Leven hospital in Dunbartonshire following an outbreak of C.difficile in December 2007, will be given by Dr Mark Miller, a leading Canadian Infection Control expert who will be advising Scottish doctors and microbiologists on lessons learnt from the Canadian experience during which lethal C.difficile epidemics in Canada took hold in 2002 onwards and were then contained following the implementation of stringent infection control procedures. Following the introduction of annual surveillance programmes, Canada now has the largest linked clinical/microbiological database on C.difficile in the world. [1]

In Scotland, C.difficile has overtaken MRSA as the leading cause of hospital-acquired infection deaths and is becoming increasingly resistant to antibiotic treatment. Whilst C.difficile rates and deaths are known to have increased it has been difficult to obtain an accurate picture of this trend. The General Register Office for Scotland, which reports deaths from all causes in Scotland, reported year on year increases in C.difficile related deaths in Scotland in 2000-2008 during which the overall rate of reported related deaths increased from 116 deaths in 2000 to 765 deaths in 2008. However, this data should be interpreted with caution as it relates to the underlying cause of death, or a contributory factor of death, as recorded on death certificates and a subsequent analysis of this data by Health Protection Scotland, commissioned by the Scottish Government, found that some causes of death had been misreported on death certificates and the overall death rates had been overstated. Conversely, some medical opinion has suggested that the death rates, as recorded on death certificates, may be understated.

The conference, on Hospital Acquired Infection (HAI), has been organised by the RCPE in order to bring together Scottish doctors and microbiologists to discuss the current and future problems related to HAI in Scotland (including emerging threats), to learn from the experiences of a number of international experts in HAI and to consider potential solutions [2].

During the event doctors will receive an update on the success of the implementation of the MRSA screening pilot in Scotland, as previously recommended in clinical guidance produced by the RCPE and the Royal College of Physicians and Surgeons of Glasgow, and Nicola Sturgeon MSP, Cabinet Secretary for Health and Wellbeing, will also address delegates about the Scottish Government’s HAI strategy.

Dr Mark Miller, Jewish General Hospital and McGill University, Montreal, Canada, said,

“The story of C.difficile infection in Canada is a tragic one. The introduction of a virulent infection into a healthcare system replete with high-risk patients and inadequate infection prevention and control strategies led to lethal epidemics. Extraordinary resources were required in each instance to control the epidemics and it is likely that similar interventions will be required in Scotland. Perhaps the most important message to convey is that C.difficile epidemics can be controlled quickly by the vigorous application of wide-ranging infection prevention and control strategies. However, it is vital that healthcare teams do not view C. difficile epidemics as requiring a one-time-only control strategy at the time of the outbreak. Control of C. difficile requires ongoing vigilance and adherence to each control measure. Any lapses in the increased level of infection control are usually followed by an increase in C.difficile rates and related deaths”.

Dr Ian Gould, Consultant Microbiologist, RCPE, said,

“Healthcare acquired infections present us with one of our greatest challenges. Whilst the development of new and more powerful antibiotic treatments has resulted in huge strides in surgical and medical treatment, antibiotic resistance to these same drugs threatens these advances and might even undermine conventional infection control measures. Both MRSA and C.difficile show how antibiotic resistance is actually leading to an increase in the number of HAIs in Scotland and worldwide.

“While HAI rates continue to increase, Scotland now has surveillance systems in place which will allow us to monitor antibiotic resistance and HAI infection rates and to control both more effectively in the future”.


Contact: Graeme McAlister on 0131-247-3693 or 07808-939395


[1] Dr Miller co-chaired the Canadian Nosocomial Infection Surveillance Program which studied C.difficile in a large number of hospitals throughout Canada between 1997 and the present time. The report found that rates of C.difficile infection varied widely between hospitals (including Quebec which had twice the level of C.difficile infection compared to other areas of Canada) and that deaths related to C.difficile infection had increased significantly (4-fold) between 1997 and 2005. The reasons for variation in infection levels remains unclear, but previous studies have suggested that antibiotic usage, the physical layout of the hospital or facility (including the presence or absence of sinks for handwashing), the presence of the new “hyper-virulent” NAP1/027 strain, and attention to infection prevention and control practices have played a role in the overall rates of C.difficile infection.

[2] The ‘Healthcare Acquired Infection’ conference will be held at the Royal College of Physicians of Edinburgh, 9 Queen Street, Edinburgh from 9.00am – 5.00pm on Tuesday 2 February 2010. Journalists wishing to attend this conference should call Graeme McAlister on 0131-247-3693 or 07808-939395.