The following information has been prepared in response to the NI Health Committee request for additional information on the issue of C. difficile.

1. Practices in place to prevent, manage and controlC. difficile?

The Western Health and Social Care Trust has a range of measures in place to safely control and manageC. difficile infection. They are:

• The use of standard, evidence-based, infection prevention and control (IPC) precautions for every patient in our hospitals. However, when a patient is admitted with or develops diarrhoea we add specific enteric precautions and move them to a single room if possible.

• If a single room is not available, where possible, affected patients are cohorted into protected bay areas. In all cases, additional measures such as extra cleaning and decontamination of care equipment are put in place.

• Patients with diarrhoea have a sample of faeces taken for analysis. Once there is a definite diagnosis ofC. difficile, the Laboratory staff inform the ward and the Infection Prevention and Control Team.

• Infection Prevention & Control Guidelines are available on all wards, including:

(1) Specific writtenC. difficile guidelines itemising the management of patients and their isolation requirements.

(2) Clear guidance on personal protective clothing worn by staff and visitors.

(3) Guidance on hand hygiene

(4) Guidance on enhanced cleaning frequencies.

• The Infection Prevention and Control Nurse(s) supports ward staff in managing the situation by phoning with initial verbal advice followed by the provision of a written advice sheet.

• Information and advice is made available to patients and their families on the management and prevention of infection.

• Since August 2007, the Trust has followed the Saving Lives campaign of the DoH(Eng) in that we are auditing the application of evidence based standards. This means that skilled nurses, with enhanced training in audit, assess hand hygiene practice, isolation arrangements, use of personal protective equipment, antibiotic history and treatments, decontamination procedures for medical equipment, and environmental cleanliness.

• The Trust has an antibiotic prescribing policy designed to underpin responsible prescribing and this has been audited in practice.

• In terms of hospitals in the Western Trust, Altnagelvin Hospital has particular challenges including high occupancy levels. However the importance of strict adherence to infection prevention and control measures is demonstrated by our practice not to allow a patient in A&E with diarrhoea and vomiting to be admitted until an appropriate bed space becomes available. This at times has resulted in patients being held in A&E in excess of the 12 hour target.

• The Infection Prevention and Control Team works extremely closely with frontline staff to ensure the application of evidence based standards.

2. No. of current C. difficile cases from 01 January 2008 to 14 February 2008?

Hospital	No. Of Cases of C. difficile
Altnagelvin Hospital	17
Erne Hospital	2
Tyrone County Hospital	1
Overall Total in Western Trust	20

3. No. of deaths where C. difficile was listed on the death certificates?

There were no deaths between the period of 01 January 2008 to the 14 February 2008 where C.difficile was listed on the death certificate.