Criminal charges could be lodged over “appalling and completely unacceptable” conditions at a hospital where there were 18 deaths linked to Clostridium difficile after a damning independent report was passed to the Procurator Fiscal, the public prosecutor in Scotland.

The report into infection control at the Vale of Leven hospital, Dunbartonshire, ordered by the Scottish government and published yesterday, describes inadequate facilities, poor practice and lack of leadership. Fifty-five patients contracted C.difficile at the hospital between last December and June and the bug was recorded as the underlying or contributory cause of death in 18 cases.

The hospital had insufficient handwashing facilities or single rooms, beds were too close together, patients were transferred frequently between wards and the building was rundown. The report also found a lack of leadership and supervision with regard to infection control, and a lack of clarity of roles and responsibilities. It noted that the hospital, which had been under threat of closure for ten years, had a lower priority than others in implementation of policies, surveillance systems and staff development.

Cairns Smith, Professor of Public Health at Aberdeen University, led the independent review team that visited the hospital five times last month and, on one occasion, walked round the wards affected by the outbreak.

Nicola Sturgeon, the Health Minister at Holyrood, said that she had passed the report to the Lord Advocate, who had in turn asked the area Procurator Fiscal for Argyll and Clyde to consider any further action.

Ms Sturgeon said: “Let me be absolutely clear that the picture painted by the review team report is appalling and completely unacceptable. The absence of clear lines of professional responsibility has fostered an environment where there was an inadequate management of a cluster of cases at ward level, or awareness at higher levels. There were also inadequacies and inconsistencies in advice to relatives and in management of patients.”

Ms Sturgeon said that she had apologised to families of the victims when she met them yesterday morning and that the health board at NHS Greater Glasgow and Clyde owed them “a direct and unconditional apology for the serious failings on its part”.

The minister demanded “a clear and unequivocal commitment” to the future of the Vale of Leven hospital and the sustainability of its services.

Ms Sturgeon pointed to a “history of neglect” at the hospital. The debate must no longer be about what services were to be withdrawn, she said, but about how the board could create a “modern, fit-for-purpose hospital”.

A report from Health Protection Scotland yesterday into levels of C.difficile across the country from last December to June found that there were 3,174 cases, of which 285 patients died with the bacterium an underlying cause or a contributory factor. There were no clusters or outbreaks that had not been identified or reported.

Tom Divers, chief executive of Greater Glasgow and Clyde Health Board, apologised to patients and families. He said: “I recognise the concerns of relatives of patients that they were not properly informed every step of the way of the infection and how to help protect themselves and others from the risk of infection.”

Mr Divers said that he had ordered immediate improvements to, among other things, hand-washing facilities and bed spacing. A system of infection surveillance across all hospitals had been introduced.

“As a result of today's recommendations we will take forward further actions to reinforce leadership, accountability and empowerment both at the ward and hospital level and ensure clear lines of communication and responsibility to the board's medical and nurse directors,” he said.

“The uncertainty over the future of this local hospital has undoubtedly been a factor in the lack of major modernisation investments. I can give a commitment that this board will bring forward proposals in August and September that will set out a clear vision for the future of the site.”

Syed Ahmed, Consultant in Public Health Medicine at NHS Greater Glasgow and Clyde, said: “The Vale of Leven certainly had more cases of C.difficile than one would expect during the first six months of 2008. Sadly, C.difficile is a germ that is in the community and there will always be sick and vulnerable patients, especially among the elderly, who will develop C.difficile-associated diseases.”

Richard Simpson, the Labour public health spokesman, and Jackie Baillie, the local Labour MSP, called for a public inquiry into the deaths. They were joined by Ross Finnie, the Scottish Liberal Democrat health spokesman, while Jackson Carlaw, of the Scottish Conservatives, said that NHS Greater Glasgow and Clyde could not avoid responsibility for the “appalling” loss of life.

Why the bacterium thrived

—No effective surveillance system for infections

—Poor leadership of infection control Inadequate isolation facilities Beds placed too close together

—Shortage of hand-washing basins and inadequate hand hygiene

—Lack of knowledge among staff that soap and water, rather than alcohol gel, prevents the spread of Clostridium difficile

—Transfer of patients between wards and hospitals

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