Surveillance systems fit for purpose
Health Boards should ensure that surveillance systems are fit for purpose, are simple to use and monitor, and provide information on potential outbreaks in real time.
- The Scottish Government's response detailed national and local surveillance data collection, including mandatory CDI surveillance (started 2006 for patients aged 65+, extended April 2009 to all aged 15+). The LDP standard requires CDI rates of 0.32 or less per 1,000 total occupied bed days.
- Scotland achieved a CDI rate of 0.27 per 1,000 occupied bed days in the year ending December 2018, meeting the target with a decreasing year-on-year trend of 7.5% between 2014 and 2018.
- The requirement that surveillance systems are fit for purpose and provide real-time outbreak information is addressed through national surveillance systems operated by ARHAI Scotland (formerly Health Protection Scotland) and local audit requirements within the HAI Standards.
- The HCAI Strategy 2023-2025 maintains surveillance and reporting as core elements of Scotland's approach to HAI reduction (Scottish HCAI Strategy 2023-2025 (https://www.gov.scot/publications/scottish-healthcare-associated-infection-hcai-strategy-2023-2025/)).
How was this evidence gathered?
Response
Accepted
Response
AcceptedSection 2.1 of the Scottish Government's response details that national and local surveillance data are collected across a range of areas to support and monitor HAI policy, including data for HAI outbreaks. Section 4.2 further explains that eHealth initiatives, with significant investment in modern information technology systems, are improving record-keeping and data sharing. Systems like TrakCare and online clinical portals enable greater traceability of patients and the secure sharing of clinical information, enhancing the fitness for purpose and ease of monitoring of surveillance systems.
Published Evidence
Published assessments of progress from inspectorates, select committees, official progress reports, and other sources. Source type badge indicates whether each assessment is independent or government self-reported.
National mandatory CDI surveillance has been in place since 2006 (65+) and 2009 (all patients 15+). Dramatic decrease in CDI incidence rates since 2008. By 2018 rate was 0.27 per 1000 occupied bed days (below LDP target of 0.32). Quarterly epidemiological data continues to be published (most recent Q3 2025).
View detailed findings
Reporting methodology changed from per 1000 to per 100000 total occupied bed days in July 2019 to align with European standards. Real-time surveillance systems operational across NHS Scotland.
Public Health Scotland published first dedicated guidance on prevention and control of Clostridioides difficile infection in community-based settings in Scotland (November 2024). Extends CDI surveillance and control beyond hospital settings.
View detailed findings
New community guidance reflects evolution of CDI prevention beyond the acute hospital setting that was the focus of the Vale of Leven Inquiry.