The outbreak of Clostridium difficile (C.

diff) at Vale of Leven Hospital in which 18 people died did much to concentrate the minds of hospital managers and the Scottish Government on the problem of hospital-based infections.

In the years since, significant progress has been made, in particular the zero-tolerance approach to bad hand hygiene on the wards, but the danger now is that everyone starts to assume C.diff has been beaten, complacency starts to spread and standards slip again.

That is just one of the risks highlighted by Professor Robert Masterton on the publication of a new report on C.diff and it might explain why, after several years of progress on tackling the bacterium, there are some worrying signs that the rate of infection might be starting to creep up again.

The most recent figures from Health Protection Scotland, for example, show there was an increase in the incidence of the infection between April and June this year, although the levels are lower than they were in spring 2012. In other words, there is no clear evidence yet that the improvements in the detection and treatment of C.diff are being reversed. It should also be borne in mind that the reporting procedures in Scotland have been improved and that might account for some of the increases.

However, Prof Robert Masterton, formerly lead clinician with the West of Scotland Cancer Network, indicates that, in some health board areas, the rate of infection has slightly increased and it is important that the right strategy is in place to prevent any worsening of this trend. Traditionally, the focus has been on hospitals and Prof Masterton has, quite rightly, praised Nicola Sturgeon for the work she did on tackling C.diff on the wards when she was Health Secretary.

On her watch, there was major investment to improve the level of cleanliness and toughen up the inspection regime. This led to significant improvements in hospital hygiene.

However, this good work on the wards, although important, is not enough, Professor Masterton warns. The infection, he points out, does not just occur in hospitals. It also happens in people's houses and in care homes and it is here, out in the community, that more can be done.

In particular, Prof Masterton believes GPs must be involved much more in helping to identify cases of C.diff and helping to prevent its spread. Family doctors are often the first to encounter a patient with the infection, but often he or she will be sent home without being identified as a sufferer.

If GPs can identify the patient, particularly those under 65 who are much less likely to be on a ward, and involve hospitals at an earlier stage, this could prevent the infection spreading to others.

This option of improving the way GPs interact with C.diff will need to be explored as part of the ongoing strategy to keep it under control. The Scottish NHS has been doing a lot right in recent years but vigilance has to be maintained. Not only that; we have to be prepared to fight the battle on new fronts.