FEARS overcrowding in Scottish hospitals is increasing the spread of the winter vomiting bug among patients have been raised by a leading clinician.
Dr Neil Dewhurst, president of the Royal College of Physicians of Edinburgh, has warned capacity in Scotland's hospitals continues to be stretched.
He has called for greater focus on the problem, which he said resulted in patients being moved around different wards, potentially spreading infections.
Bed occupancy levels above 100% have been reported in NHS Lothian and NHS Fife, while NHS Greater Glasgow and Clyde (NHSGGC) says it is experiencing high demand for emergency care and has opened extra beds to accommodate patients.
The surge in pressure on Scots hospitals this winter began around Christmas and resulted in patients waiting for beds on trolleys in accident and emergency departments for hours.
Clinicians said the situation was the worst it had been for a number of years. The prevalence of the vomiting bug norovirus has been given as a consequence of the overcrowding of wards.
In a statement, Dr Dewhurst commented on the latest hand hygiene audit that found the proportion of Scottish doctors complying with hand washing rules has slipped to 88%.
However, he continued: "This must not be allowed to detract from the fact it is increasingly recognised that high levels of bed occupancy and over-capacity, involving the boarding out of medical patients to other wards due to bed shortages, is becoming one of the main causes of the spread of norovirus in hospitals.
"The NHS in Scotland continues to experience high levels of bed occupancy and boarding with reports in the last week of 124% bed occupancy in Fife and 101% in Lothian, while it is recognised that occupancy above 85% can cause critical problems for patient care."
Patients being displaced on to wards that do not specialise in their medical problem when departments are full, a practice known as boarding, means doctors have to search hospitals for patients.
The royal college says moving patients around, as beds become free, also increases the chance of vomiting bugs spreading.
Dr Dewhurst added: "Recent Health Protection Scotland guidance reminds us that 'hospitals have high bed occupancy rates and - there is a high potential to transmit the virus to other care settings before it is recognised that patients could be infectious - effective hand hygiene alone is insufficient to prevent cross-infection'.
"Boarding out of patients to other wards magnifies and continues the problem, with the situation deteriorating further when wards have to be closed due to infection outbreaks and undergo deep cleaning. This becomes a vicious circle and action has to be taken."
In a statement, one of the boards, NHSGGC, said: "We currently have only one ward across Greater Glasgow and Clyde that is not admitting new patients as a result of norovirus.
"All our hospitals have recently been experiencing a high demand for emergency medical care which affects our bed capacity.
"We continue to admit patients and manage our beds through regular bed management meetings and as part of our winter plans have opened additional capacity."
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