Health officials are still in the dark about how a third patient died with a rare strain of the bug following two deaths elsewhere in Fife. Documents obtained by The Scotsman show that experts looked at the possibility that dirty equipment or another patient may have passed C difficile 332 strain between the two hospitals, but these were later decided to be unlikely routes. The papers, released under Freedom of Information, also revealed that health secretary Alex Neil was not briefed about the outbreak until the third death was confirmed almost three weeks later. They also showed that Health Protection Scotland was informed on 3 April of the first two deaths, which happened between December and January, and passed this information to the Scottish Government the same day. On 23 April, officials were informed of a third death in a different hospital linked to the same strain, though they could find no link in time, place or medical personnel to easily explain how the 332 bug could have spread. A report on 9 May said: “It is possible but unlikely that an individual piece of nursing equipment came across uncleaned, but no tracking system exists to verify.” The report also revealed the possibility that a patient without C difficile symptoms may have spread the bug after spending time in both hospitals. It said: “Cross-infection by a colonised but asymptomatic patient represents a plausible hypothesis but ultimately cannot be proved or disproved in this case.” Earlier this month further checks uncovered a fourth case of C difficile 332 in a patient who later recovered. Dr Gordon Birnie, of NHS Fife, said: “A concrete link between the initial two cases and the further two cases four months later has not been established.” Aberdeen-based microbiologist Professor Hugh Pennington called for more research to identify the genetic fingerprint of the bugs to give more detail about their make-up and track how they move around hospitals and in the community. “Unless we do these kind of studies we will still be in the dark as to how these bugs are getting about,” he said. The documents showed that despite being informed of the two deaths on 4 April, officials at the Scottish Government did not brief Mr Neil until 24 April. Jackie Baillie, Scottish Labour’s health spokeswoman, said: “It is now clear that we simply may never know how this rare strain of C difficile was transferred to the third person who died. But I’m concerned that lessons aren’t being learned. “I am concerned that officials took the decision not to brief the cabinet secretary and to not include the fatalities in weekly bulletins. Quite why it took a third death for civil servants to begin to worry is beyond me.” A Scottish Government spokeswoman said: “We are aware of the continued monitoring of these incidents and have been assured by HPS that NHS Fife had taken all the necessary precautions.”