DESIGN & CONSTRUCTION
Key considerations for a successful project
In the March 2024 HEJ, Consultant Medical Microbiologist, Michael Weinbren, head of Estates Risk and Environment at Belfast Health and Social Care Trust, George McCracken, Susanne Lee of independent public microbiology consultancy, Leegionella, and Consultant Medical Microbiologist at NHS Greater Glasgow and Clyde, Dr Teresa Inkster, argued that ensuring patient safety in new healthcare facilities requires a markedly different approach to design and construction. Here, in the second half of the article, they discuss some of the key issues requiring particular consideration against this backdrop to ensure a successful project outcome.
Preventing infections arising from the built environment in a new healthcare facility is a different entity to the traditional understanding of infection prevention and control (an Infection Control team patrolling the wards, and adherence to handwashing protocols etc). Any stakeholder can inadvertently take an action which results in a patient acquiring infection. This could, for example, be a manufacturer, an architect, a member of the design team, or one of the contractors on the site (this list is by no means exhaustive). The approach to mitigating these risks is quite different, and beyond the remit/skills of the Infection Prevention and Control team (see Figure 1). Within working hospitals, it has taken
time to establish that infection prevention was everyone’s responsibility, and not not just that of the Infection Prevention team. Likewise, it should become the responsibility of all stakeholders in any project to minimise the risk of their actions on patient safety.
Empowered through training Every stakeholder needs to be empowered through training, risk assessment, and continuous feedback from issues arising in the built environment within their area of expertise. The goal is to achieve informed governance – a situation where everyone understands the consequences of their actions on patient safety. This aspect of infection prevention might be better referred to as occupant safety to
‘‘
Having several AE(W)s in the Water Safety Group of a large project to ensure expertise in all areas should become the norm
Figure 1: Plastic water piping (it may appear metallic but it is plastic). Pipes are joined together using glue. In this instance poor technique (lack of training) has resulted in too much glue being applied, resulting in a substantial reduction in the interior lumen of this hot water return pipe. The reduced flow led to incorrect water temperatures, allowing bacterial overgrowth and consequent infection risks. This is beyond the remit of the Infection Control team, even though it produced an infection risk.
distinguish it from traditional infection control. Introduction of an effective safety culture system utilising the whole of the Heinrich ratio – including ‘near misses’ feeding into a risk-based approach – will intuitively help deliver occupant safety. HBN 00-09 is titled Infection control in the built environment. This is a good first attempt at informing Infection Control teams of where their ‘traditional skills’ are required. However, it requires updating, and some of the wider issues should come under the remit of project-specific safety groups (Water, Ventilation etc), as these groups should have the necessary skills to mitigate the identified risks. There is a further important aspect
to infection control and the built environment, which is highlighted in Figure 2. Disturbingly, the routine barriers put in place to prevent transmission of infection are ineffective in controlling such transmission from the built environment, in particular by water or wastewater. This is further compounded by the low sensitivity in establishing that an infection originated from the built environment (see right of image in Figure 2).
Masking the issue The inability to see a large portion of the damage inflicted by organisms originating from the built environment masks the issue, and prevents a proportionate
April 2024 Health Estate Journal 27
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68
