DESIGN & CONSTRUCTION
transmission events occur from here, yet at present anyone can decide the location of a device which places patients at risk.
12. Moving to a risk-based approach should identify critical control points in processes. These are areas requiring special emphasis, as if these fail they are likely to have a significant impact on outcomes. This also includes auditing such points.
13. Pressurising and commissioning of water systems is an example of a critical control point. A publication from 2020 highlights that incorrect commissioning of water systems is a major cause of waterborne transmission events soon after buildings open. Of concern is that this problem has been going on for almost 50 years without any improvement, the authors commenting that the resultant infections are preventable, and that poor commissioning should no longer be regarded as incidental or accidental. Within the industry pressurising and commissioning of water systems is often seen as a bolt-on, and many incorrectly perceive that the dosing of a water system with chlorine will eliminate any microbial issue. Despite a plethora of guidance on commissioning, it is carried out very poorly. The project Water Safety Group needs to ensure that the commissioning plan is completed at FBC, and that the process is under the control of the project Water Safety Group.
14. The project Water Safety Group must also ensure that the necessary governance is laid down to ensure that the correct processes occur and monitored. For example it may be written into the construction brief that water pipes will be capped. However, there is nothing to support what is written down on paper – where is the training, who is responsible and accountable, who will be monitoring the process, and how will this be demonstrated to the client? With a risk-based approach all of these issues should be identified upfront, and the necessary processes put in place.
The methodology outlined above should be applied across the board; while the examples are specific to water, it is equally applicable and essential to success of other engineering disciplines.
* Many infection control practitioners – through no fault of their own, have received no training on the risks from the built environment. In the past these individuals have been appointed to new-build project teams,
George McCracken
George McCracken joined the NHS in 1993 as a hospital engineer in Down Lisburn Trust, before this working in industry – in cable manufacture and foundry works. In 2002 he moved to the Royal Group of Hospitals, Belfast as a senior engineer, before in 2007 being appointed head of Estates Risk and Environment in the new Belfast Health and Social Care Trust, one of the UK’s largest NHS Trusts. He holds a First Class Honours Degree in Construction Engineering & Management, is a Chartered Member of the Institute of Building, and a member of IHEEM. He currently leads a Risk Team that ‘continues to provide an innovative approach to the management of risk within a healthcare estates environment’.
Susanne Lee
Dr Susanne Surman-Lee, Hon. FRSPH, FRSB, CBIOL, FIHEEM, FWMSoc, FPWTAG, is a Consultant Clinical Scientist specialising in public health microbiology, and a Director of Leegionella Ltd, an independent public health consultancy specialising in the detection and prevention of waterborne disease. A member of the Healthcare Infection Society, the Infection Prevention Society, and the Central Sterilising Club, she is also a Liveryman of the Worshipful Company of Plumbers, and a member of the WCOP Educational and Technical Committee member.
Dr Michael Weinbren
Dr Michael Weinbren is a Consultant Medical Microbiologist, a Specialist advisor for microbiology to the New Hospital Programme, and Chair of the Healthcare Infection Society Working Party on water/wastewater.
Dr Teresa Inkster
Dr Teresa Inkster is Consultant Medical Microbiologist at NHS Greater Glasgow and Clyde, with an interest in the built environment.
but bring no added value to the table. The lack of appropriate training is not restricted to Infection Control. Addressing the problem is essential to patient safety. However, when talking to one project director, they refused to ask the Infection Control personnel whether they had sufficient expertise and training, on the basis that they had worked at the hospital for a number of years, were senior colleagues, and that it would be disrespectful to do so.
** A meeting was set up between a Design Team and Estates/Infection Control personnel who had an interest in wastewater systems. The design team was initially reluctant to attend, as they felt they knew everything about wastewater systems. The meeting went ahead, and the attitude of the Design Team changed fairly quickly. It was clear to begin with that they felt they were wasting their time, but when the issues experienced with wastewater systems were
explained to them, they suddenly became engaged. Prior to this no one had communicated the issues experienced when a hospital became operational. Now that they were aware of the issues (risks to patient safety), they were able to utilise their skills to come up with solutions.
References 1 Pseudomonas aeruginosa infection in augmented care: the molecular ecology and transmission dynamics in four large UK hospitals. Halstead FD, Quick J, Niebel M, Garvey M, Cumley N, Smith R et al. J Hosp Infect 2021; May;111:162-168. doi: 10.1016/j.jhin.2021.01.020. Epub 2021 Feb 1. PMID: 33539934.
2 Sinks in patient rooms in ICUs are associated with higher rates of hospital- acquired infection: a retrospective analysis of 552 ICUs. Fucini GB, Geffers C, Schwab F, Behnke M, Sunder W, Moellmann J et al. J Hosp Infect 2023; Sep;139:99-105. doi: 10.1016/j. jhin.2023.05.018. Epub 2023 Jun 10. PMID: 37308060.
April 2024 Health Estate Journal 31
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