DESIGN, BUILD, AND ENGINEERING
The inspection and packing room – packing tables and pass-through steam sterilisers (load side).
autoclave a 10-year average lifespan, but at Barnet the equipment had far exceeded this, and the department was having to use portable cabins. The Chase Farm and Royal Free CSSD units faced similar challenges, with cramped conditions, and significant pressure to keep up with increasing demand.” With limited existing space ruling out on-site expansion, a long-term solution was thus sought to allow the Trust to future-proof its reprocessing services, and continue to ensure high quality, safe decontamination of instruments and scopes. At the same time, the Trust was keen to free up additional space for clinical activity at the hospital sites.
A partnership approach sought from the outset
From the outset – in drawing up plans for the new ‘supercentre’ – the Trust sought a partnership approach. Rob Doubtfire, managing director at CFES, which has built and engineered the new supercentre, explained: “The Trust wanted to work with like-minded people who would become part of the team, and share its vision to provide a world-class facility. It had a stringent, staged approach to the tender. Suppliers could only bid for the design phase initially – a large commitment for any business. However, we gained confidence from our engagement with the Trust, and it could see that we worked well within a partnership approach.” Other tender stages included the build, equipment provision, finance, and maintenance and management of the site. Suppliers were scored at each stage, in a ‘highly competitive’ process. The successful partnership worked closely on optimising the unit’s design, with CFES appointed principal contractor, responsible for all construction and plant, and Getinge tasked with providing ‘a holistic decontamination solution’ – from washer-disinfectors, autoclaves, and automated endoscope reprocessing units, to ‘intelligent IT’ and instrument tracking solutions.
44 Health Estate Journal August 2020 Key requirements
“At the design phase,” Rob Doubtfire explained, “the key factors were energy efficiency and the size of plant, plus the quality of the equipment providers. We set up internal tenders to ensure the best value for the Trust. Getinge demonstrated both that its solutions were cost- competitive, and that it had the expertise to work with us on solutions such as condensate recovery. Condensate is now being reused by the site, instead of being disposed of into the drain, thereby improving the facility’s environmental performance.”
The maintenance of the equipment was also a significant factor, as the Trust had strict key performance indicators (KPIs) – of 95% uptime on 80% of the specialist decontamination equipment. This was set at 80% as a proportion of the equipment is either under planned preventative maintenance (PPM), or testing and validation, each day. For the main plant, the uptime must exceed 95%. Rob Doubtfire said: “If we fall below this, there are financial penalties.”
‘Unlike most other NHS decontamination departments’, the endoscopy and instrument decontamination services operate side by side. The sterile services department utilises the latest technology, with an emphasis on ease of use, and ensuring that the process flow, correct segregation, and integrity between contaminated, decontaminated, and sterilised areas, is maintained.
Operating at well below capacity Mark Sibbons said: “The unit has been built to take 20 million instruments and 130,000 scopes annually. We are currently reprocessing 3.6 million instruments and 40,000 scopes, and operating at 25% of our capacity, but if we extend this with extra washer-disinfectors and autoclaves, and recruit more staff, the sky is the limit.” Some third-party processing work is already passing through, but the eventual aim is to provide decontamination services for other Trusts within a 50-mile radius.
Natural gas pipework, with boosters, and a steam boiler in the background.
The new supercentre received JAG accreditation in September 2019, passing ‘with flying colours’, while an IHEEM audit gave it ‘a full bill of health’. The site is completely self-sufficient, with N+1 redundancy, its own back-up power generation, and independent water supply. All the maintenance, weekly testing, validation, cleaning, and security, is undertaken by CFES and Getinge under a managed service contract. Director of Commercial Strategy at Getinge, Tim Bryant, said: “The Trust’s staff can thus simply focus on the core function of providing decontamination, without having to worry about all these other areas of the operation. It has a single point of contact to deal with any issues. It’s all about risk transfer for the Trust.”
A team of dedicated engineers A team of dedicated CFES engineers, and the company’s FM manager, Steve Rice, are on hand to deal with any plant and facilities issues seven days a week, 12 hours per day, while Getinge provides on-site support, five days per week, 12 hours per day, for the decontamination equipment. As the unit becomes busier, this service level may be increased further. Rob Doubtfire added: “Given the uptime required, we felt mobile engineers would not be appropriate. If this unit goes down, three hospitals stop operating. There is considerable redundancy built in, and the site is very self-sufficient utilities-wise. The Trust wanted to work with partners with ISO 41001 accreditation, which focuses on managing critical plant. The building management system allows us to monitor equipment performance at all times, and everything is alarmed and linked to our mobile phones. The site’s high demands on uptime and equipment utilisation make analytics essential.” Based on data provided by the plant and equipment, CFES and Getinge can foresee when a component needs replacement. Scheduling a service intervention before a breakdown occurs eliminates the downtime associated with out-of-service
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