Revisions toHTM03 should see positive changes

Andrew Steel FIHEEM, managing director at Airmec Essential Services, reportedly one of the UK’s longest- established specialist air hygiene and water treatment solutions providers, looks at some of the proposed changes in the guidance on ventilation systems in a revised version of HTM 03-01, Specialised Ventilation for Healthcare Premises. He says he sees these as ‘well-aligned with the real needs of NHS Trusts’ healthcare engineering and estates teams’.

The introduction of a revised version of HTM 03-01, Specialised Ventilation for Healthcare Premises, will no doubt be followed by a lot of commentary on the technical detail of amendments and improvements in design specifications, inspection processes, and air change rates etc. All these requirements will be documented in the standard itself when it is published, and hospital estates managers will in any case need to go through them in detail in order to match them to specific premises. None of the detailed proposals we have seen as we go to press seem to be contentious; they have real potential to plug gaps, and can reduce risks.

There is, however, likely to be an elephant or two in the room for some Trust healthcare estates managers. We imply no malpractice or complacency, but pragmatism often means that current practice focuses on ultraclean ventilation and other critical systems, but can exclude significant proportions of the ventilation infrastructure. The proposed updates appear to bring all ventilation under the HTM 03 umbrella. Meeting all the requirements of the revised standard will call for capital expenditure on new equipment, significant refurbishment, and, often, periods of shutdown while works are undertaken. Without a considerable new branch of the magic money tree, can the revisions have teeth? As we see it, the agility and professionalism of healthcare estates managers and engineers has been well proven by the COVID-19 challenges, so there is no doubt that the will to accommodate change exists. In this particular area, they may be helped by changes in the oversight of ventilation management. There are specific recommendations on membership of Ventilation Safety Groups (VSGs), building on the experience and success of Water Safety Groups. This approach will perhaps empower estates and facilities managers and streamline the changes implicit in managing the new requirements.

A well-placed inspection porthole with a working internal light in an air-handling unit can save money, and reduce downtime significantly, during the working life of the equipment. Estates managers have a vested interest in influencing design and commissioning teams.

Increased emphasis on safety In the remainder of this article I will focus on what appears to be the overarching challenge in the guidance and its implications – the increased emphasis on the safety of all ventilation equipment and infrastructure, not just that servicing critical areas. At Airmec, it has always been our belief that the entirety of the ventilation infrastructure in healthcare premises presents a potential risk to staff and/or patients if systems are not regularly inspected and maintained, and that all of its condition and efficacy should be duly checked and audited. Furthermore, we believe that most estates management teams agree with us, and that, given budget and resources, would all be doing just that. COVID-19 has surely put ventilation centre stage to remind us of this responsibility. Remember, too, that ventilation systems also include water drip trays and vital fire dampers, which brings other HTM guidance and mandatory requirements, such as HTM 04-01, Safe water in healthcare premises – into the ventilation arena.

Most NHS Trusts have heating and ventilating groups that already approximate to the Ventilation Safety Group (VSG) structure outlined in the

draft of the revised standard, and the change will not be a great leap for them. It will, however, bring more people to the table, and we welcome the greater emphasis on, and wider membership of, VSGs. The new versions of the heating and ventilating groups will typically include infection prevention and control representatives, finance managers, clinicians, and co-opted external practical expertise. From our experience of working as co-opted members of Water Safety Groups, it’s an approach that can only help to increase the efficiency and safety of ventilation systems, and help estates managers at the sharp end of maintenance to make their case for change and investment where necessary.

The legacy

To remind ourselves where we are, let us go back to 2007, when the current standard was published, referring, as it does, to new installations and major refurbishments. At the time, little consideration was given to how the installed system could be economically operated and maintained during its working life. HTM-03 is, of course, split into two parts – Part A: Design and Validation, and Part B: Operational Management and Performance Verification. With the benefit of hindsight, tempered over nearly a decade and a half of exceptional budget pressures, we can see that it is Part B of the HTM-03 that is the immediate challenge. What should all along have been routine maintenance for Trusts, has all too often turned into a maintenance backlog with no matching budget for remediation. Bringing even more plant into the equation – older and ‘non-critical’ – will only compound the problem. Older systems designed and operated under HTM 2025 were implicitly not covered by the 2007 version of HTM 03- 01, unless subject to major renovation work. The title of the standard, Specialised Ventilation for Healthcare Premises, has perhaps been taken literally. Have some Trusts confused ‘specialised’ with ‘critical’?

February 2021 Health Estate Journal 53

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