HEALTHCARE ESTATES 2021 CONFERENCE
Guidance on ventilation revised and updated
Speaking in the ‘System Governance’ stream on the first day of last October’s IHEEM Healthcare Estates 2021 conference, consulting engineer, Malcolm Thomas, the main author of the 2021 version of HTM 03-01, Specialist Ventilation for Healthcare Premises, published last June, explained the background to, and aims behind, the HTM’s revision, and highlighted some of the major changes that those responsible for ventilation plant in hospitals and other healthcare facilities need to be aware of. HEJ editor, Jonathan Baillie, reports.
Malcolm Thomas was the lead author for both editions (published in 2007 and last year) of HTM 03-01, and also of the ventilation-related HTM 2025 that preceded them. Also the lead author of the engineering section of several HBNs, he has worked in the healthcare sector for over 40 years – both within and outside the NHS. He is President of the Specialised Ventilation for Healthcare Society, and a visiting lecturer at the University of Leeds. Welcoming attendees to his presentation, he explained that as the lead author of HTM 03-01 (2021), he would explain some of the main thinking behind it, and set out the reasons for a number of key changes in the ‘rewritten version’. He began: “As some background to where the HTMs and other guidance on ventilation originated, back in 1972 Dr Owen Lidwell led a Joint Working Party on ventilation and operating suites, and this was the foundation of all the guidance that has emerged since. Many people have asked me,” he continued,” why we bother with material that is ‘so old’? The reason is that when this work was done, it was very evident what worked well in practice, and what didn’t, in a way that’s no longer nearly so clear. When you have significant infection rates in operating theatres, it’s quite easy to see whether – if you change the colour of the paintwork – it makes any difference. Conversely, with very small infection rates – which fortunately we have now – it’s very difficult to know whether changing the surgeons’ gowns, the air change rate, or the colour of the walls, or putting carpet in, makes any significant difference. We’re talking about low percentage changes. We’re in a situation now where people think changes will improve things, but they don’t actually know, and it’s hard to prove what is a good or a bad thing. Back when Owen
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outcomes in infection rate terms.” From this work, and drawing on theatres with low infection rates and good patient outcomes, Owen Lidwell and his team were able to determine the optimal airflow and temperature, and consider elements such as the impact of different gowning procedures. This in turn enabled them to draw some conclusions. “The conclusions they drew have stood the test of time," said Malcolm Thomas. Following Owen Lidwell’s work, the Department of Health and Social Security – as it was then – set up a working group, and codified the ventilation of operating departments in a document called DV4, specifying what was required for the theatre, and what worked and what didn’t, ‘taking Lidwell’s work forward’.
Malcolm Thomas, the main author of the HTM 03-01 (2021), Specialist Ventilation for Healthcare Premises, published last June.
Lidwell did this work, it was relatively easy, there were step-changes, and he was able to conduct a number of trials.”
Comparative trials
Malcolm Thomas explained that in one, Owen Lidwell and his team took a particular acute hospital, and identified two operating theatres as theatres ‘A’ and ‘B’, with had two surgical teams – also named ‘A’ and ‘B’, staffing them. He elaborated: “They picked out patients at random, drawing lots to decide which theatre they were operated in. They could thus see which team and which patients fared better under certain circumstances, and thus demonstrate changes in the
We’re in a situation now where people think changes will improve things, but they don’t actually know, and it’s hard to prove what is a good or a bad thing
Request to update guidance “When I came on board,” Malcolm Thomas explained, “I was asked to update DV4, but soon after I’d finished doing this, I was told it was now going to be an HTM, and HTM 2025 was duly published in 1994. Some years later I was asked if I could I take that forward again, and HTM 03-01, Specialised ventilation healthcare, was published in 2007. It was delayed by SARS, and avian flu, just as the Coronavirus outbreak delayed the publication of the current version of HTM 03-01. So, all of these iterations are based on some good solid work many years ago. I’ve been working in this area for some time, and it’s very evident that these earlier learnings have stood the test of time. Where we have encountered problems, it’s generally been clear that the guidance wasn’t followed.”
Historical reasons for not following guidance
Among the historical reasons for failure to follow established guidance, the speaker explained, had been changing procedures in both operating suites, and other ‘spaces’ in healthcare facilities, while on occasions people ‘had not perhaps been as careful as they should have been’ –
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