HEALTHCARE ESTATES 2021 CONFERENCE
personnel, all of whom have an input, and make some decisions on the ventilation systems and their operation.”
Derogations
In circumstances where somebody wanted to derogate in future, they would now need to take the matter to the Ventilation Safety Group, which must agree and sign up to the derogation. He added: “The Group must also record what the derogation was, why it was agreed, and who agreed it. It thus takes away this ‘Mr Jones said it was OK’-type approach. Notice too,” he said, “that somebody from Finance is involved, because some of these things have ongoing financial commitments. For example, some of the ways of installing ventilation plant mean they need more regular cleaning over time, with a financial implication ongoing for the system’s lifetime, so it’s essential that the Finance people are involved and recognise that if you go down that path, there needs to be provision to undertake the maintenance correctly over a period of perhaps 20 years.”
Guidance on refurbishments Malcolm Thomas explained that while the new ventilation HTM covers refurbishments and change, the old one didn’t. He and his counterparts had encountered ‘a lot of problems’ with people refurbishing theatres, where they had ‘completely gutted’ an existing such facility, installed new ceilings, plastered the walls, put in new doors, a new floor, new operating tables, lamps, ‘and everything’, but kept a 30-year old ventilation plant. He said: “This is like buying a new car, but taking the engine out of the old one because that will save you a bit of money.” He continued: “The ventilation plants are not as expensive as an operating table; you wouldn’t dream of using a 30-year-old operating table, so
why consider using 30-year-old ventilation plant? We should surely be taking advantage of new technology. We want new plant with good controls, not old plant ‘mashed up to save a couple of bob’. That’s an important aspect which is clearly spelt out.
Natural ventilation where possible “We have also suggested various ventilation strategies; we would like natural ventilation where practical. Such ventilation can, however, ‘be tricky in the case of hospitals’, Malcolm Thomas acknowledged. As he put it: “You’re relying on the wind blowing, and blowing in the right direction, not too much and not too little, so it’s not easy, particularly in a hospital.” However,” he added, “mixed mode ventilation, taking advantage of natural ventilation while it’s there, and then supporting it with a fan that will come on when it’s needed, and perhaps some supplementary heating etc, can be one potential solution.”
Natural ventilation wasn’t ‘just about opening a window’. The speaker elaborated: “It’s about having ventilation openings, which may be supported with some ductwork attached, with a means of adjusting the ventilation rate when the natural ventilation is available, and taking advantage of it when it is.” Where full ventilation, ‘which costs money’, was selected, the question arose about whether it needed to run 24 hours a day, seven days a week, 52 weeks a year. He said: “The answer, in most cases, is ‘no’. If there’s nobody there, you can turn it off – a really good energy-efficient way of doing it. This is not new; it was in EnCO2 for many years.”
Unnecessary plant operation Noting that people still left theatre ventilation running ‘24/7’ to keep the rooms sterile, which was ‘absolutely not
required’, Malcolm Thomas explained that he and the co-authors of HTM 03-01 (2021) had expanded the ‘Operating theatres’ section ‘quite significantly’. He said: “We’ve, for example, changed the parameters for air change rates to reflect what we can do to take advantage of the latest technology. We don’t need to have as much slack in the systems as previously. So, the advice is much more appropriate for today, although still in line with what Owen Lidwell found worked, and history has subsequently proven right.” Some of the ‘old information’ for where older theatres were still in use had been retained, but the new HTM 03-01 also incorporated ‘a whole new set of information’.
Installation guidance de
Malcolm Thomas told attendees: “In a new ‘Installation standards’ section, we’ve spelt out some of the things that cause us numerous problems – including guidance on very simple things, which cost no money to do, but if not done right cost an awful lot of time and effort. So, for instance, with a basic thing like balancing damper handles, why install them at the top of the damper? When the ceiling is up, you then can’t reach them. Air doesn’t know where the handle is, but putting the handle on the bottom of a damper costs no more installation-wise, but means that when you come to balance, or subsequently re-balance, the system, you can reach the handle without killing yourself.” Turning to another key topic in the new HTM – ‘Acceptance testing and validation’, Malcolm Thomas explained that ‘validation is a process of accepting the whole job, the whole project’, so in the theatre, wasn’t ‘just about how much air goes in, but rather about where the air comes from: what the air-conditioning and air-handling unit is like, what the ductwork is like, and what the fabric of the theatre is like’. The speaker stressed that it was ‘very different from commissioning’, and entailed looking more holistically at ‘Does it work, and can we at the end of the validation say it is safe to operate?’
A ventilation diagram for a standard operating theatre taken from HTM 03-01 (2021). 28 Health Estate Journal January 2022
Appendices expanded The authors had also expanded the appendices ‘to cover some of these things’. Here he showed a diagram of ‘an example of one of new standard schemes, and the amount of air in the theatre’. He said: “The air change rate has changed, and above this, if you look in the appendices, there’s a whole range of information that’s much more definitive compared with what we has before. So, there are four schemes – single-corridor and two-corridor schemes for standard theatres and ultraclean, and another four
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