INFECTION PREVENTION AND CONTROL
South Coast 2021
Aug 84 Sept 133 Oct
101
Nov 115 Dec
111 544
Midlands 2021
Aug Sept Oct Nov Dec
8
2 4 1 1
0
West Midlands 2021
Aug Sept Oct Nov Dec
65 7 13
20 10 15
South Coast 2022
Jan 103
Feb 101 Mar 110 Apr 159 May 163 June 156 July
155 947
Midlands 2022
Jan Feb Mar Apr May Jun July
8
2 6 1
3 2 1 1
West Midlands 2022
Jan Feb Mar Apr May Jun
19 6 6
13 13 10
July No data 67
Table 1: Drain blockages reported via a CAFM system over a 12-month period in acute hospitals on the south coast of England, in the Midlands overall, and the West Midlands specifically.
However, if drainage is impeded, which is common in the clinical environment, then such designs will disperse wastewater organisms. Staff have not been trained on the risks, so impaired drainage is usually only reported by the time the drain is completely occluded. In the meantime, wastewater organisms are likely to have been dispersed into the healthcare environment.
Scant attention to location of pipe runs
Scant attention is often paid to the location of pipe runs and the impact of blockages/ leaks on the local vicinity, and the resulting contamination in pharmacy store areas, food preparation areas, and susceptible patient groups, as well as the impact on continuing hospital activities, needs to be considered. While when a water system shows a contamination issue, or a flow problem, the design is almost always considered, often when drainage systems show the same, the design isn’t afforded the same level of concern. Most failings can ultimately be traced
back to not placing patient safety at the front and centre of everything we do, and linking this to a risk-based approach. In order to mitigate against risk, the hazards not only have to be visible, but also brought to the attention of those with the
ability and determination to make effective change.
Risk visibility is, of course, determined
by a variety of factors. The stakeholders involved in ensuring safety in the healthcare built environment extend beyond those who are immediately involved in a new-build project to include those who write guidance and compliance, manufacturers, and those involved in enforcing/ monitoring compliance. Guidance has a long history across
many industries, as indeed has the design and construction of buildings failing to achieve the necessary standards. Guidance should not be seen as a substitute for training and expertise, but in practice often is. When the Health and Safety Executive investigates incidents, the three main contributory factors are poor management, poor communication, and a lack of appropriate training
A loose definition of training With regards to the latter, the word training is used extremely loosely nowadays, and may be used to cover anything from a 20-minute online course / lecture (which is no more than very basic awareness), to what the HSE are inferring by training, which is competency-based. While a lack of competence is a contributory factor in
failures in new-builds, there is a perhaps a bigger problem with the understanding and definition of ‘competence’. To give an example – and indeed this could be equally applied to other professional groups – let us look at Infection Control. Input from this specialist discipline is rightly seen as an essential requirement for patient safety in a new-build healthcare facility. Infection control personnel will be recruited to join the project. However, many infection control personnel have had no training on, or experience of, the built environment, let alone possessing built environment knowledge as regards new-builds. Individuals are brought in who bring no added value to the project. While competent in their profession, they lack the necessary training/experience for this very specialised area.
A lack of specialist expertise The same can be said of design teams and architects – why should they know where to place a clinical handwash station to minimise the risk to patients? They are likely to be competent individuals, but lack the necessary specialist expertise. One then ends up in a situation where uninformed architects and designers are producing work which may or may not be checked by Infection Control teams who also lack the relevant expertise.
Highly resistant organism introduced through salads
In one hospital the incidence of patients acquiring a highly resistant organism increased dramatically, with a case control study showing that the acquisition of the organism was linked to eating salads. Microbiological culture of the salads on their receipt in the hospital showed them to be clear of the organism, but further investigation indicated that splashes from a nearby drain were the cause of the contamination. The hospital kitchen was in a separate building to the main hospital. The resistant strain was thought to have been introduced into the kitchen on a coil to unblock a drain in the kitchen (see photo); this had previously been used on the main sewerage stack in the hospital. Cultures from the coil yielded the outbreak strain.
42 Health Estate Journal May 2023
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