HEALTHCARE ESTATES 2022 KEYNOTES – ENGINEERING


‘Enabling infection-resilient healthcare environments’


In an interesting session opening the second day of Healthcare Estates 2022, four scientists and academics discussed hospital ventilation – including some of the key learnings for hospital engineers in the wake of COVID-19. They focused especially on improving infection resilience in the hospital environment, and tackling poorly ventilated spaces. HEJ editor, Jonathan Baillie, reports on an address by one of the four – Professor Cath Noakes of the University of Leeds – one of the UK’s leading experts on healthcare ventilation.


The ‘Engineering’-themed session began with Pete Sellars welcoming IHEEM’s new President, Alison Ryan, who had only taken over the Presidency from Paul Fenton at the previous day’s IHEEM AGM, to the stage. The first female President in IHEEM’s 79-year history, Alison Ryan briefly (see also separate report, pages 35- 38) shared some of her thoughts on her key priorities and goals in the role over the next two years, before chairing a thought- provoking conference session. She explained: “This session is focused


on how we can improve infection resilience in the hospital environment, and tackle poorly ventilated spaces. It links well with current NHSE / NHSI plans to produce new guidance for the sector on healthcare refurbishment schemes.” She continued: “We have four key speakers in all – two


professors and two doctors – here, with us, Professor Cath Noakes from the University of Leeds, two online speakers – Professor Peter Guthrie and Dr Sean Fitzgerald, both from the University of Cambridge, and, again in person here, Dr. Elaine Cloutman- Green, from Great Ormond Street Hospital NHS Foundation Trust.”


Chartered Mechanical Engineer with background in fluid dynamics Welcoming the first of the four, Professor Cath Noakes, Alison Ryan explained that the Professor is a Chartered Mechanical Engineer with a background in fluid dynamics. She said: “Cath Noakes is Professor of Environmental Engineering for Buildings in the School of Civil Engineering at the University of Leeds, and leads research into ventilation, indoor air quality, and infection control in the built environment. During the pandemic she co-chaired the Environment and Modelling sub-group of SAGE, focusing on the science underpinning environmental transmission of COVID.” Prof. Noakes began her presentation – titled ‘Enabling infection-resilient healthcare environments’ – by focusing on some of the key recent learnings on airborne transmission of bacteria and viruses in the healthcare environment, and some potential strategies for reducing such transmission, and thus the associated risks to patients, staff, and visitors. She said: “There’s nothing new in this; the environment always matters, it matters for infection control. Go back to Florence Nightingale, and she worked out – without all our modern techniques available to her, of course – that if you space your beds out, provide sufficient space, heat the room adequately, have good high


ceilings, natural light, opening windows, and cross-ventilation – then you’ll reduce infection rates on your wards.


Air quality matters for many reasons “Move forward 150 years, and we now know much more. Air quality matters for the things we see most obviously – COVID has highlighted respiratory infections – but we also know it matters for a whole raft of hospital-acquired infections, whether this applies to vulnerable patients exposed to opportunistic pathogens, such as people with cystic fibrosis, or whether it’s MRSA, C. difficile, or norovirus. All these have been associated with aerosol dissemination and environmental contamination.” Among the many sources which could put pathogens into a hospital’s air were the patients, staff, and visitors, but also the environment. Prof. Noakes said: “We know things get re-suspended when you make a bed; we know that with water systems, there’s an air / water interface. We get aerosolisation from showers, and dispersion from drains, and then, in some circumstances – particularly with vulnerable patients – the outdoor air brings pathogens in.”


Guidance and standards Turning to standards on ventilation and air quality, Prof. Noakes noted that the new HTM 03-01: Specialised Ventilation for Healthcare Premises, had introduced stronger requirements around inspection and audit, and promoted the establishment of Ventilation Safety Groups in hospitals. She said: “We know, however, that we have a challenge. Most of our hospitals are not brand new, we have a fairly limited resource, and must therefore adapt the buildings we’ve got.” She


Professor Cath Noakes OBE, FREng, FIMechE, FIHEEM, HonFCIBSE, who – during the pandemic – co-chaired the Environment and Modelling sub-group of SAGE, focusing on the science underpinning environmental transmission of COVID.


November 2022 Health Estate Journal 47


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