HEALTHCARE ESTATES 2022 KEYNOTES – ENGINEERING
Florence Nightingale – without the technology available to us today – recognised that spacing beds out, providing sufficient space, heating the room adequately, having good high ceilings, natural light, opening windows, and cross-ventilation – would all help reduce infection rates on wards.
continued: “We know we have specified ventilation for some healthcare spaces. This table (she slowed a slide featuring a table from HTM 03-01, parts A and B, 2021 update) suggests what these ventilation rates should be for a ward – six air changes / hour, but how many wards actually comply? I suspect it’s pretty hit and miss. Most of our standards also focus on the spaces traditionally considered as risky, but what about our waiting rooms, staff rooms, and corridors, and all those other spaces people interact within in a hospital?
A ‘double challenge’ “Alison (Ryan) has already touched on the Net Zero challenge,” Prof. Noakes continued, “and this is where we have a double challenge – because we know we must reduce our energy use, and that buildings account for about 10% of the total national health carbon footprint. Healthcare buildings make a sizeable contribution to our overall emissions, and ventilation is one of the key elements that comes under scrutiny.” There was then ‘the challenge of COVID’. Prof. Noakes said: “COVID changed our thinking. Suddenly, instead of airborne risk being confined to being a very distinct thing, it’s everywhere.” Many of the audience would, she
believed, have been involved in creating isolation rooms, surge spaces, and
Prof. Noakes explained that she and colleagues were undertaking research on the use of Far-UV, which she said was ‘much safer than conventional UV, and can have a spectacular impact on pathogens’, but stressed was ‘not some magic new technology’.
cohort spaces, and in trying to convert operating theatres, during the pandemic. She said: “Our new problem is that instead of transmission being most likely from seriously ill people, the biggest transmission risk seems to be from those at the beginning of their infection. We also have risks in spaces like staff rooms, which we previously thought of as safe.” The pandemic had also highlighted issues around ‘design gaps’. The Professor elaborated. “For example, does a positive pressure operating theatre pose a risk for people outside it? We don’t know some of this.” Showing a graph from the pandemic’s
‘first wave’, she said she wanted to highlight the proportion of hospital- acquired COVID cases as a percentage of all such cases. This had increased, and was now running at 25 to 30%, ‘if not higher’. “Compare that with any other hospital- acquired infection,” she said, “and it’s a shockingly high number.”
Conventional thinking on infection control Reiterating that COVID had ‘changed how we think about things’, Prof. Noakes said: “Go back to conventional infection control thinking, and we have the idea that disease is transmitted by droplets. You’re close to somebody, it’s about
big things that come out of people’s mouths; you don’t think about ventilation mattering, and airborne transmission was always thought of as something rare, containable, and ‘specialist’. For example, with tuberculosis we would put patients in an isolation room.” COVID had changed all that, because suddenly everything is airborne. “In fact,” Prof. Noakes explained, “the droplets are not all big ones. They are aerosols that stay in the air, and are simply a bit more concentrated when you are close to somebody.” Not only could they be transported
quite readily, but transmission could ‘happen everywhere’. ‘Thinking about the complexity of this’, Prof. Noakes said that – ‘as with nearly every other respiratory virus’ – COVID-19 had a human source. Expanding on this, she said: “We breathe out droplets, most of which are aerosols of different sizes. They evaporate, and move through the air; to what extent depends on the individual’s activity and location. There’s a wide-ranging distribution of particles carrying the virus. They get transported into the air, and deposit onto surfaces, but the significance of this depends on different pathogens.
Inhaling droplets “Then,” she continued, “people can get exposed. Get close to somebody, and you
Some of the common sources of airborne infection in hospitals and other healthcare facilities.
48 Health Estate Journal November 2022
Tiny aerosols can carry a virus.
Courtesy of Cath Noakes / University of Leeds
Courtesy of Cath Noakes / University of Leeds
Courtesy of Cath Noakes / University of Leeds
Courtesy of Cath Noakes / University of Leeds
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