HEALTHCARE ESTATES 2022 KEYNOTES – ENGINEERING Application


General ward (level 0


and 1 care) Communal


ward toilet Single room


Single room WC Clean utility Dirty utility


Ward isolation room (PPVL)


Infectious diseases


isolation room Neutropaenic


patient ward


Critical care areas (level 2


and 3 care) Birthing room NICU/SCBU


Ventilation Air-change Pressure rate


(ac/h) S/N E


S/E/N E S E


S E S S


S & E S & E


6


6 6


3 6 6


10 10 10 10


10 10


(Pascal - Pa)


– -ve


0 or -ve -ve +ve -ve


Lobby +10 Room 0


-5 +10 +10 0 +ve


Supply filter grade


(BS EN 16798) SUP2 –


SUP2 –


SUP3 –


SUP2 SUP2 H12 SUP1


SUP2 SUP1


35


45 35


45 45 45


35 35 35 35


45 35


18-28 –


18-28 –


18-22 –


– – – –


20-25 20-28


‘Ventilation standards’ – from HTM 03-01 Specialised Ventilation for Healthcare Premises Parts A and B (2021).


behaviour factors and the rest of the infection and prevention control measures integrated together.” This led on to ‘some bigger questions’, which the two subsequent online speakers, Peter Guthrie and Shaun Fitzgerald, would discuss in more detail. She explained to delegates: “We have carried out a big piece of work with the Royal Academy of Engineering over the past two years, following a request from the Government’s Chief Scientific Adviser, Sir Patrick Vallance, which drove questions following from the pandemic on how we can make our buildings more resilient.” The work had, she explained, resulted in the publication of detailed report, Infection Resilient Environments: Buildings that keep us healthy and safe. While the healthcare sector already knew more about the subject than many others, the team involved had wanted to look across all environments. Prof. Noakes said: “We reported in spring 2021 on immediate actions, because we were then still very much at the height of the pandemic. Phase 2, on which we reported in June 2022, focused much more on the longer- term strategic challenges with buildings, and those immediate things all focused on guidance, understanding, and incentives to improve buildings.”


Workshops held The personnel involved had held many workshops, and asked participants: ‘What does infection resilience mean?’ The speaker elaborated: “What are the impacts if you have a lack of resilience? It isn’t just about just spread of infection. There is a whole raft of other factors that stem from


50 Health Estate Journal November 2022


it, around, for example, how people change their transport modes, whether they are off sick, lose confidence, and whether people’s productivity suffers.” There was thus a broad spectrum of factors to consider. “Thinking about buildings,” Prof. Noakes


continued, “and we have many competing priorities. One of the biggest tensions is health versus sustainability. However, what about other factors – such as outdoor air pollution, comfort, and security? The challenge with opening windows in most hospitals is that their opening is restricted for security and safety reasons.” For many buildings, the speaker noted, ‘even in healthcare’ – such as GP practices and dental surgeries, infection control had never been at the heart of the design; it had simply been an ‘add-on’.


Wide-ranging report Against this backdrop, Prof. Noakes encouraged delegates to read the Infection Resilient Environments: Buildings that keep us healthy and safe report, which focuses on a wide range of factors around strategy, construction in use and retrofit, standards, regulation, commissioning, and leadership. Healthcare was ‘in some senses, ahead of the game here’, with applicable standards, regulations, and processes, to embed infection control within the engineering side. “However,” she asked, “are there issues around commissioning? Do we actually know – when somebody tells you their ward will deliver six air changes per hour, that it will do so? When did you last check?” While there was a raft of technologies to draw on to efficiently and safely ventilate healthcare spaces,


Noise Temp (dB(A)) (°C)


how many of them met standards, and how confident could buyers be that they would perform ‘as sold’? The speaker continued: “We also need


to consider how we communicate – not just within the engineering community, but with the clinical frontline, who need to actually deliver some of this.” This took the presentation on to ‘How much do we know about our environments? The Professor said the answer was ‘probably a lot less than we think.’ Her key message here was that ‘every action we take has a consequence’. For example, ventilating all the required spaces ‘brilliantly’ not only had a consequence in terms of risk / benefit for different diseases, but putting everybody in a single room might address one problem, but bring a different one – in terms of some patients feeling isolated, as well as difficulties for patient observation.


Where does the knowledge lie? She continued: “And who knows most about the environment? The designers? The people who run your hospital? Also, do your frontline clinical team understand how their environment works – because they’re the people delivering the care?” ‘Short term’, the Professor said there was ‘a need to think a bit more about better understanding what we do’. Elaborating, she said: “How do our systems perform? Where are those weak points – technical and behavioural? A naturally ventilated space, for instance, relies on somebody to open the window. We need to consider where the dependencies are – if you change one thing, does it upset something else somewhere else?” ‘Beyond infection control’, healthcare planners, designers, and architects, needed to consider ‘how we tie in noise, comfort, and energy, etc’. “So,” Prof. Noakes said, “we need to think about how we maintain balanced systems, ensure that they operate properly, and, for example, that filters in a ventilation system are changed. What about particular guidance? Have you, for example, ever given guidance on how to open windows? It sounds simple, but we just assume that people know how and when to do it. Equally, when do you use the air-conditioning? Is it a good idea or not? How do we change things? Can we take temporary capacities, what are suitable local upgrades, and what can we add in? We may not be able to build a new building, but we could perhaps add in air cleaning and disinfection strategies? How do you select the best though?”


Modelling at Addenbrooke’s Healthcare engineers already had good knowledge on simple things, such as that by changing the diffuser design, you got a better air mix in the room, and flushed out pathogens. Here Prof. Noakes mentioned some modelling focusing on ‘growing evidence around air cleaning


Source: Department of Health & Social Care.


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