GUIDANCE ‘‘
Figure 1: ‘HBN and HTM-compliant, but not safe’: these images were taken at a brand new NHS hospital which opened in 2023. The top image shows a drug preparation room with a clinical handwash station beside a work surface where drugs are being prepared. This represents a significant risk to patient safety, as splashes arising from the sink can lead to dispersal of either water or wastewater organisms over the drug preparation area, representing a significant risk to patients. The hospital changed management, and a new infection control team recognised the risk and had the clinical handwash station removed (bottom image). The original design was compliant with guidance.
A change of culture is required whereby a risk-based approach is taken, supported by evolving guidance
some members of the Design team, so a training session was held to describe how wastewater systems in healthcare facilities were a major route of dispersal of organisms and antimicrobial resistance. Once aware of the issues, the Design team was able to utilise its expertise and skills to put forward solutions. Up until then the team was unaware of the problems experienced once a healthcare facility was occupied. Such information is rarely found in guidance. Thus, by front-loading a project by bringing the necessary expertise (established by gap analysis) to work alongside design teams and architects, the culture can be changed to focus on risk and developing mitigations.
or dispersal of antimicrobial resistance are preventable. Guidance is a necessity; this is not in
question. However, understanding its purpose, limitations, and the absolute requirement to establish the correct framework (culture and training) across the stakeholders involved for it to be used correctly, is essential to ensure that safe healthcare design, construction, and commissioning, are delivered. We believe a risk-based approach is the
key to the necessary cultural change being sought by the industry. An environment of ‘informed governance’ is created, whereby everyone should understand the consequences of their actions on patient safety. This new focus moves away from
34 Health Estate Journal October 2023
cost, and whether or not the building will be delivered on time to the patient. By shifting focus, this does not mean that buildings will not be within in budget or on time. In fact, the converse is true. Through early identification of the risks, mitigations can be put in place, removing unsafe surprises further down the line, which are costly, delay completion, and harm patients. So, how is this accomplished? The
following example may shed some light. Members of the Design team at an external contractor were invited to the New Hospital Programme project Water Safety Group. A discussion ensued about the risks emanating from wastewater systems. There was a degree of scepticism among
A once-in-a-lifetime opportunity For most individuals in a healthcare facility, a new hospital build is a once-in-a-lifetime opportunity. The majority will not have been trained for such an event. For a Trust Chief Executive getting a new hospital might be perceived in the same terms as purchasing a new car. This is far from the case. Trusts need to move away from merely facilitating the new-build process, to understanding that they have to take control of, and responsibility for, the project if they are to stand any chance of acquiring a safe building. When the Health & Safety Executive investigates incidents, the three most common underlying causes identified are poor management, poor communication, and inadequate training. These are all elements of governance. What is required to be delivered is informed governance – whoever you are and whatever you do, you should have had sufficient training, i.e. be competent and understand the consequences of your actions on patient safety. Training is a word used very loosely
nowadays – ranging from an awareness session through to competency-based training. It is the latter that should be striven for. This brings us back to guidance. Not only have architects and design teams in the main not received training in the healthcare built environment, but the same is largely true of infection control personnel. No one disputes that Infection Control need to be involved in the process. However, with rare exceptions, their involvement in a new- build project is usually based upon job title, rather than whether they have the requisite expertise/training/competence in the built environment. Thus they bring no added value to the table. This is not the fault of infection control specialists. HTM 04-01,
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