HEALTHCARE VENTILATION
Cooling coil cleaning.
Cleaning a heater battery.
for the CP(V). However, hospital CP(V)s can perform all the tests necessary for annual validation for a wide range of critical ventilation systems, opening up opportunities for significant financial savings.
What are the risks and benefits? There are increased risks to health if NHS Trusts do not ensure that their ventilation systems maintain the required standards. There is a well-established link between surgical site infections and the quality of the air in the operating theatre. This was identified by a renowned orthopaedic surgeon and innovator, Sir John Charnley, in the 1960s, as well as in studies by Lidwell and others. Many NHS Trusts outsource verification because they believe they are transferring the risk to an external contractor. The patient safety risk and duty of care will still, however, remain with the NHS Trust. While Trusts may see transferring or sharing the risk as justified, it could also be argued that by doing so they are putting the reputation of the NHS Trust in other people’s hands. Loss of reputation for an NHS Trust can impact via reduced activity, resulting in elevated financial and business continuity risks. Bringing the work in house can provide the opportunity to ensure that the quality of the work is at the desired level. Competent Persons – Ventilation CP(V) are trained to perform the necessary checks and measurements, and it is within the scope of their role, as set out in the HTM: “The CP(V) is defined as a person designated by Management to carry out maintenance and periodic testing of ventilation systems.” (2021b, p.9)2
The Trust will
have demonstrated that they have confidence in their CP(V)s, as the HTM goes on to say, “All post-holders should be appointed in writing…” (2021b, p. 9).2
TEST EQUIPMENT
Pitot Static Tubes Differential
PURCHASE COST (APPROX.)
£1,000
micromanometer Balometer hood Sound level meter TOTAL
Table 1: Approximate purchase costs of test instruments.
£2,000*
£3,000 £1,000 £7,000
* Includes Hot wire anemometer and vane anemometer probes
114 Health Estate Journal October 2024
The CP(V)s will have an intimate knowledge of the CHV systems, their locations, routes to access inspection hatches and test points, and any problems or concerns. Taking measurements such as differential pressures between rooms, or air flow measurements with a balometer, will be skills that CP(V) engineers will be experienced with. They will have developed key relationships with clinical teams to enable timely access, as they are already performing routine maintenance such as filter changes and plant cleaning. With this in-depth knowledge, surely these are the best people to carry out the verifications? In addition, such work instils a feeling of ownership and pride in them as the individuals responsible for ensuring that the systems are running optimally and delivering the standard of air required for the clinical area.
Drawing on the AP’s knowledge In the early stages, while the CP(V) gains confidence, they can draw on the knowledge of an Authorised Person (AP) in the NHS Trust. The AP(V) is “…is responsible for the practical implementation and operation of Management’s safety policy and procedures relating to the engineering aspects of ventilation systems” (2021b, p. 9).2
Further
advice and support can be sought from the retained independent Authorising Engineer (AE) to provide assurances on the verifications performed by in-house staff. Another safety net is the multidisciplinary Ventilation Safety Group (VSG), who have oversight of all CHV systems. The other benefit of in-house verification is that local
staff will be able to fit the work in around clinical demands much more flexibly than an external contractor taking advantage of opportunistic availability. An external contractor will make prior arrangements with the clinical team weeks in advance of the intended visit, and their appointment may have to be cancelled numerous times due to urgent patient needs, which must take priority. In this instance there is likely to be a financial cancellation penalty for every failed attempt, further increasing the cost. In-house teams can be much more adaptable and responsive, and can take advantage of access to ventilation systems at short notice.
External vs internal costs There are several factors to consider when making cost comparisons. Clearly there are labour costs, but also the cost of test equipment and its annual calibration. Table 1 shows approximate test equipment costs, although many NHS Trusts will already have some or all of this equipment.
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