INFECTION PREVENTION AND CONTROL However, there is another aspect to this. Many items
that need to be decontaminated between patients are poorly designed from the perspective of ease of decontamination. To prevent the spread of AMR and reduce infection rates, ease of decontamination needs to become a priority – from both a design perspective and for those purchasing equipment.
Dr Michael Weinbren
Dr Michael Weinbren is a consultant medical microbiologist, a Specialist advisor for microbiology to the New Hospital Programme, and Chair of the Healthcare Infection Society Working Party on water/wastewater.
Innovation
George McCracken
George McCracken joined the NHS in 1993 as a hospital engineer in Down Lisburn Trust, before this working in industry – in cable manufacture and foundry works. In 2002 he moved to the Royal Group of Hospitals, Belfast, as a senior engineer, before in 2007 being appointed head of Estates Risk and Environment in the new Belfast Health and Social Care Trust, one of the UK’s largest NHS Trusts. He holds a First Class Honours Degree in Construction Engineering & Management, is a Chartered Member of the Institute of Building, and a member of IHEEM. He currently leads a Risk Team that ‘continues to provide an innovative approach to the management of risk within a healthcare estates environment’.
Innovation is required in many areas, as AMR continues to demonstrate deficiencies in current designs and practices. However, without an interface between the NHS and manufacturers, the chances of developing the right innovations in a timely way is very much reduced. Professionals involved with new build and refurbishment projects, from whatever capacity – clinical, non-clinical, operational, or manufacturing, must recognise the impact of their contribution on patient safety. If professionals can realise and see how they can use their skillsets to contribute to and improve the built environment, then innovation for the betterment of the patient will flourish. AMR is termed the ‘silent pandemic’. Many talk about preparedness for the next pandemic, unaware we are already going through one. The AMR pandemic is forecast to deliver disruption and human suffering on a scale which up to now has never been realised. Time is a luxury that spread of AMR does not offer. It is very difficult to mobilise society to realise the magnitude of the impending threat. The new UK AMR national action plan has made a good start by recognising the importance of the built environment. Leaving AMR to the remit of doctors and pharmacists is no longer an option, however. Developing new antibiotics and prudent use of existing such drugs is essential, but will not turn the tide. Although the NAP places the built environment as
central to the problem of AMR, it does not describe how hospitals spread AMR. Messaging is crucial to engage the key players – from designers to cleaners; otherwise the potential for patient harm may not be realised until too late. In the case of construction, financial costs for remediation may also be exorbitant. Clinical healthcare professionals cannot solve these
problems alone. We need multidisciplinary forums established to articulate the problems and draw in industry expertise to make improvements that reduce risk. The manufacturing and construction industries rightly pride themselves on being innovative when it comes to design and construction. This expertise needs exposure to the clinical environment and patient safety to create new ways of working, new products, and new aspects of design, all focused on what must be the new common aim – improving patient and occupant safety.
Suggestions looking ahead We suggest the following would help establish the necessary processes and momentum to move this forward: n Training – while the built environment may be seen as the province of Infection Prevention and Control teams (IPC), through no fault of their own, many IPC personnel have had no training in this area. A brief review of the major IPC textbooks shows the built environment not to feature.
n The Hackitt report is now over six years’ old, but the cultural change that it highlights as necessary to improve building design, construction, and commissioning, is yet to be realised. This requires translation into the healthcare sector. Again, training is vital.
This is reinforced by the new HTM 04-01 addendum.4 NHS Procurement – through engagement both with
44 Health Estate Journal October 2024
Figure 11: Patient safety should be at the forefront of everything we do. As pointed out by the American patient safety champion, Don Berwick, putting patient safety first is the most cost-effective approach. In building a new hospital, if time and money are placed at the forefront, neither will be achieved. Placing safety at the forefront, and identifying risks from the outset, is the safest and most cost-effective approach. Multidisciplinary approaches are key to all the necessary competencies being present to inform the optimal decision-making.
manufacturers and hospital staff – has an important opportunity to positively impact patient safety and reduce the spread of AMR. This will ensure the required multidisciplinary approach. The New Hospital Programme is due to design, construct, and commission, a large part of the English healthcare infrastructure. If the Programme is to succeed, then perhaps the challenge is for those managing it to pick up the gauntlet thrown down by the new AMR national action plan and develop and implement the necessary actions and solutions required.
References 1 Department of Health and Social Care. UK 5-year action plan for antimicrobial resistance 2024 to 2029. 8 May 2024.
https://tinyurl.com/yjcctzy6
2 Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet 2022; 399 (10325): 622-695.
3 Institute for Health Metrics and Evaluation (IHME), Global Burden of Disease Study 2019 (GBD 2019) Disease and Injury Burden 1990-2019.
https://ghdx.healthdata.org/gbd-2019
4 NHS Estates Technical Bulletin. Addendum (NETB) No 2024/3 to HTM 04-01: Designing safe spaces for patients at high risk of infection from nontuberculous mycobacteria and other waterborne pathogens. 27 August 2024. https://tinyurl. com/3fy9tp5j
5 Report of the Independent Inquiry into the Construction of Edinburgh Schools. February 2017. https://tinyurl. com/5ffuryzh
6 Building a Safer Future. Independent Review of Building Regulations and Fire Safety: Final Report. May 2018. https://
tinyurl.com/mry8x3z6
7 Weinbren M. Are wastewater systems a nursery for microorganisms? HEJ April 2023; 77(4).
8 Browne K et al. Investigating the effect of enhanced cleaning and disinfection of shared medical equipment on health-care- associated infections in Australia (CLEEN): a stepped-wedge, cluster randomised, controlled trial. Lancet Infect Dis 2024 13 August 2024.
9 Benbow A et al. Hospital-wide healthcare-associated carbapenemase-producing Enterobacterales outbreak: risks of electric floor scrubbers in catering facilities and kitchens. J Hosp Infect April 2024; 146: 59-65
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