HEATING AND VENTILATING
n Compliance with standards: Healthcare facilities must ensure compliance with various regulations and standards, including the CEA’s BG01 guidelines, and the PSSR.
n Impact on neighbouring areas: The assessment should consider the potential impact on neighbouring sites in the event of an incident, which is especially important in densely populated urban areas where many hospitals are located.
n Energy efficiency: While safety is the primary concern, a comprehensive TBHRA can also identify opportunities for improving energy efficiency in the steam system, potentially resulting in cost savings for the healthcare facility.
Steam boiler ancillary equipment should also be included.
For NHS Trusts and healthcare facilities, TBHRAs are particularly crucial for numerous factors, including: n Continuous operation: Healthcare facilities typically operate 24/7, placing constant demands on boiler systems. This continuous operation increases the risk of equipment failure, and requires meticulous maintenance planning to ensure uninterrupted service.
n Critical applications: Steam generated by boilers is used in life-critical processes such as sterilisation of medical equipment. Any disruption in steam supply compromises patient safety and the ability to perform essential medical procedures.
n Complex environments: Healthcare facilities often have intricate layouts, complicating risk management. Boiler houses may be located beneath hospital buildings, necessitating thorough risk assessments to account for potential impacts on surrounding areas.
Noise, ambient temperature, and ventilation are all relevant to the working environment.
n Vulnerable occupants: The presence of patients – including those with compromised health, in the vicinity of boiler operations adds an extra layer of responsibility. The risk assessment must consider the potential impact on these vulnerable individuals in case of any boiler-related incidents.
n Legal requirements: NHS Trusts and healthcare facilities are legally obligated to have a ‘suitable and sufficient’ risk assessment in place for their boiler houses. This assessment must be reviewed periodically, and cover a wide range of potential hazards. n Liability considerations: It is crucial to note that the overall responsibility for boiler plant equipment lies with the healthcare facility owner or operator. Even if third-party contractors are involved in maintenance and operation, the legal liability remains with the healthcare provider.
n Specific hazards: The risk assessment must address issues such as burns from hot water or steam, electric shock, fuel leaks, fire, asphyxiation, topography and weather conditions, and toxic effects from combustion products. These hazards are particularly concerning in a healthcare setting, where the safety of patients, members of the public, staff, and contractors, is paramount.
68 Health Estate Journal October 2024
What should a TBHRA cover? A comprehensive risk assessment for an NHS Trust or healthcare facility should be exhaustive and consider all areas. When assessing boiler specifications and location, it is crucial to consider the type of boilers (fuel-fired or electrically-heated), their age and condition, proximity to occupied areas and vulnerable populations (staff, patients, and the general public), and compliance with HTM guidelines on boiler house location and design. Operational procedures must be thoroughly evaluated, including start-up and shutdown processes, routine maintenance schedules, emergency response protocols, and adherence to BG01 guidance on safe boiler operation. Staff competence and training are paramount, encompassing the qualifications and experience of boiler operators, training programmes and refresher courses, absence cover arrangements, and compliance with HSE INDG 436 recommendations on staff competence. The integrity and reliability of control systems, functionality of safety valves and other protective devices, and compliance with PSSR requirements for pressure safety systems, must be rigorously assessed. Water treatment and quality management should be
scrutinised, focusing on the effectiveness of water treatment programmes, monitoring and testing procedures, and compliance with HTM 04-01 on water system safety. Ventilation and emissions require careful consideration, including the adequacy of boiler house ventilation, emissions monitoring and control, and compliance with environmental regulations. For fuel-fired boilers, fuel storage and handling must be
evaluated, addressing the safety of fuel storage facilities, fuel handling procedures, and compliance with relevant fuel safety regulations. Electrical safety, particularly for electrically heated boilers, should be assessed, including the integrity of electrical installations, and compliance with HTM 06-01 on electrical services in healthcare premises. Proper record-keeping and documentation are essential, encompassing the maintenance of operational logs, storage and accessibility of technical documentation, and compliance with PSSR requirements for record keeping. Finally, emergency preparedness must be thoroughly planned – including evacuation procedures, back-up systems and contingency plans, and coordination with hospital-wide emergency response plans.
Are all TBHRAs the same? While many aspects of a risk assessment are common to all types of steam boilers, there are specific considerations for fuel-fired boilers (such as Fulton’s VSRT vertical spiral rib tubeless steam boiler), and electrically heated systems (like the company’s Electropack and Europack models), that must be addressed to ensure safety and compliance.
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