HEALTHCARE VENTILATION
Left: A ‘barn’ theatre. There are very few examples of this type of theatre in the UK, and clinical staff should be reminded to pay particular attention to theatre equipment placement to avoid blocking any extracts. Right: Plantrooms should be kept tidy, clean, and secure, particularly where they contain air-handling units, to avoid contamination during maintenance. This plant serves theatres installed in the early 1990s.
Where AHU plant is not performing to the standards laid out in the HTM, the annual verification report will identify this, and as per para 4.34 of the HTM, the system ‘should not be returned to service’. In theory, this scenario should not
come as a surprise to senior leaders in a healthcare provider organisation – although in practice it often does. If the correct governance mechanisms are in place in the Trust, the Ventilation Safety Group (VSG), whose members are ultimately acting on behalf of the Chief Executive, will be made aware of any lifecycle issues, and subsequently conduct a risk assessment to determine the level of risk to patients and staff if equipment fails between re-verifications. The risk assessment should consider variables such as the type of occupancy in the rooms served by the ventilation system, the age of the plant, previous failure data, the level of current maintenance, and the depth and frequency of other maintenance or testing (if beyond the minimum quarterly inspections).
Mitigations required? Once the risk assessment is complete, the VSG should decide if there are any mitigations required. This might then provide some assurances that the plant is running optimally, the degradation is slowed, and early warning provided where the plant is reaching a point of failure. Such mitigations might include increased frequency of inspections, increased frequency of testing (for example, testing 1 m and 2 m velocities above floor level for UCV theatres to ensure they are consistently meeting minimum requirements), and settle plate testing. A key output of the risk assessment is
to log the asset on the Trust risk register. By doing so, the VSG is informing and escalating the issue to Board (typically, an
68 Health Estate Journal September 2024
informed position at Board level should be a key responsibility of the Designated Person (DP)), and in effect making the board members aware that investment is needed to either refurbish or replace the equipment. Estates management personnel should consider the interpretation of the risk, and whether the translation from any proprietary scoring differs when using matrices outside the department. It is much easier for clinical and executive teams to understand the risk rating provided by the Estates team by using the Trust risk rating matrix, which can sometimes be different to the scoring matrices employed, for example, in the construction industry. Estates teams should also consider holding a risk register independently that they periodically review (quarterly as a minimum would be a good recommendation). This will influence a backlog priority list that can be shared with the Finance team during budget setting. A replacement programme should be considered based on the risks identified in the assessments, budget costs sought, and a plan drafted to carry out the works. Identifying issues with an AHU, either
through proactive or reactive means, is often only the start of the challenges facing the Estates team. The rising cost to eradicate backlog3
across the estate
means there are competing assets for capital investment. Capital investment funding is increasingly being diverted to subsidise revenue spend,4
well-considered and planned maintenance regime with detailed procedures and strict safe systems of work, and a robust system for reactive maintenance calls. Crucially, it requires expertise at junior and mid-management level (Authorised Persons (Ventilation)) to ensure that the maintenance is being carried out as per plans, and that the system continues to be safely operated. Having oversight of all this is even more important, so reporting should be comprehensive, but succinct.
which is being
increasingly squeezed, in part due to the breakdowns experienced as a result of the estate backlog, and, perhaps more significantly, the cost of energy to run inefficient and antiquated plant. Running and maintaining end-of-life and legacy systems requires a well- trained team of competent individuals (Competent Persons (Ventilation)), a
Role of the AE Ensuring that the Trust employs an Authorising Engineer (Ventilation) who is an active participant of the VSG will be helpful for the Estates team in articulating the issues facing them to senior leadership, and provide a stronger position for securing funding. The precedent set during the COVID-19 crisis has, to an extent, focused senior leaders’ attention on indoor air quality, giving them a better understanding of the contribution that mechanical ventilation makes to patient and staff safety, and clinical outcomes. However, it may well be the impact on business continuity and capacity that will have the most leverage when considering capital investment. Over 6,700 Estates and Facilities incidents (including overheating) were reported in the latest ERIC report, with over 11,000 hours of downtime as a result of infrastructure failure. The reality for most Trusts is that significant capital investment is not a certainty; Estates teams may thus have to manage until failure; and, as discussed, this is not ideal. What can be done to improve in this situation? Individuals fulfilling the duties of CP (Ventilation) will need to be trained and proved competent, and so should understand the maintenance and inspections being carried out between annual verifications. Regular Continuing
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