HEATING AND VENTILATING
Encasement solutions add both style and protection
Many of the essential components that help to keep UK hospitals functioning are hidden from view to improve safety and aesthetics, and to simplify cleaning and maintenance regimes. Richard Braid, managing director of encasement specialist, Pendock, discusses why HVAC pipework, radiators, and structural supports, are usually concealed, and highlights some examples from hospitals across the UK, and the advantages of such practice.
UK hospitals are full of components, equipment, and materials, that the public and healthcare professionals rarely see. These include non-medical – yet still essential – items, such as HVAC pipework and radiators, and structural supports. Concealing them offers many benefits for hospitals, but primarily around improving safety, aesthetics, cleaning, and maintenance.
HVAC pipework and boxing in solutions
HVAC systems, of course, all have ancillary pipework, which helps to keep equipment like boilers, ventilation systems, and air-conditioning units running smoothly, efficiently, and safely – and hence the hospital comfortable for patients, staff, and visitors. Hospital estates managers will generally want this pipework concealed (commonly known as ‘boxing in’). In many environments, aesthetics are the main reason for ‘boxing in’ pipework, but in hospitals there’s an even more important factor to consider – safety.
Exposed pipework circulating hot water can pose a significant burns risk, especially in buildings used by children, and vulnerable adults such as the elderly and people with reduced mental capacity or mobility. Health & Safety Executive (HSE) information on managing the risks from hot water and surfaces in health and social care1
states that contact
with surfaces above 43˚C can lead to serious injury, and that particular care needs to be taken where water temperatures are circulated at above 50˚C to control Legionella. Where an assessment has identified that vulnerable people may come into prolonged contact with hot surfaces, such as exposed pipework, the guidance is for the equipment to be designed or covered so that the maximum accessible surface temperature does not exceed 43˚C.
Potential ligature risk
Furthermore, exposed pipework can be a ligature point, as a cord or rope could be attached for the purpose of hanging and strangulation, and is therefore a particular
risk for mental healthcare facilities. According to research, three-quarters of people who kill themselves while on a psychiatric ward do so by hanging or strangulation, and in 2012 the cross- Government strategy for preventing suicide in England called on mental health services to ‘make regular assessments of ward areas to identify and remove potential risks, i.e. ligatures and ligature points’.2
other services that may deal with mentally disordered patients (such as A&E departments) should be aware of the risks, and have management plans to meet them. Potential ligature points in general inpatient wards should be managed as part of individual and ward risk assessments. The guide says the risks are greater if the ligature point is in a room which patients spend time in, in private, without direct supervision by staff; is in a ward/area used by high-risk patients; the ligature point is between 0.7 and 4.0 metres from the ground, or nursing staff cannot easily observe all areas of the ward.
Outside the mental health sector, there are no specific requirements for the management of ligature risks in hospitals. However, according to the Care Quality Commission (CQC) guide on ligature points,3
Low surface temperature (LST) radiator guards can help protect vulnerable people, and are thus widely used in hospitals, care homes, and other healthcare facilities.
Removing one of the risks It is unlikely that every potential ligature point can be removed from every ward – but concealing pipework can remove one of the risks. Furthermore, ‘boxing in’ helps protect pipework from accidental or deliberate damage, reducing maintenance work and costs. Damage to pipes carrying water or gas can have major consequences, including huge building repair costs, and major disruption to essential healthcare services. In addition, boxing in can help create a more aesthetically pleasing environment, with HVAC pipework generally considered unattractive. While in some buildings there appears to be a trend, currently, for leaving copper pipes exposed
October 2019 Health Estate Journal 113
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