Medical Engineering and Healthcare Engineering: Air, Water and Drains: Why The Environment is Critical for Patient Safety
- Nigel Keery President Elect - IHEEM
There is growing awareness of the need to mitigate transmission of infection through the air in healthcare settings. This includes respiratory diseases such as Covid-19, influenza and TB as well as healthcare-associated bacterial and fungal pathogens where there is evidence that dispersion in air forms part of the transmission pathway. Ventilation is well recognised as an important element for infection control, however many healthcare settings have ventilation rates below those recommended in HTM03-01, and improving ventilation can be costly and often a practical challenge. Air cleaning technologies offer an option to mitigate airborne transmission risks at a lower complexity and energy cost than providing higher ventilation rates.
This paper focuses on the application of germicidal ultraviolet light, and in particularly the emerging technology in the 222nm UV wavelength known as Far-UVC. Compared to conventional UVC at 254nm, Far-UVC is much safer for human exposure and therefore has the potential to be applied as an open field in occupied rooms. Through a programme of work funded by UKHSA and NHS Scotland Assure, we have carried out experimental measurement of the performance of Far-UV lamps against aerosolised Staphylococcus Aureus and Pseudomonas aeruginosa in a controlled room-sized chamber and developed complementary computational fluid dynamic simulations.
Results show that Far-UVC has substantial potential to significantly reduce concentrations of airborne pathogens, with lamps that are within current exposure standards leading to around 90% reduction in S.Aureus during continuous contamination of the room - equivalent to over 30 air changes per hour. Energy consumption may be low as 15W for an 8m3 space. The study findings suggest that Far-UVC is a promising technology and real-world exploration through demonstration trials are an important next step in determining how and where it can be deployed in a healthcare setting.
The healthcare sector is a major contributor to the UK's carbon footprint, with the NHS alone creating around 4-5% of the country's carbon emissions. As a result, science-based Net Zero targets are informing UK energy policymaking and driving the thinking behind organisational climate target setting.
Given public support, political and scientific consensus on the need to achieve Net Zero by 2050, it makes commercial and social sense for organisations to develop and implement high-integrity decarbonisation strategies. Without effective action, climate change will, crucially, have profound implications for the health and wellbeing of the UK's population; the smooth delivery of our health and social care services; and the management of critical infrastructure.
In this presentation, we will review the ways in which investing in sustainability will improve capability, capacity and efficiency across healthcare estates:
• Ageing and inefficient energy estates cause wastage. Avoidable spending can be eliminated in order to enable more investment in improving patient healthcare. Focusing on sustainability can improve operational efficiency, reduce energy costs and meet regulation requirements.
• More time and money can be invested in staff, equipment and machines. As a result, more resources will be available for locum staff and the budget for staff satisfaction, lifting the pressure and strain on the workforce. Estates could also purchase automated equipment to ensure the efficiency of operations.
• A modern, compliant and robust energy strategy will reduce exposure to grid failures. This ensures effective management of energy estates and is critical to protecting patient care and health workers.
• The right partner can accelerate your efficiency goals, ensuring resilience, continuity and cost savings.
• Overall, reducing the carbon footprint of healthcare estates accelerates the UK-wide journey to net zero.
A changing world demands a new approach to energy, to both protect the future, and to improve the present.
1. Reduction of Hospital Acquired Infections (HAIs)
a. NHS Medical Director Stephen Powis: 'single rooms should be the 'default' as they boost privacy and infection control.'
b. 'minimum of 50% single rooms when investing in new or refurbished hospitals' to be considered
2. Prefabricated interior partitioning designed to refurbish existing facilities
a. flexible, adaptable and future-proof interiors are necessary for future operation of healthcare estates
b. Durable, seamless and anti-microbial materials ease operation and maintenance processes
c. Imbedding assets inside walls reduces clutter and promotes infection prevention, eliminating gaps from face-mounted solutions
a. Prefabricated interiors must satisfy HTMs and HBNs
b. Refurbishments must adhere to building regulations on fire and health and safety
c. High levels of acoustic performance should be considered for patient privacy and well-being
4. Bed Blocking
a. MMC should be considered for construction efficiency. Bed spaces are inoperative during a project; quick, efficient construction reduces bed blocking
b. Once installed, ward-closures for maintenance and refurbishments should be minimal. Materials used must be flexible, easy to maintain, repair and reconfigure, improving overall life-span
5. Patient Privacy and Well-being
a. Single rooms must be built with high acoustic performance to promote privacy and confidentiality
b. Patients should be able to opt in and out of visibility of and by others in the bay
c. Well-being is improved through interaction and distraction eg:
i. Integrated monitors and televisions
ii. Writable surfaces
iii. Graphics and natural imagery
iv. Visibility of staff and other patients to reduce feelings of isolation
v. Biophilic design
a. Prefabricated, modular wall systems prevent materials going to landfill
b. Re-use and reconfiguration accommodates technological advancements over time
c. Low emitting solutions meet green building goals and certifications
d. Precise design and off-site manufacturing reduces off-cuts and waste on site
NOTE: This presentation will be delivered as a CPD for learning and not promote any specific products or systems
Being an Authorising Engineer for Lifts is a vital role responsible for providing advice and assistance to NHS Trusts to ensure the safe operation and good management practice of elevator systems.
This role demands expertise in lift engineering, encompassing design, installation, maintenance, and regulatory compliance.
The role will incorporate the annual management auditing of the Trusts Lift Management systems. This audit will cover:
The Authorising Engineer will also assess the competence of the Authorised Person for lifts, providing a recommendation to the Designated Person.
Annual equipment audits are also carried out by the Authorising Engineer, with reports being produced on their condition, compliance and life expectancy. This will allow budget planning for projects to be realised.
Technical advice and design team assistance can also be provided by your Authorising Engineer in relation to lift projects.
NHS hospital trusts have very complex and specific utilities requirements with a real emphasis on the need to regulate heat and ventilation to ensure the comfort and care of patients. So, it's vital that facilities management teams have access to software and systems that can monitor and regulate energy usage. The data these systems produce can be used to drive efficiencies and help to reduce waste and emissions.
Kas Mohammed, Vice President, Digital Energy, Schneider Electric UK and Ireland, will discuss how facilities and estates managers can leverage digital services, and specifically digital twin and virtualisation technologies, to maintain energy efficiency across NHS hospital buildings and estates.
Learning through a safety lens – The presentation will share how the Healthcare Safety Investigation Branch approaches and analyses evidence during an investigation to support generation of safety recommendations which aim to improve patient safety at a national level. The presentation will utilise a case study where equipment was procured with additional functionality that hadn’t been fully understood or considered with dire consequences.
PFI contracts and their success have been contentious and at times divisive, so managing their expiry over coming years represents both a challenge and opportunity in order to achieve positive outcomes. Having a plan in place, benefitting from other's experiences, managing stakeholders successfully, de-risking the process, whilst decarbonising and maintaining the built environment and ensuring continuity of service provision are all key elements of the flight path to expiry and beyond.
This project demonstrates the effective healthcare planning and delivery of some of the key recommendations of the Fuller Report. .
NHS Property Services partnered with Humber North Yorkshire ICB, Nimbuscare (GP Federation), Primary Care Networks, Acute and Mental Health Trusts to reuse underutilised healthcare space and to support the creation of a neighbourhood hub.
In total, 900sqm of under-utilised space of the former mental health residential facility was transformed on a modest budget, thanks to a highly collaborative approach
The ICB led the engagement with the local primary care community, resulting in the suggestion for a shared hub which gained support from all partners.
Nimbuscare took the lead role in developing the clinical services mix working with local healthcare providers.
NHSPS took the lead on redevelopment of the site, appointing design team and construction partners.
A community café was proposed and supported the inclusion of a social prescribing element completely aligns with aspirations of partners.
The ICB supported the proposals agreeing transfer of funding to support the facility costs.
The mental health service provider have retained a presence in the facility for community services and are engaging in hub delivery.
We have estimated that the facilities will benefit many patients in the local area - potentially 22,000.
Patients will receive an enhanced range of services near to where they live.
Social prescribing and the community café is being used by a wide range of services and charities and allows local people to create support networks and potentially reduce loneliness and social isolation.
The range of services offered continues to expand and a second site development is now being considered.
Modern pleasant facilities for staff.
Capital costs significantly lower than alternatives.
Panellists in this session are:
Phil Bryant, Head of Public Sector - Sales, Centrica Business Solutions
Scott Hislop, Principal National Investigator, Healthcare Safety Investigation Branch
Ian Strangward, Managing Director, Architectural Wallsz (International) ltd
Karina Dare, Regional Partnership Director, North East and Yorkshire - NHS Property Services
Panellists in this session are:
Steven Hipwell, Digital Lead NHP Lancashire and South Cumbria, New Hospitals Programme
Kas Mohammed, Vice President, Digital Energy, Schneider Electric UK and Ireland
Panellists in this session are:
Andrew Poplett, Chair, IHEEM Ventilation Technical Platform
Graham Stanton, Chair, IHEEM Decontamination Technical Platform
Panellists in this session are:
David Smith, Director, ILECS Lift & Escalator Consultants
Matthew Vickerstaff, Deputy CEO & Head of Project Finance, Infrastructure & Projects Authority