The ‘Update from the IHEEM Technical Platforms’ was given in a mid-morning session at the 2023 AE Conference on 11 July, which was titled ‘Delivering the standard’, and also saw presentations on topics including ‘The importance of CPD’, an ‘Update from the Decontamination Board’ on the work and role of APs and CPs, and an in-depth look at a new ‘digital solution’ on which IHEEM has been working with external software and technology specialist, QuiqSolutions. This is designed to simply, and improve the efficiency of, the AE auditing process, and to help NHS Trusts and Health Boards manage year-round compliance with the relevant HTMs in each area via a new selfassessment tool (see also pages 44-45)
The updates from each IHEEM Technical Platform followed a brief introduction from Eddie McLaughlan, an IHEEM Council Member who chairs the Institute’s Technical Platform Committee. The first Technical Platform representative to speak was Andrew Poplett, an Authorising Engineer for both Water and Ventilation, who explained that a few years ago he had been approached to chair the Ventilation Technical Platform. He said:
“The Platform has existed for quite some time, but in the last three years we’ve tried to bring in more of a structure.” The Ventilation ‘TP’ was ‘slightly different to other Technical Platforms’, in that it has a governance committee structure with all of the IHEEM-registered AEs as members, and a small number of other specialists on the governing committee. He explained: “Below that we have currently 89 affiliate or other members – because ventilation covers many different disciplines, and we wanted a very broad church represented. Everybody with an interest in ventilation is welcome to be an affiliate member.”
Taking a lead on briefing notes
The Platform’s key roles include leading on, and discussing and producing, briefing notes and supplementary guidance notes – ‘especially where guidance doesn’t exist’, and fielding questions from the broader membership. Andrew Poplett added: “Once something has been drafted, it is peer reviewed by the entire VTP membership. i.e. by around 90 other people. We thus hope that when a document gets to publication stage, it is reasonably robust and well-thought-through. So far,” Andrew Poplett continued, “we’ve published a dental standard for ventilation – filling an existing gap on a topic we felt wasn’t adequately covered in the current HTM. The new standard is endorsed under consultation with the British Dental Association, and discusses they key ventilation considerations for locations offering dental services.”
He continued: “We’ve also produced briefing notes on a trend that emerged through COVID of co-infection with Aspergillus. We are looking to issue briefing notes to raise awareness here.” Currently, he explained, the VTP is working on 10 briefing notes or supplementary guidance notes, with each main committee member leading on at least one subject area. He said: “The topics include things such as the correct and appropriate installation of fire dampers, which surely now can’t be a problem? DW/145 has been out for decades; everybody should really know how you install fire dampers, and how to test them.” Andrew Poplett said the VTP had also produced a briefing paper on the orientation and management of attenuators, ‘because we’re increasingly finding they’ve been installed the wrong way around, or on air intakes, and simply acting as primary filters, where they don’t do well’.
The VTP is also keen to cover other ‘serious areas’ guidance-wise, such as where environmental air sampling is taking place in hospitals for areas other than operating theatres. He explained: “So, we are looking to try to generate minimum microbiological safe limits for different clinical areas through ventilation linked to internal air quality research work ongoing. We’re also focusing on heat recovery, and where it can and cannot be applied. So, if you’ve got the PPVLs (positive pressure ventilation lobbies) or isolation rooms, we don’t want recovery on that exhaust air; patients are in isolation for a reason – we want to avoid cross-contamination or recirculation of potential pathogens.”
The VTP Chair said the Platform was looking at publishing a number of papers in draft form over the next 3-6 months, and issuing them to its members. He encouraged all IHEEM members with an interest in ventilation to talk to Head Office, and apply to join the Platform as an associate member. He said: “You will be welcome, and then in a primary position to receive early drafts and make comments. Hopefully over the next 18 to 24 months we will fill some of the gaps identified following the publication of the latest version of HTM 03-01 and some of the other HBNs which – again – the VTP has been involved in commenting on.”
Desire to expand Water Technical Platform
The next TP representative to speak was Paul Nolan, who explained that he had been asked to address delegates in place of the Chair of the IHEEM Water Technical Platform, Mervyn Phipps, who was unable to attend. He said: “We as a Technical Platform meet every quarter, and there are half a dozen members, but we want to expand this. Our primary function is to look at any applications, and whether there are any AEs coming through, as well as focusing on anything we can do to promote the AE role – because people like me will no longer be in post one day, and we will need people to replace us. We have also been focusing monthly on a particular subject; last month it was mycobacteria, in relation to the death of two female patients at Papworth Hospital in 2019.” He had, he explained, just competed 50 hours of CPD learning on mycobacteria.
Paul Nolan said the Water TP also decided what subjects it would like to focus on in HEJ, and then asked volunteers to write the associated article, which was then peer reviewed prior to publication. He encouraged all with an interest in healthcare water systems to get involved with the Platform.
Maz Daoud, Chair of IHEEM’s Fire Safety Technical Platform – for many years an exLondon Fire Brigade firefighter, and today National Fire Safety Lead at NHS England, was the next to discuss his Platform’s activities. He explained that the Fire Safety ‘TP’ had been in existence for ‘about five years’, and currently had six members. He said: “We have representation from Wales, and now also from Scotland, and also have a member who is Chair of NAHFO, the National Association of Healthcare Fire Officers, who we work closely with.” On visiting a ‘new’ Trust as its Authorising Engineer ‘4-5 years ago’, he had asked staff why they had dispensed with their previous AE (Fire), to ‘go with someone new’. He said: “The answer was: ‘Our previous Authorising Engineer was very good, but all he did was tell us what the relevant HTM or British Standards say. That’s not what we want – we can do that ourselves. We want someone who – when we encounter a problem – will explain the options.’”
This was thus the ‘route’ the Fire Safety Technical Platform had looked to pursue. Maz Daoud expanded: “There is the ideal perfect world, but the reality is probably somewhat different from this. So, our approach is that – somewhere in between, there’s a big area which can be deemed ‘well maybe it’s acceptable; maybe it’s not.” He continued: “Alison Ryan (IHEEM’s President, who had spoken earlier) mentioned legal requirements earlier, and fire safety has its own legislation formed around the Regulatory Reform (Fire Safety) Order 2005.”
‘As low as reasonably practicable’
Maz Daoud emphasised that the RRO’s key requirement is for the responsible personnel to reduce the risk of fire ‘to as low as reasonably practicable’ (ALARP). He elaborated: “So, for instance, fire safety equipment must be maintained in an efficient, working order, in good condition. The HTM doesn’t, however, insist you maintain it to the standards in BS 9999.” Against this backdrop, the Fire Safety Technical Platform has written three technical guides, which are on the IHEEM website – one of which is on fire dampers, focusing particularly on the maintenance of such devices. He asked: “How often do you need to maintain them?” He noted that while BS 9999: Code of practice for fire safety in the design, management and use of buildings, ‘doesn’t specifically cover hospitals’, the standard does refer to fire damper maintenance, and had stipulated that electronic fire dampers should be checked every two years. He said: “On its revision in 2017, all of a sudden the recommended frequency changed from two to one year. We asked ‘Why’, and I telephoned one or two fire damper manufacturers and discussed it with them. They told me their latest dampers were more reliable than in the past, so the question remains as to why you should need to check these devices annually – bearing in mind that it costs about £40 to check each, and there are probably over 1000 in each hospital. That means hospitals paying out £40,000 or more on this activity alone to be compliant – a word we don’t much like – with that British Standard.” This was one of the reasons that the Fire Safety Technical Platform had recently issued a guide to fire damper maintenance, which was ‘risk and evidence-based’. The TP had also, Maz Daoud explained, issued two further guides – on fire doors and fire compartmentation.
Fire compartmentation and building / services work
The Platform Chair went on to explain that the Fire Safety Technical Platform was now working on guidance ‘on another aspect of fire compartmentation’. He explained: “Let’s say you want to put some new medical gas pipes through an existing fire compartment, but there has been work done in the location by some fire-stopper in the past and you don’t know which materials, or company’s materials, were used. In order to certificate that compartment again you’ve got to rip it all out and start again, which is ludicrous. Why do we need to do that? So, we are writing a document to cover this eventuality, outlining a more sensible approach. We’ve been working on this with other people, including Alan Oliver, who has done some fire-testing on our behalf, using one particular manufacturer’s fire compartment. Four different penetrations were then put through it using different manufacturers’ products, and they all worked well – so all of that money being spent on ripping out and re-doing is in most cases unnecessary. Our aim will be to explain where it is needed, and where it may not be.”
Another area the Platform is currently looking at, Maz Daoud explained, is audit. He said: “So the Authorising Engineer will go and carry out an annual audit, and the fire authority will normally visit the healthcare facility and undertake its own. So,” he continued, “what do those two groups look at, what should they be asking, and what sort of process should be gone through?” The Platform Chair said members, working closely with the National Fire Chiefs Council, had developed protocols for inspection officers from the fire authorities to follow when they undertake an inspection. He said: “The beauty of this is that it will be available to hospitals and Trusts, so they can go through it and identify all the elements they need to have in mind, so that when the Fire Service arrives, they can give the key data to them. It’s of course a legal requirement to provide this information.” He concluded: “So, that’s where we are currently. We’re working on both of these, and we will also be looking to develop more guidance compliant with the legislation, but not necessarily aligned to British Standards, and probably beyond the scope of the HTMs.”
Medical gases
Next to speak was Graeme Dunn, an Authorising Engineer for Medical Gases. He told delegates: “I’m on the Medical Gases Technical Platform – as are most of the IHEEM-registered AEs for this discipline, although I’m not the Chair.” Graeme Dunn said the ‘big hit’ for medical gases had been the COVID-19 pandemic. He explained: “The Technical Platform was quite active in producing guidance issued to the hospital APs (with input from long-standing medical gas expert, Geoff Dillow), particularly on how to maximise the output from VIE installations.” More recently, the Platform had been looking at the ‘urgently required updates’ to the medical gases HTM, HTM 02-01, which had originally been issued in 2006, and had served its purpose well. Graeme Dunn added: “However, since 2006, or possibly even before, while the document was being drafted, healthcare has changed so much, and the HTM hasn’t kept up to date. I also totally accept what was said earlier – we don’t need somebody to tell us what each HTM says; it’s how to interpret the guidance.”
Graeme Dunn’s view was that most of the AEs for Medical Gases were now in a position where they needed to provide some interpretation. He said: “This is because we know that if we apply the guidance in the current HTM, it’s not resulting in practicable solutions.” He continued: “The scoping document took time to develop from the HTM re-write, which is currently under way.”
Moving to discuss some of the key things the Medical Gases Technical Platform was discussing, Graeme Dunn said: “Well, we really need to look at flowrates and diversity factors. On a new hospital project I’m involved with, I’ve had the good fortune to have a really good meeting with an intensive care consultant and an anaesthetist. Their views on flowrates and what modern medical equipment takes are quite different from the engineers’ view. So, we need to look at flowrates and diversity factors – particularly in relation to respiratory wards in the event that we need to future-proof for a pandemic. As engineers, we can’t do this alone; we have to have engagement with clinical people, which still needs to be facilitated.”
Moving on, Graeme Dunn said that, as any Medical Gas APs would know, ‘surgical air is gone’. He expanded: “There’s very little requirement now for 7 bar air in the theatre environment, so the likelihood is that such air will disappear in the revised HTM.” He explained: “We’re also seeing evidence that medical air at 4 bar pressure is dropping right off as well, which needs to be considered when we are looking at replacing medical air plants. We still have considerable trouble convincing people that when they go to replace a medical air plant, for example, they really should not be considering a like-for-like replacement – because the demand now is going to be considerably lower than when that plant was originally specified.” This could not only affect the plant’s longterm performance, but also had a financial impact on the purchase cost
Decommissioning nitrous oxide plant
Meanwhile the sector was now – Graeme Dunn explained – actively looking at decommissioning nitrous oxide in medical applications, and he was doubtful there would now be any new nitrous oxide systems installed. He said: “We’re looking at Entonox on the ventilation side of things, and it being delivered in rooms where the ventilation air change rates are perhaps not at the required levels for it to be administered.” He added that with BOC having integral valve cylinders, there was ‘an awful lot more use’ of such cylinders to deliver Entonox in healthcare facilities, ‘even when the pipe provision is there’. He said: “Here you can have instances of that Entonox cylinder being provided to a patient, despite them being accommodated in a room never designed, ventilation-wise, for that purpose.”
He believed the sector would probably still see AGSS systems used, because if nitrous oxide ceased to be used, there would be other anaesthetic gases that would need removing from the atmosphere and safely disposing of. He said: “We also have the issue of ‘cracking’, and whether we should use an AGSS system that simply disposes of the gas without treating it in any way.” There was, he noted, cracking technology available – the effectiveness of which was ‘possibly up for debate’. Graeme Dunn said: “We’re looking at commissioning tests – and at changes proposed to training and competence – how training is delivered, and how competences are being assessed.” Work on the medical gases HTM was ‘ongoing’, with a programme established, and ‘some good people working on it’.
Mark Richards, one of the founding members of the Electrical Technical Platform, and the next speaker, explained that the ‘ETP’ had been going since 2014, ‘providing technical responses to queries from healthcare establishments’ APs across the board’. He told delegates: “Like most of the other Technical Platforms, we mainly comprise Authorising Engineers, and we too are looking for volunteers to join us – particularly with the current decarbonisation of the healthcare estate. We’d particularly welcome hearing from experts in batteries and battery energy storage systems to supplement our membership.”
Mark Richards explained that the Platform had ‘been involved quite heavily with BS 7671’, as regards contributions to the regulations, and has several members on each of the Committees that drive the standard. He said: “We’ve successfully – just recently with the amendment to BS 7671 – changed the scope of birthing pools in Section 7, and have changed regulation 422.2.1 regarding protective escape routes; when BS 7671 came out last year, this was causing some consternation with regard to the installation of cables into protective escape routes in hospital environments.”
Contributions to revised HTMs
Mark Richards said the Electrical Technical Platform had also contributed to HTM 06- 02 and HTM 06-03, with several members making contributions to those two guidance documents, which the Platform hoped would be published around this month (September). He said: “It’s taken us two years to go through them – they are reflective of each other, and we needed to make sure they are correct. They were last updated in 2006, so we’ve had a lot of work to do.” The Platform is also leading on the technical proposals for BS7671 as regards the new regulations due out in 2026, and is looking for volunteers and technical proposals from its membership to put forward to the BSI committees to make changes to BS7671 regarding healthcare. One of the changes the ETP is looking at concerns testing and inspection of operating theatres. Mark Richards added: “We also like to engage our membership on any furtherance of electrical requirements within the healthcare estate, so we are continually looking for volunteers and – as Chair of the AE Registration Board for the electrical side, I’d like to see more electrical AEs come through.”
Alison Ryan, IHEEM’s current President, who is also Chair of the Institute’s new Mechanical Technical Platform (HEJ – August 2023), was the next TP representative to speak. She explained the she has a mechanical engineering background, and is keen to hear what those working in the field are looking for in terms of new topics and key and emerging technologies – as she put it, ‘perhaps aspects that you don’t think are well covered by the other Technical Platforms’, e.g. battery storage and EV charging. She said: “I am essentially launching the new Technical Platform, so am very keen to hear others’ views.
The next to speak was Brian Kirk – the Chairman of the Decontamination Technical Platform, which he explained was ‘the Authorising Engineers (Decontamination) group’. He said: “There are 29 of us registered, and we tend to limit the membership to the 29 registered AE(D)s to make it work efficiently.” Members were – he explained – a mix of mechanical and electrical engineers, but also chemists, pharmacists, and microbiologists, because decontamination is ‘such a multidisciplinary area’. Brian Kirk said: “Most of the members are active in healthcare, but we also have a few registered AE(D)s active in the pharmaceutical and medical device sectors, but also members of supplier organisations; it is a broad church. We are just about replacing ourselves as members retire, and registering new people. In the last couple of years, we’ve had three or four new registrants, and we’re about to interview for three more very shortly, but we’ve in fact had the same number retiring, so we have the same problem as everybody – we need more people.”
Moving to discuss some of the DTP’s current ‘projects’, Brian Kirk explained that a medical device called the phaco handpiece provided a real challenge in terms of sterilisation. He elaborated: “Accordingly, there are three of us working on some guidance on how to ensure that these devices are properly decontaminated, particularly at the sterilisation stage. Once the paper is complete, we hope to be able to publish that as an IHEEM guidance document. There is also,” he continued, “an audit tool which we have developed with the endoscopists – the JAG audit tool – which Graham Stanton has continuously updated, since ideas and standards change. Coupled with that is the digitisation of that tool, so people will have access to an app that they can fill in as they go around doing their audit, which will be available to registered AEs. We’re also talking about having a pre-audit tool, which will be available to Trusts before they go through a full audit.”
A ‘basic guide’
The DTP – Brian Kirk explained – is also working with an interdisciplinary professional group to devise what he and his fellow professionals dub the ‘MAC Manual’, although it wouldn’t be thus known – a basic guide to decontamination of medical devices. He said: “Several sections will be hosted on the Central Sterilising Club website, hopefully with free access to anybody that wants a grounding in decontamination.” The Platform is also in the middle of reviewing its education framework to try and encompass some more pharmaceutical aspects of decontamination – particularly in the pharma sector, where ‘a bit of a shortfall in training’ had been identified – ‘especially for those who test sterilisers in the pharmaceutical sector’. Brian Kirk said: “A couple of our members operate in that sector, and have identified the gap, so we hope to be able to extend our education framework to include more pharmaceutical testing.” He added: “There is also some discussion around CPD for APs and CPs, and potentially moving that to a registration process Finally, during the COVID epidemic, we drafted some guidance on the reprocessing of respiratory masks, to give people some pointers on the technology that can be used, and some of the pitfalls.”
With this, Eddie McLaughlan thanked all the session’s Technical Platform speakers, acknowledged there was a ‘great deal of work going on’ within the various disciplines, and noted that in the limited time available the speakers had really only been able ‘to touch on the highlights’. He then opened up the session for questions.