Effective ventilation is vital to ensure safe, comfortable, and efficient indoor environments. For hospitals and healthcare facilities in particular, ventilation is a critical component in a building’s life-support system. There are a number of reasons that specifications for hospital ventilation systems are significantly more stringent than for typical commercial buildings. Use of healthcare premises is particularly intensive, with high power requirements and high occupancy and traffic levels due to the constant flux of patients, staff, and visitors. Patients may be highly susceptible to airborne infection risks, and their medical conditions may require close control of the indoor environment
Healthcare is a significant contributor to the UK’s climate footprint. Health Care Without Harm1 reports that in 2019, hospitals and related buildings were estimated to account for around 5.4% of total greenhouse gas emissions. Given the wide range of equipment and HVAC systems needed to maintain an optimum indoor environment, the legal and technical requirements applying to ventilation for healthcare premises are complex.
Useful guidance is provided by the Health Technical Memoranda (HTM)2 reference series, produced by (NHS) estate specialists and expert cross-industry panels. Guidance on hospital ventilation is explained in HTM 03-01. Published in 2021, it provides updated guidance drawing on the healthcare-specific aspects of current standards and best practices.
Considered an authoritative overview
While not mandatory by law, unless specifically stated, HTM 03-01 is considered an authoritative overview of ventilation requirements for NHS and other healthcare premises. It makes clear that any departure from the guidance requires detailed written justification, as part of the approval process. The guidance comes in two parts: Part A covers design, specification, installation, and acceptancetesting of healthcare ventilation systems, while Part B deals with the ongoing management, operation, maintenance, and routine testing of existing healthcare ventilation systems – irrespective of their age. Together, the documents provide an essential reference for specifiers, designers, suppliers, installers, and Estates and Facilities managers on the legal requirements, design implications, maintenance, and operation. of specialised ventilation in all types of healthcare premises
There have been many changes since the previous edition was published in 2007. The updated version focuses on achieving carbon reduction targets in support of UK legislation to reduce greenhouse gas emissions to Net Zero by 2050.
Design information for specific healthcare applications has been revised, and information on the reason for ventilation given. For example, endoscopy rooms where invasive examinations are carried out are required to have negative pressure. This helps to protect staff from exposure to waste anaesthetic gases released in the room, and airborne infection risks. The application of the change is not retrospective, but applies to new installations and major refurbishments
The HTM also introduces a standard method of identifying and labelling a ventilation system, and the creation of an inventory of installed systems. Guidance is provided on lifecycle, and updating a physical system in mid-life. Plant design information for specific healthcare applications has also been revised, with airflow rates that are more tailored to the applications to take advantage of new fan and control technology. The new technology should reduce energy consumption.
Revised air quality and filter standards are provided for new and emerging technologies. More detailed information is also included on the commissioning process, installation standards, and the appointment of an independent validator. Validation acceptance standards and methodology have also been revised, along with routine inspection and maintenance guidance.
Improving health and safety is another key driver of the updated guidance. While the updates were completed before the emergence of COVID-19, the authors point out that the guidance takes account of all known transmission evidence available at the time of publication.
In this context, it states that ventilation is firmly established as one of the principal mitigations against the virus, and should be part of a package of infection prevention and control measures. The authors conclude that the recommended ventilation rates proposed ‘are likely to provide a lower risk environment for COVID-19 airborne transmission’.
Safety and welfare of maintenance staff
The safety and welfare of maintenance staff attending to hospital ventilation is also addressed – with a requirement to provide covered access for staff while servicing air-handling units located externally on a rooftop or on the ground. This is to ensure that staff are protected, and that equipment is shielded from possible water ingress while access panels are removed during maintenance
To minimise the risk of Legionella and other sources of contamination, effective management of condensate water remains a key consideration. In compliance with the requirements, drain pipework on CIAT airhandling units for hospitals is fitted with special borosilicate glass, enabling service technicians to quickly see any build-up of deposits. The detailed, up-to-date guidance contained in HTM-03-01 provides an excellent head-start and reference for HVAC professionals and Estate managers responsible for hospital ventilation. It addresses the complex needs of all stakeholders – patients, staff, and visitors, as well as the technicians who install and service equipment. The guidance balances the specific needs of each stakeholder with the requirement to improve energy efficiency and reduce environmental impact.
HTM 03-01 states that clear lines of managerial responsibility should be in place so that there is no doubt who is responsible for the safe operation and maintenance of the equipment. It suggests that a periodic review of management systems should take place to make sure that the standards are being maintained.
People who are required to inspect, verify, or maintain ventilation equipment – such as management (duty-holder), designated person, Authorising Engineer, Authorised Person, Competent Person, Infection Prevention and Control person – will need to show that they are competent to do so, and can recognise any faults.
The management of the ventilation systems of a healthcare provider should be overseen by the Ventilation Safety Group (VSG), which should have clearly defined roles and responsibilities. The VSG must create a ventilation policy document, which may simply stipulate that the healthcare provider will follow the guidance contained in HTM 03-01 as appropriate. Suitable safety equipment and training, and how to use it, should be provided by staff carrying out routine inspection and maintenance procedures, overseen by the VSG.
Annual visual inspection requirement
In order to comply with Workplace (Health, Safety & Welfare) Regulations and Building Regulations,3 it is essential that all ventilation systems must be – at the very minimum – visually inspected annually. An annual inspection ensures that the system is still required, the plant conforms to the minimum standard, the fire contaminant has not been breached, the general condition of the system is adequate for the purpose, and the system is operating in a satisfactory manner
Critical healthcare ventilation systems have different inspection requirements. They should be inspected quarterly, and verified annually. Critical systems are defined as operating suites of any type – including rooms used for interventional procedures and their recovery area; airborne isolation facilities; critical care units, neonatal and special care baby units, and invasive treatment, endoscopy, and bronchoscopy rooms. Again, the annual verification checks are to make sure that the system achieves minimum standards specific to the application, that it is operating to an acceptable performance level, and that it remains fit for purpose.
If a critical system is unable to achieve the standard in HTM 03-01, it should not be returned to service, and the dutymanager informed immediately. Copies of the verification report should be sent to the head of the user department, the nominated infection prevention and control person, and the healthcare provider’s AP(V), as soon as possible.
For many of these systems, an equipment release or permit-to-work certificate will need to be completed to ensure that taking the ventilation system out of service for checks does not compromise the activities of the department affected.
Routine inspection and maintenance
Inspection and maintenance activities should be risk-assessed to ensure that they do not create a hazard for anyone undertaking the work. The degree and frequency of inspection and maintenance should relate to the function of the system, its location, its general condition, and the consequence of its failure. All airhandling units (AHUs) should be visually inspected, according to HTM 03-01, at least every three months, to check their external condition, pipework, and electrical connections, sensor and control elements, and the ability to maintain the desired condition in the space they serve. AHU draining systems, filters, and fan coil units, need regular checking and cleaning.
The BluEdge platform is CIAT’s ‘best-in-class’ service and aftermarket offering. Leveraging a history of innovation and deep product expertise, BluEdge gives healthcare facilities the confidence that they are covered by a team that digitally monitors and delivers expert service throughout the lifecycle of their solutions. CIAT has developed the core technologies, knows how to optimally run the equipment, and also how to maintain its peak performance.
The company’s digitally enabled lifecycle solutions use cutting-edge analytics to decipher data, draw insights, and implement solutions, before issues arise.
All our service technicians are trained to the highest professional standards, with full accreditation in F-Gas handling and all other mandatory requirements.
Engineers are equipped with the latest analytical and diagnostic tools, enabling them to pinpoint potential problems before they lead to breakdown and downtime, and optimise performance to reduce running costs and emissions. CIAT’s product ranges actively participate in reducing and controlling the risk of infectious contamination, especially in risk areas, by controlling airborne contamination and providing high-level filtering
Thanks to the Epure filtration solutions’ outstanding capabilities, and large installations or specifically developed mobile air scrubbers, CIAT adapts to various demanding environments, and goes beyond the industry hygiene standards. CIAT also offers devices using UV-C light, to help remove volatile organic compounds and improve IAQ thanks to UV photocatalytic oxidation. #CIAT4life is a campaign to spread awareness of CIAT’s advanced IAQ solutions and services to help create healthier indoor environments.
To help create a safer space, CIAT developed the CIAT CLEAN LINE Dual Mode Air Scrubber & Negative Air Machine. As an air scrubber, the unit can improve IAQ by helping to filter the smallest particle sizes that may carry bacteria and pathogens, then discharging cleaner air back into the room. The machine can also create negative pressure to prevent air from spreading to adjacent rooms in the building.
Lee Jenkins-Skinner
Lee Jenkins-Skinner, CIAT’s AHU specialist, has spent a decade working in the HVAC industry, and brings a wealth of knowledge in air-handling units (AHUs) and ventilation solutions to the company. Having studied design and industrial engineering at the University of Manchester, he began his career as a mechanical product designer, but soon found his true vocation in HVAC as an application engineer.
Joining CIAT in 2018 as a Pre-sales engineer, in 2022 he was promoted to AHU & Rooftop Product manager – a role in which he is responsible for supporting the development of AHUs and rooftop units. He supports the product by providing internal and external training specific to users’ needs, and developing or modifying selection tools to increase productivity.
He has observed CIAT’s AHUs installed in hospital operating theatres, inpatient and outpatient units, and other healthcare settings, throughout the UK and Ireland. Today, he provides the CIAT team with advice and guidance on a variety of standards-related topics, and assists with the design and build of its AHUs
References
1 Health Care Without Harm. https:// noharm-global.org/
2 Health Technical Memorandum 03-01. Specialised ventilation for healthcare premises Part B: The management, operation, maintenance and routine testing of existing healthcare ventilation systems. The Department of Health and Social Care, 2021. https://tinyurl. com/4wwpvzh9
3 Workplace health, safety and welfare A short guide for managers. Health & Safety Executive, December 2007. https:// www.hse.gov.uk/pubns/indg244.PDF