“Fit for Purpose” ventilation is essential within a healthcare environment, and as such the CQC recognise the importance of auditing verification surveys.

The following provides some detail on the key subject areas. Please contact us for further information or to discuss your requirements in more detail.

Background

Healthcare establishments supporting infrastructure are variable in age and each day there are new medical and technical developments in guidance, manufacture and surveillance. The life expectancy of buildings and equipment is ever being extended making the need for more robust monitoring and management of systems and processes fundamental in keeping Patients, Staff and Visitors safe. In the context of operating theatres and ‘fitness for purpose’ where responsibility is in doing ‘no avoidable harm,’ the validation and verification of the ventilation system is paramount.
Out of sight should not mean out of mind! Air Handling and Ventilation units are often behind the walls in the depths of a locked plant room, seen by very few people directly related to the patient; they are easy to ignore if the awareness of ‘whole organisation’ legislative responsibility is not fully understood.

Care Quality Commission

Care Quality Commission inspections recognise the importance of auditing verification surveys for critical care systems and local exhaust ventilation and will use HTM03-01 Part B as their guide. It clearly states the level of ventilation verification reporting required. The minimal requirement section asks many more questions than those in Appendices 1 and 2 and therefore to achieve full compliance these should be answered.

Validation and verification reporting should not be a ‘tick box exercise’ in the context of patient, staff and visitor safety. It should comprehensively inform key stakeholders and ultimately form part of clinical governance, thus protecting those ultimately named responsible for organisation wide safety at Trust board level.

HVAC & Clinical Health

As history shows, the environment and air around a vulnerable patient significantly contributes to patient safety. ‘Fit for Purpose’ ventilation within the built environment of the healthcare setting is essential to best practice and infection prevention adherence. Failures to comply with relevant measures may compromise ventilation functions and result in patient susceptibility to infection and cancelled lists.

Operational theatre teams are complete only where clinical engineering actually happens, and where staff know how their role may influence patient safety. Integrating HVAC is one part of operating room clinical health governance.

Validation/Verification Process

The process of verification and validation should produce a quality, informative report that highlights the ‘fitness for purpose’ of each ventilation system, corresponding to the critical area that it serves.

Verification processes do not simply highlight the equipment problems; they will also identify training opportunities for clinical and engineering staff that have inadvertently compromised the operational function.

Ventilation comes under the ‘supporting infrastructure’ of healthcare provision and is generally managed by the estates and facilities team or an external facilities management organisation.

However to ensure a whole team approach is taken in the responsibility of the organisation wide goal of ‘no avoidable infection, no avoidable harm including death’, it is essential that the language in the report is clear for the clinical staff.

Typical Areas of Non-Compliance
  • Poorly fitting filters allowing air bypass.
  • Heavily burdened supply equipment and internal fittings with dust and other matter.
  • Low air pressure.
  • Inadequate air volumes.
  • Incorrect air flow dynamics resulting in poorly balanced air flows.
  • Incorrect hierarchy of cleanliness – reverse flow pressure cascades.
  • Operating room equipment blocking air stabilising pathways.
  • Room supply air grilles inappropriately positioned.
  • Insufficient low level extract.
  • Undesirable water pooling in the equipment.
  • Corridor air volumes not measured – these are required to assess provision of “open” and “closed” door protection.
Approved Air Specialised ventilation for Healthcare premises