A look at bringing verification ‘in house’

While ventilation is used in many areas of a hospital to provide a safe and comfortable environment for patients, staff, and visitors, some clinical areas – such as operating theatres, have additional requirements. We are fortunate that guidance is available from NHS England and NHS Improvement on specialist ventilation for healthcare premises in the form of HTM 03-01,^1,2 the most recent version having been published in 2021. This guidance comes in two parts: Part A¹ deals with the concept, design, specification, installation, and acceptance testing, of healthcare ventilation systems, while Part B² addresses the management, operation, maintenance, and routine testing, of existing healthcare ventilation systems. This article will therefore draw primarily on information in Part B, the focus of which is the routine testing of existing healthcare ventilation systems. 

Starting with a definition, and according to the HTM: “…specialised ventilation is provided to help reduce airborne infection risks in areas such as operating departments, critical care facilities, isolation rooms and primary patient treatment areas”.¹ (2021a, p.1). Hospitals use air-handling units (AHUs) and a labyrinth of ducting to provide and deliver filtered air to air terminal devices (ATDs) at a flow rate and pressure suitable for the clinical setting. All critical ventilation systems require annual verification and performance testing. In many instances this is outsourced to companies that specialise in performing this work. The cost of this work therefore has to be borne by already overburdened NHS budgets. This is surprising at first glance, as all hospitals with air-handling units will have engineering staff appointed as Competent Persons for Ventilation (CP(V)). These CP(V) engineers will have been trained in the necessary audit skills and measurement techniques, and have gained the underpinning knowledge to undertake verification of critical ventilation systems. The CP(V)s will be supported in most instances by an on-site Appointed Person (AP(V)), who will have more in-depth knowledge. This paper will explore the benefits and opportunities for cost savings by moving verification ‘in house’, along with the associated risks.

A Critical Healthcare Ventilation (CHV) system, according to HTM 03-01 (2021a, p.14),¹ is defined as follows: “Certain clinical and non-clinical areas within a healthcare establishment are considered critical to its ability to provide healthcare. Typically, ventilation systems serving the following are considered critical… [e.g. Operating theatres, isolation facilities, Critical Care, Pharmacy aseptic preparation areas, MRI, CT…]” All critical ventilation systems require annual verification and performance testing in accordance with HTM 03-01 (2021). In an acute NHS hospital Trust, there may be upwards of 50 CHV systems (in some Trusts there may be over 100), all requiring an such testing. As part of this requirement, the inspection also demonstrates compliance with the Workplace (Health, Safety & Welfare) Regulations (1992)3 and Building Regulations (2010).⁴ Furthermore, performance verification is an annual requirement to comply with the provisions of the Health Act (2009).⁵