Pre-commission cleaning ‘essential’

According to recent data published by Health Protection Scotland, cases of Clostridium difficile among the over 65s in Scotland, and cases of Methicillinresistant Staphylococcus aureus (MRSA), are at their lowest since records began. Health Protection Agency annual figures published in July 2010, meanwhile, revealed that the number of C. difficile and MRSA cases in England and Wales fell by a third compared with the previous year. This is, however, no time for complacency, since these reductions have been achieved by many hospitals across the UK taking a hard line when it comes to healthcare-associated infections (HCAIs). The decreases point to good housekeeping measures controlling the spread of these diseases, rather than any significant reduction in the threat of the infections themselves. Key to controlling the spread of HCAIs is ensuring good indoor air quality. To achieve this, a hospital needs to have a clean ventilation system, including clean ductwork. With research proving a link between the spread of HCAIs and uncleaned ventilation systems, it is essential to remove this risk. To control the spread of infections, ductwork’s internal surfaces must be cleaned regularly. If not, there will be a build-up of dust and dirt – a mixture of organic compounds including a high proportion of skin and hair – which are valuable nutrients for microorganisms. These can easily become airborne and thus transmit to patients. The Department of Health’s Health Technical Memorandum (HTM) 03-01 – “Specialised Ventilation in Healthcare Premises” addresses patient comfort and the prevention and control of HCAIs, offering guidance on how hospitals can comply with their duty of care towards patients, staff, and visitors, to meet their legal requirements. The document considers functional responsibilities and minimum requirements for ventilation systems, and advises on annual inspection procedure and verification requirements, as well as addressing issues associated with inspection and maintenance.

Increased risk to patients

The introduction page of HTM 03-01 states: “Increased health risks to patients will occur if ventilation systems do not achieve and maintain the required standards. The link between surgical site infection and theatre air quality has been well established. “If the ventilation plant has been installed to dilute or contain harmful substances, its failure may expose people to unacceptable levels of contamination. Proven breaches of the statutory requirements can result in prosecution and may also give rise to a civil suit against the operators.” Although regular cleaning of a building’s ventilation system is essential for maintaining safe, comfortable, and efficient working conditions, it is not just ventilation in operational buildings that needs to be kept clean. It has long been a myth that protection of ductwork on a construction site is sufficient for maintaining the internal cleanliness of the system in a new building. This is not true. The Heating and Ventilating Contractors’ Association’s TR/19 Guide to Good Practice, Internal Cleanliness of Ventilation Systems, stipulates: “Protection of ductwork on a construction site will not guarantee internal cleanliness of ductwork. Where specific verifiable levels of internal cleanliness are required, it will be the responsibility of the designer to specify the inclusion of a specialist cleaning contractor on the outset of a contract to internally clean newly installed ductwork just prior to commissioning work commencing.”