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Health Technical Memorandum00: Policies and principles of

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Health Technical Memorandum 00:Policies and principles of healthcareengineering

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Health Technical Memorandum 00 Policies and principles of healthcare engineering

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Crown copyright 2013

Terms of use for this guidance can be found at http://www.nationalarchives.gov.uk/doc/open-government-licence/

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Preface

About Health Technical Memoranda

Health Technical Memoranda (HTMs) givecomprehensive advice and guidance on the design,installation and operation of specialised building andengineering technology used in the delivery of healthcare.

The focus of Health Technical Memorandum guidanceremains on healthcare-specific elements of standards,policies and up-to-date established best practice. They areapplicable to new and existing sites, and are for use atvarious stages during the whole building lifecycle.

Healthcare providers have a duty of care to ensure thatappropriate governance arrangements are in place and aremanaged effectively. The Health Technical Memorandumseries provides best practice engineering standards andpolicy to enable management of this duty of care.

It is not the intention within this suite of documents tounnecessarily repeat international or European standards,industry standards or UK Government legislation. Whereappropriate, these will be referenced.

Healthcare-specific technical engineering guidance is avital tool in the safe and efficient operation of healthcarefacilities. Health Technical Memorandum guidance is the

main source of specific healthcare-related guidance forestates and facilities professionals.

The core suite of nine subject areas provides access toguidance which:

is more streamlined and accessible;

encapsulates the latest standards and best practice inhealthcare engineering, technology and sustainability;

provides a structured reference for healthcareengineering.

Structure of the Health TechnicalMemorandum suite

The series contains a suite of nine core subjects:

Health Technical Memorandum 00Policies and principles (applicable to all HealthTechnical Memoranda in this series)

Health Technical Memorandum 01Decontamination

Health Technical Memorandum 02Medical gases

DESIGN & IDENTIFYOPERATIONAL

REQUIREMENTS

SPECIFICATIONSTECHNICAL & OUTPUT

PROCUREMENTCOMMISSIONING

MAINTENANCE

OPERATIONAL

MANAGEMENT

CONCEPTDISPOSAL

OngoingReview

CONSTRUCTIONINSTALLATION

RE-USE

Figure 1 Healthcare building life-cycle

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HTM 07

Environment &Sustainability

HTM 08

SpecialistServices

HTM 01

Decontamination

HTM 02

MedicalGases

HTM 06

ElectricalServices

HTM 03

Heating &VentilationSystems

HTM 04

WaterSystems

HTM 05

FireSafety

Policies andPrinciples

INTERNAT

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L&EUROPEANSTA

NDARDS

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NTERNATIO

NAL&EUROPEAN

STAN

DARD

S

INDU

STRY STANDARD

S

INDUSTRY STAND

ARD

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HEA

LTH S

PEC IF IC DOCUMENTS

HE

AL

TH

SPECIFIC

DO

CUM

ENTS HEALTH

SPECIF

IC

DOCUM

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HTM 00

Health Technical Memorandum 03Heating and ventilation systems

Health Technical Memorandum 04

Water systemsHealth Technical Memorandum 05

Fire safety

Health Technical Memorandum 06Electrical services

Health Technical Memorandum 07Environment and sustainability

Health Technical Memorandum 08Specialist services

Some subject areas may be further developed into topicsshown as -01, -02 etc and further referenced into Parts A,B etc.

Example: Health Technical Memorandum 06-02represents:

Electrical Services Electrical safety guidance for lowvoltage systems

In a similar way Health Technical Memorandum 07-02

represents:Environment and Sustainability EnCO2de.

All Health Technical Memoranda are supported by theinitial document Health Technical Memorandum 00which embraces the management and operational policiesfrom previous documents and explores risk managementissues.

Some variation in style and structure is reflected by thetopic and approach of the different review workinggroups.

DH Estates and Facilities Division wishes to acknowledgethe contribution made by professional bodies,engineering consultants, healthcare specialists andNHS staff who have contributed to the production ofthis guidance.

Figure 2 Engineering guidance

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This Health Technical Memorandum (HTM) providesgeneral guidance on the engineering, technical andenvironmental aspects of healthcare building design.Specific guidance for individual clinical settings isavailable within appropriate Health Building Notes.

Designers should ensure that they read the HTM as awhole, since further engineering guidance may beoutlined and cross-referenced throughout.

Executive summary

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Contents

PrefaceExecutive summary1 Policy, context and requirements 1

AimsScopeRecommendations

Engineering governanceEngineering services

Management of access to engineering servicesDevelopment planningDistribution requirementsAccessWorking in confined spaces

ReviewsExemplar emergency proceduresSample procedure matrixResilience and emergency preparedness

Meeting risk requirementsResilience of electrical suppliesMobile units

UtilitiesSystem capacityUtility suppliesLife expectancy of engineering plant and equipmentMetering

Access to engineering service outlets and controlsInfection controlSpace requirements for engineering plant and servicesMechanical services

HeatingVentilation and coolingHot and cold water systemsAcousticsInternal drainage

Building management systemsFire safety

General fire safety standardsFire detection and alarm systems

General electrical servicesGeneral electrical installations

Electromagnetic compatibilityPrimary electrical infrastructureSocket-outlets for cleaning equipment

Lighting systems

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GeneralEmergency lightingExternal lighting

Patient/staff and staff emergency call systems

SecurityCCTV installationExternal servicesCar park barriersDoor access control systems

Entertainment systemsIT and wiring systems

GeneralTelecommunication systemsIT systems

Pneumatic tube systems

LiftsLightning protection systemsAudio induction loop systemsSustainability and energy efficiencyValidation and handover of engineering installations

2 Statutory and legislative requirements 22Health and safety

Regulations, Approved Codes of Practice, Standards and guidanceOther commonly cited legislation

ElectricalMechanicalEnvironment

RadiationFireFoodPublic health

Risk and/or priority assessment3 Professional support 26

Management and responsibilityManagement structureProfessional structureRoles and responsibilities

Designated Person (DP)

Trust Senior Operational Manager (SOM)Authorising Engineer (AE)Authorised Person (AP)Competent Person (CP)

Variation by service4 Operational policy 29

Operational considerationsRecords/drawingsSecurityMonitoring of the operational policyContractorsMedical equipment purchase

5 Emergency preparedness and resilience 31OverviewCreating an emergency plan

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System resilience, planning and designServices and prioritiesExternal impactSecurity

ResponsibilityStaff functions

CommunicationsIncident managerResource managerEmergency procedure manual owner

Testing the plan6 Training, information and communications 35

OverviewBuilding occupiersService and maintenance staff

The required workforceImproving the workforce profileCriteria for operation

7 Maintenance 37Overview

Maintenance contractorsMaintenance policyToolsInstructionsMaintenance frequency

Maintenance planningOriginal commissioning tests

Original and amended drawingsFunctional testsInspections prior to recommissioning

Planned maintenance programmeDesign of a planned maintenance programmeReview of the planned maintenance programme

8 References 40

Contents

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1.1 This Health Technical Memorandum providesgeneral guidance on the engineering, technical andenvironmental aspects of healthcare buildingdesign. Specific guidance for individual clinicalsettings is available within the clinical topic itself.

1.2 Consultation should take place at project anddesign team level to ensure understanding of keyissues, healthcare delivery and the appropriatestandards for healthcare engineering services.

1.3 Designers should ensure that they read thispublication as a whole, since further engineeringguidance may be outlined in and cross-referencedwithin other sections.

1.4 Health Technical Memorandum 00 Policies andprinciples of healthcare engineering covers thefollowing issues:

a. overview of engineering services guidance;

b. statutory and legislative requirements;

c. professional support;

d. operational policy;

e. training and workforce development;

f. emergency procedures and contingencyplanning;

g. training, information and communications;

h. maintenance;

j. engineering services. Guidance on specific typesof engineering services can be found as follows:

(i) Decontamination (Health TechnicalMemorandum 01)

(ii) Medical gases (Health TechnicalMemorandum 02)

(iii) Ventilation systems (Health TechnicalMemorandum 03)

(iv) Water systems (Health TechnicalMemorandum 04)

(v) Fire safety (Health Technical Memorandum05)

(vi) Electrical services (Health TechnicalMemorandum 06)

(viii) Environment and sustainability (Health

Technical Memorandum 07)(ix) Specialist services (Health Technical

Memorandum 08)

(x) Other existing HTM 2000 series guidancedocuments.

1.5 The design, construction and operation of healthand community care bulidings should comply withall relevant aspects of engineering guidance,statutory requirements and best practice to ensurehigh-quality engineering installations and services

suitable for their application.1.6 The healthcare version of the National Engineering

Specifications (nes) replaces the old ModelEngineering Specifications and is designed to helpproject teams with writing specifications.

Aims

1.7 Everyone concerned with the managing, design,procurement and use of a healthcare facility shouldunderstand the requirements of the specialist,critical building and engineering technologyinvolved.

1.8 Only by having a knowledge of these requirementscan the organisations board and senior managersunderstand their duty of care to provide safe,efficient, effective and reliable systems which arecritical in supporting direct patient care. When thisunderstanding is achieved, it is expected that (inline with integrated governance proposals)appropriate governance arrangements would be putin place, supported by access to suitably qualifiedstaff to provide this informed client role, whichreflect these responsibilities.

1.9 By locally interpreting and following this guidance,boards and individual senior managers should be

1 Policy, context and requirements

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able to demonstrate compliance with theirresponsibilities and thereby support a culture ofprofessionalism which instils public confidence inthe capability of the NHS at local level.

Scope

1.10 Healthcare premises are dependent on the safe andsecure function of critical engineering services, theapplication of sound environmental measures, andthe support of key services. There are somecommon principles that apply across the full rangeof engineering guidance and support the widerinterface of all healthcarerelated equipment andits environment.

1.11 The concept of providing and maintaining safe andsecure critical services carries a high priority andapplies across the widest range of applications. Itmust apply to patients, staff and the general public,that is, all users of the healthcare environment.

1.12 In a similar way, the duty of care in operationalperformance can contribute to the overall efficiencyand safety of a healthcare organisation. Accessibilityto suitably qualified and competent staff is a keyfactor when considering governance arrangements.

1.13 Evidence suggests that a comfortable healthcare

environment can have a strong influence on thehealing cycle. This needs to be achieved in asensitive way, with design having regard to thefunction and purpose of the specific and adjoiningareas.

1.14 Staff and services must be resilient to ensurecontinuity of business and the safety of patientsand staff, and be capable of providing a suitableresponse to maintain a level of healthcare in allcircumstances. This guidance addresses the generalprinciples, key policies and factors common to all

engineering services within a healthcareorganisation. Key issues include:

general health and safety;

professional support;

operational and training requirements;

emergency preparedness;

workforce planning and capability;

maintenance.

1.15 To determine the right level of approach will oftenrequire an assessment of the risk and an evaluationof the factors that remain when reasonable and

practical measures have been taken to minimise theelements giving rise for concern.

Recommendations

1.16 Boards and chief executives as accountable officersshould use the guidance and references provided:

when planning and designing new healthcarefacilities or undertaking refurbishments;

when developing governance systems which takeaccount of risk;

to establish principles and procedures which:

(i) recognise and address both corporate and theindividuals responsibilities;

(ii) recognise the link between criticalengineering systems and emergencypreparedness capability;

(iii) reflect the important role that engineeringpolices and principles, as implemented bysuitable qualified professional and technicalstaff, can have in support of direct patientcare.

1.17 Once boards and chief executives have embracedthe principles set out within this guidance and

taken the necessary actions, their duty of careresponsibilities are more likely to be fulfilled, as willtheir ability to maintain public confidence in theNHS at local level.

Engineering governance

1.18 Responsibility and, more specifically, the duty ofcare within a healthcare organisation are vested inthe management board and its supportingstructure.

1.19 Engineering governance is concerned with how anorganisation directs, manages and monitors itsengineering activities to ensure compliance withstatutory and legislative requirements.

1.20 Systems and processes need to be in place, backedup with adequate resources and suitably qualifiedand trained staff.

1.21 Healthcare organisations should ensure that soundinternal controls, safe processes, working practicesand risk management strategies are in place tosafeguard all their stakeholders and assets to prevent

and reduce harm or loss.

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Engineering services

Management of access to engineering services

1.22 Healthcare organisations have the responsibility toensure that all service installations are specified,designed, installed, commissioned and maintained(including future upgrade) with consideration forservices modifications and dismantling during thelife of the building.

1.23 To satisfy these requirements, it is recommendedthat organisations:

a. designate a person responsible to coordinate allthe engineering services to ensure that theservices do not have any adverse effects on each

other, the structure and personnel safety;

b. ensure that a project file is available for all newprojects, alterations or extensions, regardless ofthe size of the project. The file should containspecifications, drawings, and maintenanceinformation including access and safe disposalat the end of its useful life;

c. ensure that adequate space is provided forinstallation and maintenance staff andappropriate access to services;

d. adequately brief the designers on the currentand future maintenance policies;

e. ensure that any new work, alterations ormodifications do not restrict existing access toplant and equipment.

1.24 Details of any asbestos survey must be madeavailable to the design team and any contractorsprior to carrying out any work.

1.25 The Control of Asbestos Regulations 2006 includesduties to protect those who come into contact with

asbestos unknowingly or accidentally. The surveyreport should include details of any asbestos-containing materials, their condition and location,and when they were last inspected.

1.26 A zoning policy allocating particular zones forspecific services should be agreed early in the designstage. The policy should also allocate crossoverzones, minimum separation distances and shieldingrequirements in the event of it not being possible tomeet these requirements.

1.27 Before putting any engineering systems into service,the installation should be inspected, and it shouldbe verified that access is available for

commissioning, maintenance, and futureupgrading.

1.28 It should also be verified that there are adequate

provisions made for additional services anddismantling during the life of the system.

Development planning

1.29 It is essential to ensure that both engineering andarchitectural aspects are developed simultaneouslyfrom project inception. This should ensure thatsystems are safely integrated in terms of location,distribution and future developments, and thatservice resilience is planned from the start.

1.30 The architectural design should permit sufficient

space for services. Provision of extra space to allowfor future development is considered as bestpractice.

1.31 Accurate and detailed drawings are essential forproviding space requirements. However, these maynot be available at the early design stage. Anestimate of space requirements may have to bemade on preliminary drawings in order to avoidcostly revisions.

Distribution requirements

1.32 An assessment of the distribution requirementsshould be considered, taking into accountcommunication, area, plant and distribution. Thismust be related to the specific size and shape of thebuilding etc.

1.33 Accommodation of vertical services will be decidedat an early design stage. The information may be inthe form of total area requirements to be dividedlater as design progresses.

1.34 Resilience and flexibility of services distribution

should be included at an early stage.1.35 Departments that require heavily-loaded services

should be grouped together and located near to thedistribution centre if possible. This avoids largeruns and therefore distribution losses. Dependenton the building design, it may be advantageous forservices to follow the main communication routes.

1.36 Generally, the energy centre is the first plantroomto be installed on-site. This allows the main serviceroutes to be determined. The next step would be todetermine areas required for other plantroomsincluding, for example, those at rooftop level.

1.37 Consideration should be given to maximising theflexibility of engineering services to allow the

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maximum possible changes in the use of hospitaldepartments.

1.38 In multi-storey buildings:

a. most flexibility is achieved by a small number oflarge vertical ducts with adequate provision forhorizontal space above ceiling level and belowstructural members;

b. generally, less flexibility is achieved by a largenumber of smaller vertical ducts with ceilingspaces for horizontal distribution as necessary;

c. the omission of space above ceilings producesthe least flexible arrangement.

1.39 Convenient access should be provided to all service

spaces.

1.40 In single-storey buildings:

a. sufficient headroom should be allowed forinstallation and maintenance purposes;

b. if a service trench is provided, where practicable,removable covers should be provided over thecomplete length of the trench.

Access

1.41 Access to services should be considered at everystage of both the architectural and engineeringdesign process.

1.42 The frequency of access required should be themain factor considered.

1.43 Frequent access:

a. immediate access is required for plant, valves,switches and other controls requiring frequentattention for safe operation and maintenance;

b. if enclosed, the access should be by door or

panel;c. adequate clearance should be provided for ease

of working.

1.44 Intermittent access:

a. items that require access at intervals (forexample monthly) can be provided by means offloor traps, removable panels in walls, falseceilings and so on. It is recommended thataccess panels be fitted by means of retainedquick-release mechanisms rather than screws

and cups.1.45 Renewal or modification of service:

a. most, if not all, services may requiremodification or renewal during the useful life ofthe building. Accommodation should beplanned for this to occur, taking into account

weight, size and configuration of the item.During non-emergency renewals, it may bepossible to remove door frames, windows,partitions and other non-structural items. Therenewal or modification of minor items doesnot usually create problems except where pipingor cable lengths are restrictive;

b. the destruction of finishes to open up a trenchor vertical duct or existing access could be moreeconomic than the provision of expensive butrarely-used permanent access. Costs versus

savings must be considered with regard to thecost of inconvenience/ disruption to functionsincurred at the time of replacement.

Working in confined spaces

1.46 A confined-space permit-to-work system should beestablished, and personnel trained in the use of thesystem.

1.47 The system should address the following points:

assessment of the task to be undertaken;

identification of the potential risks/hazards;

ventilation;

air quality testing, prior to entry andcontinuously during access requirements;

provision for special tools and lighting;

working methods;

implementation of the working methods;

monitoring of compliance of the system;

actions in case of emergency;

communication;

first-aid.

Reviews

1.48 Management should conduct regular reviews of theeffectiveness of the healthcare organisationsengineering structure and systems. The reviewshould cover all controls, including strategic,operational, safety and engineering riskmanagement.

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Exemplar emergency procedures

1.49 The following procedures have been prepared bytrust estates and facilities management (EFM)

personnel to meet the needs of their ownorganisations during an emergency.

1.50 They are not intended to be appropriate ordefinitive for all sites, but they give an idea of the

types of format which may be used, and thedifferent levels of technical content which may beappropriate on different sites.

1.51 Further procedures will be required within ahealthcare organisation, and a regular review isimportant to ensure that directives, staff andequipment remain current.

Procedure for electricity supply failure

Operational procedure reference no: ..

Hospital location: ..

Healthcare description (A&E, CCU, Ward 6 etc): ..

Key areas of equipment likely to be

Lighting, medical equipment, fixed and/or mobile computers and associated equipment, other non-medicalequipment (catering, waste disposal etc), communication systems (telephones, nurse call etc), heating andventilation.

Risk assessment

is procedure is linked to the overall hospital site procedure for failure of electricity supply and departmentalrisk assessment register. is document should be reviewed on a regular basis and especially if any alterations toequipment function, staff and responsibility take place.

Aims

is emergency procedure is intended to highlight the key issues that may arise at departmental level in the eventof electrical power failure. It is appreciated that this may be the result of a full site power failure, but it may alsobe the result of a local failure for which notification will be necessary. e main aim is to provide a structuredapproach to the safety of patients and staff and to minimise the risk associated with an electrical failure.

Identification of failure

is may be indicated by the failure of key observable elements, for example lighting and computer displays, butmay also be indicated by alarm signals from monitored supply panels on medical equipment, services andsystems.

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Major supply failure

In the event of an obvious full electrical failure, do not wait for the restoration of supplies by generator, but

immediately take action.Staff should safely complete or suspend any procedure being undertaken and prioritise their attention on themost critical equipment and/or patients. Local standby supplies and equipment-based systems should be checked.Where necessary, manual intervention should be started to ensure the safety of patients.

When supply is restored by generator, staff should ensure that all essential equipment is functioning correctlyand, where necessary, transfer equipment or patients onto essential supplies.

On restoration of the normal supply, staff should check that all systems and equipment have reset to normal.

Continued supply failure

If full supply loss should continue for several minutes, immediately contact the hospital duty manager via the

switchboard. e switchboard will also contact the duty engineer for attention.Within the department, prioritise duties to ensure safety of patients and take preventative measures, wherepossible, to minimise the workload.

In the event that it is identified as a local failure, contact the duty manager to gain further staff support fromother adjacent unaffected areas, or arrange to move the most critical patients to other departments.

Partial supply failure

If only part of the departments electrical systems fail, it is unlikely that standby systems will restore suppliesin the immediate term. First, minimise the risk to patients and identify the extent of the failure. Contact theswitchboard, who will alert the duty engineer and duty manager. Continue to monitor the situation and move

critical equipment and/or patients to fully supported areas where possible.

Awareness and training

Electrical supply failure is one of the most wide-ranging impacts on the normal running of a department. It islikely that staff will be engaged in the regular testing of the standby systems, but further local awareness shouldbe engaged to ensure that all staff are aware of the departmental issues and the effects of a longer-term and fullfailure. Where possible, this should be carried out at the workplace, but with minimum impact on patients.Senior managers should liaise with the estates engineer to arrange simulation and practical support.

Emergency procedures should be an essential part of new staff induction to the department to ensure all localissues are fully understood.

Review procedure

From incident experience and training evaluation, this procedure and any supporting information should bereviewed and amended as necessary to ensure the document remains up-to-date and definitive for thedepartment.

is document was first issued on: .. (Date)

Amendments: ... (Brief details and date)

Plan approved and accepted by:

Senior manager

Head of department: .

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Procedure for water contamination

Operational procedure reference no: .........................................................

Other relevant procedures: Engineering scheme to provide piped fresh water supplies

Scope

e following procedure is designed to instruct and advise on the operational requirements for dealing withcontamination of the water supply. It is not considered a definitive guide as the particular circumstances of theincident will ultimately determine the course of action taken. It will attempt to highlight the responsibilities ofestates staff, clinical staff and on-call administrators.

Causes

Water may become contaminated in a number of ways, including:

contamination of the incoming water supply to the hospital site;

contamination due to substances inadvertently or maliciously added to the water storage systems;

contamination caused by the corrosion or decay of materials in contact with the water supply, for examplerusting metal and dead animals;

cross-contamination of water supply due to the effect of a process carried out on site by staff or contractorswhere the safety devices are inadequate or non-existent, for example cross-contamination due to siphonagefrom drains and stagnant water;

misoperation/failure of water treatment plant;

migration between domestic hot and cold water services.

Effects

e possible effects of contamination are varied, and will depend on the severity and degree of thecontamination. However, further investigation should be carried out if:

staff complain about the taste of the drinking water;

the water is discoloured;

the water has a distinctive smell (this could be the result of chemicals (for example chlorine), acid, sewage ordecaying matter);

the water appears normal but people using it have become sick.

Investigation and response

e size of the affected area must first be ascertained. is will give some indication of the extent of the problemand may help to identify the source of the contamination.

e following actions may or may not require to be taken, depending on whether part of or the whole watersystem has been contaminated:

inform the senior staff of affected departments to cease using the water;

contact the local water authority. e contamination may have originated from the main water incomingsupplies; there is likely to be an obligation not to contaminate the public water network;

take samples as necessary to determine the nature of the contamination; once the extent has been determined, an assessment should be undertaken as to the nature of the

contamination. e use of microbiology staff is recommended;

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isolate the affected area from the main supply to prevent further contamination;

take samples at various points within the affected area(s) for future analysis;

contact on-call or emergency administrative staff and advise them to arrange a supply of fresh water for areasrequiring it;

dependent on the nature of contamination, the cause may be obvious or easily located. If this is not possible,carry out a systematic investigation of water supply systems;

if the cause of the contamination is located, isolate the contamination and carry out necessary works to resolvethe situation;

inform medical staff of the nature of the contamination and await advice on the clinical effect before restoringthe water supply to the area;

thoroughly flush all pipework (run taps, flush toilets, bidets etc) until further analysis shows no trace ofcontamination;

when the water quality is restored and confirmed by medical or microbiology staff, allow normal use tocontinue.

Further work

Study how the contamination has occurred and carry out preventative work if possible to avoid recurrence.

Review the operational procedure for the incident and modify as necessary.

Note the date and time of the incident, action taken and by whom, for future reference.

Relevant drawing nos: ..........................................................

Additional information...............................................................................................................................................................................

...............................................................................................................................................................................

...............................................................................................................................................................................

..............................................................................................................................................................................


Board member: .......................................................................................

Risk assessment

is document is linked to risk assessment no ..................... It should incorporate existing controls contained inthe risk assessment and should be modified if any changes to the risk assessment are made.

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Procedure for piped medical gas failure

Operational procedure reference no: .........................................

Hospital location: ...........................................................

Plant or system description: .................................................

Systems in use:

Oxygen ref ................. Nitrous oxide ref .................

Nitrous oxide/oxygen ref ................. Medical air ref .................

Aims

e aim of this emergency procedure is to provide guidance and a structured approach to the managementresponse in the case of a major failure in supply of piped medical gases, and to safeguard patients at risk from any

such failure.

Identification of the source and nature of failure

is will normally be indicated by an alarm actuation at one of the following locations:

telephone exchange;

porters lodge;

boiler room;

main corridor;

ward 1;

ward 2;

ward 3.

On actuation of the alarm, the hospital switchboard must be contacted with a description of the alarm legend.e switchboard operator will immediately contact the Duty Engineer or Duty Authorised Person (responsibilityallocated in the medical gas pipeline system (MGPS) operational policy) for the initial response and investigationof the fault, and will follow switchboard procedures.

e situation will be assessed by the Duty Engineer and categorised accordingly as a minor or major failure of thesystem.

Minor failure, not life-threateninge Duty Engineer will contact the Authorised Person to have repairs carried out in accordance with HealthTechnical Memorandum 02-01, and inform the Duty Senior Manager of the cause and outcome of the situation.Permits-to-work will be issued in accordance with Health Technical Memorandum 02-01.

Major failure of supply

If a major failure of supply has occurred, the following procedure is to be followed by the Duty Engineer, whowill carry out the initial assessment and arrange for the following personnel to be contacted:

Authorised Person Senior Manager Senior Pharmacist Senior Nurse Senior Medical Officer/Surgeon

e situation will be re-assessed by the Senior Manager and a decision taken as to whether the major incident

plan is also implemented and brought into operation, together with the procedures outlined in this document.

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Damage control

e cause and result of the damage to the system should be investigated by the Duty Engineer/Authorised

Person.Drawings and schematics should be readily available.

Steps should be taken to limit the amount of disruption, and a temporary supply should be secured by eithervalving or capping of damaged areas to enable emergency supply banks to cope during repairs. Failing this,sufficient portable cylinders should be provided at the point of use.

Following damage limitation, valve-off the damaged section where possible and ensure back-up supply banks arefunctioning.

Team members attendance should be confirmed. ey should assemble at a predetermined location wherecontrol will be handed from the Duty Engineer/Duty Estates Manager to the responsible Senior Manager.

e areas of responsibility for the various team members are outlined, but this list is by no means exhaustive andshould be further developed in the light of knowledge as the incident develops.

Areas of responsibility

Telephonist

First-line communications.

Initial coordination of response.

Assists with all communications and logs calls and responses.

Senior Manager

Coordination of all team members.

Recovery strategy and repair coordination.

Documentation.

Senior Pharmacist

Ordering and procurement of gases.

Purity checks on reinstatement of supply.

Senior Medical Officer, Surgeon/Senior Nurse

Clinical prioritisation of supply requirements.

Liaison with doctors and nursing staff.

Movement of patients where necessary.

Advice to other team members on clinical criteria.

Duty Engineer/Authorised Person

Initial response and coordination.

Damage limitation and securing supply.

Diagnosis and repair of failure.

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Provision of temporary supplies (pipeline).

Testing and verification on reinstatement.

Recommissioning and documentation.

Designated Manager, Hotel Services

Provision of portering staff for moving and changing cylinders.

Liaison with other team members for manpower requirements.

Organisation of patient transport where needed.

Organisation of transport for support services.

Liaison with outside agencies and press.

Communications.

Debriefing

Following return to normality, a team debriefing should be held to review the emergency procedure and updateor correct any apparent weaknesses.

Review procedure

is procedure will be reviewed following any change in personnel, equipment, materials and environment orfollowing any change. It will be reviewed at regular intervals not exceeding 12 months.

Training and information

All staff involved will receive adequate training and instruction to enable them to carry out these procedures withconfidence during an emergency. is training will be recorded in the log attached, and updated on a regularbasis.

Amendments


Board member: .....................................................................

Risk assessment

is document is linked to risk assessment no ..................... It should incorporate existing controls contained inthe risk assessment and should be modified if any changes to the risk assessment are made.

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Sample procedure matrix

Operationalchecklist

Defineownershipoftheproblem?

Willpatient/Public/Staffsafety/care

beaffected?

Willevacuationberequired?

Riskoffireoutbreak,orreducedfire-fightingability?

Considerimpactonelectricitysupp

ly?

Considerimpactongassupply?

Considerimpactonwatersupply?

Considerimpactondrainage?

Considerimpactonotherservices?

Increasedriskoflegionella?

Considerimpactonsitesecurity?

Impactonfirealarms?

Willmedicalgasesbeaffected?

Isthereanimpactonclinicalwaste?

Agreeresponsibilityboundaries

Clinicaldepartmentprocedures?

ControlofInfectionTeaminvolvem

ent?

Dopublicrelationsneedtobeaddressed?

ConsiderServiceLevelAgreements

withpurchasers?

Involvecommercialservices?

RecordTrustpersonnelcontactdetails?

Locatesupplyofspecialistequipment?

Locateapprovedsubcontractors?

Recordspecialistcontractorcontact

details?

Keeprecordsofactionstaken?

Air-conditioningAir pollution

Asbestos

Buildingmanagementsystems

Boilers

Clinical waste

Domestic hotwater

Drainage

Electricity supplyfailure

Explosions

Other extremeweather conditions(eg heatwaves,cold/frozen spells)

Fire

Flooding

Gas

HeatingIncinerators

Infestation

Kitchens

Laboratory failures

Lifts

Medicalengineeringequipment

Operating theatres

Piped medical gasesPaging

Refrigerators

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Resilience and emergency preparedness

Meeting risk requirements

1.52 Clinical risk, business continuity risk and safetyfactors are critical and with them the requirementfor safe and resilient engineering services in supportof the environment and equipment used to fulfilthe functions of the premises.

1.53 The design and operation of health and communitycare premises should therefore take full account ofplanned and potential future increases in clinicaland business continuity risks appertaining to thefunctions of the premises and ensure that all keyengineering services are sufficiently robust tocontinue operating satisfactorily during emergencysituations so as to minimise the risk of harm topatients, staff and visitors.

1.54 This should include consideration of engineeringservice requirements during loss of normalincoming utility and local supplies and duringactivation of emergency preparedness plans.

1.55 See also Chapter 5, Emergency preparedness andresilience.

Resilience of electrical supplies

1.56 The resilience of the electrical supply anddistribution system and the capacity of any

secondary power sources such as emergencystandby generators and uninterruptible power

supplies (UPS) should be established following theassessment of clinical and business continuity risks.

1.57 It may be appropriate to provide separate essentialand non-essential small power distribution systemsor a dual unified system. This will enhance theresilience of the electrical services as well asfacilitating the ability to test and repair faultysystem components whilst sustaining continuity ofsupply to operational areas. Electrical supplyresilience provisions should comply with therequirements of Health Technical Memorandum

06-01 Electrical services supply and distribution.

Mobile units

1.58 Certain clinical services may be delivered frommobile units, for example:

mobile breast screening units;

mobile CT/MRI scanning units;

mobile theatres.

1.59 These units may be self-contained or may need to

be connected to mains services.1.60 Where connection to mains services is required,

these should be provided in appropriate locationstaking into account the following factors:

Operationalchecklist

Defineownershipoftheproblem?

Willpatient/Public/Staffsafety/carebeaffected?

Willevacuationberequired?

Riskoffireoutbreak,orreducedfire-fightingability?

Considerimpactonelectricitysupply?

Considerimpactongassupply?

Considerimpactonwatersupply?

Considerimpactondrainage?

Considerimpactonotherservices?

Increasedriskoflegionella?

Considerimpactonsitesecurity?

Impactonfirealarms?

Willmedicalgasesbeaffected?

Isthereanimpactonclinicalwaste?

Agreeresponsibilityboundaries

Clinicaldepartmentprocedures?

ControlofInfectionTeaminvolvement?

Dopublicrelationsneedtobeadd

ressed?

ConsiderServiceLevelAgreementswithpurchasers?

Involvecommercialservices?

RecordTrustpersonnelcontactdetails?

Locatesupplyofspecialistequipment?

Locateapprovedsubcontractors?

Recordspecialistcontractorcontac

tdetails?

Keeprecordsofactionstaken?

Sewage plantSterilization

Telephones

Transport incidents

Watercontamination

Water supply

Water treatment

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external access arrangements;

supplies capacities;

the need for isolation and protection of mains

services;

earthing arrangements;

the need for weatherproofing of externalequipment;

type of connection and security.

Utilities

System capacity

1.61All engineering systems and equipment should befit for purpose and designed to have an initialcapacity to safely accommodate peak maximumloads plus an additional allowance of 25% forfuture expansion.

Utility supplies

1.62 Where new or changes to existing incoming utilityservices are required, discussions should take placewith each utility company concerned to establishincoming service routes, capacity requirements,tariffs, meter locations, access provisions and wayleave requirements as soon as practical during thedesign process.

Life expectancy of engineering plant andequipment

1.63 All principal items of plant and equipment shouldhave a minimum life expectancy as described inCIBSE Guide M.

1.64 Materials and components that will requiremaintenance and replacement during the life of the

facility, should be selected, located and fixed insuch a way as to minimise future inconvenienceand disruption and to avoid temporary closure ofall or part of the facility.

Metering

1.65 Health and community care premises should befitted with adequate provisions to monitor allprimary incoming and sub-distribution engineeringservices sufficient to comply with statutorylegislation and to support energy efficiency.

Access to engineering service outletsand controls

1.66 The design and positioning of engineering service

outlets and controls should take account of safetyand access requirements. This includesconsideration of the following:

a. height of light switches, socket-outlets, taps andcontrols;

b. temperature of hot water and surfaces ofradiators, heat emitters and hot water pipes;

c. provision of audio-visual indicators and signagewhere appropriate (for example fire alarmsystems).

Infection control

1.67 Informed by a clinical risk assessment, the designand installation of engineering services shouldincorporate adequate measures to minimiseinfection control risks so far as is practicable. Inparticular, precautions should be incorporated toensure that within areas occupied by patients, staffand visitors:

a. Ventilation provisions are adequately filtered

with air changes and pressure differentialsmaintained in accordance with Health TechnicalMemorandum 03-01 Specialised ventilationfor healthcare premises and other guidance toreduce the risk of HCAI.

b. All exposed surface finishes of engineeringservices and equipment are generally smooth,accessible and easy to wipe clean.

c. Engineering services pipework, heat emitters,electrical trunking, luminaries, accessories andspecialist fixed control equipment are

appropriately encased to present a smoothexposed surface with gaps sealed with a suitablesubstance to control the potential harboring andpropagation of bacterial growth.

d. Sloped surfaces are provided instead ofhorizontal surfaces to reduce the build-up ofdust.

e. All engineering components and equipmentthat are regularly handled by patients, such aslight switches, nurse call units, door entry

controls, TV sets etc are capable of being wipedclean and disinfected or sterilised betweenpatient use.

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Space requirements for engineeringplant and services

1.68 The building design must incorporate adequate

space to enable the full range of engineering plantand services to be installed and kept operational.

1.69 Space for plant and services should provide:

an easy and safe means of access;

secure accommodation protected fromunauthorised access;

adequate space around the plant and services topermit inspection, maintenance andreplacement; and

for the installation of further plant and servicesat a later date where this is anticipated to berequired.

1.70 Guidance on spatial requirements for engineeringplant and services is contained in paragraphs 1.221.47.

1.71 Further useful information on the provision ofspace for plant is contained in BSRIA TN 9/92,and for building services distribution systems inBSRIA TN 10/92.

1.72 With the exception of drainage and some heatingpipework, engineering services should not bebrought from the ceiling void of the floor below.Service distribution to a particular area should becontained within the service spaces on that floor.

1.73 Plant rooms, particularly for air-conditioning andventilation, should be located as close as possible tothe areas they serve, thus minimising the amount ofspace necessary to accommodate large ducts.

1.74 Care should be taken to ensure that noise andstructure-borne vibration cannot be transmittedbeyond the plant room. Further guidance onacoustics and vibration can be found in Acoustics.

Mechanical services

Heating

1.75 General space heating requirements may be met bya variety of systems including under-floorpipework, radiators or ceiling-mounted radiantpanels, or by an air conditioning system. Designersshould ensure that the most appropriate method isemployed with regard to the healthcareenvironment being provided.

1.76 The surface temperature of radiators should notexceed 43C. Ceiling-mounted radiant panels canoperate at higher surface temperatures as long asthe surface is not easily accessible.

1.77 Exposed heating pipework, accessible to touch,should be encased and/or insulated. Furtherinformation is given in Health Guidance Note Safe hot water and surface temperatures. Specialcare should be taken when facilities are beingprovided for older, confused or mental healthpatients, and where children may be present.

1.78 Care should be taken to ensure that heat emittersdo not adversely affect the local temperatureconditions of adjacent storage and preparation

areas.1.79 Heat emitters should be located under windows,

against exposed walls or in the ceiling abovewindows.

1.80 Where radiators are installed there should be spacebetween the top of the radiator and the windowsillto prevent curtains reducing the output. Thereshould also be adequate space underneath to allowcleaning equipment to be used.

1.81 Ceiling-mounted radiant panels should preferably

run around the perimeter of the building. Thepanels should not be located over beds, patienttrolley positions or in other locations where theymight radiate directly onto a patient or member ofstaff for a prolonged period.

1.82 Ceiling-mounted radiant panels should be selectedto match the appearance of the adjacent ceiling andshould be sealed to the adjacent ceiling by means ofa gasket or similar device.

1.83 Where appropriate, heating controls should beprovided to modulate heating circuit flow

temperatures to maintain the desired airtemperature.

1.84 Radiators or radiant panels may also be used tooffset building fabric heat losses in mechanicallyventilated spaces. The system should be designed toensure that the heating and ventilation systemsoperate in a coordinated manner and do not causethe space to overheat.

Ventilation and cooling

1.85 Ventilation systems should be designed inaccordance with the requirements of HealthTechnical Memorandum 03-01 Specialisedventilation for healthcare premises.

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1.86 Theoretical modeling of summer temperaturesshould be undertaken to ensure that the ventilationsystem is able to control air temperatures within anacceptable range.

1.87 It is important to achieve a balance betweeneconomy in capital and energy costs and creatingappropriate levels of comfort through mechanicalventilation/comfort cooling.

1.88 Air movement induced by mechanical ventilationshould be from clean to dirty areas, where theseareas can be defined. The design should allow foran adequate flow of air into any spaces having onlymechanical extract ventilation, via transfer grilles indoors or walls. However, such arrangements should

avoid the introduction of untempered air andshould not prejudice fire safety (through theintroduction of uncontrolled air) or privacy(through the positioning of transfer grilles).

1.89 Local exhaust ventilation (LEV) will be requiredwhere exposure (by inhalation) to substanceshazardous to health cannot be controlled by othermeans. The Health and Safety Executive (HSE)publishes guidance notes, updated annually, onoccupational exposure limits (Guidance Note EH40) for the control of exposure by inhalation of

substances hazardous to health. The limits specifiedform part of the requirements of the Control ofSubstances Hazardous to Health (COSHH)Regulations.

Hot and cold water systems

1.90 Water storage and distribution systems should bedesigned in accordance with Health TechnicalMemorandum 04-01 The control of Legionella,hygiene, safe hot water, cold water and drinkingwater systems.

1.91 Exposed hot water pipework, accessible to touch,should be encased and/or insulated. Special careshould be taken when facilities are being providedfor older, confused or mental health patients, andwhere children may be present.

Acoustics

1.92 Consideration should be given at the earliestopportunity to the requirements for privacy andnoise control. Guidance on sound attenuationrequirements is given in Acoustics. Whenever

background music or PA systems are installed, thesound quality should be such that it is intelligibleand not subject to unwanted reverberations.

Internal drainage

1.93 A system of soil and waste drainage including anti-siphon and ventilation pipework should be

provided in accordance with BS EN 12056.1.94 Where plastic pipework is used, suitable

intumescent collars should be fitted whenbreaching fire compartments, and acousticwrapping should be applied where drainagepipework runs above wards and other sensitiveareas.

1.95 The gradient of branch drains should be uniformand adequate to convey the maximum discharge tothe stack without blockage. Practical considerationssuch as available angles of bends, junctions and

their assembly, as well as space constraints, willnormally limit the gradient to about 1:50(20 mm/m).

1.96 For larger pipes, for example 100 mm in diameter,the gradient may be less, but this will require high-quality workmanship if an adequate self-cleaningflow is to be maintained.

1.97 Provision for inspection, rodding and maintenanceshould ensure full bore access and be locatedoutside user accommodation. The location of

manholes within the building should be avoided.1.98 To prevent the ingress of bacteria, waste outlets

from distillation and refrigeration plant shoulddischarge via a trapped tundish or gully to thedrainage system at a point where infection risks areminimal.

1.99 Drainage/waste systems from air-conditioning unitsshould be installed to prevent Legionnaires diseaseand back-feeding of bacteria into the unit.

1.100 Where diagnostic imaging is carried out and

providing that there is adequate dilution and thesilver content has been effectively recovered,effluent can be discharged into the internaldrainage system. Project teams should establishacceptable levels for silver and other processingchemicals at the planning stage.

1.101 All drainage that may be used for the passage ofcontaminated effluent should be clearly labelled.

1.102 At an early stage in the design process, proposalsfor the collection and discharge of chemical andradioactive contaminated effluent should be

discussed and verified with the sewerageundertaker. Some water authorities may imposerestrictions on the quantity and rate of discharge ofsuch effluent into public sewers.

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Building management systems

1.103 All engineering plant and equipment associatedwith the internal environment should, where

possible, be monitored and controlled by abuilding management system (BMS) in accordancewith Health Technical Memorandum 2005 Building management systems. Requirements forthe monitoring and control of specific types ofplant and systems are also covered in the relevantHealth Technical Memorandum.

Fire safety

General fire safety standards

1.104 Fire safety standards in healthcare premises need tobe high owing to the vulnerability of occupants.

1.105 In order to ensure appropriate fire safety standards,the design and operation of health and communitycare buildings should meet the objectives ofFirecode (Health Technical Memorandum 05suite of documents) or provide a fire-engineeredsolution that achieves similar objectives.

1.106 It is important to establish during the design stagethose aspects of fire safety strategy that affect thedesign, configuration and structure of health andcommunity care buildings. The design teamshould discuss and verify their proposals with thetrust fire officer and the building control authorityor approved inspector, and ensure that the designteam and all other design staff are fully acquaintedwith the fire safety strategy for the design in termsof operation (staff responsibilities, equipmentprovision, and building and engineering layouts).

1.107 All staff should be familiar with the operationalaspects of fire safety.

Fire detection and alarm systems

1.108 The design of fire detection and alarm systemsshould take account of the number of fire zones(compartments) within the building, which inturn will be informed by an assessment of fire risk.It is important that the architect and designengineer work together to ensure all fire risks areproperly understood and addressed in the designsolution.

1.109 For specific guidance see Health Technical

Memorandum 05-03 Part B Fire detection andalarm systems.

General electrical services

General electrical installations

1.110 Electrical installations should comply with thecurrent edition of BS 7671 IEE WiringRegulations together with Guidance Note 7 Special Locations (Institute of Engineering andTechnology (IET)) and Health TechnicalMemorandum 06-01 Electrical services supplyand distribution.

1.111 Where applicable, electrical installations shouldalso comply with Medical Electrical InstallationGuidance Notes (MEIGaN; Medicines andHealthcare products Regulatory Agency

(MHRA)).1.112 Prior to final design, a full assessment should be

made of the clinical and business continuity risks,the range of room types (including equipmentrequirements), occupation levels and resiliencerequirements. This will influence the extent andlocation of electrical services, the availability ofalternative sources of electrical supply and the needfor secondary power sources if appropriate.

Electromagnetic compatibility

1.113 Steps should be taken to prevent mains-borne andelectrical radio frequencies from affectingdiagnostic and monitoring equipment, computersor other sensitive electronic equipment. Guidanceon the avoidance and abatement of electricalinterference is given in Health TechnicalMemorandum 06-01 Electrical services supplyand distribution.

Primary electrical infrastructure

1.114 The primary electrical infrastructure (PEI),

comprising the public electrical supply (PES) andelectrical distribution system equipment for thefacilities, should be an integral part of the wholesite/building network and provide adequatecapacity for both normal and all assessed businesscritical needs.

1.115 The PES supply together with the facilitieselectrical distribution equipment should be sited inareas where access by the PES or healthcareauthorities to inspect and/or replace plant wouldnot disrupt normal communication routes. Careful

consideration should also be given to the impactfrom flooding, pipework leaks and mechanicaldamage.

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Socket-outlets for cleaning equipment

1.116 Sufficient socket-outlets (RCBO-protected) shouldbe provided to enable the use of cleaning

equipment without the need to use extensionleads. Most floor scrubbers and polishers have 9m-long power cables.

Lighting systems

General

1.117 To achieve energy efficiency, lighting systemsshould be designed to:

maximise use of natural daylight;

avoid unnecessarily high levels of illumination; incorporate efficient luminaires, control gear

and lamps;

incorporate effective controls.

1.118 Low energy or ultra-low energy lighting should beconsidered as the primary lighting source.

1.119 Where local circumstances permit, the use of timeswitches or occupancy controls using infrared,acoustic or ultrasonic detectors should beencouraged. In corridors and general circulation

areas, lighting levels should be automaticallycontrolled to allow reduced levels of lighting (e.g.with only up to 50% of luminaires switched on)when the space is not occupied during normalopening hours.

1.120 Lighting in sanitary spaces is generally assumed tooperate from passive infrared (PIR) sensors andtherefore no light switches have been indicated onthe example room layouts of sanitary spaces onthis website. Where light switches are required,reference should be made to Approved Document

M and BS 8300 for recommended locationheights.

1.121 Lighting and the appearance of luminaires shouldbe coordinated with architectural design. Inparticular, decorative finishes should be compatiblewith the colourrendering properties of lamps andspectral distribution of the light source. SeeLighting and colour for hospital design.

1.122 Where artificial lighting is provided in spaceswhere patients are examined or treated, it should

enable changes in skin tone and colour to beclearly defined and easily identified. The quality oflighting will need to be considered if videoconsultation is likely to take place.

1.123 Fluorescent lighting in areas where clinicalprocedures are carried out and/or medicines arehandled, including stores, must be derived fromlamps having suitable colour-rendering

characteristics.

1.124 Light switches should be provided in easilyaccessible positions and at appropriate locations incorridors and general circulation areas. In areaswith multiple luminaires, switches should permitthe selection of luminaires appropriate to the arearequiring illumination.

1.125 Ceiling-mounted fixed luminaires should not besited immediately above positions where people lieon a bed, couch or trolley to avoid glare. This

applies to all spaces where people are consulted,examined and treated.

1.126 Adjustable task lighting should be provided at thebedhead for patients who wish to read.

1.127 Good lighting should be provided in all sanitaryspaces and there should be no reflective glare (seeBS 8300 and Approved Document M for details).

1.128 Lighting services, including lighting controls,should comply with the following CIBSEguidance: Code for Lighting, Lighting Guide 2 Hospitals and health care buildings and GuideF Energy efficiency in buildings.

1.129 In areas where VDUs are in use, lighting should bedesigned to comply with CIBSE Lighting Guide 7 Office lighting.

1.130 Lighting is important in enabling the effectivecleaning of corners and edges that can harbourdust.

Emergency lighting

1.131 Emergency lighting, incorporating escape lightingand standby lighting, should be provided inaccordance with BS 5266 and building controland fire officer requirements.

1.132 Escape lighting should also be provided inaccordance with Health Technical Memorandum06-01, Health Technical Memorandum 05-02 Fire safety in the NHS: Guidance in support offunctional provision for healthcare services andCIBSE Lighting Guide 2.

External lighting

1.133 The issue of light pollution should be taken intoconsideration when planning external lighting.

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Where possible, external lighting should not shineexcessively into adjacent properties.

1.134 The following steps should be taken:

Avoid excessive lighting.

Use sensor-activated luminaires.

Ensure luminaires are correctly orientated.

Patient/staff and staff emergency callsystems

1.135 Patient/staff and staff emergency call systemsshould comply with Health TechnicalMemorandum 08-03 Bedhead services.

1.136 Patient/staff call points should be provided in allspaces where a patient/attendee may be left alonetemporarily, for example clinical rooms and WCs.

1.137 Staff emergency call points are for a member ofstaff to call for assistance from another member ofstaff. They should be provided in all spaces wherestaff consult, examine and treat attendees/patients.

1.138 Consideration should be given to the use ofmodern technology and location of staffemergency call points to ensure that the risk ofaccidental operation is minimal and that, wherenecessary, they can act as a deterrent to potentialaggressors in addition to enabling a response to anincident.

1.139 Patient/staff and staff emergency call systems maybe hard-wired or may form part of a multiplexeddata or radio system.

1.140 Dedicated call points for summoning the crashteam may be provided. These are not standardinstallation and need to be specified for individualrooms where patients are at a high risk of suffering

a cardiac arrest1.141 A visual and audible indication of the operation of

each system should be provided at a suitable staffbase to identify the nature and origin of the call.

1.142 Over-door indicator lamps and corridor indicatorlamps should be appropriately located to guidestaff quickly to the origin of the call.

Security

CCTV installation

1.143 CCTV systems should be installed to monitorinternal and external areas where there is a risk ofattack or vandalism. Areas such as receptions,

external entrances, car parking and pedestrianwalkways may be at particular risk at night.

External services

1.144 Where premises do not operate over a 24-hourperiod, external engineering plant and equipment,particularly security cameras and engineeringservice supplies, should be positioned and suitablyprotected to minimise the risk of damage orinterference when the premises are closed.

Car park barriers

1.145 To improve site security, and control unauthorisedparking, it may be necessary to install car parkbarriers. Where barriers are required, all electricalservices to them should be installed using externalcable runs routed below ground level as far as ispractical.

Door access control systems

1.146 Health and community care buildings willgenerally require controlled access to the buildingat the staff entrance and, internally, to staff areas.

1.147 Where door access control systems are required,these should consist of an electronic keypad, fob or

other approved door entry system installed inconjunction with a separate door entry intercomsystem.

1.148 External door entry systems should be compatiblewith insurance requirements. They should beweatherproof and vandal-resistant. Internal systemsshould be vandal-resistant.

Entertainment systems

1.149 Entertainment facilities, such as television andradio/music systems, may be provided in waitingareas to mask sound transfer for confidentialitypurposes or in staff rest areas to create a relaxingatmosphere.

1.150 The entertainment services should comply withHealth Technical Memorandum 08-03 Bedheadservices.

IT and wiring systems

General

1.151 Where possible, a structured wiring system shouldbe provided. This will permit a unified approachto the provision of cabling for:

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voice systems;

data systems;

imaging systems;

alarm systems.

1.152 While such a universal cabling system is initiallymore expensive than separate voice and datasystems, it may be more cost effective in the longrun.

1.153 In determining the nature of the IT system to beprovided, it is necessary to identify:

the areas to be served;

whether structured cabling will be used;

the density of RJ45 data and telephone outletsto be provided;

whether wiring will be on a flood or asrequired basis.

1.154 Where appropriate, specialists should be employedto assist in the design and installation of IT andtelephone systems, including interfacing withservice wiring and equipment suppliers to ensure afully operational and reliable system.

Telecommunication systems1.155 The telecommunication system should comply

with the requirements of the public telephoneoperator (PTO), various Codes of Practice andBritish Standard specifications, in particular BSEN ISO 6506 and BS 6701 Part 1.

1.156 Public telephones should be provided whererequired, complete with coin box and acoustichoods, as appropriate. Consideration should begiven to disabled persons in relation to the heightof payphones.

IT systems

1.157 The IT system should include the installation,termination, testing and commissioning of allswitches, routers, hubs, distribution cablingcomplete with cable containment system, andrequired RJ45 terminal outlets.

Pneumatic tube systems

1.158 If a new pneumatic tube system is to be installed,

significant investigation needs to be undertaken toensure that the system will meet required needs.For further guidance on the design of pneumatic

tube systems, see Health Technical Memorandum2009 Pneumatic air tube transport systems.

Lifts

1.159 Lifts may be required for general passengertransportation, bed/stretcher transportation orservice use. They may also be required in order tocomply with the requirements of the DisabilityDiscrimination Act 2005 and/or ApprovedDocument M of the Building Regulations.

1.160 Consideration may be given to the installation oflifts that do not require a separate machine room,particularly in buildings with less than three floorsand/or where there is limited space available.

1.161 For further guidance on the design of liftinstallations, see Health Technical Memorandum08-02 Lifts.

Lightning protection systems

1.162 Lightning protection systems should be evaluatedand, if necessary, installed in accordance with BSEN 62305.

Audio induction loop systems

1.163 Audio induction loop systems should be providedin main receptions, seminar rooms and waitingareas in accordance with the DisabilityDiscrimination Act. They may be fixed orportable.

1.164 They should comply with the requirements ofBS EN 60118-4, IEC 60118-4, where applicable.

1.165 Audio loop systems should be able to provide aninterface with any PA or music system. In areaswith televisions, they should be interfaced toprovide TV sound into the local area loop system.

Sustainability and energy efficiency

1.166 Engineering services should use renewable andnatural energy sources, wherever feasible. Theenergy consumption of engineering services shouldbe further minimised through the use of low/zeroenergy solutions and/or energy-saving devices.

1.167 Account should be taken of the recommendationsin the following documents:

Current editions of Building Regulations andApproved Codes of Practice.

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Energy Efficiency Office and Carbon Trust bestpractice guidance.

Sustainable development in the NHS

Environmental strategy for the NHS

Health Technical Memorandum 07-02 Encode making energy work in healthcare

Sustainable health and social care buildings

Building Services Research and InformationAssociation (BSRIA) publications.

Chartered Institution of Building ServicesEngineers (CIBSE) publications designguides, energy codes, technical memoranda,lighting guides, climate change levy.

1.167 The following factors should be considered inorder to minimise energy consumption:

Use of natural lighting and ventilation,wherever feasible.

Use of passive solar design, including the use ofsolar heating panels, the use of reflective glassand/or blinds to minimise solar gain, whereappropriate, and locating heat-sensitiveaccommodation away from south facing fascias.

Use of energy efficient equipment, includinghigh efficiency condensing boilers and motors,and energy efficient luminaries.

Use of electronic inverter speed control deviceson air handling equipment instead ofalternatives such as belt pulleys or polechanging motors.

Power factor correction to major plant.

Use of presence detection, photocell and multi-circuit systems to control lighting.

Use of a BMS system to provide automatictime control switching (to shut down plantwhen not required) and performancemonitoring (to ensure plant is operating atoptimum levels)

Implementation of heat recovery, particularlyfor ventilation systems.

Use of ground source heat pumps.

Use of sensory taps, urinal controls, low volumetoilet cisterns and grey water (i.e. rain water

harvesting or recycled water) to reduce waterusage.

Use of combined heat and power plant(including micro CHP plant) to reduce

consumption of incoming electrical supplies aswell as carbon emissions.

Use of thermostatic controls to limit

temperature increases and heat wastage. Increased pipe insulation to limit temperature

losses.

1.168 Consideration should be given to using thethermal properties of the building when thefacility is not in use, for example at night orweekends, where circumstances permit.

1.169 Engineering plant and equipment should berecycled, wherever practical. Ideally any disposal ofplant and equipment should not require a special

licence. Where a licence for disposal is necessary,these should be acquired as prescribed by statute.

1.170 Specific guidance can be found in HealthTechnical Memorandum 07-01 Safemanagement of healthcare waste, Health TechnicalMemorandum 07-05 The treatment, recovery,recycling and safe disposal of waste electrical andelectronic equipment and Health TechnicalMemorandum 07-06 Disposal ofpharmaceutical waste in community pharmacies.

Validation and handover of engineeringinstallations

1.171 It is important that, on completion of aninstallation and prior to hand-over, theperformance of the installation is fully tested andvalidated.

1.172 The final acceptable performance details should berecorded and, together with full manufacturersoperating and servicing details, test results,certificates, as-fitted drawings, manuals etc, madeavailable to users and the maintenanceorganisation before the installation is handed over.

1.173 Once the installation is fully operational, itsperformance should again be tested. This willcheck that it is operating to the designed criteria.

1.174 Any risk management plans, operationalprocedures and contingency plans should be fullyevaluated and tested with staff. Opportunitiesshould also be taken as soon as practical afterphysical completion of the facilities to familiariseand train staff in the use of all relevant equipment

and services and to practice any procedures toensure staff members understand what is requiredof them.

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2.1 There are numerous statutory and legal duties thatowners and occupiers of premises must adhere to.These are continually changing in the light of newevidence and experience. Reference should be madeto these documents at the time of application.

Health and safety2.2 Current health and safety philosophy was

developed following the Report of the RobensCommittee 1972, which resulted in the Health andSafety at Work etc Act 1974.

2.3 The standards of health and safety in the UK aredelivered through a flexible enabling systemintroduced in 1974 by the Health and Safety atWork etc Act 1974 and are typified by theManagement of Health and Safety at WorkRegulations 1999.

2.4 The Health and Safety at Work etc Act 1974 leavesemployers freedom to decide how to control therisks that they identify that is, to look at what therisks are and to take sensible measures to tacklethem. The Act is part of criminal law, andenforcement is by the Health & Safety Executive.Successful prosecution can result in fines orimprisonment.

Regulations, Approved Codes of Practice,Standards and guidance

2.5 Regulations are law, approved by Parliament. Theseare usually made under the Health and Safety atWork etc Act following proposals from the Health& Safety Commission. Regulations identify certainrisks and set out specific actions that must be taken.

2.6 Approved Codes of Practice give advice on how tocomply with the law by offering practical examplesof best practice. If employers follow the advice,they will be doing enough to comply with the law.

2.7 Approved Codes of Practice have a special legalstatus. If employers are prosecuted for a breach ofhealth and safety law, and it is proved that they didnot follow the relevant provisions of an Approved

Code of Practice, they will need to show that theyhave complied with the law in some other way, or acourt will find them at fault.

2.8 Standards (British or European), institutionalguides and industry best practice play a large partin how things should be done. They have no directlegal status (unless specified by regulations).However, should there be an accident, the appliedsafety practices at the place of work would beexamined against existing British or EuropeanStandards. It would be difficult to argue in favourof an organisation where safety was not to thedescribed level.

2.9 Guidance is issued in some cases to indicate thebest way to comply with regulations. But theguidance has no legal enforcement status.

Other commonly cited legislation

2.10 There are numerous statutory and legal duties thatowners and occupiers of premises must adhere to.These are continually changing in the light of newevidence and experience. Reference should be madeto these documents at the time of application.

2.11 Some of the commonly cited legislation can beviewed in the list below. The list is not exhaustive,but is intended to demonstrate the range of issuesthat should be considered. All references to

guidance/legislation/standards should be comparedto those current at the time of application. Latestpublished guidance always takes precedence.

2.12 Only the primary Acts and main regulations arecited here. Most of these Acts and regulations havebeen subjected to amendment subsequent to thedate of first becoming law. These amending Acts orregulations are not included in this list.

Health and Safety at Work etc Act 1974

Factories Act 1961 (as amended)

The NHS and Community Care Act 1990

Consumer Protection Act 1987

2 Statutory and legislative requirements

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Disability Discrimination Act 1995 (DDA)

The Management of Health and Safety at WorkRegulations 1999

Workplace (Health, Safety and Welfare)Regulations 1992

Provision and Use of Work EquipmentRegulations 1998

Manual Handling Operations Regulations 1992

Personal Protective Equipment at WorkRegulations 1992

Health and Safety (Display Screen Equipment)Regulations 1992

Confined Spaces Regulations 1997 The Reporting of Injuries, Diseases and

Dangerous Occurrences Regulations 1995(RIDDOR 95)

The Working Time Regulations 1998

Control of Substances Hazardous to HealthRegulations (COSHH) 2002

Health and Safety (First-Aid) Regulations 1981

Health and Safety (Consultation with

Employees) Regulations 1996 Health and Safety Information for Employees

Regulations 1989

Health and Safety (Safety Signs and Signals)Regulations 1996

Employers Liability (Compulsory Insurance)Regulations 1998

The Health and Safety (Training ForEmployment) Regulations 1990

Safety Representatives and Safety CommitteesRegulations 1977

Control of Asbestos at Work Regulations 2002

Electrical

Electricity Act 1989

Electricity Safety, Quality and ContinuityRegulations 2002

Electricity at Work Regulations 1989

BS 7671:2001 (IEE Wiring Regulations, 16thEdition)

The Electrical Equipment (Safety) Regulations1994

The Plugs and Sockets etc (Safety) Regulations1994

The Radio Equipment and Telecommunications

Terminal Equipment Regulations 2000 Electromagnetic Compatibility Regulations

1992

Mechanical

Supply of Machinery (Safety) Regulations 1992and Supply of Machinery (Safety)(Amendment) Regulations 1994

Lifting Operations and Lifting EquipmentRegulations 1998 (LOLER)

Gas Appliances (Safety) Regulations 1995 Gas Safety (Installation and Use) Regulations

1998

The Lifts Regulations 1997

Noise at Work Regulations 1989

The Pressure Systems Safety Regulations 2000

The Pressure Equipment Regulations 1999

Simple Pressure Vessels (Safety) Regulations1991

The Construction (Design and Management)Regulations 1994

The Construction (Health, Safety and Welfare)Regulations 1996

The Building Regulations 2000

Environment

The Environmental Protection Act 1990

The Control of Pollution (Amendment) Act

1989

The Waste Management Licensing Regulations1994 (as amended)

Environmental Protection (Duty of Care)Regulations 1991

The Controlled Waste (Registration of Carriersand Seizure of Vehicles) Regulations 1991

Hazardous Waste (England and Wales)Regulations 2005

List of Wastes (England) Regulations 2005 Pollution Prevention and Control (England and

Wales) Regulations 2000

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Clean Air Act 1993

Environmental Protection (Prescribed Processes)Regulations 1991

Trade Effluent (Prescribed Processes andSubstances) Regulation 1989

Controlled Waste Regulations 1992

Environment Act 1995

Packaging (Essential Requirements) Regulations2003

Control of Pollution (Oil Storage) (England)Regulations 2001

The Landfill Tax Regulations 1996 and Landfill

Tax (Qualifying Material) Order 1996 Chemicals (Hazard Information and Packaging

for Supply) Regulations 2002

Town and Country Planning Act 1990

The Control of Pollution Act 1974

Producer Responsibility Obligations (PackagingWaste) Regulations 2005

Waste Electrical and Electronic EquipmentDirective 2002

Water Industry Act 1991

Water Supply (Water Quality) Regulations 2000

Water Resources Act 1991

Water Supply (Water Fittings) Regulations 1999

Control of Lead at Work Regulations 2002

Control of Pesticides Regulations 1986

Noise & Statutory Nuisance Act 1993

The Climate Change Act 2008

Radiation

Ionising Radiations Regulations 1999 (IRR99)

The Radioactive Substances Act 1993 (RSA93)

Ionising Radiation (Medical Exposure)Regulations 2000

Radioactive Materials (Road Transport)Regulations 2002

Medicines (Administration of Radioactive

Substances) Regulations 1978

Fire

The Regulatory Reform (Fire Safety) Order2005

The Furniture and Furnishings (Fire) (Safety)Regulations 1988

Dangerous Substances and ExplosiveAtmospheres Regulations (DSEAR) 2002

Food

The Food Safety Act 1990

The Food Safety (General Food Hygiene)Regulations 1995

The Food Safety (Temperature Control)Regulations 1995

Public health

Public Health (Infectious Diseases) Regulations1998

Medicines Act 1961

2.13 This list demonstrates the complex services thatexist within a healthcare organisation. A furtherbrief description of each piece of legislation is givenin Appendix 1 of this document.

Risk and/or priority assessment

2.14 In carrying out design, operational andmanagement evaluation, a consistent method ofassessment should be engaged to ensure thatadequate information, consultation and appraisal isundertaken across the whole range of influences.

2.15 Although some elements of a particular assessmentmay be complex (for example whole-life costing,net present value, patient criticality, resilience etc),

it is important to keep the collective assessment assimple as possible.

2.16 One method is to establish an evaluation matrixwhich allows information across two scales to berepresented in an easily understood way that helpsusers come to a particular decision.

2.17 Both scales are graded from lowest to highest suchthat a combination of the assessments can berepresented. For example, an event analysis mayappear as below: mapping the likelihood of anevent happening and the consequences of theeffect.

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2.18 In a similar way, a cost/benefit matrix may beconstructed or a risk/design measure assessmentmade (see page 25).

2.19 A more detailed example of applied risk assessmentmay be found in the Department of H

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