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It pays to come clean

It is disappointing that PAS5748 does not make a stronger case for improved air quality within the healthcare environment, according to Ian Wall

Air quality appears to have been virtually ignored in the British Standards Institution's (BSI's) new Publicity Available Specification (PAS) 5748 which 'provides a framework for the planning, application and measurement of cleanliness in hospitals'.

On a list of 50 items to be cleaned within the hospital environment, the ventilation grille is number 48 and, while this may not reflect its importance, it is disappointing that PAS5748 does not make a stronger case for improved air quality within the healthcare environment.

Clean looking surfaces and equipment are important and wiping a ventilation grille clean of entrained dust particles will certainly improve the image of any internal area. However, it does not address the build-up of debris behind the 'wiped clean' grille which can harbour MRSA and Clostridium Difficile bacteria.

Any initiative to improve and measure hospital hygiene is welcome. However, it is a major concern that such a lengthy document as PAS5748 barely touches on duct cleaning, particularly as we made representations to the BSI during the consultation period leading up to its publication. Any medical facility can have the most sparkling floors, surfaces and equipment but if the ventilation ducts are dirty then contaminated air is being blown onto them, compromising the work of the infection control team.

Duct cleaning remains an important part of an infection control programme. Plenty of guidance is on hand to help keep ducts clean both from excessive particulate and bacteria. The Heating & Ventilating Contractors Association (HVCA) TR19 document gives clear advice on the threshold dust levels that trigger cleaning considerations in supply, extract and recirculatory ductwork as well as the approved methods of cleaning.

TM 03-1 and its predecessor, HTM 2025, highlight acceptable levels of bacterial activity in sterile and non sterile healthcare areas.

The missing link
What appears to be missing is the link between the infection control and estates departments. If there is an MRSA outbreak in a ward or theatre, then the ventilation ductwork will be cleaned as part of the reinstatement programme. Furthermore, if there is a refurbishment project being undertaken, then again the ductwork will almost certainly be cleaned. Therefore, why is routine maintenance - which can alleviate the risk of patient exposure to bacterial infection - almost totally ignored? It appears to be a question of budgets.

Is it not time for legislation, particularly relating to healthcare environments, to be introduced regarding the regular cleaning of hospital ventilation systems? The only requirement at the moment is that the ductwork system is inspected and the findings recorded. Should it not be that if findings from the inspection are negative then the ventilation system must be cleaned without delay not left to a judgement call or budget availability?

In these days of patient choice we are encouraged to investigate a hospital's 'track record' of performing the operations. Details on the experience of surgeon, success rates, cleaning audits, infection outbreak data and Care Quality Commission reports are all available. However, we can't enquire as to cleanliness of the air within our chosen hospital because it is unlikely that any details would be available.

The challenge should be legislation, particularly in healthcare environments, to ensure that the air patients and staff are breathing, or exposed to, is of the highest quality.

// The author is sales director of Ductbusters //
1 February 2012

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