Image and Editorial Source: Health Estate Journal

Richard Norman, Managing Director of Indepth Hygiene Services Limited, the UK’s leading company for specialist cleaning of ventilation systems talks about the importance of ensuring they are thoroughly cleaned.

There has never been a previous time when those responsible for the maintenance of ventilation systems had more reason to ensure they are maintained in a clean and safe condition.  On a fundamental level the National Health Service is charged with the responsibility in its own constitution to ensure “patients are treated by an organisation that provides its services in a clean and safe environment”.  The very air that patients, staff and visitors breathe must be safe and unpolluted.  Since the essential functions of a ventilation (air conditioning) system is to circulate clean safe air it is indisputable that those with a particular responsibility for maintaining ventilation systems should ensure that all possible steps are taken to do just that.

Unfortunately it is my company’s experience that, with some exceptions, ventilation systems are not being given the priority attention they deserve.  Even against a background of greater focus on achieving improved cleanliness under the Government’s deep clean drive there is little evidence of ventilation systems being included in the programme essentially aimed at reducing the incidence of healthcare associated infections (HCAI).

Dirty ducts

Dr Ghasson Shabha, Course Leader at the School of Property Construction and Planning at Birmingham City University has published extensively his findings on the link between uncleaned ventilation systems and the spread of HCAI.  He firmly maintains that temperature and humidity conditions typically found in ventilation ducting provides excellent opportunities for bugs to thrive.  Dust and debris on internal surfaces of the ducting invariably contains human hair and skin flakes – ideal nutrients for the growth of micro-organisms such as MRSA and C. difficile.  In fact there has been evidence in recent hospital surveys of the presence of MRSA micro-organisms in ventilation systems.  As a result of remedial cleaning of internal ducting surfaces it has been shown that these micro-organisms can be eliminated.

It is my experience that little acknowledgement has been given to the growing evidence of the link between uncleaned ventilation ductwork systems and the incidents of HCAI.  Admittedly I have seen an increase in the awareness among Estates management of the importance of ensuring system filtration is fully effective.  Of course, improved filtration can play an important role in reducing levels of contamination in system ducting and, as a result, a reduction in the prevalence of airborne particulates in the circulated air.  However, even where better filters have been introduced to improve the indoor air quality the condition of the ducting system beyond the filters has frequently been overlooked.

Dirty Ductwork

The system ductwork is often left in an unacceptable condition, retaining heavy deposits of dust and debris, which Dr Shabha has shown can provide breeding conditions for micro-organisms. Perhaps it is the concern that to access the ducting for carrying out a cleaning programme will involve disruption and inconvenience which deters managers from implementing a comprehensive system improvement programme.  Whilst I readily acknowledge that special arrangements have to be made for access to ducting that often runs above ward space, it is my experience that disruption can be kept to a minimum by careful planning of the deep cleaning programme which fully acknowledges the need to put continuing patient care as an absolute priority.

The Department of Health’s guidelines embodied in Health Technical Memorandum HTM 03-01 provides clear advice and guidance on the legal aspects of the need to maintain ventilation systems so that they do not present a potential threat to the health and wellbeing of all hospital occupants, staff, patients and visitors alike.  These guidelines point out the dangers of increased health risks should there be a failure to maintain ventilation systems which, it recommends, should be inspected at least annually.  Where ventilation systems are serving facilities requiring the highest standards of air cleanliness it is recommended that they be visually inspected quarterly and subjected to performance analysis.

There is a further major reason why ventilation systems should be viewed in their entirety – the Government’s commitment to reduce energy use throughout the UK embodied in the CRC (Carbon Reduction Commitment) Energy Efficiency Scheme.  This mandatory scheme is, initially, specifically aimed at organisations whose annual electricity consumption exceeds 6Mwh (equivalent to approximately £500,000).  This is a first step to requiring organisations to implement action to reduce their energy consumption against an established benchmark.  It has been well documented that HVAC can account for 70% of an organisation’s energy costs.

Un-cleaned Ductwork

A claim made by the Carbon Trust, which was set up to provide specialist support to business and the public sector to help cut carbon omissions and save energy, is that inefficient and dirty ventilation systems can increase energy consumption by up to 60%.  It is the condition of the ducting, coils and filters which puts the main resistance on the fan.  So there is a further very good reason why these systems should be reviewed in their entirety not just piecemeal – the need to cut energy costs.

Our Opportunity Assessment Survey, which is carried out in conjunction with Camfil – the UK’s leading provider of specialist filtration products – looks at all aspects of the ventilation’s energy use.  From the survey’s findings an action plan is developed aimed at saving energy and thereby reducing costs.  These findings invariably allow for a low, or no capital cost approach, looking at the life-cycle costs and presenting substantial energy consumption reduction opportunities and paybacks measured in months, thereby protecting precious capital budgets.

As never before, it is clearly incumbent on those charged with providing safe, hygienic conditions in hospitals to include the cleaning of ventilation systems not only as an essential part of their attack on the incidence of healthcare associated infections but also as a major contribution to the requirement to save energy costs.

However, it is not only air conditioning (general extract and supply) ventilation systems which warrant special attention to meet the overriding obligation of providing a clean and safe environment.  Grease extract ventilation systems, invariably linked to the catering facilities, are a potential source of danger to hospital patients, staff and visitors.  As grease particles from the cooking operation cool and settle on the internal ducting surfaces they present a fire hazardous risk requiring only a spark or flash flame from the cooking operation to ignite, with results which have been very well illustrated by six recent fires in public restaurants.

The Fire Safety Order (The Regulatory Reform [Fire Safety] Order 2005) places responsibility for protecting building occupants from the dangers of fire firmly on those responsible for managing premises – and this applies to hospitals as much as to any other occupied premises.

At a recent seminar, a Fire Authority spokesman stated “these installations are probably the highest fire risk in buildings where there are catering facilities”.  There is therefore both a ‘duty of care’ and a legal requirement to have in place a cleaning regime which will ensure that potentially flammable grease deposits which accumulate in the ducting are fully removed.  In other words to eliminate the potential fire hazard to building occupants as required by the legislation.  As with air conditioning systems, uncleaned grease extract systems will use more energy.

The more grease deposits are allowed to accumulate in the ducting the harder the fan has to work to maintain extract efficiency.  The harder the fan has to work the more energy it consumes.  So the legal requirement to clean extract systems to eliminate fire risks carries the additional benefit of reducing system energy costs.

Unfortunately there are cleaning contractors who will claim to have cleaned systems but where investigation shows they have not.  This photograph shows a system where the manager claimed he had had regular cleaning carried out for two years.  It remains a fire hazard.  In four of the instances of restaurant fires I mentioned earlier there were similar instances of only partially cleaned systems.  As a consequence the owners are finding insurers disputing their claims.

In order to provide the Facilities or Estates Manager with a reliable standard by which to assess the effectiveness of a ventilation cleaning programme, the Heating and Ventilating Contractors’ Association have produced a “Guide to Good Practice” Internal Cleanliness of Ventilation Systems TR19 (copies can be obtained from the HVCA Tel: 020 7313 4900 , Email: contact@HVCA.org.uk).  This gives guidance for the cleaning and maintenance of new build, upgraded and existing ventilation systems.  It is accepted as the industry standard to which ventilation systems should be cleaned.  By ensuring that only contractors are commissioned who undertake cleaning in accordance with this standard responsible managers can be confident their ventilation systems will fully perform their essential function of providing safe and hygienic conditions in healthcare premises.

For further information call Indepth Hygiene Services on 020 8661 7888 or email ductclean@indepthhygiene.co.uk.

For more information about AC Inspections, filter technology, clean air solutions, improving air quality, low energy air filters, CRC (Carbon Reduction Commitment), AHUs (Air Handling Units) and the EPBD, visit the www.ac-inspections.co.uk blog and subscribe to the RSS feed here.

Alternatively, you can subscribe to AC Inspections by Email and follow us on Twitter @Camfil_Farr

We look forward to hearing from you soon.

The Camfil Ltd Team