In the first two articles of our infection prevention control (IPC) series for the Health Estate Journal Head of Healthcare Neil Orpwood focused on the need for early collaboration between designers, architects and IPC teams, in creating safe healthcare environments, and an apparent lack of knowledge on the subject among some healthcare design teams. In the third Neil explains how we have developed an improved internal design tool to help our team implement, manage and track IPC design, derogation and risk.
Tracking Infection Prevention Control design, derogation and risk through HLM’s internal design tool.
As healthcare designers, part of our skill set is to provide assurance that we are meeting all the requirements as stipulated in guidance and legislation documents. Increasingly, we are asked to evidence the thought processes behind our design to ensure that we have identified, assessed and mitigated risk. Patient safety is inherently about not causing harm therefore proactively dealing with risk in healthcare design is crucial for positive impacts on patient care and exemplar services delivery.
Successful risk management requires whole-system-thinking along with technical knowledge insight from delivery of multiple complex healthcare projects. Rarely in healthcare design is there just one simple thought, but rather the intricate weaving of often conflicting requirements into one technical solution. With evidencing now required, increasingly toolkits are being utilised as a way to make this integral to the design procures and support golden threads of compliant decision making and resultant information.
Infection Prevention Control education and upskilling at HLM Architects
As part of the IPC education upskilling work that we undertook at the end of 2023, it was identified that an improved internal design tool, which could help implement, manage and track IPC design, derogation and risk, would greatly enhance our ability to positively impact on IPC measures within our designs as well as ensuring that we had followed and left a clearly defined audit trail.
Initial thoughts around an improved tool included:
- Workable across all the RIBA stages
- Include other disciplines to allow us to undertake our lead consultant role
- Include items for construction works to be included within prelims, employers’ requirements or risk assessments
- Record design decision
- Formatted to align with the 2023 revised NHS derogation schedules
- Supportive and linked to HLM CDM risk registers, assessments and schedules.
- Supportive and linked to HLM CDM Design, Access, Maintenance, Adaption and Disassembly strategy
- Recording golden thread for risk through identification, assessment, mitigation and management
- Compliant with HLM ISO 9001 QMS
- Instant dashboard to flag status
Infection Prevention Control within wider standards, legislation and requirements
ISO 9001 is an international standard that specifies the framework for a quality management system allowing companies to demonstrate their ability to consistently provide services that meet customer and regulatory requirements. This encourages process-based approaches and risk-based thinking, alongside a culture of continuous improvement and documented information.
Within ISO 9001 sits our responsibility to comply with the Construction (Design and Management) Regulations 2015. Documents such as the NHS Blue Book, covering the appointment of architects, engineers for commissions in NHS Estates, are very clear about the role design consultants play in CDM across all Business Case Stages (see supplementary annexure volume 3 – CDM Duties).
Alongside our designers’ duties under the CDM regulations is our requirement to comply with providing input into derogation schedules. Recently updated in July 2023, a schedule of derogations must be provided by the commissioning organisation for any project requiring external business case approval. Similarly, they may be requested for projects that have gone through an organisation’s delegated internal approvals process. The data provided in externally approved business cases will be collated centrally to help inform future updates to guidance. Applicable to 100% new build, repurposing, or refurbishment, for designers, the standout requirements from the revised guidance and controls include:
- Specific criteria against which derogations should be recorded
- Identifying derogations specifically against schedules of accommodation in addition to capturing these again in aggregate in the full derogation schedule.
- All agreed derogations should be flagged in BIM data to manage the derogations during construction and post construction phases.
- Inclusion of derogations against other standards in addition to HBNs and HTMs
- Inclusions of derogations specifically related to NHS Net Zero Building Standard, ICB and other green plans.
With growing awareness and scrutiny around the spread of infections post covid, HLM Architects is well placed to ensure the continued competence of our designs.
Easily translatable to NHS schedule
The latter points, whilst not directly related to patient safety, do highlight the need for designers, BIM, internal schedules and protocols to be linkable and easily translatable to NHS schedules.
Starting with HBN 00-09 and given the requirement to interface with other spreadsheets, our inhouse tool was developed in Microsoft excel and consists of several individual work sheets:
- How to Use: Guidance on how the tool works across the RIBA stages.
- Dashboards: showing at-a-glance the number of ‘non-compliances’ against the relevant IPC standards.
- Sign Off: A tracker to ensure that relevant information is reviewed and signed off by the IPC team
- RIBA Checklist: relevant design team activities alongside those of the IPC team to ensure engagement and aligned consideration.
- General Space: requirements regarding the size of rooms and the space around elements
- Waste Storage: requirements regarding the adequate provision of waste and associated storage
- Ancillary Space: Detailed room by room requirements to ensure IPC protocols within the facilities e.g. Dirty Utilities
- Finishes: Requirements to ensure the correct finishes in support of IPC are specified
- Fittings & Equipment: requirements around general fittings (excluding sanitaryware)
- Personal Hygiene: requirements around fittings specifically design for hygienic person use
- Engineering: an overview of engineering related IPC items to allow for architects to undertake the lead consultant role across IPC requirements
- Construction: a works sheet to assist with advising PM/QS/Contract administration teams on suitable requirements for Contractors Preliminaries and alignment with CDMC regulations.
Schedules of non-compliance created
Designed to ask questions with ‘yes’ answers for compliancy, the spread sheet siphons off data to collate schedules of non-compliance which can then be easily inputted into NHS Derogation or CDM risk registers and assessments. The headlines from all the sheets also input into an overall ‘dashboard’ which gives At-A-Glance risk and derogation profiling using simple RAG (Red Amber Green) colouring.
Whilst the current tool has been written around HBN 00-09, in support of our work north of the border the tool will be extended to cover the HAI-SCRIBE and KSAR processes for NHS Scotland. IPC issues in Scottish Hospitals have been well documented in recent headlines and with growing awareness and scrutiny around the spread of infections post covid, HLM Architects is well placed to ensure the continued competence of our designs.
