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A rolling replacement with Horne Optitherm of ageing taps across the Monklands Hospital estate, which previously included a number of different styles and brands, has led to significant improvements for the FM team, Control of Infection, housekeeping and fewer interruptions for staff involved in direct patient care.
We've only had one tap that required repair. It was replaced and then removed to the workshop. There was no 'downtime' at the handwash faciility and no closing of ward areas, meaning no disruption. I love this tap because I can fit it and forget it; it's one less headache for me BIlly Lindsay, Maintenance Manager
In 18 months, and with 175 [Optitherm] taps so far installed, we've only had one tap that required repair. That tap was replaced and then removed to the workshop - resulting in no downtime at the handwash facility concerned and no closing of ward areas, meaning no disruption. I love this tap because I can fit it and forget it; it's one less headache for me BIlly Lindsay, Maintenance Manager
Monklands Hospital is a large district general hospital in Airdrie, North Lanarkshire, offering acute services plus a 24-hour accident and emergency department. It has 535 in-patient beds.
Monklands is an ageing building; some departments opened in 1974 with the remainder fully open by 1977. Various upgrades and refurbishments over the years, and a very informal to non-existent policy on handwash station configuration, meant that a great number of different tap brands, and designs, had been installed across the hospital estate, mostly with the thermostatic mixing valve relatively inaccessible behind the wall-panelling.
Broken levers, under-performing and inaccessible TMVs, and taps with recently outlawed swan-necked spouts (having been identified as a potential reservoir of infection from pathogens) were problems that began to mount up and become an increasing battle for the maintenance team to attend to.
Sampling of the water supplies upstream of the TMV, now required as a means to identify if the water supplies are colonised with harmful pathogens, was also an increasingly time-consuming process, involving the removal of wall panelling, and exposing the services void to the ward environment. There are infection risk implications for patients in the immediate vicinity of this wall breach and, therefore, measures to avoid their exposure to harmful bacteria, viruses and fungi from within the wall cavity must be taken. These measures are both time-consuming, potentially disruptive (to the delivery of healthcare) and costly.
Although the maintenance team were well aware of the growing problem, an audit by the Healthcare Environment Inspectorate (HEI) in November 2009 drew closer attention to non-compliance with guidelines presented in HTM 64 Sanitary Assemblies (Now HBN 00-10) and SHFN 30 Infection Control in the Built Environment. The HEI also recorded complaints from healthcare staff of increasing delays between maintenance issues being reported and them being attended to, which demonstrated the scale of the problem. Another issue raised by the HEI team was a lack of evidence to suggest that Infection Prevention and Control were considered part of the procurement process for new equipment.
Monklands Hospital Board accepted the recommendations, having been aware of the need to more thoroughly address the problem - it was considering a long term ward refurbishment problem, starting with Ward 22, which had been earmarked for upgrade in December 2009. This presented an opportunity to research, define and trial a new handwashing arrangement, which, if successful, would become standard across the hospital estate.
As per the recommendations of the HEI and the Infection Control in the Built Environment document, a committee comprising estates personnel (hard FM), Infection Prevention and Control (IPC) and hotel services staff (soft FM) was established to evaluate various components that would form a standard clinical hand-washing module: IPS frame work and wall paneling, basin and trap, tap and associated thermostatic control, soap, gel and hand-towel dispensers.
The evaluation committee discussed, at length, problems encountered in the past as well as recommendations by the newer published guidelines;
At this time, a small number of thermostatic taps were available on the market, the newest being the Building Better Healthcare Award-winning Optitherm from Horne Engineering.
Other tap designs were discounted for a number of reasons:
The Optitherm had some additional features over other tap designs that Maintenance Manager, Billy Lindsay, considered beneficial:
IPC and the Soft FM team liked the overall shape and contours of the Optitherm, as well as the lack of 'nooks and crannies', which would make it easy to clean and keep clean. At first, the IPC team were concerned about the combined flow regulator and conditioner that makes up the tap's outlet fitting, and there was much debate as to whether this was an aerator (not allowed for healthcare) or not. Once its function was properly explained - it most specifically is not an aerator, it is a flow regulator to govern the flow to a constant 6 Litres per minutes and it 'conditions' the water column to ensure if falls in a uniform, unbroken manner into the basin with no splashing or forming of aerosols. This was accepted and the Optitherm was selected for trial installation on the Ward 22 refurbishment.
Ward 22, Acute Elderly Medicine and Rehabilitation, was refurbished in December 2009 and 25 new clinical handwash modules were installed.
A review of the installation highlighted the following favourable outcomes:
The success of the Ward 22 refurbishment prompted the decision to standardise on the Optitherm for clinical handwash both at Monklands and throughout the rest of the NHS Lanarkshire Trust estate. Since then, 175 Optitherm have been installed in Monklands' Acute Elderly, Haematology, Dermatology, Renal/Endoscopy wards and also the ITU, with a further 50 planned for the Outpatients department.
In 18 months, only 1 out of the 175 taps installed actually required to be removed to the workshop for maintenance - a quick swap over with a new tap body meant the wash station was never out of commission and there was no interruption to the delivery of healthcare.
This reduction in maintenance time is significant. Billy Lindsay calculates it will equate to an annual time-saving of approximately 37.5 hours. Additional savings will also be accrued in the expected use of fewer spare parts and replacements, and by not needing to breach any wall paneling for maintenance or water sampling.
