HTM 00
HTM 00
HTM 00
STATUS IN WALES
APPLIES
ISBN 0-11-322754-X
www.tso.co.uk
9 780113 227549
DH INFORMATION READER BOX
Policy Estates
HR / Workforce Performance
Management IM & T
Planning Finance
Clinical Partnership Working
Description HTM 00 gives best practice advice and a generic overview for the
Department of Health's revised Health Technical Memoranda
series. It provides a comprehensive guide, across the series, to all
common related issues for the management of engineering and
technical services, which can be applied to all healthcare facilities.
ii
Preface
About Health Technical Memoranda main source of specific healthcare-related guidance for
estates and facilities professionals.
Engineering Health Technical Memoranda (HTMs)
give comprehensive advice and guidance on the design, The core suite of nine subject areas provides access to
installation and operation of specialised building and guidance which:
engineering technology used in the delivery of healthcare. is more streamlined and accessible;
The focus of HTM guidance remains on healthcare- encapsulates the latest standards and best practice in
specific elements of standards, policies and up-to-date healthcare engineering;
established best practice. They are applicable to new and
existing sites, and are for use at various stages during the provides a structured reference for healthcare
whole building lifecycle: engineering.
Figure 1 Healthcare building life-cycle
DISPOSAL CONCEPT
RE-USE
DESIGN & IDENTIFY
OPERATIONAL OPERATIONAL
MANAGEMENT REQUIREMENTS
Ongoing SPECIFICATIONS
MAINTENANCE TECHNICAL & OUTPUT
Review
PROCUREMENT
COMMISSIONING
CONSTRUCTION
INSTALLATION
Healthcare providers have a duty of care to ensure that Structure of the Health Technical
appropriate engineering governance arrangements are in
Memorandum suite
place and are managed effectively. The Engineering
Health Technical Memorandum series provides best The series of engineering-specific guidance contains a
practice engineering standards and policy to enable suite of nine core subjects:
management of this duty of care. Health Technical Memorandum 00
It is not the intention within this suite of documents to Policies and principles (applicable to all Health
unnecessarily repeat international or European standards, Technical Memoranda in this series)
industry standards or UK Government legislation. Where Health Technical Memorandum 01
appropriate, these will be referenced. Decontamination
Healthcare-specific technical engineering guidance is a Health Technical Memorandum 02
vital tool in the safe and efficient operation of healthcare Medical gases
facilities. Health Technical Memorandum guidance is the
iii
Policies and principles HTM 00 Best practice guidance for healthcare engineering
Health Technical Memorandum 03 Electrical Services Electrical safety guidance for low
Heating and ventilation systems voltage systems
Health Technical Memorandum 04 In a similar way Health Technical Memorandum 07-02
Water systems will simply represent:
Health Technical Memorandum 05 Environment and Sustainability EnCO2de.
Fire safety
All Health Technical Memoranda are supported by the
Health Technical Memorandum 06 initial document Health Technical Memorandum 00
Electrical services which embraces the management and operational policies
from previous documents and explores risk management
Health Technical Memorandum 07
issues.
Environment and sustainability
Some variation in style and structure is reflected by the
Health Technical Memorandum 08
topic and approach of the different review working
Specialist services
groups.
Some subject areas may be further developed into topics
DH Estates and Facilities Division wishes to acknowledge
shown as -01, -02 etc and further referenced into Parts A,
the contribution made by professional bodies,
B etc.
engineering consultants, healthcare specialists and
Example: Health Technical Memorandum 06-02 Part A NHS staff who have contributed to the review.
will represent:
S T R Y S TA N D A
DU RD
IN S
& EUROPEAN
NAL ST
HTM 07
IO HTM 02
T
AN
NA
INTER
CUMENTS
Sustainability Gases
RDS
HTM 00
RDS
INTER
Policies and
Principles
DA
NA
AN
IO
ST
T
NA
DO
IC
Y S TA N D Systems
IF
C
EC
D
HTM 05 HTM 04
O
Fire
SP
U Water
C
M Safety Systems H
EN T
TS AL
HE
iv
Executive summary
This document gives best practice advice and provides a be put in place, supported by access to suitably qualified
generic overview for the Department of Healths revised staff to provide this informed client role, which reflect
Health Technical Memorandum series. these responsibilities.
It is provided as a comprehensive guide to all issues By locally interpreting and following this guidance,
relating to the management of engineering and technical boards and individual senior managers should be able to
service provision which can be applied to NHS and other demonstrate compliance with their responsibilities and
healthcare facilities, that is, wherever NHS patients are thereby support a culture of professionalism which instils
treated. public confidence in the capability of the NHS at local
level.
Within this context, it is expected that the contents of
this document will remain relatively stable while also
remaining flexible enough to support the Governments Users of the guidance
reform agenda for the NHS. Those providing NHS healthcare and operating facilities
This version of Health Technical Memorandum 00 will be the main users of this document. However, other
negates the necessity for a management policy section stakeholders will be interested and will expect that this
in other guidance within the revised Health Technical best practice guidance is being followed.
Memorandum suite. Healthcare commissioners should expect that the facilities
to which they refer patients should provide a safe, caring
Scope environment which aids a patients recovery and does not
expose them to undue risk. Therefore the resilience of
Health Technical Memorandum 00, and the series
critical engineering services and business continuity
it supports, provide comprehensive specialist advice
linked to policies for emergency preparedness and the
and guidance on the design, installation and effective
ability to respond to major incidents should be high on
operation of a healthcare facility from an engineering
a provider organisations agenda.
technology perspective. While it is not intended to
cover every possible scenario, for example the concept of
hospital at home (in a domestic dwelling), the standards Structure
and principles it advocates may be appropriate to follow Within this document, each section deals with a different
in all locations where healthcare is provided. aspect of engineering and technical management from an
overview of commonly applicable statutes and legislation
Aim of the guidance through to the training and development issues to
consider when providing the necessary levels of
The aim of Health Technical Memorandum 00 is to
professional and technical expertise.
ensure that everyone concerned with the managing,
design, procurement and use of the healthcare facility Chapter 2 provides an overview of the context of the
understands the requirements of the specialist, critical Health Technical Memorandum suite.
building and engineering technology involved.
Chapter 3 (while not intending to be exhaustive) deals
Only by having a knowledge of these requirements can with commonly applicable statutory and legislative
the organisations board and senior managers understand requirements.
their duty of care to provide safe, efficient, effective and
Chapter 4 considers appropriate professional and
reliable systems which are critical in supporting direct
technical support.
patient care. When this understanding is achieved, it
is expected that (in line with integrated governance Chapter 5 looks at development of operational
proposals) appropriate governance arrangements would policies and advocates service-user involvement etc.
Policies and principles HTM 00 Best practice guidance for healthcare engineering
Chapter 6 considers emergency preparedness etc and when developing governance systems which take
the ability of the organisation to continue to provide account of risk;
healthcare throughout emergency situations and to
to establish principles and procedures which:
recover quickly.
recognise and address both corporate and the
Chapter 7 provides guidance on staff training, systems
individuals responsibilities;
and operation and maintenance procedures.
recognise the link between critical engineering
Chapter 8 considers maintaining engineering systems
systems and emergency preparedness capability;
to provide optimum performance and maximise the
potential for critical service availability. reflect the important role that engineering
polices and principles, as implemented by
Chapter 9 looks at design and access availability with
suitable qualified professional and technical staff,
regard to engineering services.
can have in support of direct patient care.
vi
Acknowledgements
DH Estates & Facilities wishes to acknowledge the contribution made by professional bodies, engineering consultants,
healthcare specialists and NHS staff who have contributed to the various reviews.
Chris Holme, Department of Health
Will Snell, DH Emergency Planning Group
Health Facilities Management Group (HEFMA)
The Institute of Healthcare Engineering and Estate Management (IHEEM)
Engineering Knowledge Network Group
Professional Advisory Group
Welsh Health Estates
Health Facilities Scotland
Health Estates, Northern Ireland
vii
Policies and principles HTM 00 Best practice guidance for healthcare engineering
Contents
Preface
Executive summary
Acknowledgements
Chapter 1 Introduction 1
Scope
Engineering governance
Reviews
Guidance
Chapter 2 Overview of engineering services guidance 2
Health Technical Memorandum 01: Decontamination (replaces Health Technical
Memoranda 2010, 2030 and 2031)
Health Technical Memorandum 01-01: The decontamination of reusable medical
devices
Health Technical Memorandum 02: Medical gases (replaces Health Technical
Memorandum 2022)
Health Technical Memorandum 02-01: Medical gas pipeline systems
Health Technical Memorandum 03: Heating and ventilation systems (replaces Health
Technical Memorandum 2025)
Ventilation, design, installation, testing and validation (Part A)
Operational management and verification (Part B)
Health Technical Memorandum 04: Water systems (replaces Health Technical Memoranda
2027 and 2040)
Health Technical Memorandum 04-01: The control of Legionella, hygiene, safe hot
water, cold water and drinking water systems
Health Technical Memorandum 05: Firecode fire safety in the NHS (replaces the
previous Firecode suite of documents)
Health Technical Memorandum 05-01: Managing healthcare fire safety (published July
2006) (replaces Policy and principles)
Health Technical Memorandum 05-02: Guidance to support functional provisions for
healthcare premises (replaces Health Technical Memoranda 81 and 85)
Health Technical Memorandum 05-03: Operational provisions
Health Technical Memorandum 06: Electrical services (replaces Health Technical
Memoranda 2007, 2011, 2014, 2020 and 2021)
Health Technical Memorandum 06-01: Electrical services supply and distribution
Health Technical Memorandum 06-02: Electrical safety guidance for low voltage
systems
Health Technical Memorandum 06-03: Electrical safety guidance for high voltage
systems
Health Technical Memorandum 07: Environment and sustainability (replaces Health
Facilities Note 21, Health Technical Memoranda 2065 and 2075)
Health Technical Memorandum 07-01: Safe management of healthcare waste
Health Technical Memorandum 07-02: EnCO2de making energy work in healthcare
(published February 2006)
Health Technical Memorandum 07-03: Transport management and car parking: best
practice guidance for NHS trusts in England (published February 2006)
viii
Contents
ix
Policies and principles HTM 00 Best practice guidance for healthcare engineering
Instructions
Maintenance frequency
Maintenance planning
Original commissioning tests
Original and amended drawings
Functional tests
Inspections prior to recommissioning
Planned maintenance programme
General
Design of a planned maintenance programme
Review of the planned maintenance programme
Chapter 9 Engineering services 24
Management of access to engineering services
Development planning
Distribution requirements
Access
Working in confined spaces
Appendix 1 Summary of key legislation 27
1 Health and Safety at Work etc Act 1974
2 Factories Act 1961
3 The NHS and Community Care Act 1990
4 Consumer Protection Act 1987
5 Disability Discrimination Act 1995
6 The Management of Health and Safety at Work Regulations 1999
7 Workplace (Health, Safety and Welfare) Regulations 1992
8 Provision and Use of Work Equipment Regulations 1998
9 Manual Handling Operations Regulations 1992
10 Personal Protective Equipment at Work Regulations 1992
11 Health and Safety (Display Screen Equipment) Regulations 1992
12 Confined Spaces Regulations 1997
13 The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995
(RIDDOR 95)
14 The Working Time Regulations 1998
15 Control of Substances Hazardous to Health Regulations (COSHH) 2002
16 Health and Safety (First-Aid) Regulations 1981
17 Health and Safety (Consultation with Employees) Regulations 1996
18 Health and Safety Information for Employees Regulations 1989
19 Health and Safety (Safety Signs and Signals) Regulations 1996
20 Employers Liability (Compulsory Insurance) Regulations 1998
21 Health and Safety (Training for Employment) Regulations 1990
22 Safety Representatives and Safety Committees Regulations 1977
23 Control of Asbestos at Work Regulations 2002
ELECTRICAL
24 Electricity Act 1989
25 Electricity Safety, Quality and Continuity Regulations 2002
26 Electricity at Work Regulations 1989
27 BS 7671:2001 (IEE Wiring Regulations, 16th Edition + amendments)
28 Electrical Equipment (Safety) Regulations 1994
29 Plugs and Sockets etc (Safety) Regulations 1994
30 Radio Equipment and Telecommunications Terminal Equipment Regulations 2000
31 Electromagnetic Compatibility Regulations 1992
MECHANICAL
32 Supply of Machinery (Safety) Regulations 1992 and Supply of Machinery (Safety)
(Amendment) Regulations 1994
Contents
xii
1 Introduction
1 Introduction
Policies and principles HTM 00 Best practice guidance for healthcare engineering
2.1 Within the overall Health Technical Memorandum Health Technical Memorandum 01:
guidance structure, there are eight specialist
Decontamination (replaces Health
subjects supported by this core document. The
specialist subject areas are detailed below. Technical Memoranda 2010, 2030 and
2031)
Note
Health Technical Memorandum 01-01: The
The sequence of numbering within each subject area decontamination of reusable medical devices
does not necessarily indicate the order in which the
HTMs will be published/printed. However, the overall Part A Management and environment
structure/number format will be maintained as
described. 2.2 The purpose of this guidance is to provide an
overview and comprehensive advice, covering
the general and regulatory environment for
decontamination of reusable medical devices. It
How to obtain publications considers the key environment and management
To find out about publications that are finalised issues in this area including design, and operational
and currently being published, look under new management considerations. It outlines the best
publications on the Knowledge and Information practice for the philosophy of decontamination
Portal homepage at: http://www.knowledge.nhsestates. systems for the safety of patients and staff.
gov.uk
Part B Equipment
To find out about all DH Estates and Facilities
publications, go to the publications list in the 2.3 This document sets out the necessary arrangements
Knowledge and Information Portal publications for procuring and managing decontamination
folder at: http://www.dh.gov.uk systems across the healthcare environment. The
guidance is best practice and may encompass
Hard copies are available from:
compliance of other industry legislation and
The Stationery Office Ltd (TSO). Tel: 0870 600 5522; standards.
fax: 0870 600 5533.
2.4 It covers the design and pre-purchase
Online bookstore: http://www.tsoshop.co.uk considerations, validation and verification,
and operational management of test equipment,
washer-disinfectors and sterilizers.
2 Overview of engineering services guidance
Policies and principles HTM 00 Best practice guidance for healthcare engineering
of wholesome, safe hot and cold water supplies, Part C Textiles and furnishing (replaces
storage and distribution in healthcare premises. Health Technical Memorandum 87)
2.15 The temperature control regimen is the preferred Part D Commercial enterprises on hospital
strategy for reducing the risk from Legionella and premises (replaces Fire Practice Note 5)
other waterborne organisms in water systems.
Part E Escape bed lifts (published July 2006)
This requires monitoring on a regular basis.
(replaces Fire Practice Note 3)
Recommended test frequencies are listed in the
document. Part F Arson prevention and control (replaces
Fire Practice Note 6)
2.16 For other water applications, such as hydrotherapy
pools and provision to laundries etc (although Part G Laboratories (replaces Fire Practice
briefly described in this publication), reference Note 10)
should be made to specific documentation. Part H Reducing unwanted fire signals in
healthcare premises (replaces Fire Practice
Health Technical Memorandum 05: Note11)
Firecode fire safety in the NHS Part J Fire engineering provisions
(replaces the previous Firecode suite of
Part K Fire risk assessments in hospitals
documents) (replaces Health Technical Memorandum 86)
Health Technical Memorandum 05-01: Managing Part L Fire statistics (replaces Fire Practice
healthcare fire safety (published July 2006) Note 9).
(replaces Policy and principles)
2.17 This document provides a framework for the Health Technical Memorandum 06:
implementation of the Department of Healths Electrical services (replaces Health
fire safety policy (mandated by the Minister of Technical Memoranda 2007, 2011,
State (Delivery & Quality)), which may be an 2014, 2020 and 2021)
appropriate method for meeting statutory duties
under the Regulatory Reform (Fire Safety) Order Health Technical Memorandum 06-01: Electrical
2005. services supply and distribution
Health Technical Memorandum 05-02: Guidance Part A Design considerations
to support functional provisions for healthcare
premises (replaces Health Technical Memoranda 2.20 This document covers electrical distribution
81 and 85) assessment and design, which looks at the needs
of patients and how the resilience/safety of the
2.18 The functional approach is seen as enabling electrical system from source to patient can be
innovation in design while still providing an provided. It covers high voltage and low voltage
adequate degree of fire safety for patients, visitors distribution networks together with standby
and staff. Where the previous guidance was only systems including generators, uninterruptible
applicable to hospitals, Health Technical power supplies, and isolated power supplies (also
Memorandum 05-02 can be applied to all known as medical IT).
healthcare premises.
Part B Operational management
Health Technical Memorandum 05-03: Operational
provisions 2.21 This document considers the operational
management and maintenance requirements for
2.19 This part of the suite will bring together other fire hard-wired electrical systems and fixed power plant.
safety guidance which is specific in application.
2.22 The document is suitable for use with all forms of
Part A General fire precautions (replaces electrical maintenance work ranging from testing
Health Technical Memorandum 83) of plant, such as generators, to the periodic testing
Part B Fire detection and alarm systems and inspection of the electrical network(s) and final
(replaces Health Technical Memorandum 82) circuits.
2 Overview of engineering services guidance
Health Technical Memorandum 06-02: Electrical carriage, treatment and disposal, and health and
safety guidance for low voltage systems safety.
2.23 This Health Technical Memorandum gives
Health Technical Memorandum 07-02: EnCO2de
operational guidance on electrical safety
making energy work in healthcare (published
requirements for low voltage systems (up to 1 kV)
February 2006)
in healthcare premises including management,
the professional and operational structure, safety 2.29 This document replaces Encode guidance Parts I
procedures, testing, equipment and records. and II.
2.24 Guidance is intended to assist in meeting the 2.30 The purpose is to provide a primary source of
requirements of the Electricity at Work Regulations guidance on managing energy use and carbon
1989, which detail the precautions to be taken emissions in the healthcare sector. It aims to ensure
against risk of death or personal injury from that everyone involved in managing, procuring
electricity in work activities. and using buildings and equipment gives due
consideration to the implications of energy use and
Health Technical Memorandum 06-03: Electrical carbon emissions. It draws together best practice
safety guidance for high voltage systems with the intention of putting energy at the heart of
the health service.
2.25 This Health Technical Memorandum gives
operational guidance on electrical safety
Health Technical Memorandum 07-03: Transport
requirements for high voltage systems (up
management and car parking: best practice
to 11kV) in healthcare premises including
guidance for NHS trusts in England (published
management, the professional and operational
February 2006)
structure, safety procedures, testing, equipment
and records. 2.31 The purpose is to consider what measures trusts
can adopt when developing travel plans and
2.26 Guidance is intended to assist in meeting the
managing transport and car parking, drawing on
requirements of the Electricity at Work Regulations
best practice to assist the NHS in a practical way. It
1989, which detail the precautions to be taken
aims to identify best practice in developing travel
against risk of death or personal injury from
plans, give links to other assessment tools, provide a
electricity in work activities.
matrix from which to estimate a base level of car
parking provision, point to external funding
Health Technical Memorandum opportunities, and consider environmentally-
07: Environment and sustainability friendly transport options.
(replaces Health Facilities Note 21,
Health Technical Memoranda 2065 and Health Technical Memorandum 08:
2075) Specialist services
Policies and principles HTM 00 Best practice guidance for healthcare engineering
Health Technical Memorandum 08-01: Acoustics outlines the routine maintenance of noise control
hardware or acoustic treatment and the monitoring
2.35 This document outlines the principles and
and recording of noise levels. The responsibilities
considerations associated with the control of
of all parties involved are defined, either by brief
noise generated by not only the various activities
explanation or by use of reference to specific
undertaken within healthcare premises but also the
legislation, standards and/or codes of practice.
services which are required for these activities to
be undertaken. The document is concerned with
Further documents which are under consideration
reducing both the interior noise environment
affecting the exterior noise environment and vice- Health Technical Memorandum 08-02:
versa. Pneumatic air tube transportation systems
2.36 Noise from a certain activity within the premises Health Technical Memorandum 08-03:
should not appreciably intrude on activities taking Building management systems
place in adjacent areas. This may be avoided by Health Technical Memorandum 08-04: Lifts
either careful consideration of the positioning of
rooms during design conception, or by provision of Health Technical Memorandum 08-05: Bed-
sufficient sound insulation. head services
2.37 This document provides not only the Health Technical Memorandum 08-06:
considerations for use at the design stage, but also Pathology laboratory gases
3 Statutory and legislative requirements
Policies and principles HTM 00 Best practice guidance for healthcare engineering
3 Statutory and legislative requirements
Probability Rating
Certain 5 5 10 15 20 25
Likely 4 4 8 12 16 20
Possible 3 3 6 9 12 15
Unlikely 2 2 4 6 8 10
Rare 1 1 2 3 4 5
Rating 1 2 3 4 5
Effect Insignificant Minor Moderate Major Catastrophic
Policies and principles HTM 00 Best practice guidance for healthcare engineering
4 Professional support
4.1 Managers of healthcare property and services need Health Technical Memorandum
technical and professional support across a range of
guidance structure
specialist services. This support should be embraced
into the structure and responsibility framework of 4.5 Following the Health Technical Memorandum
the organisation to ensure an adequate approach guidance review, eight specialist topics have been
for each of the areas covered by the healthcare- identified:
specific technical engineering guidance. decontamination;
4.2 Within the Health Technical Memoranda, a range medical gases;
of measures are discussed to meet the needs of
each service. This section considers the principles, heating and ventilation;
standards and common features that will be water;
applicable as a core approach.
fire safety;
Management and responsibility electrical services;
4.3 Healthcare organisations have a duty of care environment and sustainability;
to patients, their workforce and the general
specialist services.
public. This is to ensure a safe and appropriate
environment for healthcare. This requirement is 4.6 Within each topic, specific duties and
identified in a wide range of legislation. responsibilities are defined. See Figure 2 in the
Preface for structure and relationships.
4.4 At the most senior level within an organisation, this
responsibility does not need to include technical,
professional or operational duties, but the Management structure
appointed person should have access to a robust 4.7 To engage and deliver the duties required, a
structure that delivers governance, assurance and healthcare organisation may consider the structure
compliance through a formal reporting mechanism. shown in Figure 3. In following this structure,
Appointed qualified
technical staff
10
4 Professional support
healthcare organisations may consider that the 4.12 Within a specific service, other support staff
necessary professional and technical resilience is for safety, quality and process purposes may be
available to provide a robust service. required.
4.13 Within certain healthcare organisations, some
Professional structure elements of specialist services are not present (high
4.8 While a chief executive and the board carry voltage electrical, decontamination, medical gas
ultimate responsibility for a safe and secure pipelines etc). In this case, an appropriate level of
healthcare environment, it can be assigned or professional support should be considered.
delegated to other senior executives. 4.14 It is possible for several organisations to share
4.9 However, it may not be generally possible to the same professional staff either individually or
maintain a senior executive with specialist collectively; however, it is usual for the Authorising
knowledge for all professional services; external Engineer role to remain independent of the
support may therefore be required. organisation, with particular regard to the critical
audit process.
4.10 An independent adviser for audit purposes,
assessment and operational advice may also be
required.
Roles and responsibilities
4.11 The structure shown in Figure 4 represents a Designated Person (DP)
professional approach to delivery of a specialist
4.15 This person provides the essential senior
service.
management link between the organisation
and professional support, which also provides
independence of the audit-reporting process.
Designated Person
Appointed senior executive
(board level) with assigned
responsibility for service
Authorised Person
Appointed qualified
technical engineer (specific to
service)
Competent Person
Assessed and qualified
craftsperson
(specific to service)
11
Policies and principles HTM 00 Best practice guidance for healthcare engineering
The DP will also provide an informed position at will be nominated by the AE and be able to
board level. demonstrate:
4.16 The DP will work closely with the Senior his/her application through familiarisation with
Operational Manager to ensure that provision is the system and attendance at an appropriate
made to adequately support the specialist service. professional course;
a level of experience; and
Trust Senior Operational Manager (SOM)
evidence of knowledge and skills.
4.17 The SOM may have operational and professional
responsibility for a wide range of specialist services. 4.21 An important element of this role is the
It is important that the SOM has access to robust, maintenance of records, quality of service and
service-specific professional support which can maintenance of system safety (integrity).
promote and maintain the role of the informed
4.22 The AP will also be responsible for establishing and
client within the healthcare organisation. This will
maintaining the roles and validation of Competent
embrace both the maintenance and development
Persons, who may be employees of the organisation
of service-specific improvements, support the
or appointed contractors.
provision of the intelligent customer role and give
assurance of service quality. 4.23 Larger sites may need more than one AP for a
particular service. Administrative duties such as
Authorising Engineer (AE) record-keeping should be assigned to specific APs
and recorded in the operational policies.
4.18 The AE will act as an independent professional
adviser to the healthcare organisation. The AE
Competent Person (CP)
should be appointed by the organisation with a
brief to provide services in accordance with Health 4.24 This person provides skilled installation and/or
Technical Memorandum guidance. This may vary maintenance of the specialist service. The CP
in accordance with the specialist service being will be appointed, or authorised to work (if a
supported. contractor), by the AP. He/she will demonstrate a
sound trade background and specific skill in the
4.19 The AE will act as assessor and make
specialist service. He/she will work under the
recommendations for the appointment of
direction of the AP and in accordance with
Authorised Persons, monitor the performance of
operating procedures, policies and standards of the
the service, and provide an annual audit to the DP.
service.
To effectively carry out this role, particularly with
regard to audit, it is preferable that the AE remains
independent of the operational structure of the Variation by service
trust. 4.25 The particular detailed roles and responsibilities
will vary between specialist services, and the
Authorised Person (AP) guidance given in the appropriate Health Technical
4.20 The Authorised Person has the key operational Memorandum should be followed to ensure that
responsibility for the specialist service. The person the necessary safe systems of working are
will be qualified and sufficiently experienced and established and maintained.
skilled to fully operate the specialist service. He/she
12
5 Operational policy
5 Operational policy
13
Policies and principles HTM 00 Best practice guidance for healthcare engineering
5.22 Adequate means of engineering plant isolation 5.27 The operational policy should set out the
and safe working areas should be provided for all responsibilities for monitoring the work of
operational and maintenance contingencies to contractors. The Authorised Person responsible for
allow temporary plant where required and safe the specific engineering services would normally
working around equipment. coordinate this. The call-out procedures for a
contractor, particularly in the event of a fault or an
Monitoring of the operational policy emergency, should be set out in the operational
policy.
5.23 The Designated Person is responsible for
monitoring the operational policy to ensure that Medical equipment purchase
it is being properly implemented. This should be
carried out on a regular basis, and the procedure 5.28 The Authorised Person responsible for engineering
for such monitoring should be set out in the services should be consulted during initial
operational policy. discussions on the purchase of any medical
equipment that will be connected to the
5.24 The responsibility for monitoring specific aspects engineering services. This is to ensure that the
may be delegated to appropriate key personnel. system has sufficient capacity and can continue to
For example, the responsibility for monitoring the deliver the required service.
implementation of the permit-to-work procedure
would normally be delegated to the Authorised 5.29 The policy should state the procedures to be
Person. The details of such delegation should be set followed and the personnel who need to be
out in the operational policy. consulted before a new item of medical equipment
is connected to an engineering service.
14
6 Emergency preparedness and contingency planning
15
Policies and principles HTM 00 Best practice guidance for healthcare engineering
organisations response to a public incident for 6.18 From an understanding of the area and the
which an immediate high level of healthcare is healthcare activity that takes place, all the estates
required; services and facilities that exist in the range of
buildings on-site should be considered.
contingency planning is generally inward-
looking and deals with actions needed to 6.19 Table 1 gives a broad list of suggested topics for
maintain a healthcare facility in a safe and consideration. It is not a comprehensive list and
operational status under adverse conditions. may not be applicable to all sites, but it should act
as a prompt to establish the services list.
6.15 It is possible that some features from both plans
may be needed for a complex incident, but lines
of responsibility should be clearly defined and System resilience, planning and design
understood at all times. 6.20 Resilience of the various systems and services (for
example water and fuel) is ideally provided at the
Creating an emergency plan design stage of a healthcare facility. This could
include:
6.16 All plans should be documented and supported by
as much information as possible. This should be priority allocation of the site by local utility
kept up-to-date and under constant review. suppliers which provide alternative routes
for site supply, should parts of the external
6.17 It is important to define the area to which the
infrastructure be damaged or contaminated;
plan will apply. This will usually be by site rather
than individual buildings to avoid repetition of resilient internal infrastructure systems which
procedures and to embrace the wider service issues. provide flexibility in services supplies to
buildings;
Table 1 Suggested systems and services for consideration when creating an emergency plan
System Services External influence
Mains electricity supply Catering patients and staff Mains water contamination
Standby generators Key clinical departments (A&E, theatres, Air pollution
UPS + other batteries critical care etc) Flooding
Mains water Estates & facilities management Mains sewage treatment failure
Hot water (including engineering, APs, CPs etc) Transport routes and infrastructure
Treated water (renal etc) Transport Infestation
Heating and ventilation Portering Civil disturbance
Steam Administration support Explosion
Pneumatics Patient information Excavation
Building Management System Cleaning Terrorism incidents
Drainage Waste disposal Communications
Surface/foul/waste Laundry
Fuel supplies Medical supplies
Gas/oil/other Fuel supplies
Communications Water drainage
Telephones (fixed) Security
Mobile
Paging
Electronic
IT and patient information system
Lifts
Sterilization and decontamination
Medical gases
Fire alarms
Refrigeration (food, mortuary, blood
supplies, pharmacy equipment etc)
Medical equipment
Building structure
16
6 Emergency preparedness and contingency planning
provision of alternative fuel sources, with 6.28 It is also necessary to discuss and establish the
appropriate storage capacity on-site (for priorities of clinical services within the plan. These
example, fuel oil as back-up to natural gas will move from life-critical functions (operating
for boiler plant); theatres, critical care areas, neonatal intensive care
units, emergency care) through diagnostic services
enhanced levels of on-site standby capacity for
(imaging, laboratories) and on to clinical support
electricity supplies by the use of CHP systems,
(blood, sterile services, pharmaceutical supplies,
the sizing of standby generator plant, and
medical gases etc).
flexible electrical distribution systems;
6.29 Prioritised but flexible, estate and facilities services
appropriate monitoring and storage capacity for,
which underpin clinical priorities will provide a
for example, water supplies.
good platform for the organisation to cope with the
6.21 Planning and designing for resilience whenever impact of emergencies and speed up recovery to
the opportunity arises that is, when new sites/ provide normal business continuity.
buildings or departments are being considered and
when major refurbishments are taking place is a External impact
key responsibility of the management board.
6.30 External influences are perhaps the most difficult
6.22 This will require a clear understanding of the element of contingency planning due to the wide
critical operational service requirements and the range of scenarios that could be presented.
type and level of ongoing service needs in the event Consequently, scenario planning for every
of an emergency/incident. eventuality is very unlikely.
6.23 Prerequisite information should be provided at the 6.31 However, some of the most likely scenarios and the
planning and design stage to enable an appropriate key issues arising should be examined, evaluated
level of resilience to be built in. For this purpose, and, where possible, tested to ensure that some
close liaison should take place between the form of response is in place for that eventuality
organisations emergency planning officer and the (for example loss of major utility, external
estates & facilities professionals at the earliest communication links etc).
possible stages.
6.24 Of particular importance in times of emergency are Security
all forms of communication systems. Email, mobile 6.32 Areas of clinical concern (for example radiology,
phones, advanced telephone/telemedicine and pathology) may require enhanced access control,
patient data systems may all require a detailed and staff and contractor screening, in accordance
analysis of the effect of failure loss. with the NHS Security Management Manual.
6.25 Proposed changes to any communication system 6.33 Adverse incidents may present exceptional
should ensure that consideration is given to requirements to control security, access, patient
the requirements of emergency plans and and staff safety etc. Planning should ensure that
communication-service resilience before decisions measures are available and understood which may
are taken. include additional staff resources (drawn from non-
6.26 These considerations should also include home/ critical roles) for entry/exit control, increased
mobile communication systems for key staff who awareness and communications, defined
will be required in the event of an emergency or management responsibility etc.
adverse incident.
Responsibility
Services and priorities 6.34 If the issue or incident remains predominantly
6.27 Maintaining services is an essential function of an estates or facilities issue, action should be
business continuity and must be a priority within a coordinated through the estates and facilities
contingency plan. Alternative sources of catering, management (EFM) structure. However, if the
laundry, waste disposal, transport etc need to be cause and/or effect escalates into a more major
confirmed, and all lines of communication and event, and a major incident is declared, the lines of
supply chains regularly tested. responsibility should revert to the major incident
plan structure.
17
Policies and principles HTM 00 Best practice guidance for healthcare engineering
18
7 Training, information and communications
19
Policies and principles HTM 00 Best practice guidance for healthcare engineering
7.8 The resulting analysis may give rise to either a 7.14 The cost of training and the cost of apprenticeships
training need for existing staff or a need for a staff/ can be difficult to secure. When presented as part
structure review with possible training implications. of an overall assessment with, at least, a medium-
It may also identify a service which may be more term plan, it can deliver cost-efficient provision
cost-effectively provided by an outsourced contract. of services meeting the future need of the
organisation.
7.9 While it is important to address the staff profile by
trade or service, it may be useful for an organisation 7.15 Training and the quality of service are inter-linked.
to link the outcome with other service profiles. Taking full advantage of multi-skilling and flexible
This may indicate some common issues, economies working practices will begin to deliver the cost and
of scale for training needs, useful feeder groups and performance efficiencies required from the services.
a better general overview of the service, which can
be used to inform a priority assessment. Criteria for operation
7.10 More advice and a checklist of issues is referenced 7.16 Maintenance staff should be trained in all
on the Department of Health Estates and Facilities maintenance procedures.
website under the workforce development section
7.17 The depth of training will depend on the level of
entitled Framework for transformation and
improvement (http://www.dh.gov.uk). required maintenance, but it should at least draw
attention to any risks and safety hazards arising due
to maintenance activities.
Improving the workforce profile
7.18 Other personnel who monitor plant or who carry
7.11 Many of the traditional training routes no longer
out routine plant maintenance should be trained
provide the level of opportunity relevant to the
in:
healthcare sector; at the same time, skills and
competences needed are becoming more and more a. understanding the visual displays;
specific to the healthcare sector. b. acknowledging and cancelling alarms;
7.12 One challenge is to encourage more young c. taking required actions following alarm
people to enter the services sector of healthcare messages;
organisations under specific programmes such as
the modern apprenticeship scheme where skills can d. obtaining the best use of the system.
be delivered to meet a specific need. Another is to 7.19 Training (including refresher training) will need
develop a multi-skilled approach to service delivery. to be repeated periodically in order to cater for
In each case, training and development will be an changes in staff or the systems.
important factor in the solution.
7.20 Records of the training provided should be kept
7.13 With an understanding of the existing workforce up-to-date.
profile, a training plan may be established to meet
the short-, medium- and long-term requirements 7.21 On completion of training, employees should be
that are needed to satisfy the organisations assessed by an Authorised Person to ensure that the
requirements. training programme has been understood and that
they are competent to undertake the work required.
20
8 Maintenance
8 Maintenance
8.5 The initial frequency of maintenance will depend 8.11 Records of service reports and attendance dates
on the manufacturers recommendations and the (both scheduled and achieved) should always be
circumstances of application. available.
21
Policies and principles HTM 00 Best practice guidance for healthcare engineering
22
8 Maintenance
Planned maintenance programme 8.31 Although the manufacturer may carry out certain
inspection and maintenance procedures under the
General terms of his guarantee, these may not constitute
a full PM programme. The user or their
8.29 The planned maintenance programme should be
representative should therefore ensure that the
designed according to the following principles: complete PM programme is carried out by the
where the correct functioning of important maintenance person during the guarantee period.
components is not necessarily verified by 8.32 The user or their representative should also
the periodic tests prescribed for the critical implement any reasonable instructions given by the
engineering service, those components should manufacturer during this period. Failure to carry
be regularly tested, and reference to testing out maintenance tasks and periodic tests could
them should be included in the schedules of affect safety.
maintenance tasks. This applies, for example,
to door interlocks that may only be required to 8.33 A set of procedures should be developed for each
perform their safety function when presented critical engineering service, containing full
with an abnormal condition; instructions for each maintenance task.
the maintenance programme should include, 8.34 It is important that maintenance is planned so that
at appropriate intervals, those tasks such as any plant or equipment is out of service for as little
lubrication and occasional dismantling of time as possible.
particular components (such as pumps), the 8.35 Where practicable, maintenance should be
need for which is indicated by normal industry scheduled to immediately precede any periodic
best practice, manufacturers advice and tests.
experience. Apart from those tasks, the
maintenance programme should concentrate Review of the planned maintenance programme
on verifying the condition of the critical
engineering service and its components by 8.36 The PM programme, procedures and records
means of testing and examination without should be reviewed at least once a year by the user
dismantling. Parts that are working correctly and the maintenance person in association with the
should not be disturbed unnecessarily. Authorised Person. To do this, it is necessary to
keep systematic records of all work done, so that
maintenance should be carried out under a judgement can be made in consultation with the
quality system such as BS EN ISO 9000. Spares manufacturer on what changes, if any, to the PM
fitted to critical engineering services constructed programme would be best.
under a quality system should be sourced from
the manufacturer or a similarly approved quality 8.37 The review should aim to identify:
system. a. any emerging defects;
23
Policies and principles HTM 00 Best practice guidance for healthcare engineering
9 Engineering services
Management of access to engineering stage. The policy should also allocate crossover
zones, minimum separation distances and shielding
services
requirements in the event of it not being possible to
9.1 Healthcare organisations have the responsibility meet these requirements.
to ensure that all service installations are specified,
9.6 Before putting any engineering systems into
designed, installed, commissioned and maintained
service, the installation should be inspected, and
(including future upgrade) with consideration for
it should be verified that access is available for
services modifications and dismantling during the
commissioning, maintenance, and future
life of the building.
upgrading.
9.2 To satisfy these requirements, it is recommended
9.7 It should also be verified that there are adequate
that organisations:
provisions made for additional services and
a. designate a person responsible to coordinate dismantling during the life of the system.
all the engineering services to ensure that the
services do not have any adverse effects on each Development planning
other, the structure and personnel safety;
9.8 It is essential to ensure that both engineering and
b. ensure that a project file is available for all new architectural aspects are developed simultaneously
projects, alterations or extensions, regardless from project inception. This should ensure that
of the size of the project. The file should systems are safely integrated in terms of location,
contain specifications, drawings, and distribution and future developments, and that
maintenance information including access and service resilience is planned from the start.
safe disposal at the end of its useful life;
9.9 The architectural design should permit sufficient
c. ensure that adequate space is provided for space for services. Provision of extra space to allow
installation and maintenance staff and for future development is considered as best
appropriate access to services; practice.
d. adequately brief the designers on the current 9.10 Accurate and detailed drawings are essential for
and future maintenance policies; providing space requirements. However, these
e. ensure that any new work, alterations or may not be available at the early design stage.
modifications do not restrict existing access to An estimate of space requirements may have to be
plant and equipment. made on preliminary drawings in order to avoid
costly revisions.
9.3 Details of any asbestos survey must be made
available to the design team and any contractors
prior to carrying out any work.
Distribution requirements
9.11 An assessment of the distribution requirements
9.4 The Control of Asbestos at Work Regulations 2002
should be considered, taking into account
includes duties to protect those who come into
communication, area, plant and distribution. This
contact with asbestos unknowingly or accidentally.
must be related to the specific size and shape of the
The survey report should include details of any
building etc.
asbestos-containing materials, their condition and
location, and when they were last inspected. 9.12 Accommodation of vertical services will be decided
at an early design stage. The information may be in
9.5 A zoning policy allocating particular zones for
specific services should be agreed early in the design
24
9 Engineering services
the form of total area requirements to be divided (i) immediate access is required for plant,
later as design progresses. valves, switches and other controls
requiring frequent attention for safe
9.13 Resilience and flexibility of services distribution
operation and maintenance;
should be included at an early stage.
(ii) if enclosed, the access should be by door or
9.14 Departments that require heavily-loaded services
panel;
should be grouped together and located near to the
distribution centre if possible. This avoids large (iii) adequate clearance should be provided for
runs and therefore distribution losses. Dependent ease of working.
on the building design, it may be advantageous for
b. Intermittent access: items that require access
services to follow the main communication routes.
at intervals (for example monthly) can be
9.15 Generally, the energy centre is the first plantroom provided by means of floor traps, removable
to be installed on-site. This allows the main service panels in walls, false ceilings and so on. It is
routes to be determined. The next step would be recommended that access panels be fitted by
to determine areas required for other plantrooms means of retained quick-release mechanisms
including, for example, those at rooftop level. rather than screws and cups.
9.16 Consideration should be given to maximising the c. Renewal or modification of service:
flexibility of engineering services to allow the
(i) most, if not all, services may require
maximum possible changes in the use of hospital
modification or renewal during the useful
departments.
life of the building. Accommodation
9.17 In multi-storey buildings: should be planned for this to occur,
taking into account weight, size and
a. most flexibility is achieved by a small number of
configuration of the item. During non-
large vertical ducts with adequate provision for
emergency renewals, it may be possible to
horizontal space above ceiling level and below
remove door frames, windows, partitions
structural members;
and other non-structural items. The
b. generally, less flexibility is achieved by a large renewal or modification of minor items
number of smaller vertical ducts with ceiling does not usually create problems except
spaces for horizontal distribution as necessary; where piping or cable lengths are
c. the omission of space above ceilings produces restrictive;
the least flexible arrangement. (iii) the destruction of finishes to open up
9.18 Convenient access should be provided to all service a trench or vertical duct or existing
spaces. access could be more economic than the
provision of expensive but rarely-used
9.19 In single-storey buildings: permanent access. Costs versus savings
a. sufficient headroom should be allowed for must be considered with regard to the cost
installation and maintenance purposes; of inconvenience/disruption to functions
incurred at the time of replacement.
b. if a service trench is provided, where practicable,
removable covers should be provided over the Working in confined spaces
complete length of the trench.
9.22 A confined-space permit-to-work system should be
Access established, and personnel trained in the use of the
system.
9.20 Access to services should be considered at every
stage of both the architectural and engineering 9.23 The system should address the following points:
design process. assessment of the task to be undertaken;
9.21 The frequency of access required should be the identification of the potential risks/hazards;
main factor considered.
ventilation;
a. Frequent access:
25
Policies and principles HTM 00 Best practice guidance for healthcare engineering
air quality testing, prior to entry and monitoring of compliance of the system;
continuously during access requirements;
actions in case of emergency;
provision for special tools and lighting;
communication;
working methods;
first-aid.
implementation of the working methods;
26
Appendix 1 Summary of key legislation
The following paragraphs give a wider explanation (iv) provide for the health, safety and welfare
of the itemised legislation listed in paragraph 3.6. of all (employees, contractors and public)
They are not a definitive summary, but are those affected by their business;
intended to explain more fully the broad content.
b. duties of employees to:
Reference should be made to the current full
documents if consideration of the legislation is (i) correctly use equipment provided;
thought appropriate. (ii) work in accordance with the organisations
policies;
1 H
ealth and Safety at Work etc Act
(iii) be responsible for their own acts and
1974 omissions;
This is the prime piece of UK general safety
(iv) cooperate with their employer.
legislation, and gives Government ministers the
legal powers to enact regulations.
2 Factories Act 1961
All employers, including healthcare organisations,
have a general duty under the Health and Safety at The Factories Act 1961 and the Offices, Shops and
Work etc Act 1974 to ensure, so far as is reasonably Railway Premises (Hoists and Lifts) Regulations
practicable, the health, safety and welfare of their 1968 require that every power-driven lift should be
patients, employees and visitors and members of of good mechanical construction, sound material
the public who may be affected by workplace and adequate strength etc. The act refers to
activities. maintenance and thorough examination by an
Authorised Person (Lifts) every six months, and
These duties are legally enforceable, and the Health states that a report of the result of every such
& Safety Executive has successfully prosecuted examination should be prepared.
employers including health authorities and trusts
for breaches of this statute. It falls upon owners 3 T
he NHS and Community Care Act
and occupiers of premises to ensure that there
is a management regime for the proper design,
1990
installation and maintenance of plant, equipment Section 60 of the NHS and Community Care Act
and systems. It is important to note that failure to 1990 removed Crown immunity from the NHS
have a proper system of work and adequate control and specified health service bodies from 1 April
measures can also constitute an offence even 1991 with only a few exemptions. This act brings
though an incident has not occurred. the local authority and the Health & Safety
Executive into play and puts the NHS into a
Key requirements are:
comparable position to any other organisation.
a. duties of employer to:
(i) issue each employee with a safety policy 4 Consumer Protection Act 1987
statement; The aim of the Consumer Protection Act 1987 is
(ii) provide a safe system of work; to help to safeguard the consumer from products
that do not reach a reasonable level of safety. The
(iii) give adequate training and supervision; main areas dealt with can be described as product
liability and consumer safety.
27
Policies and principles HTM 00 Best practice guidance for healthcare engineering
28
Appendix 1 Summary of key legislation
a. carry out an assessment of the risks associated c. dislocation of the shoulder, hip, knee or spine;
with entering a confined space and draw up a d. loss of sight (temporary or permanent);
safe system of work;
e. loss of consciousness.
b. limit entry to the confined space to employees
who are competent for confined space work and Examples of dangerous occurrences:
who have received suitable training; a. failure of load-bearing parts of lifts and lifting
c. verify, prior to entry, that the atmosphere in the equipment;
confined space is safe to breathe; b. explosion, collapse or bursting of any pressure
d. provide any necessary ventilation; and vessel or associated pipework;
e. make sure that suitable rescue arrangements are c. electrical short-circuit or overload causing fire or
in place before anyone goes into the confined explosion.
space. These rescue arrangements should not
involve risks to the safety of the people intended 14 T
he Working Time Regulations
to carry out the rescue. 1998
The regulations implement two EU Directives
13 T
he Reporting of Injuries, Diseases on the organisation of working time and the
and Dangerous Occurrences employment of young workers (under 18 years
Regulations 1995 (RIDDOR 95) of age). The regulations cover the right to annual
leave, to have rest breaks, and they limit the length
These regulations set out the responsibilities for
of the working week. Key protections include:
employers, the self-employed or those in control of
work premises to report certain injuries, diseases a. a 48-hour maximum working week. Employers
and dangerous occurrences. have a contractual obligation not to require a
worker to work more than an average 48-hour
The following events must be reported by the
week;
quickest possible route (normally telephone).
b. four weeks paid holiday;
If there is an accident connected with work and:
29
Policies and principles HTM 00 Best practice guidance for healthcare engineering
30
Appendix 1 Summary of key legislation
31
Policies and principles HTM 00 Best practice guidance for healthcare engineering
establishments from hospitals. However, the associated with its location or condition,
trainees spend much time in the associated hospital repaired or, if necessary, removed;
on educational visits. If these visits are purely
(iii) information on the location and condition
for observation, it is unlikely they are relevant
of the material is given to anyone
training; but if the trainees help with the work of
potentially at risk.
the hospital, assisting doctors at clinics or in caring
for patients, this might be relevant training, and
the hospital, as the immediate provider, would have ELECTRICAL
duties under section 2 of the Health and Safety at
Work etc Act 1974. 24 Electricity Act 1989
The primary legislation governing the electricity
22 S afety Representatives and Safety supply industry in Great Britain is the Electricity
Committees Regulations 1977 Act 1989 and the Utilities Act 2000. The 2000
Act established the Gas and Electricity Markets
If an employer recognises a trade union and Authority the office of which is known as Ofgem,
that trade union has appointed, or is about to the principal duties of which include:
appoint, safety representatives under the Safety
Representatives and Safety Committee Regulations a. protect the interests of consumers by, wherever
1977, the employer must consult those safety possible, promoting effective competition in
representatives on matters affecting the group or generation, transmission, distribution or supply;
groups of employees they represent. Members of b. secure reasonable demand for electricity is met;
these groups of employees may include people who
are not members of that trade union. c. have regard to the interests of the disabled and
sick, the elderly, those on low incomes and
23 C
ontrol of Asbestos at Work those in rural areas.
Regulations 2002 25 E lectricity Safety, Quality and
The Control of Asbestos at Work Regulations deal Continuity Regulations 2002
with the management of risk from asbestos in non-
domestic buildings and require duty holders These regulations revoke the Electricity Supply
(landlords, lessees, owners) to: Regulations 1988 and all subsequent amendments.
The requirements are separated into broad
a. take reasonable steps to find materials in equipment categories and include:
premises likely to contain asbestos, and to check
their condition; a. protection and earthing;
32
Appendix 1 Summary of key legislation
The IEE Wiring Regulations (now called BS 7671 c. compile technical documentation, which must
Requirements for electrical installations) are an be kept for ten years.
all-encompassing set of documents that give both
technical and practical guidance on the installation
and maintenance of electrical services.
33
Policies and principles HTM 00 Best practice guidance for healthcare engineering
29 P
lugs and Sockets etc (Safety) MECHANICAL
Regulations 1994
32 S upply of Machinery (Safety)
These regulations require domestic plugs in the UK
to be independently certificated as complying with Regulations 1992 and Supply of
BS 1363. Domestic socket-outlets, adaptors, fuse- Machinery (Safety) (Amendment)
links etc are required to meet the relevant British Regulations 1994
Standard. Additionally, the regulations require most
domestic electrical appliances to be pre-fitted with These regulations place duties on those who supply
a compliant standard plug. machinery and safety components, including
manufacturers, importers and others in the supply
chain. They set out the essential requirements
30 R
adio Equipment and which must be met before machinery or safety
Telecommunications Terminal components may be supplied in the UK.
Equipment Regulations 2000 There are basically three steps to dealing with the
This applies to radio equipment and requirements:
telecommunications terminal equipment, ensuring
a. the responsible person should ensure that
that relevant products meet certain minimum
machinery and safety components satisfy the
essential requirements concerning health and safety,
relevant essential health and safety requirements
electromagnetic interference, and radio spectrum
of the Supply of Machinery (Safety) Regulations
requirements.
and that, where appropriate, relevant
conformity assessment procedures have been
31 E lectromagnetic Compatibility carried out;
Regulations 1992 b. the responsible person must issue a
These regulations apply to almost all electrical declaration of conformity (or a declaration of
and electronic appliances, and regulate radio incorporation) which is issued with the finished
interference from electrical equipment. For the product so that it is available to the user. This
purposes of being able to test whether or not will contain various details such as the
equipment complies with the regulations, tests are manufacturers address, the machinery type and
divided into five classes: serial number, and the harmonised European or
a. radiated emissions checks to ensure that the other standards used in design;
product does not emit unwanted radio signals; c. when the first two steps have been satisfactorily
b. conducted emissions checks to ensure the completed, the responsible person or person
product does not send out unwanted signals supplying or assembling the final product
along its supply connections and connections to should affix the CE marking if they are satisfied
any other apparatus; it is safe.
c. radiated susceptibility checks that the product 33 L ifting Operations and Lifting
can withstand a typical level of electromagnetic
pollution;
Equipment Regulations 1998
(LOLER)
d. conducted susceptibility checks that the
product can withstand a typical level of noise In general, these regulations require that any lifting
on the power and other connections; equipment used at work for lifting or lowering
loads is:
e. electrostatic discharge checks that the product
is immune to a reasonable amount of static a. strong and stable enough for particular use and
electricity. marked to indicate safe working loads;
b. positioned and installed to minimise any risks;
c. used safely: that is, the work is planned,
organised and performed by competent people;
34
Appendix 1 Summary of key legislation
b. keep lift shafts free of extraneous piping, wiring c. arrange to have examinations carried out by a
and other fittings; competent person at the intervals set out in the
scheme;
c. keep the supply of relevant information to those
who are entitled to it. d. provide adequate operating instructions
(including emergency instructions) to any
person operating it (for example operating
35
Policies and principles HTM 00 Best practice guidance for healthcare engineering
manual supplemented by on-the-job training The health and safety requirements identified at the
and supervision for new staff ); design and planning stage must be set down in a
safety plan. This must be further developed during
e. ensure the pressure system is maintained in
the construction phase. When the project is
good repair;
complete, a safety file must be provided which
f. keep adequate records of the most recent contains the detailed information about the
examination and any manufacturers records structure and equipment within it, so the end-user
supplied with the new plant; can manage health and safety properly during
g. distinguish between installed or mobile systems subsequent use, construction and maintenance
and whether owner or user is responsible. activity.
The regulations apply to construction work on
39 T
he Pressure Equipment structures, but both the definitions are extremely
Regulations 1999 broad:
These regulations apply to the design and a. Construction. These include alteration,
construction aspects of pressure equipment installation, commissioning, assembly,
intended to contain a gas or liquid at 0.5 bar gauge conversion, repair, renovation, maintenance,
or above. Assemblies of such equipment (that is, a demolition, exploration etc. It should be noted
pressure system) are also covered. particularly that the term can apply to work on
mechanical, electrical and telecommunications
installations fixed within or to a structure.
40 S imple Pressure Vessels (Safety)
Regulations 1991 b. Structure. These include any building, railway,
shaft, bridge, pipe, sewer, gasholder, road, cable,
The legislation harmonises national laws of pylon etc.
member states across the European Union
regarding the design, manufacture and initial The regulations apply if more than four persons
conformity of simple pressure vessels which are will be involved in the construction work at any
intended to contain air or nitrogen at a gauge one time. The project requires notification to the
pressure between 0.5 and 30 bar gauge. Health & Safety Executive if it will exceed 30 days
or involve more than 500 person-days of work.
Simple pressure vessels cannot be placed on
the European market unless they meet the One of the requirements of the legislation is a
requirements of this legislation. safety plan. This is a statement of the arrangements
made in order to achieve satisfactory standards of
Before being placed on the market, vessels must health and safety during construction. It should be
bear the CE conformity marking. prepared at the pre-tender stage and be part of the
The vessel or data plate must bear, in addition to documentation used in the tender process which
the CE marking, at least one of the seven additional results in the selection of the Principal Contractor.
inscriptions described in the regulations. The purpose is to identify known hazards
associated with the project and to invite prospective
41 T
he Construction (Design and contractors to say what arrangements they will
make to deal with them.
Management) Regulations 1994
Another requirement of the legislation is to have
These regulations are intended to improve
a health and safety file. This file is a record of
management of safety during construction work.
information for the end-user, focusing on health
They establish high standards in the management
and safety. It should identify significant health and
and control of construction activity from concept
safety risks associated with the structure and the
to commissioning, rather than imposing detailed
equipment it contains. It should contain as built
engineering requirements. In particular, they
drawings and plans.
emphasise the need to take account of health and
safety aspects during initial planning to ensure that The legislation imposes a duty on various
these considerations are built into the scheme. participants, including:
a. client;
36
Appendix 1 Summary of key legislation
37
Policies and principles HTM 00 Best practice guidance for healthcare engineering
Internal stability will be maintained during fire, A house must have either a bath or shower with
and fire spread will be prohibited. ability to heat hot water.
Fire and smoke will be prohibited from Unvented hot water storage systems
spreading to concealed spaces in a buildings restrictions apply to who can install the system.
structure.
Part H Drainage and waste disposal
Externally the external walls and roof will
resist spread of fire to walls and roofs of other An adequate system to carry water used for
buildings. cooking, washing, toilet, bath or shower to a
sewer cesspool or settlement tank must be in
The building will be easily accessible for fire-
place.
fighters and their equipment.
A cesspool or settlement tank must be
Part C Site preparation and damp proofing impermeable to liquids and have adequate
ventilation. It must also have means of access
Nothing should be growing on the ground
for emptying, not harm the health of any
covered by the building.
person, and not contaminate water or water
Precautions must be taken to stop gases and supply.
dangerous substances from previous land use
An adequate system to carry rainwater away
from entering the building and endangering the
from the roof of a building (for example
health and safety of occupants.
guttering carrying water to a sewer).
Subsoil drainage will be in place, if needed,
A place to put a wheeled bin or dustbin. The
to stop the passage of ground moisture to the
place must not harm anyones health.
interior of the building and to prevent damage
to the fabric of the building.
Part J Heating appliances
The walls, floors and roof of the building shall
Must have an adequate air supply for
prevent moisture passing to the inside of the
combustion and for efficient working of a
building.
fluepipe or chimney.
Part D Toxic substances Appliances shall discharge the products of
combustion to the outside.
Insulating materials inserted into cavity walls
can give off fumes. Measures must be taken to The appliance, fireplace and chimney shall
prevent these fumes reaching occupants of the reduce the risk of the building catching fire.
building.
Part K Stairs, ramps and guards
Part E Soundproofing
Stairs, ramps and ladders shall provide safety for
Floors and walls between domestic buildings people when moving between different levels of
should have a certain resistance to the passage of a building.
sound.
Stairs, ramps, floors and balconies shall be
Sound insulation requirements also apply to adequately guarded.
floors and certain walls within individual
Safety shall be provided for people using vehicle
dwellings and new schools.
ramps and loading bays.
Part F Ventilation
Part L Conservation of fuel and power
The building must have adequate ventilation
Provision must be made for the conservation of
and provision to prevent condensation
fuel and power in a building.
occurring in the roof structure.
The fabric of the building must limit heat loss.
Part G Hygiene
Controls to operate the heating of the building
Adequate sanitation facilities. and heating of water.
38
Appendix 1 Summary of key legislation
Limit heat loss from hot water tanks and hot is through the local authority. Regulations also
water pipes. place a duty of care on all those involved in the
management of waste, be it collecting, disposing
Lighting systems in buildings should use no
or treating controlled waste which is subject to
more energy than needed and have adequate
licensing.
controls.
39
Policies and principles HTM 00 Best practice guidance for healthcare engineering
48 C
ontrolled Waste (Registration of the classification and coding of waste or
hazardous waste. The different types of waste in
Carriers and Seizure of Vehicles)
the List of Wastes regulations are fully defined
Regulations 1991 by the six-digit code for the waste and the
These regulations cover the registrations required respective two-digit and four-digit chapter
for certain waste carriers, brokers and dealers by headings.
the local environmental regulator. These controls,
together with the Duty of Care, are designed to 50 P
ollution, Prevention and Control
prevent fly-tipping (illegal waste disposal). (England and Wales) Regulations
Organisations or individuals that want to transport,
deal in and/or arrange the disposal or recovery of
2000
controlled waste, whether in liquid or solid form, These regulations apply to installations or mobile
are required to register with their environmental plant that complies with set criteria or limits, for
regulator. The carriage of an organisations own the purpose of achieving a high level of protection
wastes does not usually require registration, unless of the environment taken as a whole by, in
it is construction or demolition waste. Waste particular, preventing or, where that is not
carriers who operate in England must register with practicable, reducing emissions into the air, water
the Environment Agency. and land. This will require that some businesses
need a permit from the Environment Agency
49a H
azardous Waste (England and before they can operate. Such situations in
healthcare may include provision of an energy
Wales) Regulations 2005
centre or the operation of an on-site incinerator.
The Hazardous Waste Regulations and associated
List of Wastes Regulations (below) replaced the 51 Clean Air Act 1993
Special Waste Regulations. The regulations define
and regulate the movement of hazardous waste in This Act deals with the emission of smoke from
England and Wales from the point of production to agriculture, industrial burning, industrial furnaces,
the point of disposal or recovery. These regulations, railway engines and ships. The best practicable
among other things, require producers of hazardous means must be used to reduce emissions, and
waste to notify (register with) the environmental furnaces are required to be fitted with plant for
regulatory authority (Environment Agency for arresting grit and dust.
England and Wales) and to provide unique codes Chimney heights are also specified.
to be applied to the consignment notes which
accompany waste when transported. The act is enforced by local authorities, who can
prosecute organisations or their employees.
See HTM 07-01 Safe management of healthcare
waste. The Act also specifies maximum concentrations of
lead and sulphur in motor fuel.
49b L ist of Wastes (England)
52 E nvironmental Protection
Regulations 2005
(Prescribed Processes) Regulations
The List of Wastes Regulations, combined with the 1991
Hazardous Waste Regulations (above), implement
the requirements of the Hazardous Waste Directive This legislation defines the substances that must
and the European Waste Catalogue Codes. be controlled when released to a particular
environmental medium.
The List of Wastes effects the regulation of waste
and hazardous waste and in particular for the
purposes of:
53 T
rade Effluent (Prescribed Processes
and Substances) Regulation 1989
the determination of whether a material or
substance is a waste or a hazardous waste, as the These regulations prescribe the substances and
case may be; processes which are treated as special category
effluent. Stringent controls apply to such effluents.
40
Appendix 1 Summary of key legislation
Prescribed processes include those processes 58 L andfill Tax Regulations 1996 and
discharging chlorinated effluents.
Landfill Tax (Qualifying Material)
54 Controlled Waste Regulations 1992 Order 1996
These regulations apply to all waste going to
These regulations cover the wastes which are to be
landfill. Tax is chargeable by weight on all types of
treated as controlled waste under the categories of
waste. Two rates are applied: inert wastes are those
household, industrial and commercial wastes.
which do not give off methane or other gases and
Most wastes from industry and commerce are do not have the potential to pollute underground
controlled wastes one notable exception being water.
radioactive waste.
Lists of wastes are found in Annex A of the Landfill
Tax (Qualifying Material) Order 1996. Those liable
55 Environment Act 1995 for tax are the licence holders for the landfill site.
The Environment Act 1995 creates a system
whereby local authorities must identify, and 59 C
hemicals (Hazard Information and
if necessary arrange for the remediation of, Packaging for Supply) Regulations
contaminated sites in their areas.
2002
Each local authority must inspect its area from time
These regulations describe the requirements for the
to time in order to identify contaminated land, and
labelling of substances to indicate risks to health,
must keep a register of such land.
safety and the environment. Preparations classified
as dangerous for the environment should be
56 P
ackaging (Essential Requirements) assigned the symbol N. Some substances that pose
Regulations 2003 no particular human health and safety problem
These regulations implement Directive 94/62/EC nevertheless require to be labelled dangerous for the
on packaging and packaging waste, which relates environment.
to the essential requirements to be satisfied by
packaging. The regulations apply to all packaging 60 T
own and Country Planning Act
placed on the market in the UK, and are enforced 1990
by trading standards officers of local authorities.
This Act requires a local authority to assess the
The regulations place a responsibility on any environmental effects of certain development
company that introduces packaging onto the projects, and to consult the Environment Agency
marketplace to ensure that it is minimal, safe, and before granting planning permission.
is either reusable, or recoverable, or recyclable.
61 Control of Pollution Act 1974
57 C
ontrol of Pollution (Oil Storage) The Control of Pollution Act 1974 (CPA) gives
(England) Regulations 2001 powers to local authorities to set noise criteria
These regulations require persons having custody or within the local environment. The local authority
control of oil, or who store oil, to carry out certain therefore has the power to serve notices on those
works and take precautions and other steps for responsible for causing noise amounting to a
preventing pollution of any controlled waters. It nuisance.
is a criminal offence to fail to comply with these
regulations, but the regulations do not apply to 62 P
roducer Responsibility Obligations
premises where less than 200 litres is stored, nor (Packaging Waste) Regulations
to private dwellings where less than 3500 litres
2005
is stored, nor to farms if the oil is for use in
connection with agriculture. A company involved in the production and sale of
packaging or packaging materials has an obligation
as a producer under the regulations where
thresholds are exceeded. A producer can be a
manufacturer, converter, packer/filler, seller or
41
Policies and principles HTM 00 Best practice guidance for healthcare engineering
42
Appendix 1 Summary of key legislation
from vehicle and building alarms, loudspeakers and a. package design should be such that the risk
other noise in public areas. of any radioactive contamination or external
radiation hazard should be kept to a minimum;
RADIATION b. all shipments should be traceable to the sender;
43
Policies and principles HTM 00 Best practice guidance for healthcare engineering
f. review your findings when necessary, that is, The following items are exempt:
whenever the fire risk situation changes or at
a. bed linen (including duvets and pillowcases);
least annually.
b. loose covers for mattresses;
Under the order, anyone who has control of
premises or anyone who has a degree of control c. curtains;
over certain areas or systems may be a responsible d. carpets.
person. For example, it could be:
the employer, for those parts of premises staff 78 D
angerous Substances and
may go to; Explosive Atmospheres Regulations
the managing agent or owner, for shared parts (DSEAR) 2002
of premises or shared fire safety equipment such
These regulations set minimum standards for the
as fire-warning systems or sprinklers;
protection of workers and others from the risk of
the occupier, such as self-employed people or fire or explosions related to dangerous substances.
voluntary organisations, if they have any Petrol and LPG are amongst those substances
control; deemed to be dangerous.
any other person who has some control over a The regulations require that risks arising from those
part of the premises. dangerous substances are comprehensively risk-
Although in many premises the responsible person assessed and recorded.
will be obvious, there may be times when a number
of people have some degree of responsibility. FOOD
44
Appendix 1 Summary of key legislation
e. manufacturing;
83 Medicines Act 1961
f. storage;
Medical gases are classified as medicinal products
g. transporting; under the Medicines Act and are therefore subject
to the same procurement and quality procedures as
h. selling;
all other medicinal products.
j. distribution;
k. supplying.
45
Policies and principles HTM 00 Best practice guidance for healthcare engineering
Risk assessment
This procedure is linked to the overall hospital site procedure for failure of electricity supply and departmental
risk assessment register. This document should be reviewed on a regular basis and especially if any alterations to
equipment function, staff and responsibility take place.
Aims
This emergency procedure is intended to highlight the key issues that may arise at departmental level in the event
of electrical power failure. It is appreciated that this may be the result of a full site power failure, but it may also
be the result of a local failure for which notification will be necessary. The main aim is to provide a structured
approach to the safety of patients and staff and to minimise the risk associated with an electrical failure.
Identification of failure
This may be indicated by the failure of key observable elements, for example lighting and computer displays.but
may also be indicated by alarm signals from monitored supply panels on medical equipment, services and
systems.
46
Appendix 2 Exemplar procedures
Review procedure
From incident experience and training evaluation, this procedure and any supporting information should be
reviewed and amended as necessary to ensure the document remains up-to-date and definitive for the
department.
This document was first issued on: .. (Date)
Amendments: ... (Brief details and date)
Plan approved and accepted by:
Senior manager
Head of department: .
47
Policies and principles HTM 00 Best practice guidance for healthcare engineering
Scope
The following procedure is designed to instruct and advise on the operational requirements for dealing with
contamination of the water supply. It is not considered a definitive guide as the particular circumstances of the
incident will ultimately determine the course of action taken. It will attempt to highlight the responsibilities of
estates 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 example
rusting metal and dead animals;
cross-contamination of water supply due to the effect of a process carried out on site by staff or contractors
where the safety devices are inadequate or non-existent, for example cross-contamination due to siphonage
from drains and stagnant water;
misoperation/failure of water treatment plant;
migration between domestic hot and cold water services.
Effects
The possible effects of contamination are varied, and will depend on the severity and degree of the
contamination. 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 or
decaying matter);
the water appears normal but people using it have become sick.
48
Appendix 2 Exemplar procedures
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 areas
requiring 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 resolve
the situation;
inform medical staff of the nature of the contamination and await advice on the clinical effect before restoring
the water supply to the area;
thoroughly flush all pipework (run taps, flush toilets, bidets etc) until further analysis shows no trace of
contamination;
when the water quality is restored and confirmed by medical or microbiology staff, allow normal use to
continue.
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
...............................................................................................................................................................................
...............................................................................................................................................................................
...............................................................................................................................................................................
..............................................................................................................................................................................
49
Policies and principles HTM 00 Best practice guidance for healthcare engineering
Aims
The aim of this emergency procedure is to provide guidance and a structured approach to the management
response in the case of a major failure in supply of piped medical gases, and to safeguard patients at risk from any
such failure.
50
Appendix 2 Exemplar procedures
Damage control
The 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 either
valving 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 are
functioning.
Team members attendance should be confirmed. They should assemble at a predetermined location where
control will be handed from the Duty Engineer/Duty Estates Manager to the responsible Senior Manager.
The areas of responsibility for the various team members are outlined, but this list is by no means exhaustive and
should 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.
51
Policies and principles HTM 00 Best practice guidance for healthcare engineering
Debriefing
Following return to normality, a team debriefing should be held to review the emergency procedure and update
or correct any apparent weaknesses.
Review procedure
This procedure will be reviewed following any change in personnel, equipment, materials and environment or
following any change. It will be reviewed at regular intervals not exceeding 12 months.
Amendments
Plan approved and accepted by:
Board member: .....................................................................
Risk assessment
This document is linked to risk assessment no ..................... It should incorporate existing controls contained in
the risk assessment and should be modified if any changes to the risk assessment are made.
52
Gas
Fire
Lifts
water
failure
Paging
Boilers
systems
Medical
Heating
Asbestos
checklist
Building
Kitchens
Flooding
Drainage
Infestation
Explosions
equipment
engineering
Incinerators
Operational
Refrigerators
management
Air pollution
Domestic hot
Clinical waste
Extreme weather
Air-conditioning
Electricity supply
Operating theatres
Laboratory failures
53
Appendix 2 Exemplar procedures
54
Telephones
Sterilization
Operational
Sewage plant
Water supply
contamination
Water treatment
Transport incidents
Define ownership of the problem?
Will patient/Public/Staff safety/care be affected?
Will evacuation be required?
Risk of fire outbreak, or reduced fire-fighting ability?
Consider impact on electricity supply?
Consider impact on gas supply?
Consider impact on water supply?
Consider impact on drainage?
Consider impact on other services?
Increased risk of legionella?
Consider impact on site security?
Impact on fire alarms?
Will medical gases be affected?
Is there an impact on clinical waste?
Policies and principles HTM 00 Best practice guidance for healthcare engineering
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55
Policies and principles HTM 00 Best practice guidance for healthcare engineering
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57
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European legislation
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Official Journal L 37, 13.02.2003, pp 2438.
58