Safety recommendation
It is recommended that NHS England and NHS Improvement reviews the principles of the hierarchy of controls in its health building notes (HBN) and health technical memoranda (HTM) for the design of the built environment in existing and new hospital estate to reduce the risk of nosocomial transmission.
Response:
The General Principles of Prevention recommended in the management of Health and Safety at Work Regulations 1999, Regulation 4, Schedule 1 are equally as applicable to Covid-19 as they are to risk avoidance from other hazards.
These principles have been applied in the development of ventilation guidance and answers to FAQ shared with NHS Trusts.
The hierarchy in order of priority is
- a) eliminate
- b) evaluate risk
- c) combat risks at source
- d) adapting work to the individual
- e) adapting to technical progress
- f) substitute
- g) develop a coherent overall prevention policy
- h) group protection, over personal protection
- i) giving appropriate instruction.
The first, a), covers actions like digital/telephone consultation and zoning between COVID/suspect COVID/no COVID, b) includes workplace and system risk assessments, that is embedded in the HTMs; c) includes dilution of air through ventilation and environmental cleanliness and surface cleaning; working down to h) that includes Screens and PPE.
All of which have been written into FAQs and Guidance. All FAQs, Guidance and Instructional SOPs are consulted on with the IPC Cell before sharing as a consultative draft more widely.
Response received on 23 March 2021.