Warning that hospital cleaning guidance fails to address dangers of ventilation ducts

Ian Wall, a director of specialist contractor, Ductbusters, spoke following the unveiling of the British Standards Institute's (BSI) Publicly Available Specification (PAS) 5748, which provides a framework for the planning, application and measurement of healthcare cleaning.

He said that, while it gives a nod to cleaning the outside of ventilation grills, this will not address the serious, and in some cases, fatal, consequences of contamination. He told BBH: "All initiatives to improve and measure hospital hygiene are clearly to be welcomed and we hope as many organisations as possible adhere to the new specifications. However, we believe it is a major cause for concern that in such a lengthy and detailed document, the issue of duct cleaning has barely been touched upon. Any medical facility can have the most sparkling floors, surfaces and equipment imaginable, but if the ventilation ducts are not clean, infection will spread."

Any medical facility can have the most sparkling floors, surfaces and equipment imaginable, but if the ventilation ducts are not clean, infection will spread

This is particularly concerning as infectious diseases like MRSA and C.difficile are not only carried through ventilation systems, but can thrive and feed on the dead human skin that constitutes a large component of hospital dust and can build up in the ducts.

"However diligent healthcare teams are in cleaning surfaces and equipment within the building, if ducts are not regularly cleaned, the impact of these efforts on controlling infection will be considerably diminished," Wall said.

His comments were echoed by Dr Ghasson Shabha, facilities management MSc course leader at the School of Property, Construction and Planning at Birmingham City University. He is also MRSA project co-ordinator and is currently assessing commercial viabilities for new technologies for tackling infection control in healthcare buildings.

Ducts in hospitals, depending on type and function of rooms, should be cleaned on a three to six month basis; and filters, depending on whether multi-layered or single layered, should be replaced regularly, ideally every six months

He said: "MRSA has increasingly become one of the major sources of healthcare associated infection in hospitals in Britain and a main contributory factor to 100,000 cases every year. It thrives in relatively non-humid environments and feeds on flakes of dead, dry human skin. It withstands desiccation at temperatures of 18-37°C and is thus a frequent component of hospital dust, making it more likely to spread via ventilation and air-conditioning systems. Ducts in hospitals, depending on type and function of rooms, should be cleaned on a three to six month basis; and filters, depending on whether multi-layered or single layered, should be replaced regularly, ideally every six months as part of planned preventative maintenance programme."

However diligent healthcare teams are in cleaning surfaces and equipment within the building, if ducts are not regularly cleaned, the impact of these efforts on controlling infection will be considerably diminished

The BSI specification is aimed at all acute, community and mental health hospitals and was sponsored by the Department of Health (DH) and the National Patient Safety Agency. It can also be purchased by independent providers.

DH chief nursing officer, Dame Christine Beasley, said of the publication: "Patients and the public have made it very clear that they want to see clean hospitals. The NHS has made great strides in improving cleanliness and reducing the incidence of avoidable infection and this will provide an opportunity to drive further progress in these areas and we are delighted to have worked with partners to complete this work."