3. Analysis of information provided
3.1 Information provided
3.1.1 The support of the NHS Lothian project team in responding to questions and accessing data is gratefully acknowledged.
3.1.2 At the time of writing the majority of the information required had been received and whilst the timescale for the review means a selective targeted review of documentation was necessary, the main themes appear clear. However, some information remains outstanding, and NHS Lothian colleagues continue to pursue a response.
3.1.3 The Special Purpose Vehicle (SPV), Contractor, sub-contractors, Facilities Management Contractor and Independent Tester were not directly involved in the production of this report, nor were they requested to verify its contents and they may have additional information not considered here. It is acknowledged that some of the information provided by NHS Lothian came directly from these sources.
3.1.4 Prior to this review NHS Lothian commissioned a specialist contractor to validate the performance of ventilation systems within the facility and their report identified that elements of the ventilation system in Critical Care Units was not in accordance with current guidance (SHTM 03-01). Whilst this report notes that finding and NSS has been asked to support NHS Lothian in achieving a solution in compliance with guidance, this report focuses primarily on other ventilation issues. Additionally, Haematology / Oncology is also being reviewed as a result of changing clinical needs and NHS NSS will support NHSL in this.
3.1.5 An explanation and validation of the ventilation design whereby areas with air handling units out of service, for whatever reason, are served by an adjacent air handling unit, which also continues to serve its own area has not yet been provided.
3.1.6 The theatre ventilation appears not to have been installed in accordance with current guidance in respect to required pressure cascades in corridors and removal of contaminants from scrub areas. The Board has sought demonstration of compliance from Integrated Health Solutions Lothian (IHSL) in relation to issues identified.
3.1.7 Whilst elements of the water testing carried out as part of this review are not detailed in current guidance, and NHS Lothian could not have been expected to be aware, lessons learned recently across health systems suggest that any potential pathogenic contamination found should be investigated and treated appropriately before patients and staff move in. Water test results in RHCYP & DCN indicate some fungi in the water, mainly at taps, as well as higher than anticipated total viable counts (TVC). The latter may be related to the fact that the building is unoccupied with only maintenance processes in place to ensure water turnover. In augmented care areas testing carried out for NHS Lothian identified Pseudomonas aeruginosa found in approximately 10% of taps tested. There would appear to be no systemic contamination of the hot and cold water systems, rather, contamination has been found at outlets, and particularly thermostatic mixing taps with complex interstices and polymeric components, which can make them more susceptible to persistent contamination.
Drainage and plumbing systems
3.1.8 The drainage for the hospital utilises one gravity system and two pumped systems. The pumped systems are used to overcome gravity as they are installed below the local water table and level of the external drains. The main concern is the pumped system in the basement, in the vicinity of the kitchen, may fail. The risk is that if these fail the kitchen drains will back up requiring the kitchen to close, which would have an impact on food services to the hospital. Extensive use of standby equipment and power supplies is in place, such that multiple failures would need to occur to cause sewage to back up into the basement. Procedures for maintenance and repair have been extensively considered but will need to be tested in operation.
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