Dear Mr Haigh Rule 43 Ronald Sidney Ellwood (deceased) for letter dated 3 September, addressed to Ms Ashley; which has Thank you your been passed to me to respond: to the request for information regarding the supply of fresh air in Critical Caresareraseirorehatioeqtoeshe deat of aioRonald Ellwood, am replying as follows_ Care areas While the experience of fresh air will add to a individuals teeling of wellbeing, there are certain areas within a hospital where it is not recommended: The guidance for the design and operation of air systems in health care establishments comes from: Health Technical Memorandum 03-01: Specialised for healthcare premises: Part Design and validation from the ventilation Department of Health published 2007. The Health Technical Memorandum specifies that ventilation in Critical Care bould be regarded as critical system and as such requires annual verification of performance. ventilation and air-conditioning is made clear within this The difference between
1.24. The areas that full air-conditioning is required are document on Page 5, 1.21 indicated on Page 9, 2.19. From this rationale "fresh air" from open windows for example, being introduced into an air-conditioned system will negate air-conditioning: conditioning will have tolerances within which it works,e.9o a very hot in Air windows with sun beating on them, as is the case in an area where there large the These critical care areas within Burton Hospitals, will a strain on defined in the document on Page 83, with 10 changes of air per hour tolerances as of 18-25 Celsius (in practice this will be maintained at the uperaosgleveeg ?e paatien? WB-?avcelsie coverirgsCf Gritical Care); uppermost levels as The rationale for using air conditioning in this area is highlighted on Page 46, 75 ane here mies the paradox of fresh air; in the days of rampant tuberculosis, as youwill knoweresteair ceatment in sanatoria was the only management with any chance of day are system. put

success. Fresh air was preferable to the infected environment-of tubercblosis ard Disease wards. Today by air changing so frequently, the risk of build up of Infectious will be minimised. Open windows will allow fresh air in but may not air borne bacteria The research indicates that fresh air will only remove pockets of infected air , refer to Page 8, 2.7. of Hlealth penetrate a maximum of 6 metres into a space; please Technical Memorandum 03-0. In addition should be noted that windows o the CeccaicGareeunot hrave limited opening oi 10 cm in order to comply with Health and 'legislation and penetration of any fresh air will be much more limited than for a Safety fully open window The guidance does not indicate that microbiological testing is necessary: However, there is no evidence to suggest that there is environmental air conereinatior in the Critical Care Unit either at present %r since February 2043 The is surveyed when there is evidence of linked cases of the same environment than one patient: This was last done on the 11th organism occurring in more was minor contamination with solitary February
2013. It was found that there species of bacteria specitically spread by direct and indirect contact rather than related to air or the air conditioning: literature search has not revealed new guidance relating to the need to carry out survey routinely_ aware of no other nationally publishedladopted evidence to suggest that am should/could be open or closed: would make the simple observation that windows opening the windows will detrimentally affect air conditioning: The critical care unit has a full fresh air system with no recirculation of air; The air conditioning is conventional system with heating and cooling and was installed Cen the hospital was built: The extract air and supply air being separate frorn each other. The system is designed to operate with all windows closed so that the deederature be controlled: In 2001 when the High Dependency Unit was added to the can additional supplementary cooling was added to the critical care unit suite, hospital, again with 100% fresh air_ Set points for the system are set with general supply temperature of the Air Unit (AHU) of 189 When external temperature is below 18 the extract Handling heat exchanger for energy savings_ Reheat batteries are set to air goes through falls below 219 The supplementary cooling operate when the room temperature is system is set to operate when temperature's rise over 239C_ The room temperature sonteolled as average between two room thermostats within the critical care unit: The AHU is served by a G4 Filter as per HTM 20/25 when designed as apposed to the current design (HTM 03) for F7 tilters. The systems are subjected to annual maintenance by the estatesetaff this was last carried out in March 2013_ The ventilation duct work and systems were cleaned and systems pressures and volumes were externally assessed by Total Environmental and Mechanical Services (TEAMS) in July 2010 and there is no requirement for alterations to the system before the next revalidation checks in 2015. Following on from your letter the estates department has requested the filter manufacturer to carry out a survey of the ITU system to look at the possibility of being guide and

accept the more efficient F7 tilter, but this is likely to result in a converting the AHU to this system and the Trust will take a view decreased air flow to the areas served by consideration: when further technical information is available for on this change of the Air Conditioning Systems units within the hospital is currently A refurbishment with the next years capital program:. At this time the current planned to commence within the hospital will be re-evaluated and the system environmental conditions with the additional heat loads within the building; designed to control the environment advancement in medical equipment has especially within the ITU unit where the substantially increased the heat loadings within ITU: demonstrate that the Critical Care Unit conforms to the applcable The Trust can specialised ventilation: By opening the windows, it guidance and memorandum for air changes that may lead to gakes this system less efficient and compromise maintained increased environmental air contamination. The system is appropriately checked. there may be a perception that the environment would be more comfoatavee Although hesh aaryit must be balanced by the fact that comfort for staff and relatsvee with more that must be paid by the patient in terms of safety and exposure may come at a the Trust considers that it would be to the to additional organisms. For these reasons Care Unit to compromise the detriment rather than benefit of patients in the Critical by opening windows so the Trust will continue to specialised vendcatiorervaterclosearening CrcawCareoUnit ensure that windows remain that] Ifound the Critical Care environment unpleasant at a greatly regret stress and while we accept that no system can be pertect we time of great personal delivers the safest environment for our believe that our` air-conditioning system patients and hope this reassures yourself and further information please do not hesitate to contact me. If you require any