Decommissioning and Disposal of Health Facilities and Health Technology

OVERVIEW

This document outlines the policy and service context and attempts to illustrate the desired planning principles and design considerations for Decommissioning and Disposal of Healthcare Infrastructure and Health Care Technology.

• Part A outlines the national and provincial service and policy context which are the basic determinants of the decommissioning principles;
• Part B contains planning guidance and considerations;
• Part C develops these principles into a series of departmental requirements;
• Part D contains example worksheets and checklists and protocols
• Parts C, D and E are intended to demonstrate how the principles prescribed in Part B can be applied in worked examples. Parts C or D, if used directly, are deemed to satisfy the principles developed in Part B, but are not the only acceptable solutions.

While this document outlines design requirements and acceptance criteria which have an impact on clinical services, these requirements are prescribed within the framework of the entire IUSS set of guidance documents and cannot be viewed in isolation. The following documents should be complied with, together with this document:

POLICY AND SERVICE CONTEXT

Introduction

Healthcare systems are dynamic and constantly changing. Amongst other changes, there are changes in healthcare infrastructure and healthcare technology to meet socio-economic needs and emerging medical requirements.

Healthcare infrastructure is constantly being adapted to meet a population’s healthcare needs. Such adaptation requires alteration of physical infrastructure and construction of new infrastructure. During the alteration or construction of new infrastructure part of or entire old infrastructure becomes redundant and need to be removed from service by decommissioning to be either re-used for other purposes or disposed of.

Health Technology is constantly changing and evolving. This change results in a short life-cycle compared to fixed healthcare infrastructure. Such changes result in old technology being removed from service and posing a health and occupational risk if not properly decommissioned. Health Technology which is out of service might even be re-commissioned for use at less demanding facilities, upgraded or disposed of.

This document provides guidance on procedures to be followed in decommissioning and disposal of healthcare infrastructure and health technology.

Healthcare facilities can generate two distinct waste streams. This document deals only with the waste generated in the decommissioning process and not with the waste generated from the operational waste stream. The terms waste, healthcare waste and healthcare risk waste in this document therefore only refers to forms of decommissioning waste.

Mothballing exists as an alternative to decommissioning. This document does not detail or discuss the requirements and protocols for mothballing.

Regulations, Guidelines, Standards and Definitions

Standards

• This document should be read in the context of the SANS 10248-1 Management of healthcare waste Part 1: Management of healthcare risk waste from a healthcare facility
• The ISO 14001 is the international standard for environmental management of activities
• SANS 10234: 2008 Globally Harmonized System of classification and labelling of chemicals (GHS)

Guidelines

• The Western Cape Guideline for Environmental Management Plans (EMPs) 2005 gives guidance on the development of an EMP for the decommissioning phase of the facility life cycle.
• World Bank’s (1999) EMP Guidelines
• The Department of Water Affairs and Forestry’s EMP Guidelines (CSIR, 2002)
• DEAT Framework for Health Care Waste Management (May 2000)
• Department of Water Affairs & Forestry, 2005. Waste Management Series. Minimum Requirements for the Handling, Classification and Disposal of Hazardous Waste.

Acts and Regulations

• Public Finance Management Act No.1 1999
• Hazardous Substances Act 15 of 1973 and its amendments
• National Environmental Waste Management: Waste Act 59 of 2008, and its amendments
• National Waste Classification and Management Regulations R634 of 2013
• National Waste Information Regulations R625 of 2012
• Regulation R1332 of 3 August 1973 Regulations Concerning the Control of Electronic Products
• Nuclear Energy Act, 1999 (Act 46 of 1999).
• Standard for Infrastructure Procurement and Delivery Management (2016)

Definitions

Healthcare infrastructure, healthcare infrastructure in this document refers to hospital facilities, buildings, wet services, cold and hot water systems, electrical reticulations, Air-conditioning system (HVAC and all its components, split-units and other ventilation systems), plant equipment, catering equipment, IT equipment and any other systems and equipment which form part of the hospital facilities.

Health technology, health technology in this document refers to medical equipment and/or devices, their accessories and any component(s) and or system which may provide a link between equipment and/or devices which is used in healthcare for the purpose of preventing, diagnosing, or treating diseases as well as for monitoring and rehabilitation.

PLANNING FOR DECOMMISSIONING AND RETROFITTING

Background

While engineering systems and components may have a functional life of less than 25 years, healthcare buildings could have a life approaching 50 years. It is therefore likely that equipment and services would need to be decommissioned, retrofitted, revitalised and replaced at least once during the life of a building and these interventions should be planned for.

Projects with a retrofitting element shall include for the formal decommissioning of equipment or services which become redundant or obsolete as a result of the retrofitting project or can be conveniently decommissioned within the project. Decommissioning of any assets shall be undertaken in accordance with the Public Finance Management Act, Generally Accepted Accounting Practice, Companies Act and Good Corporate Governance Practice.

When planning for retrofitting and decommissioning, consideration should be given to the following aspects: • Establishment of a disposal management committee. • Development of and compliance with an Environmental Management Plan (EMP). • Development and implementation of a risk assessment and hazard control plan. • Assignment of a clinician and IPC manager with authority to approve or halt construction activities only under defined conditions. • Power requirements of future expansions and installations. • Emerging healthcare technologies. • Space for removal and refitting of equipment. • Potential and planning for recycling vs disposal of materials. • Toxicity and environmental impact of gasses, paints and polymers. • Specific healthcare services risks (IPC etc). • Occupational Health and Safety Regulations and requirements.

Contamination Control and Risk Planning

A project risk assessment shall be conducted and consider the following aspects • Identification of occupancy groups which are susceptible to risks. • Identification of building services, such as ventilation, in the proximity of the construction activity and the potential impact on function. Specific consideration should be given to specialist ventilation systems. • Need for supplementary protection or support systems for building services. • Impact on fire protection and response systems and action plans. • Impact of noise and vibration on occupants and equipment. Opportunistic environmental or airborne microorganisms, allergens or hazardous materials which are liberated or distributed during retrofitting and decommissioning activities, can present a significant hazard to patients and employees unusually at risk. Where the environmental assessments and risk assessments identify the need for intervention or mitigating controls, the precautionary matrix described under the heading Contamination Control Risk Planning below shall be considered in determining risk levels. The principles of contamination control for high risk sites includes the following:

1. 1. Establishment of rigid non-permeable barriers, between patient or staff and construction activities, during construction with the inclusion of appropriate clean-down ante-rooms where traffic between occupied and construction areas is required.
   2. Increased ventilation rates with high ventilation efficiency to areas at risk.
   3. Extraction and filtration systems serving the construction area. Where there is chance of re-entrainment of diluted exhausted air, a minimum of an EN779-F9 filter should be installed as the final filtration stage. Where air is actively recirculated it should be filtered with at least an EN1822-H13 final filter.
   4. Establishing a protective pressure cascade or airflow from clean to contaminated zones

With acknowledgement to Nicholas Thorne (Life Healthcare), the following construction risk matrixes provide guidance on undertaking construction, maintenance, retrofitting and decommissioning work, whilst maintaining functionality and safety in a working healthcare facility. PROCEDURE: Locate risk profile by space-type using the tabel below:

Risk Profile by Space – Type

LOW RISK	MODERATE RISK	HIGH RISK	HIGHEST RISK
Office areas Service areas Plant rooms Kitchens	Rehabilitation Unit Endoscopy Units Nuclear Medicine Physical Therapy Diagnostic radiology/MRI Procedure Rooms	High Care Units/Wards Surgical Units/Wards Trauma / Resuscitation Room Eye Centre Laboratories (specimen) Theatre-non surgical areas Paediatric Units/Wards Pharmacy Surgical Stores	Operating Rooms CSSD Central Sterile Supply Department Cardiac Catheter Lab Intensive Care Units Medical Unit/Wards Any area caring for immuno-compromised patients

Activity Classification

TYPE	ACTIVITIES
TYPE A	Inspection and Non-Invasive Activities Includes, but is not limited to: Removal of ceiling tiles for visual inspection limited to 1 tile per 10 square meters Painting (but not sanding) Wall covering electrical trim work minor plumbing and activities which do not generate dust or require cutting of walls or access to ceilings other than for visual inspection.
TYPE B	Small scale, short duration activities which create minimal dust Includes, but is not limited to: Installation of telephone and computer cabling Access to chase spaces Cutting of dry walls or ceiling where dust migration can be controlled
TYPE C	Work that generates a moderate to high level of dust or requires demolition or removal of any fixed building components or assemblies Includes, but is not limited to: Sanding of walls for painting or wall covering Removal of floor coverings, ceiling tiles and casework New wall construction Minor duct work or electrical work above ceilings Major cabling activities Any activity which cannot be completed within a single workshift
TYPE D	Major demolition and construction projects Includes, but is not limited to: Activities which require consecutive work shifts Requires heavy demolition or removal of a complete cabling system New construction

Classification matrix

TYPE	LOW RISK	MODERATE RISK	HIGH RISK	HIGHEST RISK
TYPE A (Non-Invasive/Inspection)	I	II	II	III/IV
TYPE B (Minimal Dust)	I	II	III	IV
TYPE C (Moderate Dust)	I	II	III/IV	IV
TYPE D (Major Demolition)	II	III/IV	III/IV	IV