Decommissioning and Disposal of Health Facilities and Health Technology/Tables

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

Table 2: Activity Classification

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

Table 3: 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

Table 4: Minimum routine precautionary measures guidelines

	Precautionary Measures – Before and During Activity	Precautionary Measures Upon Completion of Activity
Class I	* Execute work by methods to minimize liberating dust from construction operations Immediately replace a ceiling tile displaced for visual inspection
style="border:0.5pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;"	Class II	* Provide active means to prevent airborne dust from dispersing into atmosphere Water mist work surfaces to control dust cutting Seal unused doors with tape Block off and seal air vents Place dust mat at entrance and exit of work area Remove or isolate HVAC system in areas where work is being performed	* Wipe works surfaces with disinfectant Contain construction waste before transport in tightly covered containers Wet mop and/or vacuum with HEPA filtered vacuum before leaving work area. Remove isolation of HVAC system in areas where work is being performed
Class III	* Remove or isolate HVAC system in area where work is being done to prevent contamination of duct system Complete all critical barriers i.e. sheetrock, plywood, plastic, to seal area from non-work area or implement control cube method (cart with plastic covering and sealed connection to work site with HEPA vacuum for vacuuming prior to exit) before construction begins Maintain negative air pressure within work site utilizing HEPA filter equipped fan-filter units Contain construction waste before transport in tightly covered containers Cover transport receptacles or carts. Tape covering unless solid lid.	* Do not remove barriers from work area until completed project is inspected by the owner’s Safety Department and Infection Control Department and thoroughly cleaned by the owner’s Environment Services Department Remove barrier materials carefully to minimize spread of dirt and debris associated with construction Vacuum work area with HEPA filtered vacuums Wet mop area with disinfectant Remove isolation of HVAC system in areas where work is being performed
Class IV	* Isolate HVAC system in area where work is being done to prevent contamination of duct system Complete all critical barriers i.e. sheetrock, plywood, plastic, to seal area from non-work area or implement control cube method (cart with plastic covering and sealed connection site with HEPA vacuum for vacuuming prior to exit) before construction begins Maintain negative air pressure within work site utilizing HEPA filter equipped fan-filter units Seal holes, pipes, conduits and punctures appropriately Construct an anteroom and require all personnel to pass through this room so they can be vacuumed using a HEPA vacuum cleaner before leaving work site they can wear a cloth or paper coverall that is removed each time they leave the work site All personnel entering work site are required to wear shoe covers. Shoe covers must be changed each time the worker exits the work area Do not remove barriers from work area until completed project is inspected by the owner’s Safety Department and Infection Control Department and thoroughly cleaned by the owner’s Environmental Services Department Perform periodic particle count tests in adjacent occupied spaced during construction as well as bacteriological tests using Agar plates.	* Remove barrier material carefully to minimize spreading of dirt and debris associated with construction Contain construction waste before transporting tightly covered containers Cover transport receptacles or carts. Tape covering unless solid lid Vacuum work area with HEPA filtered vacuums Wet mop area with disinfectant Remove isolation of HVAC system in areas where work is being performed Perform deep cleaning and carry out Particle Count testing in completed areas where required.

Table 5Stakeholder engagement checklist

No	Question	Commentary/Why is this important
1	Have you notified affected providers and offered to meet to explain the rationale and process?	Engaging with affected providers throughout the process is not only good practice may mitigate a legal challenge to the process and decisions at a later stage.
2	Have you analysed the outcome of any such meetings?	Following your meeting (or other form of communication) with the provider you should be able to answer and document the following what is their response? do they want to keep strictly to the terms of the contract? is there any indication of their willingness to agree to a variation in the contractual terms?
3	Have the providers in question attended any workshops that you have run on outcomes bases service/ infrastructure?	If not then they may not be able to understand the change in policy, direction and the context for service delivery. Analyse this and if necessary provide and communicate relevant information.
4	Having gone through these stages, what is your assessment of the provider’s attitude and the chances of reaching a negotiated solution?	It will be important to ‘take stock’ at regular intervals through the process and to analyse and adjust plans according to the responses and attitudes of provider(s). The objective should always be to reach a negotiated position.
5	Is the provider inflexible?	If no negotiated solution can be found and the provider intends to stick strictly to the terms of the contract, and the contract does not provide any of the flexibility required to achieve services of the required nature, then a risk assessment and impact analysis should be undertaken.
6	Do you need to undertake a risk assessment and impact analysis?	This should include: a cost/benefit analysis Impact of decommissioning the service - effect on service users, provider organisation and on your ability to deliver services.
7	What is the advice of your legal department?	The facility owner’s legal department should be involved in the process.

Table 6Stakeholder Financial Review Checklist

No	Question	Commentary/Why is this important?
1	What will be the cost of decommissioning a service/ infrastructure?	style="border:0.5pt solid #000000;padding-top:0cm;padding-bottom:0cm;padding-left:0.191cm;padding-right:0.191cm;" | This needs to be considered in terms of the potential cost (e.g. breaching or buying out a contract) if the consequences of continuing with the existing contract is limiting or risky in terms of performance or service quality.
2	What will the cost be of not decommissioning the service?	Against this needs to be set the adverse effect on performance judgement if the facility is not making progress with policy initiatives, or is not taking incisive action over services that can be considered of an adequate quality but may be of a poor or outdated service model.
3.	If a provider is completely inflexible have you considered working and discussing this with other facilities that do business with them?	This may help a provider to reconsider their stance and enter into discussion and negotiation to find common ground and agreed solutions.

Table 7Additional Stakeholder Review

No	Question	Commentary/Why is this important?
1	What is the quality of the service/ infrastructure?	Is service quality good or acceptable? Is there a risk that if the contract is changed then it might deteriorate? It is important to pay particular attention to process quality (i.e. the service user experience of receiving the service)
2	How effective is the service/ infrastructure, particularly in terms of outcomes? Or has the service/ infrastructure service got the potential and adaptability to be effective in terms of outcomes?	Although the service may not at this point be delivering the outcomes required you need to apply your analytical skills to evaluate whether the service, if changed, has the potential to be effective.
3	Is performance, against agreed measurables, meeting the requirements of, and standards set out in, the service specification?	If this is the case it will bode well for future delivery and effectiveness of services, taken together with other factors that will be looked at as part of any decommissioning / re-commissioning / re-tendering process.
4	Is the demand for the service/ infrastructure commensurate with the service/ infrastructure that the facility is committed to paying for (particularly if this is locked into a block contract)?	If there is no longer the demand for the service, or if the block purchasing of services need to be reduced within the contract period due to the development and implementation of the personalisation agenda, then consider whether there is scope for negotiating with the provider on this point.
5	Do you need to terminate a current contract? Have you sought advice from legal and contract service/ infrastructure?	Has the provider unilaterally changed any elements of the service, withdrawn service or failed to provide services that it is contractually bound to do to any significant or substantial degree? If any of these apply then they can be used as leverage to either ensure compliance or to get the provider to become more flexible and responsive to change contractual requirements.
6	Where you terminate a contract: Are you able to develop decommissioning / transfer / transition plans in conjunction with the provider?	This is vital to effect a smooth transfer and to minimise the impact on service users and staff.
7	Have you got a communication plan?	It is important to communicate well in advance with service users and the press / media, as well as other stakeholders.
8	Have you briefed elected members and other key stakeholders? Who else should you inform or consult with? - Link to stakeholder engagement section	It is important to brief anybody within the governance structure, other stakeholders who might be affected, or where there might be an impact on other services
9	Have you developed a decommissioning / transition / transfer plan?	This should be managed by a programme/project management approach:-Link to decommissioning / transition / transfer plan
10	Have you considered future contracts to ensure that they do not constrain you unduly?	Your contracts may need to be revised to be more flexible and include scope for periodically revising the service specification. Legal advice should be sought and examples sought from other facility.

Table 8Laboratory Equipment Decommissioning Checklist

Serial Number:		Model:
Manufacturer		Description
Installation Date		Decommissioning date
Acceptance Check	Comment		Pass (yes/no)
Is equipment documentation available (acceptance certificate, calibration certificates, service records and final tests)
Hazardous material exposure possible? (Biological, chemical, radioactive and others)
Decontamination procedure
Does the equipment planned maintenance schedule exist
Has the equipment been tested for electrical safety
Does the equipment pass all of the above conditions
Will the equipment be disposed or re-used for other/laboratory purposes
Make sure that all hazards material are disposed as per the disposal procedure for all equipment due for disposal and all equipment to be reused should comply with regulations and license requirements.

Table 9Laboratory Facility Decommissioning Checklist

Building Number		Room Number
License Number
Acceptance Check	Comment		Pass (yes/no)
Inform the department of health of the intended decommissioning of the LAB
Decontaminate the room(s) and all exposed facilities of all the hazards?
Will the room(s) be disposed or re-used for other purposes?
Make sure that all hazards material are disposed as per the disposal procedure and all rooms to be reused should comply with regulations and license requirements.

Table 10Health Care Technology Decommissioning Checklist

Serial Number:		Model:
Manufactures		Description
Installation Date		Decommissioning date
Acceptance Check	Comment		Pass (yes/no)
Is equipment documentation presented (acceptance certificate, service record, final test )
Has this item been identified for decommissioning by a clinical technician
Reason for decommissioning
Is the equipment functional
Is the equipment CE market
Is the equipment class and type indicated
Does equipment have the instruction manual
Does the equipment planned maintenance schedule exist
Has the equipment been tested for electrical safety
Does the equipment contain any hazards substance such a radiation isotopes, mercury and/or other harmful materials
Does the equipment pass all of the above conditions?
Will the equipment be disposed or re-used for medical purposes
Make sure that all hazards material are disposed as per the disposal procedure for all equipment due for disposal and all equipment to be reused should comply with regulations and licence requirements.