William Loudon
Healthcare Associated Infection (HAI) – System for Controlling Risk in the Built Environment (SCRIBE)

With the appointment of Faithful+Gould’s building surveyors in Glasgow by NHS Greater Glasgow & Clyde as contract administrator and lead consultant for the alteration, repair and refurbishment of existing healthcare premises within their estate and the imminent opening of the New South Glasgow Hospital, I'll be examining one of the most fundamental considerations for healthcare providers: the need to combat Healthcare Associated Infection (HAI).

With historic surveys by NHS working parties such as the Carey Group in 2001 estimating that up to 9% [1] of hospital patients acquire an infection during their stay it is clear that this is a major issue not only in terms of healthcare providers’ hygiene standards but also in terms of how healthcare facilities are designed, built and maintained from inception to demolition.

In response, Health Facilities Scotland has developed HAI - SCRIBE to assess and manage the risk of infection within the healthcare built environment. This is a four stage approach to reducing the risk of infection:-

  • Development Stage 1: is applied to the proposed site to be developed and this applies equally to existing premises as well as new build projects

  • Development Stage 2: is applied to the planning and design stage of the development

  • Development Stage 3: is applied to the construction/redevelopment phase

  • Development Stage 4: is applied to the new/refurbished premises in operation

All stages are equally important, but at the risk of stating the obvious, the more consideration given to the issue at the outset of the project, the easier it is to implement a number of practical measures that will contribute towards a reduction in infection cases.

So what are some of the key considerations and what weighting should they be given?

  • At Stage 1, key considerations for new builds will be issues such as: contaminated land; nearby industries which may present pollution risks; and nearby cooling towers which may present legionella risks.

  • At Stage 2, key considerations for designers will be: the inhibiting of spread of infection by provision of a good layout considering items such as bed spacing; provision of a suitable ventilation system; provision of easy clean surfaces and good facilities for high standards of hand hygiene.

  • At Stage 3, a risk assessment is undertaken taking cognisance of the type and nature of works being undertaken and the nature of the treatment that the facility provides. The outcome of the risk assessment dictates the degree of control measures the contractor requires to implement on site to eliminate or mitigate the risk.

  • At Stage 4, the key consideration is the implementation of a facilities management policy that puts the management, execution and recording of ongoing cleaning, maintenance and alteration works at the forefront of a well executed planned preventative maintenance programme.

In conclusion it is clear that all parties to building works in healthcare facilities including the client, stakeholders, designers, contractors and facilities managers have a clear responsibility to contribute to the HAI - SCRIBE process throughout the duration of a building’s life from inception to demolition. Our Glasgow building surveying team has secured a framework agreement with NHS Greater Glasgow & Clyde through the Scape Asset Management, Surveying and Design Services Framework. The initial programme of works involves the refurbishment of 17 properties in and around the Greater Glasgow area. 


[1] NHS National Services Scotland, HAI-SCRIBE (Healthcare Associated Infection System for Controlling Risk In the Built Environment), Version 2, June 2007