Hospital and Healthcare Works RAMS Guide for UK Contractors

Key Topics in a Hospital Works RAMS

Infection Control Risk Assessment (ICRA)

The NHS requires an Infection Control Risk Assessment before any construction or maintenance work in a healthcare facility. The ICRA categorises the work by activity type (A–D, from inspection to major demolition) and assigns a patient risk level (I–IV) based on the proximity and immune status of patients in adjacent areas. The combination of activity type and patient risk level determines the required containment measures — dust barriers, HEPA filtration, negative pressure rooms, full air sealing of penetrations, and decontamination protocols for workers leaving the work area. The ICRA must be agreed with the Trust's Infection Prevention and Control (IPC) team and forms a mandatory pre-works document alongside the RAMS.

NHS trust permit to work systems

NHS Trusts operate site-specific permit to work systems covering hot works, electrical isolation, working at height, confined space entry, and medical gas isolation. These permits are issued by the Trust's Authorised Person (AP) for each discipline. The RAMS must identify which permits are required for the scope of work, name the contractor's Appointed Person (responsible for receiving permits and ensuring compliance), and describe the permit coordination process — including what happens if the permit conditions change during the works. Contractors must not start any permitted activity without the relevant written permit.

Medical gas isolation

Medical gas pipelines (oxygen, nitrous oxide, medical air, vacuum) run throughout hospital buildings and feed patient areas. Any work that requires isolation of medical gas pipelines — for maintenance, modification, or extension — must be carried out by a competent person under HTM 02-01 (Medical Gas Pipeline Systems). An NHS Authorised Person for Medical Gas must formally authorise and oversee the isolation. The RAMS must identify whether any medical gas pipelines run through or adjacent to the work area, confirm that no accidental damage or isolation can occur, and describe the emergency response if a pipeline is damaged — including the immediate notification route to the AP and clinical staff.

Patient area noise and vibration restrictions

Clinical areas including theatres, ITU, CCU, and endoscopy suites have strict noise and vibration limits — both for patient welfare and to prevent interference with sensitive clinical equipment (e.g. MRI scanners, which cannot be operated within certain distances of vibrating plant or magnetic materials). The RAMS must confirm that all noisy or vibration-producing operations have been scheduled outside restricted hours agreed with the clinical area manager, that the clinical team has been notified before noisy works commence each day, and that a stop-work procedure is in place if clinical activity in adjacent areas changes unexpectedly.