Healthcare Facilities Volume 42 No. 1 March 2019

PP 100010900

VOLUME 42 I NUMBER 1 I MARCH 2019

HEALTHCARE INSTITUTE of HEALTHCARE ENGINEERING AUSTRALIA

FACILITIES

IHEA HEALTHCARE FACILITIES MANAGEMENT CONFERENCE 9-11 October 2019 at ANZ Stadium, Sydney

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2

CONTENTS REGULARS

FEATURE ARTICLES

5

Editor’s message

6

National President’s message

9

CEO’s message

22 Improving sustainability in hospital wastewater management

76 News

29 A Risk Management Culture that works

BRANCH REPORTS

33 Creating an Internet of Thingsenabled Building

10 QLD 12 WA 14 VIC/TAS 16 NSW/ACT 19 SA

22

43 Engineering Queensland’s largest health infrastructure project 55 The internet of value: blockchain and facilities management 59 Cloud Computing: Facilitating Excellence in the Healthcare Sector

59

67 How hybrid theatres can be optimally designed

Visit the Institute of Healthcare Engineering online by visiting www.ihea.org.au or scanning here ➞

IHEA NATIONAL OFFICE Direct: 1300 929 508 Email: IHEA.members@ihea.org.au Address: PO Box 6203, Conder ACT 2900 Website: www.ihea.org.au Conference: www.hfmc2019.org.au IHEA NATIONAL BOARD National President Peter Easson National Immediate Past President Brett Petherbridge National Vice President Jon Gowdy National Treasurer Mal Allen Communications Darryl Pitcher Membership Registrar Peter Footner

Standards Coordinator Brett Nickels Directors Michael McCambridge, Peter Klymiuk, Mark Hooper

67 ADBOURNE PUBLISHING 18/69 Acacia Road Ferntree Gully, VIC 3156 PO Box 735, Belgrave, VIC 3160 www.adbourne.com ADVERTISING

IHEA ADMINISTRATION Chief Exexutive Officer Karen Taylor Finance Jeff Little Membership Tom McKernan (FMA), ihea.members@ihea.org.au Editorial Committee Darryl Pitcher, Mark Hooper IHEA MISSION STATEMENT To support members and industry stakeholders to achieve best practice health engineering in sustainable public and private healthcare sectors.

Melbourne: Neil Muir T: (03) 9758 1433 F: (03) 9758 1432 E: neil@adbourne.com Adelaide: Robert Spowart T: 0488 390 039 E: robert@adbourne.com PRODUCTION Emily Wallis T: (03) 9758 1436 E: production@adbourne.com ADMINISTRATION Tarnia Hiosan T: (03) 9758 1436 E: admin@adbourne.com

The views expressed in this publication are not necessarily those of the Institute of Healthcare Engineering Australia or the publisher. The publisher shall not be under any liability whatsoever in respect to the contents of contributed articles. The Editor reserves the right to edit or otherwise alter articles for publication. Adbourne Publishing cannot ensure that the advertisers appearing in The Hospital Engineer comply absolutely with the Trades Practices Act and other consumer legislation. The responsibility is therefore on the person, company or advertising agency submitting the advertisement(s) for publication. Adbourne Publishing reserves the right to refuse any advertisement without stating the reason. No responsibility is accepted for incorrect information contained in advertisements or editorial.

The editor reserves the right to edit, abridge or otherwise alter articles for publication. All original material produced in this magazine remains the property of the publisher and cannot be reproduced without authority. The views of the contributors and all submitted editorial are the author’s views and are not necessarily those of the publisher.

3

BRANCH REPORTS

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REGULARS

EDITOR’S MESSAGE

W

elcome to the first edition of “Healthcare Facilities” for 2019. By now we are well and truly into 2019, however we continue in this edition to share some of the excellent material from presentations at the IFHE Congress, held in Brisbane late in 2018. This includes articles of technical interest from Denmark and Belgium as well as a couple from our own ‘back-yard’ in QLD and WA. The increased reliance on ICT within the engineering and facilities arena, means that we should be more aware of terms like ‘block-chain’ and ‘cloud-based computing’ – both of these issues cross local and international borders – so we’ve included some ideas and case studies on pages 55 and 59. We also share with you some of the recent and future events of the State branches.

Many of you would be aware of the initiative the IHEA is pursuing with the online training platform that is being developed to support continuing professional development. This has been identified by our members and stakeholders as an important future strategic direction for the Institute. This initiative was shared with delegates at the IFHE Congress with a pilot program

launched soon after and input has been received from a number of users, including some international healthcare engineering professionals. This platform is being enhanced and you will hear more about that in coming months.

As always a special thanks to our publishers, Adbourne, who work so hard to pull this publication together, with the support from our many commercial partners and stakeholders. Without whom we could not produce such an excellent technical journal.

I hope you enjoy this edition of “Healthcare Facilities” and invite you to share this and the electronic version amongst your peers and colleagues when it arrives in your inbox or your social media stream. If you’ve not already found (and liked) the IHEA (and IFHE) Facebook pages – do a search for them, and stay connected and active with your professional peers from around the country and across the globe.

Regards Darryl Pitcher

5

REGULARS

NATIONAL PRESIDENT’S MESSAGE

At the top levels of any organisation, succession planning is critical to ensure that key positions can be filled by qualified candidates. The IHEA is no different in this respect, identifying and considering talent that can be coached, nurtured and trained to step into these slots when required is a key function of the Board.

A

lthough directors of the IHEA serve as volunteers, their responsibilities – and associated liabilities – are no different to those of directors of for-profit organisations.

As demands on our Organisation increase, our Board will face a growing challenge to recruit directors with the experience and expertise required to fulfil its mandate. Board members are elected by the IHEA’s membership at large and, whilst this is highly

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REGULARS

democratic, it may not produce the optimum mix of directors needed to form an effective board.

The Board requires directors who recognise that they act and undertake decision making in the best interests of the Organisation and understand that their fiduciary responsibilities are to the IHEA, and not to their respective States. It is important that Board members work well as a team, bring the necessary skills to the table, and share a sense of accountability to other Directors and members of the organisation. Maintaining the governance and culture of the IHEA is a continual challenge that cannot be underestimated, and it is essential to the Organisation as a whole that the Board is seen to be open, transparent and honest in its accountable dealings with our members, stakeholders and supporters.

their role, responsibilities and liabilities. If they are unable or unwilling to commit the required time and effort to diligently carrying out their duties as a director of the IHEA, they should consider their involvement with the board.

I would encourage any past Board member who is interested in undertaking a role as assessor and mentor to contact me at ihea.president@ihea.org.au I look forward to receiving your communication Peter Easson IHEA National President

One of the Board’s primary responsibilities is to ensure that the Organisation develops and maintains a succession strategy that aligns our mission with both the short and long-term vision of our members.

The succession planning process must commence with consideration of the qualifications required of individual board members to ensure they contribute effectively in carrying out the Board’s mandate.

At the February 2019 Board meeting, a proposal to establish a formal nominating subcommittee that would receive, promote and/or lobby for new Board member nominations to help the board ensure continuity, whilst remaining compliant with the constitution and rules, was endorsed.

To support the process, the Board have commenced developing a skills matrix that clearly describes the role and expectations of directors, and their required expertise and commitments.

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The skills matrix will underpin the establishment of a formal orientation program to help ensure that new Board members clearly understand the responsibilities of the role, structure and processes of the Board, ensuring that they are familiar with the issues facing the Organisation, and accelerate their ability to contribute to the Board’s business, and the matters currently under consideration.

The nominating committee will be encouraged to identify individuals from within the Organisation who are willing to support the process and act as assessors and/or mentors for any potential future directors.

Although the demands to secure those with the skillsets, attributes and commitment is ever present, IHEA directors must ensure that they fully understand

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REGULARS

8

REGULARS

CEO’S MESSAGE

T

he National Board of IHEA spent two days in Adelaide on February 8 and 9. This incredibly valuable time together included the regular quarterly board meeting and importantly a review of progress to date and future directions of our current Strategic Plan. I am pleased to report that all of the performance indicators have either been completed or have had significant progress made on them throughout 2018.

Day one – saw the Board review the Strategic Plan and make some associated decisions for the next 12 months. Key outcomes were; • progression of the current social media strategy • a complete review of IHEA Style Guide and all associated collateral • establishment of a Board Nominations Committee to manage Director succession planning, application process and recommendations for appointments based on a skills matrix and robust recruitment process

• implementation over the next 12 months of a comprehensive CPD program (more info to come over the next few months) • review of FMA arrangement with identification of issues to be addressed and future collaboration possibilities • decision to discontinue PO Box due to minimal use.

There will be more communication to follow • Zoom set up for webinar use by branches • Eventbrite set up for use in managing state events Day Two – the quarterly Board meeting was held with the following areas covered: • Branch Reports • Journal

• Standards Report • IFHE Congress update • FMA partnership update • Presidents Report • CEO Report – inc a new Code of Conduct for members and proposal for new membership enquiry pack • Financial Report (inc audit and risk) • Insurance for conferences • Membership Report 2019 Conference – Game Plan for the Future of Healthcare Facilities I am delighted to report that planning for the National conference in Sydney in October is well advanced with a draft program expected in May. Leading off what is shaping up to be an exciting array of presenters are keynote speakers Louisa Hope and Private Damien Thomlinson.

The conference will provide an overview of current and future trends in emerging technologies which are already impacting on operational requirements of Healthcare Services. The future roles of Healthcare Engineering & Facility Managers will be pivotal in ensuring these current and new upcoming technologies are implemented effectively from both a technical and strategic perspective. It is essential that Healthcare Engineering & Facility Managers have a strong and informed voice in ensuring that contemporary and emerging technology is incorporated into all facets of Healthcare Facility design.

Keep an eye out on our website for further details as they come to hand.

Karen Taylor – CEO

• Website update

9

BRANCH REPORTS

QLD BRANCH REPORT A wet start for our Northern Country Health Districts

A

very quiet start regarding our branch activities.

The Qld COM are busy putting the final details to our Townsville Country Meet, to be held on the 29th March.

Membership of the QLD Branch continues with slow growth in 2018/19.

Committee of Management President

Brett Nickels

Vice President

Adrian Duff

All this coincides with the flood impacts of Townsville and surrounding districts. The Townsville Hospital wasn’t affected but other outlying hospitals and Community Health Services were.

Treasure

Peter white

Secretary

Jason ward

State National Board

Brett Nickels

This has created trying conditions for a lot of people, no more so than the staff and contractors that support these facilities, dealing with their own life tragedies.

Our thoughts and wishes are with them as they battle the aftermath of the flood disaster, the cleanup, dealing with mould and water born infection issues associated with exposure to flood waters.

COM

Scott Wells

COM

Scott Summerville

COM

Kevin Eaton

COM

Stuart Hentschel

COM

Todd Marshman

COM

David Smith

COM

Alex Mair

COM

Christopher Ansley Hartwell

COM

Mike Ward

Our Professional Development program currently consists of: March PD IHEA QLD Country Conference & Tradeshow – 29th March 19 Topics include: • Asset Management, Lifecycle Planning & Modelling • Indoor Air Quality in Health Care & HVAC in Tropical Climates • Water Quality Infrastructure& AS 4187 Compliance • Central Sterilising Department Redevelopment Project Case Study • Townsville Hospital High Voltage Reinforcement Project, Electrical Infrastructure Systems Automation and Resilience • Ductwork Sanitisation & Mould Remediation Case Study Technical tours: • THHS – Central Energy Facilities • THHS – Central Sterilising Department Special General Meeting and Midyear PD Held over two days 18th/19th July at the Victoria Park Golf Club Theme: Standards impacting on Healthcare Services Quarterly PD’s to be advised Monthly COM meetings targeting membership, communication & bridging the distance problem

10

Membership

Representative

If you would like to communicate with the QLD branch via email, please do so at ihea.qld@ihea.org.au Brett Nickels President, QLD Branch

BRANCH REPORTS

11

BRANCH REPORTS

WA BRANCH REPORT

Accuray Cyberknife robotic radiosurgery system

Branch Activity – End-of-Year Event

John Pereira who is the Engineering and Projects Service Delivery Manager for Serco Asia Pacific at Fiona Stanley Hospital, provided a personal account of his journey from diagnosis of prostate cancer to treatment, which culminated in becoming the first patient in Australia to undergo virtual brachytherapy treatment delivered by the first private Accuray Cyberknife robotic radiosurgery system in Australia.

Sundowner – November 2018, Prince Lane Rooftop Bar

T

he end of year Sundowner was held at Prince Lane Roof Top Bar in Perth City and was well attended with 40+ members and partners enjoying the alfresco event.

The evening was also an acknowledgement of professional achievement. The WA Branch Achievement Awards were presented to our members who were outstanding in their field throughout 2018.

The winners were decided by majority vote and results were as follows:

Left: Apprentice of the Year – Lennard Thwaite, Refrigeration Apprentice, Centigrade Services Right: Tradesperson of the Year – Yuri Deans, Mechanical Fitter, North Metropolitan Health Service

John’s account highlighted the need for early detection with an emphasis to get regular checks.

He also emphasised the need to be informed on the options available for this treatment. Where radical surgery has typically been the treatment of choice, John was fortunate in having worked with Professor David Joseph previously and knew of his visionary work and research.

John briefly explained the technology that allows a linear accelerator to be housed on a robotic arm with several degrees of movement, unlike conventional linacs which can only operate in an arc around the patient. John concluded his talk highlighting how the modern diagnostic techniques including 3T MRI have made early detection possible.

Hospital Engineers discussing the merits and mechanics of the Cyberknife

Engineer/Facilities Manager of the Year – Andrew Waugh, Engineer, Serco

Recipients were acknowledged at the Sundowner and presented with a certificate. Recipients will also receive complementary registration to the 2019 WA State Conference and a cheque for $250.00.

12

Branch Meeting – February 2019, 5D Clinic, Claremont

Professor David Joseph presented 5D Clinics and introduced the staff, including oncologists and therapists.

This was a Men’s Health Awareness Topic showcasing 5D Clinic’s Accuray Cyberknife robotic radiosurgery system.

David showed the evolution of radiation delivery from standard linacs to treatment of surgically inoperable tumours using stereotactic radio-neurosurgery, general

BRANCH REPORTS

intensity modulated radiation therapy (imRT) delivered by linacs finally to the Cyberknife and complementary techniques such as immunotherapy targeting just the cancer cells.

David explained that the Accuray Cyberknife was the brainchild of Dr John Adler, a professor of neurosurgery and stereotactic radiosurgery at Stanford, where he introduced David to the technology for brain and spinal lesions. David discussed how this now includes other areas such as the lungs, prostate, liver and pancreas. This ablative radiosurgery technology allows for real time motion correction and delivery to sub-mm precision thus limiting the dose fractions to just the tumour. He explained his research and cited his papers over the last 25 years showing the success rates of high dose rate brachytherapy (From left) Peter Podias, Prof David Joseph, John Pereira

• Calling for nominations for the 2019 WA Branch Achievement Awards. Categories are Tradesperson, Apprentice and Facilities Manager/Engineer of the year • WA Branch is undertaking proactive membership drive.

Upcoming Branch Meetings • 14th March – SJoG Hospital, Murdoch. Murtec Function Room 2. Sponsor: Invisible Systems. PD session on Legionella • 4th April – 108 St Georges Terrace, Perth CBD. Level 51. Sponsor: AppTegral. Creating innovative technologies to manage the maintenance of healthcare facilities Acknowledgment The WA Branch of IHEA would like to acknowledge the following WA members: 1. Donald Kelly 30 years’ service retired member 2. Allan Lees 20 years’ service retired member 3. John Vry 10 years’ service active member 4. Neil Oliver 10 years’ service active member 5. Craig Aggett 10 years’ service active member

Peter Podias, 5D Clinic’s senior radiation therapist then took the attendees on a tour of the system with some simulations highlighting the degrees of movement, the radiographic registration of the patient prior to and during treatment, and the treatment planning and delivery control system.

The IHEA WA would like to thank 5D clinic and John Pereira for hosting this event and for sharing their cutting-edge technology and experience with our members. We all enjoyed the visit immensely and at the very least, it left us all with plenty to think about in terms of our own health and well-being and that of our friends and family.

Actions • Draft annual program being developed for the next 12 months and focusing on professional development opportunities.

Thomas Kelly has resigned as State Secretary. Tom and his partner are relocating to the WA Pilbara.

The WA Branch would like to thank Tom for his time, contribution and efforts as the State Secretary, especially for the transferring of information to the new Google format. Fred Foley, Vice President has agreed to take on the role as State Secretary.

Committee of Management Peter Klymiuk Greg Truscott Fred Foley Rohit Jethro Fred Foley Peter Klymiuk Angela Te Haara Alex Foster Philippe Tercier John Bose

President Immediate Past President Vice President Treasurer Secretary National Board Representative Journal Representative

• Planning underway for the 2019 “Country Conference”. The proposed venue is the new Warren Health Service, formerly Manjimup Hospital.

Dates Friday 3rd and Saturday 4th May.

To contact branch committee members please email us at: ihea.wa@ihea.org.au

• WA Branch State Conference, Friday 9th August, 2019

WA Branch President

Greg Truscott

13

BRANCH REPORTS

VIC/TAS BRANCH REPORT

Question 5

Branch Activities

T

he Vic-Tas Branch opted for a lunch function to allow retired members to attend the Christmas event, which was held on Saturday 1st December at Cargo in the Docklands precinct. 30 attendees including members and partners enjoyed the event together. Services awards were distributed to Kevin Moon (30 years), and Simon Roberts (10 years), whilst Heidi Moon was awarded honorary membership for services rendered at both a national and branch level.

Would you be likely to attend a metro meeting at venues below?

Metro Train Project?

The Committee of Management would like to gauge your thoughts on proposed activities Question 1

Sporting Stadium?

Question 6

Question 2

6

8

11

Mon

Tue

Wed

Thur

Fri

Sat

Sun

1

1

1

0

6

2

2

10am

11-3pm

3

3

Question 7 Topics Distribution board failures (explosion)

1

2

Morning

Anytime

12-2pm

Wed

3

1

3

1

Venue

2

3

4

6

DHHS

Board design lessons learnt Engineering trends in healthcare Facilities Management

Institute of Engineering Aust Health Department – Building Authority Annually MCG 0

1

Yes

No

6

2

Question 8 Any other feedback Participation during business hours is extremely difficult I have put down the highest level for participant days as I believe that your association has a lot to share and it is important to connect as regularly as possible

2

Question 4 Would you be likely to attend a country meeting at venues below?

14

Preferred time of day?

1

6

Tasmania

2

Preferred day of the week?

4

Would you like to visit non health sites to review other industry Asset management plans?

Latrobe Valley

No

7

Heavy Engineering – Non Hospital

How many Professional Development days should we conduct?

Question 3

Yes

Topics and/or venues, (please add venue contacts) 4

How many Webinars should we conduct?

What time of the day is preferred to participate?

No

9

Victoria Tasmania Branch Activities for 2019 Survey The following details the result of the snap survey carried out by members at the Christmas function:

Yes

Keep doing the great job you are already doing!

Continue to look for something different & emerging

Proposed Professional Development Days 2019 Dept. of Health and Human Services – Sustainability workshop – Friday 15 February 2019 Yes

No

7

3

Yes

No

5

3

PD1 – Strategic Asset Management – TBC (March 2019) PD2 – Country Meeting – Latrobe Hospital – Steve Jones – TBC – (Friday May 2019)

BRANCH REPORTS

The National Board recently purchased a Zoom Webinar licence to allow webinar access for members. The branch is planning its first webinar (topic & date TBC) for March/April 2019, the goal this year will be to create a webinar library of topics (as Youtube clips) in the member’s only section. Keep your eyes open for more advice on this.

Branch Committee – this is a call for nominations to the Vic/Tas Branch Committee of Management, with elections to be held in May 2019. This is a great entry into the management and oversight of IHEA, and you don’t need to leave your work to participate.

Branch meetings are held as a video conference meeting once a month, this allows country and metro members to participate. If you are interested email: ihea.victas@ihea.org.au.

Membership

Branch Committee of Management The Committee of Management meet monthly via teleconference and at the end of PD days.

Victoria/Tasmania Branch

Committee of Management

Branch President

Michael McCambridge

Branch Secretary

Peter Crammond

Branch Treasurer

Steve Ball

Committee of Management

Howard Bulmer

Committee of Management

Sujee Panagoda

Committee of Management Meeting Convenor

Simon Roberts

Committee of Management

Mark Hooper

Committee of Management Communications

Roderick Woodford

Nation Board Reps

Michael McCambridge Mark Hooper

The Committee of Management is actively targeting membership growth, so if you know of people working in the health environment, email the Committee their details, we will be targeting potential members from Private Hospitals, Aged Care, and Public Private Partnership Facilities Managers, prospective members will be invite to our Professional Development Days, and Webinars, sent the journal electronically to see firsthand what the Institute has to offer ‘try before you buy’

If you would like to make contact with the Vic-Tas branch please email us at ihea.victas@ihea.org.au

THE MOON CONNECTION

membership correspondence (printing meeting flyers, stamped envelopes to our first e-bulletins at a national level).

T

he Moon name has been connected to the IHEA at a National and Branch level for over 30 years. Kevin is an Honorary Fellow and has been an active member and former National Treasurer, restructuring the financial management systems to ensure good governance & compliance, the foundations of the restructure is a legacy of his work.

Kevin has worked in numerous health facilities both as an engineer, and also consultant in his area of expertise ‘bugs and infection prevention/control, within the health engineering environment, Kevin has presented at many forums on the subject.

The lesser known but just as active in IHEA is Heidi Moon. Heidi was the engine behind both the National Board, but also Victoria/Tasmania Branch for the past 16 years, from Journal proof reader to secretariat and communications/membership manager, sending out

Michael McCambridge – VIC/TAS Branch President

With the membership/secretarial contract with Facilities Management Australia, Heidi’s role has reduced to just Vic/Tas secretariat.

Heidi’s commitment and work for the Institute was noted at the October Board Meeting and the Board unanimously agreed to bestow Honorary Membership to Heidi, I had the Pleasure of presenting Kevin with his 30 year certificate and advising Heidi of her membership at the Branch Christmas function lunch in December.

We look forward to continuing the association with the Moon’s into the future.

15

BRANCH REPORTS

NSW/ACT REPORT Activities

P

rofessional Development day was held at Royal Prince Alfred Hospital on the 28th November.

The event generated some strong interest with the theme being around safety at work focused on working at heights and confined spaces, there was a very interesting presentation from SafeWork NSW relating to height safety as well as some hands on rescue training from Circa Solutions. I’d like to take the opportunity to especially thank Circa Solutions for their ongoing support of our branch. Included in the day’s events were site visits to the RPA fire training simulator which enables fire training for clinical staff in an actual ward type environment and the recently completed NSW State wide Biobank which is a high tech repository for cell samples from across the state.

Planning is now finalised for the next IHEA Professional Development Day at Coffs Harbour Health Campus.

This event continues the IHEA principals of providing continuous professional development and exposure to industry best practice, products and technology in the ever changing arena of hospital engineering and healthcare facilities management.

The proceedings will commence at 10:00 am on Friday the 22nd of March 2019, with registration, followed by a day comprising of technical presentations, panel discussions. We will even feed you.

Reminder: the 2019 national conference is being hosted by the NSW/ACT branch and will be held at the ANZ Stadium in Sydney (former Olympic Games site) 9th – 11th October. The branch COM is currently working on the program and technical tours. Keynote speakers are now confirmed as Louise Hope and Private Damien Thomlinson. Sponsorship interest is starting to build with calls for abstracts and sponsors still being open.

Technical Event 3D PRINTING: The utilisation of 3D printing in health is now becoming popular in the Bio-med Engineering spaces, however from a clinical perspective, better governance on how to safely manage the introduction of this type of manufacturing is required to ensure safe and effective use.

Hunter New England Local Health District will be hosting in conjunction with Biomedical Engineering and the Procedural Network a 3D printing forum to be held at HMRI (Hunter Medical Research Institute), John Hunter Campus on Saturday 30th June.

16

BRANCH REPORTS

IHEA Healthcare Facilities Management Conference 2019 9-11 OCTOBER 2019 / ANZ STADIUM SYDNEY

This year’s theme is Game Plan for the Future of Healthcare Facilities which aims to give delegates an overview of current and future trends in emerging technologies which are already impacting on operational requirements of Healthcare Services. The future roles of Healthcare Engineering & Facility Managers will be pivotal in ensuring these current and new upcoming technologies are implemented effectively from both a technical and strategic perspective.

It is essential that Healthcare Engineering & Facility Managers have a strong and informed voice in ensuring that contemporary and emerging technology is incorporated into all facets of Healthcare Facility design.

For more info & to receive event updates visit www.HFMC2019.org.au

The forum will cover: • Current and future applications of 3D printing.

• Current uses of 3D printing in HNE LHD • Regulation and governance of 3D printing in the hospital setting

joining recently. The CoM is discussing a variety of strategies on an ongoing basis.

Committee of Management Name

Position

Jon Gowdy

President

Robin Arian

Vice President

Mal Allen

Treasurer

Standards Australia in conjunction with a technical committee consisting of members from various groups including IHEA has undertaken a review of this standard which has been underway for over twelve months.

John Miles

CoM

Robin Arian

CoM

Jason Swingler

CoM

Marcus Stalker

CoM

The draft is currently at the stage of final review by the committee and once completed, the draft will then progress to editorial review. Once this is completed the Draft Standard will put out for public comment.

Brett Petherbridge

CoM

Peter Lloyd

CoM

Greg Allen

CoM

AS2896 Update AS2896 Medical gas systems—Installation and testing of non-flammable medical gas pipeline systems.

Please visit the IHEA website for further details or contact any of the CoM members regarding these events, we also welcome and encourage suggestions from members for future areas of interest for professional development Membership

To contact the NSW-ACT Branch please email us at ihea.nswact@ihea.org.au Jon Gowdy – NSW State President Director Engineering Services SLHD MIHEA

Membership growth continues to be a challenge however interest from both industry groups and health facility management practitioners is increasing and it’s been great to see some new corporate members

17

QUALITY AIR FILTRATION BRANCH REPORTS

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BRANCH REPORTS

SA BRANCH REPORT Activities

T

he last quarter was bookended by the highly successful National Conference in October 2018 which provided the opportunity for IHEA to host the International Federation of Hospital Engineering (IFHE) Congress. The Congress had a special importance to the SA Branch as our Darryl Pitcher took over the reins as President of IFHE and our congratulations go out to Darryl for the recognition of his contribution to healthcare engineering on an international scale.

A number of SA members attended the IFHE Congress, some who were supported in their attendance through the Branch scholarship program: Peter Cooper, St Andrews Hospital John Gilbert, Frazer-Nash Consultancy Robin Harding, Stirling Hospital Darryl Pitcher, Bethsalem Care Michael Scerri, Arc Blue Consulting Group/Resolute Projects Kate Toner, Frazer-Nash Consultancy The Congress was highly successful with a great exposure to the latest developments and trends in healthcare engineering, both nationally and internationally, shared with delegates. The usual fantastic opportunities for networking between members/delegates were well received and enjoyed by all.

A very successful members’ Christmas function was held during December 2018 with good numbers

attending and great opportunities for networking and briefings on upcoming Branch activities provided.

Pleasingly, a number of guests who were invited to attend have now taken up membership or are in the process of doing so.

Through our collaboration with CIBSE and other partners, a number of other PD opportunities have been offered to our members over the last quarter of 2018, covering diverse topics such as: • Earthquake Restraint and Design Requirements • New jointing technology for Refrigeration and Air Conditioning pipe work • Hydronic Underfloor Heating/Cooling and Concrete Core Tempering • Changes in fire safety regulations • Forum on current responses to combustible cladding issues • What can South Australia learn from Grenfell Tower?

(CIBSE UK visitor) • Flinders University Solar Photovoltaic (PV) system One additional PD event has already taken place this year (February) with members invited to participate in a site visit to a refurbishment project at 50 Flinders St, a project developed in late 2015 as a 6 Star Green Star development and which is now close to achieving a 6 Star NABERS rating. One of our local corporate members (Alerton) was involved in presentations on the evening.

The Committee of Management meets regularly to review opportunities for future PD events, many in collaboration with CIBSE and other partners. A number of topics are planned or are under consideration, including: • New Royal Adelaide Hospital site visit • Latest developments in microbial research in water quality • Developments in electrical vehicle infrastructure • Latest issues in electrical engineering in healthcare settings • Seminar on EnHealth Legionella Control Guidelines • Cyber security developments • Calvary Hospital redevelopment • Building certification Q&A session • Revised BCA fire safety verification methods • Thermal storage projects

19

BRANCH REPORTS

Membership The AGM held during the IFHE Congress gave us the opportunity to recognise the long service of a number of SA members. We thank the following members for their membership and contributions to Institute of Healthcare Engineering Australia and to the healthcare engineering field: Peter Cooper, St Andrews Hospital – 30 years Lyell McEwen Hospital – 10 years Darryl Pitcher – 10 years Through the efforts of several CoM members, a number of new leads for new members are being explored with several new members already signing up and with others showing considerable interest.

We welcome the following new members who have joined the Branch since mid-2018:

Regular monthly coordination meetings are held with CIBSE and affiliated organisations to plan and promote joint PD activities. As noted above, where appropriate, events arranged by CIBSE and these other organisations have been circulated to/made available to our members, with a small number of our members taking up the opportunity to attend these events.

In the interest of providing further development opportunities for our members, the CoM is pursuing discussions with Facilities Management Australia and the Australian Institute of Project Management (healthcare special interest group) to explore any mutually beneficial opportunities to share PD events.

Details of the current Committee are provided below: Elected Person

Position

Peter Footner

President

Built Water Solutions

John Jenner

Vice President

Frazer-Nash Consultancy

Peter Footner

Treasurer

Jason Edson

Michael Scerri

Secretary

Peter Footner

National Board Rep

Vince Russo

Committee Member 1

Darryl Pitcher

Committee Member 2

Tony Edmunds

Committee Member 3

Michael Frajer

Committee Member 4

Ross Jones

Committee Member 5

Richard Bentham

Committee Member 6

Administration The new, expanded Committee of Management has been meeting regularly and meetings are increasingly productive as the Committee progresses planning around PD events and new membership opportunities.

Through the good graces of the management of St Andrews Hospital, late in 2018, CoM meetings are now being held in the Hospital’s Waverley House meeting rooms – a very salubrious, historic place as the attached photo attests.

To contact the SA Branch, please email us at ihea.

SA@ihea.org.au Peter Footner President, SA Branch

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FEATURE ARTICLES

IMPROVING SUSTAINABILITY IN HOSPITAL WASTEWATER MANAGEMENT A DANISH CASE STUDY

By Jakob Soholm

Worldwide there is growing recognition of the threat of micro pollutants such as bacteria, viruses, hormones and Active Pharmaceutical Ingredients (APIs) in the wider environment, as these are difficult to remove by conventional wastewater treatments.

A

pioneering project in Denmark is leading the way for a better approach to hospital wastewater treatment that can deal effectively with some of the most challenging and hazardous pollutants in wastewater and increase sustainability in hospital wastewater management.

HOSPITAL WASTEWATER POSE A RISK Hospital wastewater contains a complex mixture of hazardous pharmaceuticals, harmful pathogens and antibiotic resistant bacteria.

Municipal sewage treatment plants are not designed to deal with pharmaceutical products and antibiotic resistant bacteria mainly excreted from patients.

Consequently, these substances are now being detected in waterways.

Even at very low concentrations these can affect animal life. Estrogens, for example, can cause hermaphroditic fish, while some painkillers are poisonous to trout, and certain psychopharmaceuticals can affect fish and animal behaviour.

Very importantly it also pose a direct threat to the public when exposed to raw sewage as a consequence of heavy rain and overflow events.

But also for those working in the sewers and at the wastewater treatment plants.

Table 1 – Hospital effluent characteristics and outlet quality

22

Parameter

Raw untreated sewage

Final outlet from plant

COD N-tot P-tot

876 mg COD/litre 62 mg N-tot/litre 13 mg P-tot/litre

11 mg COD/litre 2,5 mg N-tot/litre 0,3 mg P-tot/litre

Toxic and persistent antibiotics (eg. ciprofloxacin, clarithromycin and sulfamethoxazole), painkillers (eg. diclofenac), and cytostatics (eg. capecitabine)

Factor 10-300 exceeding of effect limits for water living organisms

No exceeding of effect limits for water living organisms

X-ray contrast media (eg iomeprol)

High concentration (2,5-7 mg/l)

99% removal

Antibiotic resistant bacteria

High presence of multi-resistant bacteria

No faecal or multi-resistant bacteria

Ecotox effect – Fish fry (zebra fish)

100 % mortality (death) within 96 hours

0 % mortality (death) within 96 hours

Ecotox effect – Crustaceans (daphnies)

No offspring (all daphnies died)

Off springs survives like in clean water

Hormone disrupting effects

Estrogene effects

No estrogene effects

FEATURE ARTICLES

Hospital

No. of beds

Catchment area

A: Highly hazardous pharmaceuticals [kg/yr]

B: Hazardous pharmaceuticals [kg/yr]

New Northern Zealand

670

Small/ fresh

130

989

Hvidovre

800

Large/ marine

111

818

25

New Bispebjerg

860

Large/ marine

108

708

Rigshospitalet

1,100

Large/ marine

436

1,381

New Herlev

950

Large/ marine

181

700

Table 2 – Hospitals mapped as major point sources in the capital region of Copenhagen. *Ratio between Measured Concentration and Guiding Limit Value as set

by Danish Authorities

Especially antibiotic resistant bacteria is an increasing threat to public health as high usage of antibiotics automatically leads to formation of resistant bacteria which ends up in the wastewater. The hospitals often turn out to be significant point sources of use of antibiotics and hazardous pharmaceuticals which ends up in the wastewater.

In the capitol region of Copenhagen, Denmark, with around 1,8 mio inhabitants, the usage of the four biggest hospitals and a new greenfield hospital under construction has been mapped, which shows that these hospitals contribute with up to 79% of the antibiotics use in their respective catchment areas and hundreds of kilograms of hazardous pharmaceuticals.

LOOKING FOR SOLUTIONS Since 2013, the authorities has started to include requirements to hazardous pharmaceuticals and bacteria in Danish hospitals wastewater discharge permits.

Danish municipalities (which regulates hospital discharge permits in Denmark) have developed methods to rank hospitals according to their importance as point sources, so that regulatory focus is on the most significant sources. And only the major sources are required to install their own wastewater treatment plant, where as minor sources need to look for substitution etc. The ranking system takes into account both the total consumption of hazardous pharmaceuticals as well as the hospital’s antibiotics consumption compared to the consumption in the rest of the catchment area.

Sum of exceedance of limit values [MC/GLV]*

Antibiotics contribution (excl. penicillins) [%]

Classification as point source

79

Major source

27

Major source

48 and 172

8

Major source

105

28

Major source

104

18

Major source

THE HERLEV PUBLIC PRIVATE INNOVATION PROJECT The capital region of Copenhagen, Denmark and Grundfos, a private technology company, signed in 2012 a Public Private Innovation agreement with the aim to develop and demonstrate a technological solution to this problem in full scale at the Herlev Hospital and set the standard for future regulation of hospital wastewater in Denmark. Potentially in other countries as well.

Herlev Hospital is the biggest emergency hospital in the capital region of Copenhagen, with many highly specialised departments and research activities. The hospital holds 949 beds, 6,300 employees and keeps expanding with new activities and buildings.

The wastewater treatment plant is the largest and first installation in the world to test and demonstrate a complete solution to on-site wastewater treatment specifically targeted to remove the unique pollutants generated in hospitals.

The plant was commissioned in May 2014 and after two years of testing and optimisations in went into normal operation.

PLANT OVERVIEW The full-scale WWTP has been designed to treat the total wastewater flow from the hospital which is around 150,000 m3/year, equivalent to the needs of a small town with 3,000 inhabitants. The system can deal with a broad range of substances from viruses and multi-drug resistant bacteria to medical contrast agents, chemicals for cancer treatments as well as hormone-disrupting substances.

As well as treating the wastewater, the plant has also been designed to clean air emissions for pathogens and odour – so it can be placed closed to the hospital and neighbours. Other aspects of the plant were the ability to ensure that the by-products of the treatment

23

FEATURE ARTICLES

can be disposed of in an environmentally sound way – and not just moving the problem to another location. In other words – a complete solution.

Figure 1 – Overview of Herlev wastewater plant consisting of different modules: 1 - Pretreatment, 2 - Bioreactors, 3 - Sludge Treatment, 4 - Supply, 5 - Filter, 6 - Polishing.

2

Loadings on plant (2014) Average flow on working days

460 m3/day

Average flow during weekends

300 m3/day

Annual wastewater discharge

130,000-160,000 m3/year

Effluent Quality (August 2014) COD total

12 mg/litre

N-total

3 mg/litre

P-total

2.3 mg/litre only using bio-p 0.1 mg/litre expected with chemical precipitation

Pharmaceuticals

Below limited of detection for most pharmaceuticals Below PNEC fresh without dilution for the rest

Plant Capacity Volumetric load capacity

600 m3/day

Organic load capacity

3,000 PE

Polishing Line 1 GAC empty bed contact time

>45 minutes

Ozone dose

Up to 10 g/m3

Polishing Line 2 Ozone dose

Up to 25 g/m3

GAC empty bed contact time

>45 minutes

Table 3 – Capacities and flows within the WWTP.

THE WWTP DESIGN The wastewater treatment plant, placed inside a 15x33 m building at the south-end of the hospital ground, comprises a number of separate modules holding different functionalities of the plant Bird view of the Herlev Hospital and the WWTP.

6 5 4 3 1 The first stage is the pre-treatment or screening stage where the heavy solids, hair and fibres are filtered out of the wastewater using 1.5 mm screens before entering the reactor tanks placed outside the building.

Here, biological processes with activated sludge in combination with microfiltration membranes, known as membrane bioreactor (MBR) technology takes place to remove not only conventional nutrients such as organic compounds, nitrogen and phosphorus, but also a fraction of the micro pollutants generated in the hospital. The rotative ceramic microfiltration membrane holds back the bio-sludge and ensures completely suspended solids free water for the following polishing stages.

THE POLISHING STAGES Following the MBR, the wastewater is treated further with ozonation, granular activated carbon and finally UV. Ozone is a powerful oxidation agent and it reacts with those organic substances normally difficult to degrade including pharmaceuticals. Ozone is generated from standard liquid oxygen stored outside the plant.

Granular Activated Carbon (GAC) filters remove a range of contaminants like pharmaceuticals, hydrogen sulphide, heavy metals (lead, mercury and copper), chlorine and organic compounds from water by either adsorption or catalytic reduction; a process involving the attraction of negatively charged contaminant ions to the positively charged activated carbon. Organic compounds are

24

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FEATURE ARTICLES

removed by adsorption and residual disinfectants such as chlorine and chloramines are removed by catalytic reduction. When the GAC has used their full adsorption capacity, the GAC is sent for re-generation in Germany so they can be re-used again and again.

Finally UV is installed as an extra barrier against bacteria. UV works by a process of photoionisation and destroys bacteria and other germs as well as removing odours.

The whole process takes place in a closed system, and odour critical points like storage bins for screenings and sludge etc. are underpressurised, and all air emissions are treated with photoionisation in order to ensure an odour and pathogen free environment in- and outside the plant.

Sludge, including any remaining pathogens, is dried on site and then transported for incineration at the nearby incineration plant. Only between 1-3 m3 of bio sludge are produced weekly.

PROVEN TREATMENT RESULTS During the test period, water experts DHI has monitored and tested the treated water for the presence of around 90 different substances more than a 100 times. The analysis of pharmaceuticals in the wastewater was performed by the Institute of Energy and Environmental Technology in Duisburg, Germany and Eurofins, Denmark. Tests for toxicity and genotoxicity were carried out by the Research Institute for Ecosystem Analysis and Assessment in Aachen, Germany. Amongst the tested parameters are APIs, toxicity, bacteria (drug resistant bacteria), viruses, volatile substances, xenobiotics and radioactive substances.

The project demonstrated that the hazardous substances could be removed and that the quality of the treated water is very close to drinking quality.

Different water qualities at Herlev Hospital plant.

Left: Raw sewage.

Middle: Permeate after the MBR. Right: Final outlet after the polishing stage.

COMPETITIVE COST Around 4.5 M€ has been spent to build the plant.

The investment is depreciated over 30 years, during which an expected 4.5 mio m3 of wastewater will be treated, which equals app. 1€/m3. Operational and maintenance costs for running the plant is roughly 2 €/ m3. So in total the cost for the hospital for having their own WWTP is around 3 €/m3. Today, the hospital is being charged 3.4 €/m3 of wastewater discharged to the public sewage system.

Overall in this case a highly advanced on-site wastewater treatment plant is cost competitive to a public sewer and conventional treatment alternative.

MORE SUSTAINABILITY Though in addition to direct potential savings on effluent cost there are a number of added benefits, which can increase the sustainability and economical feasibility of an on-site wastewater treatment plant.

More life in local water streams. On-site treatment will often lead to discharge into smaller more near-by streams, as opposed to a public sewer network that often transport the wastewater/ground water used over long distances to a discharge point near the sea side. More water in smaller streams, which suffers from water shortage due the above mentioned, creates more water and life in the local water streams. At the Herlev Hospital the wastewater will be discharged into the nearby small water stream Kagsåen, which used to suffer from low water levels during summer periods.

Water re-use. The reclaimed water can be re-used for technical purposes like cooling towers or for recreational purposes like irrigation etc. bringing potential savings on drinking water resources. At the Herlev Hospital re-use of 15,000 m3 per year for cooling towers is under planning/construction.

Heat recovery. In Denmark significant amount of energy is used for heating the building and for producing hot water. A part of this energy leaves the building again with the wastewater. The wastewater at Herlev Hospital has an all year round temperature between 16-25°C, which is suitable for heat recovery.

The potential has been calculated to around 1 €/m3 in saved energy cost.

OTHER BENEFITS Monitoring the state of health of the hospital operations. Herlev hospital is part of project head

by DHI together with Herlev hospital doctors running until 2019, where the wastewater is being sampled on

26

FEATURE ARTICLES

a weekly basis and tested for resistant bacteria. By combining DNA results from the wastewater samples with results from inpatients, the early warning system makes it possible to go backwards and identify the sources, so faster and appropriate actions, eg.

Isolation of patients or increase of hygiene levels, can be initiated and the number of hospital carry-over infections with antibiotic resistant bacteria can be reduced – which ultimately will help save lives.

No concerns with odour and placing a wastewater treatment plant near a hospital and other residential buildings. Closest residential building is only 50 meters away – no odour complaints has been received since start-up. Scientists from Danish national research centre for working environments, NFA and Danish Technological University, DTU has further tested and concluded that the air emissions does not pose any treat to public health.

CLOSING COMMENTS The project at Herlev has been very successful in demonstrating that on-site wastewater treatment, is an effective way that will enable hospital managements to take responsibility and protect the environment against the negative impact of their operations, and reduce the risk of spreading antibiotic resistant bacteria via their wastewater.

In addition to this the project has shown a number of added benefits, like more life in local water streams, water re-use, heat recovery and an early warning system to reduce the risk of hospital infections with resistant bacteria, which makes hospital operations even more sustainable.

And finally it may be more cost effective for the hospital than using public sewer and wastewater treatment services.

So why not improve health care operations, when the generations to come can be benefitted at the same time.

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FEATURE ARTICLES

A RISK MANAGEMENT CULTURE THAT WORKS

THE EXPERIENCE OF THE TECHNICAL TEAM AT UZ LEUVEN HOSPITAL IN BELGIUM

By Eddy De Coster, ir head of department, Technical facilities UZ Leuven

UZ Leuven is the largest university hospital in Belgium with 1500 hospital beds and a revenue of 1200 million US dollar.

W

e are part of the KULeuven, the catholic university of Leuven, in the Dutch speaking part of Belgium in Western Europe.

Our technical department is staffed with 250 employees and has an average turnover of 36 million US dollar on maintenance costs and more than 60 million US dollar in construction development and renovation a year.

We have a long history starting in 1426. Around that time also a brewery was founded in Leuven which still exists today: Stella Artois, now part of AB Inbev and which made Belgium the land of beer and chocolates.

I hope you already had the occasion of tasting one of them.

In 2003 we started a masterplan to reduce the hospital campus from 4 sites to 2, which are the main plant, the Health science campus Gasthuisberg, and the rehabilitation plant in Pellenberg.

The masterplan foresaw in reducing the duration of the hospitalisation but also the deploying of more ambulatory cure. As a result of building a network of hospitals in Belgium working together with UZ Leuven, severe patients come to Leuven less severe are staying in the local hospitals, hereby intensifying the complexity of patient care and technical needs to do so. The plan also accommodated the request for full integration of the research and development sections and the educational part of the medical faculty on the campus Gasthuisberg.

It took about 4 years to start the construction of the first building of the masterplan. In the masterplan

there is a distinct place for education, research and development, hospital and ambulatory care. We started with an energy masterplan and a mobility plan.

The latter included a strong need for parking lots due to the special location of the hospital within the city (more than 5000 parking places). All new parking spaces are provided underneath the new buildings.

With regards to energy management we planned for high redundancy and high reliability combined with an important sustainability and energy efficiency.

When we compare the health science campus Gasthuisberg with a residence, we have a consumption of: • Electricity 64,300,000 KWH or the equivalent of 15,000 residences • Gas for heating 82,000,000 KWH or the equivalent of 3,600 residences • Water 333,000 m³ or the equivalent of 3,300 residences Now we have more than 300.000 m² of hospital buildings and about 200.000 m² of education and research buildings.

We at UZ Leuven are proud to be the first JCI (Joint Commission International) accredited hospital in Belgium and that since 2010 with a last survey in 2016.

The goal of JCI is creating and exploring a patient safe hospital. For the technical services the most important issues are safety and security of energy, medical equipment, clean air, fire safety, infection prevention etc.

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FEATURE ARTICLES

What do we do at UZ Leuven to reduce the risks of technical installations and technical activities on the patient safety? First of all we always need to remember that it are the people working in and for the technical department that are the most important link in the chain of looking after a patient safe environment.

Therefor we trained our technical personal by giving them a ten points program: 1. Keep technical areas tidy, always close the door.

2. Prevent risk of falling, keep corridors free of ceiling panels, loose cables, etc.

3. Keep the working environment organised and clean, avoid spreading of dust and debris in the hospital.

4. Restrict access to the construction site for unauthorised people, take care of the signalisation.

5. Request a ceiling permission when the ceiling will be opened for more than one day.

6. Request a fire permission when grinding, welding, flame cutting, burning off of paint, etc (except in workshops) 7. What to do in case of fire?

8. Be recognisable, wear your badge and uniform, register yourself at the services.

9. Keep dangerous tools and products away from children and other vulnerable patients. Keep your work cart locked.

10. In doubt, ask for advice of your supervisor.

It is a work of more than ten years now and today our people themselves have the know-how of making risk assessments required in a hospital. We have to cover risks originating from maintenance control, as well as risks related to the construction works in own execution and tasks that are performed by contractors: renovation, building and technical equipment.

Starting from energy continuity the most important energy source that we have to secure is electricity.

We made a double net on 10,000 V. That we have completely renewed from 2009 till now. We have a “NORMAL” distribution net coming from the external energy distributor, and we have a second “NOOD – Emergency” net that in normal conditions is fed from the normal net. When something goes wrong on the external distribution, we go on emergency and a set of 4 DIESEL-ALTERNATOR-groups take over within 15 seconds, giving electricity for the most necessary

30

patient-connected needs. In normal condition we have a peak use of 12 MW and in Emergency we can supply a maximum of 4 times 2 MW. For the most essential uses we have a distributed net of UPS (uninterruptable power supply) for instance the lighting and medical equipment in the operating theatres. We test this every month and once a year we do a life test by asking the energy supplier to turn off the hospital from the electricity net for 5 minutes.

For heating we use a centralised boiler-room with 4 boilers (with a total of 40MW heating capacity). To secure this we have mixed-burners who can work on oil and on gas.

Medical gasses, like compressed air and oxygen, are crucial for life support of some patients. Medical gasses are regulated by pharmaceutical laws in Belgium and Europe and so a lot of rules have to be followed. Most important rules are to assure supplying the right gas therefor you always need the ability to deliver from 3 separate sources and always under pharmaceutical hygienic conditions.

WATER Although Belgium has a very extended net of water supply, the challenge is to get the water in good condition to the patient. Water is very important for instance for haemodialysis, sterilisation, for those use cases we can rely on the delivery of water coming from external supply that we treat in the hospital by reverse osmosis so we can guarantee the quality of the water. For drinking water the law is very strict, in our hospital only patients with reduced immunity get water in bottles all the rest is coming from external supply. To assure sufficient water supply at all times we have a reservoir controlled by the external supplier for several days. And the supply to our hospital comes in by three separated ways. All the new water pipes for both cold and hot water are insulated so the temperature is correct and can be measured and alarmed. We do water tests every month at 100 points chosen by our experts as the most critical points.

AIR QUALITY For special applications, in operating theatres, cleanrooms for pharmaceutical use… we have clean air coming from hygienic groups and by the use of absolute filtering we can guarantee the quality of the air. Particle counting is applied every year on air samples to be sure that the quantity of particles does not succeed the acceptable maxima conform the norm.

FEATURE ARTICLES

catch them before they fall®

DATA AND VOICE In the patient treatment of today all essential technical installations and equipment are coupled on a digital information system. All the necessary parameters are analysed and an alarm informs the nurses on the patient parameters, and technical and fire alarms are sent to the technical services. 24 hours a day 7 days a week we have a manned dispatch who treat all these alarms. There is also a highly schooled technician in the hospital 24/7 to handle the first necessary actions, technicians from all disciplines can be alarmed at home to come to support.

WHAT TO DO WHEN SOMETHING GETS REALLY WRONG? Therefor we use our hospital incident management system (HIMS). We have analysed all sort of risks (not only the technical risks but also the risks of lack of nurses, pharmaceutical products, severe weather….)

First we establish preventive measures that we use every day to prevent incidents from occurring. For instance we do preventive maintenance on all equipment, and we have the most essential spare parts in our own technical store in the hospital.

But if an incident happens, and we all know that it will happen whatever we do preventive, we must have procedures to tell the people what they have to do in those emergency situations. We have made a lot of emergency procedures and we store them in an digital system called MUZLIDOC. A special feature of this system is that it offers the possibility to have the procedure approved by several stakeholders, but also that after a certain period all these people have to review the procedures. Having procedures is not enough, you have to train your staff on those procedures, because hopefully they occur rarely.

In case we don’t get control of the incident there is a possibility to switch to the state of “disaster management”. The possibilities are to receipt; evacuate, isolate or relocate, the patients from or to other locations in our hospital. But let’s all hope we never need these plans.

We have so far addressed the technical risks in exploitation, but there is also a special risk in the building process of hospitals. And as we all know there is a lot of construction work to do in hospitals in order to have buildings and equipment that are up to date for our patient care. The most important risks to be treated are infection prevention coming from dust and water. We start with determining the risk index, before starting with the study of the work and the search for

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FEATURE ARTICLES

a contractor. The contractor needs to know what kind of execution methods he needs to apply for minimising any inconvenience for the patients during the works, especially noise, vibrations, circulation ‌ The risk index from 1 to 4 is based on a decision table that primarily rates the risk for infection of the patient. The second parameter is the type of work to be performed, going from just opening a ceiling for inspection to the demolition of a concrete wall. Based on the index we have to take measures in order to have no dust in the patient environment. We close doors, make temporary walls in wood (not plastic, they must be there during the whole working period), and consider how to transport the materials from and to the construction site. We have a strict signalisation on every entrance door of the construction yard listing the point of contact for information and action. All contractors must have a badge with the name of their organisation. But most important is that all installations have to be checked 100 % by the contractor, the engineering bureau, if necessary the official inspection agency, and the engineer from the technical service.

32

If all those stakeholders have given their approval, the hospital prevention engineer will allow that patients can be treated in this area.

We have a culture of reporting near-accidents (however small they might be), with the analysis of all those reports we succeed to prevent real accidents.

We recently started a Last Minute Risk Analysis (LMRA) to enable and encourage our staff to think ahead and be optimally prepared for any safety concern related to a task upfront.

So I have given an overview of how the technical service in the University Hospital of Leuven (Belgium) deals with risks from technical installations and buildings. You never can be sure of having no accidents, but it is necessary that the responsible people can sleep well every day by thinking we have done what is possible for us to limit the consequences from our operations in the technical services on the well treatment of the patient. And that is very important to the people of the technical services.

FEATURE ARTICLES

CREATING AN INTERNET OF THINGSENABLED BUILDING: ST. JOHN OF GOD MURDOCH HOSPITAL

By Roy Arindam, VP Sales, Australia, New Zealand, & SEA, BuildingIQ

Hospitals are the beating heart of the healthcare system. They provide a focal point for medical and professional expertise, disease control, advanced diagnostics, emerging medical procedures and technology, acute and convalescent care, and medical research. Hospitals dominate healthcare organisationally and financially, accounting for roughly half of the $170 billion in health care expenditures in Australia in 2016. Today, there are 701 public hospitals and 630 private hospitals operating in Australia, with the public sector accounting for nearly two-thirds of the beds.

S

t. John of God Murdoch, a hospital located in the suburbs of Perth, is one of the leading private health care campuses in Western Australia. It has 507 inpatient beds, 16 operating theatres, a maternity ward, a 24-hour emergency department, 5 endoscopy suites, 2 angiography suites, and an educational centre.

It was founded in 1994, and is part of St. John of God Health Care, a not-for-profit health care group serving Australia, New Zealand, and the wider Asia-Pacific region. The Group includes more than 20 allied hospitals in Australia.

Hospitals are prodigious consumers of energy and are notoriously difficult complexes in which to implement energy conservation measures. Conservation efforts run up against concerns about operational disruption, patient comfort, airflow regulations, 24/7 HVAC demand, the strict requirements of critical theatres, limited facility staff, and budgetary constraints.

Nevertheless, St. John of God Murdoch Hospital sought a third-party vendor to explore the possibility of increasing energy efficiency and saving money. The hospital selected the BuildingIQ 5i Intelligent Energy Platform, a suite of technology-enabled services, that are based on a five-pillar approach of data capture and analysis; advanced modelling; measurement and verification (M&V); predictive control; and expert human analysis.

The approach starts by establishing a close partnership with the onsite facilities staff. Once the 5i IoT-enabled solution is connected to the building, together they

will learn how the building operates and performs, uses advanced diagnostic tools to identify problems, and applies forward looking algorithms to control the existing building management system (BMS) based on weather predictions and energy pricing. The result is a building that is continually energy optimised for what is going to happen.

A Network Operations Centre (NOC) monitors the site 24/7 and reviewing trends and analysing thousands of data points from the building in real-time. The NOC operators do the heavy lifting of data ingestion, interpretation and analysis, freeing up the hospital staff to do more and with greater impact than they could on their own.

The 5i platform includes a fault detection, which combines machine learning analytics and M&V with the judgment and experience building optimisation engineers. The technology-enabled services have a proven track record in commercial buildings of all types, achieving operations savings even in some considered high performing, and has been deployed in over 1100 commercial and government buildings.

THE UNIQUE CHARACTERISTICS OF THE HOSPITAL MARKET The challenges of implementing energy efficiency programs in hospitals stem in part from their unique characteristics. These include:

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• Non-disruptive — Unlike almost any other building, hospitals need solutions that can be implemented without disrupting operating and patient care areas.

Installing equipment in the walls with the inevitable distribution of dust into the air system is a nonstarter, making it critical to leverage existing, built-in, equipment as much as possible. It’s also imperative to maintain patient and medical staff comfort without intrusion, even while saving energy.

• Budgetary constraints/Cost reduction — Despite the billions of dollars that flow through hospital accounts, many are strapped for cash and welcome any opportunity to improve cash-flow. Hospital O&M (operations and maintenance) budgets have to compete with critical care and advanced medical technology. Energy consumption can be a major expense in a hospital. Reducing kWh consumption while maintaining staff and patient comfort can provide a significant stream of financial benefits. The hospital market requires O&M approaches that require limited to no upfront investment, can be installed easily, and can generate positive cash-flow quickly and continuously.

• Complex operations — Hospital operations are extremely complex, involving comprehensive services, multiple theatres of operation, exacting schedules, and integrated technologies. The precision and accuracy of operational data, analysis, and findings are imperative. Vendors must be reliable, stand behind their technology, and be able to work in close harmony with the hospital operations and facilities teams.

• Skill set — For budgetary reasons, the technical depth of the operations staff at many hospitals may be limited. They typically have a chief engineer and a senior engineer who understand the systems and processes, but the bench is not deep. The technicians below senior level may understand only their specific craft. They fix an electrical or mechanical problem as assigned but may not discern a more systemic underlying problem. Teaming hospital operations staff with outside experts who bring data analytics and decades of experience to the job can improve overall system performance.

IMPLEMENTING BUILDINGIQ’S PLATFORM AT ST. JOHN OF GOD MURDOCH In 2016, the Murdoch hospital asked to test and evaluate the potential of the 5i platform to improve the facility’s energy strategy. The immediate objectives were to understand energy usage patterns, stabilise the building, reduce energy consumption, and improve the hospital’s cash flow. Investments were to be kept

to a minimum with payback expected within one year.

Patient and staff comfort during initial system setup and subsequent operations was critical.

The hospital staff wanted to proceed incrementally and cautiously. Management requested a six-month proof of concept period. The project started with a commitment to saving 5% of total energy based on optimising 80% of the building space within the first 6 months of a 3.5-year contract.

Physical connection began in January 2017. Per agreement, connectivity to the BMS would be strictly in a monitoring role during the start-up window. It would use its analytics and expertise to identify anomalies, and make recommendations to improve the efficiency of the building. Both teams worked closely to monitor energy performance data and the responsiveness of the building management system (BMS). This was the beginning of an integrated teamwork relationship that continues today.

In February and March, the first set of recommendations were made to the hospital staff. Some unexpected power surges and some issues of concern with the mechanical plant were found. Also found, some settings that could be adjusted, and some equipment and instruments that needed to be fixed. Daily communication and a formal monthly progress report were done during that period.

One area of particular concern was the chiller plant. It was acting very erratically. It was not in tune and was oscillating, turning on and off far too frequently. It was running particularly hard, creating hot spots, which has had a negative compounding effect on the air-side of the HVAC system.

While the platform was initially used only to analyse data, it was eventually scaled to include fault detection, as well as optimised control of specific HVAC zones.

Through a combination of machine learning and predictive analytics, the platform delivered an optimised balance of energy savings, operational efficiency, and occupant comfort.

Optimisation work began slowly in May 2017, with BuildingIQ taking control of the building in increments, starting with one floor, one zone, then moving on to the next. Patient and staff comfort were carefully monitored, as was the responsiveness of the building to signals being sent by the NOC to guide air supply and temperature.

Results came in faster and more positively than the hospital staff expected. By the end of May, shortly after optimisation began, savings were already at the 2.5% level. By the time energy savings reached the

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contractually targeted goal of 5% of total power in July 2017, BuildingIQ had only optimised 50% of the 38,445 sqm hospital. Since HVAC represents about half of total kWh power consumption, HVAC energy savings themselves were closer to 10%.

cloud-based analytics, and building optimisation experts are now fully integrated. Pattern recognition of potential HVAC technical issues are quickly reported by telephone and email, and resolved through consultation and teamwork.

Savings continued to climb for the first six months, then slid as problems with the BMS and mechanical plant took its toll on the energy optimisation effort. Following repairs, savings were restored. The project has now optimised about 22,000 sqm, or 55-60% of the building.

Given that operating theatres and other critical areas of the hospital are off limits to energy optimisation, the plausible upper limit of BuildingIQ’s optimisation of the hospital was around 70%.

Client reaction to the recommendations and results was one of excitement during the startup phase. The senior engineer’s first response at the monthly meeting was extraordinarily positive. Their comment was that BuildingIQ’s staff was communicating issues they needed to be aware at the exact time they needed to know and that in essence they were the eyes and ears of the building, bringing advanced capability and complementary expertise to the table. They had become an extension of the hospital facilities staff.

Month after month the hospital staff were learning from the external team. And it became a journey taken jointly, not just an outcome.

Arguably more significant than the successful optimisation of energy efficiency has been the success of the outsourcing model itself. By turning the task of continuously monitoring the building’s performance over to BuildingIQ’s NOC in Sydney, early fault detection that prevents small problems from cascading into larger problems are now part of the daily routine. On-site staff,

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THE JOURNEY OF THE 5I PLATFORM The journey is based on collaboration and continuous learning. It begins with learning the building— interviewing, inspecting, analysing, modelling, and interrogating the BMS. It discovers how the BMS thinks, directs, and interacts and how it responds to signals. It models how the building responds thermodynamically to changing conditions and occupancy. The learning process continues through round the clock monitoring by experts, through dynamic modelling, and continuous commissioning to ensure the building remains in top order. Optimisation ensures dynamic learning continues and that energy efficiency continues to improve.

The Journey of the 5i Platform rests on five pillars: 1. Data capture and analysis — The NOC captures and integrates multiple data streams, from the BMS and its directives to occupancy patterns and utility tariffs.

2. Modelling — A series of models use algorithms to understand the performance of the building over time and through changing internal and external conditions.

Occupancy models, thermodynamic models, weather models, predictive models, and diagnostic models are made to work together.

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3. Measurement and verification — Effectiveness must not only be measured but its accuracy verified according to baseline models. BuildingIQ’s 5i Platform has a built-in M&V model that conforms to the highest professional standards of energy efficiency modelling.

4. Control — Following preliminary learning, engagement, and retrofits, the platform is set to take control of the BMS, using algorithms to adjust the set

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points for various zones in the building on a minuteby-minute basis. Control is automated and carefully monitored.

5. Human expertise — Combining the talents and experience of those closest to the building — the facilities and operations staff — with the deep analytical experience and modelling capabilities of the building optimisation staff provides the right teamwork to bring out the best in building performance. Hundreds of years of experience in buildings and HVAC systems are combined to provide the best outcome possible. And operating staff bring years of first-hand experience with their own building.

STAYING AHEAD WITH OUTCOME-BASED FAULT DETECTION SERVICE With tens of thousands of integrated controls, sensors, moving mechanical parts, and digital subsystems at work in a building’s internals, alarms that sound every possible anomaly, odd reading, and potential faults are triggered almost continuously. In fact, the fault detection systems of yesterday inundate facilities teams with so much data and guesswork these alarms are largely ignored.

Outcome-based Fault Detection (OFD) springboards off rudimentary systems and adds a layer of artificial intelligence — in the cloud — to separate the significant from the insignificant, and to take the analysis to more advanced levels. The OFD service includes a cloudbased NOC to translate faults into diagnoses, and from there into concrete actions and manageable planning. Further, it offers tools to allow the hospital facilities staff to become more proactive problem solvers and troubleshooters. The workflow underlying OFD

ultimately forms a knowledge centre that stores and makes available the deep knowledge of what cause a fault or issue, the conditions surrounding it, discussions and analysis, diagnosis, corrective actions, resolution and validation. The deep knowledge, over time, will serve St. John of God to mitigate the risk of changes in personnel and systems – a major failing point with almost all buildings as they evolve.

The advanced quantitative and deep qualitative analysis of OFD provides a holistic process that drives action from initial anomaly identification to resolution of the issues to the measurement and validation of the efficacy of recommended corrective actions. In particular, OFD can pinpoint both small and significant HVAC energy leakages commonly found in nonpatient room air conditioning spaces. These include lobbies, nursing stations, meeting rooms, lift corridors, dining areas, and rehab centres. The OFD service takes resolution one step further by embedding validation in the process. Instead of simply closing work tickets by the subcontractor or staff member, the service looks at data points before and after resolution to validate that the work ticket actions were performed and to gauge the impact.

Data collection and analysis on an ongoing basis through the NOC is the key to driving the hospital to higher levels of energy efficiency and patient and medical staff satisfaction. OFD service allows the facilities staff to prioritise and filter issues based on multiple variables — energy, comfort, urgency, risk, and cost. It identifies the location and nature of major faults and carries out a diagnosis of deeper underlying issues. An air-handling unit, for example, may not be responding appropriately to the signal from BMS because an upstream control valve on the chiller is stuck. Root cause analysis and troubleshooting ensures that problems are fixed at the source in a timely manner.

Identifying problems early through monitoring and advanced analytics can transform an existing maintenance process — comprised of both planned and reactive maintenance work orders — into a highly optimised workflow. Output-based fault detection can reduce reactive work orders dramatically, in some cases by 80%. Regular, calendar-based maintenance procedures can either be too early (not needed) or too late (fault/failure), wasting resources and increasing the erratic jumble of reactive work orders. The alternative, condition-based maintenance handles potential faults in a timely manner, catching them before they cascade into larger problems. Advanced analytics allows pattern recognition to signal an impending problem, predicts the time to failure, and schedules a new work order.

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Teamwork is just as important as analytics to ensure the best from OFD. The ideal process requires forming close relationships with the onsite engineering staff and facilities team to continuously learn about the hospital’s physical needs, and to refine the service offerings accordingly. Weekly or biweekly calls with the facilities team is ideal to track issues, to provide detailed troubleshooting, to evaluate and monitor energy consumption patterns, and to brainstorm new approaches. With quick, accurate detection and rapid response to problems, maintenance time and costs can be reduced significantly. The US-based National Institute of Science and Technology (NIST) claims advanced fault detection and diagnosis can improve the operating efficiency of commercial HVAC systems by 10-30%.

6 REASONS WHY THE 5I PLATFORM IS WORKS WELL IN HOSPITALS 1. Staff and patient comfort is a top priority — There’s a deep understanding that hospitals are naturally cautious given the significant impact

HVAC disruption could have on patient care and emergency procedures. Continuous monitoring allows the NOC team to adjust airflow and temperature in any zone immediately following complaint. At St. Vincent’s Hospital in Sydney, Australia, for example, comfort was a top priority. In the end, not only were the energy savings great, but also comfort levels improved. Nurses and doctors made unsolicited comments about how much more comfortable the hospital felt now that the overcooling had been brought under control.

2. No major changes to the buildings are required — The operation is on a turnkey basis. The work is done with the building as constructed and the BMS as it exists. The platform makes them work more efficiently, and utilises optimisation tools to get the best out of them. This approach makes it easier for the hospital to try the platform without incurring great expense or risk.

3. Cost reduction is the major benefit — No upfront investment for is required. It’s a SaaS (software as a service) subscription and cash flow turns positive quickly, typically within 6 months. Hospitals

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are like landlords without tenants to pass costs on to. Therefore, cost reduction is a primary benefit, and that’s where this solution is frequently seen as a success maker.

4. Extension of staff — Below the senior engineering level, technical depth for building maintenance at hospitals is relatively thin. Building optimisation experts add technical depth to the bench, and bring with them new analytical tools to diagnose, anticipate, predict, and rectify problems. With its continuous monitoring, BuildingIQ acts as the eyes and ears of the building.

5. Using analytics to guide the journey — The first part of the journey with a new client is to get a handle on how the building is operating, helping with corrections, retro-commissioning, tuning, and resolving low-hanging fruit, simple things like dampers that are stuck. Many are issues that can’t be seen on a day-today basis, but can be identified with diagnostic tools.

Analytics is then used to guide the journey in the most effective way from day one.

6. Increasing asset lifetime — Machines last longer when every moving part works in harmony.

When a team of building optimisation engineers is monitoring and doing analytics, problems that create downstream problems are identified. If a chiller is oscillating a lot, starting on and off frequently, it puts pressure on its own internal parts and the compressor.

The chiller can be guided so oscillation is reduced, overall efficiency is improved, comfort is increased, and the life of every asset in the chain is increased.

SUMMARY Non-intrusive, cloud-based analytical skills, along with a team of highly trained experts can easily handle the task of improving energy efficiency in large hospitals. The result is an ongoing extension of hospital staff capabilities, improved cash flow, a reduction in maintenance, and a longer life for key hospital assets.

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ENGINEERING QUEENSLAND’S LARGEST HEALTH INFRASTRUCTURE PROJECT – A PUBLIC PRIVATE COLLABORATION

By Mark Reardon, Technical Design Director, Herston Quarter Redevelopment Project, Metro North Hospital and Health Service

Herston Quarter is Queensland’s largest health-focussed urban renewal project. This major development opportunity is the latest catalyst for the expansion of the broader International Federation of Hospital Engineers Herston Quarter Redevelopment Pro health and knowledge hub and will contribute to a sustainable healthcare future for Brisbane Conference 2018 Herston Health Precinct.

INTRODUCTION

T

he redevelopment of Herston Quarter will complement the 20Ha Herston Health Precinct (the Precinct). The Precinct is home to Queensland’s and Metro North Hospital (Metro North) and Health Service’s largest quaternary hospital – Royal Brisbane and Women’s Hospital (RBWH) – the University of Queensland (UQ), the Queensland University of Technology (QUT) and the Queensland Institute of Medical Research (QIMR) Berghofer Medical Research Institute, and is a community of 13,000 staff, researchers and students.

The master plan for the $1.1 billion Herston Quarter Redevelopment Project (the Project) proposes to create a vibrant mixed-use precinct that adds to the surrounding health, research and education uses through the provision of new health facilities, commercial, residential, retirement, aged care, community and retail development.

This 5.15Ha prime redevelopment site is only two kilometres from Brisbane’s central business district and is well-serviced by arterial road networks and major public transport infrastructure.

This paper will discuss; a) Project background: Why the Project was initiated by the State Government to identify possible health-

Figure 1 – Herston Quarter Redevelopment Project – artist impression Source: Australian Unity

related uses for the future and how to best deliver the Figure 1 - Herston Quarter Redevelopment Project – artist impression Project; Source: Australian Unity b) structure: Key element of the Project ThisCommercial paper will discuss; brief to achieve a commercially viable development;

a) Project background: Why the Project was initiated by the State

Government to identify possible uses for the future and c) Herston Quarter master plan:health-related Australian Unity’s how to best deliver the Project; delivery of the new public and private health b) Commercial Key element of the Project brief to achieve a infrastructure andstructure: mixed-use development;

commercially viable development; c) Herston Quarter master plan: Australian Unity’s delivery of the n public and private health infrastructure and mixed-use development; d) Engineering challenges: Requirements of Queensland’s largest hosp local community, topographic and geotechnical site conditions with

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d) Engineering challenges: Requirements of Queensland’s largest hospital, local community, topographic and geotechnical site conditions with the changes to aged services infrastructure;

The State’s preferred business case identified a clinical development opportunity to deliver a planned procedure centre as the preferred public-health outcome.

e) Site constraints – Design challenges & solutions: Maintaining a live hospital environment whilst achieving the successful separation of services;

The proposed centre would allow for the separation of elective and emergency surgery, help reduce public wait times and relieve capacity at the major quaternary hospital and improve access to emergency surgery.

The Project area compromises the former children’s hospital site (approximately 17,800m2), which included four separate, but interconnected buildings that were delivered over 20 years, an additional building north of the former hospital, plus an adjacent seven-storey car park.

f) Heritage values: Site and heritage limitations; g) Staged works: The Project required investigation and design to separate and divert services from the existing network. Proximity to a range of sensitive use clinical, research, teaching and supporting services, heightened the importance to appreciate the impact of construction upon operations; h) Delivery model: The flexible delivery framework and how it ensures the ability to respond quickly to changes; i) Benefits realisation: The Project will help deliver infrastructure, jobs, education and training opportunities and generate long-term economic benefits for the State; and j) Future development opportunities and master plan: The whole of site master plan review for the balance of the Precinct by Metro North and consideration of cultural shifts, technology disruptions and changes within the transport sector.

PROJECT BACKGROUND Following the relocation of Queensland’s children’s health’s services from the former Royal Children’s Hospital (RCH) at Herston to the new Lady Cilento Children’s Hospital at South Brisbane in 2014, the State used the opportunity to identify possible health-related uses for the future and how to best deliver it. The State wanted to realise the health-related outcomes via an innovative delivery model that would not be funded from public revenue, and that fully transferred risk and returns to the private sector.

The State recognised a development opportunity to consider alternative uses from the disused site, to unlock value from its residual and under utilised healthcare assets, and to review its healthcare planning for a sustainable future.

This presented the private sector with an opportunity to deliver a master planned health-related development, which capitalised on the co-location to Herston Health Precinct and proximity to adjacent research and education institutions and developments.

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Adjacent buildings which were also available for redevelopment included the heritage protected former nurse’s residential quarters (Lady Lamington towers and Dods building), plus the Lady Norman building (the founding children’s hospital ward) and the Edith Cavell building. The curtilage of the heritage buildings is the “Green Heart”.

To unlock the potential of under utilised governmentowned land, the State declared the site a Priority Development Area (PDA) in 2016 to accelerate development of the health and knowledge precinct.

A PDA is governed by a streamlined planning instrument and sets the development criteria for the site to permit fast tracked future development and strengthens development certainty.

COMMERCIAL STRUCTURE The key elements of the development brief were to achieve a commercially viable development that prioritised delivery of key health uses, specifically early delivery of the public health facility, and the adaptive reuse of the heritage buildings in advance of the commercial stages of development.

Following a competitive bid process led by Queensland Treasury, in 2017 the preferred proponent Australian Unity, entered into a Development Agreement (DA) and commercial agreement with Metro North that included a public-private partnership (PPP) for the Specialist Ambulatory and Rehabilitation Centre (SRACC). Whilst the arrangement provided flexibility for the developer, it also aimed to reuse the heritage places and improve the under utilised part of an aged precinct, with effectively “no net cost” to the State.

The Development Agreement provides the framework governing the redevelopment with a structure that provides for a single “Master Developer” to partner with

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Metro North and meets a State requirement for a single point of accountability and responsibility for the delivery of the master plan.

The public-private funded health project will help meet healthcare demands and sets a benchmark in ways government and the private sector can work together to deliver health infrastructure.

on a market based rental structure. This provided an assessed value for money improvement to Metro North over a traditional PPP financed project in the context of the public health facility.

HERSTON QUARTER MASTER PLAN Australian Unity’s multi-staged master plan will see the transformation of Herston Quarter into a mixeduse community with new public and private health infrastructure, a range of residential living, commercial and retail development. Key aspects of the project also include the restoration of the heritage buildings, improvements to the public realm and repositioning of infrastructure to allow Australian Unity to deliver its master plan.

The SRACC was procured under a lease arrangement based on the PPP framework and risk allocation by the Australian Unity Healthcare Property Trust (HPT) real estate investment trust (REIT).

This is the first investment by a REIT in a hospital PPP. It is the first PPP deal financed without bank or bond financing with 100% of the capital provided by HPT. The project is structured as a lease rather than a Build Own Operate Transfer (BOOT) principle with Metro North retaining the option to buy the asset at the end of the lease term.

The Project includes managing site challenges and the realignment of aged service infrastructure, which has been incrementally delivered and evolved since the hospital’s inception in 1867. Importantly the development is within an operational quaternary hospital that includes sensitive environments such as

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and security has required detailed investigations and conformation prior to effecting network changes.

6.

Site constraints - Design challenges & solutions FEATURE ARTICLES The Project is located two kilometres from Brisbane’s CBD and is serviced by

major public transport infrastructure and will benefit from major transport infrastructure projects, such as the $5.4 billion Cross River Rail and $0.95 billion Brisbane Metro projects, which are planned to be completed around 2024.

Major road corridors servicing the Project include Bowen Bridge Road and the Inner City Bypass (ICB). Feeding into these primary access roads are the CLEM7, Airport Link, Legacy Way, the Inner Northern Busway and the Northern Busway.

mental health, oncology and infectious diseases units and medical research facilities.

Primary vehicle movements to Herston Quarter are via Herston Road and movements accommodated by internal roads and a Bramston Terrace with secondary movements accommodated by internal roads local road (see Figure and a local roadnetwork network (see Figure 2). 2).

ENGINEERING CHALLENGES The redevelopment opportunity is faced with the challenge of balancing the competing design and engineering requirements of an operational hospital, interests of the local community, topographic and geotechnical site conditions with the changes to aged services infrastructure.

The Precinct contains a complex network of high and low voltage (HV & LV) power comprising five HV Ring mains and complementary LV ties for diversity. The private HV rings have a series of transformers located discrete locations across the campus that allow multiple backup provisions in the site. Supporting this network are several backup generators within the Central Energy Plant (CEP) which are automatically managed with a supervisory control and data acquisition (SCADA) enable monitoring and the issuing of process commands to backup generators in the event of a power failure.

Two oxygen rings service the RBWH and several research and co-located medical facilities. These oxygen rings each have their own primary and secondary cylinders with vacuum insulated evaporator (VIE). On average the RBWH daily demands 67m3 oxygen, requiring automatic alert to refill on demand.

Multiple redundant communications (ICT) pathways link the Precinct to other Metro North health facilities and other State hospitals throughout Queensland. Mapping aged technology over the Precinct, maintaining operational integrity and security has required detailed investigations and conformation prior to effecting network changes.

SITE CONSTRAINTS – DESIGN CHALLENGES & SOLUTIONS The Project is located two kilometres from Brisbane’s CBD and is serviced by major public transport infrastructure and will benefit from major transport infrastructure projects, such as the $5.4 billion Cross River Rail and $0.95 billion Brisbane Metro projects, which are planned to be completed around 2024.

Major road corridors servicing the Project include Bowen Bridge Road and the Inner City Bypass (ICB). Feeding into these primary access roads are the CLEM7, Airport Link, Legacy Way, the Inner Northern Busway and the Northern Busway.

Primary vehicle movements to Herston Quarter are via Herston Road and Bramston Terrace with secondary

46

Figure 2 2 –- Vehicle movementroutes routes Figure Vehicle movement

The is also by two helipads that helipads permit air ambulance services ThePrecinct Precinct is serviced also serviced by two that permit to the RBWH.

air ambulance services to the RBWH.

The current configuration of the internal infrastructure of the Precinct listed in Table 1, includesconfiguration services needed toof support the hospitalinfrastructure and research The current the internal facilities.

The separation of the the balance services of the Precinct required of the Precinct listed inProject Tablefrom 1, includes key infrastructure to be realigned to allow the balance of the Precinct to operate needed to support the hospital and research facilities. independently.

The separation of the Project from the balance of the Precinct required key infrastructure to be realigned to allow the balance of the Precinct to operate independently.

IFHE Paper - Mark Reardon Herston Quarter | Page 6 of 14

Table 1 – Herston Health Precinct Internal Services

Ring Main Service

Non-Ring Main Services

Chilled water

BMS

Water supply

Steam and condensate

Fire services

Electrical Low Voltage (LV)

Electrical High Voltage (HV)

Gas

Communications and IT

Sewer (House drainage)

Oxygen

Pneumatic Tube System (PTS).

Supervisory control and data acquisition (SCADA)

Whilst Australian Unity is responsible for the design, delivery and cost of the services realignment, Metro North is responsible for the approval of the final design and construction methodology of the services realignment, to ensure that the capacity of existing services is not compromised. Most services which service the Precinct originate from the Central Energy Plant (CEP).

The primary challenge is maintenance of a live hospital environment whilst achieving the successful separation of the Project, to permit the future development. Design challenges are compounded by traffic adjacent to and within the precinct, pedestrian safety, and internal pedestrian routes that are not all DDA compliant due to the site’s topography.

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HERITAGE VALUES In addition to the physical site constraints, the project has heritage limitations to consider. The most significant being the heritage listed Lady Lamington buildings (comprising the original Dods Building and the North and South Towers), the Edith Cavell and the Lady Norman buildings. Whilst Lady Norman building is the remaining example of a pavilion type ward (a concept promoted

by Florence Nightingale), the Edith Cavell and Lady Lamington buildings were built to provide nursing accommodation. 1,2,3,4,5 The Edith Cavell block was built in 1922 to provide accommodation for nurses working in the children’s hospital until the late 1980s when variations to the nurses’ award and training no longer required nurses to live on site.3 The Lady Lamington Nurses’ Home was erected in five stages (1896 to 1938) to provide accommodation for nurses at the Brisbane General Hospital. 1 Changes to the nurses’ award in the mid-1970s abandoned compulsory live-in for training nurses and transferred hospital based to university based training.1,4,5 In the early 1990s, remaining live-in nurses were required to seek alternative accommodation and in late 1993, the buildings were closed. Until 2016, the buildings were partially vacant and used for administration space and accommodated the Nursing Museum and remained vacant until redevelopment began in 2017.

Metro North commissioned the preparation of Conservation Management Plans for the Lady Lamington and the Edith Cavell buildings to document historical significance of the heritage buildings and to inform the design of the adaptive re-use of buildings.

The plans outlined policies for the appropriate changes to the building whilst protecting its cultural heritage significance and guidance for ongoing care and maintenance which will return value to these disused buildings.

In March 2018, the Queensland Heritage Council commenced Metro North for its best practice approach to conserve these cultural heritage assets.

To the eastern side of the Lady Lamington building is a garden referred as the Green Heart and the importance of this parkland has been recognised with a separate Conservation Management Plan.

STAGED PROJECT WORKS Redevelopment commenced in early 2017 and began with the isolation of the Herston Quarter from the

balance of the Precinct. This comprised investigation and then design to separate and divert services from the existing network connected to the former RCH buildings before its demolition.

To advance progression of the SRACC, it was agreed to deliver Stage 1 in two parts. Stage 1A works involved the isolation and relocation of existing services from that part of the Project site, including the former children’s hospital buildings. Completion of this work allowed Stage 2 SRACC Preparatory Works to proceed. Stage 1B was to complete the Stage 1 works (that comprises primary infrastructure for Metro North under the DA) but, is now being delivered with a subsequent Stage 4A to complete the Services Relocation Works.

HV electrical and SCADA cables form a critical ring network of power supply for the RBWH. To move the cables that traverse the Project into the Herston Health Precinct, a new HV & SCADA cable from the substation located on Herston Road (within the Bancroft Building), was placed in a new permanent location from Herston Road. The cable alignment was between the former location of Building C1 (Surgical) of the former hospital complex and the QIMR Bancroft Building. As a temporary arrangement in Stage 1A, this cable was connected back into the existing services tunnel (west of the Lady Lamington buildings) until a new services trench was built across the eastern frontage of the Lady Lamington buildings. In Stage 1B the cable route continued north across the eastern face of the Lady Lamington buildings.

Stage 1B works required relocation of several major ring mains being HV Power, ICT networks, Oxygen plus twin 450dia Chilled Water mains and a 250dia Fire Water supply main and a 200dia Fire Ring main. To allow for future maintenance and potential replacement these services were place within a 3.5m wide concrete culvert covered with a multi-part lids shown in Figure 3.

Concurrent with the construction of the SRACC, design attention for the Project has moved to the development of a multi-level car park. A key requirement of Metro North was that the Northern Carpark support a future medical facility on top of the structure, allowing for expansion of the health facilities.

The new car park will be located adjacent to a range of sensitive use clinical, research, teaching and facility management buildings. This heightened the importance to appreciate the impact of construction upon operations nearby.

Engagement with users adjacent to the car park site is critical due to the proximity to sensitive clinical facilities

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Stage 1B works required relocation of several major ring mains being HV Power, ICT networks, Oxygen plus twin 450dia Chilled Water mains and a 250dia Fire Water supply main and a 200dia Fire Ring main. To allow for future maintenance and potential replacement these services were place within a 3.5m wide concrete culvert covered with a multi-part lids shown in Figure 3.

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Concurrent with the construction of the SRACC, design attention for the Project has moved to the development of a multi-level car park. A key requirement of Metro North was that the Northern Carpark support a future medical facility on top of the structure, allowing for expansion of the health facilities.

The new car park will be located adjacent to a range of sensitive use clinical, research, teaching and facility management buildings. This heightened the importance to appreciate the impact of construction upon operations nearby.

Engagement with users adjacent to the car park site is critical due to the proximity to sensitive facilities which will remain in operation throughout which will remainclinical in operation throughout construction construction andhave do notan have an option decant patients and staff. and do not option totodecant patients and staff.

Without recognised Australian standard for mould in buildings, the effect on mould is determined at an individual level by: • the type of mould; • exposure route and sensitivity of the exposure victim; • their age; • activity level and physical condition; and • climatic conditions.

Whilst it is not possible to provide any safe levels for mould, dust levels can be managed and were well below relevant guideline levels.

Figure 3 – Stage 1B Service Culvert

To evaluate an acceptable environmental allowance Figure 3 - Stage 1B Service Culvert for construction activities upon the adjacent clinical

Meteorological conditions do vary the results thus, weekly wind rose plots for three weather stations were collected to assess wind speeds and prevailing wind direction. These were compared against the local Bureau of Meteorology data.

services, current conditions to construction be To evaluate the an acceptable environmental needed allowance for activities upon the adjacent Baseline clinical services, the current conditions needed(to to be appreciated. environmental monitoring appreciated.

Baselineand environmental (to measure indoorand and outdoor measure indoor outdoormonitoring air quality and noise air quality and noise and vibration levels at sensitive receptors) was undertaken Excavation and construction of the car park will vibration levels at sensitive receptors) was undertaken to generate noise and vibration. Noise monitoring was to inform construction environmental management plans and to minimise inform construction construction impacts on: environmental management plans undertaken in accordance with AS1055. Loggers were and to minimise construction impacts on:

a) risks to patient care and wellbeing (including immunocompromised patients) and access to health services, focusing on managing dust and airborne contaminants from demolition and construction that can lead to potential health issues and increase risk of infection;

set to collect data using a sample time of 15 minutes to capture all relevant parameters (L,max, L1, L10. Leq, L90) for indoor location and Octave Band loggers for two external locations to enable the effect of insect noise to be removed to represent the cooler months of the year.

IFHE Paper - Mark Reardon Herston Quarter | Page 9 of 14

c) disruption to the delivery of patient care and clinical services (including the operation of critical clinical equipment);

Seismic Recording Unit loggers recorded vibration velocity levels. Noise and vibration loggers were installed for six weeks and were set to histogram combo mode and recorded vibration levels every 15 seconds. Noise parameters removed periods of unsuitable weather (e.g. rain, high winds) and considered emergency helicopters operations but, that didn’t have a significant effect on the overall levels.

d) delivery of research, training and other support services necessary for the running of hospital campus; and

Ambient data was used to inform the construction noise and vibration management to minimise construction impacts.

e) other users and the public, including traffic and pedestrian access.

DELIVERY MODEL

b) disruption to staff, patients and clinical and nonclinical services;

Over six weeks, baseline environmental data included: • static monitoring for dust and pollutant monitoring; • weekly monitoring using handheld devices for mould, dust and airborne pollutants; • monitoring for airborne asbestos in some buildings; • weekly representative bio-tape mould samples form external filtration media of the air-conditioning systems of adjacent hospital and research buildings; and • soil sampling for mould.

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The framework around the delivery of the Project is flexible by design, ensuring the ability to respond quickly to changing influences. Strategies for the delivery of the Project have evolved during the first year, though not unexpectedly given the complexity involved in delivering such a diverse master plan within an operating hospital site.

At times, contractual imperatives pressured the program delivery, project team resources and practical approach to technical solutions. In the short time of the Project the following lessons have been learned:

FEATURE ARTICLES

a) Designs need to be based on consistent and aligned contractual arrangements. Inconsistent contractual alignment can induce design problems which could impact the quality of constructed product; b) The Design Brief should be succinct and unambiguous to ensure it does not create unacceptable interpretation of deliverables. A clear brief will reduce any gaps so as not disrupt design nor delivery program; c) Realistic times for delivery needs to be allowed to reduce the potential risk to hospital operations; d) Critical infrastructure design should be based on accurate engineering and infrastructure data to be develop a fully considered design; e) The documentation needs to be well coordinated.

Additionally, the design development plus installation by the Builder should be delivered using structured HOLD points to confirm sequential design and installation processes; and

f) Effective communication and engagement is critical to a successful project. Ongoing priority to keep the various stakeholders informed of construction impacts and any anticipated alteration to their environment is imperative to manage safety and operational coordination.

BENEFITS REALISATION Metro North has not looked at the redevelopment in isolation and has defined potential benefits to be leverage through the delivery of the Project. It will deliver health service efficiencies, enhance clinical planning and services, deliver new models of care, create greater healthcare outcomes and help meet future healthcare needs.

The Project will help deliver infrastructure, jobs, education and training opportunities and contribute to expansion of the Herston Health Precinct and generate long-term economic benefits for the State. These include: • increase research and development activities on site and opportunities for translation of research;

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FEATURE ARTICLES

• provide more efficient pathways for patients to access integrated care, clinical services and new models of care; • increase efficiencies of the RBWH service delivery; • provision of more social and health infrastructure for delivery of health services and improvements in healthcare; and • attract and retain leading health workers, researchers, academics and students.

FUTURE DEVELOPMENT OPPORTUNITIES AND MASTER PLAN The Project will deliver new and upgraded infrastructure, which will provide greater certainty of services plus improved and sustainable infrastructure strategy for the Herston Health Precinct and has facilitated improvements to the network that will better adapt to changing technologies. This has catalysed Metro North to review its procedures to manage the future expansion of the hospital campus and create efficiencies and planning its estate to meet tomorrow’s healthcare needs.

The Project has coincided with the whole of site master plan review for the balance of the Precinct by Metro North. This master plan will benefit Metro North through: • a structured approach to expansion of the Precinct which reduces cost and operational impacts during implementation; • an improved and efficient public realm for betterment of patients, the public and staff; • defined infrastructure service corridors which are flexible for future expansion; • enhanced wayfinding and ultimately the patient’s experience; and • future proofed infrastructure by planning for future healthcare needs, changing technologies and future disruptions in health and other industries.

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CONCLUSION The Project presented the private sector with an opportunity to deliver a master planned health-related development, which capitalised on the co-location to Herston Health Precinct and proximity to adjacent research and education institutions and developments.

Following a competitive bid process led by Queensland Treasury, the preferred proponent entered into a Development Agreement (DA) for HQRP that included a public-private partnership (PPP) form of contract for creation of the Specialist Ambulatory and Rehabilitation Centre (SRACC).

A key objective for the Project has been the successful progression of a clinical development opportunity to deliver a planned procedure centre as the preferred public-health outcome, to help reduce public wait times for surgery and relieve capacity at the major quaternary hospital. The Project also aims to assist the improved access to emergency surgery, and improve the efficiency of service delivery.

Project success relies upon detailed investigations and interrogation of historic records, practical technical solutions, innovative yet thoughtful healthcare planning, fully considered design that provide urban-design led through master planning and future proofed ideas to maximise opportunities for expansion of the health and social infrastructure for the future.

Due to the site constraints and sensitive nature of the operations within the Precinct, the Project will continue to experience engineering and delivery challenges.

The governance of the Project will enable Metro North to utilise its project controls to overcome these challenges. The Project will draw from its experience to date to collaborate to find pragmatic solutions going forward and at the same time maximise service infrastructure and development outcomes for the Precinct.

Cultural shifts and disruption from technology changes such as smart campus management and changes within the transport sector need to be consider as the Herston Health Precinct master plan advances. It is likely a greater emphasis will be placed on people and physical attributes.

REFERENCE

The way doctors interact with patients, current commuting options and an adoption of share riding and car sharing networks (PAYG), electric and autonomous vehicles will change how people will commute and the ways in which existing infrastructure is regarded both now and for future networks.

3. Thom Blake & Peter Marquis-Kyle, Lady Norman Wing Conservation Management Plan, 2018

1. Thom Blake & Peter Marquis-Kyle, Lady Lamington Nurse’s Home Conservation Management Plan, 2018.

2. Thom Blake & Peter Marquis-Kyle, Edith Cavell Block Conservation Management Plan, 2018

4. Thom Blake, Michael Kennedy and Robert Riddel Architect, The Herston Hospitals Complex conservation plan, 1994.

5. Robert Riddel Architect, Lady Norman wing, Royal Children’s Hospital Conservation Management Plan, 2002.

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FEATURE ARTICLES

THE INTERNET OF VALUE

BLOCKCHAIN AND FACILITIES MANAGEMENT

By Rogier Roelvink, Associate Director, Turner & Townsend

Blockchain is being touted as the next version of the internet, superseding ‘the internet of information’ with ‘the internet of value’. Individuals, start-up businesses, large organisations and financial institutions are now exploring smart contracts and blockchain. Blockchain is credited with the ability to solve global wealth distribution inequality, improving climate change and radically changing society and global economies. With such accolades, it is important that the facilities management (FM) industry starts to review how it can benefit from this technology too.

WHAT IS BLOCKCHAIN?

B

lockchain is a list of records called blocks, which are linked and secured using cryptography. Harvard Business Review describes it as “an open, distributed ledger that can record transactions between two parties efficiently and in a verifiable and permanent way”. For use as a distributed ledger, a blockchain is typically managed by a peer-topeer network collectively adhering to a protocol for validating new blocks. Once recorded, the data in any given block cannot be altered retroactively without the alteration of all subsequent blocks, which requires collusion of the network majority (Wikipedia).

In simple terms, it is a secure chain of individual blocks that represent a permanent record of ‘if/when… then’ scenarios that cannot be altered. Although blockchain is currently associated with Bitcoin and financial transactions, many industries are looking at blockchain and the opportunities it offers.

Blockchain promises increased transparency, improved certainty,

A simple illustration of blockchain in FM.

cost and time savings as well as removing the institutional middleman who does not add value.

sheet systems and employment/ HR systems. Blockchain shares the relevant data to verify records automatically.

The above illustration might seem cumbersome in relation to the required verification, but this is not an additional activity, it is already part of existing business processes.

Blockchain requires these currently separate silos of information to be shared, e.g. records of training institutions, government departments, security system, time

Security concerns can also be easily overcome via blockchain, its cryptography and multiple copies of the same information that cannot be altered makes it secure. Blockchain can also be set up to only allow the sharing of information between trusted sources– private blockchain.

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FEATURE ARTICLES

BLOCKCHAIN IS CHALLENGING BUSINESSES According to Don Tapscott (TEDTalk: How blockchain is changing money and business, 16 September 2016) it is not big data, social media, robotics or machine learning that will change our world, but blockchain is the technology that will do so. Technology advances will continue however, they are being developed based on the current internet of information underpinned by institutions using closed protocols.

Blockchain is a distributed ledger on an open platform that does not exist as a central (institutional) database. It is a shared database that exists on thousands or even millions of computers/clouds. A ledger in the case of blockchain is a transaction of value which can be both a physical or digital asset and service.

FM comprises the provision of services to organisations, individuals and built environment assets. Some of the challenges FM has is transparency of an action, achieving and proving certainty of an outcome, maintaining records, providing evidence of actions and making informed decisions based on data from a trusted source.

All of these challenges are being touted as fundamental benefits that blockchain can provide.

FM BLOCKCHAIN With the introduction of blockchain, process will become a commodity, quality will be the differentiator and knowledge the value. In an industry that is data rich, knowledge can sometimes be poor. Blockchain could be the disruptor the FM industry needs.

Consider the data silos currently in operation in FM; Building Management Systems, Computer Aided FM, Building Information

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Management, Security Management System, Contractor Management Systems, Space Booking and Utilisation systems etc. All of these systems operate independently, yet all aim to contribute to the same common goal of facilitating a fit for purpose built environment.

• The ability to determine with a high level of accuracy when maintenance is actually required based on historical operational records, independently verified by hundreds or thousands of sources rather than relying on manufacturer instructions and manuals. (Block #3)

Intertwine service delivery by people and perhaps robotics and some might describe this as organised chaos. Everybody and everything only does what it knows without considering its associated partners or direct sphere of influence.

• Accurately predicting when the next maintenance service will be required, based on continual monitoring of the asset and its operations as well as estimating using historic performance and ‘in use hours’ of the asset, verified by one or multiple systems. (Block #5)

Blockchain allows professionals to link individual systems and operations to achieve greater efficiency and effectiveness – two aspects inherent in the FM industry.

The illustration below highlights a basis non-descript maintenance activity.

This illustration identifies a number of significant improvements that blockchain could bring to FM that are currently never spoken about including:

In the example, FM is usually applied to manage and administer manual processes that rely heavily on silo institutions for execution and verification. On reflection, a significant amount if not all of the FM processes are in effect – ‘if/ when…then’ scenarios that could be controlled and administered through a blockchain to increase efficiency, effectiveness, transparency, certainty and ultimately achieve a fit for purpose built environment.

FEATURE ARTICLES

Blockchain development is still in its early stages and FM might not currently be a high priority area for development and innovation, however if blockchain was applied to FM it could be the next step change in service to benefit everyone.

BLOCKCHAIN IS FM’S FUTURE Blockchain is coming, therefore FM needs to accept it to drive development and progress in service provision, management, governance, contract administration and data and information management. Blockchain has the potential to deliver the significant benefits that FM seeks in striving for an efficient and effective operation in the built environment. Operational efficiency and effectiveness continues to be the primary focus for FM managers however, development and progress of existing systems and processes is often hindered by

the institutional middle man. Blockchain is coming. FM needs to be ready for this disruptor.

ABOUT ROGIER ROELVINK Rogier has 17 years’ experience in strategic facilities management advisory working across Europe, the UK and Australia. Sector expertise includes government, health, education, manufacturing, infrastructure, utilities and corporate. He has a wealth of experience in providing advice, conducting service reviews and authoring numerous service specifications. Rogier is passionate about the strategic application of facilities management and is actively involved in a number of industry associations and working groups to advance this industry.

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Allwater Technologies (AWT) is a specialist division of IMC focussing on, but not restricted to Corrosion Management Solutions.

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FEATURE ARTICLES

CLOUD COMPUTING

FACILITATING EXCELLENCE IN THE HEALTHCARE SECTOR

By Colin Nicol, Director, Do Diligence Ryan Milne, Director, Do Diligence / Ecosafe International

With the world changing faster than ever before, we need to be more agile to achieve excellence in Health Care Management.

Below we illustrate how Cloud software can assist in achieving the compliance standards required within the Health Care industry. Cloud based software is a catalyst that can be used to empower individuals to be more efficient and proactive and to drive transparency and accountability within an organisation.

A

dopting cloud solutions has proven not only to free up your staff and contractors, but also provides access to data that would previously been cost prohibitive or simply not available. This allows for in-depth data and smarter analysis and provides the foundation for informed risk-based decision making.

is still that TIME is a limiting factor for everyone and people are always pursing that extra efficiency or timesaving measure that will give them more time to be more effective.

Figure 1: capturing and viewing data across multiple platforms is at the heart of cloud-based compliance.

Utilising smart Cloud Technologies not only allows benchmarking but also actual industry experience/ knowledge to inform operational and capital works planning.

Using experience and data from around the globe, we share insights of what has facilitated excellence in healthcare facility management and some common challenges, as well different but successful approaches to everyday challenges.

THE PURSUIT OF IMPROVEMENT IS INHERENTLY HUMAN We strive for improvement in all things we do.

The overwhelming benefits of this human need is evidenced everywhere. This is particularly apparent in field of healthcare, where progress is improving patient care and prognosis at a rate that can scarcely be believed.

However, while medical advancement blazes forward, many challenges remain. The key challenge

The world is evolving rapidly, and the expectation, which is all around us, is that people can achieve more with less. That expectation is not only down to the individuals, but is placed on

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FEATURE ARTICLES

us by peers, industry, regulators and ‘best practice’.

To achieve more with less, we need to work smarter rather than harder and cloud-based compliance software provides this opportunity.

Introducing cloud computing… not that it needs much introduction as it has been with us for some time, and in the context of technology it is no longer new technology, but rather a facilitating technology which allows new technology, software and innovation to emerge.

Cloud technology has numerous benefits, particularly in the healthcare sector and we are now entering into an imbedded aged where cloud computing is facilitating the delivery of healthcare, engineering and ancillary services.

Some of the Key Features of Cloud software Include: • Scale – we can scale up and down in moments.

Allowing workflows and processes to be implemented, adjusted, improved and removed in moments. This allows not only compliance to internal and external organisational standards, but also to data to measure performance and drive improvements.

• Data scale – having access to useable information (data) is a key driver for measurement and improvement. Previously data was gathered by relatively small means, surveys, audits, samples etc. but with cloud computing, data gathering is taking place 24x7x365 and this provides more robust data and allows decision making on reliable and verifiable information.

• Flexibility – in today’s workplace, the only constant is change. Providing systems that allow flexibility is essential. Cloud based systems facilitate rapid change and flexibility within operational systems.

By logging on to a system while on your way to a meeting, you can facilitate the change requested on the same day. This change can be adopted across the local operation, across the county or around the world.

• Speed to deploy – cloud based systems are peerless when it comes to speed of deployment.

Setting up new users or completing new tasks in the field can be done in a matter of minutes (or less) and allow for actions to be scheduled and completed as quickly as needed.

In the context of compliance within the healthcare industry, there are multiple opportunities to work smarter to not only achieve compliance and best

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practice, but also to demonstrate this too via a robust audit trail.

As we move into the mobile electronic age, the opportunity to embrace technology exists like never before. We are all aware of the massive developments in computers use and capability over recent years. The changes are clear for us to see in the direction that we are moving, from static computers sitting on a desk to the mobile phone or tablet. The ability to take computers with us wherever we go, gives us access to information, software and work tools previously unprecedented. It is for us to take advantage of the available tools and make practical and efficient use of them.

There are many tools available to help organisations achieve compliance. Some specialised and some broad in scope. But with over 5.7 million apps available across five major platforms, there is likely an app available that can provide a solution for you. The question therefore, is what are you trying to achieve?

Figure 2: Data should be used to highlight areas of focus and intervention

• Data in one location: the ability to view all data in context, without looking at separate spreadsheets, hardcopy folders and sampling results provides a powerful tool that gives you a view of the ‘whole picture’.

• Data as a predictor: when data is used well, it not only tells a story, but allows you to start predicting behaviours, be they people, infrastructure systems or seasonal impacts.

• Data as evidence: being able to demonstrate, at the click of a button that you have done what is required by the various standards and legislation is a precious commodity.

• Systems that are: oa ble to oversee the complex requirements of healthcare compliance, interpret them as

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simple tasks to be captured at known points or assets. These tasks are simply relayed to the right persons who can then undertake the task in accordance with the schedule. o able to record results and track actions taken when results are out of specification. The audit trail is critical in demonstrating your due diligence and should be included in any electronic compliance tool. o able to report the data in a simple and consistent format that provide management with an overview of people and system performance. o easily amendable that can adapt to changes in legislation and ‘best practice’, so that when changes are needed, these can be easily and efficiently made. o the spine of your compliance management.

People will change throughout the lifetime of your hospital. It is imperative that you have a system that can be easily used and adopted by new staff or contractors and that your system is ‘people proofed’ so that people are not able to change or disregard the system.

Figure 3: Creating a range of compliance tasks, broken down into disciplines, allow hospital engineers to have a simple understanding of their compliance across a range of compliance fields.

PRACTICAL APPLICATION With our experience and the access to the experience of our partners in supporting over 1,000 healthcare facilities, including hospitals in the NHS, private hospitals in the US, UK and Australia, as well as nearly 53 million individual results, we have an insight into practical application of cloud-based systems.

Practically, we have found that people are looking for simple, efficient and transparent systems. While it may seem a juxtaposition to ask for simple innovative cloud-based solutions, the successful applications deployed in the healthcare sector have proven to be quick to adopt and simple to use. Simple to use means for persons from any level of the organisation to be able to pick up and be operational with minimal training.

EFFICIENCY, TRANSPARENCY AND CONTROL ARE AT THE HEART OF WHAT CLOUD COMPUTING BRINGS. Performing tasks and measurements using mobile phones in real time removes the requirement for paper-based reporting and the well documented, and expensive challenges that come with paper records.

By using mobile devices, such as tablets or phones, records are stored electronically, with a record of users, time and date and geo location, just a few of the inherent records able to be interrogated and produced as and when required.

By utilising cloud-based systems, hospitals, and in particular hospital engineers have been able to schedule and demonstrate the level of activity required to maintain a compliant facility. From fire inspections, water compliance, medical gas compliance, emergency infrastructure and so much more, capturing all the scheduled tasks and all results, (favourable or otherwise) has provided engineers and contractors with much needed visibility of whether critical, but routine tasks are being completed.

Areas that successfully utilise cloud-based software include: • Fire – with a significant number of physical tasks required to be completed weekly, monthly or less frequently, fire compliance is a critical area where the devil is in the detail and this detail should be transparent. Fire contractors have traditionally relied on a single service report at the end of each visit, and clients have happily accepted this as their

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management mandate has been discharged.

However, with new services available, the level of detail and interrogation of reports is not only possible, but is critical to ensure the integrity of the essential services is maintained.

• Water – maintaining a healthy water system is critical in the immuno-compromised world of healthcare facilities. Big data, continual operational management and strict controls around system performance are only a few of the key actions required to demonstrate that proactive risk management actions are in place and are diligently being undertaken.

• Electrical – the lifeblood of any hospital, electricity is essential for every process in the hospital to function.

Maintaining a compliant electrical infrastructure, while remaining compliant to national/international standards requires careful planning and diligent execution. With distribution boards, electrical equipment and infrastructure dispersed across large areas of the hospitals, maintaining the routine inspections and compliance across all the electrical infrastructure is essential. How is this done without electronic systems? How is the engineer certain this is being done without spending hours checking, reviewing and then checking again…?

• Emergency equipment – essential equipment that is required to be well maintained and hopefully never used. Often the only time this presents a problem is when the auditor finds that critical checks are not being carried out on critical infrastructure. However, that is the best-case scenario… what happens if this equipment fails the one time that is needed? This is where cloud based software takes the baton from traditional methods. By scheduling and recording all checks that are undertaken at the equipment, clients can be certain that all tasks are completed, all defects are closed out and the equipment will be in operational if it is needed.

Achieving excellence consistently in healthcare is a challenge that all hospitals face. The sheer volume of maintenance activities, compliance tasks and risk management actions mean that being able to schedule, track, measure, manage and demonstrate compliance is an area that cloud based computing is ideally placed to do. And fortunately, there are many companies and organisations that have created software that is designed and created to address the many challenges faced specifically by the hospital engineer.

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LEGIONELLA MANAGEMENT – AN AUSTRALIAN CASE STUDY: A look at how cloud-based software has helped a client manage the risk of exposure to Legionella within their hospital environment.

Figure 5: Real data from a client highlighting the impact of, amongst other controls, introducing cloud-based compliance software

Figure 6: Understanding data provides opportunities for proactive interventions

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A client (700+ bed hospital) understood that they had a legionella problem. They were undertaking traditional sampling and testing for legionella and were finding Legionella within the reticulation systems.

Up to twenty percent of their samples were coming back positive each month. At each positive result, expensive remedials were undertaken, but largely these were ineffective across the reticulation system.

In collaboration with the Water Quality management team and by implementing a cloud-based software system, the team quickly obtained sufficient data to see where the challenges were. The data highlighted areas that were consistently failing, were not meeting the enHealth guidelines and falling outside of the site risk management plan. Understanding the data led to simple and effective interventions (largely what is described as operational monitoring) and some infrastructure changes in the areas that were identified as high risk.

With the controls being managed by regular operational controls, and data to evidence that this is taking place, the hospital has been able to reduce the sampling program using an evidenced and risk-based approach. This the introduction of the cloud software has not only had a significant return on investment, but has also provided the hospital executives, engineering team and infection control with greater management control and greater peace of mind. All of which is an excellent outcome for patient care, patient experience and compliance within the hospital.

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With the visibility of whether tasks were being completed; understanding and adjusting the temperature settings and chlorine residuals, the hospital, within a few months moved to a ‘zero legionella burden’ for 8 months and counting…

Legionella management is a journey and due to the ‘natural’ bacteria that leads to legionella, there is no quick fix, so a robust management approach must be adopted. Using cloud-based technology has proven to be vastly superior to traditional paper-based and reactive (verification) based approaches. This has resulted in a legionella management program that is transparent, data driven and proactive in managing a significant risk within the hospital environment.

Figure 7: Understanding the incoming chlorine levels is critical to legionella management at any facility.

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HOW HYBRID THEATRES CAN BE OPTIMALLY DESIGNED

By Julian Grimaldi With the percutaneous devices used in interventional radiology departments becoming ever more complex, and more and more minimally invasive procedures being undertaken in conventional operating theatres, a new ‘breed’ of so-called ‘hybrid’ theatres has emerged, and is now a feature of many hospitals worldwide. Here Julian Grimaldi, senior business manager, Hybrid OR, for Getinge in Germany, examines some of the key considerations when designing, fitting out, and equipping such theatre spaces.

Getinge says addition to a hospital of a hybrid operating room allows ‘more innovative and efficient treatment and surgical procedures’ to be performed.

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Real-time availability of high quality imaging helps surgeons preserve as FEATURE ARTICLES much healthy tissue as possible.

T

he hybrid room or hybrid operating theatre – an increasingly common phenomenon in 21st century hospitals – is a surgical room were percutaneous and surgical procedures can both take place thanks to the use of a C-arm imaging system integrated with a surgical table for complex patient positioning for hybrid procedures. The addition to a hospital of a hybrid operating room allows more innovative and efficient treatment and surgical procedures to be performed – resulting in better outcomes, shorter patient stays, and optimised workflows.

Patient benefits include a speedier diagnosis to treatment process, access to innovative minimally invasive therapies that reduce recovery times, eventual elimination of corrective surgeries, and real-time availability of high quality imaging that helps surgeons preserve as much healthy tissue as possible. Among the benefits for hospitals are closer collaboration among specialists throughout the treatment chain, diagnostic advantages for new and innovative therapeutic techniques, the potential to enhance the hospital’s reputation, the ability to both increase patient satisfaction and boost revenues, and greater likelihood of attracting and retaining a high quality workforce.

COMPLEXITY OF PROCEDURES INCREASING Over time, the complexity of hybrid surgical applications has evolved, and there is now increasing

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multidisciplinary use of hybrid facilities within hospitals, by specialities including neurosurgery, cardiovascular, orthopaedics, traumatology, thoracic surgery, oncology, and urology. Today’s hybrid ‘ORs’ are also associated with a growing range of imaging modalities, with C-arms, CT, and MRI scanning equipment often used in combination with the surgical table (multi-modality intraoperative advanced imaging). This type of set-up is seen both on a standalone basis, and combined in what is known as a ‘multi-modality hybrid OR’. The development of new methods of undertaking hybrid procedures has resulted in more complex workflows and, equally, radical new ways of designing surgical rooms.

ENSURING MAXIMUM WORKABILITY To successfully design a complex and ‘futureproof’ multimodality operating theatre with sufficient flexibility to adapt to changing surgical and clinical trends, it is essential to find the right technology partnership for both imaging technology and room design, and equipment supply and installation. Of course creating a well-equipped, versatile hybrid theatre requires a substantial investment of time, a significant project management burden, and considerable capital outlay, so why are hospitals willing to invest in such facilities? The answer is that using an imaging system in combination with a surgical table gives the surgeon the best anatomical information possible in real time, and enables he or she to perform highly complex surgeries.

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A hybrid room or theatre of this kind is the only surgical environment within which patients can be diagnosed and treated at the same time. Surgeons can get quick and detailed information, and superior precision and control, while different specialties can work together to treat more complex cases. Surgeons can also check on the results of the surgery at any time during the procedure, and while applications using a surgical table in tandem with an imaging system are only currently in their infancy, we believe they have a great future.

For a successful hybrid theatre scheme, however, it is imperative that the hospital or theatre manager not only determines at the planning stage which surgical disciplines will make use of the hybrid theatre, but also considers the impact of, and interplay between, the room design and layout with the existing theatres and future workflows. Decisions also need to be taken early on who will manage the project, which team will be assigned to it, and which technology partner can best ensure an efficient and smooth project implementation.

THE PLANNING CONCEPT The hybrid OR is a composition of diverse components that need to work seamlessly as a singular functional unit, to ensure smooth workflows and clinical success.

The need to accommodate a wide range of patient positioning across multiple surgical disciplines affects the placement of the surgical table, imaging system, lights, ceiling service units, and monitors.

Equipment placement must also be sufficiently flexible enough to accommodate the increased number of people in the operating theatre. Cardiac procedures often require a dedicated workspace for a perfusionist, and a heart/lung machine. Neurosurgery often requires the help of microscopes and navigation systems. The anaesthetist may need additional flexibility in positioning. The use of 3D software supported by VR is especially helpful during the evaluation stage to help visualise avoidable collisions and workflow optimisation in design of the theatre.

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Equipment placement must be sufficiently flexible to accommodate the increased number of people in the theatre.

The design of a hybrid OR require a systematic approach in a logical step-by-step manner. The key steps should include: • Selecting the wall system to be used – traditional construction versus flexible modular wall. This has a significant overall impact, since despite their initial higher costs, modular walls can reduce the time needed for, and cost of, future room modifications and technology upgrades, bringing long-term savings.

ADAPTING TO DIFFERENT SURGICAL NEEDS

• Choosing the appropriate imaging system depending on surgical needs (C-arm, CT or MRI, or a combination), plus auxiliary equipment.

Planners have the task of ensuring that the hybrid OR quickly adapts to the needs and preferences of each surgical discipline. Understanding the relationship between medical staff, equipment, and information flow, is vital to help planners create a safe and ergonomic environment, regardless of what type of surgery will be performed.

• Determining the optimal workflow between the hybrid theatre and adjacent rooms.

• Selecting a hybrid OR surgical table with interchangeable tabletops, including a carbon fibre floating tabletop and universal breakable tabletop with carbon fibre back rest, both to accommodate

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• Designing and integrating the air-conditioning system to ensure effective laminar flow and sterile working conditions for a range of different patient positions.

• Selecting the ceiling-mounted equipment (surgical lighting, ceiling supply units), and determining the optimal positioning to ensure an effective surgical environment and interactivity between the various devices.

Planners need to ensure that the hybrid OR quickly adapts to the needs and preferences of each surgical discipline.

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• Evaluating the available digital integration systems to ensure effective image handling inside the OR, centralise documentation, enable communication with people outside the room, and control equipment functions.

• Selecting an anaesthesia system.

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Getinge recommends selecting a hybrid OR surgical table with interchangeable tabletops to accommodate a wide range of patient positioning, and for the comfort of the surgical team.

Detailed 3D visualisation, DWG, and BIM drawings should be completed for the new hybrid theatre, crosschecked, and approved by each equipment supplier.

• Determining the need for additional equipment (ultrasound, heart-lung machine, injector, robotics, microscopes, and navigation system) based on room utilisation.

In traditional ‘stick-built’ construction, last-minute alterations can result in expensive changes and unacceptable delays. For this reason, many hospitals have chosen modular stainless steel wall panels that facilitate any required modifications without affecting installation scheduling. Limiting the number of suppliers involved in supplying equipment and technology has, equally, proven to minimise the potential for connectivity and installation issues that can delay the commissioning of the project.

PROJECT MANAGEMENT RISK The inherent complexity of hybrid ORs introduces a level of project management risk that can only be mitigated by the participation and interaction of knowledgeable stakeholders and consultants.

Common issues include workflow interruptions, missing software and hardware interfaces, patient positioning challenges, and collisions due to misaligned equipment installation. Hospitals that have successfully implemented their first hybrid OR have taken the following steps to avoid these potential problems: • Involving experienced consultants to help ensure that there are no oversights in the planning process.

• Teaming with solution providers rather than equipment-focused vendors; this approach will help you better and more effectively manage the interface between the various systems and platforms in terms of planning, installation, and service, which, if not adequately co-ordinated, can delay project implementation or limit the theatre’s usability.

• ‘Visualising’ the hybrid OR using 3D tools with VR technology, to facilitate discussions among stakeholders, while helping to identify potential problems that would otherwise not be readily apparent to the planning team.

FROM DESIGN TO IMPLEMENTATION The duration of any hybrid OR project strongly suggests the need to have continuity of involvement by the stakeholders who participated and were most closely involved in making the planning decisions. At this point in the process, successful installation relies on confirming the room configuration, equipment specifications, and exact placement of all the hybrid OR technology. Detailed 3D visualisation, DWG, and BIM drawings should be completed for the new hybrid OR, crosschecked, and approved by each equipment supplier, to help avoid unanticipated installation issues.

NEED FOR AN INSTALLATION SCHEDULE Regardless of the number of suppliers, a mandatory installation schedule is key to ensuring that everyone and everything is on site when is required. In addition, in-depth discussion should take place between project leaders and suppliers to establish best practices in determining the optimal sequence of installation steps and areas of concern, and the key areas where collaboration is required among multiple vendors and specialists to successfully interface hardware and software. Finally, an effective training plan for the staff that will use the new theatre can reduce the time it takes for them to adapt to new equipment, and, for example, different working practices, as well as increasing staff confidence, satisfying regulatory requirements, and meeting internal performance standards. Getinge also recommends that key users are identified to facilitate knowledge transfer to all current and future staff members.

CONCLUSIONS The planning and commissioning of a hybrid operating theatre requires the active participation of a diverse group of stakeholders and consultants whose decisions contribute to the effective and seamless interaction of all the selected hardware and software platforms.

Limiting the number of solution-oriented vendors can lower the risk of failure, prevent compromised performance, and eliminate delays by reducing the inherent inefficiencies of multiple service and maintenance interfaces. Meanwhile, 3D modelling of the hybrid OR, including the placement of equipment and staff (to scale), helps stakeholders visualise

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workflows and relative positioning of multiple elements in the hybrid environment.

An increasing number of hospitals are installing multiple modalities of imaging systems (angio, CT, MRI) to handle intraoperative imaging for planning, guidance, and final check-up without having to reposition or transport the patient.

The placement of the theatre table in relation to the imaging system, laminar flow alignment and coverage, positioning of the room ceiling supply unit, and surgical lighting, merit particular attention during the planning process, to ensure ergonomic and collision-free utilisation across multiple disciplines and procedures. User and application training is also fundamental in reducing the time it takes a surgical team to adapt to a new theatre facility and in increasing staff confidence, while satisfying regulatory requirements and meeting internal performance standards.

BIBLIOGRAPHY This his article is based on Roadmap to the Hybrid suite (white paper) – Optimizing the Planning Process for designing and Commissioning the Single Discipline, Multidisciplinary and Multi Modality Hybrid OR, GSW-BR-10001016-EN-1.

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ABOUT JULIAN GRIMALDI Julian Grimaldi, MBA Biomed Eng, is a graduate biomedical engineer who specialises in operating theatre design. Senior business manager, Hybrid OR, for Getinge in Germany, he holds has a Masters degree in Business Administration. Born in Buenos Aires, Argentina, he undertook his university degree there, and first became being involved in operating theatre design early in 1995. His career subsequently continued in Spain, where he completed his Master’s degree.

Joining Getinge (formerly Maquet) in 2007 in Spain to develop a project department, he also served as a Professor on the Master’s for Hospital Architecture course at the Universidad CEU in San Pablo. In 2013 he joined the international organisation for Getinge Surgical Workplaces in Rastatt in Germany, working in the Hybrid Department. Alongside his business responsibilities for Western Europe, Latin America, the Middle East and Africa, he is in charge of developing architectural concepts solutions for Hybrid Surgical Rooms – from single to multiple rooms – for different imaging equipment and modalities.

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he management of physical assets can be a confronting and complex business. The frequent attention to service medical equipment particularly can tend to be quite demanding in comparison to traditional assets such as buildings or infrastructure. Whether its scheduling services, communicating with your technicians or finding ways to optimise your tasks – it becomes a task to combine all these assembling components within a single and controlled framework.

As a reaction, there have been new enterprise asset management software gradually emerging. However, applications catering specifically for the medical servicing field are limited. AppTegral has looked into the main challenges preventing businesses from operating their own all-purpose and multifaceted systems. Our experiences within the medical servicing field has allowed us to innovate solutions for the shortages and needs we have commonly come across.

Adapting your app to pre-existing systems A large concerning issue for businesses is transitioning from pre-existing management arrangements to an updated mobile system. TegralMed is a customisable app that accommodates for businesses wanting to keep any formatting to allow for a seamless transition.

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User-friendliness A user-friendly experience for Technicians or Managers in the field must be ensured to eliminate any costly humanerrors to your business. TegralMed focuses on providing a simple interface, hiding all the complexity within the background. Ensuring an easy-to-use system for all users.

Capturing accurate data from the field Cloud-based software by now, have been successfully integrated within most business operations. However there is still a disjointed transition of data between Technicians recordings in the field, and Operation Managers. Considering the piles of work orders affiliated for a single project alone- duplicate entries, missing entries or other errors are bound to compile up.

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NEWS

AUTOMATING FLOOR CLEANING Healthcare facilities nowadays have to go through dramatic shift to meet the needs of customers within fast-paced environment. Many technologies have been applied to many different areas. Patients can ensure their comfort and safety thanks to the supply of high-tech equipment, although the operating theatres are still being cleaned just with 3,000-yearsold mop and bucket – the same method that has been used to clean pyramids during the dynastic period. How much have we been efficient in solving problems revolve around building hygiene and the work flow?

Perhaps it is time to automate the floor cleaning process. Just like any other innovations, the real efficiency of robotic floor cleaning machines is ready to move forward.

“We have spoken to some of our existing customers in healthcare facilities that have raised different facility challenges ranging from operation management, timeefficiency, to quality management system,” said Murray McDonald, Director of Duplex Healthcare, “today a fleet of intelligent cleaner can carry out corridor cleaning at midnight in low traffic times.”

IMPROVEMENT AND CONSISTENCY ON QUALITY AND EFFICIENCY We know that it is critical to focus on quality and efficiency, particularly in healthcare cleaning system where infection control is well-regulated and monitored. However, there are always flaws in manual system. Perhaps your cleaners did not deliver good quality of cleaning, or the tools are not supportive enough to help them maintaining 100% of cleanliness. There is just no consistency in the quality. Automating the process means you are setting up a quality system that will stay the same until you decide to change it. It will manage and monitor the floor cleaning quality in your healthcare facility on a daily basis through app evaluation tool.

REDUCE MANUAL HANDLING RISK “Repetitive activities of lifting, pushing, pulling, moving, holding, or carrying have created many negative impact on workforce,” added McDonald, “in fact, 28% injuries come from manual handling. It is time for a great step up to automation.”

Manual handling and chemical use have their own history of creating dangers and injuries for cleaners. Although not all of the activities are dangerous, changing the cleaning system or simply removing manual handling work within healthcare facilities will give significant changes to increase safety within the healthcare building environment.

CORDLESS SYSTEMS Cordless systems have been winning over wired tools for a period of time. It helps to reduce the risk of danger caused by wires as well as increase flexibility for cleaning process.

Automating the process means having cordless systems that are safe for everyone, not only the employees but also patients. Cordless systems mean it can go clean anytime, anywhere you want.

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IT IS JUST A MATTER OF TIME Wireless tools and chemical-free cleaning systems are not new.

Automation, too, has been around for decades, especially in America and Europe.

Duplex Healthcare has been leveraging the standard of cleaning within healthcare facilities for the last 20 years.

Creating wide range of innovations that are not just about cleaning and infection control, but also doing it right. This includes the application of eco-friendly concept and its constant attention towards manual handling risk reduction.

These days, the company is focusing on developing automations in cleaning system through the use of optical censors and navigational mapping system.

“It is important to use versatile machine that can be applied for more than one function to save time and money,” said McDonald, “we are now focusing on creating machines that can be used autonomously for many areas and produce better results for healthcare facilities.”

Its latest product, Lithium Evolve, was produced with lightweight lithium battery and cordless design that can sweep, wash, scrub, and dry floors in single pass with 40% better cleaning performance. Their robotic tools too are expected to kick off soon as a multi purpose cleaning machine.

“In the future, people should focus more on automating the process. The development of floor robots is not just for fun nor a threat to substitute human workers – people can do more complex task and work hand in hand with robots, producing better results in no time,” said McDonald.

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AIREPURE CELEBRATES 20 YEARS OF OPERATION Leading national air filtration company, Airepure Australia has recently celebrated 20 years of operation.

Founded in December 1998 by three friends and colleagues – Peter Wingfield, James (Jim) McIntosh and Roger Van Oosten – Airepure has steadily grown, based on their objectives to provide air filtration products and solutions that are purpose built for quality, reliability and value.

Today, Airepure offer a comprehensive range of core particulate and gaseous filtration products that are stocked and supported nationally through several dedicated office/ warehouse locations within Australia and New Zealand.

Custom air filtration, air purification and airborne containment solutions are designed and engineered in-

house to meet specific client requirements. Relevant, valueadd support services are also provided by the company, including product installation, routine maintenance and NATA accredited on-site testing and certification.

“We value our staff and their professional development” says Airepure CEO Roger Van Oosten, “We consistently invest in resources to provide our clients with a reliable support team; which includes in-house engineering, dedicated product/ project specialists, knowledgeable technical sales and experienced NATA certified field service technicians.”

To commemorate 20 years, Airepure have created a web timeline highlighting significant company milestones.

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CARE SYSTEMS & EMPREVO BUILD AN INDUSTRY CHANGING PARTNERSHIP Are you tired of Aged Care management software that is not connected and seems to make your lifer harder, not easier?

• Publishing the working roster in Care Systems automatically makes unfilled shifts available to advertise to staff in Emprevo;

Care Systems came to the conclusion that there had to be a better way. After scoping possible solutions, Care Systems management system has been turbocharged through an integration of its Rostering function with the Emprevo shiftfilling platform.

• All shifts accepted on Emprevo automatically populate the Care Systems Roster, requiring NO data entry;

Emprevo takes the time, agency costs and frustration out of filling shifts and has developed a simple but powerful mobile solution. The integration to Care Systems means that Aged Care providers can now manage just-in-time shift filling centrally without the frustration of manually engaging staff

by SMS or phone at short notice.

This ensures a seamless rostering & shift-filling experience for management and staff.

Care Systems users can now have Emprevo seamlessly integrated into the existing platform, delivering numerous benefits:

• All staff can set their availability in the Emprevo app, allowing managers to see who may be able to accept a shift vacancy; and • All staff will be able to view their standard rostered shifts, and new Emprevo shifts in the Emprevo work calendar on their mobile phone.

For managers and staff wanting more time in their day and less frustration, Care Systems now has an end-to-end solution that ensures much better outcomes and significant cost savings.

Contact Paul Johnston at Care Systems on 0432 396 399 or paul.johnston@caresystems.com.au to find out more.

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NEWS

STEAM FOR STERILIZATION – WHAT DO THE STANDARDS REQUIRE? The standard that governs steam quality and purity for large healthcare sterilizers is AS/NZS 4187:2104 Reprocessing of reusable medical devices in health service organizations.

This standard in turn references the following international standards as Normative References: • EN 285 Sterilization – Steam Sterilizers – Large Sterilizers • ISO 17665 Sterilization of health care products – Moist heat – Part 1: Requirements for the development, validation and routine control of a sterilization process for medical devices Part 2: Guidance on the application of ISO 17665-1 It also refers to CFPP 01-01 Part C, which is produced by UK National Health and has since been replaced by Health Technical Memorandum (HTM) 01-01: management and decontamination of surgical instruments (medical devices) used in acute care, Part C Steam sterilization. HTM 01-01 is a useful guide and is available as a free download, making it a useful reference for those who do not have access to all the international standards that are referenced.

Steam Quality AS/NZS 4187:2014 refers to EN 285 for the test methodology to determine the quality of the steam supply to the sterilizer chamber. This includes tests for steam dryness, noncondensable gases (NCG’s) and superheat.

The test methodology in EN 285 has long been established and outlines the apparatus and method required for each test. The steam quality tests should be done in accordance with EN 285, which includes having specific test points in the steam supply pipe (for example a minimum of 400mm straight horizontal pipe upstream of the elbow where the dryness pitot tube is inserted).

Not following the testing methodology as outlined in EN 285 (including test point requirements) may lead to inaccurate results. EN 285 does allow for alternative test methods to be used, but these alternative methods and/or test points must be shown to give equivalent results to the methodology specified in EN 285.

AS/NZS 4187:2014 requires that steam quality testing shall be conducted as part of IQ (Installation Qualification), or OQ (Operational Qualification). This means that there must be at least one recorded steam quality test. The requirement for on-going steam quality testing is left as optional in AS/NZS 4187:2014, however EN 285 and ISO 17665-1 both indicate that periodic steam quality testing should (EN 285), or shall (ISO 17665), be done. Best practise then would be to include steam quality testing in the periodic testing programme.

Steam Purity AS/NZS 4187:2014 indicates that steam purity testing shall be conducted as part of IQ or OQ with on-going annual testing.

An accredited laboratory is to be used for the actual analysis

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of all purity samples. Reference is made to table E.2 of EN 285 for the steam purity, however EN 285 was revised in 2015 (after AS/NZS 4187:2014 was released) and no longer includes a table E.2, or indeed any table equivalent to E.2. This may cause some confusion, however by referencing ISO 17665 and HTM 01-01 it is possible to bring some clarity to the steam purity testing requirements.

Steam purity can be divided into two parts, contaminants with regard to contamination of the load and contaminants with regard to corrosion of materials. The requirements with regard to contamination of the load is the minimum requirement and table A.2 of IS0 17665-2 covers this (and table A.2 is the same as table E.2 that was in EN 285 prior to 2015, so using table A.2 follows the intent of AS/NZS 4187:2014).

The move to clean steam is aimed at reducing corrosion of materials. This is driven by on-going research which is pointing to the negative effects of corrosion on instruments (for example biofilms) and the increasing complexity of instruments (for example as used in robotic surgery). Where the move to clean steam has been made (i.e. a dedicated steam generator is used) then the steam purity should not only meet the requirements with regard to contamination of load (table A.2), but also should meet the requirements in relationship to corrosion of materials, the latter being covered by table A.1 of ISO 17665-2. Further the feedwater to the dedicated generator is also to be tested and be in accordance with Table B.1 of EN 285.

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South Pacific Laundry specialises in the provision of quality linen and supplies for the customer service, hospitality and healthcare industries

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Currently, the South Pacific Group is establishing a strong network of modern laundries across Victoria, New South Wales, Queensland, Western Australia and South Australia with plans for several more facilities up the East Coast of Australia.

The relocation of our Sydney operations to a new larger facility in Bankstown together with the relocation of our Brunswick plant to Broadmeadows will establish South Pacific Laundry as the single largest privately owned laundry in Australia and in the Southern Hemisphere.

Contact Robert Teoh National PR & Marketing P: (03) 9388 5300 M: 0421 716 888 Coverage Australia wide

• A 365 day service to all its clientele with a 24 hour turnaround (depending on location).

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South Pacific Laundry (SPL) has been a provider of commercial laundry and linen services to the hospitality industry in Melbourne for the last 20 years.

SPL provides:

Pricing Information Contact supplier direct Delivery Free daily delivery within 25km city metropolitan areas Minimum Order Contact supplier direct

• A leading edge technology in RFID to assist housekeeping and managerial staff in time reduction and efficiency.

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• A dedicated software design package and centralised billing system enables seamless transactions, paperless and customised reports.

• Delivery rationalisation systems, providing and streamlining efficient delivery routes which will reduce the company’s carbon footprint.

• Building of partnerships and sharing benefits with the customers from savings made through its constant laundry process innovations and group purchasing power of linen products.

• Dry cleaning and uniform cleaning services.

• Provision and supplying of corporate uniforms/work wears and customised hotel room amenities.

Full Contact Information South Pacific Laundry 9-23 King William St Broadmeadows VIC 3047 P: (03) 9388 5300 F: (03) 9387 2399

*Melbourne, Albury only

E: customerservice@southpacificlaundry.com.au robert.teoh@southpacificlaundry.com.au

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AH-CSG Clean Steam Generator

■ Clean Steam to AS/NZS 4187:2014 4 ■ Clean Steam operational pressure of 3 to 5 barg ■ Delivers up to 300kg/hr of clean steam ■ Typically supplying up to 3 sterilisers ■ Efficient compact design ■ On-board water degassing and heating ■ Designed and built in Australia

Spirax Sarco offers installation and turnkey solutions available for clean steam generation including clean steam distribution systems, plant steam modifications and steam quality testing to AS/NZS 4187:2014. Providing tailored maintenance and service agreements for your business. Contact us for more information on the AH-CSG. 

1300 774729 (SPIRAX)

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info@au.spiraxsarco.com

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