Healthcare Facilities Spring 2019 by Adbourne Publishing

PP 100010900

VOLUME 42 I NUMBER 3 I SEPTEMBER 2019

HEALTHCARE

FACILITIES ANZ STADIUM

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CONTENTS REGULARS

43 Improving critical first-aid response at time of disaster

Editor’s message

National President’s message

CEO’s message

88 News BRANCH REPORTS 10 QLD 19 WA 24 VIC/TAS 26 SA 28 NSW/ACT FEATURE ARTICLES Acoustic separation in 31 healthcare facilities 35 Lacrosse decision – What does this all mean?

47 Lady Cilento Children’s Hospital: Precinct-based energy trigeneration – the large hospital experience

53 How can IoT for elevators and escalators improve transparency and reliability? 57 Searching for sustainability: Low-tech design for the Hillside Clinic in the arid Karoo, South Africa 71 Anatomy of a smart building 75 Know your risk 79 Doctors without borders (MSF), much more than field hospitals

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

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

IHEA ADMINISTRATION Chief Executive Officer Karen Taylor Finance Jeff Little Membership Angeline Canta (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.

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REGULARS

EDITOR’S MESSAGE

elcome to the 2019 Spring “pre-conference” edition of “Healthcare Facilities”. With the IHEA National Conference almost upon us, we thank our partners for their ongoing support and look forward to sharing another fantastic trade show. The exhibition component of the IHEA National Conference is a great place to showcase products and share technology and experiences across the healthcare engineering network. The conference and gala dinner will be held in Sydney at the ANZ Stadium – part of the venue for the famous 2000 Olympics. In keeping with the location, the theme is “Game Plan for the Future of Healthcare Facilities”, so if you’ve not already registered check out the details inside and go to www.HFMC2019.org.au for more information. In this Spring Edition we share with you news of interest from branch activities together with a fantastic array of technical articles and product news. Risk and liability continue to feature in this edition and with issues around building cladding still appearing regularly in the media, the summary of the findings

of the Victorian Civil and Administrative Tribunal through Judge Woodward might be a useful read. Further afield, articles from Japan considering first aid responses to a disaster, the work of sustainability at the Hillside Clinic in the arid region of Karoo, South Africa, as well as a fascinating story from Médecins Sans Frontières (Doctors Without Borders). You may recall the presentation from the IHEA / IFHE Congress in 2018, which highlighted the changing context of humanitarian medical aid provided around the globe. This paper sheds some light on the increasing challenges faced by those engaged in providing these front-line services, often in areas of crisis and unrest. I hope you enjoy this edition of “Healthcare Facilities” and the national Conference in Sydney in October. Unfortunately I will miss the IHEA conference as I will be attending the IFHE Council and Executive meetings being hosted by our UK equivalent, IHEEM in Manchester, UK. I look forward to hearing how it goes and sharing it with you in our next edition. Regards Darryl Pitcher

REGULARS

NATIONAL PRESIDENT’S MESSAGE

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It is hard to comprehend that this is my last Presidents message to our membership. After 2 years in the role it’s almost time to handover to the incoming President Jon Gowdy and it is with disbelief just how quickly the years have gone by.

uring my time in the Chair the support I have received from all Directors and the Chief Executive has been second to none and this is testament to the dedication, competence and commitment of each and every one of the Directors. We have been able to discuss, debate and reach a consensus on many operational and strategic issues in a highly democratic and professional manner. And I thank you all for your support during my tenure.

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While change is inevitable it does provide opportunities to refresh and refocus on the future priorities of our organisation. The change of guard does allow occasion to reflect on how far we have travelled over the last 24 months. When I took over the role as President from Brett Petherbridge in October 2017, our biggest focus was on the hosting of the prestigious IFHE Congress in Brisbane, and what a success that was.

REGULARS

catch them before they fall®

In February 2018 we undertook a critical review of our Board membership, skills and competencies and it was very satisfying to note that the external reviewers summary stated “In our experience, the IHEA Board performs its governance role very well, particularly given the voluntary nature of its directorship, the generous personal time commitment that Directors give, and the dispersed membership spread geographically across Australia”. Every February the Board convenes, not just for the regular Board meeting, but also to undertake a day of strategic planning and review on progress towards our targets. I took the opportunity at the February 2018 strategic review, to present a paper to the Board on the necessity for the IHEA to provide a more formalised Learning and Development process for our members. There was unanimous agreement that, in order to raise our level of professional recognition, we had to adopt a supporting mechanism whereby members would be in a position to demonstrate and have recognition of their level of skills, qualifications and professional development. We subsequently partnered with Intrinsic Learning, and launched the Learning and Development Program in July of this year where financial members receive automatic enrolment into our “IHEA Logbook”. We are also able to offer members the opportunity to elevate their learning and development, towards a recognised Professional Certificate in Health Facility Management. In recognition of the fact that a considerable amount of experience would likely be lost to the Board post the 2019 AGM with a number of Directors stepping down, a formal succession planning process was adopted with the creation of a nominating subcommittee that will receive, promote and/or lobby for new Board member nominations, thereby reducing the future risk of Board instability and supporting ongoing continuity. Not to be forgotten, we have rebranded the IHEA with the introduction of a contemporary logo and style guide, updated our webpages, had some early success with the use of “zoom” video conferencing and made inroads into the use of social media with our own Facebook and LinkedIn sites. It has been an enjoyable and enlightening two years which would have been far more challenging without the support of the Board and the CEO and I thank you all for making my role far less challenging than it could have been. I look forward to catching up with you all at the forthcoming National Conference in Sydney.

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REGULARS

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REGULARS

CEO’S MESSAGE

• CPD ensures your capabilities keep pace with the current standards of others in the field. • CPD ensures that you maintain and enhance the knowledge and skills you need to deliver a professional service. • CPD ensures that you and your knowledge stay relevant and up to date. You are more aware of the changing trends and directions in the industry. The pace of change is probably faster than it’s ever been – and this is a feature of the new normal that we live and work in. If you stand still you will get left behind, as the currency of your knowledge and skills becomes outdated. • CPD helps you continue to make a meaningful contribution to your team. You become more effective in the workplace. This assists you to advance in your career and move into new positions where you can lead, manage, influence, coach and mentor others.

The Importance of Continuous Professional Development

n July 1st IHEA launched the Learning and Development Program (IHEA LDP). Part of this growing suite of offerings is the Continuous Professional Development (CPD) requirement for full individual members, including the ’IHEA Logbook’ and ‘IHEA Logbook Professional’ App. On our road trip around to branch meetings in May and June to introduce the program we talked lots about the rationale for the IHEA LDP and in particular the CPD component. There are also videos and other resources available on the IHEA website to explore and understand this new offering. CPD is important because it ensures you continue to be competent in your profession. It is an ongoing process and continues throughout a professional’s career. The ultimate outcome of well-planned CPD is that it safeguards the public, the employer, the professional and the professional’s career. Well-crafted and delivered CPD is important because it delivers benefits to the individual, their profession and the public.

• CPD helps you to stay interested and interesting. Experience is a great teacher, but it does mean that we tend to do what we have done before. Focused CPD opens you up to new possibilities, new knowledge and new skill areas. • CPD can deliver a deeper understanding of what it means to be a professional, along with a greater appreciation of the implications and impacts of your work. • CPD helps advance the body of knowledge and technology within the profession. • CPD can lead to increased public confidence in individual HCFMs and their profession as a whole. • CPD for HCFMs contributes to improved protection and quality of life, the environment, sustainability, property and the economy. The importance of continuing professional development should not be underestimated – it is a career-long obligation for practising professionals. For these reasons and more, many professions now mandate or require CPD. But at its core it is a personal responsibility of professionals to keep their knowledge and skills current so that they can deliver the high quality of service the profession requires. The IHEA LDP is in essence a personal responsibility that we provide tools and support for in order to make CPD an easy and effective part of your everyday work. We hope you will find the program of benefit to you, your colleagues and your employer. Karen Taylor – CEO

BRANCH REPORTS

QLD BRANCH REPORT Branch Activities Special General Meeting and Midyear PD

ur mid year conference this year was a very successful event that was well attended and enjoyed by our members, visitors and sponsors alike. The Theme was “Contemporary Challenges in Healthcare Engineering” that was held over two days on the 18th & 19th July at the Victoria Park Golf Club. The program consisted of: • Critical Infrastructure in a Live Hospital – The ERRP, presented by Matt Brace Electrical Engineer from Wood and Greive Engineers. Metro North and Health Service have embarked on an extensive electrical infrastructure replacement program at Redcliffe Hospital following identification of aging infrastructure of aging supporting infrastructure.

• Air Quality Management Plan for Mould Control, presented by Curtis Bettell from Opira. Curtis presented their Indoor Air Quality Risk Management Plan (IAQMP) on how to manage the health risks of building occupants associated with poor air quality by establishing an indoor Air Quality Management plan. This provides a framework to actively maintain acceptable air quality in the healthcare facility and prevent the identification of significant, wide spread issues that would then require large scale reactive works. • Latest on AS4187 and the Challenges in Meeting Compliance – presented by Andy Gay from SAV. Andy is a leading expert on the subject and prepared an excellent paper on the standard and also backed it up with a second presentation from a clinician’s perspective.

Matt spoke at length of the trials and tribulations of delivering a substantial project with the support and collaboration of the Hospitals BEMS, Facility Executive and Clinical stakeholders.

• Water Quality in CSSD and RO, presented by Mark Collen from Aqualyng. Mark spoke of compliance with AS4187 when looking at the water component of CSSD, discussing various methods, challenges and advances available to ensure compliance and reduce the infection performance rates in the facility. • Breathing Life into an Aging Asset – Chilled Water & Ventilation program within a live hospital, presented by Patrick Chambers, a Mechanical Engineer from Wood and Grieve Engineers. Patrick is overseeing a site wide mechanical upgrade in a fully occupied facility including performance testing, laser scanning and point cloud. He proposed comprehensive and welldesigned mechanical services within the Redcliffe Hospital.

BRANCH REPORTS

• Herston Quarter Redevelopment Update presented by Mark Reardon a Technical Director for the MNHH. The Herston Quarter is certainly the largest and most complex project Metro North are undertaking and Mark provided an overview

• Managing ICT and Technology in Healthcare Environments, presented by Peter Ganter, Technical ICT Director for MNHHS. Peter provided an overview on the specification and the stakeholder collaboration in delivering IT infrastructure within a healthcare district • Verification of Patient Area Electrical Installations - AS3003 Update, presented by Peter Winters from Paragon Care. Peter focused on four main topics:

o Changes in the standard AS 3003 2011 to 2018,

o The relationship between the super-set of standards being AS3003, AS3000, AS3008, AS3551 & AS2500

The Branch would like to thank a long standing member, Alex Mair, who has decided to retire as an active member of the branch and COM. Alex has represented the Branch COM and the National Board for several years which has been greatly appreciated we wish him well. Committee of Management President

Adrian Duff

Vice President

Brett Nickels

o The shortfall between patient procedures, are design and the final real-world utilisation of patient areas.

Treasurer

Mike Ward

Secretary

Danny Tincknell

National Board Rep

Brett Nickels

o What is considered, within the context of verification, “As Far As Practicable”

COM

Scott Wells

COM

Artur Melnitsenko

• Engineering Drawing Management, presented by Chris Ryan from Redeye – Chris spoke on how to meet the changing face of engineering through innovative asset management

COM

Kevin Eaton

COM

Darren Williams

COM

Todd Marshman

COM

David Smith

Our appreciation and thanks goes to our speakers.

COM

Cliff Pollock

COM

Christopher Ansley Hartwell

COM

Peter White

To our sponsors Wood & Grieve Engineering, Higgins Coatings, Armstrong Flooring, Opira, Vertiv, Aqualyng, ABB, Australian Medical Suction, Redeye, NHP, Aeris Environmental, New life Restoration, Honeywell & Galvin Engineering, our thanks and gratitude for your support.

Acknowledgement

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

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BRANCH REPORTS

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

Game Plan for the Future of Healthcare Facilities Register Now! Register via www.HFMC2019.org.au to secure your attendance at IHEA 2019 in Sydney.

GOLD SPONSORS

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Subscribe to event updates at www.HFMC2019.org.au

#HFMC2019

The Institute of Healthcare Engineering, Australia (IHEA) invites you to register for the IHEA Healthcare Facilities Management Conference BRANCH REPORTS (HFMC 2019) to be held on 9-11 October 2019 at ANZ Stadium, Sydney.

CONFERENCE PROGRAM

This year’s conference 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. The conference will feature two engaging keynote speakers:

Louisa Hope

Private Damien Thomlinson

LOUISA HOPE is a survivor of the Lindt Café Sydney siege that occurred in December 2014. These days Louisa devotes her time and energy to making a difference with the Louisa Hope Fund for Nurses. PRIVATE DAMIEN THOMLINSON is an Australian veteran of the war in Afghanistan and his story is one that continues to evolve and inspire people around the world. His triumph against adversity, positive attitude and ambition for the future continues to resonate with people from all walks of life. Above all, Damien’s incredible journey stands as proof that no challenge is too great and that the ANZAC spirit truly is alive and well.

TECHNICAL SITE TOURS

The conference will feature six technical site tours as part of the program • Olympus • ANZ Stadium • ICC Sydney

• Westmead Children’s Hospital • Westmead Redevelopment Project • Concord Redevelopment Project

SOCIAL PROGRAM The conference social program includes: • Welcome Reception & Trade Night, sponsored by Sondex • Conference Dinner at ANZ Stadium, sponsored by NHP • Partners Program

The full conference program is now available at www.HFMC2019.org.au

BRANCH REPORTS

12.45pm - 1.45pm

Lunch & Exhibition

BRANCH REPORTS

Stream: Towards best Practice – Step up or Step out 1.45pm

Getting AS4187:2014 implementation right first time Mark Collen, Aqualyng

2.15pm

A novel approach to monitoring water quality in hospital and healthcare facilities Richard Bentham, Flinders University

2.45pm

Gameplan for the future: Data & Compliance Management Colin Nicol and Ryan Milne, Do Diligence

3.15pm - 4.00pm

Group Photo of IHEA delegates / Afternoon Tea & Exhibition

Stream: Challenge your assumptions – be the driver for change 4.00pm

A blueprint for Innovation in FM Donald Macdonald, Macdonald Lucas Pty Ltd and Kanishka Atapattu, Head of Operations CAMS, RMIT University

4.30pm

ANZEX DELEGATE PRESENTATION: Clinical Engineering; How Biomeds make hospitals safer Michael Brown, Canterbury District Health Board

5.00pm

Conference Sessions Conclude

6.30pm - 11.00pm

Conference Dinner Location: ANZ Stadium, Olympic Blvd, Sydney Olympic Park Enter via Gate L of the Western Stand, Level 4, Members Room

Sponsored by

DAY THREE: FRIDAY 11 OCTOBER 2019 7.30am - 2.45pm

Registration desk open Location: ANZ Stadium, Olympic Blvd, Sydney Olympic Park Enter via Gate C of the Eastern Stand, Level 4, Millennium Room

8.15am - 3.00pm

Partners Program Meet in the Novotel Sydney Olympic Park hotel lobby for departure at 8.15am. Walking is involved so please wear closed in comfortable shoes. Please bring sunglasses, hat and water bottle.

All conference sessions will be held in the Millennium Room, Level 4, ANZ Stadium (entry via Gate C of the Eastern Stand) 8.30am

Conference Welcome & Housekeeping Conference Emcee: Paul Chippendale

8.40am

KEYNOTE ADDRESS Private Damien Thomlinson

9.40am

Gold Sponsor Address Q-bital Healthcare Solutions

Stream: Pushing Healthcare technology boundaries; Healthcare Engineering accomplishments now and looking to the future 9.50am

Total Body Irridiation (TBI) Bed Cindy Wang, Royal Prince Alfred Hospital

10.10am

Managing Healthcare Technologies: How to implement current projects whist enabling for emerging technologies Rob Arian, SWSLHD

10.30am - 11.00am Morning Tea & Exhibition 11.00am

Case Study: Cabrini Gandel Building Development Rafx Hamilton, Cabrini Health

11.30am

Biomedical engineers and renal dialysis Edward Li, Royal Prince Alfred Hospital

12.00pm - 1.00pm

Lunch & Exhibition

Stream: Pushing Healthcare technology boundaries; Healthcare Engineering accomplishments now and looking to the future 1.00pm

Breathing new life into an aging health care facility Todd Marshman, Metro North Hospital and Health Service

1.30pm

Legionella is the headline, however is Pseaudomonas the bigger issue? Charles Cheesman, Bion Systems

2.00pm

Could adopting a safety case regime improve patient safety in Australia’s hospitals? Matthew Kennedy, Frazer-Nash Consultancy

2.20pm

2020 Conference Presentation

2.30pm

Conference Close & Prize Draws Jon Gowdy, IHEA 2019 Conference Convenor

2.45pm

Conference Concludes This program is an outline only and the organisers reserve the right to change the topics, times and presenters if necessary. For the most up-to-date version of the program, view the conference website www.HFMC2019.org.au

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BRANCH REPORTS

2019 WA IHEA STATE CONFERENCE REPORT

t 8:30am Friday 9th August 2019, 104 members and guests descended on the Pagoda Resort and Spa on the South Perth foreshore for the IHEA WA 2019 State conference. For the next 8 hours delegates were treated to a variety of presentations focused on the “Changing Face of Healthcare.” The conference was opened by the State President, Mr Peter Klymiuk. The opening address was delivered by Mr Peter Easson, the IHEA National President, who illustrated the vast changes in healthcare facilities that have occurred during his 30-year career.

The first of four keynote speakers, Ms Wendy Davis from Gerflor, presented a thought-provoking paper on Hospital Acquired Infection. Research has estimated that Hospital Acquired Infections cost the Australian Health Services two billion dollars each year and affect 1 in 75 patients. The problem is complex, yet the solution can be as simple as washing your hands. What was clear from Wendy’s presentation is that the rise in super bugs in Healthcare facilities is a matter for all Healthcare professionals, including Facilities Managers.

With each person taking about 23,000 breaths each day (8,500,000 per year) it is no wonder that Indoor Air Quality (IAQ) is becoming an area of concern for Facility Managers. Opira’s Mr Mark Graham and Mr Scott Summerville delivered an interesting and informative insight into the management and significance of good quality indoor air. Mark demonstrated how an IAQ management plan can identify, reduce and control IAQ hazards, whereas Scott centred his presentation on the air quality within our clean rooms, and the relationship between the ISO clean room classes and post-operative infections. Post-lunch delegates were in for a surprise. Delegates were treated to a unique, exciting and creative team-building activity, facilitated by Human Rhythms. Members were easily encouraged to participate. Different coloured hollow tubes were handed out to tables and delegates banged the tubes onto their palms creating a multitude of notes. The facilitator then conducted the tables, to create a number of simple tunes, ending in the group standing and walking the room banging in time, filling the conference with a timed rhythm. The session provided

BRANCH REPORTS

lots of smiles and laughs and helped delegates recognise their strengths, and strengths of others. In a relaxed atmosphere delegates were kept motivated, just what the “doctor ordered” post- lunch, and a special thank you to Conference Convenor Rohit Jethro for organising this unique experience.

most of those present were aware of these changes, having then explained in detail and the impact they pose, generated a healthy response from the audience with questions flowing well past the allotted time.

Asset Management in 2019, and the requirements it places on Facility Managers, has changed over the past decade. Today Facility Managers are being asked to provide a lot more detailed information in relation to how they manage the assets within their facilities. Mr Sandy Dunn, from Assetivity, explained the intricacies of two main ISO Standards, ISO 55001 and ISO 41001. He went on to compare each in detail and then offered advice on which standard is best for your business. Workplace safety is always paramount in a Facility Manager’s mind, so Mr Allan McCallum’s presentation on the recent changes to the Electrical Working Guidelines was well received. Allan represented the Master Electricians Association, and even though

Intertwined between the keynote speakers were presentations by the conference sponsors. The topics were diverse and informative. The delegates were shown how the Internet of Things (IOT), Building

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BRANCH REPORTS

Analytics, new innovative products and service delivery models can assist Healthcare Facility Managers to meet their obligations and commitments. The IHEA WA Committee of Management wishes to thank Key Note Speakers Wendy Davis – Gerflor Australasia, Mark Graham and Scott Summerville – Opira WA, Sandy Dunn – Assetivity, and Alan McCallum – Master Electricians Australia, as well as presenting Conference sponsors Enware Australia, Temp Refrigeration Services, Schneider Electric, BAE Services/Reliable Controls, Advance Care (Digital Communication Systems), Arcus Australia, Siemens and Softlogic. Also thank you to our advertising sponsors, Gerflor Australia, Greenstar, Nilsen, Atlas Copco Compressor’s Australia, Progility Technologies, Allegion and Maxwell Robinson Phelps. This excellent day could not be possible without your support. The day ended with the delegates and their partners being served a sumptuous dinner in the Pagoda’s historic Ball Room. The night featured good food, good camaraderie, renewed friendships, and great conversation, accompanied by light musical entertainment.

BRANCH REPORTS

WA BRANCH REPORT June 6th

A’s last branch meeting of the year was held at the International Foundation for Accident Prevention (IFAP) and was hosted by the Australian Fire Safety Team members, Mr Daniel Langoulant and Mr Bob Doleman. The branch meeting also gave delegates the opportunity to meet with the National IHEA CEO, Ms Karen Taylor. Bob Doleman’s presentation showcased an extremely effective, yet simple fire suppression device, the DRA FM200 Electrical Switchboard Fire Suppression System. The DRA FM200 system utilises the clean agent FM-200 gas in a specially designed tube. When exposed to fire the gas expands and ruptures the tube at the point of maximum temperature, providing a Spot Accurate Fire Extinguisher. Being a clean agent gas, it leaves no residue, which makes it highly desirable for electrical installations ranging from basic battery boxes and switchboards, to large scale data centres and telecommunication facilities. The DRA system utilises a non-pressurised canister containing the proprietary ISTO-1 powder. The powder is highly effective in fire suppression, while providing low cleanup, and is also environmentally friendly. The canisters can be activated manually, or by thermal or visual sensor. The different sized canisters can supply up to 250 cubic metres of fire suppression. Fire classes A, B, C and E are covered by this system. The presentation also included a live demonstration. A purpose-built electrical switchboard was set on fire to show how effectively the suppression system responds. Within seconds the non-pressurised canister burst, and the fire was extinguished. This was greeted with loud applause from the floor. Following on from the Australian Fire Safety Team’s presentation, National IHEA CEO Karen Taylor, along with Clive Jeffries, provided members with an overview of the IHEA Learning and Development Programme (LDP). A video presentation demonstrated how to access the programme by downloading a mobile App to a preferred device. Via the App, members can upload learning activities, both formal and informal, in real time and accrue certified professional development points. Members took the opportunity to ask Karen and Clive a number questions focusing on accessing and using the programme. Members were very enthusiastic about the IHEA’s innovative approach to provide members with recognised continuous professional development.

The meeting conclude with members networking and enjoying light refreshments provided by hosts, the Australian Fire Safety Team. July WA Branch Special General Meeting IHEA WA Special General Meeting On Thursday July 4th 2019 the IHEA WA members met at Bethesda Hospital in Claremont WA for the 2019 Annual IHEA WA Special General Meeting. Bethesda Hospital is an independent, acute surgical and specialist palliative care hospital situated on the stunning shores of Perth’s picturesque Swan River, overlooking tranquil Freshwater Bay in Claremont, home to boats and yachts that would do a 1st division lotto win justice. The meeting was opened by host and Committee of Management member Philippe Tercier. Philippe welcomed members and introduced Deborah Bell, Executive Manager Clinical and Support Services. Ms Deborah Bell welcomed members to Bethesda, acknowledging the Aboriginal Elders past and present. She went on to explain the cultural and operational aspects of Bethesda Hospital. Deborah and Phillipe

BRANCH REPORTS

Mr Peter Klymiuk then presented the President’s report, followed by Mr Fred Foley with the Secretary’s report. Mr Rohit Jethro, the state Treasurer, delivered an innovative financial report. With the formalities completed, the President called upon Mr Roy Aitken to take the chair of the meeting, and to dissolve the 2018/2019 WA Branch Committee. Roy then proceeded to oversee the nomination and election process of the 2019-20 Committee of Management. The elected IHEA WA Branch Committee Members for 2019/2020 are: Role Elected

Upcoming IHEA WA Events • September - John Pereira, from Serco, will host the branch meeting at Fiona Stanley Hospital. The meeting will be held on Thursday 6th September, and will focus on an investigation undertaken by John Pereira resulting in recall of a Nitrous Oxide/ Oxygen (N2O/O2) Blender, and the journey with the Therapeutic Goods Administration (TGA) of Australia. • October - There will be no Branch Meeting in the month of October. The focus will be attending and supporting the National Conference. • November - The Branch Meeting will be in the form of the annual social event for members and partners. The 2019 WA Branch Achievement Awards, for the categories Tradesperson, Apprentice and Facilities Manager/Engineer of the year, will be awarded on the night.

President

Mr Peter Klymiuk

Vice President & Secretary

Mr Fred Foley

Treasurer

Mr Rohit Jethro

Immediate Past President

Mr Greg Truscott

Membership

Committee Members

Mr Alex Foster

WA branch continues to undertake a country membership promotion for 2019/2020, working with Country Regional Managers to grow our country membership base.

Mr Philippe Tercier Mr John Bose Mr Yuri Deans Mr Darryl Carter Mr Leif Jensen Mr Andrew Waugh Newly elected WA CoM

It was very encouraging to have a good number of country delegates attend the State Conference, encouraged by Dave Bower. WA IHEA welcomed 5 new members in the last quarter. Acknowledgements I would like to thank the Committee for all the good work and contributions they have made over the past 12 months, delivering 8 Branch Meetings, 2 Country Conferences (Karratha and Manjimup), and the recent State Conference, and for their collective decision to continue on the Committee. I would also like to thank the newly elected members, Mr Yuri Deans, Mr Darryl Carter, Mr Leif Jensen and Mr Andrew Waugh. I am sure Yuri, Darryl, Leif and Andrew will find this a rewarding experience, as will the entire committee, who will be no doubt benefit from the experience and enthusiasm they will bring to these roles..

The meeting ended with members enjoying a fine selection of nibbles and light refreshments, whist networking.

To contact the WA Branch please email ihea.wa@ ihea.org.au Peter Klymiuk WA Branch President

BRANCH REPORTS

VIC/TAS BRANCH REPORT Victoria Tasmania Branch Activities for 2019

ebinar 1 – 26th June 2019, Biofilm Controls at Basins Following the direction that members are too busy to attend PD days Vic / Tas is embarking on a series of webinar sessions, that the entire membership can log into for professional development. The inaugural webinar was presented by Vanessa Beever, Gentec Australia State Sales Manager, 26 June 2019, we had 15 Members and visitors tune in, and two membership follow ups post the event. PD 2 12th August 2019, Northern Hospital, Victorian Health and Human Services Building Authority Hospital Design Guidelines review / Northern Hospital Intensive Care Unit tour Local Engineering Manager Colin Woodward hosted the branch meeting, 18 attendees

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participated in an interactive session reviewing the content of the draft design guidelines presented by Simon Witts LCI the session concluded with a site visit to the New Intensive Care unit at Northern hospital, 12 beds opened in March 2019. Northern Hospital is in a growth corridor of Melbourne with one of the busiest emergency departments in Australia. PD 3 – Greening he Healthcare Sector Forum, Monday 23 & Tuesday 24 September 2019, Sunshine Hospital, this is a joint run forum with Western Health and IHEA, Monday sessions are targeted towards Facilities Managers and Engineers, the day will be coordinated by IHEA PD 4 – Site Visit (Non health, possibly Metro Tunnel Project) date to be determined Future Webinar Topics • How to use the Zoom video conferencing product • Craig Marshall to be approached to present on sustainable controls • Approach previous conference presenters to carry-out a webinar off their existing presentation • Implementation of the new AS4187. Challenges, ideas • Maintenance of complete back up power systems, UPS, ATSs, Generators • Communicating with medical staff about their systems, i.e. how many know the difference between red and blue power points, what a WIP phone is, how do we inform them? • Certificate of Occupancy for dummies. What does this mean, can it be modified, what I need to do • Height safety systems, anchor points, walkways, ladders. How do we use them? How do we maintain them? • Disinfection of water systems following detection of bugs • Duct cleaning, why, how often, by who? • How does an isolation room work? What do I need to do to keep it working? • Members area of IHEA website • Mind map of a Facilities Manager Membership Growth Opportunities Committee of Management have agreed to fast track an active campaign to grow branch membership linked to 2019 PD sessions & webinars. Improving membership. Establish a project to complete the following points, including use of secretarial support to carry out the work.

BRANCH REPORTS

(We have had preliminary discussions with Heidi who has state knowledge to complete the project)

Victoria / Tasmania Branch

Committee of Management

ihea.victas@ihea.org.au

Branch President

Michael McCambridge

Melbourne Health

Branch Secretary

Peter Crammond

Wimmera Health Care

Branch Treasurer

Steve Ball

Epworth Geelong

CoM

Howard Bulmer

Macutex Property

CoM

Sujee Panagoda

Monash Health

CoM Meeting Convenor

Simon Roberts

CETEC Consultants

CoM

Mark Hooper

Echuca Regional Health

Branch Committee of Management

CoM Communications

Roderick Woodford

Castlemaine Health

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

Nation Board Reps

Michael McCambridge Mark Hooper

Melbourne Health Echuca Regional Health

COM Elections structure for 2019 / 20 in the table opposite.

Note Steve Ball will be replacing Michael McCambridge on the Board at the October AGM.

1. C reate a state based list of all health facilities Public Hospitals, Private Hospitals, Aged Care, and Public Private Partnership Facilities Managers 2. U pdate CEO letter of introduction & include forthcoming events including Sydney conference 3. C ommence mail e-journal, e-bulletin out to all health service CEO, cc Facilities Manager, Engineer for 2019, and measure the increase in participation / membership.

Michael McCambridge – VIC/TAS Branch President

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BRANCH REPORTS

SA BRANCH REPORT New Committee

he SA branch welcomes a newly elected management committee this year. In particular, we welcome the involvement of new committee members Daniel Romeo and Andrew Russell. At the same time we thank outgoing committee member Michael Frajer. My personal thanks also goes to Peter Footner who has stepped down as branch President after serving the committee well in this capacity for an extensive period. Peter’s experience is invaluable and he continues to serve as Secretary and Treasurer. The following Committee Members has been elected to serve the SA Branch: Position

Elected

President

Michael Scerri

Vice President

John Jenner

Treasurer & Secretary

Peter Footner

National Board Rep

Peter Footner (to October) Michael Scerri (from October)

Committee Members

Richard Bentham Tony Edmunds Ross Jones Darryl Pitcher Daniel Romeo Andrew Russell Vince Russo

Events The new committee has met on a number of occasions since the State special meeting in June to consider membership retention and growth strategies and financial management. The group has also committed a significant portion of time to planning a raft of professional development and networking events for the forthcoming year. In particular, we are in the process of confirming event dates for the following events: • Calvary Adelaide Hospital - members will be able to experience the largest private hospital ever built in South Australia before it opens to the public! The $300 million Calvary Adelaide Hospital in the

Angas Street, Adelaide will be the biggest and most comprehensive private hospital ever built in South Australia and is predicted to redefine the quality and excellence of private hospital and health care in this state. • Office of the Technical Regulator - members will have the opportunity to meet the regulator and hear about its compliance roles and responsibilities. • The Future of Patient Safety Technologies members will be given a glimpse into the future of nurse call and patient safety systems, including a consideration of regulatory needs, emerging technologies and their impact and benefit on our healthcare facilities. • The New Year is also anticipated to see presentations on water quality issues and emerging treatments, the opportunities that temporary theatre buildings present to new builds or refurbishments, pre-cooling systems and their potential to reduce energy usage and operational costs, as well as featuring a visit to the Royal Adelaide Hospital. • Through our CIBSE partnership, we are also offering events on thermal storage projects and Building Information Modelling (BIM) for post-occupancy and maintenance. State Conference Of key note for the 2020 event calendar, the SA branch is in the early stages of planning for a potential State conference. The conference would likely be held in a regional centre in the second quarter of 2020. We would be keen to hear from organisations that are interested in sponsoring part of the event. Look out for more information on this exciting initiative in the next journal! Congratulations We also congratulate two SA Branch members Matthew Kennedy and Richard Bentham who were selected to present technical papers at the upcoming National Conference. We look forward to their contribution in Sydney. Michael Scerri President, SA Branch

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BRANCH REPORTS

NSW/ACT REPORT

ANZEX

Events

lanning is now confirmed for next NSW Professional Development Day. The event will be held at the John Hunter Hospital on the 29th November 2019. Theming for the day will be around Fire Safety and associated issues, with speakers locked in from SafeWork NSW, FM Global, NSW Fire and Rescue. This is an excellent opportunity to gain some insight into a very important element within healthcare facility management. We are looking forward to a great event and are looking forward to good support. Detailed programs listing the day’s itinerary and accommodation options will be distributed to members later this month.

The ANZEX delegate for the IHEA 2019 national conference from NZIHE is confirmed as Michael Brown from Christchurch Hospital. Michael will be visiting several of our large Sydney metropolitan hospitals as well as sitting in on the National Board meeting. Rob Arian (the current NSW state president) will be attending the NZIHE national conference on behalf of the IHEA. The NZIHE event is being held in New Plymouth in November. AS2896 Medical Gases IHEA NSW CoM member Mal Allen has attended several meetings with the Standards Australia working committee. These meetings which have been discussing public comments on the draft publication recently circulated, noting the process has had to deal with over 500 comments.

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Given the large number of responses the review is ongoing and draft will be sent out again for further public comment, the revised standard is anticipated for finalisation by end of 2019 Membership Interest from both industry groups and health facility management practitioners is increasing and it’s been great to see some new corporate members joining recently. The CoM is discussing a variety of strategies on an ongoing basis. To contact the NSW Branch please email ihea. nswact@ihea.org.au – we look forward to engaging with you at the National Conference in Sydney in October and during the upcoming branch activities.

NSW Committee of Management Name

Position

Robin Arian

President

Jason Swingler

Vice President

Mal Allen

Treasurer

Marcus Stalker

Secretary

Jon Gowdy

CoM

John Miles

CoM

Dean Benke

CoM

Darrell Milton

CoM

Greg Allen

CoM

Jon Gowdy – NSW State President Director Engineering Services SLHD MIHEA

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ACOUSTIC SEPARATION IN HEALTHCARE FACILITIES By Attila Szabo, Director of Polyvox Sound Masking – Associate Project Consultant at SLR Consulting

This article is aimed to present a Focus Study on specifically the acoustic separation and privacy elements of acoustic design in healthcare facilities. It is aimed to be an educational article for use by Acoustic Engineers, Architects, Project Managers and other stakeholders in healthcare projects.

here are a number of considerations making acoustic design of healthcare spaces unique. This article will help Acoustic Engineers understand what guidelines are present, and what needs to be considered while designing a space. It will explain possible construction paths and the benefits of each to Project Managers and Architects. It will also help any other stakeholders in healthcare projects to understand the acoustic concerns within a healthcare environment, and make better informed decisions on their projects/facilities. Healthcare projects are more complex than your typical Building Acoustic project. The environment is a lot more dynamic than a standard Office environment. There are a large number of spaces with completely different functional requirements, which place huge limitations on your typical Acoustic Treatment. There are some basic variations from the normal acoustic project, such as noise from Emergency Helicopter flights, emergency vehicle access, higher levels of noise within certain hospital spaces, higher range of noise level fluctuations due to the dynamic environment within Hospitals. Your Acoustic Engineer or designer can take these considerations into account and present you with a functional design. It is important however to put together a team that understands the intricacies of the healthcare environment: • Infection Control measures • Sterilisation and cleaning requirements of surface finishes

• Pressure differential requirements within certain spaces • Information and Communications Technology • Medical Gas Systems Any typical team will be able to put a design together that ticks all the required boxes, and meets all commissioning requirements. But piecing together an experienced team will allow you to meet all these requirements, while also creating an environment that works cohesively and is wholesome, all while saving time and money for stakeholders in the project. If we look specifically at the Acoustic Design of a space, did the Engineer just tick the boxes required for commissioning (Background levels and Reverberation), or has Speech Privacy been considered within the space? There are effective solutions to create a private environment, WHILE maintaining all infection control requirements within spaces. Paying more attention to privacy in hospitals and how it can be achieved will allow designers to: • Minimise full height walls thus avoiding complicated penetration details • Provide a steady background noise level maintaining privacy at all times • Reduce sleep disturbance in wards by adding sound conditioning

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An extract from the NSW Government Health Infrastructure Guideline Engineering Services publication dated 26th August 2016 (replaced the TS11 Technical Series Engineering Services Guideline) states‘Acoustic design is fundamental to the quality of healthcare buildings. There is a growing body of clinical research that shows that better acoustics leads to improved health outcomes. Well-designed, high quality spaces have been shown to facilitate a reduction in the use of analgesics, improved patient recovery times, increased staff efficiency and reduced staff turnover’. It is clear that during typical Commercial project Value engineering phases, acoustics is often the first design element on the list to be reviewed in hope of scrapping elements to save costs. However, this cannot be done in a Healthcare Environment. It is very clear that proper Acoustics in Healthcare Environments is critical. When designing the sound isolation rating of a partition, we must consider the following: • Speech privacy requirements of the spaces • Flanking paths above, below and through the partition

Also from the Health Infrastructure Guideline, the Table below illustrates the linear dependence of speech privacy on both sound insulation performance and background noise levels. Typically when designing spaces, the Acoustic Engineer understands that the background noise levels are reliant on air conditioning noise. This has to be designed for. However, since mechanical equipment noise fluctuates with loading, duct-work construction, airflow turbulence etc, a factor of safety has to added when designing for privacy. The consultant might recognise the Privacy Rating between two spaces is required to be Confidential, with a Privacy Factor target of 85. The Acoustic Isolation requirement can be deduced as follows:

• The composite sound isolation performance • Background noise level in the receiver room Acoustic privacy is typically quantified using the following ‘Privacy Factor’, which is becoming more prevalent in relevant Guidelines and Documentation (such as British Standards, Australian Standards, Green Start Rating Guidelines, Health Infrastructure Guidelines etc). A higher subjective privacy is represented by a higher Privacy Factor number: Privacy Factor = Background Noise Level (LAeq) + Partition Performance (Dw rating) Speech privacy levels are defined in the Health Infrastructure Guidelines as below:

The alternative is to use sound masking (aka sound conditioning) to set the background levels at 40 dBA permanently, or even to the upper end of the proposed background noise level range (with confidence). This would result in removing our Factor of Safety as background levels are fixed, thus resulting in only needing a Dw 35 isolation performance compared to Dw 40 if we are relying on mechanical background levels. The difference between these 5 performance points can be substantial! If we look at the difference between a typical Dw 35 and Dw 40 wall, we can see how much difference there is.

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The benefits can be seen clearly. Utilising a sound masking system to give you confidence in background noise levels allows you to run less walls full-height, remove layers of plasterboard on certain walls, save costs associated with penetration detailing through the full-height section of walls, all while providing a STEADY and SECURE background level and thus privacy level between spaces. The critical point to remember is that there are limitations on construction in a healthcare environment. A number of relevant points extracted from the â&#x20AC;&#x2DC;Australasian Health Facilities Guidelines- Part D Infection Controlâ&#x20AC;&#x2122; to be considered during Acoustic design are listed below: 880.1.05- In healthcare facilities, all surfaces in patient care areas should be smooth and impervious, and easily cleaned. Avoid unnecessary horizontal, textured, moisture-retaining surfaces, or inaccessible areas where moisture or soil can accumulate. 880.2.00- Finish all exposed ceilings and ceiling structures in areas occupied by patients or staff, to ensure that these can be readily cleaned with equipment used routinely in daily housekeeping activities. 880.2.05- Except in areas required to support ceiling mounted equipment such as radiology rooms and inpatient units with ceiling hoists provided, set plasterboard ceilings from wall to wall without fissures should be provided. Note that open joints or crevices may retain or permit passage of dirt particles in operating rooms, birthing rooms, positive and negative pressure isolation rooms, nurseries, and sterile processing rooms. Ensure that light fittings are recessed, flush fitting and designed to prevent dust build up on the surfaces of the fitting, and to prevent ingress of dust. 880.2.10- Acoustic and/or lay-in ceilings where particulate matter may interfere with hygienic environmental control should not be used, for example in acute ward setting. It should be noted that typically in these spaces, acoustic absorption cannot be utilised to control the reverberant sound level. This combined with the fact that these wards are open spaces where privacy and sleep disturbance are critical, means other acoustic measures have to be taken to create a satisfactory space.

Speech privacy is critical in wards where there is no isolation between patients. In these circumstances, privacy relies purely on background noise levels. There are solutions available that allow sound masking technology to be used in set plasterboard ceilings without cutting through and causing infection control issues. This allows Polyvox to provide higher levels of Privacy and limit Sleep Disturbance, all while the requirements of 880.2.05 and 880.2.10 of the Infection Control Guidelines are still met. The LogiSon Acoustic Network transducers are fixed to the top of set plasterboard ceilings and produce the same sound as a standard speaker, without penetrating through the plasterboard. In Conclusion, stakeholders on projects need to make sure the design team understands intricacies of the project, that are specific to the healthcare environment. There are limitations on the number of acoustic treatments that are available due to Infection control driving the design. But it is important to remember, there are definitely solutions out there that allow you to achieve Acoustic targets, even with difficult constraints like in surgeries and open wards. Privacy is a critical concern in these environments, and should be addressed from the beginning of the design process. The benefit of paying more attention to this detail is prevalent in the construction simplification and savings from reducing wall build-up and full-height partition instances. Contact Polyvox Sound Masking today to discuss how we can work with your Acoustic Consultant or design team in providing an effective solution- that benefits all stake holders involved in your project.

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LACROSSE DECISION – WHAT DOES THIS ALL MEAN?

By Bronwyn Weir, Managing Director at Weir Legal and Consulting Pty Ltd

here have already been many articles written about the outcome of the VCAT proceeding concerning the fire at the Lacrosse tower in Docklands in back in 2014. Judge Woodward delivered his 227 page decision this week which dissects the practices of key practitioners in the building approvals process with masterful precision providing the industry with much needed legal authority and putting an end to the finger pointing - at least for now. Whilst the decision makes it clear right up front that the findings apply to the facts in this particular case, it will nonetheless give a great deal of clarity to all practitioners about what the courts expect of them and where they might stand in relation to disputes about combustible cladding rectification going forward. If there is a win to be had from all this it is that this decision gives the industry an opportunity to learn from its mistakes and change the way that it does it job. In this article I am not going to go over the facts of the case or the outcome of the decision in detail. Instead, I am going to share my thoughts on what this means for the key practitioners involved.

BUILDERS For builders, on first blush, this decision may look like a win. The Tribunal found that although the builder was in breach of the statutory warranties that apply to all domestic building works in Victoria, it was not negligent. The builder was primary responsible but is entitled to have 97% of the damages payable to the owners reimbursed by the fire engineer, building surveyor and architect. The builder will pay the 3% of damages attributed to the occupier that smoked the cigarette that started the fire. The Tribunal accepted the evidence of the builder that at the time that the non-compliant ACP was installed, it did not know that these panels were a fire risk and it was entitled to rely on the advice of the 3 consultant experts.

However, the following passage from para 308 should be noted: That is not to say, of course, that a substantial commercial builder like LU Simon is inoculated against a finding of negligence, so long as it can show that it complied with the specifications and instructions given by other building professionals. Clearly its expertise and experience is such that there will be many instances where it would be reasonable to expect it to identify errors by another building professional. The case law is replete with examples of this. But where (as here) the skill involved is beyond that which can be expected of a reasonably competent builder and there is no actual relevant knowledge, I consider that LU Simon’s relationship with each of the other building professionals is analogous to that between a developer and a building professional. Builders should take from this that the law expects a reasonably competent builder to question errors or anomalies that they detect in building plans and other documents. Further, the expected knowledge of builders will change over time. For example, a court may be much less likely to make the same findings about builder where ACP was installed on a building after the Lacrosse fire, when all of the industry (in Victoria at least) became acutely aware of the fire risks associated with ACP.

ARCHITECTS The architect made several arguments in their defence of the matter. They gave evidence that at the relevant time, they were not aware that ACP products were a fire risk. They argued that despite the words in their consultancy agreement, the builder had assumed all responsibility for the design when it was appointed by the developer. They argued that although they had specified the use of ACP by referring to ‘indicative to Alucobond’ in the drawings, the builder could have chosen any product in that range including products which were more fire resistant that the 100% PE product that was chosen. In addition, the builder substituted Alucobond for Alucobest. The architect said even though an Alucobest sample was submitted to the

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architect and approved, the approval only related to the colour and look of the product. Finally, the architects argued that one or more of the fire engineer, building surveyor or builder were responsible for ensuring the cladding was complaint with the BCA and it is not the responsibility of an architect to be aware of these things. All of these arguments failed. Whilst the Tribunal accepted that of the 3 consultants, the architects were the least responsible for knowing that most ACP products used at the time would not comply with the BCA, it nevertheless found that the services the architect agreed to provide under its contract included the preparation of contract material in a manner consistent to satisfy the legislative requirements which included the BCA. The upshot of this for architects is that subject to the terms of their consultancy agreements, the courts do expect them to prepare drawings and documents that demonstrate compliance with the BCA. Whilst it would be good if other designers or the building surveyor picked up and corrected aspects of the architect’s design which did not comply with the BCA, if they don’t this won’t get the architect off the hook. Taking that one step further, everyone in the chain is expected to do their job properly. Architects need to understand the BCA and produce documents that will comply with it.

BUILDING SURVEYORS I begin by noting that the Tribunal found that the use of ACP on the balconies of the Lacrosse building was not compliant with the BCA. It rejected arguments from the building surveyor that the product was a ‘bonded laminated material’ within the meaning of C1.12 of the applicable BCA at the time. At paragraph 207 Judge Woodward states: In summary, a “bonded laminated material” can be expected to comprise a bonding material (adhesive) and two or more laminates. C12.1(f) is plainly seeking to deal in express and precise terms with the potential combustibility of each of these elements. Combustible adhesive is permitted up to a maximum thickness of 2mm. But each of the laminates (including the polyethylene laminate) must be noncombustible. The building surveyor had initially also argued that the ACP was complaint because it was used as an ‘attachment’ as set out in clause 2.4 of Specification C1.1. Ultimately the building surveyor abandoned this argument conceding that it was not arguable that the ACP met clause 2.4 in this case. Despite this, there is a

discussion of clause 2.4 at paras 271 to 278. In the end, Judge Woodward notes that the various assertions by the experts for the building surveyor about common interpretations of clause 2.4 that prevailed at the time lacked ‘any real analysis of how or why this approach was justified.’ (para 278) The building surveyor went on to argue that even if the use of ACP on the Lacrosse building was not compliant, it was common industry practice for building surveyors to approve its use in this way at the time and therefore the ‘peer professional opinion defense’ available under s 59 of the Wrongs Act 1958, applied. Judge Woodward found that building surveying was a ‘profession’ to which this defence could apply. He accepted that it was a uniform practice for building surveyors to treat this product as a ‘bonded laminated material’ thereby approving its use as a deemed to satisfy (DTS) solution. However, he said there was no logic in that practice and therefore the Wrongs Act defence did not apply. At para 388 Judge Woodward says his general impression of the evidence from the building surveyor and his 3 experts was: that otherwise experienced and diligent practitioners were beguiled by a longstanding and widespread (but flawed) practice into giving insufficient scrutiny to the rationale for that practice. There was a discussion about whether the changes to the BCA since the Lacrosse fire were evidence that the use of ACP was complaint at the relevant time. At para 378 the Judge states: In this context, each of the Gardner Group Experts put significant store in their evidence in the ABCB’s decision since the Lacrosse tower fire to amend BCA C1.12(f) (which is now found in BCA C1.9(e)(vi)). For example, Mr Leonard asserts in his report that an advisory note foreshadowing this change confirmed that the ABCB was “well aware that clause C1.12 BCA was being interpreted in a manner that permitted the use of ACP with a combustible core”.611 In my view, the Gardner Group Experts overstate what conclusions or inferences can be drawn from the change. At most is shows that at some point (probably after the fire), the ABCB became aware of the Relevant Practice. Moreover, the explanatory note expressly states that the “clarification was made to prevent the incorrect interpretation” of the concession in C1.12(f) (emphasis added). The Judge’s discussion of the building surveyor’s evidence was lengthy. He noted at para 349 that the building surveyor ‘probably believed that ACPs were BCA complaint but had not undertaken a robust or

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critical analysis, investigation or inquiry to determine this.’ He said that the surveyor had adopted an unreasonable construction of A2.2 and C1.12 in the context of the BCA as a whole and that he wrongly relied on the test certificate alone in circumstances where the ACP was to be used in continuous vertical run and as part of unsprinklered balconies. Ultimately the court found the building surveyor had been negligent in issuing the relevant building permit and had also engaged in misleading and deceptive conduct under the Australian Consumer Law. The message for building surveyors is clear. Applying DTS is not a tick box or paper collection exercise. The courts will expect building surveyors to undertake a reasoned analysis of the proposed design having regard to the context of the BCA as a whole even where DTS solutions are used. The clear intention of the BCA is to provide for public safety and amenity. This is what the community expects. That is the lens through which the BCA must be interpreted at all times. The court noted that the building surveyor had

no contemporaneous notes or memory of what he actually did when considering the proposed use of ACP for this building and that even with hindsight, his justification for approving the use of ACP whilst genuine, lacked logic and common sense. Building surveyors are expected to apply logical reasoning to their decisions and should document that reasoning so that their decisions are transparent.

FIRE ENGINEERS The fire engineer and all of the experts for all parties that were fire engineers, said they were aware at the relevant time that ACP with a 100% PE core was a fire risk and did not comply whit the DTS provisions of the BCA. Despite this and despite the fact that the fire engineer admitted that he was aware that ACP was proposed for use on the building, he argued that it was not his role to question the use of ACP. Further, he argued that he had discharged his duties because his report provided that ‘Unless otherwise noted, external areas (e.g. balconies, eaves, overhangs etc.), which comprise non-combustible construction, need not be sprinklered.” The Judge rejected these arguments. He noted that the fire engineer had not followed the requirements in the International Fire Engineering Guidelines (IFEG). He said the IFEG required the evaluation of the structure and construction materials early to establish potential fire hazards for the building which had not been done in this case. The Judge also noted that the various versions of the Fire Engineering Report (FER) gave an incomplete description of the materials to be used in construction making no reference to the use of ACP. This included the fifth version of the FER that formed part of the documents approved by the building surveyor and was submitted to the MFB for its report and consent. He said the FER referred to an outdated edition of the IFEG and contained ‘boilerplate’ language. He states at para 487

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My impression generally of Thomas Nicolas’s approach to the FERs and other documents, was that there were a number of instances of the use of template or “boilerplate” language (as well as reference to out-ofdate guidelines), without much attention being given to what the words actually meant or required. Thomas Nicolas is, of course, not alone in this. It is often the case that diligent and competent professionals blithely reuse standard documents that have served them well over the years, focusing only on those parts that need to be tailored to each job. It is only when something goes wrong and the lawyers become involved, that any real

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attention is given to how that boilerplate language informs potential liability. The fire engineer argued that notwithstanding the terms of his consultancy agreement required him to undertake a ‘full engineering assessment’, this was not his actual role. At para 480 it says Thomas Nicolas opened its case on the basis that “it was never expected that the fire engineer would have the role of going through architectural drawings and identifying possible non-compliances”. 737 Rather, the role of the fire engineer was limited to responding to the alternative solutions or “deviations from the DTS provisions” identified by the “Authority Having Jurisdiction” (namely, in this case, Gardner Group). The Judge said the fire engineer’s understanding of his role was at odds with the services he’d agreed to provided under his consultancy agreement. At para 481 the Judge says The obligation may not have extended to undertaking “never ending searches…for noncompliances”. But it at least required some proactive investigation and assessment of the principal building materials.

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Ultimately the court found the fire engineer had been negligent in undertaking his services and had also engaged in misleading and deceptive conduct under the Australian Consumer Law. The decision confirms that subject to the terms of a consultancy agreement, the courts will expect fire engineers to undertake an assessment of the building as a whole when performing their role. Judge Woodward found that of the 3 consultants, the fire engineer was the consultant that was relied on the most to question the proposed use of ACP. He said that the notation in the FER that the external areas be of non-combustible construction was not sufficient to discharge his duty. To the contrary, in circumstances where the fire engineer knew that a combustible product was proposed to be used on the balconies, he should have done more to object to that use or to propose a design that would accommodate the use of the product in accordance with the BCA. (see para 483) As a consequence of these findings the fire engineer received the highest apportionment of damages at 39%.

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he WaterLink Spin Touch™ is the most advanced system for the precise use of wet chemistry ever. Water analysis no longer has to rely on time consuming tests and clean-up procedures. It’s very easy and simple to use with no vials to fill, no prep time or guessing involved. The test results are available quickly, and with the release of the testing of potable and industrial water, is now made just as easy as pool and spa water. All the user has to do is fill a sealed reagent disc which contains the precise amount of reagent needed to run a complete series of tests. The user places the disc in the meter, taps “start” and all results are shown via the touch screen. All that is needed is less than 3 ml of water and the vital tests are done automatically—in just 60 seconds! With a built in lithium ion battery, there’s no need for a power connection either. The meter is truly portable for out in the field. Test results are displayed on the touch screen, which can also be transferred via Bluetooth to mobile apps and then to WaterLink Solutions for instant analysis, with step-by-step treatment instructions supplied. Test history is then stored via Cloud database for real time monitoring.

Reagent discs have up to 11 test parameters per disc. Parameters cover Chlorine/Bromine, Chlorine/Bromine plus Phosphate, Chlorine/Bromine plus Borate and Biguanide plus Borate, as well as pH, total alkalinity, total hardness, Calcium hardness, Cyanuric Acid, Copper and Iron. The new industrial discs also test for total iron, ferrous and ferric iron, nitrate and nitrite.

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BOC: Living healthcare BOC is a trading name of BOC Limited, a member of The Linde Group. © BOC Limited 2019. Reproduction without permission is strictly prohibited. Details given in this document are believed to be correct at the time of printing. Whilst proper care has been taken in the preparation, no liability for injury or damage resulting from its improper use can be accepted.

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IMPROVING CRITICAL FIRST-AID RESPONSE AT TIME OF DISASTER AN EMPIRICAL ASSESSMENT By Kana Egawa

INTRODUCTION

n Japan, seismic hazards occur frequently. Thus, establishment of a set-up method that accommodates large numbers of casualties at medical first-aid stations is desired. Many municipalities have plans for installing medical first-aid stations in public facilities such as hospitals and schools. A medical first-aid station first triages casualties, and then moves each individual to the appropriate area for treatment. The set-up and management procedures for medical first-aid stations must be established immediately so that they can be implemented smoothly during a disaster. Thus, we repeated an investigation that analysed set-up and management methods, and created a manual based on the results. We also considered casualties predicted at the time of a seismic hazard.

RESULTS The manual of first-aid medical station in school To determine an optimal set-up method, we asked 15 doctors and nurses specialising in disaster medical treatment to set up a first-aid medical station in a school using a model. Afterwards, they were asked for feedback about each area. All interviews were recorded, and the responses were collated. The results revealed both undesirable and useful floor layouts and furniture to consider when selecting a location. We summarised these in the manual. We designed a medical-first-aid-station disaster scenario in order to conduct this research using a model experiment. To allow respondents to easily imagine the scenario, we referred to the contents of the disaster prediction manual and medical firstaid set up of a hospital in Tokyo A ward where the respondents worked. According to A ward’s local plan for disaster prevention, the potential for the highest number of injured occurs at 12:00 p.m. on winter days, and that number is predicted to be 7,163 persons (of which 894 would be seriously injured). Currently, ten schools are specified as medical first-aid

stations in A ward. We created a scenario in which about 720 persons (including 90 serious injuries), which is the total number of predicted casualties divided by the ten medical first-aid stations, required treatment over the course of the super-acute 72-hour period of a disaster. In the resulting manual, we summarised the results of this experiment. On the 1st and 2nd pages, there is a summary of matters for consideration at the time of setting up a medical first-aid station. We indicated specific matters for certain areas that require careful consideration. In the triage area, which determines a casualties’s priority, key points include “Easy-tonavigate installation near the main gate”, “Avoidance of a location that overlaps with the flow line of persons accessing the shelter”, “Selection of a position that is barrier-free and can be easily accessed by all casualties”, “Securing sufficient space for ease of patient transportation in and out of the area and for a waiting area”, and “Consideration of a position that allows easy conveyance to the red area, which deals with casualties in serious condition”. In the red area, which provides medical examination and treatment for the highest priority casualties, key points include “Conveyance from the triage area, and securing an entrance that allows direct vehicle access for conveyance out”, “Secure space for patients, either on beds or on the floor, which allows access for treatment”, “Choice of a room where the furniture is easy to move or which has little furniture”, and “Requirement of a place equipped with a water supply and a hot-water supply system”. We included examples of layouts of rooms for medical treatment on the 4th page, and examples of arrangements for all rooms the 5th and 6th pages. Examples of medical first-aid station arrangement in schools In A ward, participants performed training that assumes acceptance of casualties by schools

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specified as medical first-aid stations. Here, we introduce two examples. In the first example, a plan to carry out triage in front of the entrance was considered. First, those who could walk at the time of initial triage were guided to a green area (minor casualties), which was not crowded. However, it was pointed out during training that the size of the green area may be insufficient when there is a high volume of casualties. Next, in the green area, a detailed triage was carried out and patients were cared for. Since chairs were arranged in a grid pattern and casualties sat freely in any vacant space, it was pointed out that midway through the training it became difficult to distinguish between patients who had been triaged and those who had not. Moreover, it was unclear where patients should go after medical examination or treatment. For the yellow (moderate) and red (severe) areas, the passageway in front of a classroom was made into a medical examination and treatment area. After training, it was pointed out that this area overlapped

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with the flow line, making it hard to use. For this reason, it was thought necessary to work with the school to allow the use of classrooms from now on. The school in the second example has many different levels near its entrance, and, on the whole, the inside and outside of the buildings are used as a shelter for the area. For this reason, although the school is specified as a medical first-aid station, a vacant space at the front of a neighbouring construction company building has been designated as the triage and green areas. Since a hospital is located on the opposite side of the road, when casualties are triaged as red or yellow, they are sent across the road and taken care of in the hospital. Thus, adapting to the surrounding environment, the school and the hospital are each utilised as resources, providing an example of local cooperation. Examples of medical first-aid station arrangement in hospitals Here, we summarise the results to date of our investigation of the arrangement situation of medical first-aid stations taking in casualties at hospitals, and we introduce 2 cases. In the first example, casualties and others were classified at the main gate of the hospital. This is to prevent those merely seeking shelter and casualties who do not require hospital-level medical attention from entering during a disaster when the hospital is crowded. Moreover, since there is a high possibility that many casualties with minor injuries or illnesses will also visit the hospital, a green area was established outside the hospital with the intention of avoiding confusion in the building. The green and triage areas are adjoining, making them easy to navigate without assistance, thus allowing more staff for the yellow and red areas, where casualty priority is higher. Furthermore, the placement of the green area near an entrance other than the main gate makes it easy to guide those who are going home. Inside the hospital, the Emergency Department is used for the red area and the Outpatient Department is used for the yellow area. One factor that must be considered is that children and a pregnant women are classified differently than other casualties; thus, in this example we see that the concern is less with urgency and more with setting up additional medical examination areas. In the second example, all areas, including the triage area, are coordinated together inside in consideration of the weather and other conditions. It has been taken into account that disasters occur not only during temperate weather, but also during inclement or harsh weather. For this reason, this plan gives priority

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to the triage and medical treatment of casualties being done in the same position regardless of the situation. In this example, the red area, the yellow area, the green area and the black area (death group) should be in neighbouring positions in order to allow cooperation between health professionals in each area, making it easier to coordinate movement of casualties as their conditions change. In an area screened from the wind at the entrance of the hospital, casualties can wait separately from other persons. The triage and yellow areas are established in the entrance hall. Oxygen lines are already installed in the entrance hall as an emergency measure for taking in mass casualties, thus this space can be used for the yellow area. In addition, supplies for the yellow area are stored nearby, making it easy to access the supplies required to set up the yellow area, and it can be arranged with little manpower in a short time. However, even if there is little damage to or in a building, at the time of a seismic hazard, the elevators stop, and it takes time to restore them. Therefore the use of elevators is often impossible during the superacute period of a disaster in Japan. For this reason,

in this example, a temporary ward is installed on the first floor in consideration of the possible difficulties involved in movement to wards of upper floors.

CONCLUSION Here, we clarified prediction of the number of casualties for medical first-aid stations at the time of a seismic disaster and completed a set-up manual for medical first-aid stations that will allow greater efficiently in carrying out medical treatment of casualties. We collated points of concern that were raised during disaster training scenarios, and we would like to use this feedback to improve our medical first-aid set-up manual. Moreover, since we have seen an example in which a school and a hospital cooperate, we would also like to clarify cooperation methods which would harness the merits of both. Appreciation of funding of this study from the Research Institute of Science and Technology for Societyďź&#x2C6;RISTEX) 2017ď˝&#x17E;2019.

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LADY CILENTO CHILDREN’S HOSPITAL PRECINCT-BASED ENERGY TRIGENERATION – THE LARGE HOSPITAL EXPERIENCE

By Michael Campbell, Senior Director Facilities & Capital Infrastructure, Children’s Health Queensland

Abstract: Clinical healthcare delivery is transforming with integrated electronic medical records, increasing digitisation of clinical processes and innovative clinical solutions. In a similar transformation, healthcare asset infrastructure at Children’s Health Queensland is using digital twins to accurately model the performance of the advanced trigeneration energy plant. Digital twin modelling enables real-time comparisons of the relative benefits and costs of tri-gen operations to optimise and adjust the functioning and operation of the plant and equipment powering the healthcare precinct. Critical services and assets used in healthcare service delivery require 24/7 365 day energy and essential services supply in fluctuating market conditions. The Queensland Children’s Hospital precinct uses tri-generation plant year round to reduce the carbon footprint of major healthcare and research buildings in Brisbane, Australia. The hospital precinct is one of only a small number of large hospital sites world-wide to use such technology to supply lower-carbon electricity, hot water, steam and chilled water. The hospital precinct deploys digital ePlan solutions for building plans as well as completing advanced forward planning of statewide healthcare facilities and infrastructure to deliver care close to local communities. The ongoing transformation of healthcare service delivery in the digital age requires advancing asset infrastructure solutions and modelling to ensure healthcare and hospital assets deliver the required functionality and performance supporting these advancements.

INTRODUCTION

CH is one of only a few hospitals in the world with a Tri-generation (Tri-Gen) energy plant, powered by natural gas which provides energy to the QCH hospital precinct. In the Queensland context, we are a truly unique government and hospital business in terms of our energy generation capacity. The Tri-Gen energy plant uses the energy and latent heat (from the gas engines) to produce hot water and heating / cooling

(for air conditioning) which makes the hospital very efficient to operate compared to similarly sized hospitals powered using traditional electricity supply. The tri-gen plant currently operates 16 hours 5 days per week as it is more economic to run during these peak price hours rather than obtaining electricity from the electricity grid. Use of the tri-gen reduces the CHQ carbon footprint and greenhouse gas (GHG) emissions by about 20% in comparison to using electricity from the grid.

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CHQ has forward energy supply contracts procured through whole-of-Government processes. CHQ has been fortunate, that with careful planning, the current gas and electricity contracts are appropriately matched to the current energy demand profile of QCH, however continued work is required to adjust tri-gen operations.

OVERVIEW AND CURRENT OPERATION QCH is one of only a few hospitals in the world with a Tri-generation (Tri-Gen) energy plant, powered by natural gas which provides energy to the QCH hospital precinct. The QCH precinct has the capacity to be powered by the Tri-Gen (natural gas), electricity and diesel fuel (this capacity is referred to N+1+1). The Tri-Gen energy plant uses the energy and latent heat (from the gas engines) to produce steam, hot water and heating / cooling (for air conditioning) which makes the hospital very efficient to operate compared to similarly sized hospitals powered using traditional electricity supply. The QCH Precinct receives an electricity supply (through the energy plant) from the external electricity supply (grid) via two Energex feeders (this has previously been three feeders, however the hospital only ever requires one feeder for power). In addition, the precinct can be powered by the tri-gen gas generators (powered using natural gas) which can generate electricity and other services as by-products and as emergency back-up there are four diesel generators which are currently only used for standby power generation. CHQ has two tri-gen engine generators and only uses one engine at any time. This provides very good redundancy so that if one of the generators is out of service for planned maintenance, the second generator can be used to provide supply (the tri-gen engines can be brought into service in less than 10 minutes). Should mains power from the electricity grid be lost for whatever reason, or should the tri-gen units fail, the four diesel generators will supply the full electrical requirements of the QCH precinct (the diesel engines operate on a very fast timeline providing power in less than a minute to critical areas- in many cases there is a minimal loss of power). The tri-generation plant currently operates 16 hours per day 5 days per week (used between 07:00hrs and 23:00hrs) as it is more economic to run during

these peak electricity price hours rather than obtaining electricity from the grid. Use of the trigen units reduces the CHQ carbon footprint and greenhouse gas (GHG) emissions by about 20% in comparison to using electricity from the grid. The diagram on the right is a Sankey diagram which maps the energy throughput (this is shown in a larger form as an attachment to this paper) and shows the energy use average over a whole month. Without the power generation of the tri-gen plant, QCH precinct electricity demand (and costs) would more than double. Based on current operations, approximately 49% of QCH energy demand is provided from the tri-gen plant (averaged over a weekly period) with 51% supplied from the electricity grid.

OPTIMISATION OF THE TRI-GEN PLANT The tri-gen plant has settled into a reasonably optimised operation as far as providing adequate energy to the QCH precinct requirements. There is regular optimisation of complex plant and equipment which requires a diligent and balanced approach. This includes ongoing and regular tuning of the gas engines, load balancing across the energy sources has delivered benefits in terms of improved operation and harmonisation of power supply during transition (where QCH shifts from electricity to gas powered tri-gen). There is ongoing work with Honeywell, Veolia and our external consultants (Synengco) to develop advanced models (both thermal and financial models) to match electricity and gas market supply of inputs. Since opening, energy requirements to operate QCH have been lower than the original design modelling suggested (the assumed load of the precinct was significantly higher than what the actual load is). As a result, the hospital only uses one of the tri-gen units for power generation, hot water and chilled water via an absorption chiller (the QCH emissions certificates and permissions are matched to this current operation). Whilst it may seem preferable to operate both tri-gen units at the same time, there are a number of significant elements that need careful engineering assessment. The existence of a second tri-gen unit may highlight that there is some additional capacity for electricity generation, however there would need to be configuration changes to the system to permit the exporting of electricity.

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QUEENSLAND ENERGY MARKET SUMMARY – ELECTRICITY AND NATURAL GAS CHQ has utilised energy supply contracts procured through whole-of-Government processes coordinated by the Department of Housing and Public Works (DHPW). These forward gas and electricity contracts have been managed by DHPW and incorporate external energy analysts and consultants to inform the forward outlook and likely forward pricing for the Queensland markets. These discussions suggest that the current price volatility in these Queensland markets and predict that this trend will continue. This is the current short term state that CHQ will work with until the current contracts expire. CHQ has been fortunate, that with careful planning, the current gas and electricity contracts are appropriately matched to the current energy demand profile of QCH. Both contracts have enabled CHQ to ride out the market volatility, and avoid significant unit cost increases. There are also National Energy Market (NEM) changes occurring. Due to government intervention in June 2017, electricity prices did soften slightly however, continued uncertainty around generation supply and capacity during the current summer months has seen pricing remain higher than historical averages. The Queensland Government has announced the Powering Queensland Plan which outlines the strategy to guide the state through the short-term and long-term challenges facing the Queensland energy market. Initiatives under this plan include the return to service of the Swanbank E gas-fired power station, the restructure of Government owned energy generators, confirmation of the Queensland Government’s commitment to a 50 per cent renewable target by 2030 (analysts advise that this is yet to be priced into current market pricing), and implementation of the Gas Action Plan (which adds 450 square kilometres of new gas tenure for supply to the Australian East Coast gas market). The Queensland Energy Security Taskforce (as part of the Powering Queensland Plan) will guide energy security and also implement the COAG Energy Council agreed Finkel NEM Review recommendations. It is not known what impact these initiatives may have on CHQ at this current time.

Additional market outlook factors that might impact in 2018 are: • Gas availability and pricing continues to be an issue and the Australian Government has begun discussions with gas industry participants to ensure ongoing supply of reasonably priced gas for the domestic market • The Federal Government Domestic Gas Security mechanism (which assesses gas availability for the year ahead and determines if a shortfall exists) and the energy regulators have identified that the national gas market is 100 petajoules of gas short. The Prime Minister has asked Santos, Origin and Shell to act on the shortages by November 2017 or face legal controls over their exports. Current advice from energy advisors is for agencies not to lock into long term gas contracts as this is a short term hump and the market will loosen up in 2018. • It is anticipated that more renewable energy projects should start to come online during 2018 which will increase generation and supply into the market. • Uptake of rooftop solar photo voltaic (PV) across the state continues to have a large impact on reducing demand by approximately 150-250 MW per year (of note- PV arrays have been considered by CHQ in the past, however PV arrays the size of about 5 football fields are required to provide CHQ with adequate electricity, and installs of this size are currently uneconomic). CHQ will work with energy advisors to ensure there is close monitoring of market electricity and gas pricing to optimise tri-gen operations with current market rates. Any energy market changes following Federal Government intervention will be included in any CHQ forward contract renegotiations. Fluctuations in market prices for gas and electricity supply will influence the operation of the trigen plant, hence the need for continued close monitoring.

QCH ENERGY CONSUMPTION DATA The average QCH precinct electricity demand is approximately 3,986kW per hour (which equates to about 70,000kW over a 24 hour period), with the tri-gen providing 2,400kW of this hourly demand and with 1,586kW supplied from the electricity grid (during times when the tri-gen is operating). For QCH, off-peak electricity demand drops from

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the peak demand (3,986kW) to approximately 3,000kW and this off-peak load is supplied largely from the grid. In general terms, this level of energy consumption is equivalent to that used to power 4,500 homes. Based on this balanced load apportionment and the current operation of the tri-gen plant, about 49% of QCH energy demand is provided from the tri-gen plant (averaged over a week) with 51% supplied from the electricity grid (this apportionment is based on a balance between the current gas and electricity contract pricing and the needs of the hospital, and based on the current operation of the tri-gen units 16 hours 5 days per week). The above use of the tri-gen represents a saving of between $600,000 and $1.0 million in offset efficiencies annually through the use of the tri-gen plant during peak electricity hours. It should be noted that this figure excludes the savings from heat recovery for the absorption chillers and hot water boilers. Recent detailed engineering investigation and analysis on the actual energy demand and consumption data (with readings taken from the complicated array of meters measuring gas, electricity and energy usage) has indicated a fluctuating energy demand profile based on high utilisation of the hospital.

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The QCH Precinct consumed: • 1.342 GJ/m2.a of total energy in the 2015 calendar year • 1.383 GJ/m2.a of energy in the 2016 year • Estimates that 1.40 GJ/m2.a of energy will be consumed in 2017 • As a benchmark, QCH is below the national average energy intensity of capital cities hospitals in Australia which is 1.415 GJ/m2.a (reference is sourced from Baseline Energy Consumption and Greenhouse Gas Emissions in Commercial Buildings in Australia, 2012). This demonstrates the energy efficiency of the QCH precinct buildings. • The tri-gen plant uses efficient energy strategies to use waste heat (from the gas engines) to produce steam, hot water and heating (for air conditioning)- the waste heat load feeds steam and hot water boilers as well as absorption chillers (for HVAC) • Floor area - QCH 114,256m2 and CCHR 15,201m2

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Unique cold plasma technology to create Hydroxyl Clusters which naturally kill all airborne pathogens. These groups also react with odour causing chemicals such as ammonia and methane gas to produce neutral compounds such as Co2, Nitrogen and Water. The harmless way to create a safer and cleaner environment.

Protection for Residents & Staff.

Hydroxyls are the single most important cleansing agent in our environment. * 33% more effective at oxidizing pollutants than ozone. * 2.5 times more germicidal and fungicidal than liquid chlorine * Perfectly safe to breathe and use in occupied spaces In a room of 28m2 at 27ºC the Baxx reduced bacteria levels by 99.9% within 90 minutes, and viral traces were reduced by 88.96%. Ammonia levels reduced from 100% saturation down to zero in 30 minutes - without Baxx intervention the levels are 48%. Decomposition and ethylene gases are also effectively reduced/eliminated by Hydroxyls produced by Baxx. TESTS INDICATE EFFECTIVE ELIMINATION OF THE FOLLOWING ESCHERICHIA COLI (E COLI) STAPHYLOCOCCUS AUREUS LISTERIA MONOCYTOGENES PSEUDOMONAS and ASPERGILLUS NIGER CAMPYLOBACTER BACILLUS SUBTILIS SPORE SALMONELLA SACCHAROMYCES CEREVISIAE MRSA, C.DIFF(SPORE FORM) AND NOROVIRUS

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HOW CAN

IOT FOR ELEVATORS AND ESCALATORS

IMPROVE TRANSPARENCY AND RELIABILITY? By CLAYTON BOLADERAS, SALES MANAGER, THYSSENKRUPP ELEVATOR

The better the technology, the more invisible it becomes to the user. The elevator is a classic example: it is only when it breaks down that users perceive the underlying technology. Advances in edge computing, mobile connectivity and cloud storage allow the harnessing of big data from connected elevators, resulting in many benefits to Management, Staff and Patients.

WAITING

any don’t realise it, but elevators are the most consistently used means of transport on the planet. Around the world, 12 million elevators ferry approximately one billion passengers from floor to floor every single day. Most of us probably don’t appreciate just how integral they are to our lives, or how they allow our cities to thrive at heights that they couldn’t otherwise reach. They go largely unnoticed. That is, until they break down. When elevators are out of service we become acutely aware of their function and importance. And

it happens often enough. Combined, elevators spend around 190 million hours out of service each year. That time isn’t enjoyable for anyone. Would-be passengers are frustrated, and repair technicians arrive on site with a lot of pressure to make repairs quickly.

SMARTER ELEVATORS The addition of microprocessor controls in the late 70’s gave elevators the ability to collect data, but this was generally only accessible once the technician arrived on site. Advances in edge computing, mobile connectivity and cloud analytics have now ‘unlocked’ these data streams.

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An elevator IoT system generally consists of a small box, installed in the lift shaft or machine room, that continuously collects data and sends it to the cloud. Machine data such as door movements, journeys, interior calls and fault codes are captured and transmitted by the networked elevators. In the cloud, intelligent algorithms evaluate the operating data and, for example, can calculate the remaining service life of individual components and advise that they be exchanged before the elevator goes out of service with a defect.

PARTNERSHIPS According to management consultancy firm McKinsey, “establishing a robust data backbone is a fundamental enabler for digital reliability and maintenance.” Choosing the right partners is critical to ensuring that the best return on investment is realised over the long life of the asset. The power is not only in the hardware, connectivity and analytics, but also the large connected asset-base which provides the ‘big data’ necessary to enable ‘machine learning’.

This data is used to identify common failure patterns across hundreds of thousands of elevators, and by using anomaly detection algorithms, develop failure patterns that are specific to each asset. According to thyssenkrupp Elevator’s head of digital operations Hyun-Shin Cho - “Even if two elevators are the same model and make, they will have different usage patterns and subcomponents. You cannot apply a single set of rules to this vast heterogeneous environment – that is where machine learning is ground-breaking for us.”

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However, gathering this data and developing these algorithms is not about outsourcing maintenance work to Artificial Intelligence â&#x20AC;&#x201C; a successful IoT project requires technicians capable of partnering with technology to improve service delivery, and equipment reliability. The data classification is achieved through end-to-end feedback loops which are verified by experienced technicians on site, and the targeted maintenance and scheduled repairs are carried out by skilled workers.

THE BENEFITS Greater Transparency. The dashboards and alerts which are made possible by IoT data allow Hospital Engineers to be able to see, real time, the status of their elevators, even remotely. This can facilitate a more transparent dialogue with the maintenance provider, hospital management, staff and patients. Additionally, when preparing budgets, real data on equipment usage and condition can be utilised to make the best capital planning decisions. Better Service. IoT allows service technicians to be better prepared prior to arriving for breakdown call,

as the system sends them the equipment operating modes, fault codes, likely problems and proposed solutions, as well as a list of parts and tools required. Not only does the technician arrive sooner (as the system flags the breakdown as soon as it happens), but the fault is confirmed and rectified sooner, and disruption minimised. Improved Reliability. Maintenance quality improves as the technician has targeted tasks identified by the machine learning algorithms in addition to scheduled safety tests, adjustments and regular checks. Human and Machine work together, with AI assisting the technician, who in turn trains the AI. Reduced Downtime. As the algorithms become more accurate in their diagnoses based on the data collected, the system can inform a technician that an issue is likely before it happens, and that technician can then arrive ready to prevent it from occurring. Furthermore, technicians can also schedule maintenance at a time when the elevator is likely to be unused, rather than making the repair during what is a busy point in the day.

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PARTNERS IN WIRELESS MONITORING SOLUTIONS g needs; ‘Invisible systems’ is the complete end-to-end solution to your monitorin rint, designed to reduce costs and improve your energy efficiency, carbon footp Legionella risk management, food safety, and more. • Enhanced compliance by providing ongoing system testing and automated monthly reports. • Installation costs and disruptions are minimal as it is a totally wireless system. • Continuous real time monitoring of energy or temperature information updated at intervals determined by the client. • Information can be accessed from a web browser from anywhere

and using any device including mobile devices. • Alarms are immediately despatched for corrective action via SMS or email. • Online dashboard gives instant snapshot of information including sensor readings and settings. • A full suite of reports and audit trail is available as and when they are required.

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Invisible Systems has a full range of wireless sensors to suit all your monitoring needs. KEY BENEFITS • Cost effective compliance of food safety temperatures for fridges, freezers, dishwashers etc. with HACCP Food Safety Regulations. • Can be used to manage your carbon footprint, thereby reduce operating costs. • Energy costs savings of 20% can be achieved. • Temperature monitoring ranging from -80 to +240 degrees • Utility usage monitoring (Gas, Electricity and Water) • Environmental condition monitoring (Humidity, Moisture, Pressure, CO2, etc)

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SEARCHING FOR SUSTAINABILITY:

LOW-TECH DESIGN FOR THE HILLSIDE CLINIC IN THE ARID KAROO, SOUTH AFRICA By Ulrike Kuschke, Yusuf Jacob, Jehan Bhikoo

INTRODUCTION

he Hillside Clinic that was completed in 2017 is located in the town of Beaufort West, approximately six hours’ drive from Cape Town. The Western Cape Department of Transport and Public Works (DTPW) and provincial Department of Health, with a consultant team of architects, engineers and quantity surveyors, developed the 1 045m2 project with an emphasis on reduced energy consumption, whilst ensuring that the statutory requirements for ventilation rates and acceptable indoor temperature were achieved. Further imperatives were a reduced carbon footprint during construction, creating local employment, and skills development.

CONTEXT Climate: Beaufort West is situated in an arid climatic zone, with large diurnal and seasonal temperature swings. It falls within the Köppen-Geiger climatic classification BWk – Arid Desert Cold. It

is anticipated that the extent of land area that falls within this climate classification may increase by 16% if climate change causes a mean global temperature rise of 2°C. This project therefore presents a useful opportunity for investigating energy-saving technologies appropriate for a climate type whose footprint is likely to increase. Location: Beaufort West is the largest town in the Great Karoo region, with a population of 53 000 and an anticipated growth rate of 1% per annum. It was formerly an important railway marshalling yard and remains the centre of a mainly sheep farming agricultural district. Patient profile: This clinic serves the currently uninsured, low-income population. According to the 2017 Western Cape Socio-Economic Profile for Beaufort West the three largest socio-economic risks are drought, a lack of financial sustainability (dependency on social grants), and stagnating

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economic growth. Life for many people can be characterised as a battle for financial survival in an area with few opportunities. In addition, South Africa has the highest number of tuberculosis (TB) deaths in the world (5% of the global burden of this disease). Social sustainability: The Green Building Council of South Africa (GBCSA) Green Star SA rating system is modelled on the Australian system and has been customised for the local context, with the noteworthy additional Socio-Economic Category certification option. Although DTPW seldom registers projects for GBCSA rating, there is potential value in applying for independent verification of the positive socio-economic impact of targeted infrastructure development such as that of the Hillside Clinic. All public projects target labour-intensive approaches, local employment, skills development for labourers, and targeted procurement of goods and services. (At

present, South Africa does not have a Green Star healthcare facility rating tool.)

DESIGN RESPONSE It was clear from the outset that a robust and innovative heating, ventilation and air conditioning (HVAC) system was required to ensure adequate ventilation and thermal comfort, and that affordability would be a key design driver. During the design stage, the professional team considered how the clinic could respond to the local climatic conditions and meet the ventilation requirements for infection control. The facility also needed to be patient- and staff-friendly, easy to maintain, with lower energy consumption than a conventionally designed facility. The positive socioeconomic impact of the capital expenditure needed to be maximised in support of social sustainability.

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Passive design principles were applied, with careful attention to the particular climatic conditions and bearing in mind a very constrained budget. The design mandate was to achieve a capital- and life cycle-cost-effective, as well as energy-efficient building, whilst using relatively low-technology and low maintenance building materials and easily maintainable mechanical and electrical systems.

Soil for the walls was sourced from the local dam. Note the same colour striations on the dam wall in the background as on the finished rammed earth wall.

Short-term employment during the construction period would be created through labour-intensive construction methods. Furthermore, the promotion of skills development would improve economic opportunities for the participants once the project was complete. Due to the relatively remote location, albeit on the main route between Cape Town and Johannesburg, most conventional building materials and higher level technical skills would have to be transported over long distances. Because this would result in a relatively large carbon footprint with reduced local spending, the potential of unconventional and locally sourced materials was closely examined.

Starting from first principles of passive building design â&#x20AC;&#x201C; taking advantage of natural energy such as sunlight, wind and temperature differences to achieve a desired result â&#x20AC;&#x201C; the site and location informed the concept design. Although all aspects of the design are interdependent, they are described individually below. Orientation: The long facades of the building are oriented to face north/south, to derive maximum benefit from the low winter sun. The short east and west facades are mostly unglazed, to minimise morning and afternoon heat build-up during summer. The single-banked corridors double up as subwaiting areas, which assist with patient flow and separation for infection prevention. There is generous visual connection to planted courtyards and the surrounding context, without loss of patient privacy. The waiting areas are naturally well-lit and the relative transparency allows for good overview and orientation. Through a temperature modelling study, it was determined that patient waiting areas would be optimally located on the northern side, to benefit from

Rock stores and chimneys: Sections showing high level chimneys and underfloor rock stoires.

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Why choose thyssenkrupp Elevator?

We believe in thinking differently. We believe in our values, driving our entire team and underpinning our high standards and commitment to our customers. They include:

Customer care and value:

Our customers and their safety always come first. We are committed to be a transparent, seamless company to do business with. Customer satisfaction is the basis for all our designs and service products.

Excellence:

Why Whychoose choose thyssenkrupp thyssenkrupp Elevator? Elevator?

We stand for outstanding performance and customer service. With a longstanding heritage, we are a trusted name in the industry, known for staying ahead of trends and delivering on time, every time.

Innovation:

Our team of industry leading experts is known for developing advanced automated solutions and innovatively applying existing technologies to address customer needs. Thus, we can provide you with our most innovative and ground-breaking products like TWIN, MULTI, MAX, HOLOLENS and ACCEL.

Sustainability:

We believe in thinking differently. We believe in ourinvalues, driving our entire team team We believe in thinking differently. We believe our values, driving our entire Embedded in ourstandards culture is our the environmental and underpinning our high and commitment to to ourreducing They They and underpinning our standards high andcommitment commitment tocustomers. our customers. footprint of our products, processes and operations. Sustainability also plays include: include:

A trusted partner

an integral part of our corporate strategy with innovative products and solutions securing a sustainable future for our business.

Customer Customer care care and and value: value: Our people:

Our customers Our customers and their and safety their safety always always comecome first. We first.are Wecommitted are committed to be to a be a We believe our people are our most important asset, and our strong positive transparent, transparent, seamless seamless company company to do to business do business with. Customer Customer satisfaction is centric is culture supports this, with long termwith. employees which havesatisfaction customer the basis the basis for allfor our alldesigns our service and products. products. values at designs theirand core. We service also provide ongoing training to 24,000 service technicians worldwide and specialise in focused local training to support our customers. As an employer of choice, we also believe in securing the

future of thyssenkrupp Elevator through continuous apprenticeships and the Excellence: Excellence: employment of specialist engineers.

We stand We stand for outstanding for outstanding performance performance and customer and customer service. service. With aWith longa longstanding standing heritage, heritage, are we a are trusted trusted namename in the inindustry, the to industry, known known for staying for support staying for all Youwe can count ona thyssenkrupp Elevator provide world class aheadahead of trends of trends and and delivering on time, on time, everyevery time. kindsdelivering of different elevator systems. We time. are your “One-Stop Shop” for quality and reliable service!

Innovation: Innovation:

Big enough to manage large projects, small enough to offer personalised attention, thyssenkrupp Elevator supports our customers around the world throughout your project lifecycle, from the design through the installation to the service. Every step of the way, we fully understand your needs and consistently deliver the safest, highest quality next-level transportation solutions. Our capabilities include highquality, customer-focused service as well as individual maintenance and modernisation packages. Globally, our highly skilled technicians efficiently service a multi-brand portfolio consisting of more than 1.2 million units under maintenance globally. At thyssenkrupp Elevator we pride ourselves on the fact that we build long term partnerships. From major national and international clients, residential strata segments to tertiary educational campuses. This signifies thyssenkrupp Elevator in the market place as a customer-centric lift technology company.

Our team Our team of industry of industry leading leading experts experts is known is known for developing for developing advanced advanced automated automated solutions solutions and innovatively and innovatively applying applying existing existing technologies technologies to address to address customer customer needs.needs. Thus,Thus, we can weprovide can provide you with youour withmost our most innovative innovative and ground-breaking and ground-breaking products products like TWIN, like TWIN, MULTI,MULTI, MAX, MAX, HOLOLENS HOLOLENS and ACCEL. and ACCEL.

Sustainability: Sustainability: Embedded Embedded in ourinculture our culture is ouriscommitment our commitment to reducing to reducing the environmental the environmental footprint footprint of ourofproducts, our products, processes processes and operations. and operations. Sustainability Sustainability also plays also plays an integral an integral part of part ourofcorporate our corporate strategy strategy with innovative with innovative products products and solutions and solutions securing securing a sustainable a sustainable futurefuture for our forbusiness. our business.

Our people: Our people: We believe We believe our people our people are our aremost our most important important asset,asset, and our andstrong our strong positive positive culture culture supports supports this, with this, long with term long term employees employees whichwhich have have customer customer centric centric valuesvalues at their at core. their core. We also We provide also provide ongoing ongoing training training to 24,000 to 24,000 service service technicians technicians worldwide worldwide and specialise and specialise in focused in focused local local training training to support to support our customers. our customers. As anAs employer an employer of choice, of choice, we also we believe also believe in securing in securing the the 12 futurefuture of thyssenkrupp of thyssenkrupp Elevator Elevator through through continuous continuous apprenticeships apprenticeships and the and the employment employment of specialist of specialist engineers. engineers. You can Youcount can count on thyssenkrupp on thyssenkrupp Elevator Elevator to provide to provide worldworld class class support support for allfor all kindskinds of different of different elevator elevator systems. systems. We are Weyour are “One-Stop your “One-Stop Shop”Shop” for quality for quality and reliable service! and reliable service!

Office Locations

thyssenKrupp Elevator Australia www.thyssenkruppelevator.com.au National Call Centre:1300 799 599

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Hybrid passive – Mechanical ventilation

Community Standard SADCSTAN TC 1/SC 5/CD SAZS 724). Sedimentary material from the local dam, which has been dry for many years, was tested to confirm its suitability for this type of construction. Numerous sample walls were built with various mixes to establish the most suitable specification. Organic material was removed from the soil and then batches of dam material, builder’s sand, lime and cement were mixed in a conventional concrete mixer on site. Reusable timber shutters were fixed on top of brick foundation walls, clear of the natural ground level. The 600mm wide cavity was then filled in layers of 300 mm and tamped down from the middle to the edges. After curing for approximately seven days, the shuttering was stripped and the quality revealed. After some early teething problems, it became somewhat of a competition to see who could build the best wall. To finish the walls, a breathable sealant was applied externally and a weak plaster mix internally. An in-situ cement window sill protects the walls beneath from water ingress, whilst a concrete ring beam forms a lintel over openings and carries the roof structure. Importantly, the walls are low maintenance and require no paint. Local material was used, requiring less transport and the use of fewer kiln fired bricks, achieving a reduction in embodied energy.

the penetration of morning sun in winter There would be fewer uncomfortably cold days per annum, but a few more uncomfortably hot days. Overall, the annual number of hours of thermal comfort is increased. Windows and roof overhangs were designed to allow for deep sun penetration in winter and for effective shading in summer. The overhangs also protect the rammed earth exterior walls from weathering. These lime stabilised rammed earth walls increase the thermal mass of the building and thereby assist in keeping the interior at a more constant temperature by slowing down the transfer of heat from outside to inside. Construction work was carried out in accordance with the SAZS 724:2001 Zimbabwe standard code of practice for Rammed Earth Structures (subsequently replaced by the Southern African Development

The construction process was labour-intensive and provided an opportunity for skills development. It is hoped that these newly acquired skills will be used again for other projects in the area. High level chimneys and underfloor rock stores: Because air conditioning consumes the greatest portion of electricity in the day-to-day operation of a clinic, it also presents the greatest opportunity for savings. In the interest of airborne infection control, our clinic requirements were for 100% ducted fresh air, with minimum of six air changes per hour (AC/h) in consulting rooms and 12 AC/h in waiting areas. In summer and winter, Beaufort West has long periods where it is necessary to temper any supply of fresh air in order to create the indoor conditions required for a comfortable and healing environment. To reduce the amount of cooling and heating energy required in this fresh air supply process, a system of roof stacks and underfloor rock stores was developed.

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The system works on the principle that, as air moves through a rock store, there is a transfer of heat between the air and the rocks. Heat transfer always occurs from hotter to cooler bodies, so hot air loses heat to cooler rocks while hot rocks lose heat to cooler air. Given the large diurnal swing in outside air temperatures typical of Beaufort West, a rock store can be used to temper fresh air before it is circulated inside the building. At the Hillside Clinic, fresh air is taken in through high-level chimneys and circulated through the underfloor bed of rocks, which tempers the air and reduces the burden on the mechanical HVAC system by reducing the temperature differential of the supply air. Fresh air is taken in via chimneys that mimic those of the surrounding houses and used air is expelled via another set of chimneys. The cowl design is based on an airplane wing, to create an updraft. Research indicated that we needed to find rocks that both had a high heat capacity, and sufficient surface area for efficient energy transfer. The optimal stone was described as round with a diameter of 90-100 mm. Most fortuitously, the surrounding countryside is littered with rocks that match this specification perfectly. After developing the model further, it was determined that the most economical and practical method for implementing the rock stores was to separate them into six individual local stores, each serving the area immediately adjacent to it. It was anticipated that a temperature moderating effect of +/- 4°C would be achieved, with

Measured CO2 levels

a resultant reduction in energy consumption. Construction of the rock stores: breeze walls were constructed inside the “basement pit”, parallel to the length of the foundation walls and 600 mm away from them, to form a plenum on either side. These breeze walls were lined with wire mesh to further contain the rocks. After being cleaned to remove all dust and loose sediment, the rocks were closely packed between the breeze walls and covered with polystyrene insulation panels, followed by a reinforced concrete floor slab.

View into main waiting area.

The air intake chimneys are directly connected to the intake plenum below the floor. Air moves through the breeze wall and through the rocks to the plenum on the opposite side, picking up heat from the rocks or losing heat to them, depending on the relative temperatures. When desired, this tempered air is fed into the fan-driven ventilation system that supplies air to the clinical spaces and which then cascades through transfer grilles to the sub-waiting areas. This system is augmented by individually controlled split air conditioning units in the clinical spaces to bring

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continue operating in summer mode, thereby supplying the clinic with colder air via the rock stores. This programming error is being remedied. According to the South African National Standard for Energy Efficiency in Buildings (SANS 2041) the peak energy demand and consumption for a G1 classification of use (consulting rooms or offices) in the climatic zone 2 (Temperate Interior) is 75 VA/m2 and 190 kWh/ m2/annum respectively. Socialising in the winter sun at the entrance forecourt.

the temperature to the desired level. The combination of chimneys and rock stores thus form a passive system to reduce the energy consumption of the split airconditioning units by pre-heating or pre-cooling the fresh intake air before it is distributed into the facility.

PRELIMINARY RESULTS (AUGUST 2018) Capital expenditure: The total project construction cost was ZAR 19,3m, which is considerably less than the cost of a similar-sized clinic with conventional HVAC which was completed at the same time. It must be noted that the winning bidder had priced very competitively at the time.

was 30% and 20.5% above that of an average clinic. Following an investigation several items were found to have been incorrectly installed. Most notably, some of the fans were operating in reverse. After corrective actions were implemented the energy performance of the clinic improved markedly. When the monthly kWh usage per square metre for the Hillside Clinic over a six-month period is compared to the average usage of a similar clinic, the Hillside Clinic performs significantly better during autumn and uses 40% less energy usage than similar facilities. Further investigation revealed that the relatively poor winter performance is due to the incorrect programming of some of the rock store controllers, which

Hillside Clinic had a peak energy demand of 37.5 VA/m2 and an annual energy consumption of 73 kWh/m2, or approximately 50% and 62% below the maximum respective figures allowed by the standard. Energy savings: The annualised average monthly energy consumption of the Hillside Clinic, compared to an “average clinic”, indicates an annual energy saving of ZAR 26,574.20 (2018). Indoor air quality: A comprehensive study of the performance of various features of the clinic was undertaken by the Council for Scientific and Industrial Research (CSIR), a recognised South African research institute. This study included an analysis of the indoor air quality (IAQ) and the indoor environmental quality (IEQ).

Energy performance: Not much data is available for clinics generally, as systematic monitoring was only commenced recently. The Riversdale, Wellington and Grassy Park Clinics in the Western Cape were used in this study to calculate the energy consumption of an “average clinic”. The initial results for Hillside were very disappointing. During September and October the energy usage per a square metre

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Indoor air quality was assessed by using carbon dioxide (CO2) levels as a proxy for the concentration of respiration-derived airborne pathogens such as TB. Comparing the indoor levels of CO2 to the outdoor levels provides an indication of the number of times the air has been re-breathed by the occupants of the clinic and thus an indication of the risk of infection.

working, the temperature measurements show that the rock stores alone are not providing adequate warming or cooling of the air to an appropriate comfort level temperature of approximately 24Â°C. Indoor thermal comfort is therefore adjusted using additional warming and cooling through split AC units in clinical spaces throughout the facility.

Measured CO2 levels indicate the outdoor reference level as 420 ppm, which compares favourably to the main waiting area at 543 ppm with 14 occupants at the time of measuring. When the waiting area was later re-measured with 31 occupants present, the reading increased to 614 ppm. The relatively small increase in CO2 levels indicates that the ventilation system was providing an adequate volume of fresh air, especially considering that all windows and doors were closed during the measurement period.

LESSONS LEARNED

Indoor temperature: Although the results give a good indication that the central ventilation system is

Hillside Clinic has now been in use for approximately one year. Measuring and analysing data did not commence immediately, but early indications are that the facility design decisions are indeed having the desired benefits and should be considered when designing new facilities. Measuring and monitoring should remain an upfront consideration: Despite a clear desire for a facility with a low environmental impact, budget holders are highly risk-averse. Due to budget

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Wide single banked corridor waiting areas catch the sun in winter, but are shaded by roof overhangs in summer.

View across the park towards the entrance of Hillsaide Clinic.

constraints, an inadequate control and monitoring system was implemented but, with hindsight, a more sophisticated system should have been provided. Presently, a large quantity of potentially valuable data is not being recorded because the probes are not connected to a logging device. Challenge everyone to get on board and stay on board: The building energy performance consultants

were employed to do the initial modelling, but not retained during the design development stages. Although the remaining multi-disciplinary team succeeded in delivering a well-integrated design, some initiatives necessarily fell by the wayside. The integration of low-tech and vernacular methods with relatively high-tech modelling, monitoring and analysis can potentially deliver even better outcomes,

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but this would require all stakeholders to remain positively engaged throughout the project. The energy consultants were appointed again for a postoccupation evaluation, with funding from another source. Allow for post-completion monitoring and tuning: When embarking on a project that tests innovative technology, it is necessary to make contractual and financial allowance for post-completion monitoring and tuning over at least a 12-month cycle to help ensure that the facility operates at its full design potential. Adequate training of operational and maintenance staff is essential, and may need to be repeated. Maximise the development and transfer of skills: Whether unskilled or highly skilled, local or national, the search for greater sustainability in buildings depends on the development and transfer of skills.

ACKNOWLEDGEMENTS The authors have been privileged to work on projects such as the Hillside Clinic. We thank the Western Cape Government Department of Transport and Public Works for the opportunity, and the CSIR and our colleagues for their support. We also wish to credit the professional consultants who undertook this journey with DTPW: Gabriël Fagan Architects; Mbatha Walters and Simpson Quantity Surveyors; CMB Consulting Mechanical & Electrical Engineers; Henry Fagan and Partners Structural Engineers; and Greenplan Consultants Sustainability Consultants.

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Evidencing the suitability of hybrid design strategies in achieving the recommended Indoor Air Quality in clinics: Case study Hillside Clinic, Beaufort West. Authors: Coralie van Reenen, Toby van Reenen, Jako Nice, Lorato Motsatsi, Dirk Conradie, Peta de Jager, Llwellyn van Wyk, Jehan Bhikoo, Ulrike Kuschke

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IMPROVING WATER QUALITY IN HEALTHCARE FACILITIES By Colin Long, Healthcare Manager & Service Manager – Victoria, Veolia Water Technologies

Water is a critical element in the healthcare industry. In a fast-paced healthcare environment, a reliable source of high-quality water is crucial to effectively maintain a wide range of patient services — from washing surgical tools and equipment, to providing a soothing environment for therapeutic treatments like hydrotherapy.

ith the compromised immune systems of many patients, it is vital that the water used in healthcare settings is not contaminated in order to safeguard patient health. Water-borne pathogens, such as Legionella, can pose a risk to patients even if present in low amounts. As a result, decontamination is a growing concern. It is crucial that medical and dental equipment, in particular those that can be directly connected to main water lines, use uncontaminated water during medical procedures so as to prevent nosocomial infection and outbreaks. In the area of research and pathology laboratories, water purity affects the performance of a laboratory and patients are put at risk when analysis and diagnosis are affected. Water purity is also essential for minimising spotting and staining of medical instruments and equipment — which extends the longevity and integrity of these assets, and reduces expenditure on replacements in the long-term. In order to keep water in healthcare facilities safe, risk assessments of the water supply and efficient water quality control technologies are paramount.

RAISING WATER QUALITY IN HEALTHCARE FACILITIES — A WAVE OF CHANGE Increasingly, the regulations governing the quality of water used in various healthcare services have been raised to improve water quality and address the risks involved for both patients and staff in healthcare facilities. One of the most recent changes would be the amendment to the AS/NZ 4187, where Australian day

surgeries and hospitals will be required to comply with water quality standards for use in disinfection by December 2021. ISO quality systems are also in place for renal dialysis, including ISO 23500:2011 (Guidance for the preparation and quality management of fluids for hemodialysis and related therapies), ISO 13959:2014 (Water for hemodialysis and related therapies), and ISO 26722:2014 (Water treatment equipment for hemodialysis applications and related therapies). These recommendations provide guidance for healthcare facilities to ensure that only highly purified water is used for this critical application to help cleanse the blood of renal patients. Various states of Australia have also introduced regulations to prevent water-borne contamination and infection outbreaks. Following several cases of Legionnaire’s Disease outbreaks associated with potable water supply in Australia, authorities have issued guidelines to healthcare facilities to improve their understanding of the nature of the issue, extent of the risks involved, and the recommended responses to water quality sample results through a series of protocols. These standards can impact boilers and cooling towers, circulation and water distribution systems, and points of use. And failure to maintain regulatory compliance can result in the shutting down of the water treatment plant — disrupting patient services and adding substantial costs to the facility. Producing water that meets required standards is merely the start of a challenging process. Water quality must be maintained within the specification as well — so

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the design of a system must also ensure the pipes loop through to the points of use without any opportunity for contamination. It can be a challenge to ensure that everything is kept sanitary, so pipe design within each system must be considered from the outset. In fact, many healthcare facilities are now looking into upgrading existing water treatment systems, or redesigning and installing new ones in a bid to meet the plethora of requirements for various services.

ACHIEVING A WORRY-FREE WATER SUPPLY Water management is not a core business and many healthcare facility managers may not possess the necessary knowledge and expertise to navigate the challenges involved. Having a dependable and professional water solutions partner, who understands the economic and operational constraints that apply to water in the healthcare sector, is not only important, but also helpful to address existing or impending challenges. Some facility managers may be tempting to opt for low-cost options at the initial phase due to economic constraints. However, it is important to consider that this decision may sometimes lead to additional spending to rectify issues in future, and even affect facility operations as well as quality of patient care — especially when the central sterile supply department (CSSD) is impacted. Healthcare facility managers should also consider appointing service and solutions partners based on the reliability and consistency of results delivered. The water treatment system should boast a cost-effective but robust design that does not compromise water treatment quality or reliability, in order to ensure compliance to regulatory requirements.

PUBLIC HOSPITAL CASE STUDY: NARROGIN HEALTH SERVICES For Narrogin Health Services, a public hospital located in Western Australia’s wheat belt region, choosing a reliable partner with a proven track record was a key criterion when they set out to install a water treatment plant for their new Central Sterilisation Department (CSD). One of the key challenges Narrogin faced was that the local water supply fluctuates in quality and is typically classified as hard water with a high concentration of silicates. The AS/NZS 4187 standard stipulates a low silicate level, but for Narrogin, removing the silicates for compliance while keeping costs low was a significant challenge during the system design phase. After much research into what the industry had to offer, Narrogin decided to entrust the project to Veolia Water

Technologies. Veolia’s expertise and track-record in the provision of packaged pure water solutions and services for healthcare applications had made them the natural choice of Narrogin. Having garnered over 80 years of experience in the healthcare sector, Veolia had the know-how to ensure ongoing compliance in an everincreasing regulatory environment through time and manpower invested in consulting with industry folks. To address Narrogin’s needs, Veolia supplied and installed an OSIRIS 600/500 Duplex Reverse Osmosis (RO) system along with pre-treatment, final permeate polishing, a thermal sterilisation tank, and a stainlesssteel ring main. This system feeds water that is compliant to the AS/NZ 4187 standard, to various aspects of the facility’s functions, including batch washers, trolley washers, sterilisers, and endoscope reprocesses. With Veolia’s RO system, Narrogin is assured of a chemical-free distribution loop for sanitisation and compliance. The longevity of the system is also secured as only the best materials were used for the plant. Narrogin’s staff can now shift their focus to other areas of work with the assurance that the system has also received validation for complying with the required standards. Without a doubt, healthcare facilities have much to gain by turning to professional and reliable water solutions providers. As demand for healthcare services continues to grow with rising wealth and longer life expectancy, experienced water solutions providers can help hospitals ensure compliance to state standards and regulatory requirements for water quality and supply, enabling them to focus on their core business of patient care.

ABOUT VEOLIA Veolia group is the global leader in optimised resource management. With over 171,000 employees worldwide, the Group designs and provides water, waste and energy management solutions which contribute to the sustainable development of communities and industries. Through its three complementary business activities, Veolia helps to develop access to resources, preserve available resources, and to replenish them. In 2018, the Veolia group supplied 95 million people with drinking water and 63 million people with wastewater service, produced nearly 56 million megawatt hours of energy and converted 49 million metric tons of waste into new materials and energy. Veolia Environment (listed on Paris Euronext: VIE) recorded consolidated revenue of €25.91 billion in 2018. www.veolia.com

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Ensure a strong level of interoperability by using open protocols which have third-party listing laboratories to verify adherence to your protocolâ&#x20AC;&#x2122;s form and function.

Employ a single sign on (SSO) architecture with compliance to scalable credentialing architectures and secure tunneling methodologies such as BACnet virtual private networks (B/VPN).

Select lifecycle-centric manufacturers who minimize the negative impacts of waste with long-term warranty and repair services while adhering to WEEE, RoHS and LEED directives.

Specify integrated FDD (IFDD) that delivers real-time fault detection, step-by-step root-cause diagnostics while using all your existing cabling structures, including twisted-pair networks.

Enjoy the long-term benefits of suppliers who engineer a path forward to new technologies while remaining backwards compatible without third-party gateways or hardware replacement.

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ANATOMY OF A SMART BUILDING By Paul Dearlove – Western Region Director, IBMS Pty Ltd

Modern high-rise buildings would not exist in their current form without advances in technology. The discovery and harnessing of electricity led onwards to the development of efficient electric lighting, elevators and air-conditioning – all of which are necessary in a modern building.

he invention of microprocessors in the 1960s led to the development of a wide range of control and monitoring systems for buildings in the 80s. Systems such as DDC for air-conditioning, electronic access control, microprocessor control of elevators were introduced that greatly improved the operational efficiency of the building. A typical modern building can include anywhere between 2080 different control systems. We have advanced to a point where the dominant technologies we hear about today include smart mobile devices, the Internet of Things (IoT), Cloud Computing and Big Data. How will these technologies impact the next generation of buildings? Before we can look at the anatomy of a smart building, it is important to agree on a definition of what is a smart building: • Some define it by connectivity – how many sensors and controllers does a building contain.

• Some base it on efficiency – how well does the building perform in terms of resource consumption or environmental benchmarks • Some base it on automation – how many processes in the building are automated to make it easier to run. From this author’s perspective, a smart building is one that can add any technology, IoT device or software solution from any vendor at any time. These systems would all interoperate using a common collection of data.

TRADITIONAL APPROACH The microprocessor systems that were developed in the 80’s were designed to a complete standalone solution with hardware, network cabling and software from the one vendor. There was minimal interconnection between these early systems and each was left to run independently. This led to isolated silos of control forcing operators to have to deal with duplicated infrastructure and needing multiple platforms to run the building. Furthermore, data generated from these systems is segmented, hidden

Figure 1 - Traditional “Siloed” Architecture

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or stored in proprietary formats, making it difficult and expensive to integrate and support An overview of this traditional architecture shows the vertically arranged silos that prevent the building operating efficiently. Despite the rapid advances in technology mentioned earlier, the great majority of control systems still being supplied today are based on this architecture and designs from the 80’s. Without an Integrated Platform,

Table 1 - Integration Layers

Layer

Description

Presentation

Any application that requires data exchanges between one or more connected systems. Web and mobile based applications used to deliver value to each stakeholder group. The presentation of the client’s key objectives.

Application

The business layer used to govern all decisions via workflows, calculations, consolidations, conversions, normalisations, analytics and data sharing. Key logic is used to determine the required course of actions based on the inputs from each connected system.

Data

Management of all real-time and historical data. Data extraction, transformation and loading into data warehousing. Long term and life data storage using a data warehouse environment. Load balancing occurs in this layer to protect the process layer systems.

Communications

Open protocols, web services and application programming interfaces used to exchange data to/from every connected system.

Network

Deploying an Integrated Converged Network throughout the building enables physical connectivity of all base building network equipment (switches, servers, UPSs, firewalls, etc.), controllers, sub controllers and cloud services. This layer also governs all network addressing, VLANs and security.

Process Systems

Any building control system connected to the network.

MODERN DESIGN An Integration Platform is a crucial component for a smart building to allow the latest technologies of today and tomorrow to be deployed. It provides the key to accessing, collecting and consolidating data from any building system so it can be made available for any current or future enterprise application to use. These applications provide each building stakeholder with the visibility and the connected experience they require. A standard and proven approach to achieve these design requirements is using a Layered design. The following diagram shows a high-level view of each layer. The purpose of this design is to govern the flow of data from each building system (in the Process Layer) to the applications that will use and display the data (Application and Presentation Layers). Figure 2 – Integration Platform – Layered Architecture

BENEFITS OF AN INTEGRATED DESIGN A properly designed Integration Platform provides the foundation of a modern smart building with the following capabilities: • Centralised, consolidated, consistent data from all connected systems produces lifecycle cost reductions in accessing the data. Eliminates proprietary data sources that require costly, complex high-level interfaces.

Using a layered approach enables the Integrated Platform to expand at every level. It also makes it easier to define the performance requirements to ensure the design and implementation is done correctly. The purpose of this approach is to allow data from a single source of truth to be used for multiple purposes and provides protection to the slower, more volatile systems in the Process layer.

• Reduces costs by ensuring building owners are not locked in to a single supplier. Each layer in the platform can be supported by multiple vendors allowing for competitive maintenance and variations • Protects older building control systems from the increased data demands of modern applications. Also supports a single cybersecurity solution for all building systems.

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• Futureproof the building to add technologies can use an integrated platform without the need to re engineer and be able to cost effectively and easily deploy new Initiatives as technology and client demands evolve. • Allows for data exchange with cloud based or onpremises applications to provide wider choice and more cost-effective options. • Repository for all data from every system to drive timely decision making for all stakeholders. This Data becomes a valuable owned building asset that will impact favourably on asset value in the future • Consolidates multiple alarms into a single console improving response times and removing the need to learn multiple systems • An environment that natively supports dashboards, web pages and mobile devices will deliver functionality that makes operators and tenants more efficient • Gain efficiencies by sharing building data with other business areas / departments • Creates an environment that can continuously expand and capture big data over time, thus positioning for future advances in Machine Learning and Automated Intelligence.

ABOUT THE AUTHOR PAUL DEARLOVE – Western Region Director, IBMS Pty Ltd Paul is the Director of the Western Region and a founding Director of IBMS. He has extensive experience in design, communications, control systems and the Integration of Extra Low Voltage Systems (IELVS). Paul has been heavily involved in cutting edge technology in the Building/IT industry for over 36 years. He has a sound understanding of project management issues including commercial and financial aspects, contract law and managing multiple deadlines. Paul leads the IBMS team in the development of the technical strategic direction for leading assets, including conceptual approaches, detailed design specifications and implementation strategies. A leader in his field, Paul is often called upon to provide independent peer reviews, technical submissions and contractor works. Paul has a Bachelor of Engineering with Honours from UWA and is a Green Star Accredited Professional and a NABERS Accreditor Assessor.. He is a member of Engineers Australia, a Graduate of the Australian Institute of Directors and an Associate Fellow of the Australian Institute of Management.

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KNOW YOUR RISK By Kristy Keech, AESC Pty Ltd – Qld State Manager

Health care facilities have a very important role in the community and part of those responsibilities are to ensure the safety of the occupants whilst in these facilities. Part of these obligations relate to fire and life safety installations and adhering to the various regulations and legislation that encompass these buildings.

ngineering and Maintenance departments or those responsible for the facilities have a constant challenge to keep up with the various maintenance compliance aspects and interpretation within the built environment. Modern managers have more than ever a common law duty of care to ensure the building is safe, maintained and compliant to the relevant requirements. As requirements have variations from state to state, having a base level of understanding is important. Below is a state by state description for the essential services maintenance requirements, what the annual compliance sign off is and the correct way to document and store / retain your maintenance records. This ensures your maintenance contractor is completing the correct maintenance and providing compliant maintenance documentation so the building may be verified for compliance each year. This also drives a professionalism and quality outcome aspect to ensure buildings perform to not only their design but maximise performance for tenants and owners. There have been significant changes recently, in particular to the New South Wales Regulations. These changes significantly impact how Annual Fire Safety Statements (AFSS) are issued for buildings as well as putting more onus on building owners with the AFSS process. One of the biggest changes applied is the Introduction of competent fire safety practitioners (CFSP), with removal of the term “properly qualified person”

STATE AND TERRITORY DEFINED REGULATIONS AND LEGISLATION The building blocks of the state based defined maintenance regulations are in order of the following hierarchy.

Act – An Act of Parliament, a law or primary legislation Regulation – This is authorised by an Act and prescribes the methodology and onus of responsibility to fulfil the Act, noting any applicable penalties to enforce compliance. Building Code of Australia (BCA) – This is referenced by Commonwealth, State and Territory legislation, setting minimum technical requirements, references to other codes and standards. Australian Standards – Required by law if referenced in regulations or through state authority e.g. AS1851.2012 Routine service of fire protection equipment. There is also a common law obligation, which has been promoted by the Fire Protection Association in support of the national adoption of AS1851.2012. In addition to statutory law provisions (Acts/ Regulations, codes and standards) it is likely that an individual or a responsible entity (such as the owner, occupier, employer or manager of a building) will have a common law duty of care to maintain fire protection systems and equipment, and to be able to demonstrate that they have met their responsibility.

STATE-BASED OVERVIEWS NSW • Act: Environmental Planning and Assessment Act 1979 • Regulation: Environmental Planning and Assessment Regulations 2000 • Compliance Certificate: Annual Fire Safety Statement (AFSS) by “Competent Fire Safety Practitioner (CFSP)” • Defined Term: Essential Fire Safety Measures

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• Maintenance Documentation Retention: The requirement of records is not specifically referenced in the EP&A Regs; although from a risk management perspective to cover the onus of the manager, owner and occupier of a building, retaining maintenance documents and logging egress and passive structure inspections fulfils EP&A Regulations. ACT • Act: Building Act 2004. Emergencies Act 2004 • Regulation: Building Regulations 2008 • Compliance Certificate: Fire safety policies currently under review • Defined Term: previously Essential Services • Maintenance Documentation Retention: Recommend that an Annual Fire Safety Statement be kept onsite. QLD • Act: Fire & Rescue Services Act 1990 • Regulation: Building Fire Safety Regulation 2008 & Queensland Development Code MP6.1

SA • Act: Development Act 1993 • Regulation: Development Regulations 2008, Ministers Specification SA76 (2015) • Compliance Certificate: Building Age Specific – Form 3 • Defined Term: Essential Safety Provisions • Maintenance Documentation Retention: Minister’s Specification SA 76 part 3 states that in order to ensure every prescribed fire safety element has been identified, inspected and where appropriate any defects have been remedied, it is recommended that a site maintenance record book is retained onsite (covering the essential safety provisions). TAS • Act: Building Act 2016

• Compliance Certificate: Occupier Statement

• Regulation: Building Regulations 2016

• Defined Term: Fire Safety Installations

• Compliance Certificate: Annual Maintenance Statement – Previously a Form 56

• Maintenance Documentation Retention: Section 55 of the Building Fire Safety Regulation 2008 specifies mandatory requirements for keeping records of maintenance. NT • Act: Northern Territory Building Act, Fire and Emergency Act Regulation: Northern Territory Building Regulations, Fire and Emergency Regulations • Compliance Certificate: No specific document, reliance on yearly condition report as per AS18512012

• Defined Term: Essential Building Services • Maintenance Documentation Retention: Recommend that the annual maintenance statement with supporting maintenance records be available onsite. WA • Act: Western Australian Building Act 2011. • Regulation: Building Regulation 2012. Division2A— Maintenance of Buildings • Compliance Certificate: Maintenance proof required and to support the general duty of care

• Defined Term: Building Fire Safety Measures

• Defined Term: Safety Measures

• Maintenance Documentation Retention: Applicable maintenance service records shall be available onsite. Yearly condition report be kept onsite.

• Maintenance Documentation Retention: To meet the WA Building Regulation 2012, Division 2A Maintenance; there is a requirement to ensure the safety measures in each part of the building can perform. To demonstrate this, it is recommended that annual maintenance statement with supporting maintenance records be available onsite.

VIC • Act: Building Act 1993 • Regulation: Building Regulations 2018 • Compliance Certificate: Annual Essential Safety Measures Report (AESMR) • Defined Term: Essential Safety Measures (ESM) • Maintenance Documentation Retention: Building Regulations 2018, Part 15 Annual ESM Report (AESMR) to be produced annually and regulation

225 records relating to ESM’s must be made available onsite. Recommend that the Annual Essential Safety Measures Report be kept onsite.

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SOMETIMES THE BEST ASSETS ARE THE ONES WE SIT ON

ho would have thought that a patients experience with a toilet seat could affect your hospital?

repeated daily. Send a tradie to fix a badly designed, low quality toilet seat in a hospital, and watch the dollars burn.

Doesn’t matter which it is, a wobbly seat that doesn’t know it’s place or a crack in the surface, both give a reason to feel genuinely disappointed when using the toilet.

Ineffective repair to problematic issues like broken hinges or seats coming away from the toilet, are common place. Maybe the motto is, use a well know brand that’s got a good track record and make sure you can quickly get your hands on spare parts from a local source.

Then there is the hygiene topic, stained toilet seats, or hinge fittings that have obvious signs of dark black gunk growing on it, don’t make you rush to rest yourself on such an object for any period of time. Now there’s always a direct line to the headperson who governs hospital maintenance, with many conversations about toilet seats needing attention

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Ashburner Francis are professional building services consulting FEATURE ARTICLES engineers with over 43 years’ experience as specialists in the health and aged care sector throughout QLD, NSW, NT, WA, PNG, and the Pacific Islands. Our services include: Electrical • Power • Telecommunications • Lighting • Nurse Call • Security • Fire Alarms

Mechanical • Air conditioning • Medical gases • Vertical transport • Ventilation • Heating

Hydraulics • Fire hydrant/sprinklers/hoses • Stormwater downpipes • Stormwater, sanitary & trade waste drainage • Rainwater harvesting & reticulation • Hot & cold water • Gas services

Some of our health projects include: • Royal Darwin Hospital Chemotherapy Wing & Cyclotron Building • Royal Darwin Hospital CT & PET development • Royal Darwin Hospital Main Entry & Outpatient Developments • Darwin Private Hospital Mental Health Wing • Darwin Private Hospital Nurse Call System Replacement • Prince Charles Hospital Paediatric & Emergency Ward • St Andrew’s Hospital Toowoomba EndoAlpha Operating Theatre • Baralaba Hospital Site Redevelopment • Narrabri Hospital Site Redevelopment • Winton Hospital Site Redevelopment • Mt Morgan Hospital Site Redevelopment • New Ingham Hospital • Mackay Base Hospital Outpatient Facility • Bowen & Moranbah Hospital Capital Infrastructure Planning Studies • Toowoomba Hospital Operating Theatre Suite Upgrade & New Theatre 7 • St Andrew’s Hospital Toowoomba Cancer Care and Radiation Therapy Centre • Toowoomba Hospital 3 Tesla MRI Facility CONTACT: Brisbane, SE QLD & NSW Darren Cardy 07 3510 8888 Toowoomba & SW QLD Brian Kenny 07 4512 6070 78

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Energy • Energy Cost Reduction (ECR) consulting • BCA Part J Assessments • NABERS Assessments • Greenstar • Renewable energy systems

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DOCTORS WITHOUT BORDERS (MSF), MUCH MORE THAN FIELD HOSPITALS By Elvina Motard, Strategy & Programme Manager; Maria Ten Palomares, Energy Project Developer; Céline Van Lamsweerde, Construction Referent

INTRODUCTION

he concept of humanitarian action — impartial life-saving assistance provided to people suffering from severe crisis — has not changed in years, and the contexts in which the humanitarian actors are working have always been affected by power structures, social-political dynamics, and environmental factors. Medical humanitarian organisations play a key role to alleviate suffering and maintain human dignity during and after both acute and protracted crises and recovery situations. But some things have changed. The technical specialism of some medical responses has increased from general coverage of basic lifesaving medical actions in the 1970s and 1980s to a level of considerable expertise and specialism in some medical fields today. The quick-in and quick-out approach still exists in some acute emergencies, but we now more frequently adopt a quick-in and gradual-handover approach, leading to longer project durations. As one of the best known international humanitarian medical organisations, Médecins Sans Frontières— widely known as MSF or Doctors Without Borders — is facing a growing need to integrate innovative strategies when designing health facilities adapted to the new operational realities.

MSF IN HUMANITARIAN ACTION MSF is an organisation working in the humanitarian field since 1971. We work in 72 countries and have an average of around 460 projects around the world, providing medical assistance to people affected by conflict, epidemics, disasters, or exclusion from healthcare. In the Brussels Operational Centre (one of MSF’s five Operational Centres and representing 26% of MSF’s field operations), we manage 113 medical response projects in 37 countries and employ around 11,000 international and locally-recruited staff.

To build an operational response, we first conduct an assessment of needs; then a medical strategy is defined together with adapted solutions and options, taking into account an analysis of contextual parameters. The operational response is always the result of an arbitration between: • T iming: the deployment time as well as the expected duration of the operational project; • Quality: linked to the standards set in place. We take into account local standards but also we apply our own standards depending on the kind of activities performed; and • Resources: organisational resources as well as the local sourcing possibilities.

MSF AND HEALTH FACILITIES Since the mid-2000s, MSF developed and worked with increasingly complex health facilities. In 2017, 749,700 patients were admitted in MSF’s facilities around the world, 288,900 births were assisted (including caesarean sections) and 110,000 major surgical interventions were performed. Depending on operational ambitions, the solutions deployed for health facilities range from setting up temporary structures, to rehabilitations of buildings or new constructions. This choice is made depending on the nature of the response. Following a crisis or a natural disaster, we need to be effective as fast as possible. To increase our effectiveness in this first line emergency response, we developed rapid deployment kits, ranging from a rapid intervention surgical kit setup in few hours and with an initial lifespan of 3 days, to a full modular field hospital made of inflatable tents deployed in about 3 days. Kits for water and sanitation as well as energy (sources and distribution) are part of the set-up. In a second phase, we often develop post-emergency responses, providing semi-permanent or permanent infrastructures to continue assistance to the population.

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Regardless of the response phase, our facilities need to be self-contained, allowing us to run our installations autonomously (energy and potable water supply, medical waste and waste water processing, biomedical equipment, etc.). After their setup, we manage and maintain these facilities in the short (<2 years), medium (2–5 years), or long term (>5 years) depending on rapidly changing operational needs; then they are handed over to other — often local — organisations or authorities. This process allows an integrated phased approach.

Example: phased approach Event:

Emergency response:

Post emergency response:

Project end:

Typhoon Haiyan rips through the Philippines

Emergency tent hospital operational (general hospital)

First patient in prefabricated hospital

Handed over to local authorities

Nov 8th, 2013

Mid-Nov, 2013

June 23rd, 2014

October 2014

Today, in the Brussels Operational Centre, we are involved in 25 projects (out of 113) where MSF has responsibility for the oversight and management of a health facility. The medical activities carried out in these facilities are increasingly complex: obstetric

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surgery, trauma care, orthopaedic surgery, neonatal care, and, perhaps in the near future, reconstructive surgery. Compared to the non-humanitarian health sector, our health facilities are rather small (maximum capacity of 300 beds), but they often cope with huge volumes of activities. Indicative volumes Name & location of facility

Type of activity

Number of beds

Volume (2017)

Tabarre, Haiti

Trauma centre (orthopaedic and general surgery)

121

6,539 surgeries

Khost, Afghanistan

Mother & Child care (Maternity, OT, neonatology)

23,000 births

L’Arche, Burundi

Trauma centre

4,100 surgeries

As the diversity of contexts and complexity where the current humanitarian response takes place are increasing, MSF is facing a rapid growth of activities. In 2017, we completed or started 9 construction projects, with a total building size of 12,900m². In 2018, 8 construction projects are ongoing, with an additional total building size of 30,000m². The figure below shows a part of the Brussels Operational Centre’s health facilities portfolio; facilities currently running and under construction. Three of the largest ongoing construction projects are a 50-bed general hospital in Bar Elias, Lebanon; a 50-bed trauma centre in Kunduz, Afghanistan; and a 161-bed mother and child hospital in Kenema, Sierra Leone. These facilities are representative of our current challenges as they are in diverse contexts, the first one being close to the Syrian border, the second one being in a conflict zone, and the third one being the country with the highest maternal mortality in the world. We will refer to these projects throughout this paper.

DESIGNING, IMPLEMENTING, AND RUNNING HEALTH FACILITIES IN THE HUMANITARIAN FIELD: CHALLENGES Setting up and running health facilities for a medical humanitarian organisation presents many challenges, leading us to rethink traditional logics of health facilities’ planning and implementation. With the specialisation of our medical activities, our quality requirements become more rigorous in terms of infection control, space management, and comfort,

which challenge us in the type of structures and equipment we use and maintain. Almost 60% of our projects last for more than 4 years, with an average project lifetime of 8 years, which makes us reflect from the early stages on the sustainability of our structures. However, even if the lifespan of our projects tends to be longer, the timeframe to implement new projects often remain s very short. This is due to the nature of the organisation, as well as the volatile contexts in which we intervene. It is of critical importance to find the right balance between quality and timing. The timing, quality, and resources factors are also impacted by local contextual constraints. One of them is climate. We have to develop technical solutions in countries with temperatures above 40°C, as in South Sudan, or in countries such as Ukraine, with more than 40°C temperature difference between summer and winter. Accessibility and security are another two key constraints. Sometimes plane or boat are the only means of transport, or we need to develop specific security contingency measures (i.e. ballistic protection or specific flow management). Local availability of material and/or expertise are also key, as these will heavily impact the design of our solutions, resources planning, and timing. Finally, cultural factors, such as the need to segregate male, female or caretakers in countries as Afghanistan, need to be taken into account. The combination of these constraints, together with the rapidly evolving needs of the humanitarian response, requires the definition and implementation of flexible solutions, easily adaptable to each unique situation.

FROM CHALLENGES TO SOLUTIONS: EXAMPLES Modul(h)o, prefabricated modular buildings To face some of these challenges for post-emergency responses, and provide modular and flexible solutions, we have investigated into building health facilities with prefabricated infrastructures since the mid-2000s. One of the first full deployments was done in the aftermath of the earthquake in Pakistan in 2005. An 84-container (1,128m²) semi-permanent 50-bed secondary healthcare facility was built to replace the destroyed district referral hospital. In 2010, using the same prefabricated container manufacturer, we deployed a 121-bed trauma centre made of 268 containers (4,000m²), following the earthquake that hit Haiti in 2010. Capitalising on this experience, we went for another prefabricated solution (made of wood-fibre and resin composite with anti-microbial properties) to

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build a 70-bed general hospital in Guiuan, Philippines after the Haiyan typhoon. This pavilion structure, made of 18 prefabricated buildings (2,600mÂ˛) was designed to last 5 years and was designed and deployed in 5 months.

Guiuan hospital, Philippines, 2014

Tabarre Hospital, Haiti, 2012

In 2016, with the lessons learned from these experiences, we started to develop a modular prefabricated solution. The goal of this project is to design health structures with high quality standards to be deployed in any context within a short timeframe, with a limited need for trained staff, and with a long lifespan. It is based on a basic module of 90mÂ˛ which can be connected to other basic modules to create any medical services used in the field today. To shorten the design phase and to ensure well-suited space management, 23 standard layouts were defined for all medical services, with dimensions based on requirements for a 100-bed facility. The product, defined with an external partner, is modular, allowing easy addition and removal of wall panels, doors, and windows and adaptation of the building to the changing needs. The modules

Guiuan hospital, Philippines, 2014

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are made from an aluminium frame and insulated sandwich panels that can be easily cleaned, and are long lasting (estimated lifespan of 30 years). The floor slab is incorporated within the metal framework and the foundations are above ground, meaning limited groundworks and a ‘dry’ construction without concrete. Water and sanitation kits, as well as energy kits, were also developed to have a fully functional structure. Light and dismountable, the module doesn’t need heavy machinery to be installed, and it can be deployed in one week by 8 people (one specialised staff and 7 labourers). Low-tech principles were applied to ensure quality care and optimum comfort for patients and medical staff: improved heat insulation, passive natural ventilation, protection from rainwater, and direct sunlight through covered walkways. Following this R&D process, a supply plan was elaborated to deploy the hospital modules in the field in a fast and efficient way. A set of basic modules and adapted kits are prepositioned for fast deployment. Since 2016 we have deployed this structure in 3 countries, in existing health facilities where we wanted to increase the volume and/or the quality of infrastructures. We are currently using this solution to build the Kenema and Kunduz hospitals.

Location

Number of modules

Deployment time

Facility built

Doro, South Sudan

9 (1,300m²)

13 weeks

Obstetric department, inpatient maternity department, neonatal intensive care unit, emergency consultation ward

Bassikounou, Mauritania

4 (580m²)

8 weeks

Operating department

Tabarre, Haiti

7,6 (1,100m²)

15 weeks

Outpatient structure

Kunduz, Afghanistan

24 (3,900m², 35% of total buildings)

ongoing

Trauma centre

Kenema, Sierra Leone

56 (6,700m², 35% of total buildings)

ongoing

Mother & Child hospital

With a cost of about 1200€/m² (including transport), this solution tackles several challenges around availability of expertise and quality of local constructions, and provides a good balance between deployment time and operating lifespan. Beyond traditional energy setups The long-term nature of some MSF projects and their increasing complexity are causing an energy demand growth by order(s) of magnitude. Energy use in MSF’s health facilities is usually higher than in health facilities

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beyond the electricity system itself, involving improvements in the thermal energy performance of buildings that are subject to heating, ventilation, and air-conditioning (more than 50% of the overall energy is used to ensure a suitable indoor climate and to prevent airborne infections). As an example, the Modul(h)o buildings that are to be used in Kunduz are upgraded with canvas coverings to better cope with the cold climate; in Kenema solar heaters will be used to heat the water for the laundry; and in Bar Elias solar heaters are used to preheat the water used in the air handling units. There are also high ambitions regarding the use of renewable energy sources for electricity, such as in Kenema, where the energy setting will be a solar-diesel hybrid system including 1.7 MWp of photovoltaic panels. The cost benefit analysis of this energy solution showed a sixyear return on investment and a 75% reduction in CO2 emissions.

in the Global South and comparable to European hospital settings. The most common source of energy supply in MSF is generators. We estimate around 350-400 stationary generators are currently deployed globally by the Brussels Operational Centre, using approximately 5,000m3 of fuel and amounting to 13,500 tons of CO2 per year (2016 data). Energy production is key for MSF’s operations; ensuring quality energy supply together with the safety of people, the protection of equipment, and the continuity of service is a challenge. All of these factors called for an extension of the vision of what energy means to MSF, and how we meet the needs of our patients and staff. Concepts — largely based on existing technology — were needed that could offer both cost-effective and more sustainable energy solutions. Based on this, we formulated a comprehensive energy vision aiming to evaluate the potential of all energy sources (renewable and nonrenewable). We are now implementing this vision in Kunduz, Kenema, and Bar Elias. In these locations, the high estimates for energy use strongly motivate considerable efforts to administer energy-saving measures and implement the most energy-efficient setups to supply them. This includes considerations

On the supply-side management, instead of the traditional use of differently sized generators during different parts of the day to better match variations on the load side, Kunduz and Kenema’s hospitals will use synchronised generators (8 of 220kVA and 4 of 220kVA, respectively) to increase the possibility of following the load variations and thus improve the life-time of the generators. In Bar Elias, to improve the operation and management of the hospital, an energy monitoring strategy was developed to assess and re-assess the actual service needs. This will allow it to be used as an internal benchmarking — where the energy consumption can be followed over time — as well as an external benchmarking to allow for comparison to other facilities and give input on future energy setups. Running our health facilities: technical management The longer our projects run and the higher the medical complexity gets, the more difficult it becomes to maintain our facilities, taking into account our challenges linked to changing operational needs and the turnover of team members. In most countries, the health facilities that we run are not subjected to norms and it is not an aim for MSF to reach international certifications. We however get inspired by these norms and methodologies to develop our processes and tools. With that approach we have developed a toolkit for the technical management of health facilities. It provides general guidance in terms of preventive and corrective maintenance, inspired from CMMS

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and adapted to our operations. This toolkit includes generic preventive maintenance plans and protocols based on our standard installations and equipment. In order to identify and mitigate threats linked to the contexts in which we operate, we are using the Risk Analysis and Risk Response-RARR methodology. We are now starting to use this methodology to also analyse and mitigate the risks linked to our technical installations, to raise awareness within our teams, to help in prioritisation of mitigation measures, and to move towards an integrated risk management culture within the organisation. Having such processes and methodologies, and embracing a risk management culture, helps us to face our challenges. It makes our interventions more sustainable as these processes build the analytical skills of our staff. This way, when our activities are handed over, our locally trained staff can continue to use them. Furthermore, it helps our international staff face the technical management of health facilities, even if there is a high turnover of staff.

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CONCLUSION â&#x20AC;&#x201C; DISCUSSION: ENGINEERING SERVING THE PURPOSE OF HUMANITARIAN ACTION? MSF considers its strength to come from its identity as a medical humanitarian emergency organisation; however, the traditional emergency context our teams work in is changing. The complexity of our medical activities is growing; the socio-political contexts are getting more complex and volatile and the lifespan of our projects is increasing. Within this framework, there is a need to design and implement health facilities able to provide a longer-term operational response and which may differ from those that are fast and effective in a classical emergency context. The challenges of this evolving context require flexible engineering solutions in all technical domains. In this paper we presented some of these solutions on the construction, energy, and technical management side. These solutions make it possible to adapt to specific contextual factors and, at the same time, provide a high quality medical space for our patients and medical teams. However, these solutions bring complexity into our operations. The specific expertise required for their setup and maintenance, the turnover of our staff, and the diverse and changing contexts in which we operate sometimes make our decision-making slower. Several questions arise then from this new picture: how can we ensure that this specialisation will not impact our effectiveness as an emergency humanitarian organisation? How will we transform these challenges into opportunities without losing flexibility, an essential part of the nature of our organisation? How are we going to remain an organisation acting based on needs, without being biased by technological trends? Lastly, how can we develop this expertise while not losing jack-of-all-trades versatility? If we want engineering to be an opportunity and not a threat, those questions must be further discussed and tackled. We need to find professionals with highly varied backgrounds and willing to work on the ground; professionals able to adapt and transfer their knowledge and expertise while serving the purpose of humanitarian action.

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FULL STEAM AHEAD WHY STEAM? Traditionally steam has been a key part of the infrastructure of many institutions, hotels and in particular most healthcare facilities. This is not by accident, and if we look at the benefits of steam it is easy to see why it is so widely used.

such as hot water and building heating is easily measured in terms of Mega Watts, and so represents a large amount of electrical power. If all these thermal processes were to convert to electricity, the infrastructure to generate and supply (both transmission from point of generation and It all boils, excuse the pun, down to the need for heat then distribution within the facility) this level of electrical energy. The need to heat different process, from building power would be immense. Further if the processes were heating to domestic hot water and even sterilisation in considered as critical then back-up generation capacity healthcare, requires energy. Traditionally this energy has would be required on site, with consideration given to how come from the combustion of fossil fuels but, as it is not it may cope with some of the processes placing sudden practical to light a fire under every process that needs heat large loads on such back-up generation (for example energy, some way of transferring the heat energy from the the pulsed energy demands of sterilisers). There is also the combustion process to the heating question of storage – current methods process is required. Steam is the ideal are not practical for the amount medium to do this. of electrical power that would be • High in energy required for thermal processes. Steam is essentially water with heat • No pumps to distribute energy added. A large amount of In this regard the combustion of fuel heat energy is added to get the phase to provide the energy to thermal • Easily controlled change from water to steam and processes will likely remain a key this comes from the heat provided consideration, but this is not to say • Efficient by the combustion of the fuel in the that this can’t be done in a renewable boiler. The steam is then transported, • Produced from water fashion. Biomass and hydrogen are via the steam reticulation system, to possible renewable energy sources • Inert the point of use, where the steam that could be used. The latter can will come into contact with a cooler be made efficiently from renewable • Sterile surface (heat exchanger) or product sources such as solar and wind, (direct contact) and immediately and overcomes the storage and • Direct heating condense and give up that heat distribution issues, so has great energy. The large amount of energy • Indirect Heating potential. put in to change the phase, in the boiler, is released to the process when Whether using a fossil fuel, or a it condenses, and this energy transfer renewable fuel, the key will be to is quick and efficient. The condensed water can then be make the use of energy in thermal processes as efficient returned to the boiler to receive more heat energy and as possible. Reducing the thermal energy usage, where repeat the cycle. possible, will be a major part of this, but even if energy demand can be reduced, there is still likely to be a Apart from the high energy content of steam, it is also high energy requirement (unless cold showers and cold easy to control and distribute. No pumps are required and buildings are to be accepted – unlikely). Steam remains steam will automatically flow to where the heat energy an ideal energy transport medium for thermal processes, is required (due to condensing steam causing a pressure both for indirect contact through heat exchangers, and drop at the point of use). Steam only has a small mass for direct contact through processes such as sterilisation and systems do not need to be drained and refilled for and humidification, so making the steam system more maintenance. Further it is made from water, so is not toxic efficient will also be critical. This can include how the (no contamination issues if there is a leak), and depending steam is generated, using more efficient boilers, or even on the method of generation can also be clean and sterile co-generation or tri-generation, using more heat recovery for direct contact applications (for example sterilisers and and efficiency improvements in the steam system itself. In humidification of air). the next edition of this journal we will look at how steam systems, that are often integral to delivering thermal We know that steam is an ideal energy transporter, but the energy, can be made more efficient, allowing steam to be need to look more closely at energy and carbon means embraced as the primary, or only, thermal energy medium that how energy is sourced and used is under scrutiny. The needed within a facility. desire to move away from fossil fuels and to use renewable energy is a strong driving force. Electrical power is often put For more information, please contact Spirax Sarco on forward as the way to do this, but it is not quite that simple. 1300 774729 (SPIRAX) or info@au.spiraxsarco.com In most facilities the heat energy provided to processes

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