Healthcare Facilities Spring 2017 by Adbourne Publishing

PP 100010900

VOLUME 40 I NUMBER 3 I SEPTEMBER 2017

HEALTHCARE INSTITUTE of HEALTHCARE ENGINEERING AUSTRALIA

FACILITIES

IHEA Healthcare Facilities Management Conference 2017

COMPLIANCE IN MOTION

11-13 OCTOBER 2017, PULLMAN MELBOURNE ALBERT PARK

Day One: Wednesday 11 October 2017 9.30am - 10.00am

Registration desk open for Masterclass attendees Location: outside Element Room, Ground Floor of Pullman Melbourne Albert Park

10.00am - 1.00pm

Optional Masterclass Workshop: Bridging the Gap to AS4187 Facilitator: Kevin Moon Location: Element Room, Ground Level of Pullman Melbourne Albert Park Optional Masterclass Workshop Presenters: Development of AS4187 Andrew Gay, Steriliser Validation Australia The European Perspective Allard van Beek, Miele Australia. Steam Requirements for AS4187 Graeme Harley, Spirax Sarco Manufacturers Perspective Sean Boston, Atherton Water Quality Requirements of AS4187 Measure Your Gap to AS4187 Compliance Trish Seagrove, Infection Control & Sterilisation Practitioner Forum - How to meet the implementation challenges for Engineers

1.00pm

Optional Masterclass Lunch

From 2.00pm

Optional Technical Tours

2.30pm - 3.30pm

Technical Tour 1 Victorian Comprehensive Cancer Centre (VCCC)

2.30pm - 4.00pm

Technical Tour 2 Royal Children's Hospital (RCH)

2.00pm - 5.00pm

Technical Tour 3 Atherton

5.30pm - 8.00pm

Registration desk open for all delegates Location: outside Grand Ballroom 1-4, Pullman Melbourne Albert Park

6.00pm - 8.00pm

Trade Night Exhibition Area, Pullman Melbourne Albert Park Dress: Smart Casual

Sponsored by

Day Two: Thursday 12 October 2017 7.00am - 4.45pm

Registration desk open Location: outside Grand Ballroom 1-4, Pullman Melbourne Albert Park

All conference sessions will be held in Grand Ballroom 1-4 8.00am

Official Conference Opening & Housekeeping MC: John Dixon

8.15am

Welcome To Country Elder Ian (Warrend-Badj) Hunter

8.25am

Official Conference Address & Opening Gabrielle Williams, Parliamentary Secretary for Health

VICTORIAN CANCER CENTRE – 8.40am KEYNOTE COMPREHENSIVE ADDRESS Dr Louise Mahler 9.40am FMA IHEA Partnership Wendy Clayton, FMA & Karen Taylor, IHEA IHEA Conference technical tours available 9.45am Morning Tea & Exhibition 10.00am - 2.00pm

Partners Program – Melbourne By Foot Walking Tour

Stream: Building Code of Australia including occupancy certificate, essential services, statutory

CONTENTS REGULARS 5

Editors message

National Presidents message

CEO’s message

93 News

36 Managing the energy consumption and utilities performance re your life safety 44 A & firefighting systems “Fit for Purpose”

10 WA

Design considerations for 50 operating theatre ventilation Systems

14 VIC/TAS

BIM and security 59

16 QLD 19 NSW/ACT

Operating theatre 64 commissioning and testing

CONFERENCE

Facilities management 69 accreditation

BRANCH REPORTS

20 The IFHE 2017

Driving healthcare facility 72 performance

VALE 27 Charles Edward Shields

Using analytics for Improving 80 building performance

FEATURE ARTICLES

INTERNATIONAL STORIES

Bad power quality, 29 bad for hospital health

Hospital innovations 2016 83

Background, development 33 and implementation of the national enHealth

Visit the Institute of Healthcare Engineering online by visiting

www.ihea.org.au or scanning here ➞

IHEA NATIONAL OFFICE Direct: 1300 929 508 Email: admin@ihea.org.au Address: PO Box 6203, Conder ACT 2900 Website: www.ihea.org.au Conference: http://hfmc2017.org.au IHEA NATIONAL BOARD National President Brett Petherbridge National Immediate Past President Darren Green National Vice President Peter Easson National Treasurer Mal Allen National Secretary/Communications Darryl Pitcher Membership Registrar/CHCFM Coordinator Peter Footner Standards Coordinator Brett Nickels

Asset Mark Coordinator Greg Truscott Directors Michael McCambridge, Rod Woodford

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

IHEA ADMINISTRATION

ADVERTISING

Secretariat/Website Administrator Heidi Moon

Melbourne: Neil Muir T: (03) 9758 1433 F: (03) 9758 1432 E: neil@adbourne.com

Finance Jeff Little Membership Wendy Clayton (FMA), members@ihea.org.au Editorial Committee Darryl Pitcher, Brett Petherbridge and Darren Green

IHEA MISSION STATEMENT To support members and industry stakeholders to achieve best practice health engineering in sustainable public and private healthcare sectors.

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 1431 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.

BRANCH REPORTS

• • • • • • •

EDITOR’S MESSAGE

CREATING A CULTURE OF SHARED RESPONSIBILITY In our last editorial I talked about compliance, and that ticking the boxes and achieving a minimum set of criteria did not ensure that all was necessarily OK within an organisation. It is a good sign if compliance is achieved of course, and not to be diminished in any way, but compliance is not always a guarantee of successful delivery of healthcare or engineering solutions.

t a recent conference I attended there was a presentation about how an organisation can create a culture that shares the responsibility for safety, compliance and sustainability. The focus of this session was around patient and staff safety and organisational sustainability. This session rang particularly true for me because of the context of compliance and regulation that exists within the Australian health sector. It is of little value if senior managers of an organisation are committed to safety and sustainability, if the whole team who have so many touch points with these issues are not committed to the organisational objectives. Some may recall when occupational health, safety and welfare systems were introduced to the workplace – around the early to mid 1980’s. In many cases OHS&W systems were ‘bolted on’ to existing management systems. Over the years we have seen OHS&W, now WHS, become more embedded, and greater responsibility shared within organisations. This process has been driven by legislative reform, and greater sharing of legal responsibilities to anybody who makes decisions within an organisation. In some cases we have heard of prison sentences and significant fines applied to individuals where WHS has not been well managed. These measures always help to share the responsibility from the top down. The idea of creating a culture of shared responsibility for safety and sustainability looks a little different to enforcing fines and penalties. It aims to work from the ground up to connect with people right across an organisation, because everybody shares some responsibility for

safety and sustainability. Creating a culture that shares responsibility is a journey. The accepted starting point, from every perspective was communication – this is an organisational imperative without which it is very hard to make any progress. Once good communication is in place, the speaker identified five key steps to creating a culture of shared responsibility: Education – everybody needs to understand the broad context of how systems operate and interconnect. Leadership – needs to be shared to increase autonomy and decision making. Leadership is a behaviour not management. Ownership – encourage everybody to ‘own’ their actions and the consequences of those actions. Transparency – ensure that there is visibility where shared ownership has been adopted. Accountability – measuring effectiveness and sharing the outcomes promotes the value of ownership, leadership and transparency. Many opportunities exist to share the responsibility for safety and sustainability – and it doesn’t only sit within the engineering team, but these teams are the most aware of how systems operate together, and what the organisational costs are for not taking responsibility. Perhaps this is just the beginning of the education process. Regards Darryl Pitcher

REGULARS

NATIONAL PRESIDENT’S MESSAGE

As we move towards our premier Professional Development event, the IHEA National Conference I am reminded of just how much work is undertaken to ensure its success. The Conference Organising Committee from the Vic/Tas Branch along with our Professional Conference Organisers have worked tirelessly over the past 12 months. The role of the conference convener is critical in our partnership with the PCO. My thanks to all who have contributed to this year’s National Conference.

t is with a heavy heart that I must inform members the passing of our long term member Mr Charlie Shields on 22nd June 2017. As most will recall Charlie was our guest at the National Conference in Adelaide in 2016 having reached 60 years continual membership. Charlie was held in high regard by all who met him and will be sadly missed by all.

SUMMARY OF KEY ACTIVITIES Over the last 3 months the National Board has undertaken the following. • Transfer of the IHEA Membership database to Facilities Management Australia (FMA) under our partnering agreement for administrative support. • IHEA Annual Membership Renewals • Completing the Annual Report and Directors reports • Annual Audit of the IHEA Financial accounts • Commenced the revamp of the IHEA Website • A face to face meeting with Federal Health Minister Chief of Staff • Members Survey

• Preparing for the launch of the IHEA Social Media strategy at the National Conference

FMA ALLIANCE Much work has been undertaken to ensure a smooth transition of our members database to the FMA Administration. This culminated in many hours undertaken by our CEO, Secretary and Membership Registrar. My personal thanks to all. FMA will be represented at the National Conference and available for any questions, feedback on the membership renewals process.

IHEA WEBSITE – REVAMP This package of work is now complete and the new website is ready for launch. Much work has been undertaken behind the scenes to ensure we capture the critical information for members and prospective members. Please check out the new website – the actual launch date will be advised by e-bulletin to members.

MEETING WITH FEDERAL HEALTH MINISTER As part of our efforts to raise the IHEA portfolio, the IHEA wrote to the office of the Hon Greg Hunt MP – Minister for Health and Minister for Sport, to introduce the Institute of Healthcare Engineering Australia,

REGULARS

discuss our ability and willingness to assist with and provide input to the National Health Standards as they relate to infrastructure and facilities and to inform them about our international connections and the upcoming international congress we have secured in 2018 in Brisbane. The Minister’s Chief of Staff met with our CEO and Darryl Pitcher in Melbourne in July. This meeting was very successful and we have added the Minister to our mailing list for the Health Facilities Journal.

MEMBERSHIP SURVEY The IHEA has undertaken to survey its members in September annually. The results from this and the post National Conference report feed into the Strategic Planning that is undertaken by the IHEA at its Board Meeting in February. Please ensure you complete this survey as your feedback is very important to the Board and is much appreciated.

SOCIAL MEDIA The IHEA will launch its Social Media strategy at the National Conference as a result of feedback obtained through the member’s survey. This is new ground for some of us as we look at new avenues for members interaction and growth. Some of us have a very steep learning curve ahead so please be patient as we learn and embrace “new technology”.

IFHE CONGRESS 2018 Our 2018 Conference Website is up and going and we have released our call for abstracts worldwide. Our planning is well advanced and our promotion has commenced locally and internationally. This is a very exciting opportunity for the IHEA to showcase to the world not only our country but also our members. Please ensure you clear your diaries for next year and attend, this is a conference not to be missed. Check in at the website www.ifhe2018.com to register for updates and submit abstracts.

SUMMARY In closing I have thoroughly enjoyed my time as National President. Much has been achieved during the past 2 years and this would not be possible without the dedication and support of the Board Directors and our CEO. I would like to personally thank all Board Directors that have served during my tenure and our CEO Karen Taylor. I now move into the Immediate Past President Role and 2018 IFHE Conference Convener. To all members, thank you for your past support. I now pass over to Peter Easson to assume the National Presidents role and have every confidence his enthusiasm and dedication along with the full support of the CEO and Board Directors will showcase the IHEA into the future. Brett Petherbridge IHEA National President

The National Board of Directors is as follows:Name

Position

Brett Petherbridge

National President

Peter Easson

Vice President

Darren Green

Immediate Past President

darren.green@gsahs.health.nsw.gov.au

Darryl Pitcher

Secretary

D.pitcher@bethsalemcare.com.au

Mal Allen

Treasurer

Mal.Allen@hnehealth.nsw.gov.au

Karen Taylor

Chief Executive Officer (ex officio)

ceo@ihea.org.au

Peter Footner

Membership Registrar

pesarash@adam.com.au

Brett Nickels

Director – Standards

Brett.Nickels@health.qld.gov.au

Greg Truscott

Director – Asset Mark

Greg.Truscott@health.wa.gov.au

Michael McCambridge

Director (co-opted)

Michael.McCambridge@mh.org.au

Executive Committee

brett.petherbridge@act.gov.au Peter.Easson@health.wa.gov.au

REGULARS

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REGULARS

CEO’S MESSAGE

IHEA embraces social media

017 has been a period of great activity aimed at increasing benefits for IHEA members. Significantly we have engaged Facilities Management Australia to coordinate all our member administration services and engaged Nucleus to redevelop our website and implement a social media strategy. Representatives from both FMA and Nucleus will attend the conference in October to provide members with a more comprehensive update. These initiatives have been a direct result of feedback from our members via our annual survey. Please keep an eye out for the next chance to have your say in our members’ survey due to be released in mid-late September. As part of the website redevelopment the Board made a decision to embrace social media and all the benefits it can provide for IHEA and its members. Why? It is estimated that 75% of people get their news from social media sites. Should we all be afraid of social media? Absolutely not. We believe social media will help IHEA thrive, connect, and engage with new and existing members. Many IHEA members are already communicating via social media–its time IHEA was included.

We hope to launch online discussion boards and other online communities, increasing the opportunities for members to network and learn from one another. Social media will keep you informed of IHEA activities and events and will allow you to have input to the those even if you can’t attend! IHEA believes that social media will deliver the following benefits for members • increase organisational awareness, by engaging with users and sharing relevant content, photos, and events. • attract new members by highlighting the exciting community IHEA offers. • build relationships with members. By engaging in real-time conversations, answering questions, and sharing helpful and relevant content, IHEA can continue to build meaningful member connections. • inspire action through an active and exciting social media presence Look out for the Nucleus team at the conference in October and join in the conversation! Karen Taylor CEO

BRANCH REPORTS

WA BRANCH REPORT Branch Meeting June 2017, Crown Towers

‘

Are we really in Perth?’ was the frequently asked question from the delegates touring the opulent 6 star Crown Towers luxury hotel, recently opened on the Crown casino complex adjacent to the CBD. The annual joint AIHE (Australian Institute of Hotel Engineering) & IHEA branch meeting was hosted by AIHE president Tony Fioraso, who welcomed the 60 members to the exquisite hotel, along with an informative ‘behind the scenes’ tour. Crown Towers Entry Foyer

equivalent to two basketball courts and costs a shade under $21,000 a night, featuring four bedrooms, a grand central staircase, a wrap-around balcony, a private gym and of course, a 24-hour private butler service. The spectacular sculpture residing on display behind the reception desk is by West Australian artist Ian Dowling and consists of 6,000 separate ceramic pieces. The ceiling in the lobby was specially reinforced to support the 3-ton weight of the unique chandeliers, each consisting of over 20,000 individual glass beads, designed by the world renowned South African artist Adam Hoets. Delegates inspecting the Ballroom

Crown Towers Reception Pool Sun Loungers

Built at a cost of $650M (including land purchase) to serve high rollers’ expectations, Crown Towers is Australia’s most expensive hotel and boasts some impressive statistics. The hotel is home to 480 guest rooms and villas. The two-storey Chairman’s Villa boasts a floor space

Aerial View of the Pool

Interestingly, floors 4 and 14 are non-existent within the 23-level hotel, as in some East Asian cultures the number 4 is considered unlucky, hence both floors 4 and 14 are ‘missing’ within the building.

BRANCH REPORTS

The hotel is projected to attract 200,000 guests to Western Australia, including 80,000 from overseas, who will in turn inject over $60 million annually to the local tourism economy. If you fancy a dip, the meandering swimming pool covers an area of 1,800m2 – equivalent to 1.5x Olympic size pools and holding 1.8 million litres of water. 1.5 million individual mosaic tiles were painstakingly installed during its construction. View of the Pool

Hosting the SGM at the Ramsay Hollywood Hospital, WA Treasurer Mr Rohit Jethro presented the full Financial Year report. The main points of the report confirmed that the IHEA at both Branch and National levels was in a financially sound position after the past 12 months. Mr Mark Stokoe was then called upon to dissolve the current Committee of Management and conduct the process of members electing a new WA Branch Committee of Management and Office Bearers for 2017/18. The results of the Election are as follows: Branch Office Bearers State President

Mr Greg Truscott

State Vice President

Mr Peter Klymiuk

State Treasurer

Mr Rohit Jethro

State Secretary Vacant State National Representative Mr Greg Truscott Committee of Management Members Mr Steve Dallas Mr Peter Easson Mr Alex Foster Mr Rob Foley Mr Neil Oliver The evening’s sponsor, Blueforce, was represented by Dale and Sam Lofts, who presented their wide range of turnkey ELV solutions. Established in August 2002, Blueforce is a leading provider of integrated security, life safety and communications systems throughout Australia. Their mission is to deliver innovative and interactive solutions across all sectors, including surveillance, access control, intercom, staff duress and nurse call, personal emergency response systems, and audio-visual and media integration. With a team of mobile and highlyskilled technicians and backed by a local 24-hour monitoring centre, Blueforce delivers a professional and reliable service using the latest technologies.

Mr Simon Marsh Mr Tom Kelly Mr Fabien Edwards Mr Philippe Tercier Mr Fred Foley Mr Craig Aggett

The Committee wishes to thank the immediate past State President, Mr Craig Aggett, and recognise Craig’s contribution during his service to the WA branch, along with the following committee members who are stepping down after a number of years’ valuable service. Mr John Dransfield

Special General Meeting July 2017, Hollywood Private Hospital

Mr Robert Falls

The Special General meeting, attended by 32 members, was called to order by the State President Mr Greg Truscott, who presented and tabled the Annual Report and acknowledged the work undertaken by the CoM during the past 12 months.

Mr Rishi Wakle

Mr Peter Klymiuk, the state secretary, spoke and tabled the Branch Secretaries Report.

(immediate past President)

Mr Mark Stokoe Annual State Conference – August 2017 ‘Contemporary Challenges in Healthcare Facilities Management’ The WA Branch, State Conference had the theme ‘Contemporary Challenges in Healthcare Facilities Management’. Retired IHEA member Mr Lionel

BRANCH REPORTS

Delamotte was the Master of Ceremonies for the day and the Conference was very well supported, with the number of delegates, presenters and sponsors, attending, totalling 92. The Conference was opened by Dr Gervase Chaney, who is the Executive Director of the soon to be opened $1.2B Perth Children’s Hospital. During most of the development time for this project he was the Medical Leader and his presentation highlighted that the key principals of the project were patient safety and that it had been designed with the focus on the children and their families. He also identified the challenges the team had to overcome, to meet the high goals set for the project. Dr Gervase Chaney delivering the Opening Address

During the proceedings, Mr Peter Easson, IHEA National Vice President, was called upon to present the WA annual achievement awards to the following people who have excelled in the Health Care Facilities Industry: • Health Facilities Manager/Hospital Engineer of The Year, was awarded to Mr Phillip Hawkins of King Edward Memorial Hospital (KEMH). Phillip was recently asked at short notice to step up to the role of Campus Facility Manager at KEMH while also continuing to fulfil many of the duties of the Operational Engineer. He acquitted himself very well in this new role and also took the lead for a project to change from 6.6Kv to 11Kv transformers and associated switch gear at KEMH. Congratulations on your achievement. Mr Phillip Hawkins (right) receiving the Health Facilities Manager/Hospital Engineer of the Year Award from Mr Peter Easson.

Keynote speakers – Steve Gaffey (“Changes to the WA Health Facility Guidelines 2006 for release as 2017 update), Brett Benz of Atherton (“Reprocessing of reusable medical devices in Health Services”), Rishi Wakle (“Obsolescence Management in Healthcare Facilities”) and Ryan Milne of Ecosafe International (“Effective Implementation of the Enhealth Guidelines”) provided great insights into the contemporary challenges within each of the areas they spoke about. Steve Gaffey delivering his Keynote Address Rishi Wakle delivering his Keynote Address

• Healthcare Facility Tradesperson of the Year was awarded to Mr Jerard Latchmiah. Jerard not only received high praise from his employer, Alex Foster of Foster’s Services this was also supported by many of the Healthcare Facility Engineers, who noted the high quality electrical work he carried out at their hospitals. Congratulations on your achievement. Mr Jerard Latchmiah (right) receiving the Tradesperson of the Year Award from Mr Peter Easson.

Delegates enjoying the presentations at the Conference venue

• Apprentice of the Year was not awarded this year. Despite many requests, sadly the IHEA WA branch did not receive any nomination for this award.

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BRANCH REPORTS

VIC/TAS BRANCH REPORT Activities

The Vic/Tas branch committee’s activity has been focused on preparing the program for this year’s IHEA National Conference, ‘Compliance in Motion’ 11th-13th October 2017. We are excited to advise that the conference will be opened by Gabrielle Williams, Parliamentary Secretary for Health. The Conference MC is to be the Vic/Tas member, John Dixon, with the confirmed keynote speakers being; Dr Louise Mahler, Dynamic leadership influencer and Professor David Hood, Civil and Environmental Engineer. Technical tours will include the Victorian Comprehensive Cancer Centre, The Royal Children’s Hospital, Atherton – a well-known manufacturer of hospital equipment. Optional masterclass will include “Bridging the gap to AS4187 – Reprocessing of reusable medical devices in health service organisations.” The conference dinner will be hosted at the well known Etihad Stadium on Thursday evening, October 12th. Make sure you plan to join the Vic/Tas branch and your national colleagues in Melbourne to be part of this premier event for members with the supporters and partners of IHEA. With the cost of utilities sky rocketing, the branch and the Department of Health agreed to hold a joint forum on environmental management. The forum

will allow Health Engineers to document and present their successes, break-evens and failures, which will be handed over to consultants (Point Advisory) to consolidate into an Energy & Climate Change report. We look forward to the input of members into this important forum. Look ahead activities National Conference 11th-13th October 2017, Pullman Melbourne, Albert Park – Theme “Compliance in Motion.” IHEA/DHHS – Environmental forum – 24th November 2017 – Venue to be confirmed. Branch Christmas function – 24 November 2017 – Venue to be confirmed. Membership There has been slight growth in branch membership, and members who are yet to sign up for 2017/18 will be followed up by branch members over the next two months. Committee of Management At this year’s special meeting the committee of management was ratified as per below. All branch members are encouraged to participate in local activities including setting out the professional development agenda for 2018. Michael McCambridge VIC/TAS Branch President

Committee of Management

Branch President

Michael McCambridge

michael.mccambridge@mh.org.au

Branch Secretary

Peter Crammond

peter.crammond@whcg.org.au

Branch Treasurer

Roderick Cusack

rod.cusack@brhs.com.au

Committee of Management

Howard Bulmer

howardjbulmer@gmail.com

Committee of Management

Sujee Panagoda

sujee.panagoda@monashhealth.org

Committee of Management

Steve Ball

steve.ball@epworth.org.au

Committee of Management

Mark Hooper

mhooper@erh.org.au

Committee of Management

Roderick Woodford

rwoodford@castlemainehealth.org.au

Nation Board Reps Nominee – to be confirmed at the AGM

Michael McCambridge Mark Hooper

michael.mccambridge@mh.org.au mhooper@erh.org.au

Conference Convenor 2017

Roderick Woodford

rwoodford@castlemainehealth.org.au

BRANCH REPORTS

QLD BRANCH REPORT

n behalf of the QLD Branch I would like to acknowledge the continued support of the QLD IHEA Branch Committee of Management, all Branch members and our many and varied sponsorship partners all of whom have contributed to another successful year.

Name

Position

Scott Wells

President

Scott.wells@health.qld.gov.au

Brett Nickels

Vice President and State Board Rep

Brett.Nickels@health.qld.gov.au

Kym Collins

Secretary

kcollins@ellisair.com.au

Jason Ward

Treasurer

Jward@beckerpump.com.au

Michael Ward

Committee

MichaelJ.Ward@health.wa.gov.au

Scott Summerville

Committee

scott@opira.com.au

Peter White

Committee

palapac444@hotmail.com

Activities

Alex Mair

Committee

ama58500@bigpond.net.au

QLD Branch Mid-Year Conference July 2017 – Victoria Park

Adrian Duff

Committee

Adrian.duff@health.qld.gov.au

Kevin Eaton

Committee

kevineaton@sdp.net.au

This year’s conference was a success at all levels – there were a good number of supportive sponsors, it was well attended from the Queensland branch delegates, and we were privileged to have an excellent array of quality speakers. The Conference kicked off with an early round of golf, supported by a loyal group of eight delegates who were brave enough to make a very early morning start.

Stuart Hentschel

Committee

Stuart.Hentschel@health.qld.gov.au

The theme was focussed on two areas of healthcare Facility

Geoff Adams (Ramsay Healthcare) delivering his address on medical device interactions.

Committee of Management

Management that regularly require our input – “WiFi Challenges” and “Humidity in Healthcare”. The Conference was opened by the Metro North Hospital Health Services Chief Executive, Mr Shaun Drummond.

giving up their time. Events like this require a lot of effort and time to ensure their success and our midyear conference was just that. A special thanks to our sponsors who supported our conference and branch activities.

Along with all the speakers who contributed to the success of the Conference, I’d like to take the opportunity to thank the organising committee especially Peter White, Alex Mair & Scott Sommerville for

Branch Special Meeting

QLD State Branch Committee of Management

The annual branch special meeting was held on July 21st and was focussed on establishing the new Committee of Management

BRANCH REPORTS

to oversee the branch activities into 2018. Iâ&#x20AC;&#x2122;m pleased to advise that the new committee includes the table opposite. The Branch Committee of Management will continue to meet monthly with a focus on providing members with networking opportunities through social events, professional Developments and conferences. I encourage any QLD members to make contact with the committee members above for matters relating to state or national activities of the IHEA. Brett Nickels QLD Vice President

IHEA Partner - Armstrong Commercial Flooring

IHEA Partner - Symbio Laboratories

IHEA Member Alex Mair receiving a prize from Clevertronicsâ&#x20AC;&#x2122; Barry Aulfrey

BRANCH REPORTS

NSW/ACT REPORT

NSW members enjoying a site visit

Activities

Committee of Management Contact details Name

Position

Phone

Jon Gowdy

President

0411 040 834

Jon.Gowdy@sswahs.nsw.gov.au

Robin Arian

Vice President

0423 170 114

Rob.arian@sswahs.nsw.gov.au

Mal Allen

Treasurer

0467 761 867

mal.allen@hnehealth.nsw.gov.au

Darren Green

Secretary

0418 238 062

darren.green@.health.nsw.gov.au

John Miles

CoM

0408 403 025

John.miles@health.nsw.gov.au

Robin Arian

CoM

0408 869 953

peter.allen@hnehealth.nsw.gov.au

Jason Swingler

CoM

0423 299 221

Jason.swingler@sswahs.nsw.gov.au

Marcus Stalker

CoM

0409 157 870

Marcus.stalker@sswahs.nsw.gov.au

CoM

0418 683 559

brett.petherbridge@act.gov.au

CoM

0428 699 112

peter.lloyd@.health.nsw.gov.au

CoM

0467 711 715

Greg.allen@swsahs.nsw.gov.au

CoM

0459 896 171

Ashwin.singh@swsahs.nsw.gov.au

CoM

02 6244 3186

Chris.tarbuck@act.gov.au

SW/ACT branch held a Brett Petherbridge professional development Peter Lloyd day on the 16th June at Greg Allen the Rydges Hotel Campbelltown in south western Sydney. The Ashwin Singh theme of the day was “Asset Chris Tarbuck Management – Breathe Easy” and covered a range of relevant topics including opportunities for interactive group participation. The day was well attended by both members and industry representatives with the presentations on the importance of clean air and water in a healthcare environment were very well received. It was pleasing to see the level of interest and participation in the group discussions with some robust discussions around the direction health facility management is taking in NSW. A tour of the recently completed Campbelltown Hospital redevelopment was part of the day’s activities with group consensus regarding the excellent condition of the plant areas in particular – well done Campbelltown team! The day was rounded out with a special general meeting and the election of a new Committee of Management and some much needed networking refreshments. Membership

Membership interest from both industry groups and health facility management practitioners is increasing and the incoming CoM will be discussing strategies on how to ensure that this pattern of growth continues.

Actions Planning for the 2017 AGM is now well underway with a date and location now settled on. The AGM will be held in Wollongong on the 24th and 25th November 2017. Strong sponsor interest is already being shown and the COM will be working hard to leverage on this to ensure that an exciting and interesting event is provided for our members and other attendees. Committee of Management I would like to welcome the new members to the CoM that were voted in at the Campbelltown event. The strong level of interest shown from members is reflected in the high number of new recruits and I’m looking forward to working closely with all over the next 12 months Jon Gowdy Director Engineering Services SLHD MIHEA NSW State President

Mal Allen presenting to NSW Branch meeting

Vale Geoff Johnston, Charles Shields It is with great sadness that I announce the passing of Geoff Johnston and Charles Shields. Both were very well regarded NSW/ACT Branch IHEA members of long standing with 34 and 61 years membership respectively

CONFERENCES

THE INTERNATIONAL FEDERATION OF HOSPITAL ENGINEERING 2017 BRAZIL COUNCIL MEETING, RIO DE JANEIRO

As active ‘A’ members of the IFHE, the IHEA has regularly had representatives at the Council meetings held each year. Council meetings in non-Congress years are hosted by national organisations, usually in conjunction with their own national conference.

he 50th IFHE Council Meeting was held on Monday 28th August 2017 at Hotel Rio Othon Palace in Rio De Janeiro. The location was particularly picturesque just across the main esplanade from Copacabana Beach. The agenda was a full program as the Council worked through normal business and the introduction of a new initiative – some interactive group breakout sessions. The meeting was well supported with representatives from some 30 countries which provided a good blend of input from this cross section. The IHEA was represented formally by Darren Green on behalf of the National Board Executive and Darryl Pitcher who sits on the IFHE Executive Council as the International Vice President. Importantly as part of the agenda items IHEA was given the opportunity to present our Annual IFHE Report to the Council and Report on planning for the 2018 Brisbane Congress. Future IFHE Council Meetings were confirmed as 2018 Brisbane, Australia; 2019 Manchester, UK and 2020 Rome, Italy. Interestingly the break-out sessions were conducted with five (5) groups focussed on two key questions being discussed together:

Responses around question 1. • Congress themes and topics should be contemporary and internationally relevant. • It was noted that English speaking countries seem to get greater value from Congresses, publications and membership. There was keenness for effort to be applied to break down the language barriers. • It would be ideal if all countries had the ability to input into the appetite and focus topics for congresses and conference themes. • Provide better access to federation association members for technical papers and presentations. • That there should be a focus for harmonising standards and other regulatory tools and members get information on ‘lessons learnt’ (good or bad!).

1. What do national associations and individuals want and need from the IFHE?

• Broaden educational, training and opportunities for developing countries.

2. What can individuals do to contribute to hospital engineering, architecture or facilities management around the world?

• Provide international visitation contacts and promote opportunities for sharing.

In summary all five (5) groups echoed similar feedback revolving around breaking down geographical, language and cultural barriers and improving access to information and providing input into international building and technical standards.

Darren Green presenting the IHEA report to Council

• Provide a platform for technical staff certification, status and recognition. • Facilitate the breaking down of isolation caused by geographic, regional, cultural and language gaps. • Aligning International Standards and other regulatory regulations.

CONFERENCES

Darren Green and Darryl Pitcher promoting IFHE 2018

Darryl Pitcher & Darren Green presenting re IFHE 2018

Responses around question 2.

The session was well received and presented a good opportunity for all international delegates to contribute, information was later collated and will feed into future strategic plans and planning.

• Share and contribute local learnings to the international community of healthcare engineering. • Share and build on ‘lessons learnt’ (good and bad).

The IFHE Council Meeting was also linked to a three (3) day technical program hosted by the Brazilian Association of Healthcare Architecture and

• Support and attend learning opportunities. • Deliver presentations.

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CONFERENCES

Engineering to the theme, “The Hospital Environment for Patient and Worker Safety”. There was a blend of interactive workshops, technical presentations and technical site visits. August 29 – Day 0ne (1) Workshop 1. Global Innovation for Healthcare Sustainability Panel 1. Safety Sustainability in Health Buildings Panel 2. Resilience in Engineering and Architecture – Disasters Panel 3. Contemporary Panorama of Health Buildings 01 August 30 – Day Two (2) Workshop 2. Electrical Patient Safety Regulatory Requirements and Responsibilities. Panel 4. Safe Hospitals for Patients and Workers Panel 5. Building Maintenance and Safety – Technology Panel 6. Contemporary Panorama of Health Buildings 02

August 31 – Day Three (3) Technical Site Tours The panel presentations were delivered by a wide range of experienced healthcare engineering and design professionals and allowed for interaction and questions. There were presentations from Netherlands, USA, Australia, Brazil, Portugal, Argentina, Germany, UK, Mexico, Canada, Japan, Chile, Paraguay to name just a few. One of the important tasks for the Australian delegates was to promote next year’s congress in Brisbane in October 2018. Darren Green provided an update to the assembled Council meeting, and both Darren and Darryl Pitcher provided a multi-media presentation to the 300+ Conference delegates on Day 2. After this promotion, fliers were circulated together with other promotional material, with a very positive response from many delegates. We are hopeful that this work will attract many international delegates to the IHEA/IFHE Congress next year.

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FEATURE ARTICLES

Visit www.HFMC2017.org.au to secure your attendance at this year’s Conference including: • Plenary Sessions • Optional Master Class Workshop • Technical Site Tours • Trade Night • Conference Dinner at Etihad Stadium • Partners Program

COMPLIANCE IN MOTION

The conference aims to bring together all the key contributors to the delivery of healthcare FM services and we look forward to you joining us in October.

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The Institute of Healthcare Engineering, Australia (IHEA) is pleased to invite FEATUREManagement ARTICLES Conference (HFMC 2017) you to the IHEA Healthcare Facilities to be held on 11-13 October 2017 at Pullman Melbourne Albert Park.

COMPLIANCE IN MOTION

This year’s theme is Compliance in Motion and aims to give the participants an overview of how Health Services manage compliance. With the role of Healthcare Facility Manager transitioning from technical focus to strategic and operational performance driven, there is additional pressure and responsibility to enhance Compliance Management and actively participate in the continual improvement of processes related to infrastructure management. The mission of facility managers is to embrace a culture of excellence and address Compliance Management with professional pride. Effectively, we become a change agent and a driver for quality in the built environment. The HFMC 2017 organising committee have put together a diverse, challenging, rewarding and enjoyable plenary program. Under the broader theme of ‘Compliance in Motion’, the program includes presentations across a range of streams such as: • Department of Health and Human Services building design requirements • Building Code of Australia including, occupancy certificate, essential services, statutory and regulatory maintenance • Council and Heritage requirements • Country and Metropolitan Fire brigades. • Health Service compliance, including OH&S, Infection control, waste and pollution and energy management. HFMC 2017 will feature two engaging keynote speakers: DR. LOUISE MAHLER is a communication specialist and a proven performer in moving individuals and groups to take a positive action through a unique perspective focusing on the unsung wisdom of voice. Louise will help unlock your confidence and have your voice heard! PROFESSOR DAVID HOOD AM is a civil and environmental engineer with vast experience across major civil and military projects, professional development in emerging economies, senior management in both the public and private sectors and in education.

OPTIONAL MASTER CLASS WORKSHOP

The optional master class, Bridging the Gap to AS4187, will include presentations from key parties involved in the development of “AS4187 – Reprocessing of reusable medical devices in health service organisations”. Experienced industry and practitioner representatives will outline the standard of services required, to meet processing equipment compliance, under this standard. To assist Engineers and Facility Managers to determine their level of compliance with the standard, a gap analysis tool will be introduced, for participants to evaluate their facilities and equipment. Participants will have the opportunity to ask questions of industry experts and are encouraged to engage in a forum, to explore ways to compliance with the standard.

TECHNICAL SITE TOURS

HFMC 2017 will also feature three technical site tours as part of the conference program: • Victorian Comprehensive Cancer Centre • Royal Children’s Hospital Melbourne • Atherton

IHEA Healthcare Facilities FEATURE ARTICLES Management Conference 2017

COMPLIANCE IN MOTION

11-13 OCTOBER 2017, PULLMAN MELBOURNE ALBERT PARK

Day One: Wednesday 11 October 2017 9.30am - 10.00am

Registration desk open for Masterclass attendees Location: outside Element Room, Ground Floor of Pullman Melbourne Albert Park

10.00am - 1.00pm

1.00pm

Optional Masterclass Lunch

From 2.00pm

Optional Technical Tours

2.30pm - 3.30pm

Technical Tour 1 Victorian Comprehensive Cancer Centre (VCCC)

2.30pm - 4.00pm

Technical Tour 2 Royal Children's Hospital (RCH)

2.00pm - 5.00pm

Technical Tour 3 Atherton

5.30pm - 8.00pm

Registration desk open for all delegates Location: outside Grand Ballroom 1-4, Pullman Melbourne Albert Park

6.00pm - 8.00pm

Trade Night Exhibition Area, Pullman Melbourne Albert Park Dress: Smart Casual

Sponsored by

Day Two: Thursday 12 October 2017 7.00am - 4.45pm

Registration desk open Location: outside Grand Ballroom 1-4, Pullman Melbourne Albert Park

All conference sessions will be held in Grand Ballroom 1-4 8.00am

Official Conference Opening & Housekeeping MC: John Dixon

8.15am

Welcome To Country Elder Ian (Warrend-Badj) Hunter

8.25am

Official Conference Address & Opening Gabrielle Williams, Parliamentary Secretary for Health

8.40am

KEYNOTE ADDRESS Dr Louise Mahler

9.40am

FMA IHEA Partnership Wendy Clayton, FMA & Karen Taylor, IHEA

9.45am

Morning Tea & Exhibition

10.00am - 2.00pm

Partners Program â&#x20AC;&#x201C; Melbourne By Foot Walking Tour

Stream: Building Code of Australia including occupancy certificate, essential services, statutory & regulatory maintenance 10.15am

Beyond compliance: meeting the indoor environmental needs of the occupants in hospital buildings Prachi Garnawat, RMIT University

10.35am

Epworth Hospital Richmond: making the spectacular safe and easy to maintain Carl Sachs, Workplace Access & Safety

10.55am

Australian ANZEX DELEGATE PRESENTATION: Embedding a Compliance Culture into Business as Usual Jon Gowdy, Sydney Local Health District

Stream: Department of Health and Human Services building design requirements 11.25am

How can this happen to me? Mark Hooper, ECHUCA Regional Health

11.55am

Regulatory Compliance of Healthcare Facilities Cameron Milne, Amec Foster Wheeler

12.15pm

IHEA AGM

12.30pm

Lunch & Exhibition

Correct at time of printing, this may be subject to change. Visit www.HFMC2017.org.au for the most up to date program.

#HFMC1725

Thursday 12 October 2017 continued Stream: Health Service Compliance, including OH&S, infection control, waste and pollution and energy management FEATURE ARTICLES 1.30pm

The implications of the Climate Change Act 2017 on the health and human services sector Tiernan Humphrys, Department of Health and Human Services

1.50pm

Facility Design and Complying with AS/NZS 4187:2014 Andrew Gay, Sterilizer Validation Australia

2.10pm

Infection Prevention and Workplace Safety in Operating Rooms by Airborne Particles and Bacteria Dictate Changes in Existing Standards Rupert Mack, Weiss Klimatechnik GmbHJ

2.40pm

Facilities Management Performance Measurement and Improvement Royce Vermeulen, Turner and Townsend

3.00pm

Group Photo of IHEA delegates followed by Afternoon Tea & Exhibition

3.45pm

National legislative requirements for the maintenance of essential safety measures Tony Stokes, Stokes Safety

4.15pm

ANZEX DELEGATE PRESENTATION: Compliance in an ageing Facility - A practical New Zealand Experience Warren Crawley, Palmerston North Hospital, MidCentral District Health Board, NZ

4.45pm

Conference Sessions Conclude

5.45pm

Conference Dinner Departure Meet in the Pullman Melbourne Albert Park hotel foyer at 5.45pm for a prompt 6.00pm bus departure

6.30pm - 11.30pm

Conference Dinner Etihad Stadium, Melbourne

Sponsored by

Dress: Cocktail

Day Three: Friday 13 October 2017 7.30am - 2.45pm

Registration desk open Location: outside Grand Ballroom 1-4, Pullman Melbourne Albert Park

All conference sessions will be held in Grand Ballroom 1-4 8.00am

Welcome & Housekeeping MC: John Dixon

8.15am

KEYNOTE ADDRESS: Climate Change and the Risks for Healthcare Engineering Professor David Hood AM

Sponsored by

Stream: Health Service Compliance, including OH&S, infection control, waste and pollution and energy management 9.15am

Developing a Water Quality Risk Management Plan Sarah Bailey, QED Environmental Services

9.45am

Meeting compliance and minimizing the risk of further waterborne pathogen related outbreaks in Australian hospitals Morten Schnoor, Pall Water

10.15am

Morning Tea & Exhibition

10.15am - 1.30pm

Partners Program - Chocolate Foodi Tour

10.45am

Safety-in Design Responsibilities for Hospital Engineers and Facility Managers - How to avoid being left with difficult and expensive to resolve safety issues David Oakeshott, A.G. Coombs Advisory

11.15am

Compliance with OHS, Legionella and Environmental Legislation and the Role of Management Systems Rafx Hamilton, Engineering Services Manager, Cabrini Health

11.45am

Lunch & Exhibition

12.45pm

Non-Compliance and Hospital Acquired Infection: Using Design Methodologies to Improve Hand Hygiene Practices Kieran John & Donald Campbell, Monash University

1.05pm

Facility Hygiene - How clean is clean? or How Clean does it need to be? Brett Cole, Biosafety

1.35pm

Common Approach for Asset Management and Statutory Obligations Seyed Safi, Covaris

2.05pm

2018 Conference Presentation

2.20pm

Conference Close & Prize Draws Rod Woodford, IHEA 2017 Conference Convenor

2.45pm

Conference Concludes

Correct at time of printing, this may be subject to change. Visit www.HFMC2017.org.au for the most up to date program.

26Register now at www.HFMC2017.org.au

#HFMC17

FEATURE VALE ARTICLES

CHARLES EDWARD SHIELDS

9/7/1926 – 22/6/2017

early loved husband of Colleen, much loved father and father-in-law, brother and brother-inlaw, uncle, great uncle and friend to so many. Charlie was a family man, through and through and always boasted the triumphs of his kin with unrestricted pride. A well-known gentleman with a wealth of knowledge and stories particularly around horses and hospital engineering. Charlie became involved in those organisations that mattered and in the healthcare industry, one such organisation was the Institute of Healthcare Engineering Australia (IHEA). Even after Charlie retired and his beloved Wallsend Hospital closed its doors, Charlie had plenty to offer. Many of the IHEA members have spent countless entertaining hours listening and learning from Charlie’s many years’ of experience. Charlie was the type of person who always left something with you every time you met, be it knowledge, happiness or a positive disposition, I never once walked away from Charlie without a smile on my face. Joining the IHEA in January 1956 and holding various positions over his years of membership, Charlie’s achievements were crowned on January 17, 2016 when Charlie reached the milestone of 60 continuous year’s membership to the IHEA. This was an extraordinary occasion and achievement that really typified Charlie’s resilience and tenacity. Charlie

was subsequently hosted by the IHEA at the Adelaide National Conference and his many years of service acknowledged by the National Board with a special presentation at the Conference Dinner. As always he demonstrated his personality, practical approach to people and problems, sharing a combination of wit and wisdom. Charlie always spruiked his love and obvious innate knowledge of horses, he always gave tips and information on the who’s who of horses and racing, especially if you mentioned the Melbourne Cup. There was little that rivalled Charlie’s devotion to the IHEA however I might suggest attending the Melbourne Cup was one. It was a sad day when news of Charlie’s illness echoed around the healthcare engineering fraternity, this was amplified on his passing with a flurry of emails and kind thoughts for friends and family of this great man. Characteristic of Charlie, in his last days he made a decision with his family not to have a funeral but to have a wake after he was gone so that his friends and family could “have a pie and a beer” and remember the good times … touché Charlie. Charlie was a man who gave so much too so many, for so long, never losing his sense of humour and passion for those things that were close to his heart. Charlie was a close friend to so many and a character that will be sadly missed.

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FEATURE ARTICLES

BAD POWER QUALITY, BAD FOR HOSPITAL HEALTH By Colin Kinsey, Power Systems Specialist, Power Parameters Pty Ltd.

Power quality is important in two ways: one – bad power quality adds to the electricity bill, and two – it is a silent killer of equipment, equivalent to high blood pressure in a patient.

The main switchboard of Frankston Hospital, being equipped with Ablerex active harmonic filters in order to improve power quality.

ospitals are large energy users, consuming of the order of 80 GJ/100 metre3 annually with electricity being a significant portion, perhaps around 40%, amounting to an annual figure of 8.9 Megawatt-hours/metre3 with approximately 50% of the electrical energy bill for HVAC and medical equipment. Conserving energy usage is therefore top of the agenda. Power quality, on the other hand, escapes the attention of the accounting department. However poor power quality has financial implications.

POWER QUALITY Incoming electrical power quality is defined by: • Degree of phase balance of voltages in three-phase supply • Level of voltage harmonics in the distribution network In practice, connection to medium voltage supply will take care of phase balance. Voltage harmonics

FEATURE ARTICLES

will be low at typically less than 5% (note; defined as total harmonic distortion of voltage (THDV)). Connection to low voltage supply, i.e. 415 volts, three-phase often poses phase imbalance problems. Even small imbalance of the order of a few percentage points can severely affect motor service life and cause other problems. In addition to the considerations affecting incoming power quality, there is the effect of electrical load on power quality, in other words, the problems caused within the installation. Chief culprits are high efficiency lighting, IT equipment, ‘electronic front ends’ for equipment including scanners, X-ray, ultrasound, etc., as well parts of the HVAC system, chiefly compressors.

HARMONICS Rather than voltage harmonics, current harmonics are the main internal problem. Of course, the flow of distorted, non-sinusoidal current will cause some voltage distortion. Rules imposed by the distribution network provider (DNSP) will limit the amount, and frequency of the harmonics. In practice, sorting out whether harmonics are imported from the DNSP, or exported to it requires analysis with appropriate measurement instrumentation.

HARMONICS EFFECTS Overheating of switchboards is very common. For example a 50% loaded hospital switchboard had to operate with doors open, and external fans

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FEATURE ARTICLES

providing cooling draught. Power factor correction capacitors can overheat, even burst into flames as a result of resonance with certain harmonics. Locally generated harmonic voltages can cause excessive heating of direct-on-line connected motors. Harmonics can also affect power bills, depending on the type of metering employed. Many hospitals have demand tariffs for billing purposes because of their high level of electricity consumption. The demand tariffs can be on the basis of kVA, kVAr, power factor, or kW. Generally kVA is the chosen demand parameter. Depending on the metering protocol, the kVA measurements can be increased by harmonic current content. Supply companies tend to be a bit coy about this. If harmonics add to the kVA, then increases as high as 3 to 5% in kVA can result. Note: Even a small percentage can have serious cost implications if the tariff structure includes a punitive tariff over and above a contracted demand limit. Generally kVA tariff hospitals would traditionally install power factor correction capacitors, however in the current situation, many hospitals have a very large component of electronic front-end equipment with generally a high power factor (displacement power factor) diminishing the importance of capacitor correction equipment. Rather than employing capacitor correction, the use of active harmonic filters at the main switchboard would be a more sensible solution. Confusion arises on the definition of power factor. The accompanying diagram hopefully clears up some aspects. On the left, in black, the conventional power triangle is shown. However with the advent of harmonics total apparent power as measured by kVA is affected by the contribution of harmonic kVA. The process is illustrated on the right hand side. As can be seen by means of the red arrows, the overall improvement in power factor involves mitigation of the harmonic kVA contribution. Active harmonic filters reduce harmonic currents. Depending on where in the installation they are installed, they can provide cleaner voltage (reduced distortion) and reduce wiring losses. A large hospital will generally have a series of second tier switchboards with some required for emergency supplies (diesel operated uninterruptible – DRUPS, and battery operated UPS). Harmonic filtering at these boards can provide improved power quality

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FEATURE ARTICLES

for the electrical installation. Obvious installation points are at HVAC switchboards.

PRACTICAL ASPECTS OF POWER QUALITY IMPROVEMENT

In addition to harmonic filtering, active harmonic filters can provide voltage balancing and power factor correction. Phase balancing can be very important as an unbalance of as small as 3% can cause motor current to increase ten-fold to 30% over normal full load current. Variable speed drives are also affected, specifically DC link voltages drop when imbalance goes to 4% or more, and this than lowers the torque of connected motors, becoming very evident when trying to restart plant such as compressors.

The process starts with a survey of the hospitalâ&#x20AC;&#x2122;s electrical installation. Using appropriate equipment with spectrum analysis capability, and harmonic power flow indication, the initial picture is arrived at. Harmonic power flow studies generally indicate where active filters should be placed. Unfortunately much equipment has been installed without first performing a comprehensive installation analysis, covering not only harmonics but also voltage balance. Without an adequate data base, there is no way of gauging improvements. It is also important to note that commissioning of active filters is not just a matter of ensuring that the apparatus is working but far more importantly, that the overall performance in terms of power quality improvement is actually being achieved.

FEATURE ARTICLES

BACKGROUND, DEVELOPMENT AND IMPLEMENTATION OF THE NATIONAL EnHealth “GUIDELINES FOR LEGIONELLA CONTROL IN THE OPERATION AND MAINTENANCE OF WATER DISTRIBUTION SYSTEMS IN HEALTH AND AGED CARE FACILITIES” By Andrew Vickers, Health Protection Programs, SA Health

BACKGROUND

he widely publicised Wesley Hospital Legionnaires’ disease outbreak in Queensland in May 2013 was one of many instances of Legionnaires’ disease cases or Legionella bacteria detections occurring in health and aged care facilities across Australia. The Wesley Hospital paid dearly for the outbreak, in organisational reputation, patient inconvenience and significant financial impact. A subsequent government ordered state-wide testing regime resulted in large costs for many public and private hospitals and healthcare services, for testing and remediation. As a result of the outbreak and detection of Legionella in many other QLD hospitals, at the request of Lawrence Springborg, MP, the QLD Minister for Health, the Queensland Chief Health Officer undertook a review on the prevention and control of Legionella pneumophila infection in Queensland. One of the key recommendations arising from the resulting Queensland Chief Health Officer’s “Review of the Prevention and Control of Legionella pneumophila Infection in Queensland” (September 2013) was that “National collaboration be sought with regard to the following – guidelines for the operation and maintenance of drinking water systems for hospital and residential aged care facilities”. Subsequently, in March 2014 the Australian Health Protection Principal Committee (AHPPC) tasked the National Environmental Health Standing Committee (enHealth) to develop national guidance for health and aged care facilities to support interventions to

control Legionella through the operation and maintenance of drinking/potable water distribution systems.

DEVELOPMENT (REFER FIGURE 1) A project team was established comprising representatives from various Public Health Departments across Australia (South Australia, Victoria and Queensland) and New Zealand to develop the project specification and oversee the project. In April 2014, the project specification was completed and expressions of interest were sought from a number of apparently suitably qualified and experienced consultants. The task of the successful consultant was to provide a document that details the key elements for controlling Legionella and minimising exposure in health and aged care facilities that can be used as the basis for developing local measures (such as risk management plans and programs) across Australia and New Zealand. A key requirement was that the document developed must support small to medium facilities whose capacity to engage consultants to design and operate specific Legionella risk management plans is limited. The successful applicants, a joint submission consisting of CETEC Pty. Ltd., Norman Disney and Young, Dr Paul Bartley (Wesley Hospital), Dr Claressa Lucas (CDC, Atlanta USA) and Professor Elizabeth Hartland

FEATURE ARTICLES

(University of Melbourne), were awarded the contract in mid May 2014. After much input from the project team, the consultant’s final version of the document was accepted in late October 2014 and was sent for professional editing into a working draft. Form early November 2014 to early June 2015 the project team continued to refine the content of the working draft and developed risk management plan template for use with the Guidelines. A company specialising in graphic design and editing of complex scientific and health documents prepared the final draft Guidelines for consultation. In late June 2015 the final draft Guidelines and risk management plan template were published on the SA Health website and stakeholders were invited to comment on them by the end of July 2015.

Feedback from 44 individuals and organisations was received and considered, resulting in considerable changes being made to the Guidelines. The main changes to the Guidelines resulting from consultation were as follows: • ‘Drinking’ removed from title consistent with the focus on risk management of all water systems within health and aged care facilities (excluding cooling towers). • Removed all mention of total bacterial count (TBC) in verification monitoring as it is considered not representative of Legionella risk and its use is inconsistent with World Health Organisation advice. • Clearly recommended that activated carbon filtration not be used on ice machines and water coolers in health and aged care facilities. • Added the following clear and practical flushing recommendations for unused outlets: “All unused outlets should be flushed every 7 days at full flow. Where outlets have the facility to mix warm and

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FEATURE ARTICLES

cold water, both warm and cold sections must be flushed. The period of flushing must be sufficient to remove all stagnant water leading to the outlet and for the operating temperature to be reached at the outlet.” • Removed prescriptive methods for hyperchlorination, as the original method described was considered not practical for some facilities and may cause damage to some systems. • Modified the guideline structure to be consistent with the risk management plan template. • Expanded the definitions section significantly to address all matters of confusion highlighted. The final versions of the Guidelines and template were then endorsed by the project team and enHealth and were finally approved by the AHPPC on 15 December 2015. The endorsed documents were published online and promoted widely in late December 2015.

“compliance” or “box ticking” exercise. Seriously assessing and managing Legionella risk requires organisational commitment to take real action to reduce the potential of healthcare facility acquired cases of Legionnaires’ disease. This is a process that must be owned and driven internally with an appropriate budget, executive support and staff training where necessary (and with outside expertise engaged when necessary). There are no short cuts and it is not appropriate to hand such programs over to external contractors to deliver. Facilities should also be very wary of implementing processes, protocols and/or proprietary infrastructure that establish dependence on a particular contractor or supplier as that in itself gives rise to risk.

To download a PDF of the guidleines, please visit: http://www.health.gov.au/internet/main/publishing. nsf/content/health-pubhlth-publicat-environ.htm

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NATIONAL

Figure 1: enHealth Legionella Guidelines Development timeline

IMPLEMENTATION Each State and Territory Public Health Department will implement the Guidelines as they see fit within their jurisdiction. In South Australia, the initial approach will be to promote the Guidelines as a best practice risk management tool. However, the review of the South Australian Public Health (Legionella) Regulations 2013 may see the introduction of mandatory Legionella risk management plans in hospitals and residential aged care facilities.

TAKE HOME MESSAGES It is important to note that using the Guidelines and associated template to develop and implement a Legionella risk management plan is not a

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MANAGING THE ENERGY CONSUMPTION AND UTILITIES PERFORMANCE

OF THE LARGEST AND MOST ADVANCED GREEN STAR RATED HEALTHCARE FACILITY IN AUSTRALIA By Nick Stokoe

The new Royal Adelaide Hospital (new RAH) has achieved a 4 Star Green Star rating and is accompanied by a clear commitment to reduce energy, water and waste in operation. In the context of a vision for a Carbon Neutral Adelaide and a target to implement a 30% improvement to the energy efficiency of Government buildings by 2020, bringing online the most advanced hospital in Australia presents numerous opportunities and challenges. This paper investigates what is required of the new RAH Facility Management team in order to meet and exceed the energy and sustainability expectations during the mobilisation phase and operating term of this world leading healthcare facility.

THE 4 STAR GREEN STAR RATING

he starting point to ensure good energy and water management practices is to provide a building with systems designed to facilitate this. Part of the approach taken for the new RAH was to utilise the Green Building Council of Australia’s (GBCA’s) Green Star – Healthcare v1 rating tool. The tool provides an independent and nationally recognised mechanism to assess attributes of the design and construction with regard to overall environmental impact. The new RAH has been awarded a 4 Star Green Star Design rating and at the time of writing, the project team are nearing completion of the As Built rating which is also expected to result in 4 Stars. These results represent Australian Best Practice in environmentally sustainable design and construction for a healthcare facility. The Green Star rating is made up of ‘points’ awarded for selected ‘credits’ which fall under specific environmental ‘categories.’ A breakdown showing the contribution of the points awarded for the new

RAH under each category making up the complete 4 Star rating follows:

It can be seen that emphasis on Energy and Water efficiency is embedded within the design and construction as initiatives under these categories make up nearly half of the full Green Star rating result.

OPERATIONAL PERFORMANCE OF GREEN BUILDINGS There are a number of instances where buildings with environmental certifications for design and construction do not operate more efficiently

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compared to buildings without such certifications. Typical contributing factors often include design trade-offs, indoor environment quality provisions, energy efficiency implementation and, perhaps most significantly, insufficient training and engagement of Facility Management teams and tenants throughout the design process and during handover. Another prominent issue can also be the use of overly complex designs and building systems believed to be necessary for achieving energy and water efficiency goals. This results in a need for very specific, non-standard operating procedures which can be onerous and impractical and which if, not adhered to, can result in significant inefficiencies.

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At the current phase of the new RAH project (mobilisation), it is very important for the Facility Management team to recognise and understand these issue and the potential contributing factors so that operational management strategies can be formulated to limit any impacts on the energy, water, waste and sustainability expectations for the project. Following are some project specific examples: • As a fundamental requirement of its function, the new RAH provides a high quality indoor environment. This assists with creating spaces for patients which promote healing and comfort and spaces for staff which promote wellbeing and productivity. The new RAH includes initiatives such as the provision of high volumes of outside air, access to daylight, external views, places of respite and user controlled openable windows. However, some indoor environment quality initiatives are contrary to the energy and water efficiency goals for the project. Examples include the need to air-condition higher volumes of outside air and the need to provide additional air-conditioning in response to larger areas of external glazing (which provide daylight and external views). Ultimately it is the responsibility of the Facility Management team to ensure that energy and water management strategies are in place during operation to control and continue to reduce the energy and water impacts resulting from all required functions of the facility. • For the new RAH, the potential disconnect between intentions and outcomes (e.g. utilising systems with complex operating requirements to achieve simple operational efficiencies) has, in part, been dealt with by ensuring the Facility Management team was heavily engaged in the design process. The Green Star ‘Management’ credit for ‘Maintainability’ was awarded to the project in recognition of this process delivering a building design which facilitates

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ongoing maintenance, and minimises the overall need for ongoing building maintenance throughout the building’s lifecycle. Moving into the operating term, the Facility Management team must then ensure that suitable handover training has taken place and that a continued program of high quality training and education occurs so that the building systems are always operated efficiently.

TARGETS A number of clear sustainability targets are mandated in the new RAH project brief. This provides an excellent foundation for the project and an effective blueprint for the Facility Management team to work to. Targets include: • A normalised greenhouse gas emissions target • Monthly energy volume and demand targets • A normalised water usage limit • Recycled water contribution targets • Renewable energy contribution targets

This aspect of the brief also, in effect, communicates the South Australian State Government’s expectations with respect to reducing energy consumption and optimising the utilities performance of the new RAH. This is further clarified by the inclusion of an additional requirement which specifically states that the Facility Management team must provide a proactive and integrated approach to ensuring sustainability targets are achieved and exceeded during the operating term.

THE CHALLENGE To successfully meet the targets, manage energy consumption and utilities performance and to deliver the sustainability outcomes for the new RAH, a conventional approach to providing Facility Management services is insufficient. For a facility as large and complex as the new RAH, the key to success depends on the capacity of the Facility Management team to develop and successfully implement robust sustainability policies. Importantly, these policies must be:

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• Clearly communicated to all stakeholders including Facility Management staff, SA Health staff and even visitors and patients • Embedded in the delivery of all Facility Management services • Fully endorsed by senior management within the Facility Management team • Adopted and implemented by all stakeholders but led by the Facility Management team • Capable of being regularly updated and continuously improved. The culture of the Facility Management team needs to set the example for all building users and the approach to managing energy consumption and utilities performance must be fully integrated in the delivery of all Facility Management services. All building users must, to the extent appropriate to their roles or levels of interaction with the facility, feel empowered to contribute to and act upon reducing the environmental impact of the new RAH and it is the responsibility of the Facility Management team to

enable this and to ensure it continues to occur. A shift in thinking is required as the Facility Management team effectively needs to assume the role of ‘Change Agent’ in developing and successfully delivering sustainable outcomes for the new RAH. To do this, the Facility Management team first needs to ensure that behavioural changes are cemented within their own organisation and then, by utilising their relationship with tenants and building users, sustainability policy messages will spread organically. The most recent results of an annual survey conducted by the British Institute of Facilities Management (BIFM) looking at influences which prevent effective management of sustainability responsibilities by outsourced Facility Management providers resulted in the following top 4 influences: 1. Physical Constraints (consistently the highest since 2011) 2. Financial Constraints (gradually decreasing since 2011)

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building but the residing tenants do not consider energy efficiency in any of their actions. The result is then poor whole building performance despite the actions of the Facility Management team. In the case of the new RAH, efficiency in the whole of facility performance is the goal and therefore both the Facility Management team and the tenant must have practices which are complementary and which positively contribute to environmental performance.

3. Organisational Engagement (gradually increasing since 2011) 4. Lack of Engagement Across Middle Management (consistent since 2011) Of particular note is the upward trending impact regarding lack of organisational engagement and similarly the lack of middle management engagement. This further supports a strong focus on policy development and wider engagement which is being adopted by the Facility Management team in mobilising the new RAH.

ENERGY MANAGEMENT STRATEGY AT THE NEW RAH The energy management strategy at the new RAH is consistent with Option D: Calibrated Simulation from the International Performance Measurement and Verification Protocol (IPMVP) and can be broadly summarised as follows:

Risk of non-compliance and underperformance will ultimately be driven by lack of engagement with building users and lack of recognition that the achievement of desired sustainability outcomes cannot be the responsibility of a single service line but rather must be integrated across all services (with full buy in from all stakeholders). An analogous example is where a Facility Management team might be contracted to deliver an energy efficient base

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utilised throughout the operating term to account for any changes that occur to the baseline conditions or independent variables, where the baseline conditions represent all information used in preparing the energy model (including assumptions) and the independent variables specifically represent weather conditions, occupancy and facility usage levels. The results of the adjusted energy model form the revised operational energy benchmark after changes have occurred. Over time, as operational data is gathered, the energy model is also calibrated to ensure consistency with the actual operation of the facility. • Sub Metering: An extensive sub metering system is provided which is supported by an integrated Energy Management System (EMS). The EMS is capable of gathering and reporting on specific energy data from the sub metering system as required by the Facility Management team. During operation, data is gathered via the EMS for performance reporting, benchmarking, apportioning costs and the measurement and verification of operational performance. • The presentation of reporting and how the associated information from the EMS is utilised are critical factors for successful energy management. Reports generated, based on EMS data, must clearly and concisely demonstrate the right messages as they will often be used to form the basis of business case proposals as well as to verify the performance benefits of initiatives that have been implemented.

THE BENEFITS OF A PPP The Public Private Partnership (PPP) framework is a good foundation as the Facility Management team is provided with a longer contract term which can include incentives and penalties relating to sustainability performance. The longer contract term also increases the likelihood for uptake of projects that have longer payback periods and where the benefits relate to wider sustainability issues beyond just the reduction in energy and water consumption and waste generation. This includes improved occupant wellbeing, considering the full lifecycle impact of procurement decisions, social issues and the impact of climate change.

BEYOND ENERGY Similar to the energy management strategy, benchmarking, measurement and verification will be applied by the Facility Management team at the new RAH for water and all other relevant utilities including waste. A waste reduction and purchasing plan (WRAPP) will also be adopted to ensure operational implementation of the ‘waste hierarchy’ principles and which also aims to move beyond the waste hierarchy to a fully circular approach to waste.

SUMMARY AND CONCLUSION Best practice in energy management requires a methodical approach to collecting, analysing and understanding data together with formulating and implementing solutions to achieve good and efficient use of energy and resources. However it is important to recognise how much of an influence human behaviour can have, building users need to have an attitude geared towards being conservative, effective, efficient and less wasteful, otherwise the impact of energy management will be limited. Simply put, all building users need to be encouraged to ask themselves ‘what is the impact of my actions and what can I do to improve things?’ and through continued engagement and leadership, the Facility Management team can foster enthusiasm for sustainability and actually empower individuals to change their approach. The plan for successfully managing energy consumption and utilities performance at the new RAH as well as delivering on the expectations and requirements around sustainability is based on implementing a robust energy management strategy coupled with developing and facilitating the uptake of clear sustainability policies and assuming the role of Change Agent in this regard. With all stakeholders being engaged in sustainability policy, capturing opportunities that are effectively ‘low-hanging fruit’ will be made much simpler and will occur on a more frequent basis. This enables the Facility Management team to focus on monitoring performance and identifying efficiency opportunities which are supported by clear business cases. By engaging people in the task of enhancing the new RAH with respect to its environmental impact then the task itself is ultimately made more manageable and a greater likelihood for success will be the result.

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ARE YOUR LIFE SAFETY & FIREFIGHTING SYSTEMS “FIT FOR PURPOSE” AND IF NOT WHO IS RESPONSIBLE?

By Richard Hosier, Regional Manager, Asia/Pacific, MICC Group

Electric cables provide the connectivity which keeps the lights on, air-conditioning working and the lifts running. They provide power for all equipment and computers, data, communication and entertainment systems. The most important electric cables enable all the life safety, firefighting and security systems by connecting fire alarms smoke and heat detectors, break glass alarms, fireman’s telephones, EWIS and CCTV. They connect smoke extracting fans and shutters, air pressurisation fans and dampers, emergency and exit lighting, fire sprinkler pumps, automatic doors and facilitate all the features of a modern building management system. If these essential cables were to fail during fire then the connected life safety and firefighting systems will also fail.

e seldom think about electric cables because they are mostly hidden in the construction, ceiling spaces, riser shafts and wall cavities. Cables are installed by many different trades for different applications but what is not often realised is that the many miles of cables and tons of plastic polymers which make up the cable insulation system can represent a major fire load and propagation path in the building. For this reason it is important cables don’t significantly add to any fire risk by spreading fire, smoke or toxic byproducts.

Fortunately we have regulations, building codes and standards which recognise the potential risk electric cables present and require compliance with various tests to demonstrate a minimum level of performance. What is often not realised is that these standards and codes are only minimum requirements and should a project or location require more robust performances it is the responsibility of the owners and professional design engineers to provide this. What this means is simply following code may not in all circumstances absolve owners and engineers from liability.

Electrical cables have often been blamed as the cause of fires and research tends to support this however, it is often not the failure of the cable which starts a fire but the misuse of the cable by damaged insulation, overloading due to incorrect or insufficient circuit protection, short circuit or over-voltage. These situations can cause high temperatures in the cable conductors or electrical arcing which may heat the cable insulation and any surrounding combustible materials to start a fire. Old cables may also pose problems as the plastic insulation ages it often becomes brittle increasing risk of shock or breakdown.

In the UK, British Standard BS8519:2010 and BS EN12485 clearly recognise areas with ventilation limitations and areas such as underground car parks, loading bays and storage areas as “Areas of Special Risk”. In these environments more stringent requirements for fire resistance are recommended and especially for any electric cables supplying power to life safety equipment which are installed in or run through these locations. In Australia we don’t have an equivalent Standard so it is left to engineers to identify and design accordingly.

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FIRE RESISTANCE For circuits that are needed to keep working during fire which includes all Life Safety and firefighting systems, Australia and New Zealand have ASNZS3013:2005. This test method subjects the cable, supports and fixings samples to the time temperature protocol of AS/NZS1530pt4 for 2 hours in a 1 meter by 1 meter horizontal furnace. The test has an option test for water sprinkler resistance after the fire test but only requires 1 sample from selected groups to be tested for qualification of the whole group. This test allows for a 2 out of 3 pass criteria should the first sample fail. Whether a 2 out of 3 performance is good enough for life safety and firefighting systems is perhaps questionable and this without any representative vertical test component leaves the relevance of this fire test method problematic for the professional engineers responsible for designing with reasonable skill and care ‘Fit for Purpose’ systems. Looking at global best practice for fire resistance testing of essential electrical wiring systems it is clear the American UL 2196 test method is more robust. This test is done in a large 6.6 x 7 meter vertical furnace where cables, fixings and accessories are all tested together in the mounting configuration they will be actually installed. The most demanding installation configuration is for vertical runs of cables, which in most large buildings and high rise is an unavoidable installation condition. UL2196 requires that cables are tested at their rated voltage (rather than just the operating voltage) and with a minimum 5 samples across a range of small to large sizes. All these circuits are mounted both horizontally and vertically in 3 meter (10 foot) lengths with bends and joints if needed. The cables are energised and samples are subjected to the fire time temperature protocol of ASTME-119-75 which is virtually identical with the Australian ASNZS1530pt4. During testing the cables, fixings and supports experience significant mechanical stresses caused by expansion and contraction. After 2 hours at a final temperature of 1,020°C the cables are immediately subjected to a fire hose stream test which not only imparts huge thermal stresses on the wiring system but also significant mechanical stresses. All 5 samples must survive in working condition and certification is given independently for horizontal and/or vertical mounting. (Note, it is well established that fire testing representative lengths of vertically mounted cables for electrical integrity is significantly more demanding than testing short lengths of horizontally mounted circuits).

What has not been factored into any standards in Australia or USA is the effect fire temperatures will have on the electrical resistance of the conductor. The resistance of copper will increase almost 5 times at 1,000°C and this negatively impacts the cables voltage drop and current rating capacity. This effect must be considered by the design engineers to ensure the reliable operation of connected essential equipment even when parts of the wiring system maybe involved in the fire.

FIRE PROPAGATION The Australian standard for flame propagation testing of installed circuits of cables is AS/NZS 1660.5.1 (harmonised with IEC60332-3) this standard may be unrepresentative for flame retardance testing of power cables due to fact this test method does not require preconditioning of cable samples to their operating temperature and only tests at ambient temperature. The current rating standard AS/ NZS3008.1.1:2017 allows many LV power cables to operate with current ratings inducing conductor

Both these electric cables meet code for Life Safety Systems.

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temperatures of 90°C and some even up to 110°C, so it is a surprise to some to learn the cables they specify and install might only be flame retardant if they are not energised! It is well documented that electrical wires have caused fires due to short circuit or overload. Despite this there is no mandatory test on electric cables for ignition under short circuit or overload conditions. Tests conducted at Australian universities and published in a Ji-cable conference report in Paris, June 2011, show that some common LV polymeric cables (meeting AS/NZS1660.5.1) can, under uncleared short circuits, self-ignite within 60 seconds when subjected to gross overloads.

SMOKE EMISSIONS The Australian standard for testing cables generation of smoke during fire is AS/NZS 1660.5.2 (harmonised with IEC61034) This standard requires smoke testing by burning cable samples in an alcohol flame. It does not require testing in a non-flaming mode. Many common insulating materials generate significantly more smoke in a non-flaming mode than in a flaming mode. Users of this standard thus are often misled into thinking the cable materials they use are low smoke and in many cases, like uncleared short circuit/overload, incomplete burning, or high heat this can be quite the opposite.

Singapore MRT 2013 – Newton Underground Station. Cable overloaded and caught fire

TOXIC BYPRODUCTS OF COMBUSTION The Australian standard for testing cables for toxic halogen gas emissions in fire is AS/NZS 1660.5.3 (IEC 60754.1). This test is specified widely in Australia and around the world with many manufacturers, consultants and authorities believing Halogen free cables will be safer in case of fire. In fact what commonly happens is cable manufacturers then make Halogen Free cables with Polyethylene insulation which is Halogen free and cheap but due to its extremely high calorific value in fire can generate significantly more heat, eat more oxygen and can generate large volumes of toxic Carbon Monoxide, especially during burning in reduced oxygen

environments like in most building fires. Whilst CO is not a Halogen gas, it is highly toxic and is claimed to be responsible for many toxicity deaths in fires. (Note; the increase in man-made fibres light weight building materials, plastics is reported to be increasing the amount of HCN generated in modern building fires). In America many building standards do not require halogen free cables. Certainly this is not because Americans are not wisely informed of the dangers, rather the approach taken is that: “It is better to have highly flame retardant cables which do not propagate fire than minimally flame retardant cables which may spread or contribute to a fire” (a small fire with some halogens may be better than a large fire without halogens). There are many factors to consider when choosing appropriate cables and especially when designing wiring systems enabling life safety and firefighting equipment. When the limitations of current standards are known it is important to ensure that with reasonable expertise, all precautions and factors have been properly assessed. Fortunately there are wiring systems and expertise available to address all these concerns and the purpose of this article is to provide a background for owners and engineers so that the right questions can be asked.

ABOUT THE AUTHOR Richard Hosier is the Regional Manager in Asia/ Pacific for the world’s largest manufacturer of mineral cables the MICC Group: www.miccltd.com Mr. Hosier has lectured at institutions and universities around the world publishing many technical papers on advanced fire safe cable design. He was the winner of the Institute of Fire Protection Officers UK technical trophy award in 2014 for his research into fire performance wiring systems and previously served on 3 Australian and New Zealand technical standards committees for fire safe wiring systems and cables. Other publications by this author: • Fire Resistant Cables – April 2017 • Wiring Systems for Hospitals – June 2015 • Wiring Systems for Nuclear Power Stations – July 2014 • Wiring Systems for Road and Rail tunnels – July 2014 • Electric Cables Fire Performance – May 2014

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service due to worn internal mechanisms or lack of air flow through the switchboard resulting in power outages. NHP’s 3C temperature condition system actively senses and communicates the temperature of conductors, connections and contacts of critical switchgear and inaccessible busbar zones. Facility managers can use this advanced indication to better manage the maintenance of their switchboards and avoid catastrophic failures. 3C temperature condition monitoring is just one of NHP’s many intelligent power distribution solutions that ensures critical buildings maximise power availably, improve safety for people and reduce operating costs. To discuss how you can implement an intelligent predictive maintenance solution, visit us at the upcoming IHEA Conference at booth 3 and 5.

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DESIGN CONSIDERATIONS

FOR OPERATING THEATRE VENTILATION SYSTEMS By Kristian Kirwin (B.ENG Mechanical) and Shannon Roger (B.Ed) for Airepure Australia

There are many types of operating theatres within hospitals and healthcare facilities – all of which require a suitable “final stage of air filtration” that is dependent on facility purpose and healthcare requirements. Air filtration options for operating theatres include individual HEPA modules, laminar flow and UCV (ultra clean ventilation) systems. This article will focus on some important design considerations relating to these air filtration options within operating theatres.

he fundamental function of air filtration within an operating theatre is to remove contaminants from the air, to reduce the possibility of particulate entering a wound, and ideally to provide a protective sterile zone around the wound. The ultimate aim is to reduce the risk of infection from airborne particulates.

WHAT ARE YOU TRYING TO ACHIEVE? In asking “what are you trying to achieve”, there are really several questions being asked; 1. What types of surgeries are intended for this operating theatre? 2. What standards or Health Department “Operating Theatre Guidelines” do you want to comply with? 3. What cost have you budgeted for? How much money are you willing to spend? More importantly; 4. What level of risk is the functioning body (hospital/ healthcare facility) willing to take? 5. What is the potential financial impact on the patient and the healthcare provider with the incidence of surgical site infection (SSI) by airborne contaminants? All too often a decision is made based on the minimum cost to meet a particular standard or guideline (for a particular type of surgery) without really considering the risk properly. Whether a new installation or a re-work of an existing theatre, an

improvement on what was available previously is the minimum we must strive to achieve, with an aim to maximise the cost benefit for all.

MINIMUM ACCEPTABLE REQUIREMENTS Assuming that the minimum acceptable requirement for an operating theatre is to meet AS1668; this requires the supply air to the theatre to have a final HEPA grade filter, a minimum air change rate (ACH) of 20 air changes per hour and to be at a positive pressure to the surrounding areas. HEPA filter location – All moving matter generates particles, and within an operating theatre, particles may be generated by the movement of theatre personnel, the electric motor on a piece of surgical equipment, and from airflow through the supply air duct. Particles generated within the supply air duct may include metal oxides from the duct itself, or mould/spores growing within. As such, the ideal scenario is to locate the HEPA filters as close to the supply air outlet as possible, at the terminal. This ensures any particles introduced or generated within the duct are caught by the HEPA filter just prior to the air entering the operating theatre. Air change rate (ACH) – The air change rate is a simple calculation of the room volume x 20. This is the minimum requirement to meet standard for operating theatre ventilation but may not be sufficient to control the airborne contaminants.

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Note: a supply air quantity that achieves the minimum 20 ACH, probably won’t be sufficient for a Laminar flow or UCV system.

• Correct hygiene procedures

Positive air pressure – This is the easiest part, and is a simple matter of ensuring sizing is done correctly. The sum of the return, exhaust and leakage must be less than the supply (which has a fixed minimum).

• Full body suits for the theatre personnel (which is highly unlikely)

By meeting these three requirements, you ensure that; • the air supplied into the theatre is clean/and sterile (HEPA filters), • the air is provided in a quantity deemed sufficient to dilute particulates in the room to a suitably low level, based on the number of particle per cubic meter (ACH), • the air entering the theatre does so in a controlled way, and only from the HEPA filtered supply terminals (positive air pressure)

• Prophylactic antibiotics (which with MDR bacterial can be limited)

• Laminar flow or UCV systems • Correct surgical technique when operating with a UCV (not leaning over the patient into the airstream onto the patient)

INDIVIDUAL HEPA MODULES It is possible to meet minimum acceptable requirements (through the application of HEPA filters, required air change rates and air pressures) using individual HEPA modules and a conventional theatre layout – whereby four (4) terminal HEPA modules are located around the clean zone. 4 x Individual Supply HEPA Modules.

What it does not ensure is that the air introduced is done in such a way that particulate are kept away from the operating zone. This is where theatre system design is critical, as there is a possible risk of contamination by airborne contaminants which may cause surgical site infection (SSI). Note: the operating theatre temperature and humidity is a function of the theatre AC system capacity and is not influenced by the theatre air quality management.

INDIVIDUAL HEPA MODULES/LAMINAR FLOW SYSTEMS (UCVS)

Figure 1. General velocity plot showing flow through the corner units m/s.

Many studies discuss the advantages and disadvantages of theatre types, and a significant point raised is cost versus the reduced risk of SSI. The theatres in question generally range from low airflow, terminals (with a lower installation and maintenance cost) through to high airflow, laminar flow or UCV systems with higher installation and ongoing running costs. There are studies that question the benefits of laminar flow and UCV systems over individual terminals (refer to Brandt, C article.1) However, when you take into consideration all studies and other factors there is a general consensus that a well-designed (downward) laminar flow/UCV system will provide an approx. 2% reduction in SSI’s.2,3,4,5 Primary recommendations found to reduce SSI’s include:

Figure 2. Threshold velocity of 0.15 m/s – showing that in the rest of the room the velocity is below 0.15 m/s.

As can be seen by CFD modelling in Figure 1 and Figure 2, this provides limited areas of coverage. This method introduces supply air to the theatre

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functions by “dilution”; mixing clean sterile air with the particulate laden air. This proves effective in a static state, but has a balance point that can be far from ideal when the theatre is occupied and surgery is occurring. In a static state, minimal particles are generated within the space, so providing clean sterile air through terminals will progressively dilute the particle load to an acceptable level (possibly achieving a cleanroom classification of ISO 7 or 6, or even better). However, once personnel enter the theatre and surgery begins, the rate of dilution cannot keep up with the generation of particles, and as such the particle levels within the theatre increases.

air, downward from the diffuser – and as the air slows toward the operating table, air movement also occurs outwards, away from the table. This is the start of a laminar flow system. As a general guide, (Australian State Guidelines) a “Laminar flow” is a system with a diffuser outlet greater than 1800 x 1800mm and an “Ultra Clean Ventilation (UCV)” is a diffuser greater than 2400 x 2400mm. It should be noted individual Australian state guidelines provide values for table velocities for Laminar flows/ UCVs. These values vary from state to state, and likewise these vary internationally.

Unfortunately also due to the turbulent nature of airflow within a theatre with individual terminals, there is minimal control of where this particle laden air may end up. Although the air within the theatre is much cleaner than outside, there is still a high risk of particulate (carrying bacteria or viruses) being carried in an uncontrolled way into the operating zone and ending up in the wound.

Figure 5: Comparison of Recommended Table Minimum Average Velocity Values Table 1: Comparison of Recommended Minimum Table Velocity Values

Minimum Value

Maximum Value

NSW

0.20 m/s

0.25 m/s

QLD

0.20 m/s

0.30 m/s

VIC

0.30 m/s

0.17 m/s

European (DIN 1946-4 & HTM025/03)

0.15 m/s

0.25 m/s

Some guidelines also provide a nominal diffuser velocity of 0.35-0.41 m/s in order to achieve the required table velocity. Figure 3 and 4. Threshold velocity of 0.4 m/s – showing little uniformity of airspeed, and as such directional control, so the particles within the space are being removed via dilution rather displacement.

LAMINAR FLOW OR UCV SYSTEMS If we take the above four (4) terminal HEPA modules; progressively make them larger and move them closer together – the coverage area and the ratio of sterile to contaminated air increases. The airflow uniformity improves and ultimately the outlets merge to become one large outlet. This then provides uniform flow of

A well designed and applied Laminar flow/UCV provides protection to the operating clean zone in two (2) ways; (1) positive pressurisation with sterile air ensures that no contaminants can migrate into the clean zone and (2), any air contaminated from within the protected zone is rapidly displaced by clean air. Figures 6 and 7 clearly show the uniformity of airflow, down and across the operating table, with the required table velocity achieve directly above the clean zone.

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Figure 6 and 7. CFD modelling of a UCV System

The primary advantage of a laminar flow or UCV is the controlled airflow across the operating area, with sterile air sweeping across the immediate clean zone (any particulate generated in the area is swept away, and with correct operating technique the likelihood of particulate from the operating staff being swept into the clean zone and wound is reduced.

diffuser velocity; the table velocity and airflow uniformity is also being met and the clean zone is still swept in sterile (non-infectious) air.

Studies suggest that this results in an approximately 2% reduction in SSI’s.2,3,4,5 2% may not seem a large percentage rate, however with the thousands of surgeries occurring every day, this small percentage certainly adds up.

A system that is designed to meet the European DIN1946-4, with generally lower target table velocity’s, will require more meticulous setup works and additional testing to confirm correct operation, with resulting table velocities that may still not meet Australian state guidelines. As such this is a decision that can only be made by the end user/designer, when weighing up the final risk versus any benefits that may be gained.

Although there is some variation within the guidelines, we recommend the below airflows as a starting point for, procedures/size and airflow size:

THE EFFECT OF BLANKING SECTIONS OF A LAMINAR FLOW SYSTEM

Table 2: Recommended laminar flow/UCV airflows by operating theatre type

Theatre type

Small theatres/ Day procedure

General surgery/ Orthopaedic

Orthopaedic/ Major surgery

Diffusion size

1,900mm x 1,900mm

2,400mm x 2,400mm

2,800mm x 2,800mm

Nominal airflow

1500-1750l/s

2200l/s

2980l/s

LOWER VELOCITY SYSTEMS (EUROPEAN) The European Standard DIN 1946-4, permits lower table velocities (partly as a driver for energy consumption) and as such lower airflows. With the lower velocity, the risk of buoyancy effects and turbulence from natural heat sources (people/lighting) affecting the clean zone is increased. In an untested environment (theatre setup) this could result in a failure to meet the downward airflow requirements across the clean zone (and as such the potential for mixing of air and contamination of the wound site with particles). To counter this (and mitigate the risk of noncompliance and potential contamination), the DIN 1946-4 standard also stipulates more stringent testing requirements to ensure that with the lower

Figure 8 and 9. CFD Modelling of laminar flow system with blanked centre section: a circulating flow region is created, suspending particles

Figure 8 and 9 represent how spaces between individual diffusers, or how the blanking of a section of a laminar flow system can introduce an area of non-uniformity and turbulent air. This results in noncontrolled air or air contaminated with particulates (such as squames or skin cells from operating staff) possibly entering the wound site and increasing the risk of SSI’s.

AIRBORNE PARTICLES AND SSI’S A number of technical papers and reports have been written relating to the significance of airborne particles contributing to SSI’s. “The majority of SSIs are a result of hygiene-related factors associated with surgical personnel. With respect to bacteria transmitted to the surgical site

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through the air, squames or skin scales, are the primary source of transmissionâ&#x20AC;?.6

Figure 10: Traditional 4 Terminal HEPA module arrangement

Airborne particles are found to be responsible for about 80%-90% of microbial contamination (CDC 2005). It is generally understood that indoor air in an operating theatre may contain particulates from a number of sources (including people and processes or activities in the operating theatre), and that micro-organisms on these air particles can settle on the wound, dressings and surgical instruments and cause infections.

Figure 11: Laminar Flow/UCV Theatre

Reductions in hospital acquired infections can have a significant impact on improved patient outcomes and minimising the cost to the health care facility. While hygiene-related prevention is the most practiced and proven method, airborne-related contamination control offers one area that could play a much larger role. One area of ongoing discussion is the role of operating theatre ventilations systems and system design in airborne containment control to assist in the reduction of hospital acquired SSIâ&#x20AC;&#x2122;s.

OPERATING THEATRE AIR QUALITY In 2010, Airepure undertook a review of the air quality within two operating theatre systems utilising independent industry resources; one with a traditional design for the ventilation system incorporating four terminal HEPA filters and 20 air changes per hour, and one with laminar air flow theatre ventilation with 40 air changes per hour (2.4 x 2.4m square laminar flow system with a face velocity of approx 0.4m/s).7

The traditional theatre (Figure 10) showed a high level of particle contamination, both at the operating theatre table level and throughout the theatre. The tests were carried out for three traditional theatres in the same surgical department with similar results for each theatre. The results of the laminar flow theatre (Figure 11) showed a dramatic reduction in the airborne particle contamination both at the operating theatre table level and throughout the theatre. The assessment was carried out using a calibrated particle counter

with particle counts measured and recorded in the 0.3 micron, 0.5 micron and 5 micron particle size ranges. For both theatre ventilation systems the results were zero particle counts for all three particle sizes when the air quality was measured at the discharge from the diffusers below the HEPA filters however the results showed significant improvement in the air quality readings at the table height in the laminar flow theatre compared to the traditional turbulent flow theatre.

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A summary of the results of the particle counts recorded are summarised in the following: Table 3: Particle count results for Traditional 4 x Terminal HEPA module arrangement and Laminar Flow/UCV Theatre

Location

Particle Count/m3 Size 0.3 micron

Particle Count/m3 Size 0.5 micron

Particle Count/m3 Size 5.0 micron

Traditional theatre at 1m below the terminal HEPA diffuser

34,500

8,000

824

Traditional Theatre at operating theatre table

304,000

119,000

6,950

Traditional Theatre at the wall

563,000

677,000

4,360

Laminar flow theatre outside perimeter of laminar flow diffuser

6,000

2,130

706

Laminar flow theatre at the wall

15,900

5,300

1,680

Laminar flow theatre at operating theatre table

The most interesting observation is the rapid decline in air quality below the HEPA filters in a traditional theatre with the individual HEPA filters arrangement. This is due to the entrainment of particles from the adjacent space. On comparison with clean room design principals, the turbulent flow arrangement would not be acceptable. High turbulence leads to pollution or contamination as well as surface areas.8 During the theatre observations there were numerous staff entries from the sterile corridor to set up for the next series of procedures, this had no discernible effect on the observations at the table location (zero values returned). A well designed laminar flow/UCV system provides two protective effects: positive pressurisation, with no contaminated external entering the theatre by inflow from open doors reaches or perimeter areas can migrate to the protection zone and any air contaminated with in the protected zone is rapidly displaced by clean air from the laminar flow/ UCV system.9

FINAL THOUGHTS Whilst any improvement to existing operating theatre ventilation systems is an advantage, the ultimate consideration compares cost and risk. How does the installation, operation and ongoing maintenance costs of a chosen operating theatre ventilation system compare with the cost of SSI’s (patient readmission, additional care and/or surgery)? A % improvement of SSI’s associated with a welldesigned and applied Laminar flow/UCV system may seem a small percentage, but with the emergence of multi-resistant bacteria’s, this may be critical for patient and a greater cost benefit to all in the long term.

Airepure Australia offer a range of products, services and consulting expertise that can assist you with your compliance to ACHS, DHS VIC Guidelines (and equivalent for QLD, WA and NSW), ISO/IEC 17025:2005 Requirements, AS 1668.2, AS/NZS 2243.3:2010 and AS/ NZS 2243.8:2014. Airepure is a national air filtration company providing unique, powerful and integrated air filtration solutions, ranging from basic HVAC filtration and odour control right through to high end HEPA/ULPA filtration and airborne containment technologies. Airepure recommends ELTA and Fantech Fans. For more information, visit www.airepure.com. au or call 1300 886 353.

REFERENCES 1. Brandt C et.al; Annals of Surgery – Volume 248:695-700 November 2008. 2. Knobben J Hosp Inf; 2006. 3. Scaltriti S et.al; 2007:Risk factors for particulate and microbial contamination of air in operating theatres. J Hosp Infect 664: 320–6 4. Kakwani RG et.al; The effect of laminar air flow on the results of Austin-Moore hemiarthroplasty. Inury 2007;38:820-823. 5. Bosanquet et al; Laminar flow reduces cases of surgical site infections in vascular patients; Ann R.Coll Surg Engl; 2013 Jan; 95(1):15-9. 6. Woods; 1996 7. Sutherland, A: Operating Theatre Ventilation System Review, Part 1: AHE Journal Issue 37, Dec 2014, Part 2: AHE Journal Issue 38, Mar 2015 8. Baumgarth S et. Al; Compendium of Air Conditioning Technology; Vol 1: Basics. 4th Ed. Karlsruhe (Germany): 2000 9. CEN, Ventilation for Buildings – test procedures and measuring methods for handing over installed ventilation and air conditioning systems. German Version EN 125999; 2000

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AND USE ANYTHING OTHER THAN A

WEISS CANOPY? ULA OT CIRCULATING AIR CANOPY Effectively protect patients and staff by integrating the complete system in the suspended ceiling.

How it works The optimised low-turbulence circulating air canopy consists of an outlet element, terminal airborne particle filters, a plenum with sound absorbers and recirculating-air modules. In order to guarantee maximum safety alongside optimum efficiency, the ULA mixes the theatre air supply and supply air in the recirculating-air module. For this purpose, the theatre air is sucked into the recirculating -air module and mixed with the supply air coming from the airconditioning unit. The mixed air is transported to the plenum positioned above the filter. From there, it is conducted in its particle filtered state as clean air into the operating theatre and the preparation room, where it forms a protective zone.

Protective Zone The protective zone is formed by way of a lowturbulence displacement flow. It covers the total sterile environment for surgical procedure. The sterile environment also includes the material and instrument table as well as the persons in sterile clothing. As a result, the patient, surgical staff, material and instruments are optimally protected against particles and airborne bacteria. The area of the protective zone is marked on the floor.

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BIM

AND SECURITY By Simon Hensworth

Imagine if you knew all the security issues a building would suffer during its entire lifespan before you even start to build. You could design these issues out before they ever became issues. Well, the ability to do this is now closer than ever. Building Information Modeling (BIM) which uses a 3D format to design buildings is becoming more widely used as designers and engineers recognise the advantages and efficiencies it produces. With this wider use comes new advantages for Security design.

BIM

IM stands for Building Information Modeling. It generally uses software such as Revit to produce a 3D virtual model of a building in place of the typical 2D plans used in conventional building Architectural and Building Services design. Whilst the actual virtual building model is designed in 3D, BIM is often described as being a 6D system,

where the fourth dimension represents time, the fifth dimension being cost and sixth dimension being lifecycle. This enables efficiencies in the planning of the facility in terms of its overall design staging and associated costing. Whilst it has been suggested that the concept of BIM has been around as early as the 1970â&#x20AC;&#x2122;s, the first implementation of BIM (in its infant stages) was not

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Constructing a 3D virtual model of a building generally follows the same construction process as constructing the actual 3D building in real life. Initially, pads and footings are designed and modelled, followed by walls, roofs, infrastructure, services, right down to the final fittings and furnishings. 3D representations of building infrastructure, services, furnishings and fittings are all modelled using accurate real life dimensions and can even include manufacturersâ&#x20AC;&#x2122; details for specific equipment and technologies.

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This provides a realistic preview of the building process and potential issues that may arise. The outcome is a perfect 3D virtual model representing the final finished building.

ADVANTAGES ETC recently used BIM to design and document the Electrical and Security design for the Onslow Health Service. The use of the 3D modelling assisted in meeting a number of challenges including spatial constraints for services, and early assessment of security considerations. One of the greatest advantages of BIM is the enhanced ability to visualise the finished building. This allows the building owner to see an almost perfect representation of the finished product at the design stage. This is very useful for security design as it provides the ability to select optimum locations for CCTV, and

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select specific fields of view (FOV) for each camera at the design stage. This also allows security inspections and CPTED (Crime Prevention Through Environmental Design) reviews at the design stage using the model, so that design elements that may offer opportunities for crime or unwanted behaviour can be identified an mitigated early in the design process.

The 3D design assists in maximising the transfer of information from the design team to the construction team and on to the end user.

The enhanced visualisation of a 3D model also assists in communication of potential security issues to the building owner. For example, climb points and natural ladders that may allow intruders to climb the building or access points that may be used which could put people in danger are easier to visualise and demonstrate on a 3D model than they are on a 2D plan. The 3D model allows more advanced consideration and assessment of the spatial relationships in and around the building and analysis of lighting for sustainable design purposes. The 3D model can be designed concurrently by all disciplines which assists in the early identification of clashes in services.

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All information making up the model is a structured database. Information can be scheduled to enable the extraction of quantities, and materials/ equipment can be easily extracted from the model for pricing purposes. Builders are provided with far more detailed and specific information that provides efficiencies in construction. For example, a builder can have building elements manufactured to the exact dimensions required to save work on site.

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The BIM could be used downstream by an end user to go back and reference elements of the building throughout its design lifecycle. For example, if extensions are required to security systems, rather than a building operator search through documentation, or have technicians inspect conduit runs through the building, the BIM will show specific details of what exists and where it is located.

NOTE

Future advantages of BIM are its potential to be used for 3D printing of buildings.

ABOUT THE AUTHOR

END NOTE Designing in 3D has already started to supersede traditional 2D design methods, and the efficiencies and advantages it offers is sure to accelerate it as a preferred design method. BIM’s early advantages have already started to include enhancements for Security design and as BIM evolves and becomes the design standard, it is sure to offer even greater potential to safety and crime prevention.

Before undertaking any activity related to this article, it is recommended you consult a Security Professional licensed in your State. Some information from this article has been referenced from: http://en.wikipedia.org/wiki/ Building_Information_Modeling

Simon is a Senior Security Professional with Engineering Technology Consultants – ETC. Simon has over 14 years’ experience in providing security advice, design and consultancy services for a range of clients with major assets in Western Australia. He is a registered Security Professional on the Australasian Security Professionals Registry and one of 10 CPTED practitioners certified by the International Crime Prevention Through Environmental Design Association (ICA), worldwide. Simon is involved in all aspects of Security Management, security design and documentation, CPTED and promoting Security Awareness.

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OPERATING THEATRE COMMISSIONING AND TESTING – A NOVEL QUICK TURNAROUND APPROACH By Sarah Bailey, QED Environmental Services

Operating theatre testing to determine the microbial quality of the air currently uses a microbiological culture based system that can take up to five days to provide results. QED saw that there is a real need to speed up this process, as downtime for theatres can be expensive and cause distress to patients when procedures area cancelled. With this in mind, QED has developed, in association with a NATA accredited laboratory, a quick turnaround method, that can provide results in as little as six hours from sampling.

perating theatres are required to provide clean, HEPA (High Efficiency Particle Arrestance) filtered air to the sterile operating apron – the area in which surgery is carried out. Design of air handling systems in Operating theatres is complex, and must undergo a series of tests and validation prior to the room being used for surgery. Among these are HEPA filter validation, pressure gradients and ultimately, microbiological testing of the air that is supplied over the operating area1.

The use of HEPA filters to exclude microorganisms and other particles from the air that is entering the operating theatre is to attempt to prevent surgical site infections in patients. This is important in all operations, but of especial importance in areas such as orthopaedics, where very small numbers of bacteria can set up slowly progressing, but, ultimately extremely devastating infections within the new joints2. SSI has a high cost – both to the hospital and to the patient. Around 14-17% of hospital acquired infections (HAIs) are acquired in the operating theatre. These result in prolonged stays in hospitals – and average increase in length of stay of around 7 to 10 days per patient3. The most recent Australasian Public Hospital Cost Report (2013-14)4 gives an average cost per day of stay in a public hospital as $2209 in Western Australia, slightly less in other states. However, patients with SSIs tend to be more complex patients, so this figure is likely to be much higher. If a fungal infection

is involved, then and additional cost on top of his has been calculated at an average of $30,957, and $80,291 if an Intensive Care Unit stay is required, in 20095. Added to this monetary cost is the significant personal cost to the patient and their families in terms of increased illness, increased side effects from drugs, and reduced quality of life and earning capacity during illness. There is also a 2-11 times higher risk of death for a patient with an SSI than for a patient who does not acquire one. With the recent move in the United States for both Medicare and Insurance companies to not reimburse hospitals for patient costs associated with HAIs, this looks set to have a significant impact on the running costs of a hospital, as well as the impact on the individual patient. There have been documented cases of surgical site infections directly from the Operating Theatre air handling systems in the United States. An outbreak of Aspergillus fumigatus a notoriously pathogenic and difficult to treat fungus in a tertiary care facility, caused significant surgical site infections, and of the six people infected, two died6. Mechanical testing that had been carried out on the HEPA filters in this case gave no suggestion that the filters were not working to standard. Microbiological testing of the air ultimately entering the theatre had not been carried out, until the outbreak was noted. The infections occurred after renovations had taken place on the air handling units, and were found to have stemmed from the Variable Air Volume (VAV) Units which

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were installed after the HEPA filtration. Moisture had built up in the units and allowed a proliferation of Aspergillus fumigatus on the insulation material. There is the potential for many thousands of spores to be released from this fungus into the air stream, and the operating theatre air supply became contaminated. Microbiological testing of the ultimate supply air to the operating table after the renovations had been carried out may have prevented these tragic consequences.

TESTING OPERATING THEATRES

The main difference between these guidelines is the number of allowable bacteria and/or fungi per cubic metre of air. The WA Guidelines require less than 10 cfu (colony forming units) of total bacteria and fungi per cubic metre of air in order to pass the Operating Theatre as suitable for use. ASID Guidelines allow a level of up to 35 cfu of bacteria per cubic metre of air, and advocate separate testing for fungi if required.

The main reason for testing the microbial air quality of operating theatres is to ensure that the air supplied over the patient is free from microorganisms that may cause harm. Whilst testing of the HEPA filters and of the particle levels within the theatres is carried out, it is wise to know what these particles present are â&#x20AC;&#x201C; and if they have the potential to cause infection. If a theatre has low levels of particles in the >1Âľm range, but these particles are made up of Aspergillus fumigatus spores, or bacteria, then there is still a problem that needs rectifying within the theatre. In Western Australia, guidelines for testing for Operating Theatres are provided by the Department of Health Western Australia Operational Directive (OD 0610/15) Microbiological Air Sampling of Operating Rooms in Western Australian Healthcare Facilities, June 20151. These guidelines must be followed by any public healthcare facility in WA, or any private facility that treats public patients. These guidelines set a limit of <10cfu/m3 air for bacteria and fungi underneath the HEPA filtered area in an Operating Theatre1. Alternative Guidelines are available from ASID (the Australian Society for Infectious Disease) Healthcare Infection Control Specialist Interest Group7.

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As we are based in WA, we follow the WA Guidelines, and have anecdotal evidence that other states follow the same guidelines.

WHEN TO TEST AN OPERATING THEATRE Validation is required by the WA Guidelines whenever a new theatre is opened, or has been renovated, and after certain types of construction work. Types C and D construction work as defined in the Australasian Healthcare Facility Guidelines are the major dust generating construction activities and so carry a high risk of introducing microbial contamination into the Operating Suite. These activities include, but are not limited to demolition, removal of ceilings, sanding, floor covering removal and major cabling activities8. Along with testing after planned construction, testing should also be carried out after adverse events that may impact upon the air quality of the Operating Theatres â&#x20AC;&#x201C; such as water ingress or fires, or in the case of an outbreak for investigation. There is controversy about the need for regular testing of operating theatres for microbial air quality, and there is not a national or international consensus. However, almost every paper detailing outbreaks of surgical site infection calls for better air quality in the operating theatre and more stringent testing. The Australian Guidelines for the prevention and control of infection in healthcare state that filtration of air is an effective way to reduce the risk of airborne pathogens, and that the level of control should be proportional to the risk9. Operating Theatres are not classified as Cleanrooms, but most theatres in a good state of operation meet the standards for Class 7 Cleanrooms. Cleanroom validation and routine testing includes microbiological testing, so the inclusion of a regular microbiological air quality monitoring programme for the operating theatres could be argued to be within the duty of care of the hospital to make sure that the hospital is not providing a harmful environment within the operating theatre. This could be carried out in association with the HEPA filter annual validation testing, to ensure that the final air delivered to the Operating table is fit for purpose.

HOW TO TEST AND HOW LONG DOES IT TAKE? Operating theatres must be tested using an approved method, and the samples analysed at a NATA (National Association of Testing Authorities) Accredited laboratory1, 7. Active air sampling, where a known volume of air is drawn through a sampler and onto a sampling

medium, is the only currently recommended method for testing microbial air quality in operating theatres. This method allows all microbial particles to be sampled, regardless of size, and allows the calculation of the microbial load per cubic metre of air. Older, non-active methods such as settle plates, where an open agar plate is left in the theatre for defined length of time, are not adequate. Currently, analysis of the samples is carried out by culturing the samples â&#x20AC;&#x201C; the samples are placed in an incubator for 3-7 days, and then the numbers of bacterial and fungal colonies counted. This however, can cause delays in opening or re-opening theatres after construction or renovation, as the theatre cannot be used until the results are available. This can be quite costly if testing has had to be carried out because of an unplanned event, such as fire damage or water damage. The cost of cancelled procedures and staff time can run into many thousands of dollars per day in lost revenue and increased costs.

THE NEED FOR A QUICKER METHOD QED has carried out Operating Theatre validation and testing for many clients over many years, both public and private â&#x20AC;&#x201C; and a need for a quicker turnaround testing method is very clear. With Operating Theatre managers often waiting on results to schedule theatre time and reschedule cancelled procedures, a wait of 3-7 days can be detrimental to the smooth running of the theatre suite. QED have therefore worked to develop a new testing protocol that can have results available in as little as six hours from taking the sample, which would have a drastic impact on the reduction of lost theatre time and cancelled procedures. We have using existing and very well established technology to develop a qPCR (Quantitative Polymerase Chain Reaction) based test to detect the level of fungal and bacterial contamination within the air. The method uses established sampling techniques and can be analysed in a NATA accredited laboratory. Samples are taken of one cubic metre of air, as in the traditional culture method, onto a specially developed proprietary medium, and analysed to determine the number of bacteria and fungi in each cubic metre of air. Results can therefore be directly compared to the WA and ASID guidelines. The polymerase chain reaction works by breaking open the microbial cells present in the samples to release the genetic material (DNA) contained, and this can be detected to determine the numbers of cells in the sample10.

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Our initial results were promising and we have been carrying out validation testing of the method for some time now.

4. IHPA National Hospital Cost Data Collection Australian Public Hospitals Cost Report 2013-2014 Round 18. https://www.ihpa. gov.au/sites/g/files/net636/f/publications/nhcdc-round18.pdf accessed 10 October 2016

We have shown that there is a good correlation of the results from the traditional culture based methods with our new DNA/PCR based method. We have also shown that very low levels of bacteria and fungi can be detected within the samples.

5. Ananda-Rajah MR1, Cheng A, Morrissey CO, Spelman T, Dooley M, Neville AM, Slavin M.Attributable hospital cost and antifungal treatment of invasive fungal diseases in high-risk hematology patients: an economic modelling approach. Antimicrob Agents Chemother. 2011 May;55(5):1953-60

One big advantage with this method is that if a sample or laboratory test should fail, which has so far not been the case, the test would produce a false positive result – that is, the test would produce a results that bacteria/fungi were present over the allowed levels. The culture plate that will be taken at the same time will then be used to validate the theatre, or the test can be repeated. With this in mind, using this test, an Operating Theatre would never be said to be safe to use when it was not.

6. Lutz BD, Jin J, Rinaldi MG, Wickes BL, Huycke MM. Outbreak of invasive Aspergillus infection in surgical patients, associated with a contaminated air-handling system. Clin Infect Dis. 2003 Sep 15;37(6):786-93. Epub 2003 Aug 28.

This new method has very obvious benefits in the reduction of down time for Operating Theatres, and a massive saving in lost revenue along with the reduction in cancelled procedures.

10. The Real Time PCR Handbook. Thermofisher Applied Biosystems. Thermofisher.com Accessed 10 October 2016

7. http://hicsigwiki.asid.net.au/index.php?title=Operating_theatre_ commissioning_-_Microbiological Accessed 10 October 2016 8. Australasian Healthcare Faciltity Guidelines https:// healthfacilityguidelines.com.au/accessed 10 October 2016 9. NHMRC Australian Guidelines for the Prevention and Control of Infection in Healthcare 2010

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The method has shown very promising results so far – and more validation of the method is in progress. A six hour turnaround time would be available in WA, with overnight turnaround for other states at the present time. As the technology used is well established, there is the potential for more laboratories in other states to be able to analyse samples if the need is there, which would further reduce turnaround times. Once more validation has been carried out, the method can then be published and presented to the WA group that produce the Operational Guidelines for Microbial Air Sampling of Operating Rooms in Western Australian Healthcare Facilities.

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REFERENCES 1. WA Government Department of Health Microbiological sampling of operating rooms in Western Australian Healthcare Facilities. 2015 2. Stephen J McConoughey,1 Rob Howlin,2 Jeff F Granger,1 Maurice M Manring,1 Jason H Calhoun,3 Mark Shirtlif,4 Sandeep Kathju,5 and Paul Stoodley. Biofilms in periprosthetic orthopedic infections. Future Microbiol. 2014; 9(8): 987–1007. 3. Patricia W Stone. Economic burden of healthcare-associated infections: an American perspective. Expert Rev Pharmacoecon Outcomes Res. 2009 Oct; 9(5): 417–422.

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FACILITIES MANAGEMENT ACCREDITATION – THE FUTURE?

By Nicholas Burt, Facility Management Association of Australia (FMA)

The facilities management industry is evolutionary and continues to develop and adapt to meet the growing needs of technical changes in the industry, growing expectations of clients (in terms of service) and pressure to improve the cost structure – which underpins that service delivery. As such the role of a facilities management professional has continued to evolve. The question is – can an FM accreditation deliver an outcome.

IMPACTING FACTORS

he industry has struggled for more than two decades to establish a key role that truly represents and recognises the impact this profession has on a client organisation. It can’t be an accident that other professions – usually support professions – have been able to articulate a clear value proposition which has seen their profession rise to the highest strategic positions within an organisation. Is human resources any more, or any less, important than facilities management? The ability to have productive people in a workspace is ultimately a multifaceted proposition, but the space in which people operate in commercial organisations would have to be a significant factor. Unlike human resources, facilities management moves beyond the commercial to include other facility types like recreation, residential and retail, just to name a few. It is arguably more important than some other enabling professions that only impact workspace because facilities management is not only concerned with productivity, but also health, safety, and well-being. If the industry was not important then there would not have been a significant growth. According to 2006 sizing study, the industry was in the order of $20 billion, little more than a decade later that number has grown to $32 billion. This is over 50% growth in a decade. The industry continues to grow in both size and breadth.

How do we turn the tide on how the profession is viewed? I think a key area is the development of the international standard and using it as a catalyst to drive a recognition of professionalism.

INTERNATIONAL STANDARDS The development of the ISO is a significant step towards a level of accreditation previously unattainable in facilities management. To date, 32 countries have been involved in the development and review of an international standard, once initially implemented it will achieve 3 key outcomes. The first is to establish the terms and definitions for the industry. This is important to ensure a common understanding, and if nothing else were achieved, this would provide a significant step forward from the current position of the industry. Consistent terms and definitions for the key concepts set the base level understanding of definitions that impact the industry. The second part of the standard is the guidance on the development of service agreements. In an industry which in Australia is close to 60% outsourced, and relies very much on the subcontracting of technical and specialist services, the common platform for engaging services (whether in-house or external) will be a positive step towards building industry consistency.

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The third part of the standard is probably the part which will have the potential to maximise future impact on the industry: A management system standard (MSS) which will provide a framework for accreditation of organisations operating within the industry. The MSS will aim to distinguish the key areas of structural performance (including policies and strategies), which need to be present in an organisation and its operational and strategic systems for that organisation to meet a specific threshold to allow accreditation.

MOVE TO FORMAL ACCREDITATION One key opportunity is through broad based industry accreditation. An accreditation program ideally provides an opportunity to demonstrate the competency. An industry based accreditation program is shaped by the industry, for the industry, providing a minimum requirement of a professional level of competence. A formal accreditation process has been developed previously for facilities management. There is, of course, a number of specialist accreditations and general credentials available, but nothing that can potentially be aligned to an applicable international standard, and the relevant Australian industry competencies matrix for facilities management professionals. The MSS sets out a consistent approach to terms and definitions and provides a clear framework for ensuring the competency matrix is aligned to the internationally accepted terms and definitions. The development of the standard will provide clear parameters for the accreditation of organisations, ensuring that a certain level is required to be met to achieve an accreditation of a facilities management organisation. How does this translate to an accreditation applicable to demonstrating competencies in individuals? An accreditation for individuals will be linked to a number of researched sources. The role of the standard is to outline the organisational requirements for accreditation of facilities management organisations. In order to meet these requirements, facilities management individuals must be able to deliver or produce such requirements. This is a translation exercise, a simple example might include the needs for a facilities management plan, this then dictates that if you have a plan, a facilities manager should be able to draft a plan, this then becomes a competency required in the accrediting of individuals. The other sources of guidance is the breadth of work already completed through education. Because of the

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development of the Diploma of Facilities Management, a full competency assessment driven by an industry reference group has been achieved. This too becomes a source for accreditation requirement, depending on the level needed. The result: an accreditation system which is developed by the industry to meet the needs of the needs of the industry.

CHANGE PROCESS Is accreditation of an industry a simple proposition? I think not! The need to balance legacy competencies and skills with the future direction is never an easy road to navigate. However, putting it off only makes the future more difficult and results in one of two outcomes – the industry continues to be formally unrecognised at a strategic level and/or the industry will result in gaps of knowledge in regards to things like technological advances. In the most recent skills matrix developed by the association, 60% of the competencies required by a facilities manager were management competencies, this was not the case a decade ago.

OTHER FACTORS In some respects the evolution of facilities management has moved to draw a number of specialisations to a set of generalist competencies.

Is this the right direction? Perhaps, but will it deliver the most technically robust outcome for building occupants? This all depends. I think there is a clear need for specialisations, as hospitals are not the same as retail or the same as commercial. Sure there are some core skills which apply to all, but the importance of specialist knowledge can’t be overlooked, because the needs of facilities users should not be unnoticed. The analogy is simple – would you want a lawyer who specialised in criminal law acting on behalf of a client in family law? Or would you trust your brand new Mercedes with a mechanic who has only trained in repairing a Kia? In both cases specialisation is a positive aspect delivering better outcomes. Facilities management is no different.

CONCLUSION Does facilities management benefit from accreditation? I think the logical answer is yes – clarity in a role, understood purpose and defined levels of competency. These are all aspects of a professional that can strengthen the ability to articulate a value proposition to a client, to an organisation’s executive, but also to an apartment owner, a shopper or a sports fan. Accreditation has been tried previously and has had limited traction. I believe the industry is now at a point where it supports this as the next logical step.

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DRIVING HEALTHCARE FACILITY PERFORMANCE

USING ANALYTICS BASED MAINTENANCE STRATEGIES By Cara Ryan, Schneider Electric

INTRODUCTION

he healthcare sector in Australia has been long challenged by the need to improve efficiency, productivity and effectiveness. Key issues faced today include:

• Growth – our population is both growing and ageing, increasing pressure on funding, staff and facilities. The population over the age of 60 is expected to double by 2020. • Patient satisfaction – More than 50% of healthcare executives note patient satisfaction as a top 3 concern. • Energy Use – hospitals are the number one consumer of energy in buildings, and account for more than half the emissions from Australian government buildings. Against this backdrop, we are experiencing rapid advances in technology. Smart technology is the new norm. It’s in our pockets, cars, and hospital facilities. Today, 4.9 billion things connected to the internet. By 2020 this will have increased to 50Bn connected things and 5.5Bn of those will be in buildings. Through bridging the digital enterprise and the physical environment, this technology is changing how professionals interact with healthcare facilities, staff and patients – and the outcomes that can be driven.

Taking advantage of the internet of things and smart buildings, data analytics provides an opportunity to cost effectively implement a predictive maintenance approach. In the past, facility managers have spent time manually checking equipment or reviewing data, historical trends or alarm logs to identify issues or opportunities. Analytics uses automated fault detection and diagnostics to highlight those issues and opportunities most impacting building performance in terms of energy waste, comfort conditions and operational impact. With this information available to them, facility managers and their team can act immediately on high priority issues, and direct maintenance activity to address the most impactful issues or opportunities. Using data analytics can be compared to an engineer reviewing every piece of equipment 24/7, looking for inefficiencies or opportunities for improvement. Information is available to calculate a return on investment for fault rectification or sustainability improvements. Issues can be addressed before building occupants are even aware they exist, resulting in improved comfort and productivity A smart building also changes the problems that Facility Engineers are able to solve. With access to insights never available before, new questions can be answered

and additional value can be given to the overall hospital operation. A smart hospital has the potential to provide a human centred service, not just better energy and maintenance outcomes.

AUTOMATED DIAGNOSTICS AND FAULT DETECTION Technology has become an important tool in managing facilities, taking an increasing role in providing the information facility managers use to perform their jobs. Increasingly sophisticated Building Management Systems (BMS) integrate with other building systems to provide alarm notifications, helping facility managers attend to immediate issues. However, to really use the BMS to understand performance, and to drive improvements, requires patience and attention to detail, a significant time investment, and often a relatively high skill level. In more recent years facility managers have used energy dashboards to further understand building performance and identify areas requiring attention, or opportunities for improvement. Tools like energy dashboards let you view a buildings performance metrics, manually spot trends, and gather insights. Where they excel is in providing visually rich information for public kiosks, assisting to raise awareness of a facility’s energy consumption and projects, and to

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drive positive behavioural change in visitors and staff.

o Excess reheating

Within facility management they can be useful in understanding building behaviour, but the data can be complex and challenging to understand and use. In fact, even if facility staff have the time and skills to review and understand the data, dashboards only tell part of the story about how a building is performing. They can be used to identify where inefficiencies exist but usually not why, which requires additional troubleshooting and investigation. Dashboards show where energy is being consumed, but don’t reduce consumption – this requires further, often considerable, effort.

o Passing valves or broken dampers

The opportunity exists for Facility Managers to use data analytics software to help them interpret the huge amount of BMS data available. Data analytics software is of particular benefit in a healthcare facility given the volume of Figure 1 buildings, their varied use and their differing ages. Analytics software takes the large amount of data available, and does three key things:

o Short cycling

• Prioritises these anomalies in terms of avoidable energy cost, comfort issues, or operational problems so facility managers can easily identify where to invest time and funds to maximise results More sophisticated systems also allow the use of the information available for commissioning, measurement and verification. A core feature of more advanced data analytics software is automated fault detection and diagnostics (aFDD). This identifies problems and recommends opportunities for improvement without human intervention. These systems are based on hierarchical, rule based diagnostics to identify faults, diagnose mechanical systems and determine the saving

incurred through making repairs, improvements or upgrades to the building operation. aFDD utilises many interrelated rules within larger analyses, as well as model based fault detection and diagnostics to identify root causes in plain English and graphical illustration, monetise any energy wastage, and track maintenance and comfort impacts. Below are simple examples of the types of findings automatically detected by the aFDD. In figure 1, an anomaly has been detected when a fan has run outside its expected schedule. In figure 2, an anomaly has been detected where a temperature is “hunting” – constantly overshooting the desired setpoint and then overcorrecting. This is an example of a hidden problem, wasting energy and causing unnecessary wear on equipment.

• Collects, stores and automatically trends building data • Automatically detects anomalies – systems operating outside parameters, or areas of inefficiencies such as:

Figure 2

o Simultaneous heating and cooling o Sub optimal economiser controls o Opportunity for higher or lower setpoints

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IMPLEMENTATION There are different methods of developing and implementing analytics, including: Developing a site specific system Some facility managers choose to build their own on-site building data analytics system that can be customised specifically for and integrated into their buildingâ&#x20AC;&#x2122;s systems. This gives facility managers the greatest flexibility, as they have exclusive access to the servers, software and tools, however it can be a costly option. On-site software can be expensive because a library of automated rules and diagnostics needs to be built from scratch for all the specific equipment, environments and situations of each building. Since every building is unique, this makes the system more difficult to deploy in a campus environment where there is little consistency between building equipment. Therefore site specific solutions in a healthcare environment are not only expensive but very time consuming to deploy. Additionally, as the use of campus buildings change or upgrades are carried out, modifications to the data analytics software are required. This means skilled staff or vendors are required on a regular basis to implement changes. Embedded Analytics An emerging option is to embed and integrate diagnostics into existing BMS hardware and software. This works well in new construction, less so in upgrades or retrofits. This option is still emerging and today there is limited functionality available, however over time this is likely to become a standard inclusion. Software as a Service A more cost effective and efficient option is a cloudbased Software as a Service (SaaS) based data analytics solutions. Data is automatically pulled from building management systems and analysed in a virtual cloud environment. This provides both the powerful insights of an analytics solution and flexibility of remote access across multiple sites and systems. It significantly reduces setup and ongoing costs. These systems, which use a mass-customisation approach, cost less to deploy as they use an existing library of complex diagnostics that can be customised to each building relatively quickly. However, they still require staff to manage the software, interpret and analyse the data, and, most importantly, act on the opportunities identified.

Managed Software as a Service In order to maximise their investment, facility managers have the option to choose a Managed Software as a Service (MSaaS) solution as an analytics solution, which combines the SaaS analytics solution with the oversight of remote and local engineering experts. This provides remote support from a team of engineers who can work with the site team to fully understand priorities, budgets, financial goals, and performance objectives so building management can be viewed within the context of the overall site operation. Remote support also eliminates the need for additional staff resources, allowing internal teams to focus on their core day-to-day responsibilities and also focus on repairs/maintenance with the highest impact. A MSaaS solution can increase the efficiency of vendors by consolidating and integrating data from various building systems. Data can be made available to all parties, saving time and making building services more effective. The analytic findings can also be easily used make sure issues are fully resolved and do not reappear, enhancing vendor management.

INCORPORATING DATA ANALYTICS IN MAINTENANCE STRATEGIES Over the life of a building 75% of costs are incurred in ongoing maintenance and operation, not on construction. Further, over 50% of buildings we will occupy in 2050 are already built today. Maintenance strategies play a significant part in controlling costs as well as ensuring patient satisfaction. There are 3 typical maintenance strategies employed, being reactive, preventative and predictive. Incorporating analytics into a predictive maintenance regime provides a cost effective approach. Reactive Reactive maintenance is the practice of fixing equipment when it breaks down or when performance deteriorates to the point that it is no longer acceptable. Apparent advantages include a lower short term cost and minimal staff requirements. This approach may work well when equipment is brand new, however over times leads to increased costs, unplanned downtime, possible secondary equipment damage and inefficient use of resources due to an inability to forecast and plan activities, including out of hours work.

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Preventative Preventative maintenance is the practice of regularly maintaining equipment based on a predetermined schedule. This approach maintains better uptime and equipment performance than a purely reactive approach and is less expensive over a significant length of time. However, preventative maintenance means all equipment is treated equally, with no ranking of activities based on potential consequences or actual conditions. Research conducted by NASA and the US Navy has shown that the traditional preventative approach to maintaining equipment is actually only addressing age-related faults which make up 18% of potential faults, while the remainder 82% are of a random nature1. Predictive Predictive maintenance is the practice of addressing issues based on actual equipment condition. For example, key operating parameters are checked regularly, either automatically or by staff, and then analysed and used to evaluate equipment condition and need for adjustment, repair or replacement. This means work is carried out at the ideal time, resources are not wasted on unnecessary work and equipment is maintained at a higher level of performance. Whilst often perceived as expensive, predictive maintenance can save 8-12% over regular preventative maintenance2. Further, it has been shown that predictive maintenance can extend the lifetime of a building by several years. One perceived disadvantage to a predictive approach is the need to earmark funds to implement and support systems capable of capturing data on the actual condition of systems and equipment, along with training and possibly additional staff. Whilst these start-up costs are not inconsiderable, this supposed higher expense is an illusion, the return on investment for predictive maintenance is realised several times over. Regardless, this higher initial cost presents a challenge in some healthcare facilities, as this new maintenance approach must be bought-into by upper management in order to obtain necessary funds. Predictive with Analytics Predictive maintenance can utilise automated sensors to help prioritise maintenance. Taking this concept the next step, it is now possible to use data analytics to provide the basis of a predictive maintenance approach with minimal staff input.

Such a maintenance strategy allows the facility to leverage the data that the BMS collects and use this to reduce energy use, improve comfort and reduce operational issues. In the healthcare environment with multiple buildings serving multiple purposes and with varying equipment and operation, using a data analytics driven maintenance strategy enables a broader view of issues and performance, and a superior way of prioritising activity. Because of these advantages, the adoption of analytics to drive maintenance activity is expected to grow by 20% annually over the next few years3.

MAXIMISING THE BENEFITS Data analytics and aFDD provide a wealth of information, but the key to effectively using this approach to maximise returns is the process identified to take advantage of the actionable information to drive results. This is particularly critical in a healthcare environment where the enormous volume of inputs typically present on a campus result in a large quantity of information, and potential “information overload”. Therefore, it is imperative that prior to implementation the supporting process is mapped, which may look like this: • On a daily basis, critical issues only are investigated and actioned – on a healthcare campus, this might be those issues causing large energy wastage, or it might be comfort problems in critical areas such as laboratories. • On a regular basis (fortnightly or monthly), the enormous advantage of analytics to aggregate and prioritise information is taken advantage of – the system is used to identify and prioritise top issues in each category of energy, comfort and maintenance based on their severity and frequency of occurrence. The facility team and vendors investigate to confirm root cause and execute repairs on these prioritised issues. • On a periodic basis (quarterly or half yearly), trends are reviewed to confirm progress – is the overall number of issues and their severity decreasing – if so, the process is working, if not what is causing this? One possible reason is that root causes and remedial actions are being identified but not implemented swiftly.

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Figure 3

Figure 3 above shows the process steps undertaken in a MSaaS delivery model

EXAMPLES OF USE The success stories below show that data analytics can successfully form the basis of a predictive maintenance strategy, providing both initial and long term benefits. 137,000 square meter lab and education facility Within this 5 years old facility 52 VAV valves were found to be passing, resulting in an enormous hidden energy cost. The building is still being monitored using Analytics, and the service is being used to discover faults, to accelerate retro-commissioning activities, and to automate verification of energy investments. 7 Storey Commercial Facility In this case, analytics was used to uncover energy efficiency opportunities and then provide measurement and verification, as well as driving proactive maintenance. Pressure and temperature setpoints were changed to gain savings with no comfort impact, hidden faults were identified and rectified.

Small Community Facility This small facility used relatively simple HVAC equipment comprising rooftop package units. Data analytics was used to provide ongoing commissioning. Despite the low level of complexity and instrumentation, several key issues were diagnosed resulting in an ROI of 23%. Remote Healthcare Facility Remote facilities present an excellent case for data analytics. In this particular facility the maintenance vendor can now review analytics outputs, assess requirements and discuss rectification or parts required with customer before travelling to site, resulting in reduced travel time and speedier rectification.

CONCLUSION By better harnessing and analysing building data, healthcare facility managers have the ability save energy, improve conditions and reduce maintenance issues. Analytics helps to understand not only how a building is operating and where there may be inefficiencies, but why. Through proactively identifying operational problems that would not otherwise be detected, analytics helps facility managers gain a

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deeper understanding of the “why,” which in turn leads to more permanent and effective solutions. Analytics can be delivered via a customised on site solution, SaaS or MSaas, with SaaS or MSaaS providing the most cost effective and quick deployment on large campus style sites. Data analytics excels at identifying the most impactful repairs, replacements and upgrades. To use data analytics to make the most impact, the process to be used to take advantage of the actionable information should be determined at the outset, including daily, monthly and periodic tasks. Benefits of implementing an analytics based maintenance strategy include: • Buildings operate at a much higher level of performance, • Operating budgets are more predictable, • Diagnostic analysis is conducted on a daily basis instead of manual periodic checks,

• Activity and recommendations are prioritised for the most important systems and issues, • Building system information is always current and easily accessible By better harnessing and analysing building data, healthcare facility managers can fully realise the return on their investment by saving energy, improving conditions and reducing maintenance issues. Total performance of the facility is improved through data analytics as facility managers achieve a higher level of building intelligence through the prioritisation of actions.

REFERENCES 1. RCM Guide, NASA, Sept. 2008, and U.S. Navy Analysis of Submarine Maintenance Data 2006 2. “Operations & Maintenance Best Practices: A Guide to Achieving Operational Efficiency,” Federal Energy Management Program, US Department of Energy, August 2010 3. “Business Strategy: Analytics and data management for Smart Buildings,” IDC Energy Insights, November 2012

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FEATURE ARTICLES

USING ANALYTICS FOR IMPROVING BUILDING PERFORMANCE By Andrew Smith, Leader Building Technologies A.G. Coombs Advisory

Advances in digital technology are providing valuable information to help improve the operation and maintenance of installed building systems including HVAC, electrical and lighting systems, and lifts and escalators.

ew technology is facilitating the cost effective acquisition of detailed information about plant assets and their real-time operation. This powerful asset management system and ‘rules based’ analytics software enables us to sort, assess and evaluate this new wealth of data to provide powerful insights into how to better manage, operate and maintain building services systems for improved systems performance, life cycle cost and energy efficiency outcomes. There are broadly two approaches that are being applied, these can be termed Asset Analytics, and Operational Analytics. Whilst separately effective, when used together they provide particularly good insights to support improved performance, plant reliability, and

reduced asset life cycle costs and overall maintenance and energy spends. Asset Analytics considers both the static physical, and historical attributes of an asset including make, model, age, installed environment, condition rating, hours of operation, maintenance and repair history and expenditure. Low cost and large scale acquisition of this data is now enabled through the development of ‘asset apps’ to support the field collection of information, and powerful data storage and manipulation capabilities. This data can be analysed to develop and support tailored predictive maintenance programs that are a ‘best budget fit’ for the needs of the equipment and its purpose, and inform capital upgrade and or

FEATURE ARTICLES MEDICAL

replacement plans, ensuring money is spent where itâ&#x20AC;&#x2122;s needed. Whilst predictive, and condition based maintenance has long been widely applied in industry, its application in the built environment has often been limited by cost and capability to large items of equipment such as chillers, and plant and systems serving critical facilities. Operational Analytics considers the real-time operational performance of systems and equipment to identify poor or out of specification performance, inefficient operation, wear and malfunction, incorrect interaction between system elements and system instability. Operational analytics is not a new concept, and has previously been carried out as a manual intervention by specialist technicians using the Building Management and Control System (BMCS) as part of fault finding and fine tuning of building services systems. What is new is the emergence of software that continuously acquires and analyses detailed operational data from the BMCS. This uses an automated â&#x20AC;&#x2DC;rules basedâ&#x20AC;&#x2122; data analysis approach to look for system operational and maintenance issues that would previously have been masked or hidden. Once identified these issues can be rectified with adjustments to control strategies or settings, or through targeted maintenance activities. These rules can be complex, or as simple as identifying heating and cooling operating concurrently. These software systems are typically deployed either via a direct link into the BMCS database or by duplicating the BMCS field points into a separate module. In either case, care must be taken not to place undue burden on the performance of the BMCS. It also should be recognised that many BMCS have in-built automated analytics capabilities which can often be programmed to provide real-time graphical visualisation of system operation to highlight issues, capture operational data in trend logs, and apply rules to determine alarm conditions. This capability should be reviewed before implementing additional operational analytics software applications. Together Asset and Operational Analytics can offer particularly valuable insights; with asset records providing the historical financial and technical framework for decision making, and operational analytics identifying issues in real time. This enhanced information base can underpin significant improvements in building services asset management and targeted maintenance resulting in lower overall costs, improved system performance and enhanced energy efficiency. www.agcoombs.com.au

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HOSPITAL INNOVATIONS 2016

LORD CARTER SAYS SHARING BEST PRACTICE IS KEY By Jonathan Baillie

Efficient productivity through innovation’ was the theme of the first ever Hospital Innovations conference and exhibition at Olympia, London in late April. At the two-day event – supported by organisations including IHEEM, the Legionella Control Association, the Water Management Society, the BRE, and a sizeable number of English NHS Trusts – the Day Two keynote address by Lord Carter very much reflected this theme. Following his address at Healthcare Estates 2015, the Labour Peer focused further in London on his team’s recent review of the ‘productivity and efficiency’ of English NHS Trusts, and explained how the initiative would progress in coming months. One of his key conclusions was that while the NHS consistently rates as one of the world’s most efficient public health systems, innovation and good practice are rarely sufficiently shared or widely replicated service-wide, resulting in a considerable ‘gap’ between the best and worst-performing Trusts.

ord Carter first spoke to IHEEM members about his team’s work reviewing the ‘productivity and efficiency’ of English NHS acute Trusts in a presentation at last October’s Healthcare Estates 2015 conference (HEJ – January 2016), discussing he and his team’s findings after examining the ‘operational productivity’ of 22 NHS Trusts across England, and highlighting some of the areas with the greatest scope for improvements as set out in his initial review, Review of operational productivity in NHS providers, Interim report, published last June. This review suggested that given sufficient commitment, and action in areas ranging from making more productive use of staff to improving estate utilisation, acute NHS Trusts could reduce the NHS’s costs by around £5 bn annually by 2019/2020. Lord Carter’s follow-up and ‘final’ review, published in February, confirmed that by addressing the ‘unwarranted variations’ his team had uncovered in ‘productivity and efficiency’ across all the major NHS resource areas, the service’s annual bill could indeed be cut by the £5 bn predicted. Speaking on Day Two of Hospital Innovations 2016 – organised by the same Step Exhibitions team that co-ordinates IHEEM’s annual Healthcare Estates

event – Lord Carter gave an interesting update on he and his team’s findings and conclusions, and their continuing work with acute Trusts across England. He acknowledged that it would take substantial commitment and effort, particularly from the least ‘productive and efficient’, to achieve the cost reductions of the scale outlined in his two Reports. However, if the NHS was to remain sustainable, the only alternative if such efforts did not bear fruit would, he believed be rises in taxation.

MANY EXAMPLES OF GOOD PRACTICE While his team’s review had uncovered many examples of excellent existing practice, more Trusts needed to follow the example of their better-performing peers to raise their ‘productivity and efficiency’. In a short welcome address immediately before Lord Carter spoke, IHEM’s President, Chris Northey, had touched on some of the recent overseas visits by senior IHEEM personnel, particularly to the Far East, and Lord Carter remarked as he opened his speech that he had been surprised to learn ‘just how

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The exhibition provided plenty of opportunity to see some of the latest innovations, renew acquaintances, meet with suppliers and customers, and enjoy the benefits of networking with fellow estates and facilities professionals.

international IHEEM and its activities are’. In turn, one of the elements he would be touching on would be his experience of healthcare systems internationally. He told the conference: “Having been involved in healthcare for over 30 years, one of the key things I have learned is that high quality patient care and value go together; if you can manage care well, you can generally manage your costs. In my view, what makes a good healthcare provider is constant attention to detail; going back every day and making sure the big machine you are responsible for is working well. Another thing great organisations do is innovate. Innovation is critical in healthcare, and I am thus delighted to be here at the inaugural Hospital Innovations show. The pace of change is so great, and the challenges so demanding, that unless the NHS continually innovates, it will be sunk by demand.”

DISSEMINATING GOOD PRACTICE One of the major challenges the NHS faced in achieving the cost and efficiency savings demanded, Lord Carter believed, was that, historically, it had not been good at disseminating best practice. He said: “When I started this piece of work, somebody said something very wise to me: that the NHS has done everything right, ‘once’. The challenge we face is to take the best practice some of you in this room have developed and make sure we use it at scale.”

Having in February published his second and ‘final’ report on ‘productivity and efficiency’ in the acute Trust sector, Lord Carter said he would next take a few minutes to take the audience through it, before focusing more specifically on ‘estates and services’. He said: “One point really is clear – and I think the Mid-Staffs crisis woke everybody up to this – there has been a certain degree of complacency in the NHS historically, and a high degree of public acceptance of sometimes pretty average performance. I think Mid-Staffs was the wake-up call that, actually, the

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service isn’t very good in some places, and that we must do better. I believe we are thus now much more focused on quality not being negotiable. Healthcare systems cannot have second best, because it means people die. We must ensure we continue to seek out best quality, but simultaneously best value – based on the fact that the public are not only the service’s users, but also its funders. This means healthcare professionals being as rigorous in pursuing value as they are in pursuing quality.”

EXCELLENT STANDING WORLDWIDE While the NHS faced unprecedented financial pressures, Lord Carter noted that its global standing continued to be excellent, with studies by the Commonwealth Fund – which looks at world healthcare systems every year – consistently rating it highly. Lord Carter said: “Taking just 7.1% of GDP, the service is one of the world’s cheapest healthcare systems for what we actually get – one key reason being that we sweat our assets hard. In contrast, go into a US hospital and they are ecstatic if their

occupancy is 60 per cent, and even more so if they get paid for 60 per cent, because in America, if you go into an emergency department the hospital must treat you regardless of whether you can pay. They thus probably only get paid for about half the care they deliver.” By contrast, Lord Carter noted, hospitals in England ran ‘at nearly 90 per cent full’. He said: “Sometimes you could argue they run too hot; but actually we have a very efficient recovery system for those fixed costs, and, of course, we can keep our hospitals full because there is always a backlog to work through. Thus our hospitals are highly effective in some ways, but not in others.” One of his team’s key findings – highlighted in the ‘final’ report – was the now widely referenced ‘unwarranted variations’ between Trusts, in areas ranging from productive use of staff, to the price paid for medicines. Lord Carter elaborated: “To uncover these variations we had to establish a methodology and database that let us compare the performance

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of hospitals facility by facility, and then discuss with the individual hospitals why the variations were there. Sometimes they were explicable; for example, what would be the worst combination for a hospital? – probably a PFI with some old buildings attached to it, multiple site operations, and insufficient capital spent on it. Such a facility will have very high costs, while in contrast, a Trust with a really ‘crackerjack’ hospital financed out of public money, with no debt, will inevitably have much lower costs. You have to factor these things in. Why the word ‘unwarranted’ is critical is in trying to understand what is justifiable, as opposed to really not acceptable.”

TELLING TRUSTS WHAT THE DATA SAYS What his team had done with the sizeable cohort of English acute NHS hospitals studied, was to take the data they had provided, process it, and then go back to the hospitals and tell them: ‘This is what your data says.’ Lord Carter expanded: “When I confronted some Trust personnel with their data, they remarked that didn’t recognise it; it didn’t ‘reflect the

reality’. However, systematically we then kept going back and got a consensus as to what Trust personnel were prepared to accept. We found unwarranted variations across a wide range of areas.” Key to the whole exercise, Lord Carter emphasised, was to work with Trusts ‘to help them, rather than to tell them what to do’. Following the initial discussions, many Trusts now had people asking: “Is this what ‘good’ looks like?” “For example,” Lord Carter said, “we were in one very large teaching hospital looking at its radiology department, and it was awful – with slow use of imaging equipment and perhaps only getting through a couple of scans per hour, when a good hospital could have got through five.” “The chief executive asked me: ‘Is the department really that awful?’ I replied: I’m afraid it is; it’s your data; and I have data from other hospitals to compare it with.’ The CEO then asked: ‘So that’s bad, but what does ‘good’ look like? What should my radiology department be aiming for?’ This approach was then repeated through every hospital department, resulting in us being able to present

++ ++ ++

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After his speech, Lord Carter received a certificate from IHEEM President, Chris Northey, in recognition of him being made an Honorary Patron of the Institute.

the Trust with a vision of what good looks like, and what we would expect it to achieve to be running the hospital really well. When we ran all that data, we became firmly convinced we could save £5 bn annually by 2020 out of an acute hospital base. Putting this in context – fail to save this money, and we will have to find it from elsewhere – my guess would be through taxation.

SAVE THE MONEY OR FACE HIGHER TAXES “Currently,” Lord Carter told the audience, “the NHS in England consumes the whole of VAT. Last year we collected £120 bn in VAT, and frankly passed it straight through to the NHS. I am sure the mathematicians here can calculate by how much we would have to raise VAT if we don’t save the £5 bn annually. These are really meaningful numbers that will impact everybody’s lives. We really have to get this right.”

Lord Carter said he wanted to make clear, however, that the fact that there was such scope for ‘productivity and efficiency’ savings was ‘not a failure of the NHS as a whole, but rather of individual hospitals to be as good as they can be’. “He elaborated: “I could take you to hospitals around England that are the best in the world in various ways, but we haven’t been consistent, and there are too many people not doing things right. It’s all about how we help them do this, and become possibly a little bit intolerant of the waste, or the inability to tackle a problem quickly. Having said that, there is always a danger in the NHS of what I would call ‘episodic management’ – somebody in the centre dreams up another initiative, and the hospital has to respond to it. We see this time and time again; people working their way through the steady management of the thing, only to find some new imperative has been dreamt up, or some local organisation has requested data which takes everybody off on the wrong track.”

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WHERE THE MONEY GOES Turning to focus on where NHS money currently goes in the acute Trust sector, Lord Carter said currently the ‘big number’ was pay. He said: “We spend around £34 bn on staff, but how productive are they? What you see is considerable inconsistency in how people manage their staff. We think there is £2 bn that can come out of greater workforce productivity, £1 bn from pharmacy, £1bn from procurement, and £1 bn out of FM costs.” Lord Carter said he would next take delegates through a hospital ‘model’ to illustrate some of the points just made. He said: “If you think what a hospital is, then you can see the sort of components that need managing. Essentially a hospital admits patients, with about 5 per cent arriving by ambulance. Some say around 30 per cent shouldn’t be admitted, and that 40 per cent should be discharged, so we have a couple of problems immediately. However, what you really look at is departments and wards – things like pathology, radiology, catering, and estates. Break those down component by component, site by site,

and you can see significant variances. Nursing hours would be good example. In February we compiled data on 1,000 wards and found that, in some, to care for a patient for a day took 15.6 hours’ nursing time, but in others just six. Often when we challenged people they couldn’t quite explain why rotas were working as they were. Sometimes it was convenient for staff; sometimes it was all about weekends when nurses didn’t want to work, but in good hospitals there was an absolute grip on it, and they were the most productive. Similarly, we asked, why do some doctors get through five procedures in a session, and some just two? We all have different working practices, and one doesn’t want to be dictatorial, but it is wise to ask the questions.

OUT-OF-DATE PHARMACEUTICALS “Similarly with the use of pharmaceuticals,” Lord Carter continued, “one of the biggest costs is outof-date products. People put them on the shelves and don’t rotate them properly. They then have to be written off, and we consequently lose huge

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amounts of money. Yet in some hospitals, they take that public money, and husband it really well.” As an example, Lord Cater explained that he had recently spent time with the Salisbury NHS Foundation Trust at Salisbury District Hospital, and had been impressed by the savings that work undertaken by the hospital’s pharmacy team under the auspices of the chief pharmacist had secured. He said: “It was all about taking £64,000 out of that particular line, £18,000 out of that line, £26,000 here, and another £5,000 there. Overall it all adds up to a lot of money, and it’s that attention to detail to systematically go through every cost, cut it where possible, and push the resulting savings onto patient care that counts, and is what we are advocating. We’re saying to Trusts: ‘Here is a set of metrics; compare yourselves with them; if you want to be in the bottom quartile, go ahead’, but most people don’t; and gradually we’re seeing a tightening up because generally what gets measured, gets managed.” Lord Carter felt one of the reasons for the ‘unwarranted variations’ was that some Trusts didn’t know what was going on in terms, for example, of the prices even neighbouring Trusts were paying for the same goods. He elaborated: “Take orthopaedics – when you talk to hospitals they always tell you they have the best price, because the salesman has told them so. However, drill down, and you find some people are paying twice as much for the same product as others.”

PRODUCTIVE USE OF SPACE Turning to focus on estates and facilities, and some hospitals had told the Carter team that up to 35-40 % of their space was not productively used ‘in the sense of delivering care’. In undertaking a major project for the Government five years ago, Lord Carter had talked to the American military about its property rationalisation programme. He elaborated: “The personnel involved told me the most effective thing they ever did was to knock down under-utilised property. They had a ball and chain team, and if people didn’t use their buildings they demolished them. They thus not only reduced heating, insurance, and maintenance costs, but also forced people to make choices.” The ‘unwarranted variations’ the Carter team had uncovered, Lord Carter explained, applied not only between Trusts, but also site-by-site. He expanded: “I was talking earlier today to the Department of Health’s Peter Sellars, and we discussed one big hospital where, on one site, the cost of cleaning per square metre was three times that of that another

– apparently for no other reason other than the management of the process, the supervision, and the contract that had been let.”

DATA THEY CAN ACCEPT AND COMPARE What his team was seeking to do to support Trusts was to give them data they could ‘accept and compare’. Lord Cater explained: “We say: ‘Give us five Trusts you think you are like, and we will provide the data and you can see how you are faring in comparison.’ Many Trusts are doing great things, and we are then able to ask them: ‘How do you do that so well?’ They are then able to tell us, and we can effectively then, in a sense, buy their idea wholesale from them, and retail it to the rest of the system. People have a hunger to know what good is, and what we are trying to do is to engage with Trusts, share good practice, and ask the poorer-performing Trusts: ‘Why aren’t you doing this?’, or ‘Perhaps you might like to go and visit that particular hospital and see what they are doing on this particular front?”

RIF TAGGING’S SUCCESS As an example of a failure to disseminate information on good practice, Lord Carter cited the Royal Wolverhampton Hospitals NHS Trust, which, ‘seven years or so ago’, had received a grant from an NHS funding body to research the use of RFID tracking. He said: “They wanted to stamp out infection, so they applied RFID tags to care staff, and on dispensers for cleaning hands. They wiped out infection within a year, because they could immediately check if a nurse or other carer had cleaned their hands. They then went on to RFID tag almost everything in sight. For instance, they tagged patient beds, which enabled them to prove that nurses had visited a particular patient regularly. They also found they could find items such as ultrasound machines left in a corridor much faster. “This was great piece of work, but nobody really found about it, because the grant-awarding body got disbanded. Time and time again – as here – we find we know how to do it once. We in my team regard our job as taking that learning – the good from each of you – and putting into a system. We then encourage Trusts by suggesting they adopt a particular approach. These are very challenging times financially, and it is like the chief pharmacist in Salisbury – every £5,000 saved here or there counts. There are no longer any big easy answers; no silver bullet. Particularly I suggest in estates and facilities management, there is quite a long way to go.

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REVIVING AN INVESTMENT FUND “We clearly need to find a way of reviving an investment fund to actually back up providers in making the necessary investments,” he continued. “Four years ago we set up a £50 m fund, which was heavily over-subscribed, and went very quickly. It was so successful we never did another one. That is the problem; where do we spend the money that is really going to impact costs?” Lord Carter said he was ‘really a great advocate of encouraging people to run their hospitals well’. He added: “A lot of it is about keeping people focused on the daily details. When you look at what senior hospital management teams do globally, one of the key questions daily for the chief executive in Germany or the US is: ‘How many patients have I got in today, and am I being paid for them?’, and, secondly, ‘How many hours of care did I expect to deliver for those patients’ needs yesterday, and did that care turn up?’ Had we seen that approach at Mid-Staffs it would have been obvious to anybody that the Trust was not delivering the right amount of care.” Contrastingly, in an English hospital what the CEO typically worried about was ‘the latest worry from the middle – whether it’s infection rates or A&E attendances’. Lord Carter said: “So all the time you have a different agenda, and the best healthcare systems have this relentless attention to detail every day. Thus what we are doing is to put a support mechanism within NHS Improvement, which will have domain expertise behind it. It will have an interface person and an engagement person or team with the hospital. Behind that lie 14 areas of expertise, feeding into that engagement, so that right the way across the Board, there are seven metrics. We will make sure non-executive directors understand them, and make it compulsory for them to attend courses to ensure they do. Otherwise many senior Trust personnel have no means of knowing whether their hospital is good or not.

ESTATES AND FACILITIES “I think estates and facilities management is so important, and is an area we can get right by comparing what we are achieving with other hospitals. My experience is that if staff believe the data they are presented with they will act upon it. The great thing is we already have some good data. What has made it easy to determine the efficiency of Trusts is that we have billing data from all hospitals. If, for example, you take trauma and orthopaedic departments, we know what a particular hospital

billed on T&O in a given year. We also know from the ESR (Electronic Staff Record) database what the cost of providing that service is, so by running those two output and input ratios across the system, you see significant, inexplicable variances. Some hospitals, for example, are sloppy; the theatres always start late, they can’t organise themselves, and cancel all the time, so they don’t get the revenue, but they have all the staff there. Gradually, by drilling down, and having a good debate, people start improving how they work. So, we have great data, but what we need now is to run it into actionable information, so management can do something with it. “In conclusion, I would argue that it is vital to put processes in place that hold management to account, not in a didactic, head office way, but rather via a set of good data that lets good people compare their performance and make the right decisions. We must, though, remember that the experience we are able to gain in a big system like this needs to be shared. The biggest factor of all, however, is innovation; no healthcare system will make it unless we continually innovate; it isn’t the big stuff, but, for example, it’s about getting the patient flows in our hospitals right. What we are seeing globally is the move of healthcare away from being a craft service to an industrial process. We can’t cope with the volume of patients if we don’t standardise protocols, procurement, and specifications.

A WORLD-LEADING SERVICE “I believe we stand a chance of making the NHS the world’s best healthcare system. We have a remarkably efficient structure, and if we can manage things tighter, with everybody doing their bit, we have a chance, for 8-9% of GDP, of having a system equal to or better than those countries spending 16 per cent of GDP. In terms of opportunity for everybody, that means we have an export product. If we can continue to build the lowest cost and most effective system, and demonstrate we have the managerial processes, I believe a lot of people across the world will beat their way to our door. That is good for both the NHS and for the people who provide innovative solutions.” With this, Lord Carter concluded a very interesting and thought-provoking address. Next year’s Hospital Innovations conference and exhibition is already in planning, and will again be held at Olympia, London, from 25-26 April, 2017. For more information, visit www.hospital-innovations.com/ or T: +44 (0)1892 518877

Healthcare Facilities Artwork_Sept_Hendry_PRINT.pdf 1 6/09/2017 12:36:59 PM

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CMY

REGULARS

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ASCOM Ascom expands its healthcare platform with the launch of the new Ascom Myco 2. Ascom Myco 2 is an advanced information system that brings together versatility, durability, and convenience in one handset. Providing users the ability to connect to a myriad of hospital systems such as medical devices, electronic medical records (EMRs), laboratory equipment, nurse call systems, and other healthcare communications and IT infrastructures. Ascom Myco 2 offers new features such as embedded near field communication (NFC) and infrared (IR) positioning. These enable tag-and-go data updates and the exchange

between similarly compatible devices and equipment items. They also have an automated “nurse presence” function that automatically records interactions between hospital staff and patients. The Ascom Myco 2 runs under the Android 5.1 Lollipop operating system and is available in a Google-certified version with access to apps through the Google Play Store. For more information on Ascom Myco 2 visit www.ascom.com/myco2 or email us at au-marketing@ascom.com

NEWS

STEAM VAPOUR CLEANING HELPS TO REDUCE HOSPITAL ACQUIRED INFECTION RATES Steam vapour is seen as one of the leading methods of disinfecting healthcare facilities, including patient rooms, bathrooms and operating theatres. Steam vapour is used to kill healthcare grade bacteria including C.diff, MRSA and VRE. Duplex Healthcare is a leading supplier of Duplex steam vapour machines that clean hospitals in conjunction with microfibre.

Director of Duplex Healthcare, Murray McDonald, says using the old “spray and wipe” method is no longer a healthcare standard of cleaning. “Low grade chemicals and regular cloths can move bacteria around a surface, rather than disinfect,” Mr McDonald said. “Our steam vapour machines produce high-temperature, dry steam vapour, which is renowned in Australia and overseas for its bacteria killing abilities and to safeguard against healthcare acquired infections. ““It is most commonly used for touch point, regular, outbreak and discharge cleaning. “Our latest machine, the Jetsteam Maxi Inox is one of our most popular models, due to its compact size, its maneuverability and ease of use. “Its state-of-the-art features include a robust, stainless steel build, improved digital control panel and waterproof LED hose control system.” For more information on the Jetsteam Maxi Inox, visit www.duplexhealthcare.com.au or call 1800 622 770.

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CAIRNS MACKAY

BRISBANE Armidale

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

Coffs Harbour

PERTH

PORT MACQUARIE Newcastle

ADELAIDE

SYDNEY

ALBURY Colac

Sale

Warrnambool

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

Geelong

MELBOURNE

Currently, the South Pacific Group is establishing a strong network of modern laundry across Victoria, New South Wales, Queensland, Western Australia and South Australia with plans for several more facilities up the East Coast of Australia in 2017. The relocation of our Sydney operations to a new larger facility in Bankstown together with the relocation of our Brunswick plant to Broadmeadows will establish South Pacific Laundry as the single largest privately owned laundry in Australia and in the Southern Hemisphere.

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

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

SPL provides: • A 365 day service to all its clientele with a 24 hour turnaround. • A leading edge technology in RFID to assist housekeeping and managerial staff in time reduction and efficiency. • Dedicated account managers and experienced support staff who are available 7 days a week. • A dedicated software design package and centralised billing system enables seamless transactions, paperless and customised reports. • Delivery rationalisation systems, providing and streamlining efficient delivery routes which will reduce the company’s carbon footprint. • Building of partnerships and sharing benefits with the customers from savings made through its constant laundry process innovations and group purchasing power of linen products. • Dry cleaning, Uniform cleaning services, Housekeeping services, Dust mat hire and Cleaning services. • Provision and supplying of Corporate uniforms/work wears and customised hotel room Amenities.

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

*Melbourne, Albury only

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

Australian Healthcare Clean Steam Generator. The Spirax Sarco AH-CSG is the perfect solution for hospital steam sterilisation: •

Clean Steam to AS/NZS 4187:2014

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Efficient Compact design - Up to 300kg/hr output with minimal footprint 1350x800x2050h

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Clean Steam operational pressure of 3 to 5 barg, featuring onboard water degassing and heating

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Control via local process controllers

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Minimal Installation and commissioning from a preassembled unit

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Designed and built in Australia

Spirax Sarco provides tailored maintenance and service agreements for your business. Installation and turnkey solutions available for clean steam generation including clean steam distribution systems, plant steam modifications and steam quality testing to Australian Standard.

Contact Spirax Sarco for more information on the AH-CSG  1300 SPIRAX (774729)  info@spiraxsarco.com.au  spriaxsarco.com/global/au