PP 100010900
VOLUME 42 I NUMBER 4 I DECEMBER 2019
HEALTHCARE
FACILITIES IHEA 2019 NATIONAL CONFERENCE AND GALA DINNER
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CONTENTS REGULARS
38 A blueprint for Innovation in FM
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Editor’s message
7
National President’s message
43 Getting AS4187 implementation right first time
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CEO’s message
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51 Could adopting a safety case regime improve patient safety in Australia’s hospitals?
77 News
59 Game plan for the future – Best practice and data management
BRANCH REPORTS 10 QLD 12 VIC/TAS
65 Creating an Internet of Thingsenabled building
14 WA 19 SA
72 Waterproofing healthcare bathrooms
CONFERENCE
75 How embracing microfibre cleaning can assist healthcare facilities
22 IHEA Conference 2019
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FEATURE ARTICLES 25 An Australian approach to recording learning online 34 A novel approach to monitoring water quality in hospital and healthcare facilities Visit the Institute of Healthcare Engineering online by visiting www.ihea.org.au or scanning here ➞
IHEA NATIONAL OFFICE Direct: 1300 929 508 Email: IHEA.members@ihea.org.au Address: PO Box 6203, Conder ACT 2900 Website: www.ihea.org.au Conference: www.hfmc2019.org.au IHEA NATIONAL BOARD National President Peter Easson National Immediate Past President Brett Petherbridge National Vice President Jon Gowdy National Treasurer Mal Allen Communications Darryl Pitcher Membership Registrar Peter Footner
Standards Coordinator Brett Nickels Directors Michael McCambridge, Peter Klymiuk, Mark Hooper IHEA ADMINISTRATION Chief Executive Officer Karen Taylor Finance Jeff Little Membership Angeline Canta (FMA), ihea.members@ihea.org.au Editorial Committee Darryl Pitcher, Mark Hooper IHEA MISSION STATEMENT To support members and industry stakeholders to achieve best practice health engineering in sustainable public and private healthcare sectors.
59 ADBOURNE PUBLISHING 18/69 Acacia Road Ferntree Gully, VIC 3156 PO Box 735, Belgrave, VIC 3160 www.adbourne.com ADVERTISING Melbourne: Neil Muir T: (03) 9758 1433 F: (03) 9758 1432 E: neil@adbourne.com Adelaide: Robert Spowart T: 0488 390 039 E: robert@adbourne.com PRODUCTION Emily Wallis T: (03) 9758 1436 E: production@adbourne.com ADMINISTRATION Tarnia Hiosan T: (03) 9758 1436 E: admin@adbourne.com
Adbourne PUBLISHING
The views expressed in this publication are not necessarily those of the Institute of Healthcare Engineering Australia or the publisher. The publisher shall not be under any liability whatsoever in respect to the contents of contributed articles. The Editor reserves the right to edit or otherwise alter articles for publication. Adbourne Publishing cannot ensure that the advertisers appearing in The Hospital Engineer comply absolutely with the Trades Practices Act and other consumer legislation. The responsibility is therefore on the person, company or advertising agency submitting the advertisement(s) for publication. Adbourne Publishing reserves the right to refuse any advertisement without stating the reason. No responsibility is accepted for incorrect information contained in advertisements or editorial. The editor reserves the right to edit, abridge or otherwise alter articles for publication. All original material produced in this magazine remains the property of the publisher and cannot be reproduced without authority. The views of the contributors and all submitted editorial are the author’s views and are not necessarily those of the publisher.
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REGULARS
EDITOR’S MESSAGE
W
elcome to the Summer 2019 “post-conference” edition of “Healthcare Facilities”. This edition showcases some images from the very successful IHEA National Conference held recently in Sydney at the ANZ Stadium complex for you to reminisce over, together with the presentation that received “Best Paper Award” from Dr Richard Bentham of Built Water Solutions, for his presentation entitled “A Novel Approach to Monitoring Water Quality in Hospital and Healthcare Facilities”. In coming editions we will continue to share the technical presentations made a the Conference for your learning and enjoyment. As noted in our previous publication I was unable to be part of the IHEA National Conference, due to a conflicting appointment in Manchester, UK. This was to attend the IFHE Executive Committee and Council meetings, and to attend the UK equivalent of our national conference, IHEEM Estates. Both of the meetings we held went extremely well, and Karen Taylor (CEO) represented IHEA at the Council Meeting, and presented an excellent perspective from our part of the world on a number of matters raised. I was also privileged to be delivering the International Keynote Address on the first day of the Conference. In past conversations with IHEEM CEO, Pete Sellars, considerable
interest has been expressed in the IHEA Learning and Development App, so I was happy to provide some insights to the IHEEM delegates on the background and intentions of this IHEA initiative. An excellent summary of the presentation was made by Johnathan Baillie, Editor of IHEEM’s Health Estates Journal and with his permission his article is reproduced herein. The obvious synergy of what has been achieved with the IHEA LDP application is identified in the article, given what is being pursued in the UK with recognition for the development of healthcare facility managers and professionals. Considerable interest was again shown in the IHEA app by colleagues from around the world with comparisons being made to excellent efforts emerging in Europe that is working hard to recognise and certify the professionals who work in Healthcare Engineering. With this edition we close out 2019 – once more, a huge thankyou to our contributors, partners and supporters for making this Journal possible, to Adbourne publishing for their efforts (and patience!), and to you our readers and members. I wish you all a happy holiday season, and hopefully a well-earned break over the coming Summer months. Regards Darryl Pitcher
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REGULARS
NATIONAL PRESIDENT’S MESSAGE
It is an honour to be appointed as the IHEA national president for 2019-21 and I am eager to get to know more of you along with your interests and concerns in the coming year. The National Board, together with Karen, our CEO, and I will be working hard over the next year to widen the engagement of the IHEA and show how membership of the IHEA can make a difference to your professional experience.
O
ne of my top priorities for this year and into the future is rethinking the nature of our profession in the face of challenges in the form of service model transformations, the ever spreading creep of digital integration into facility management and our ageing workforce..
dedicated to the ongoing management and development of this and other emerging educational opportunities. Board member and immediate past president Peter Easson has carriage of the portfolio and will welcome feedback and suggestions as the program progresses.
This point in particular is now becoming a major issue with the recent speech by the Federal Treasurer advocating for an increase in the pension eligibility age more or less obliging older members of the workforce to stay at work longer and along with this, ensuring their skills are maintained to enable a good quality of employment.
The 2019 IHEA National Conference held at the Homebush Olympic Park complex in October was a great success and congratulations go out to the organising committee and event management staff for putting together a great event.
Traditionally, staff working in healthcare facility maintenance/engineering tend to be in the over forty age bracket and as such will be effected by this change, if implemented. The introduction of the IHEA CPD and online training program is one of the most accessible means available for those employed in healthcare facility management to track on the job learning and leverage off their workplace experience and is suited even to those with limited computer skills.
In closing I would like to acknowledge the great work done by the previous board members and specifically thank outgoing board members, Mal Allen, Brett Petherbridge, Peter Footner and Michael McCambridge for their advice and guidance over the last few years. Echoing Karen’s thoughts in wishing you all a safe and happy festive season and looking forward to an exciting and productive new year for the IHEA. Jon Gowdy – IHEA National President
The importance of this initiative has been recognised by the IHEA Board with the creation of a new portfolio
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REGULARS
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REGULARS
CEO’S MESSAGE
I was privileged to represent IHEA at the IFHE Council meeting in Manchester in October. The meeting formed part of the 2019 IHEEM Conference held at Manchester Central Convention Centre.
I
HEA is one of over 60 member countries to participate in the annual council meeting, last held in Brisbane 2018 as part of the bi-annual IFHE Congress. The current President of IFHE, our own Darryl Pitcher, did an excellent job steering us through a full and sometimes challenging agenda. As always, there was much goodwill in the room with everyone focused on international outcomes to further Healthcare Engineering. The meeting also demonstrated there is much more we have in common with others around than world than differences. The agenda included an overview of the President’s activities for the last 12 months, much of which was focused on growing IFHEs profile and importantly advocating on behalf of Healthcare Engineers everywhere. Having Darryl in this role ensures that Australian Healthcare Engineers and Engineering have had particular attention. The Administration and Secretariat provided a report on the operations of IFHE including financial and membership status. Italy and Canada reported back on the planning progress of the 2020 and 2022 IFHE congress respectively, both of which are well on track to be excellent events.
After 2 years of consultation and work in line with the constitution the name change from International Federation of Hospital Engineering to International Federation of Healthcare Engineering was approved. This now brings IFHE in line with most of its member organisations who have made this change to their respective names to reflect the developments within the sector. Of note was the agreement to establish several working parties, each with a range of international members, to further the engagement and impact of IFHE and its members. These meetings are always of real value to IHEA and its members and I thank the board and IFHE for the opportunity to attend to represent our members and the industry in Australia. As we approach the end of the year I wish you all a safe and restful holiday season. I look forward to working with you in 2020. Karen Taylor – CEO
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BRANCH REPORTS
QLD BRANCH REPORT Branch Activities
B
ranch activities have been quiet, since our midyear seminar and the 2019 National Conference in Sydney absorbing most of our time.
Our final Professional Development for the year on 5 December 2019 is on the Nurse-call Systems for the 21st Century and an Update on AS3811. • AS3811 discussions by Austco • Nurse Call Systems in the future.
The committee has been working quietly behind the scenes, organising our final PD for the year and on the back of our successful country meet in Townville in March 2019, we are working to host another PD in Mackay in March 2020.
• The impact of the “internet of things” on nurse call systems
The National conference from a Queensland prospective was well attended and enjoyed by all. Many thanks and congratulations to our NSW colleagues for an excellent program.
In conjunction with Cliff Pollock, Director Facilities Manager in Mackay Hospital and Health Service, the Queensland Branch of the IHEA are planning for our country meeting to be held in Mackay on 26 and 27 March 2010.
This session will be available as a webinar after the event. QLD Branch Country meeting – Mackay
The visit will include a bus trip and site visit to Bowen with the formal PD session to be held at Mackay Base Hospital on Friday 27 March 2020. ANZ Stadium
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BRANCH REPORTS
“Go the Maroons”
Membership Membership continues to evolve with at least 11 new members joining us in 2019. Committee of Management President
Adrian Duff
Vice President
Brett Nickels
Treasurer
Mike Ward
Secretary
Danny Tincknell
State National Board Rep
Brett Nickels
COM
Scott Wells
COM
Artur Melnitsenko
COM
Kevin Eaton
COM
Darren Williams
COM
Todd Marshman
COM
David Smith
COM
Cliff Pollock
COM
Christopher Ansley Hartwell
COM
Peter White
If you would like to communicate with the QLD Branch via email, please do so at ihea.qld@ihea.org.au Brett Nickels Vice President, QLD Branch
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BRANCH REPORTS
VIC/TAS BRANCH REPORT
10 years – 2009 > 2019
Victoria Tasmania Branch Activities for 2019
Mark Burrell
PD 3 Greening the Healthcare Sector Forum 2019
Wood & Grieve Engineers
onday sessions of the Greening the Healthcare Sector Forum, held by CAHA, Western Health and the Institute for Healthcare Engineering Australia, Vic / Tas Branch took place at Western Health in Monday, 23rd September. The forum was an opportunity for those working in healthcare to come together to focus on the sector’s environmental and climate footprint, the big picture changes needed to address its environmental impacts and demonstrate positive steps being taken to make our healthcare system more sustainable.
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Topics covered included the carbon footprint of healthcare, climate risk and corporate governance, technological innovations, water and energy planning, wellness and healthy buildings, waste management, social procurement, health and climate change research, environmental strategy and framework development, and more.
The Annual Conference held at Sydney’s Homebush Stadium was enjoyed by all branch members who attended. A number of branch members were recognised for lengths of membership at this year’s AGM at the Sydney National Conference, certificates and badges will be presented at a branch function or mailed to the member:
Schneider Electrics, Building Australia 30 years – 1989 > 2019 Bruce Leslie Jeremy Bowler 40 Years – 1979 > 2019 Robert Smith The Committee of Management are looking forward to catching up with many branch members at our Branch Christmas Function Saturday 30th November 2019 12:00pm to 3:00pm at Berth, Docklands. We would like to wish all members a safe and happy Christmas, and year ahead. MEMBERSHIP GROWTH OPPORTUNITIES Committee of Management have an active campaign to grow branch membership linked to 2020 PD sessions & webinars. Focusing on improving membership we are reaching out to non-member health facilities, such as Public Hospitals, Private Hospitals, Aged Care, and Public Private Partnership Facilities Managers. BRANCH COMMITTEE OF MANAGEMENT The Committee of Management meets monthly via teleconference (Zoom) and at the end of branch functions. Event planning for 2020 has commenced with site visits and additional webinars plan, details will be emailed as an e-bulletin and posted on the IHEA website. Committee of Management structure for 2019 / 20 below: Victoria / Tasmania Branch
Committee of Management
ihea.victas@ihea.org.au
Branch President
Michael McCambridge
Melbourne Health
Branch Secretary
Peter Crammond
Wimmera Health Care
Branch Treasurer
Steve Ball
Epworth Geelong
CoM
Howard Bulmer
Macutex Property
CoM
Sujee Panagoda
Monash Health
CoM Simon Roberts Meeting Convenor
CETEC Consultants
CoM
Mark Hooper
Echuca Regional Health
CoM Communications
Roderick Woodford
Castlemaine Health
Nation Board Reps
Steve Ball Mark Hooper
Epworth Geelong Echuca Regional Health
Michael McCambridge – VIC/TAS Branch President
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BRANCH REPORTS
WA BRANCH REPORT
S
eptember saw a very “family� focussed professional development opportunity at Fiona Stanley Hospital, a journey co-hosted by Mr John Pereira, Service Delivery Manager Serco Estates Team and Mr Andrew Waugh. John spoke, on an incident investigation of a nitrous oxide/oxygen (N2O/O2) blender (used as an analgesic by labouring women) and subsequent Therapeutic Goods Administration (TGA) of Australia world-wide unit recall and redesign. John shared how he later visited the TGA and met with members of their team responsible for the recall and redesign with the manufacturer, thanking him for his diligence in reporting this to the TGA and ensuring a chain of custody for the physical evidence for later examination. This has led to world wide improvements and John was recognised with a global Serco achievement award. Andrew followed on by leading the presentation on the new $1.8m Family Birthing Centre at Fiona Stanley Hospital from a clinical engagement and engineering delivery project. A pre-recorded interview with passionate clinician Peta Fisher, FSH women, children and newborns clinical nurse coordinator, described the considered use
Birth bath
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BRANCH REPORTS
and science of colour and biophilia to reduce stress in expectant mothers. For the engineers in the room the contemporary birthing furniture helped achieve a 32% increase in “output delivery capacity” … which led to wide-eyed reactions of awe and amazement throughout the room. Mr Nils Mathesin from Serco’s Additional Works team shared lessons on how to incorporate 1 tonne baths into the 3rd floor slab, while redesigning spaces to achieve clean lines and a non-clinical feeling that you might expect from a hotel resort. This was a desirable outcome led by mothers in the user group who were constantly engaged and referenced throughout the project. The on time and on budget delivery of this amazing facility was inspected by members during a tour, prior to the “official” opening by the WA Health Minister later in October. The facility has since seen the first baby delivered with both mum and baby healthy and safe. The September professional development session was sponsored by Serco at Fiona Stanley Hospital and coordinated by committee member Mr Andrew Waugh, where refreshments were enjoyed by all.
During October a contingent of WA members journeyed east to join their colleagues at the National Conference in Sydney. The Western Australian delegates all agreed that the presentations were enlightening and insightful. The courage and strength displayed by the two key note speakers generated a lot personal reflection. Well done Sydney and the NSW-ACT Branch for putting on an excellent event. The Sydney event also saw the handing over of the 2020 National Conference to Western Australia. The WA committee of management are working very hard behind the scenes with the IHEA National Board and Iceberg Events in preparation for September 2020. The 2020 National Conference theme is Healthcare Engineering in the 21st Century – New Frontiers. As we journey towards 2050 every aspect of our lives is touched by an increasing avalanche of technology. Whether it is with Siri, your Fitbit Watch or your BMS, Healthcare Facility Managers interact with algorithms in technology every day. Healthcare Engineering and Facility Managers need to remain focussed on where we are heading and remain in control of how we interact with these contemporary and
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BRANCH REPORTS
Network after the tour
Mr Nils Mathesin - Serco Programme Manager with IHEA WA Secretary Fred Foley
Tour of new family birthing centre
emerging technologies to ensure how we can deliver the best healthcare outcomes for patients.
State Treasurer – Mr Rohit Jethro;
UPCOMING IHEA WA EVENTS
Committee Member – Mr Alex Foster;
November sees the last branch meeting for 2019 and the WA membership is looking forward to celebrating the festive season with a social function and awards evening where achievements will be celebrated and friendships renewed. A call for nominations for Engineer, Tradesperson and Apprentice of the year was sent out and our membership responded with several exceedingly high quality submissions for the Committee of Management to select from. Irrespective of who is awarded the final accolades all were very worthy candidates. WA is well blessed with excellent Healthcare Facility Management Professionals.
Committee Member – Mr Philippe Tercier; Committee Member – Mr John Bose; Committee Member – Mr Yuri Deans; Committee Member – Mr Darryl Carter; Committee Member – Mr Leif Jensen; Committee Member – Mr Andrew Waugh; On behalf of the WA Committee of Management I wish all IHEA members across Australia a happy and safe Christmas and a prosperous New Year.
IHEA WA CoM Members
The WA Committee of Management can be contacted via email at ihea.wa@ihea.org.au
State President – Mr Peter Klymiuk
Peter Klymiuk
Immediate Past President – Greg Truscott
WA Branch President
State Vice President – Mr Fred Foley;
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State Secretary – Mr Fred Foley;
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BRANCH REPORTS
SA BRANCH REPORT
T
he SA branch committee’s recent management meetings have centred on membership retention and growth strategies. Intertwined with this objective is the paramount need to facilitate professional networking and practical and professional development opportunities for our membership that complement the Learning and Development Program. To that end, the committee is progressing plans for a number of significant events in 2020, including: • A behind the scenes visits are being coordinated to the newest private and public hospitals in Adelaide.
the program in the early part of next year we would welcome further interest in contributing to the success of the event. The SA branch also continues to enjoy cooperation with other volunteer associations including the CIBSE group and the Australian Institute of Project Management. These relationships offer our members a greater number and wider variety of professional development opportunities. Recently, the SA branch was pleased to recognise the contribution of locals Matthew Kennedy and (committee member) Richard Bentham in presenting to the 2019 IHEA Conference. We were particularly happy that Richard’s
• Delivery of a professional development seminar on water quality and legionella management in the first quarter of 2020. • A regional State conference in the first half of 2020. It has been encouraging to receive a number of expressions of interest from both public and private organisations that are keen to support the event. As we firm up
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BRANCH REPORTS
presentation took out the award for Best Conference Paper presentation. Richard has assured us that his award will take pride of place in his office - congratulations Richard! Our November event was a fitting closeout for 2019. We enjoyed networking with our colleagues and learning about the latest in healthcare technology. Our generous event host Konica Minolta treated our members and invited guests to a series of engaging presentations and demonstrations on the multiple applications and benefits of 3D printing in the healthcare industry, as well as emerging wound management solutions utilising 3D scanning technology. The group was also privileged to be the first in Australia to witness the very newest in tracking technologies, with application to aged care and hospital facilities alike. As the event was being held whilst a number of Australian regions were under threat from bushfire, a collection was taken to support those affected by these disasters. We raised $200 to assist victims affected in the recent bushfires - thank you to everyone who contributed, especially Konica Minolta. This meeting also presented an ideal opportunity to farewell our out-going State President of many years – Peter Footner. Peter has been actively involved in motivating the SA Branch and progressing activities, conferences and events for many years, and on behalf of the SA Branch and National Board, where Peter represented the SA membership, a small presentation was made and thanks expressed by those in attendance. I wish all our members a happy, safe and restful holiday season. In anticipation of the year to come, Michael Scerri President, SA Branch
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AN AUSTRALIAN APPROACH TO RECORDING LEARNING ONLINE Speaking in a keynote on the first day of October’s Healthcare Estates 2019 conference in Manchester, shortly after the director and head of Profession for NHS Estates & Facilities at NHSE / NHSI, Simon Corben, had emphasised the importance of a flexible EFM workforce willing to embrace new skills and adapt to new challenges in his address, Darryl Pitcher, President of the International Federation of Healthcare Engineering (IFHE), explained how the profession in Australia is taking steps to boost the skills and capabilities of its workforce, and such personnel’s transferable skills, including via a new online tool for continuous recording of ‘on-the-job’ learning and development. HEJ editor, Jonathan Baillie, reports.
E
lected as President of the International Federation of Hospital Engineering (the IFHE’s Council approved a name change to ‘the International Federation of Healthcare Engineering’ at its meeting at Healthcare Estates 2019) in 2018, Darryl Pitcher is, in his ‘day job’, chief executive of Bethsalem Care and Greenbriars Village, a combined residential aged care facility and retirement village in South Australia. He has over 30 years’ healthcare engineering experience, and is a board member and Past-President of the Institute of Healthcare Engineering, Australia (IHEA). As part of his role on the IHEA board he oversees technology and communications, and is editor of Healthcare Facilities, the Institute’s quarterly journal. His passions include ‘sustainability and innovation to deliver efficient and improved services to improve health and wellbeing’.
RISING TO THE CHALLENGE Darryl Pitcher’s presentation was titled, ‘Rising to the Challenge – Developing and recognising workforce capability – A new Australian perspective’. He was introduced to the stage by IHEEM’s CEO, Pete Sellars, and opened his address by thanking delegates for coming to hear him speak, and offering them ‘Greetings from Down Under’. He gave his presentation immediately following that of Alasdair Coates, the Engineering Council’s CEO, who had discussed the role and remit of an organisation which – as the regulatory body for the UK engineering sector, is responsible for licensing the UK’s professional engineering institutes. This, in turn allows such professional bodies – including IHEEM – to assess candidates for inclusion on the national register of
Darryl Pitcher, the IFHE’s President, took a detailed look at the work of Australia’s IHEA in developing an online system to enable the country’s healthcare engineers and healthcare estates professionals to record and certify their on-the-job learning.
professional engineers and technicians. Alasdair Coates also considered some of the existing formal requirements for registration as an Engineering Technician, Incorporated, or Chartered Engineer, and looked at the future of engineering education, and the need for it to ‘innovate to develop future engineers’. The Engineering Council CEO emphasised that in an increasingly global economy, the skills and expertise of engineers, and the major contribution
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that their activities make to many aspects of daily life, need to be internationally recognised.
CURRENT AUSTRALIAN INITIATIVES The IFHE President said the aim in his address would be to share what the Institute of Healthcare Engineering, Australia (IHEA) is currently doing to develop the capabilities of the Estates workforce in his home country. He said: “I’d like to give you a feel for how the work we are doing at the IHEA – around learning and development for our membership – aligns with the comments Alasdair has just made about the importance of a really well-trained, adaptable, and flexible workforce.” Before getting to the crux of his presentation, Darryl Pitcher thanked IHEEM and its CEO, Pete Sellars, for hosting the International Federation of Healthcare Engineering (IFHE) at Healthcare Estates 2019, and for the work that the latter had done with the IFHE-EU Group. Beginning with a little information on his own career, he said: “I’ve been involved in healthcare engineering for a little over 30 years, having started work in hospitals in the late 1980s at the Royal Adelaide Hospital. Having at that point just completed an
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electrical apprenticeship, I joined the hospital and worked for that organisation for about 20 years. My final role there was as director of Engineering & Building Services. So, having started out as a very young, fresh, tradesman, I went through a learning programme, and finished up directing the staff and the Estates Management team.”
REPLACED BY A BRAND NEW FACILITY The Royal Adelaide Hospital had, he explained, served the population of South Australia for around 160 years, having only recently been replaced by the ‘New’ Royal Adelaide Hospital, which opened in 2017 about a mile away from the existing hospital. Darryl Pitcher showed slides of both the ‘old’ and ‘new’ hospitals, with the contrasting images highlighting just how much the design of healthcare buildings and the way they are run has changed over the decades. He said: “The modernisation, technology, and complexity involved in the new hospital in Adelaide, are all endeavouring to meet a growing demand and changing healthcare sector needs. There is now a considerable focus not only on technology, but also on efficiency, sustainability, and the increasing complexity of disease
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response required. More people are being treated, with an expectation that treatment for a range of conditions and illnesses will happen more quickly, with better outcomes. That what’s expected from a facility like this – the kind of healthcare facility many of you will indeed be involved with.”
A MORE REGULATED SECTOR With such changing clinical practice and expectations, the engineering environment in hospitals and other healthcare facilities was also ‘changing apace’ – while healthcare engineering was becoming ‘increasingly regulated’. The pressures being brought to bear on healthcare engineering professionals thus included not only increasing scrutiny from statutory and regulatory bodies, as well as from Government bodies with overall responsibility for the delivery of improved healthcare, but also rising expectations from healthcare ‘stakeholders’ and the community. Darryl Pitcher said: “We know engineering is at our core, but what we are finding in Australia, and possibly you are finding here too, is that there is a far broader expectation around the work and capabilities of your
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Figure 1: The Entrustable Professional Activities, or ‘EPAs’ of the IHEA Learning & Development Programme (there is a photo of this) are designed to encompass the wide range of skills needed by a healthcare engineering / estate management professional.
healthcare engineers, with an increasing focus on facilities management. Our experience is that there are now many broader, multidisciplinary roles, and an accompanying need for personnel with the skills to fill them; people are being stretched outside what might have been their core engineering qualification.” Such changing demands and expectations required ‘a different response from those responsible for developing EFM services’, the Australian speaker maintained. He said: “There are also new entrants to our field, with some different skills, and we are responsible for ensuring that they too are upskilled and developed, and can grow as individuals, both personally and in terms of their technical expertise, and thus support the expectations of our organisations and community.”
A NEW BILL IN VICTORIA Against this backdrop, he explained that a new Bill had recently been introduced in Victoria in Australia to change legislation specifically around the regulation of various engineering disciplines. “The Bill’s intention,” he explained, “is to ensure that the professionalism we have just heard about – the quality, the compliance, the legislation, and the laws and codes – are what the healthcare consumer comes to expect from the healthcare engineering / healthcare estate management sector.” Darryl Pitcher said that when the Bill was introduced to Victoria’s Parliament, the IFHE had ‘immediately pricked up its ears’ and asked: ‘Is this somewhere the IHEA can become involved?’ He said: “The regulation and certification of engineers is something that will become mandated across the traditional engineering qualifications.” The IFHE President said he had been pleased to hear, from representatives form Malaysia, Canada, and Europe, at the Federation’s Council meeting held just before Healthcare Estates
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2019, of the work being undertaken to certify and qualify people working in healthcare engineering and estates and facilities management in these countries / regions to further develop and build upon their expertise and professionalism.
NO ‘ROBUST PROCESS’ In Australia, and within the IHEA, there had, until recently, been no ‘robust process’ for certification of hospital engineers per se. Darryl Pitcher said: “In our environment, which focuses on engineering in the healthcare sector, we encounter a broad range of engineering disciplines and professionals. However, we rarely find healthcare engineers with a professional healthcare engineering qualification.” In recent years, he went on to explain, a Diploma of Facility Management had ‘emerged’ in Australia, but while this covered ‘quite a range of expertise’, it didn’t necessarily capture ‘the unique and technical engineering requirements that the profession knows exist in hospital and other healthcare facilities’. There is in Australia, he noted, a specific degree based on clinical engineering, or as it is referred to there, ‘Biomedical engineering’, but currently no degree specific to healthcare engineering for hospital engineers. He told delegates: “When I entered healthcare engineering back in the late 1980s, there was no recognised qualification for a biomedical engineer. Such individuals might have been studying for an electronics or electrical or mechanical IT qualification, and were often supported by some industry-based learning, usually specifically based around the work at the facility they worked at, and possibly even provided by a nonregistered training organisation.” Consequently, while such professionals developed their skills and expertise, sometimes backed by ‘in-house’ training, they were
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never likely to be recognised outside their own working environment. Darryl Pitcher told delegates: “This on-thejob learning was often fantastically helpful in developing skills, but these skills weren’t really transferable to another organisation, let alone to overseas, or to another environment. Sometimes this considerably restricted the individual’s career progression.”
NO REAL ‘STRUCTURE’ Equally, the IFHE President said, the ‘specific and unique requirements’ for a healthcare engineer brought together a broad range of skills and experience, ‘but often without any structure and recognised pathway for certifying their knowledge and skills, and the values and attitudes required’. Darryl Pitcher said: “Accordingly, at professional bodies organisations like IHEEM, IFHE, and IHEA, and many other international peers, we find ourselves seeking an appropriate means of recognising the diverse field of healthcare engineering and certifying those professionals in a transferable, affordable way.” It was with this in mind, he explained, that earlier this year the IHEA launched what he dubbed ‘a platform and framework’ that supports the Institute’s members in their Continuing Professional Development’ that is not only ‘robust’, but can also be certified against recognisable tertiary qualifications. The platform was, he explained, based around two online systems for recording CPD and a wide range of learning and professional development – IHEA ‘Logbook’ and IHEA ‘Logbook Professional’ with an associated ‘app’ and a desktop computer interface.
BRISBANE CONFERENCE He said: “Some of you in the audience today were at the IFHE 2018 Congress in Brisbane last October, where Dr Mark Keough (of ‘EdTech start-up’, Intrinsic learning in Melbourne; he is also a researcher at the College of Education, Psychology and Social Work at Flinders University in Adelaide), one of the real pioneers of ‘e-learning’ in Australia, spoke.” The IHEA had, Darryl Pitcher explained, decided to ‘partner’ with Dr Keough and his business. “At the conference, Dr Keough really challenged some of our thinking around ‘What does new learning look like?’,” he explained. “What we’ve done is to launch the IHEA ‘Logbook’ and Logbook Professional programme with him and Intrinsic learning, with a pilot programme launched a year ago. The overall aim is to is to secure greater recognition for IHEA members of the learning that takes place in the workplace. The new online resource recognises informal, formal, and peer-to-peer learning, offers access to learning programmes and resources, and allows the user to log the learning from their own activities linked to their daily tasks and role.” By facilitating this process, Darryl Pitcher explained, the IHEA’s goal is to be able to professionally certify the skills, experience,
Pete Sellars, IHEEM’s CEO, introduced Darryl Pitcher to the stage.
and on-the-job learnings of healthcare engineering and healthcare estates and facilities management personnel. He said: “The intention is then to be able to map these learnings against a robust professional qualification – the Diploma in Facilities Management.”
FORMAL RECOGNITION The IHEA was, he said, keen to be able to formally recognise the value of learning ‘that is intrinsic in what people are doing in their everyday tasks’. In developing the online resources, the Institute had thus needed to make it straightforward for people to ‘capture’ that learning, which was often ‘self-motivated, and particularly relevant to a current challenge, and thus very meaningful and useful’. While much such ‘valuable learning’ already occurred in the workplace, the challenge had been to find an effective way to recognise it, record it, and certify it. Moving to discuss the IHEA’s ‘solution’ – the IHEA’ ‘Logbook and Logbook Professional – Darryl Pitcher said that developing the ‘framework’ for the programme required ‘mapping the broad spectrum of activities of a healthcare engineering professional, or healthcare facility manager, into a group of learning domains’. He explained: “We’ve called these learning domains ‘Entrustable Professional Activities, or EPAs – learning activities that enable us and the healthcare community to trust the professional certified to perform them within their level of competency.” Having been used for many years in supporting the assessment and certification of medical professionals, EPAs were, the IFHE President explained, brought to the IHEA’s attention by Professor Olle ten Cate, a Professor of Medical Education at the University of Utrecht in the Netherlands. He had identified them as a way of upskilling medical personnel
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across a broad range of activities, and certifying that they were competent and capable in these areas. The EPAs had since been ‘picked up’ by a number of medical colleges worldwide, including in Australia, Canada, Europe, and the US. “What we’re recognising,” Darryl Pitcher explained, “is that there is a lot of learning that actually takes place in the workplace – which we call ‘intrinsic learning’; it is embedded within what people already doing. It’s recognised that intrinsic motivation in learning actually has some far greater outcomes than might be seen via traditional learning methods. It increases persistence and creativity, and in some cases creates a higher quality leaning outcome.”
MASTER AND APPRENTICE Thinking about how good skills and expertise were passed on in the past, Darryl Pitcher reflected that there was once a Master and an apprentice, with the latter sitting down with the former to watch him and thus learn his art / craft. This had also been the practice in medicine in its early days, although the medical community was fortunate today that the available technology allowed life-like simulation, ‘with a lower life cost and personal impact’. While learning had been undertaken thus for perhaps two Millennia, the modern era had seen it transition ever more to the classroom. The speaker said: “In many respects, and for many of us, our initial learning around healthcare engineering and estate management skills was in a classroom environment. Perhaps we didn’t benefit from the sort of learning shown in the Master / Apprentice slide unless we undertook a traditional apprenticeship.”
NOT PROVEN UNTIL ‘TESTED’ IN THE REAL WORLD During formal learning, the IFHE President said considerable effort tended to go into assessing the competency of the student, which was ‘absolutely appropriate’, in enabling the training organisation to be certify the individual as ‘competent’ at its end. “However,” he said, “that competency is not proven until it is tested out in the real world. How many of you, I wonder, have employed a qualified person, and subsequently wished they had had some real-life experience? Probably all of us.” Developing the skills of individuals was, he argued, what organisations like IHEEM and IHEA did; they ‘went out on a limb’, by perhaps employing a graduate with a certificate ‘because they had sat in a classroom and undertaken some of the learning required’. Equally, if not more important in the longer run, however, was the subsequent learning gained on the-job, which was often underrecognised.
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Entrustable Professional Activities were brought to the IHEA’s attention by Professor Olle ten Cate, a Professor of Medical Education at the University of Utrecht in the Netherlands.
Darryl Pitcher said: “At the IHEA, our view is that the future of learning should include conversations; self-directed activities, and potentially discussion and published papers and reading of journals. It will also include work projects and tasks that people are undertaking every day, and workshops and attendance at events such as this. These are all valuable learning opportunities which may not necessarily be so easily captured in the context of a professional qualification.”
BROAD ACTIVITY SPECTRUM COVERED The IHEA speaker explained that within its own recently developed Learning and Development programme, the IHEA had created a broad range of EPAs – learning domains that it believes ‘capture the wide spectrum of activities that a healthcare engineer or hospital facility manager might need to have some skills in’. Before doing this, the Institute had canvassed the opinions of a number of healthcare engineering professionals both around Australia and in other countries, asking them what they considered the key areas for well-rounded healthcare engineering personnel to have some experience in. They thus arrived at these 25 EPAs (see Figure 1), which sit at the core of the IHEA Learning and Development Programme. Darryl Pitcher expanded: “These are the areas into which most of the key activities of a healthcare engineer or hospital facility manager would fall. The activities captured against these EPAs must be evidenced in the healthcare setting. In fact,” he continued, “many of these components of facilities management would apply equalling in, say, corporate real estate, but we need to take them and tie them closely into the environment we are working in, recognising that breadth of experience makes a robust, really useful healthcare engineering professional.”
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One of the pages from the IHEA Logbook ‘app’.
SOME ‘COMMON THEMES’ He continued: “You’ll see some obvious common themes, and indeed there are some that are extremely broad. For instance, there is one EPA called ‘Engineering systems’, and we recognised that the such ‘systems’ within a healthcare environment can be both very, very board, and very, very specific. Our aim has been to create a simple process for our IHEA members to be able to capture and record their daily activities and tasks against these EPAs.” The expectation, Darryl Pitcher explained, is that every IHEA member will score 100 points’ worth of activities across a two-year period, which must be garnered across at least 15 of the 25 categories. He said: “So, while you may be an experienced engineering professional and able to capture hundreds of points against ‘Engineering systems’, that doesn’t necessarily make you a good healthcare engineer. It doesn’t capture the broad range of activities required to manage and operate our hospitals.” The IFHE President explained that in his early years at the Royal Adelaide Hospital, he had a ‘mentor’ who often told him that ‘the university of life provides the best education’, but added, sagely: “It’s just unfortunate that the school fees are so high.’ He told the Healthcare Estates audience: “As we go through life we learn a great deal, but sometimes this learning comes at great cost, so we feel that this lifelong learning can be captured via this ‘Logbook programme – through which we can encourage
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our members to focus on the breath of the role they are undertaking, and upload into the associated ‘app’ the learnings they are gaining.”
A ‘LOGBOOK PROFESSIONAL’ OPTION Darryl Pitcher explained that the IHEA also offered a ‘Logbook Professional’ version of the web-based learning and development programme, at an additional cost. He said: “It is mapped against the same EPAs, but the number of points is double, and there is an additional requirement for participants to undertake six specific projects, and to submit them to a panel for assessment.” Moving to the Logbook ‘app’ itself – he showed some screen shots – Darryl Pitcher explained that it is ‘transferable’, and works on an Android or iOS phone, as well being accessible via a desktop version. He said: “On the ‘Home’ page you have your ‘Account’ and ‘Profile’ settings, and the app gives you a summary of the progress you have made against the requirements, to achieve your CPD. The app also gives you access to online short courses, and there are useful videos and training for our members.”
CAPTURING AN ACTIVITY To ‘capture’ an activity, the user selects the EPA they are they are aligning their activity against via a ‘dropdown’ list, identifies the type of activity, gives it a name, enters the
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details of the provider, the date and the duration, and ‘uploads the evidence’. “Importantly,” Darryl Pitcher said, “there needs to be evidence attached to the activities being recorded.” To ‘sit in the back end’ of the database, the IHEA was, he explained, in the process of building some Artificial Intelligence that would be able to read and survey the data uploaded to ensure correlation between the EPA selected and the ‘evidence’ uploaded. The IHEA speaker said: “To maintain their Institute membership, every member of the IHEA will, within two years, have to have captured 100 points across the 25 EPAs. By so doing, they will be demonstrating to ourselves, their employers, and the broader community, that they are a certified healthcare facility manager. Such certification will also demonstrate their commitment to ongoing Continuous Professional Development. This is our Australian experience. We think the system is probably a world-first for healthcare engineering. The ‘app’ has been developed with other industry methodologies and sectors in mind, but we are using it specifically for healthcare engineering. We believe that it will allow us to grow and develop our members to gain significantly broader healthcare engineering and estate management experience, the plan being to ‘map’ this against a diploma-level qualification that is the transferable and useful in other locations.”
SELF-REGULATED, BUT WITH ‘CHECKS’ BUILT IN Darryl Pitcher explained that while the IHEA’s Learning & Development programme and associated ‘Logbook’ and ‘Logbook Professional’ online ‘tools’ were self-regulated, there were ‘system checks’ built in. He said: “When we talk about ‘self-regulated learning’, experts suggest we will actually be harder on ourselves in a professional sense when we are reporting self-directed learning. For those participating in the ‘Logbook Professional’ programme, there are the extra requirements, plus an application fee, additional CPD points, the requirement for completed projects, and the assigning of a mentor for each participant.” The IFHE President closed by explaining that more information on the IHEA’s LPD and the Logbook and Logbook Professional resources were available on the IHEA’s website, at: www.ihea.org.au, while any questions could be emailed to the Australian Institute at: ihea.ldp@ ihea.org.au He said to the audience in conclusion: “We’d like to hear what your experiences are, and if you have any questions or comments, we’d love to hear from you. Thank you for your time, and thank you, IHEEM, form inviting us to be part of your fantastic event here in Manchester.” Article first appeared in the November 2019 issue of Health Estate Journal (www.healthestatejournal.com)
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A NOVEL APPROACH TO MONITORING WATER QUALITY IN HOSPITAL AND HEALTHCARE FACILITIES By Dr Richard Bentham, Dr Harriet Whiley
THE AUSTRALIAN CONTEXT
K
idney disease, otherwise known as renal failure, refers to a large loss of kidney function, primarily through the loss of more than 40 percent of total kidney functionality. It affects around 1 in 10 Australian adults, with people aged 60 and over most at risk. Kidney disease is associated with 1 in 9 deaths in Australia. The emergence, or recognition, of other waterborne pathogens causing significant disease in health care has also been noted. It is certain that the majority of waterborne infections in health care premises are not Legionella species. These other organisms (Pseudomonas, Non-tuberculous Mycobacteria, Acinetobacter etc) present more of a challenge than Legionella. The organisms may cause infection from multiple different exposure routes. The cause of infection may not be aerosol related (via inhalation), affect a much broader susceptible population and, are clinically more difficult to combat. The well established response to these health risks is good management and monitoring of the water supplied to outlets. This is mandated or recommended in most Australian jurisdictions. Water Risk Management Plans (WRMP) place a significant emphasis on monitoring and control. Two key components of this are temperature control and flushing of outlets. Operational control is a critical element in an effective WRMP. Any operational control measure must be SMART. SMART is the acronym for Sensitive, Measurable, Accurate, Reproducible, Timely. Operational monitoring that does not meet all of these criteria is probably doomed to fail. Temperature control and flushing of outlets (moving water) are necessarily interlinked. Within a building system stagnation causes warm water to cool and, vice versa, cold water to warm. Flushing of outlets moves water within the building reducing stagnation and optimising temperature control. Flushing is arguably the most effective control strategy, especially if disinfection is applied to the system. Movement of disinfected water
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enhances temperature control and ensures disinfection of outlets where the vulnerable are exposed. Though flushing is such an integral part of water risk management it is often problematic. Ensuring all outlets are flushed (to avoid dead legs) and identifying responsible persons for completing the process are major issues. In short, SMART monitoring of flushing activities is difficult to achieve. In this paper we present a novel approach to flushing of outlets fitted with Thermostatic Mixing Valves (TMVs). In this study a remote sensing system detected when TMVs were activated, for how long and the temperature attained at the outlet. Data was collected over 3 years from a Hospital in NSW. The goal was to identify associations between flushing and bacterial colonisation and temperature control. The system was also able to identify in real time outlets that were not being flushed.
METHODS Using the EnWare TMV remote technology 220 outlets were monitored. Samples were collected relating to TMV operation, water temperature and microbial counts over in 3 year period a Sydney Hospital. Concurrently 865 samples were taken for Legionella and Total Heterotrophic bacteria testing during this period. Water flow rates were calculated from data regarding the TMV operation and estimated flow rates from the outlet. Flushing frequency and outlet temperatures collected during the test period were then statistically correlated with the microbial test results. An algorithm was then used to identify and separate flow events based on changes in temperature. These were broken into flow/flushing events greater or less than 15 s duration. The collected data was separated into different categories according to the flushing frequency. â&#x20AC;˘ Total flushing events less than 15 s duration on day of sampling,
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increased numbers of flushing events prior to samples being taken.
• Total flushing events longer than 15 s on day of sampling, • Total flushing events during the 7 days prior to sampling. A total of 865 water samples were collected from faucets attached to TMVs as part of the hospital’s mandatory verification monitoring program in accordance with NSW Code of Practice for the Control of Legionnaires’ Disease (2004). Microbial analysis was conducted by a National Association of Testing Authorities Australia (NATA) accredited laboratory. Total heterotrophic bacteria were enumerated on plate count agar using AS/NZS 4276.3.1:2007; Legionella spp. (other than L. pneumophila), L. pneumophila SG1 and L. pneumophila serogroup 2–14 were enumerated on BCYE-GVPC agar in accordance with AS 3896:2008.
Number of Flushing Events Simple scatter plot with loess line of fit showing the association between total heterotrophic bacteria (CFU/mL) and the total number of flushing events during the 7 days prior to sampling.
Statistical analysis was conducted using SPSS version 25.0 (IBM, NY, USA).
The data showed reduced heterotrophic bacterial numbers were statistically associated with increasing average water temperatures in the 7 days prior to
RESULTS AND DISCUSSION The data (presented below) showed a general trend in reduced heterotrophic bacteria was associated with
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sampling (Chart below). This may seem to be a conflicting result as bacteria multiply better at warmer temperatures. Increased average water temperature is, of course, related to the frequency and duration of flushing events. The number of flushing events in the 7 day period before sampling had a greater influence on bacterial counts than flushing events on the day of sampling. This emphasises the value of reducing stagnation and introducing disinfectant residuals as an operational control strategy for microbial control. Paying attention to reducing stagnation by maintaining flow rates seems to be more a useful control strategy than maintaining temperature control.
The system, by recording temperature, also permits monitoring of TMV performance and can identify outlets that are not being flushed. It also has the potential to remotely flush outlets based either on frequency of use or on water temperature during the first use of the valve.
CONCLUSIONS The remote monitoring system was able to identify significant relationships between water flow, water temperature and total bacterial counts through Thermostatic Mixing Valves. The data suggests that frequent operation of the valves will reduce microbial load from outlets. Movement of water through building systems is an imperative that should form the basis of all building water risk management. The data provided by the system identified that weekly flushing of TMV outlets is not sufficient to control or reduce microbial colonisation of the outlets. It also identified that flushing every 3 days may be insufficient to achieve control. The system has potential to provide a SMART solution to the issue of flushing outlets. This can be used to address and validate one of the most effective control strategies for managing microbial contamination in high risk building water systems.
Simple scatter plot with loess line of fit showing the association between total heterotrophic bacteria (CFU/mL) and average water temperature (ºC) during the 7 days prior to sampling.
Of interest is that the data showed a statistical correlation between higher total bacterial counts and low numbers of flushing events in the 3 days prior to sampling. This means that weekly flushing of outlets may not have a significant influence on bacterial colonisation between flushing events. The weekly flushing protocol adopted by guidelines globally has no empirical basis. This data may be the first to suggest that weekly flushing is inadequate, and even flushing every 3 days may be inadequate. The data also showed that the number of flushing events on the day of sampling influenced the sample results. Low numbers of flushing events prior to the sample were likely to cause higher CFU/mL and conversely higher numbers returned lower numbers. This points to the ‘snapshot’ nature of sampling where the unknown history of the outlet usage before sampling will critically influence the outcome of the sample test result. For sample results to be meaningfully interpreted it is necessary to know the prior activity of the water usage at the sample point. The remote monitoring of outlet usage presented in this study enables meaningful sampling of TMV operated outlets. The technology also permits ‘real time’ monitoring of outlet flushing and water temperature control.
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Limitations of this study are: Contamination of outlets (by the users) may skew sample data and is a separate management issue. Users may contaminate outlets either by direct contact or ‘splash back’ during operation. This applies to heterotrophic bacteria that would include Pseudomonas species, but not to legionella species. The technology can currently only be applied to Thermostatic Mixing Valves.
ACKNOWLEDGMENTS The authors gratefully acknowledge Jason Hinds, James Xi, EnWare Australia for data collection and technical input. A more detailed and comprehensive account of this study is the subject of a short communication published in the International Journal of Environmental Research and Public Health 2019, (16) 8:1332. Dr Bentham is an IHEA SA Member and ‘Winner of Best Conference Paper’.
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FEATURE ARTICLES
A BLUEPRINT FOR INNOVATION IN FM By Donald Macdonald from Macdonald Lucas
In these days of smart phones, smart TV’s and smart everything else, industry in general is coming under increasing pressure to be innovative. Facilities management is no exception. However, innovation in FM is suffering from dual pressures. On the one hand we live in fast moving fickle times, what is innovative today, will be passé tomorrow and old hat the day after that. Against this background how does FM provide a service that continues to innovate over time? A service which uses technological developments to improve the cost and/ or the quality and/ or the timing of FM service delivery. Enabling FM to be perceived by the host organisation as more of a strategic partner rather than simply a cost burden.
I
f keeping up with the changing technical landscape is one challenge for FM, financing innovation is another. Let’s face it FM is the no plaudits Cinderella industry. FM is rarely appreciated in whichever environment it is being delivered. This puts it at a disadvantage when competing, with core business, for scarce funds. This challenge is particularly pronounced in the healthcare sector where funding for innovation in FM whether by hospital engineers or ward cleaners is always likely to come second to demands for new and novel ways to treat patients. At one time outsourcing may have been seen as a pathway for organisations to secure more innovative FM. The rationale being that by passing responsibility for service delivery to specialist service providers their subject matter expertise would help drive innovative practise into their client’s sites. However there have been a number of impediments to the achievement of this aspiration. They include: • Typical FM contracts feature low profit margins and high bid costs leaving little funding available from which to fund innovation.
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and thus the competitive tension that, in other industries, drives innovation is typically lacking. • Bids are often evaluated, and tenders awarded, based on perceived innovation’s demonstrated in tender response documents. Rather than the service providers methodology for innovating over the contract term. • It is challenging to write an FM specification and contract in a manner that effectively incentivises innovation. As these are the main mechanisms for influencing contractual outcomes it is not difficult to see why innovation is rarely seen in FM contracts. • As illustrated by Steven Johnson in his illuminating Ted Talk “Where Good Ideas Come From” innovation is typically the result of a collaborative process, collaborative processes of a type that are typically absent from FM contracts. And yet, whatever the obstacles, for FM to remain relevant and for it to continue to add value to core business, into the future, it is essential that it innovates effectively. The affordable funding of research and development is key to the realisation of this goal.
• Initial contract terms are fairly short, typically, say three years, with the opportunity to have them increased in one or two year increments up to a total length of five or seven years. This makes the return on investment on innovation difficult to calculate and thus the business case a challenging one to make.
Facilities management is of course a multi- faceted discipline. Better defined perhaps by what it is not rather than what it is. In a nut shell it comprises those activities that core business does not have an interest in but for which core business inherits a responsibility for delivering as a by – product of existing.
• Once an FM contract is secured, as long as the service promise is met, security of tenure is assured,
Activities like cleaning, security, catering and maintenance are often perceived as facilities
FEATURE ARTICLES
management. But in a healthcare setting it is unusual for the maintenance of biomedical assets to be managed in the same way that heating, air conditioning, ventilation and other building related assets are managed. This is largely due to the much closer relationship that exists between core business and biomedical assets than exists between building assets and core business. Not because of any great material difference between the activities involved in maintaining these two different asset classes. One area of FM fertile for innovation is analysis of the ways in which asset populations perform and deteriorate in situ. Enabling an improved understanding of how planned maintenance, reactive maintenance and life cycle replacement impact on each other. In turn, assisting with more accurate budgeting for life cycle works through life cycle modelling. The wider FM industry typically uses a deterministic, linear approach to life cycle modelling. Often relying upon spreadsheets to predict the point in time when assets are likely to reach the end of their design life and
need to be replaced. This is an inaccurate method of predicting asset failure. For example, where a large population of identical assets are introduced into service on the same day, such as split systems in a large new building, using this methodology, they are all likely to require to be replaced at the same time. Not only is this impractical it is also highly unlikely. In contrast RMIT has developed a web enabled life cycle estimating tool titled CAMS (Centralised Asset Management System). It has evolved over a number of years through a variety of grants and relationships with several partners including: • Brimbank City Council, VIC; • City of Kingston, VIC; • City of Melbourne, VIC; • City of Monash, VIC; • City of Port Phillip, VIC; • Hume City Council, VIC; • Mornington Peninsula Shire, VIC; and, • Swan Hill Rural City Council, VIC.
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CAMS offers a far more accurate methodology for lifecycle modelling than the deterministic techniques used by other parts of the FM industry. It has been developed by a team of RMIT research students using probabilistic statistical analytical techniques including Markov Chain, Monte Carlo and genetic algorithms to produce a suite of 720 asset specific curves that model degradation over the course of an assets design life. An example of one of these curves is shown in the figure below. Figure 1- Example Degradation Curve
• Helped with the development of CAMS as described above; • Provided a pathway for RMIT graduates into the FM industry; and, • Enabled Macdonald Lucas to recruit graduates that have prior practical experience of CAMS and are therefore adept at its implementation and application and are thus capable of ‘hitting the ground running’ upon commencement with the company. The partnership between RMIT and Macdonald Lucas may be considered innovative because: • By working with a partner from the tertiary education sector, whose core business is innovation, Macdonald Lucas have been able to escape the limitations typically imposed on FM by constrained R&D budgets; and, • Through it, a robust methodology has been developed, and continues to evolve, to model asset deterioration more accurately than the methodologies typically seen elsewhere in FM.
Figure 1 above shows the probable distribution of condition, over a period of time, of a population of identical assets all introduced into service simultaneously. These curves are applied at individual asset level and become tailored to reflect how each individual asset is deteriorating over time as data regarding its changing condition is periodically uploaded. The organisation is able to reach a decision about when to budget for asset replacement based upon the risk represented by the failure in service of each individual asset. The more critical the asset, the greater the consequences for the organisation of asset failure in service the lower the probability of asset failure in service that the client is able to risk. Through a relationship dating back to 2015 Macdonald Lucas have worked collaboratively with RMIT providing them with feedback on and input into the development of CAMS from an industry point of view. This industry perspective has enabled the CAMS development team to focus on the aspects of the tool of greatest value to industry. This input has proved invaluable in helping RMIT to maximise the commercial value of CAMS and thus optimise industry adoption. The relationship between Macdonald Lucas and RMIT has been a symbiotic one. It has:
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However perhaps the true innovative value of the partnership between RMIT and Macdonald Lucas lies not in what has been achieved to date but rather in what is likely to be achieved going forward. Through the marriage of an academic organisation whose core business is innovation with an FM and asset management consultancy whose stated purpose is to bring robust, research-based consultancy support to the FM and asset management sectors. Exciting innovations currently on the horizon include: • Developing algorithms that model how underground drains are affected by issues like traffic, ground type and the presence and nature of vegetation. Enabling asset condition information collected about a relatively small sample size to be extrapolated across a much larger population of similar assets; • Modelling how structures like roads and bridges deteriorate over time; and, • Quantifying the content of in situ assets that are appropriate for recycle. To help minimise the volume of waste from building works going to land fill. Enabling revenues generated from the recycling of these assets to cross- subsidise the cost of asset replacement and asset refurbishment works.
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GETTING AS4187 IMPLEMENTATION RIGHT FIRST TIME By Mark Collen
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ustralian Standard 4187 (AS4187) is the government standard governing the functioning of Central Sterilising and Supply Departments (CSSD) which must be fully implemented by December 2021. This standard will require all CSSD units to be compliant in order for the facility to gain or maintain Accreditation status through the implementation of the National Safety and Quality Health Service (NSQHS) Standards (second edition) 2019. Current facilities are starting to look at their CSSD compliance with the new standards as the changes may mean that the unit as it currently operates will not meet the requirements. While December 2021 seems like a long time in the future, facilities are starting now to look at future needs and allocate the necessary resources for any upgrades needed. There are many factors involved in upgrading a CSSD unit and this paper will focus on water management and the requirements thereof. There is a significant amount of misunderstanding when it comes to water and water quality such as responsible parties, material selection, sanitisation methods. First, many facilities believe that the water utility provider is responsible for water quality. That is true but only as far as the utility provider’s front gate. Once the water leaves the treatment facility, the provider is no longer responsible for the water quality. This issue raises its head regarding water entering a facility pertaining to legionella risk and other contaminants. The utility takes no responsibility here. Simply put, a Reverse Osmosis (RO) plant does not deliver AS4187 compliance. The RO if sized and designed correctly will provide potentially compliant demineralised water. If the design has not been completed correctly minerals such as silica breach the limit. It is noteworthy that the issue of silica breaching is so severe, that recently AS4187 has undergone an amendment seeing silica limit lift from 0.2 to 1ppm. I have been told by some reputable manufacturers that they simply cannot build a plant that will comply with neither the new 1ppm nor the old 0.2ppm requirement. It is interesting to note that the power industry of which Aqualyng has been a supplier of for many years, uses RO plants that require less than 0.01ppm consistently, and this is achievable. It is possible and not extremely expensive.
Just takes some extra home work by the supplier to build the correct plant to meet the standard. A proper survey of the site and provision of correct recommendations is the best way to provide a compliant plant. I have surveyed facilities where compliance to the standard has been thought to have been met, however the survey reveals non-compliance. If the system selected isn’t compliant, it’s the engineering team in the Hospital responsibility to fix it. Below are some factors to consider when commencing the process to select a water treatment plant. 1. Get samples and have them tested for RO requirements. This testing should include all the requirements of AS4187, but also include a fully metal analysis (cations), TOC, anions, SDI (silt density index) – this measures the concentration of ultra-fine particles (above 0.45um). Temperature should also be checked. 2. Get water authority testing data where possible from the water utility. Ensure the data covers the past 6 – 12 months. 3. Ensure the contractor has all the information needed. It is often assumed that the contractor has this information and does modelling accordingly. This information should allow for variation in the inlet water quality, including temperature which has significant effects on RO performance. 4. Make sure that the volume needed is matched to RO production plus at least 20%. Make sure the capacity allows for future unit growth. 5. Select the ring main material of construction. 316L Stainless Steel (SS) is expensive but experience says it’s the best choice. Bacterially it out performs others excluding PTFE/PVDF. I have included a chart outlining this later in the document. 6. Select the sterilisation method for the ring main. Thermal is strongly recommended by the author of this document. This therefore excludes selection of plastics
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(excluding PTFE) for ring main construction. The reason for thermal is its ability to penetrate small crevices and areas where bacteria can accumulate. According to the author of this document, chemical sterilisation has the drawback of not penetrating deposited material, not reaching lower flow areas (such as pipe work to a hand basin) and can simply burn the surface of a bio film, and in fact not kill off the bacteria in it. The development of an implementation plan is foundational to achieving compliance. This plan discusses the evaluation of process flow, water quality, procedures and training. Water quality can have direct influence on sterility through interfering with cleaning efficacy and advancing corrosion on instruments. Research has indicated that corrosion can mask biological presence and even provide a home for growth of bacteria hazardous to patients. (Rogers et Al, Journal of applied microbiology 1994) As a supplier of Water Treatment Plants (WTP), it’s easy to centre on purely water quality in versus product out. It’s important however to understand how the CSSD process works to understands the uses of water within the processes.
BACTERIAL RISKS Contaminated water poses significant risks to the sterilising process through contaminants such as gram negative bacteria. Gram negative bacteria are heat resistant and the endotoxins released from such bacteria (from their peri plasmid space – this is the substance that protects the nucleus of the cell from attack) during the growth or death phases can be difficult to kill. These endo toxins cause septic shock, and possible death of patients infected. (Rogers et Al, Journal of applied microbiology 1994) Removing bacteria means reducing the risk of endotoxins. Hence, improving infection control with clean water is a relatively simple thing to do, with ideal outcomes. Researchers suggest that endotoxins could be transported in steam. Recent research indicates this is not possible. (http://www.deconidi.ie/html/conf/assets/ wfhss_conf20070503_lecture16_en.pdf). Endotoxins should be removed from sterile instruments. Due to the thermal tolerance of the species, research suggests that inadequate sterilisation can fail to eliminate these endotoxins. Endoscopy cleaning units use filters on the water to remove particles. The finer filters used for endoscopy are 0.2um.
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As per the filtration spectrum, spores of bacteria can fit through these filters. Endoscopes can’t be thermally sterilised but rely on the use of biocides. These biocides are rinsed off. If the rinse water is contaminated bacteria and endotoxin materials can possibly be redeposited. Recommendation is to apply treated water fed by the CSSD RO ring main (including thermal sterilisation of the ring main – UV – 0.02um filtration) You will notice that endox toxins are to be <0.25cfu/ml as per table 7.2 in the standard. The challenge is the thermal stability of the material. Bio films that are pictured here are extremely good thermal insulators. This means that if they are present on a shielded surface such as that of an instrument with a complicated structure, endotoxins potentially will remain active even following steam sterilisation. It is important to note that the rinse water that conducts final rinsing of the instruments prior to steam sterilisation is critical. This is exactly why the water quality is specified for the final rinse. Deposition of sloughing bacterial matter onto instruments then exposing to steam sterilisation may still permit endotoxins to remain. Another consideration is that when we measure bacteria, we are only measuring 5-10% of the true number of bacteria in a system. When we talk about biological activity in a pipe, we typically look at two forms that bacteria can be found in – sessile and planktonic. Sessile occur in the slimy bio films we find on pipes, sides of swimming pools, on filter media or membranes. >90% of bacteria in a system will exist in the sessile form. When we look at planktonic bacteria, these are the mobile bacteria – the ones that move around in the bulk water and most importantly these are the ones we measure when we take a sample. As you can see from the picture on the right, the bio film - sessile bacteria grow as a community. These will be the populations that grow in dead legs. When ready, the bio film will break apart and populate other parts of the pipe or system. We see accumulation of this sloughed off material in filters, aerators, and low flow zones. When we thermally treat a system or hyper chlorinate a leg, we are looking to kill off the sessile bacteria – the bio film in that leg. When we add chlorine, chlorine dioxide, peroxide or similar in constant dose, we aim to control both planktonic and sessile bacterial growth.
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The top photo shows the impact of cleaning chemicals that can cause deterioration of SS surfaces. Interaction of hardness or other cations with polyphosphate treatment chemicals in rinse agents can accelerate corrosion of the stainless steel. Chlorides are well known to cause attack on SS particularly on stress, joins or weld points. Higher temperatures see increased activity of chlorides on stainless. The photo below shows chloride-based corrosion. Steam purity can also impact on SS condition. Some water treatment companies can use amines which remain in a gaseous state in the steam. This can cause deterioration of instruments. In addition, due to the amines attack of copper lines, copper-based deposition could also be observed. It is important to note that susceptibility to chloride attack on SS is temperature dependent. Note with concentrated chloride on the surface of 316 stainless instruments, corrosion is likely. Temperature is the driver here combined with chloride. 1. https://www.mediquip.com.au/news ASNZS41872014andReverseOsmosis Photo 1 shows severe deterioration of the instrument. This level will cause the instrument to be rejected and disposed of. Likely cause is mineral surface reaction. The stain seen is likely hard bonded to the metal and virtually impossible to remove. Photo 2 sees attack of the surface of the instrument by chlorides likely at the cerated area where chlorides can concentrate
CONTAMINANTS
When instruments are not cleaned thoroughly removing salts from cleaning or from operations, corrosion of the stainless can easily be the result. Silicate is a common problem with water used in the CSSD. Silica is more difficult to measure and poorly understood. However, its impacts are very significant. Some areas such as Toowoomba in Qld have very high levels of silica- levels over 60ppm are not rare. I have seen facilities where silica is not tested including testing of the ring mains water. When it was, it did not comply with the Table 7.2 requirements. It is important to note that recent amendments to the Table 7.2 water quality requirements have seen silica (SiO2) in delivery or ring main water limit amended to a max of 1ppm. Looking at the standard, the table 7.2 prescribes required water quality. Please note the change to silica (as Sio2) has recently been altered to <1ppm. When looking at water in CSSD, we are looking at water in a pipe. No matter what material is used, we are dealing with the same basic issues: 1. bacterial growth in water 2. minerals in water and their impact on instruments 3. water volume of supply. Inside a pipe, we know we will have bacteria â&#x20AC;&#x201C; no pipe is excluded. If there is water, air, and even extremely small amounts of nutrient, bacteria are present.
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Even though a RO is used, there is no surety that the water will be bacteria free. UV, filtration, and other treatment methods cannot stop bacteria – they can assist in control, but never elimination. RO water in a pipe is corrosive. This means leaching of metals into the water. This can provide risks for deposition of oxides and scales onto surgical equipment and related items. Use of plastics as has been seen widely even in plants supposed to be compliant with the requirements of AS4187:2014, Plastics however can provide an ideal environment for bacterial growth, providing an adhering surface and nutrient source.
Note correct location of sampling points. Samples should be representative of what is going into the washers. A sample on the return is preferable. This provides for the longest distance from the UV and allows for a “worst case” measurement. As we have discussed, just having an RO doesn’t guarantee compliance or minimisation of risk for bacteria. I have seen post RO bacteria measured at 2000X times the acceptable limit. I have also seen ring mains cleaned post RO where the water was brown tinged coming out, from the bio matter. Bacteria will breed where there is moisture, air, and a nutrient source. As we have seen that nutrient source can be the pipe or metallurgy in the line itself.
SYSTEM SANITISATION One method is put UV in the ring main along with a fine UF filter (0.04um). This filters planktonic bacteria. However, as we discussed earlier, most of our bacteria are not planktonic, but sessile. So the method also needs to include methods to eliminate sessile bacteria. There are two main methods – thermal – pasteurisation up to 80-85c for extended period. Or chemical – this can be peracetic acid, chlorine and peroxide.
The table (courtesy of Rogers et Al, Journal of applied microbiology 1994) shows leached organic materials (presented as total carbon). These materials are nutrients for bacterial growth. Note the leached levels of material from PP, PE and latex materials. 50X higher than the PVC materials. The sectional area shows bacterial growth in a crevice in 316 SS. This is an important consideration when looking to ensure the water is maintained as sterile. Many sites utilise SS but rely purely on RO to produce sterile water. Though the water coming out of an RO may well be sterile, the water will not remain sterile.
RING MAIN DESIGN CONSIDERATIONS The ring main is the distribution pipe work that sends the water from the RO storage tank to the washers, taps, ultrasonic cleaners, and other usage points. The design is very important. Ensuring the correct flow velocity is approximately 1-1.5ms-1 with no low flow zones. This means ensuring the take-offs for feed to the washers etc are as short as possible. We use the definition of a dead leg – 2x the pipe diameter – any longer and the take off point becomes a dead leg or low flow zone and a risk point. If there are any low flow zones in the pipe then the system cannot be sterilised, and compliance will suffer.
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Thermal is energy hungry and requires significant time to ensure all the ring is up to temperature and the temperature must soak through any bio matter in the pipe to ensure complete kill. However, as we discussed, some bacteria are thermally tolerant. Selecting the most effective material for a ring main is not as simple as it may seem. Suppliers recommend PVCU, SS, and some utilise other plastics. Many facilities use PTFE which is very expensive, and others utilise copper. Some have chosen polyethylene as it was what their plumber recommended. The table shows bacterial growth in identical conditions for various materials. Note the levels of bacteria growing on EPR, PP, and alike are significantly higher than comparing with SS.
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However, note the PVC material showing low levels of bacterial growth. The report author suspects this is due to the toxic materials (vinyl chloride) being leached from the pipe which is toxic to the bacteria. Concern here is raised about using such water for sterilisation purposes. Rating the material performance by a colonisation ratio we the see the following. 316Stainless Steel shows as best overall performer. Note the poor performance of PE. And EPR. This rating applies to any gaskets, seals, and alike. PVDF is expected to perform extremely well due to its nonstick nature and low leachable TOC (nutrients). PVDF is also sterilisable at temperature and highly chemically resistant. Considering material selection, we can produce the table above as a summary. Considering the factors of bio performance, method of sterilisation, and corrosion an overall material of preference can be seen The use of chemical sanitisation is another option for reaching compliance. Oxidising biocides that are used in chemical treatment of ring mains tend to burn the surface of biofilm i.e. sessile bacteria. This burning of the top layer gives the bacterial population at the top a sun burn, but the bacterial hive underneath is unaffected. Temperature sterilisation above 80c for a suitable soak time penetrates and kills the bacterial colony. 1. C hemicals can be quite corrosive. Some companies use Ozone â&#x20AC;&#x201C; Ozone is very corrosive towards all materials including stainless steel. Itâ&#x20AC;&#x2122;s an extremely powerful oxidiser and will even embrittle plastics. 2. C hemicals must be flushed out of the ring main or these chemicals will go into the washers, basins etc and onto instruments.
REFERENCES The author wishes to acknowledge the following references. AS4187:2014 May 2019 amendment. https://tuttnauer.com/blog/autoclave-sterilization/preventingthe-spread-of-infection-in-hospitals http://www.deconidi.ie/html/conf/assets/wfhss_conf20070503_ lecture16_en.pdf https://event.icebergevents.com.au/uploads/contentFiles/ files/2017-IHEA/Robin%20Burgess%20IHEA%20Presentation.pdf https://southlandfiltration.com.au/ensure-you-get-as4187compliance-reading https://www.mediquip.com.au/news/ ASNZS41872014andReverseOsmosis Rogers et Al, Journal of applied microbiology 1994
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3. H andling of the chemicals, measurement, and control can be quite poor. Temperature is easy to measure and control.
CONCLUSION In conclusion, there are many factors to be considered when designing a AS4187 compliant plant for CSSD units, some of these include the pre-treatment of the water coming into the plant from the facility water supply to remove contaminants from the water supply before it enters the CSSD unit. Removing contaminants such as bacteria and minerals will reduce the possibility of failed sterilised equipment. It is also important to consider the type of sanitisation to be used and the materials used within the plant to facilitate the method of sanitisation. By considering these factors the facility will be able to provide a plant which is compliant and ensure the smooth, reliable supply of suitable water for the CSSD unit to function effectively.
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COULD ADOPTING A SAFETY CASE REGIME IMPROVE PATIENT SAFETY IN AUSTRALIA’S HOSPITALS? By John Gilbert, BEng, MEng, MBA, CPEng Matthew Kennedy, BEng, MTechMgt, EngExec, MAICD
ABSTRACT
A
safety case regime has been adopted by a number of high hazard industries, such as rail, nuclear, chemical processing and offshore oil and gas, as a means of identifying risks and demonstrating due diligence. This paper examines whether adopting a similar safety case regime could improve patient safety in Australia’s hospitals. This paper argues that safety cases are most beneficial in situations where risks are characterised by severe consequences and interactive complexity. An examination of risks in hospitals shows that some risks share these characteristics. This paper also argues that an effective safety case regime is enabled by technically capable organisations and empowered regulators. An examination of regulatory regimes shows that the required mechanisms are not currently in place, but that other industries provide useful parallels that could be adopted. This paper concludes that a safety case regime could be a beneficial risk management approach, but that the absence of enablers would limit the benefits in the short term. Government health departments should consider preparing hospital safety cases as a means of identifying risk and demonstrating due diligence, while state safety regulators should consider adopting a safety case regime as a means of assuring the ongoing safety of hospitals.
INTRODUCTION Safety cases have been required in high hazard industries for a number of years. Often this requirement has been born out of a major accident. For example the public enquiry into the Piper Alpha accident, which caused 167 fatalities on a North Sea oil platform in 1988, recommended the adoption of a safety case in the UK offshore industry [1]. In Australia safety cases and similar assurance mechanisms are required by law for applications including: onshore major hazard facilities [2,3], offshore oil and gas facilities [4,5], certain nuclear facilities [6,7] and the rail industry, for example in South Australia [8]. The Department of Defence
has voluntarily adopted an assurance case regime, which includes elements of a safety case, within Navy [9]. This paper examines whether adopting a similar safety case regime could improve patient safety in Australia’s hospitals. It begins by describing the safety case approach and presenting the circumstances in which a safety case is an appropriate risk management tool. It then considers whether similar circumstances could exist in a hospital environment. It then examines important enablers to a safety case regime. Recommendations are made for hospital operators and policy makers.
THE SAFETY CASE APPROACH What is a Safety Case? Different industries define safety cases in different ways. Safe Work Australia guidance defines a safety case as “a written presentation of technical, management and operational information about the hazards and risks that may lead to a major incident […] and the control of those hazards and risks” [3]. The National Offshore Petroleum Safety and Environmental Management Authority (NOPSEMA) describes a safety case as “a document produced by the operator of a facility which: identifies the hazards and risks, describes how the risks are controlled, and describes the safety management system in place to ensure the controls are effectively and consistently applied” [5]. Within the Australian Nuclear industry a safety case is defined as “the collection of scientific, technical, administrative and managerial arguments and evidence in support of the safety of a facility covering the suitability of the site and the design, construction and operation, the assessment of radiation risks, and assurance of the adequacy and quality of all of the safety related work that is associated with the facility” [7].
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Similar definitions are seen internationally, for example in UK Civil Nuclear [10], UK Defence [11], UK offshore oil and gas [12]. From these definitions, a number of common themes can be distilled. A safety case: • Is produced by the “operator’ of a facility; • Presents information regarding hazards and risk and documents the controls in place to manage those hazards and risks; • Is documented as a body of evidence; • Is a commitment by the operator to manage those hazards and risks into the future; and • Is the mechanism by which the operator assesses risks, identifies controls and demonstrates due diligence to stakeholders. What makes up a Safety Case? As noted previously a safety case is a documented body of evidence. A “typical” safety case will consist of three main parts: (1) A description of the facility and its associated activities, which sets the scope of the safety case; (2) A summary of the safety assessments that have been conducted, which identify hazards arising from the facilities and activities, and identifies the controls required to manage those hazards; and (3) A description of the Safety Management System (SMS) for the facility’s operations, including a description of how the operator will manage the identified controls. This documentation serves as a means of demonstrating “due diligence” [13] as required under the Work Health and Safety Act [14]. Who develops a Safety Case? The safety case regime is predicated on the idea that the prime responsibility for safety must rest with the organisation responsible for the facilities and activities that give rise to the risks [15] - this organisation is typically termed the ‘operator’ of the facility. It is the operator’s job to assess their processes, procedures and systems to identify and evaluate risks and implement the appropriate controls, because the operator has the greatest in-depth knowledge of their facility. This assessment is documented within the safety case. Why use a Safety Case? Safety cases arose from the recognition that prescriptive regulations could not keep up with changes in technology [1,15]. Prescriptive rules, such as those set out in industry standards, can be useful for simple hazards that are readily apparent; for example, most people can readily identify a
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rusty ladder that should not be used. Hazards that arise from the complex interaction of multiple elements and actors are more difficult to control via prescriptive rules. For example, the Nimrod XV aircraft crash in Afghanistan in 2006 was the result of a fuel leak (several causes were suggested, but the investigation was not able to definitively say how the leak occurred), interacting with a section of high-temperature ducting, in a compartment that was inaccessible and did not have fire protection installed [16]. Sitting behind the safety case are a number of safety assessments, the purpose of which is to examine in detail the significant and complex hazards at a facility. Again, the focus of each industry area will be slightly different. Offshore oil and gas places increased focus on “Major Accident Events” [17], being events with the potential for multiple fatalities [4], while Major Hazard Facilities place increased focus on “Major Incidents” [18] involving hazardous chemicals, and nuclear focuses on radiation hazards [6,7]. To generalise, the safety assessment is a detailed exposition of those risks exhibiting a greater degree of complexity, inherent hazard. For example, operators of offshore gas facilities will undertake detailed fire and explosion modelling, chemical manufacturers will undertake dispersion modelling of toxic gas releases and nuclear facility operators will model the migration of radionuclides following identification of a hypothetical accident. This is done in order to understand the unique and complex hazards arising from the facility, which in turn provides the basis for selecting controls. This is not to say that minor hazards (e.g. falling from ladders, injuries from lifting heavy loads, slipping in a wet floor) are not important, but rather that these hazards can be readily managed by workplace policies and procedures and do not warrant any closer examination under the safety case regime. Due Diligence The WHS Act (Part 2, Division 3) [14] sets the expectations for the Person Conducting a Business or Undertaking (PCBU) for the management of safety as it relates to their business. The PCBU must ensure, so far as is reasonably practicable, that the workplace, the means of entering or exiting the workplace and anything arising from the workplace are without risks to the health and safety of any person. The safety case is the mechanism by which the operator assesses risks, identifies controls and demonstrates due diligence to stakeholders [13]. The important take away from the Act is that the operator of a hospital, whether regulations require it or not, has an obligation to manage health and safety that extends beyond their own staff or their sub-contractors. They must consider the health and safety of staff, visitors, patients within the hospital. In some circumstances, where the hospital is
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providing critical clinical services to other parts of the health network, the hospital operator may also have to consider the health and safety of patients at other facilities. A safety case would provide a framework for the identification of these complex risks, their assessment, the identification of controls and mitigations, and the ongoing management of residual risks. It would be a key piece of evidence that demonstrates the operator has taken all reasonable measures to understand the risks associated with the operation of the hospital, and to actively control those risks. An Brief International Example The US National Fire Protection Association have developed the Health Care Facilities Code (NFPA 99 [19]). Although not titled a “safety case” the Health Care Facilities Code requires a detailed exposition of hazards that pose a risk to the facility and demand for its services, known as a “Hazard Vulnerability Assessment” or HVA. Within the HVA, the impact of hazards on the continuity of operations is to be assessed and mitigation strategies to be considered include (inter alia) “redundancy or duplication of essential personnel, critical systems, equipment, information, operations or materials” [19]. The HVA then informs strategies for maintaining critical functions, including: communications, resources and assets, safety and security, clinical support activities, essential utilities and systems and exterior connections. It should be recognised that maintaining continuity of services is aligned with Australian WHS Duties to protect workers and affected personnel.
RISKS AT AUSTRALIA’S HOSPITALS This section asks whether risks characterised by severe consequences and interactive complexity could exist within Australia’s hospitals. This is answered by first reviewing National Safety and Quality Health Service Standards (NSQHS). The primary aim of the NSQHS is “to protect the public from harm and to improve the quality of health service provision” [20] and so this represents a good place to start identifying categories of risks that could be amenable to management by a safety case regime. A loss of infection control is one such risk that may have local, national or global significance [20]. The nature of infections is varied and although some control elements will be common, the overall control strategy will need to be tailored to the local conditions and context. Multiple systems are required to manage the risk of infections. Moreover, the nature of infection can evolve overtime requiring adaptive strategies and controls.
Medication safety is another risk that can have wideranging safety impacts [20]. In the first instance, incorrect prescription or dispensing of medications could affect individual patients, but perhaps more significantly for those hospital that produce their own medications, the production of “off-spec” medicines can affect multiple patients in a single occurrence. Likewise, the incorrect management of blood or blood products has the potential to affect multiple patients in a single occurrence. Examination of other hospital accidents reveals further risks that are characterised by complexity and severe consequences. In July 2016 a death occurred when incorrect medical gas was dispensed at the BankstownLidcombe Hospital to two neonates as a result of crossconnected piping. The investigation report cited “flawed testing and commissioning” processes and gaps in “engineering governance and management processes” [21]. In February 2018 a power failure occurred at the Royal Adelaide Hospital during routine generator testing [22] that affected a significant area of the hospital. In this instance multiple safeguards were ineffective, resulting in the generators running out of fuel while under test. Fires have occurred also at a number of Australian hospitals forcing evacuation of patients [23,24]. Fire is particularly challenging in a hospital. In a hotel, by contract, people will respond and use the fire exits to leave the building. In a hospital many patients cannot easily be moved and are unable to respond in their own right. Continuing to provide essential support to patients during a fire is also challenging and can be compromised by poor planning that requires evacuation of critical support areas and personnel. Some of the risks identified above are not unique to a hospital. However there is a clear distinction between how these risks are managed in a hospital, as compared to how they would be managed in equivalent sized buildings, such as hotels or office buildings. That distinction is the people exposed to the risk. The population in a hospital is intrinsically more dependent on the correct functioning of the hospital’s services than occupants in a hotel. In fact the lives of many in a hospital literally rely on the correct functioning. For example, the failure of the Heating, Ventilation and Airconditioning (HVAC) system in a hotel will leave the facility uncomfortable however the occupants can simply leave the facility, with no risk to themselves. In a hospital however patients may be relying on the HVAC system to prevent the spread or cross contamination of infectious diseases, or they may be highly susceptible to small changes in temperature and humidity. Importantly, in both cases the hospital patient has no other option – they cannot simply leave until it is fixed.
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If these are the sorts of risks addressed by a safety case, one might ask which risks would not come under particular examination? In general, risks that are of lesser consequence and relatively simple in their manifestation do not warrant further examination and are generally managed by workplace policies and procedures. Such risks might include: • Manual handling injuries while lifting a patient; • Falling from a ladder while conducting maintenance work; and • Minor burns from a hot water system.
Moreover, a safety case is produced “in the knowledge that it will be scrutinised by a competent and independent regulator” [5]. This requires the regulator to also acquire sufficient competency to act as an “intelligent customer” of safety cases produced by hospital operators. This need for regulator competency as an enabler of nonprescriptive regulation has been highlighted in the US National Academy of Sciences study on “Designing Safety Regulations for High-Hazard Industries” [26]. The regulator also needs to be independent of the operating organisations.
To conclude, it is clear that some of the risks within a hospital share the characteristics of severe consequences and interactive complexity. Adoption of a safety case methodology will support the comprehensive investigation of these complex risks, the early identification of design requirements to eliminate them, and the parallel development of operational controls that most effectively manage residual risk. How a safety case regime can be made to work is set out in the next section.
A state-wide or even national safety case regime will be enabled by a legislative mandate. Currently no such mandate exists for hospitals under state based WHS and OHS legislation (although duties to exercise due diligence and manage risks are in place). Examination of other high hazard industries in Australia, such as oil and gas, rail, nuclear or chemical processing will offer useful benchmarking for designing safety case legislation; however a detailed examination of the differences between safety case legislation is beyond the scope of this paper.
ENABLERS TO THE SAFETY CASE REGIME
CONCLUSIONS AND RECOMMENDATIONS
A safety case should not be seen as a panacea. There are three important enablers of the safety case regime that must also be achieved: a technically enabled operating organisation, an independent and technically enabled regulator and a legislative mandate.
This paper has drawn on the experience of other industries that manage significant and complex hazards under a safety case regime, and argued that such an approach should be applied to our most advanced and complex hospitals.
As described earlier, the “operator” is central to the safety case regime. As the organisation responsible for managing the hazards, it is critical that the operator be technically enabled and capable of acting as an intelligent customer. The UK Office of Nuclear Regulation (ONR) [25] sets out core safety and “intelligent customer” capabilities that provide a useful benchmark. Specifically operators must define the competencies required in order to manage the hazards for which they are responsible and then ensure that those competencies are maintained by the organisation. This can be achieved by having an “intelligent customer” policy and establishing competency frameworks for those positions that have authority for making safety-related decisions. This does not mean that consultants or subcontractors can’t be used by facility operators – but it means there must be sufficient organisational competency within the operating organisation to act as an informed buyer of products and services. As an operator it is not sufficient simply to pass responsibility down to a subcontractor, the operator needs to ensure firstly that the requirements are appropriately specified and then ensure that the product or service they receive is fit for purpose. Simply pointing to a consultant’s report and saying “they said it was ok” is not sufficient in terms of demonstrating due diligence.
Safety cases are most effective when risks are characterised by interactive complexity and high inherent hazard; two characteristics shared by risks found in a hospital environment. It was identified that a safety case can be used as a means of demonstrating due diligence to stakeholders (including regulators) and represents a commitment to managing risk in a particular way that can then be audited by a technically enabled regulator. Historically, it has taken a major incident to make an industry adopt a safety case regime – we have an opportunity now to do so proactively, and hopefully not have the accident at all. The following recommendations are made to hospital operators: • Consider developing a safety case for your hospital. Start by building a safety case around a single risk, perhaps a loss of infection control, and see if you are convinced that the risk is managed. Have the safety case peer-reviewed by an independent group within your organisation to see if you can convince others that the risk is managed.
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• Build a technically enabled organisation that can act as an “intelligent customer”. Take responsibility for the hazards you own and ensure you have the technical capability to specify and accept work from consultants and contractors. Ensure this technical capability is anchored into the organisation, through artefacts such as an “intelligent customer” policy, competency frameworks and minimum competency requirements (including those for consultants and contractors), position descriptions and organisation structures. The following recommendations are made to government policy makers: • Examine the lessons learned from other Australian industries that have adopted safety cases and ask yourselves if those lessons could be applied to our most advanced and complex hospitals. • Consider establishing a safety case regime for hospitals within regulations, and look to other Australian industries, such as oil and gas, rail, nuclear or chemical processing for guidance.
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• Build a technically enabled regulator that can independently probe and challenge operator safety cases.
REFERENCES 1. The Hon. Lord Cullen; The Public Inquiry into the Piper Alpha Disaster Volumes 1 and 2; 1990. 2. Safe Work Australia; Model Work Health and Safety Regulations; 15 January 2019. 3. Safe Work Australia; Guide for Major Hazard Facilities Preparation of a Safety Case; March 2012. 4. Offshore Petroleum and Greenhouse Gas Storage (Safety) Regulations 2009; F2013C00945. 5. National Offshore Petroleum Safety and Environmental Management Authority; web page “what is a Safety Case”; https://www.nopsema.gov.au/safety/safety-case/what-is-asafety-case/; accessed on 20 February 2019. 6. Australian Radiation Protection and Nuclear Safety Regulations 2018; F2018L01694. 7. Australian Radiation Protection and Nuclear Safety Agency; webpage: Information for stakeholders - 5. International Best
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Practice; https://www.arpansa.gov.au/regulation-and-licensing/ safety-security-and-transport/radioactive-waste-disposal-andstorage; accessed 19 August 2019. 8. South Australia; Rail Safety National Law (South Australia) Act 2012. 9. Australian Government - Department of Defence; Defence Seaworthiness Management System Manual; MJ Noonan, AO Vice Admiral, RAN Defence Seaworthiness Authority Department of Defence, Canberra, 04 December 2018. 10. Office for Nuclear Regulation; Nuclear Safety Technical Assessment Guide – The Purpose, Scope, and Content of Safety Cases; Revision 4; July 2016. 11. UK Ministry of Defence; webpage: SMP12. Safety Case and Safety Case Report; https://www.asems.mod.uk/guidance/ posms/smp12; accessed 19 August 2019. 12. UK Health and Safety Executive; webpage: Safety Cases; http://www.hse.gov.uk/offshore/safetycases.htm; accessed 19 August 2019. 13. Risk Engineering Society of Engineers Australia; Safety Case Guideline – Clarifying the safety case concept to engineer due diligence under the provisions of the model Work Health & Safety Act 2011; Third Edition. 14. Safe Work Australia; Model Work Health and Safety Act; 21 March 2016. 15. National Offshore Petroleum Safety and Environmental Management Authority; web page “Safety Case Approach”; https://www.nopsema.gov.au/safety/safety-case/safety-caseapproach/; accessed on 31.07.2019.
4e541f29-9ea2-4a06-becb-77ad3fecb9e7-mMA2bLF; accessed 19 August 2019. 23. Australian Broadcasting Association (ABC); “St John of God Hospital fire: Patients transferred as blaze forces evacuation of building”; webpage: https://www.abc.net.au/news/201611-02/fire-forces-mount-lawley-hospital-evacuation-patientsmoved/7987340; article updated 2 November 2016; accessed: 19 August 2019. 24. Australian Broadcasting Association (ABC); “Canberra Hospital fire risk identified a year before switchboard blaze forced evacuations”; webpage: https://www.abc.net.au/news/2017-0801/canberra-hospital-fire-risk-identified-year-before-blaze/8764576; article updated 1 August 2017; accessed 19 August 2019. 25. Office for Nuclear Regulation; ONR Guide - Licensee Core Safety and Intelligent Customer Capabilities; NS-TAST-GD-049; Revision 6; April 2019. 26. National Academy of Sciences; Transportation Research Board Special Report 324 Designing Safety Regulations for High-Hazard Industries; The national Academies Press Washington DC; 2018; ISBN 978-0-309-46606-6; DOI 10.17226/24907.
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16. Charles Haddon-Cave QC; The Nimrod Review - An independent review into the broader issues surrounding the loss of the RAF Nimrod MR2 Aircraft XV230 in Afghanistan in 2006; 28th October 2009.
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17. National Offshore Petroleum Safety and Environmental Management Authority; Guidance Note – Hazard Identification; N-04300-GN0107; Revision 5; December 2012.
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18. Safe Work Australia; Guide for Major Hazard Facilities – Safety Assessment; March 2012. 19. National Fire Protection Association; NFPA 99 Health Care Facilities Code; 2018 Edition. 20. Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service Standards. 2nd ed. Sydney: ACSQHC; 2017. 21. New South Wales Department of Health; Bankstown-Lidcombe Hospital Medical Gases Incident: Final Report; Prepared by the Chief Health Officer; 26 August 2016. 22. SA Health; RAH Loss of Power Root Cause Analysis Summary of Interim Findings; Frazer-Nash Consultancy; 06 April 2018; webpage: https://www.sahealth.sa.gov.au/wps/ wcm/connect/4e541f29-9ea2-4a06-becb-77ad3fecb9e7/ FNC+Technical+Note+-+Summary+of+RCA+Interim+Findings+%28 Issue+01%29+2.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-
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GAME PLAN FOR THE FUTURE â&#x20AC;&#x201C; BEST PRACTICE AND DATA MANAGEMENT By Colin Nicol
The definition of best practice evolves as quickly as ever for hospital engineers.
B
eing able to identify the changes and the impacts that they have on hospital operations is critical. Having the capability and flexibility within your systems to incorporate the changes is equally as critical. Understanding the importance of data and how data is driving actions, strategy and best practice is important for engineers as well as understanding the key metrics and data that needs to be considered when establishing new systems. This article provides an overview of embracing the use of cloud-based technologies and how IOT is helping hospitals around the world to drive efficiencies and productivity whilst enabling them to become proactive with data to drive best practices forwards.
1: Cloud-based technology is able to keep people informed like never before.
To see the future, we often need to look backwards. Healthcare management in the engineering context and the future of thereof, if history is anything to go by, is that engineers workload will increase. Not only will the volume increase, but also the level of detail and complexity of tasks that need completed as authorities look more and more into on site activities and evidence based reporting.
Again history tells us this increase is unlikely to be paralleled by an increase in resources to meet this demand. In order for hospitals to meet the evolving definition of Best Practice, engineering teams need to work smarter and more efficiently. This will require the adoption of new technologies, innovation and methods to keep pace. The adoption of cloud-based technologies is one of the key drivers that enables engineers to achieve compliance and best practice. With case studies showing hospitals to be responsible for completing over 40,000 tasks per month and being able to demonstrate and prove each task is completed correctly. The complexity of completing and demonstrating compliance is ever increasing. To add to the volume of tasks, these tasks span across an array of disciplines and areas of compliance and are delivered by both in-house hospital engineers and multiple specialist contractors meaning standardisation of data through technology will become more and more critical in the effective management data. Systems that not only allow but dictate real-time data capture are driving the new industry standard. The old days of using paper to tick off or capture a reading is just no longer suitable, manual data entry is not only time consuming but often inaccurate. If a task requires a resource to be sent to the point of operation to record task results, then those task results are essential for evidence based reporting and so it is critical that the data not only gathered but the data that was missed is escalated and alerted to the relevant people and/or authorities as well as being available to view 24/7. Making best use of an ever stretched resource, which in this case is staff or contractor time, cloud-based technology via the use of mobile phones, tablets and IOT (Internet of Things) devices, put a significant amount of critical data and time saving power in staff and contractor handâ&#x20AC;&#x2122;s. Capturing the data once (rather than handling the data up to 3 times), advising staff in the field of what
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results are in spec or out of spec, capturing the name, date, time & (geo)location when the task is complete is all information that becomes not only essential for the day to day management of the estate but critically important when needed for audits and inspections without using up valuable time and to find and use the data.
2: Cloud-based technology allows operators and managers to see the same information in real-time no matter where they are. Making informed decision making simple and collaborative.
By moving to cloud-based applications, we are able to see significant time savings by staff and contractors alike. A recent client where a cloud-based system noted, “using the software has pretty much halved the time I take to complete my daily inspections”. This has allowed this valuable member of staff complete other tasks that were sitting on the ever increasing ‘To do’ list. While at another hospital site, the onsite plumber has noted that the time taken to undertake and record the flushing and chlorine and temperature testing has reduced significantly. He stated, “now I have time to do my plumbing job. While I understand the importance of water hygiene management, I am very happy that my time has been freed up to undertake more plumbing activities”. Now that the data is captured, the next step is for it to be useful. In order to achieve and continually strive for best practice, the data needs to be used, understood and standardised where possible. The interpretation of data and the value of the data is significantly increased with electronic systems. Consider the review of data, and the effort taken to view data from paper based records when compared with electronic systems… Many (if not all) systems now have dashboards to view your data, with reporting widgets, Red, Amber, Green rated issues and trend graph analysis all providing critical management data for hospital engineers to run the facility efficiently, safely and proactively. Systems that provide the ability to login to one place with customised dashboards with multiple data streams, whether it be the manual data collection on mobile apps,
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API links from other systems or IOT sensor devices allows engineers to view the critical data upon which the facility operates is a key component in driving best practice forward. Feedback from Engineers to date has been that they are very busy and don’t have time to operate in the level of detail that is required. They rely on the cloud-based systems to keep them informed. How many engineers have the time to know if every single check is made on the emergency generators each month? How about the negative pressure rooms, or the automated doors? Ice machines, gas manifolds, pumps etc.? There is so much detail that needs to be completed so, within the confines of limited resources, a single point of data is critical. Moving beyond dashboards, reporting by exception becomes critical to the time-poor engineer. Hospital Engineers we currently work with consistently advise that the being notified, either on the dashboard or by reports, that tasks are being missed or failing is an area of critical importance. “How can we take action if we don’t know about it and how can we know everything all the time” was an enlightening statement from one of our clients. While I have no doubt that most Hospital Engineers have a good understanding of their critical operations, they may not have an intimate knowledge of the more routine activities. But often, if these are not well managed, they become challenges that take up more and more time until they are resolved. So obtaining and making use of the data captured is the next step in working smarter, allowing engineers to proactively intervene when the data identifies action required. Moving from lag metrics to lead metrics is where the hospital engineers add value and can be a key component in managing risk across a healthcare facility. With the aid of cloud-based technology, hospital engineers can create systems (tasks, activities, measures etc.) that allow others to complete the activities, but the Engineer to able to view the information and intervene where required. And while we are talking about efficiencies… capturing all the data into a cloud-based system is great, but being able to review interpret and report is equally as important and if not done well can be even more time consuming than completing the task itself. Effective cloud based system make use of smart reporting tools. Whether these are online dashboards, automated alert or automated reports, or reports that can be manually created, the systems allow for efficient and urgent data to be shown. Automated reports in particular have been a very well received by hospital engineers. Where tasks are missed or fail, a report is issued to designated persons to alert them. This not only ensures the engineers are well informed, but
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also have visibility of people and system performance. If nothing else, the engineers have praised the value of these features and made it clear that the time saving capability of this function alone has helped them to feel more in control of their systems and to be satisfied that thing are operating as they should… unless they aren’t and then they know about it. While all hospitals have adopted cloud-based system in one or many forms, there are challenges that come along with the software. The current biggest challenge we hear from our clients is the number of systems out there and the number of different systems that are currently deployed on their facility. While the hospital itself has a limited number of systems (and one facility management system), the contractors often introduce their own systems and provide the client with a login and dashboard to view information. While this is of a great benefit to the contractor, it is not always well received by the engineer and their team, as they have to learn, adopt and operate a new system to obtain a relatively small amount of data (in the context of hospital management).
adoption and integration is maturing and in many cases the early adopters are having to look to their providers to develop rapidly to maintain pace with new systems and products that are emerging into the market. An emerging trend in cloud-based computing is the ‘Internet-of-Things’ which allows any number of assets to be connected to the internet. Long gone are the days where probes and diagnostic devices were large and bulky and needed to be allowed for in the design stages of a project simply to be housed in the facility. With probes and other data logging equipment now able to be retro fitted to any number of pieces of equipment and hardware, the gathering of data is becoming simpler, easier and less expensive. In the health care industry this will have many impacts in the future allowing for greater automation and customisation of spaces and equipment. It will also allow for a greater level of data to be captured and if that data can be put to good use, the facility itself will benefit. While IOT is widely recognised as ‘the next big thing’ in cloud based computing it will always be important for the data to be sent to a system that allows for capture, storage, display and reporting. This will require careful consideration of cloud based software that is able to receive data from multiple sources and also for the careful consideration of IOT devices that are compatible with your selected software. The very definition of best practice, by definition keeps changing. With continual improvement a key component in every hospitals management approach, the key consideration is to select systems and solutions that allow for continual improvement and innovation. With many software solution options available to hospital engineers to embrace, the technology solutions to drive best practice certainly exist like never before and are set to improve rapidly in the years to come.
3: All data being filtered through a single system allows the engineer to view the single source of the truth and reduces the need to learn other systems.
While this may or may not be a challenge to all hospitals, the solution exists. Software systems are getting smarter and understand the need to integrate. Many of the existing systems are built with API (Application Programming Interface) functionality which allows systems to communicate with each other. This allows data from one system to be imported to another to provide the hospital engineering team to view data from contractors and consultants, even though they use other systems. This does rely on both parts of the software having an API and will require some IT team input to get them to communicate. While cloud-based computing has been around for some time, we are still in the early days of adoption and workbased application. The journey towards more workplace
AUTOMATED DOORS – A CASE STUDY One of our health care clients, a large public private hospital in Australia started using our software to help manage their water hygiene and quality. After the successful adoption of the system, we were asked to help with the management of automated doors. The automated doors (and booms) are required to be inspected several times per year. This hospital has just over 200 automated doors that need to be inspected. The previous method of inspection (by a contractor) included a paper-based inspection form being completed on site. The completed form was then sent back to the contractor office where the results were transferred onto an excel workbook with over 200 tabs (one for each door) and the results transcribed onto the sheet.
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The excel workbook was emailed along with scanned copies of the hardcopies The engineering team were then tasked with reviewing each tab (door) to review the report and generate any workorders identified for any defects on each door. The new cloud-based system has eliminated all bureaucracy and replaced it with the following process: • Scan the barcode on the door with a smart device • Complete the checklist on the smart device
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• Out of spec findings (including photos) sent direct to engineering management; • Any tasks not completed on the 200 auto doors reported to management; • Monthly report issued at months end. A simple demonstration of the incredible efficiencies made by the use of the cloud-based software. The contractors time reduced, but importantly, the engineering teams time has been significantly reduced and allowed persons to focus on other important tasks.
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GEOCLIMA
eoclima, an Italian chiller manufacturer, established its Australian presence in 2014, when they set up the Operations, Service & Training Centre and a comprehensive stock of spare parts and chillers in Melbourne. “Since our beginnings four years ago we have now installed a couple of hundreds of chillers and customised systems, developed our service and support network and an impressive portfolio of loyal customers” says their Sales Manager Ashley Morgan. “The service response and its high standard comes from the fact that each Geo chiller has a remote access capability and regularly uploads its operational data into our www repository, which our customers find very useful, especially when it comes to diagnostics of the whole chiller plant. This stored information stretches far beyond of the chiller supply limits, enabling our customers to make assessments of their towers, AHUs, water loops, power quality and many other parameters prior to booking a service visit. Very often such service calls can be avoided, thank Geoclima’s sophisticated control algorithms and remote access. This mobile communications link is invaluable at the fine tuning and the energy optimisation stages as well” says Ash.
A retrofit of a water cooled 600 kW chiller at Holiday Inn hotel in Sydney took place over one weekend in 2015 and it was a brilliant case of “before” and “after” for the comparison of energy consumption. “Geoclima TMH2A550 model replaced our original chillers with oillubricated compressors. An average daily savings of some 2000 kW-hr kicked in immediately from commissioning and has continued to-date” says Steve Mitchell, hotel’s Chief Engineer. “The chiller is well-tuned and performs some of the traditional functionality of BMS, managing our pump and providing the details of the plant performance” Geoclima product cover a very wide range of equipment, from pharmaceutical grade AH Units, through to chillers powered by scroll, VFD-equipped screw and oil-free compressors. We are very proud to be one of the Turbocorauthorised service and training providers in Australia and to serve in low temperature glycol specifications, ice rinks, mission-critical data centres, process cooling and comfort HVAC applications. Our 4-pipe, evaporatively-assisted or ultra-quiet ranges do not have direct equivalents outside of Geoclima and the skid-based chillers combined with pump units and tanks are popular where customers have limited plant room space.
ENVIRONMENTALLY FRIENDLY Chiller Solutions
Geoclima are a chiller manufacturer that produces highly efficient and environmentally friendly chiller equipment. Our most efficient Turbomiser air-cooled chiller uses Magnetic Bearing Compressors and is equipped with innovative evaporative system. Exploiting the natural process of adiabatic cooling, hot and dry air normally drawn into air cooled condensers passes through the wet media before reaching the actual condenser. The evaporative effect reduces the air temperature reaching the condenser coil by as much as 8 degrees increasing the chiller efficiency. In low ambient temperatures the evaporative pads automatically move away from the condenser coils to allow free passage of air reducing fan power. Power savings of up to 25% can be easily achieved using this system which is particularly effective in the Southern parts of Australia. The TMA ES EC model chillers are also available in low noise and super low noise versions utilising our Dynamic Noise Control System.
For more information visit: www.geoclima.com or send an email to admin-au@geoclima.com Telephone +613 9580 3847
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TOTAL SOLUTIONS FOR EVERY BUILDING DESIGN APPLICATION Grills & slot diffusers
Variable volume control
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TROX Australia Pty Ltd Level 32, 101 Miller Street North Sydney 2060 Office: + 61 2 8923 2551 Email: tonyw@troxaustralia.com www.troxaustralia.com
FEATURE ARTICLES
CREATING AN INTERNET OF THINGSENABLED BUILDING: ST. JOHN OF GOD MURDOCH HOSPITAL
By Roy Arindam, VP Sales, Australia, New Zealand, & SEA, BuildingIQ
Hospitals are the beating heart of the healthcare system. They provide a focal point for medical and professional expertise, disease control, advanced diagnostics, emerging medical procedures and technology, acute and convalescent care, and medical research. Hospitals dominate healthcare organisationally and financially, accounting for roughly half of the $170 billion in health care expenditures in Australia in 2016. Today, there are 701 public hospitals and 630 private hospitals operating in Australia, with the public sector accounting for nearly two-thirds of the beds.
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t. John of God Murdoch, a hospital located in the suburbs of Perth, is one of the leading private health care campuses in Western Australia. It has 507 inpatient beds, 16 operating theatres, a maternity ward, a 24-hour emergency department, 5 endoscopy suites, 2 angiography suites, and an educational centre. It was founded in 1994, and is part of St. John of God Health Care, a not-for-profit health care group serving Australia, New Zealand, and the wider Asia-Pacific region. The Group includes more than 20 allied hospitals in Australia.
The approach starts by establishing a close partnership with the onsite facilities staff. Once the 5i IoT-enabled solution is connected to the building, together they will learn how the building operates and performs, uses advanced diagnostic tools to identify problems, and applies forward looking algorithms to control the existing building management system (BMS) based on weather predictions and energy pricing. The result is a building that is continually energy optimised for what is going to happen.
Hospitals are prodigious consumers of energy and are notoriously difficult complexes in which to implement energy conservation measures. Conservation efforts run up against concerns about operational disruption, patient comfort, airflow regulations, 24/7 HVAC demand, the strict requirements of critical theatres, limited facility staff, and budgetary constraints.
A Network Operations Centre (NOC) monitors the site 24/7 and reviewing trends and analysing thousands of data points from the building in real-time. The NOC operators do the heavy lifting of data ingestion, interpretation and analysis, freeing up the hospital staff to do more and with greater impact than they could on their own.
Nevertheless, St. John of God Murdoch Hospital sought a third-party vendor to explore the possibility of increasing energy efficiency and saving money. The hospital selected the BuildingIQ 5i Intelligent Energy Platform, a suite of technology-enabled services, that are based on a fivepillar approach of data capture and analysis; advanced modelling; measurement and verification (M&V); predictive control; and expert human analysis.
The 5i platform includes a fault detection, which combines machine learning analytics and M&V with the judgment and experience building optimisation engineers. The technology-enabled services have a proven track record in commercial buildings of all types, achieving operations savings even in some considered high performing, and has been deployed in over 1100 commercial and government buildings.
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IP Nurse Call & Patient Engagement Solutions • True IP Nurse Call • Patient Engagement Solutions • Guest Wi-Fi including Hills Nurse Call is designed and manufactured in Australia, utilising local R&D and is supported by a team of local technicians and system experts at branches across Australia and New Zealand. Ownership of the intellectual property set us apart from the competition
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A fully autonomous robot emitting concentrated UV-C light onto infectious hotspots in patient rooms and operating theatres, supporting the normal manual cleaning procedures
• Kills 99.99% of all bacteria • Prevents and reduces the spread of infectious microorganisms in the environment by breaking down their DNA structures • Reducing hospital acquired infection rates and operating costs • Autonomous mobile solution • Fast and efficient disinfection process • Easy to install and use For more information contact sales@icdisinfection.com.au
www.icdisinfection.com.au 66
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THE UNIQUE CHARACTERISTICS OF THE HOSPITAL MARKET The challenges of implementing energy efficiency programs in hospitals stem in part from their unique characteristics. These include: • Non-disruptive— Unlike almost any other building, hospitals need solutions that can be implemented without disrupting operating and patient care areas. Installing equipment in the walls with the inevitable distribution of dust into the air system is a non-starter, making it critical to leverage existing, built-in, equipment as much as possible. It’s also imperative to maintain patient and medical staff comfort without intrusion, even while saving energy. • Budgetary constraints/Cost reduction —Despite the billions of dollars that flow through hospital accounts, many are strapped for cash and welcome any opportunity to improve cash-flow. Hospital O&M (operations and maintenance) budgets have to compete with critical care and advanced medical technology. Energy consumption can be a major expense in a hospital. Reducing kWh consumption while maintaining staff and patient comfort can provide a significant stream of financial benefits. The hospital market requires O&M approaches that require limited to no upfront investment, can be installed easily, and can generate positive cash-flow quickly and continuously. • Complex operations—Hospital operations are extremely complex, involving comprehensive services, multiple theatres of operation, exacting schedules, and integrated technologies. The precision and accuracy of operational data, analysis, and findings are imperative. Vendors must be reliable, stand behind their technology, and be able to work in close harmony with the hospital operations and facilities teams. • Skill set— For budgetary reasons, the technical depth of the operations staff at many hospitals may be limited. They typically have a chief engineer and a senior engineer who understand the systems and processes, but the bench is not deep. The technicians below senior level may understand only their specific craft. They fix an electrical or mechanical problem as assigned but may not discern a more systemic underlying problem. Teaming hospital operations staff with outside experts who bring data analytics and decades of experience to the job can improve overall system performance.
IMPLEMENTING BUILDINGIQ’S PLATFORM AT ST. JOHN OF GOD MURDOCH In 2016, the Murdoch hospital asked to test and evaluate the potential of the 5i platform to improve the facility’s
energy strategy. The immediate objectives were to understand energy usage patterns, stabilise the building, reduce energy consumption, and improve the hospital’s cash flow. Investments were to be kept to a minimum with payback expected within one year. Patient and staff comfort during initial system setup and subsequent operations was critical. The hospital staff wanted to proceed incrementally and cautiously. Management requested a six-month proof of concept period. The project started with a commitment to saving 5% of total energy based on optimising 80% of the building space within the first 6 months of a 3.5-year contract. Physical connection began in January 2017. Per agreement, connectivity to the BMS would be strictly in a monitoring role during the start-up window. It would use its analytics and expertise to identify anomalies, and make recommendations to improve the efficiency of the building. Both teams worked closely to monitor energy performance data and the responsiveness of the building management system (BMS). This was the beginning of an integrated teamwork relationship that continues today. In February and March, the first set of recommendations were made to the hospital staff. Some unexpected power surges and some issues of concern with the mechanical plant were found. Also found, some settings that could be adjusted, and some equipment and instruments that needed to be fixed. Daily communication and a formal monthly progress report were done during that period. One area of particular concern was the chiller plant. It was acting very erratically. It was not in tune and was oscillating, turning on and off far too frequently. It was running particularly hard, creating hot spots, which has had a negative compounding effect on the air-side of the HVAC system. While the platform was initially used only to analyse data, it was eventually scaled to include fault detection, as well as optimised control of specific HVAC zones. Through a combination of machine learning and predictive analytics, the platform delivered an optimised balance of energy savings, operational efficiency, and occupant comfort. Optimisation work began slowly in May 2017, with BuildingIQ taking control of the building in increments, starting with one floor, one zone, then moving on to the next. Patient and staff comfort were carefully monitored, as was the responsiveness of the building to signals being sent by the NOC to guide air supply and temperature. Results came in faster and more positively than the hospital staff expected. By the end of May, shortly after optimisation began, savings were already at the
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FEATURE ARTICLES
2.5% level. By the time energy savings reached the contractually targeted goal of 5% of total power in July 2017, BuildingIQ had only optimised 50% of the 38,445 sqm hospital. Since HVAC represents about half of total kWh power consumption, HVAC energy savings themselves were closer to 10%. Savings continued to climb for the first six months, then slid as problems with the BMS and mechanical plant took its toll on the energy optimisation effort. Following repairs, savings were restored. The project has now optimised about 22,000 sqm, or 55-60% of the building. Given that operating theatres and other critical areas of the hospital are off limits to energy optimisation, the plausible upper limit of BuildingIQ’s optimisation of the hospital was around 70%. Arguably more significant than the successful optimisation of energy efficiency has been the success of the outsourcing model itself. By turning the task of continuously monitoring the building’s performance over to BuildingIQ’s NOC in Sydney, early fault detection that prevents small problems from cascading into larger problems are now part of the daily routine. On-site staff, cloud-based analytics, and building optimisation experts are now fully integrated. Pattern recognition of potential HVAC technical issues are quickly reported by telephone and email, and resolved through consultation and teamwork. Client reaction to the recommendations and results was one of excitement during the startup phase. The senior engineer’s first response at the monthly meeting was extraordinarily positive. Their comment was that BuildingIQ’s staff was communicating issues they needed to be aware at the exact time they needed to know and that in essence they were the eyes and ears of the building, bringing advanced capability and complementary expertise to the table. They had become an extension of the hospital facilities staff. Month after month the hospital staff were learning from the external team. And it became a journey taken jointly, not just an outcome.
THE JOURNEY OF THE 5I PLATFORM The journey is based on collaboration and continuous learning. It begins with learning the building—interviewing, inspecting, analysing, modelling, and interrogating the BMS. It discovers how the BMS thinks, directs, and interacts and how it responds to signals. It models how the building responds thermodynamically to changing conditions and occupancy. The learning process continues through round the clock monitoring by experts, through dynamic modelling, and continuous commissioning to ensure the building remains in top order. Optimisation ensures dynamic learning continues and that energy efficiency continues to improve.
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The Journey of the 5i Platform rests on five pillars: 1. Data capture and analysis—The NOC captures and integrates multiple data streams, from the BMS and its directives to occupancy patterns and utility tariffs. 2. Modelling—A series of models use algorithms to understand the performance of the building over time and through changing internal and external conditions. Occupancy models, thermodynamic models, weather models, predictive models, and diagnostic models are made to work together. 3. Measurement and verification—Effectiveness must not only be measured but its accuracy verified according to baseline models. BuildingIQ’s 5i Platform has a built-in M&V model that conforms to the highest professional standards of energy efficiency modelling. 4. Control—Following preliminary learning, engagement, and retrofits, the platform is set to take control of the BMS, using algorithms to adjust the set points for various zones in the building on a minute-by-minute basis. Control is automated and carefully monitored. 5. Human expertise—Combining the talents and experience of those closest to the building—the facilities and operations staff— with the deep analytical experience and modelling capabilities of the building optimisation staff provides the right teamwork to bring out the best in building performance. Hundreds of years of experience in buildings and HVAC systems are combined to provide the best outcome possible. And operating staff bring years of first-hand experience with their own building.
FEATURE ARTICLES
STAYING AHEAD WITH OUTCOME-BASED FAULT DETECTION SERVICE With tens of thousands of integrated controls, sensors, moving mechanical parts, and digital subsystems at work in a building’s internals, alarms that sound every possible anomaly, odd reading, and potential faults are triggered almost continuously. In fact, the fault detection systems of yesterday inundate facilities teams with so much data and guesswork these alarms are largely ignored. Outcome-based Fault Detection (OFD) springboards off rudimentary systems and adds a layer of artificial intelligence —in the cloud— to separate the significant from the insignificant, and to take the analysis to more advanced levels. The OFD service includes a cloud-based NOC to translate faults into diagnoses, and from there into concrete actions and manageable planning. Further, it offers tools to allow the hospital facilities staff to become more proactive problem solvers and troubleshooters. The workflow underlying OFD ultimately forms a knowledge centre that stores and makes available the deep knowledge of what cause a fault or issue, the conditions surrounding it, discussions and analysis, diagnosis, corrective actions, resolution and validation. The deep knowledge, over time, will serve St. John of God to mitigate the risk of changes in personnel and systems – a major failing point with almost all buildings as they evolve.
The advanced quantitative and deep qualitative analysis of OFD provides a holistic process that drives action from initial anomaly identification to resolution of the issues to the measurement and validation of the efficacy of recommended corrective actions. In particular, OFD can pinpoint both small and significant HVAC energy leakages commonly found in non-patient room air conditioning spaces. These include lobbies, nursing stations, meeting rooms, lift corridors, dining areas, and rehab centres. The OFD service takes resolution one step further by embedding validation in the process. Instead of simply closing work tickets by the subcontractor or staff member, the service looks at data points before and after resolution to validate that the work ticket actions were performed and to gauge the impact. Data collection and analysis on an ongoing basis through the NOC is the key to driving the hospital to higher levels of energy efficiency and patient and medical staff satisfaction. OFD service allows the facilities staff to prioritise and filter issues based on multiple variables— energy, comfort, urgency, risk, and cost. It identifies the location and nature of major faults and carries out a diagnosis of deeper underlying issues. An air-handling unit, for example, may not be responding appropriately to the signal from BMS because an upstream control valve on the chiller is stuck. Root cause analysis and troubleshooting ensures that problems are fixed at the source in a timely manner.
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Identifying problems early through monitoring and advanced analytics can transform an existing maintenance process— comprised of both planned and reactive maintenance work orders—into a highly optimised workflow. Output-based fault detection can reduce reactive work orders dramatically, in some cases by 80%. Regular, calendar-based maintenance procedures can either be too early (not needed) or too late (fault/failure), wasting resources and increasing the erratic jumble of reactive work orders. The alternative, condition-based maintenance handles potential faults in a timely manner, catching them before they cascade into larger problems. Advanced analytics allows pattern recognition to signal an impending problem, predicts the time to failure, and schedules a new work order. Teamwork is just as important as analytics to ensure the best from OFD. The ideal process requires forming close relationships with the onsite engineering staff and facilities team to continuously learn about the hospital’s physical needs, and to refine the service offerings accordingly. Weekly or biweekly calls with the facilities team is ideal to track issues, to provide detailed troubleshooting, to evaluate and monitor energy consumption patterns, and to brainstorm new approaches. With quick, accurate detection and rapid response to problems, maintenance time and costs can be reduced significantly. The US-based National Institute of Science and Technology (NIST) claims advanced fault detection and diagnosis can improve the operating efficiency of commercial HVAC systems by 10-30%.
6 REASONS WHY THE 5I PLATFORM IS WORKS WELL IN HOSPITALS 1. Staff and patient comfort is a top priority—There’s a deep understanding that hospitals are naturally cautious given the significant impact HVAC disruption could have on patient care and emergency procedures. Continuous monitoring allows the NOC team to adjust airflow and temperature in any zone immediately following complaint. At St. Vincent’s Hospital in Sydney, Australia, for example, comfort was a top priority. In the end, not only were the energy savings great, but also comfort levels improved. Nurses and doctors made unsolicited comments about how much more comfortable the hospital felt now that the overcooling had been brought under control. 2. No major changes to the buildings are required— The operation is on a turnkey basis. The work is done with the building as constructed and the BMS as it exists. The platform makes them work more efficiently, and utilises optimisation tools to get the best out of them.
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This approach makes it easier for the hospital to try the platform without incurring great expense or risk. 3. Cost reduction is the major benefit— No up-front investment for is required. It’s a SaaS (software as a service) subscription and cash flow turns positive quickly, typically within 6 months. Hospitals are like landlords without tenants to pass costs on to. Therefore, cost reduction is a primary benefit, and that’s where this solution is frequently seen as a success maker. 4. Extension of staff—Below the senior engineering level, technical depth for building maintenance at hospitals is relatively thin. Building optimisation experts add technical depth to the bench, and bring with them new analytical tools to diagnose, anticipate, predict, and rectify problems. With its continuous monitoring, BuildingIQ acts as the eyes and ears of the building. 5. Using analytics to guide the journey—The first part of the journey with a new client is to get a handle on how the building is operating, helping with corrections, retro-commissioning, tuning, and resolving low-hanging fruit, simple things like dampers that are stuck. Many are issues that can’t be seen on a day-to-day basis, but can be identified with diagnostic tools. Analytics is then used to guide the journey in the most effective way from day one. 6. Increasing asset lifetime—Machines last longer when every moving part works in harmony. When a team of building optimisation engineers is monitoring and doing analytics, problems that create downstream problems are identified. If a chiller is oscillating a lot, starting on and off frequently, it puts pressure on its own internal parts and the compressor. The chiller can be guided so oscillation is reduced, overall efficiency is improved, comfort is increased, and the life of every asset in the chain is increased.
SUMMARY Non-intrusive, cloud-based analytical skills, along with a team of highly trained experts can easily handle the task of improving energy efficiency in large hospitals. The result is an ongoing extension of hospital staff capabilities, improved cash flow, a reduction in maintenance, and a longer life for key hospital assets.
FEATURE ARTICLES
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FEATURE ARTICLES
WATERPROOFING HEALTHCARE BATHROOMS There are three essential components to a sound bathroom. It must be structurally sound, aesthetically pleasing, and able to withstand its fair share of wear and tear. However, all three of these components can be compromised without adequate waterproofing.
A
leaking shower seal can be disastrous. It can lead to further leaks, spalling and deterioration, and can be a hotbed for mould growth. If these problems spread to other parts of the building, the repair bill could be eye watering.
Another major problem is the poor priming of parts and surfaces before waterproofing membrane is applied. The Institute recommends using aluminium flashing angles and waterstop angles over PVC wherever possible, and to apply the correct primer depending on the material used.
WHY DO SHOWERS LEAK?
Considering the potential costliness of shower leakages, itâ&#x20AC;&#x2122;s essential to respond to the problem as soon as possible.
The main reasons behind a leaking shower seal are the building settling into its foundations, and the buildingâ&#x20AC;&#x2122;s natural movement with hot and cold weather. Over time, this movement causes the grout and waterproof membrane in the shower to crack, allowing water to enter the surface below. While this problem may not be visible at first, larger cracks can cause tiles to come loose, and cause damage to structural materials such as plasterboard and timber. There are a number of warning signs for leakages. Keep an eye out for swelling skirting boards, dampness, mould, or peeling paint. Damp must smell on the carpet or wallpaper is another sign, along with stained timber under the floor, cracked tiles and missing grout. The problem is widespread in the industry. The Australian Institute of Waterproofing says almost 80% of all complaints against builders relate to water penetration and the resulting damage. In the majority of cases, the Institute finds poor workmanship to be the cause. Rushed installation of flashings, joints and angles can jeopardise efforts to apply waterproofing membrane. Before
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After
WHAT CAN BE DONE ABOUT IT? There are a number of products on the market providing long-term solutions to shower seal leakages. We spoke with the Shower Repair Centre about what products are available. One is its Hydro Barrier Sealant, which prevents water and moisture penetrating the surface below the tiles. It is a clear sealant painted over the tiles and grout in the shower recess. The DiamoSmart system facilitates the micro-erosion of the sheen from the blade of the tile without damaging its aesthetic quality. The SealRight product can then bond with the biscuit of the tile to complete the seal. The products were developed in partnership with an industrial chemical company, and applied concepts used in the marine industry to shower waterproofing. The product is part of an eight-step process offered by the Shower Repair Centre:
Before
After
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WHO CAN WATERPROOF?
1. Removing grout from walls and floor as required; 2. R eplacing with special anti-fungal grout to reduce mould; 3. P reparing junctions of the shower with a high speed diamond tool; 4. A pplying the specially designed SealRight product to all junctions of the shower; 5. Applying the Hydo Barrier Sealant to the tiles and grout; 6. Sealing the shower screen;
Regardless of which company you go through, it is essential to choose a qualified installer with a current waterproofer’s license. This is to ensure their work complies with the Australian Standard AS 3740 - Waterproofing of domestic wet areas. A written guarantee of workmanship should also be supplied. The importance of fixing waterproofing issues cannot be underestimated, so be sure to research the best options available to you. The information in this article was provided by The Shower Repair Centre.
7. Sealing floor waste, and; 8. Servicing and sealing taps, if required. Another aspect of the service is the use of infrared thermal imaging to diagnose problems. The Shower Repair Centre began applying the technology to shower repairs after seeing how thermal imaging could detect hot spots in electrical circuitry. When applied to a bathroom, the technology can determine dry and wet areas without removing tiles or other components. For example, it can determine if a leak is coming from a shower, or the roof into a wall cavity. This leads to more efficient and costeffective solutions.
Before
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AFPRO A+ filter main quality features are: ● effective on even the smallest fine dust particles (PM1) ● extremely energy efficient due to low air resistance ● innovative filter media with a durable pre-layer for easy installation ● Eurovent guaranteed performance
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PHYSICAL CONTROL OF MICROBIAL CONTAMINATION OF WATER IN HEALTHCARE FACILITIES
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and QPoint are trademarks of Pall
provides a protective environment from chemical and thermal disinfectants and is extremely difficult to eradicate, once established. Biofilms can contain opportunistic waterborne pathogens, which are potentially harmful for immunocompromised people, including Legionella pneumophila, Pseudomonas aeruginosa, non-tuberculous mycobacteria, Stenotrophomonas maltophilia and Klebsiella spp. L. pneumophila and P. aeruginosa have been shown to be a major cause of severe infections including pneumonia in high risk patient populations. Mechanical retention of these microorganisms with sterilising grade filtration at the point-of-use has been shown to be effective in providing microbiologically controlled water. Several independent publications can be found in the scientific literature reporting efficacy of sterilising grade filtration as a physical barrier against waterborne pathogens such as Legionella spp. and Pseudomonas aeruginosa at the point-of-use. Furthermore, application of these physical control measures does not lead to an increase in microbial tolerance or resistance, and delivers an immediate barrier effect. The use of sterilising grade water filters at the point-of-use as an immediate control measure in critical contamination and/or outbreak cases, or as a potential longer term measure against waterborne pathogens has been included in many drinking water recommendations worldwide, including those from the World Healthcare Organisation.
FEATURE ARTICLES
HOW EMBRACING MICROFIBRE CLEANING CAN ASSIST HEALTHCARE FACILITIES By Jonas Cruz, ANZ Sales & Trade Marketing Lead at Rubbermaid Commercial Products Creating a clean environment within healthcare facilities is a critical element for success. According to the Australian Guidelines for the Prevention and Control of Infection in Healthcare1, there are around 165,000 HAIs each year in Australian acute healthcare facilities, making HAIs the most common problem for patients in hospital. The development, innovation and practice of cleaning techniques and materials such as microfibre is helping to reduce and manage, health risks and most importantly prioritise the wellbeing of staff, patients and visitors in hospital and healthcare facilities.
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ntroducing and updating cleaning guidelines and standards, however, is not enough, itâ&#x20AC;&#x2122;s also important to stay up-to-date with latest technologies and embrace the best, new solutions offered on the market and implement a rigorous cleaning regime. Frequently cleaning all surfaces and equipment to prevent contamination or infection requires attention to detail and effective end to end cleaning techniques.
when on-site and also significantly decrease work related injuries and illnesses. The unique design of different polymers featured in microfibre products creates positive attraction, holding pathogens and dirt amongst the fibre, reducing the risk of infection and contamination. Its versatility for use on a range of surfaces and touchpoints encourages productivity whilst upholding a high standard of cleaning.
The introduction of microfibre products into healthcare facilities has brought a huge disruption into the traditional wet mop process. Central to maintaining a healthy and safe healthcare environment, microfibre has proven to remove 99.9 per cent of bacteria on surfaces and is becoming the go-to for cleaning staff in the healthcare industry.
If a member of cleaning staff can clean a room in a more productive manner, using products which reinforce a higher standard of cleaning, remove dirt without streaking and dry surfaces quicker than traditional cleaning techniques and leave a visibly cleaner environment behind the more successful and better chance a facility has at providing more effective patient or resident care.
Facilities are always seeking alternative and innovative ways to reduce WHS. Including microfibre products to the cleaning regime can help reduce work related injuries or illnesses to cleaning staff, thanks to a reduced amount of water and chemicals. According to SafeWork2, a hazardous chemical is defined as any substance, mixture or article that has the potential to cause acute or chronically adverse health effects through inhalation, skin contact or ingestion. Through regular cleaning, staff, patients and also visitors can be exposed to these types of chemicals which can lead to harmful skin contact and inhalation of fumes associated with their use.
The reusable advantages provided by microfibre products offers a dependable, highly durable and washable product which is overall more effective than its traditional competitor. Whilst it may present a higher upfront cost, a lower cost is recorded overtime thanks to the lifetime use and the fact it can be washed again and again and reduces the amount of product waste going to landfill. By introducing microfibre into the cleaning process, healthcare and aged care facilities will be able to reap the benefits starting from WHS advantages, increased productivity and ultimately reducing the amount of waste.
Furthermore, transporting large buckets of water and chemicals from room to room can pose risk and injuries to the back, shoulders or neck. Using microfibre eliminates the usage of large volumes of water and chemicals typically used in cleaning, ensures staff, patient and visitor safety
REFERENCES 1. Australian guidelines for the prevention and control of infection 2. Hazardous chemicals
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NEWS
Providing Energy Saving & IAQ Solutions to the Health Care Industry
Leaders in Ultra-Violet Sterilisation & Purification
* Specifically Designed & Engineered UVC technology for HVAC & R * Highest Industry Performance in Cold Moving Air * Australian Independent Certified Measurement & Verification * Clinically Validated & Successful Government Audited Trials * UL & Australian Electrical Safety Certification * Superior IAQ resulting in levels of Pandemic & HAI Protection * Engineers and Facility Managers can easily discern the differences * Real Results!! - Perpetually Clean Coils = Better Heat Transfer Efficiency
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info@steril-aire.co.nz
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NEWS
REGISTRATIONS OPEN FOR ARBS 2020 Visitor registration is now open for the ARBS 2020 trade exhibition, Australia’s foremost platform to connect the air conditioning, refrigeration and building services industry. ARBS 2020 will be held in Melbourne from 19-21 May 2020, at the Melbourne Convention and Exhibition Centre, and offers access to Australia’s most comprehensive display of products, innovations and services from the top HVAC&R and built environment suppliers in the southern hemisphere. Visitors will have the opportunity to connect with thought-leaders to discuss future trends, explore the latest technologies and network with the industry. Visitors can also immerse themselves in intelligent building technologies and solutions within IBTech@ARBS our newest precinct within the exhibition, dedicated to the latest smart, connected and sustainable building and property technology. A thorough schedule of events complements the exhibition including the ARBS Industry Awards, which celebrates the talent that sustains our industry. Information rich presentations will also be delivered at the highly anticipated Speaker Series and IBTech Insight Series; a complete program of speakers which has been developed to support the industry and will be released in the coming months. Sue Falcke, ARBS Exhibition Manager said the exhibition is surpassing all previous size records in Melbourne and is shaping up to be a bumper offering. ‘ARBS is the largest HVAC&R and building services event within Australia and if there is only one event to attend this year, this is it! We encourage all within the industry to join us.’ ARBS 2020 is a must attend event for the entire industry to connect, explore and discuss what’s important in HVAC&R and building services, all amidst an exceptional series of displays, hands-on sessions and seminars. Register at www.arbs.com.au.
ABOUT ARBS 2020 Where: Melbourne Convention and Exhibition Building Exhibition dates: Tuesday 19 May – Thursday 21 May 2020 Cost: Exhibition – free of charge, trade visitors only Seminars – costs to be advised with final programme Awards Presentation Dinner – costs to be advised
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NEWS
FULL STEAM AHEAD EFFICIENT STEAM GENERATION In the last edition of this journal we looked at why steam has, and continues to be, so widely used as the thermal energy medium of many institutions and most healthcare facilities. In this article we will look at why embracing steam as the primary, or only, thermal energy medium makes good sense, and how to optimise the steam generation for maximum efficiency. Steam can be used for all the thermal energy needs of an institution or healthcare facility and includes the following processes: • Building heating (air handling units) • Domestic hot water SSD (sterilisers, washers and RO water loop heating) •C • Kitchen
Embracing steam as the energy medium for all the thermal processes eliminates the need for multiple systems and has many advantages:
• T ypically this will provide a reasonable base load that allows more steady and efficient operation of boilers
re-treat make-up water (softener and perhaps Reverse •P Osmosis) to reduce feedwater TDS and allow higher cycling
ecover energy from TDS blowdown to heat the feedtank and •R preheat make-up water
Embracing steam as the energy medium for all the thermal processes eliminates the need for multiple systems and has many advantages…
•B oilers sized to cater for varying load conditions (usually seasonal) to enable a combination of boilers to be run for maximum efficiency • S team boilers store energy in the pressurised water, which helps them to react to peak loads, and further, a steam accumulator can be used to even out peak demands on the boiler to help boiler efficiency • F ewer systems (boilers) means more capital is available to be used to ensure boilers have high efficiency (boiler design, burner selection and control, stack energy recovery etc.) •E asier to measure and monitor a single system and to integrate energy recovery and efficiency measures as all the thermal processes use the same system and are more likely to be in balance ritical mass to allow knowledge and skills to be built on one •C system, or to engage a specialist contractor to help maintain the system Efficient steam generation will be at the heart of the modern steam system. This will require boilers designed to provide maximum efficiency with modern modulating burners and control. The boilers should be sized to suit the likely load
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•M aximise condensate return – it not only has a high heat energy content, but also has very low Total Dissolved Solids (TDS), so reduces boiler blowdown
•U se automatic TDS control to maintain the optimum TDS level in the boiler
• Humidification
•E asier to implement duel fuel to ensure continuity of supply
Blowdown is often considered an area of loss with a steam boiler, but it is possible to minimise blowdown and, or, recover energy from blowdown. Some aspects to consider are:
educe Oxygen by heating the feedtank and thus use less •R chemical treatment (chemicals increase TDS)
• Laundry (washing, drying, ironing)
•R edundancy only required for one system (less equipment/boilers and less space)
conditions, which may mean different size boilers that can be run in combination to suit the load conditions (avoiding load conditions where the boiler may not run at maximum efficiency, such as very low or very high loads).
The use of a combined cycle allows greater use of the high energy potential of the fuel source. Co-generation will produce electrical power and heat (steam), while Tri-generation will provide electrical power, heat (steam) and cooling (chilled water via an absorption chiller). The use of combined cycle systems, that can produce steam, may be a good fit with the overall energy requirements of a facility.
Measure, monitor and optimise. If there is no visibility of what is happening, then how well the system is working, and if it can be better, are hard to determine. Installing meters to measure boiler and system flows provides the raw data, however this by itself will not normally provide an effective outcome. Monitoring and analysis of this data is required to benchmark the system and identify potential improvements to efficiency and performance, and to maintain these gains ongoing. Recovering energy from the flue gas can greatly increase the overall steam boiler efficiency. The use of an economiser to preheat feedwater going to the boiler is the traditional method of energy recovery from the flue. However, it may also be possible to recover energy to other processes, for example a LTHW system. And what if this could cool the flue gas to a level that condenses the water vapour, and allows the steam boiler to approach an efficiency on par with a condensing hot water boiler? This concept will be looked at in a future edition of this journal along with more on the efficient use of steam.
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