Healthcare Facilities Winter 2019 by Adbourne Publishing

PP 100010900

VOLUME 42 I NUMBER 2 I JUNE 2019

HEALTHCARE

FACILITIES IHEA CONFERENCE SITE VISITS Go behind the scenes at ICC, ANZ Stadium or Westmead Hospital

IHEA IHEA 2019 2019 CONFERENCE CONFERENCE Early-bird registrations now open

CPD – IHEA Learning and Development Program

FEATURED INSIDE:

KEEPING A FIRST WORLD HOSPITAL AFLOAT – Literally CHRONIC CLADDING DISORDER – Learning from the past

CONTENTS REGULARS

FEATURE ARTICLES

Editor’s message

National President’s message

Taking control of your Building 35 Management and Control Systems and delivering the ‘new digital promise’

77 News IHEA ANNOUNCEMENT 9 CEO’S MESSAGE: Introducing the IHEA Learning & Development Program – ‘Logbook’ and ‘Logbook Professional’ BRANCH REPORTS 14 QLD 22 WA 26 NSW/ACT 28 VIC/TAS 30 SA

42 Chronic cladding disorder: Diagnosing and treating the risk of hospital facade fires

53 Keeping a first world hospital afloat – literally 59 The rehabilitation and upgrading of Mulago National Referral Hospital, Uganda 67 Remote health engineering: Implementing proactive maintenance and compliance methods that work

VALE Alan ‘Have a Chat’ Hale 33

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

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

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

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

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REGULARS

EDITOR’S MESSAGE

elcome to the Winter 2019 edition of “Healthcare Facilities”. In this edition we continue to publish international articles presented at the IFHE Congress held in Brisbane in October 2018, with a special article on the Mercy Ships initiative. You may recall John and Sue Clines delivered the story of their personal experience in Brisbane when working on board the Africa Mercy. Their story continues on page 53. Also shared herein is a paper co-authored by Sam SB Wanda, President of UNAMHE (Uganda National Association for Medical and Hospital Engineers). Unfortunately at the last minute Sam was unable to secure a visa to travel to the Congress, but we are delighted to share with you the story of the upgrading of the Mulago National Referral Hospital in Kampala, Uganda.

so I encourage you all to think about how you could benefit from sharing your story and networking with healthcare professionals in the IFHE context. The IFHE Council meetings in 2019 are being hosted by the Institute of Healthcare Engineering and Estate Management – our UK equivalent, in October 2019, alongside the IHEEM Conference and I note that registrations are open. I know for a fact that Aussies will be warmly welcomed to Manchester and encourage all IHEA members to consider contributing your stories in the international arena. Keep your ears and eyes open for opportunities to connect with your international colleagues through the IFHE network. If you are considering a European adventure in 2020, think about joining SIAIS in Rome for the 2020 IFHE Congress – another event not to be missed.

As members of IHEA, you are also members of the International Federation of Hospital Engineering – a tight-knit global community who share the same objectives and ambitions with Healthcare Engineers and Facility Managers across the world. I’m sure you will see reflected in the Sam Wanda’s story, elements of what you are dealing with every day,

I hope you enjoy this edition of “Healthcare Facilities” and encourage you to share this and the electronic version when it arrives in your inbox or your social media stream. Regards Darryl Pitcher

REGULARS

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To achieve recognition and enhance the organisations standing, the IHEA must be able to demonstrate that our membership criteria and associated levels are commensurate with industry requirements and promote confidence amongst health care authorities by ensuring that every person accepted into the Institute is fully qualified for their particular membership level. In my Winter 2018 journal article I spoke of the importance of Continuing Professional Development

REGULARS

(CPD) for our membership, an obligation that underpins our strategic intent to “lead the way for our members to excel in providing state of the art health care facilities and leading-edge management services to support the health and wellbeing of all Australians”. In recognition of the need to raise the professional profile of the IHEA, over the last 12 months, the Board has placed a significant focus on reviewing the credentials for membership gradings and assessing the requirements to maintain or advance an individual’s level of membership. Ongoing learning and development are fundamental aspects in any profession, and is imperative of our organisations intent to cultivate and maintain the highest possible standards of knowledge, skill, ethics and efficiency for those involved in the design, construction and maintenance of health care facilities. The Board has established that in order for an individual to achieve or retain full membership, a predetermined number of CPD points must be attained every year.

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To support members recording professional development achievements, upon payment of membership fees, individuals will be eligible to access the IHEA Learning and Development Program ‘Logbook’ and ‘Logbook Professional’ both of which will facilitate a structured process of documenting professional development activities and allotting CPD points based on the activity performed. The logbook app allows an individual to capture all learning activities, both formal and informal, in real-time or immediately on completion. The process will keep all learning and development records, achievements and evidence in one place where it is always available for immediate update, review and reference. On achieving and maintaining requisite CPD points, a member will be recognised as an “Endorsed IHEA Professional” ratifying the individual as a full and active member of the Organisation. See page 31 for more details of this exciting new opportunity. The Board remains fully committed to position the IHEA as the professional organisation of choice, not just for individuals seeking a career in healthcare engineering or healthcare facilities management, but also for any employer seeking to recruit professionals to their business. Peter Easson IHEA National President

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IHEA ANNOUNCEMENT

CEO’S MESSAGE

INTRODUCING THE IHEA LEARNING & DEVELOPMENT PROGRAM –

‘LOGBOOK’ AND ‘LOGBOOK PROFESSIONAL’ We’re providing more services and enhancing the value and benefits of your membership including new learning & professional development opportunities.

HEA has embarked on an innovative, exciting new strategy to recognise members’ current skills and knowledge and to ensure Continuing Professional Development (CPD) and skills currency. I am proud to introduce the IHEA Learning and Development Program. As of July 2019, all members will be required to complete 100 CPD points every two years, in order to maintain their member level status. This has been designed to capture and record what you are already doing in your dayto-day job and not to be an additional onerous requirement. Members who wish to further develop their skills and knowledge can enrol in the IHEA Professional Certificate which, on completion, will elevate your member level to IHEA Professional. For those members currently at Associate level or not actively involved in the industry the new Affiliate grade is for you and has no CPD requirement.

IHEA is committed to ensuring that our members are leaders in Healthcare Facilities Management and that your membership reflects your expertise. I hope you are as excited about this initiative as we are! I am therefore pleased to introduce you to the new IHEA Learning & Development Program – ‘Logbook’ and ‘Logbook Professional’. Commencing in the 2019-20 membership year, the opportunity for Continuing Professional Development is provided to all Full Members as well as optional pathways to upgrade your membership status in the future. Continuing Professional Development is critical in maintaining competency and skills. Keeping pace with new thinking and knowledge is in everincreasing demand by our employers, government regulators and client stakeholders alike.

IHEA ANNOUNCEMENT

Your IHEA Membership will now include the objective of accruing 100 professional development points every 2 years using the new ‘IHEA Logbook’ process - a Mobile App that makes recording professional development activities a breeze. Introducing the IHEA Learning & ogram Development Pr

Capturing these activities and the associated points, confirms you as a full and active member of IHEA and our industry with current and relevant expertise.

what Capture and record w! you’re doing right no ur way! Your education – Yo

& Support, Develop reer Enhance Your Ca

A further opportunity is available to enrol at any-time, for an additional course fee, and elevate your learning and development to IHEA’s ‘Logbook Professional’ which, on accruing 300 professional development points over 2 years, leads to the IHEA endorsed ‘Professional Certificate’ recognising your investment into your career and the enhanced resume that comes with its completion.

nal’ ‘Logbook Professio gram ‘Logbook’ and earns you & Development Pro g and rnin eze Lea bre A a IHE ies The ent activit A with current fessional developm active member of IHE makes recording pro firm you as a full and con to nts poi d ate associ ry expertise. and relevant indust al and informal, in g activities, both form – capture all learnin p Ap k boo Log • The completion it or immediately on ence in real-time while doing ievements and evid pment records, ach elo ce dev and g rnin lea , review and referen ate upd ate edi • Keep all of your imm always available for ‘Endorsed an as n itio one place, where it’s ogn rec ns you full fessional’ course gai L) for higher • The ‘Logbook Pro of Prior Learning (RP ential Recognition pot & ’ nal sio fes Pro IHEA re details to come. tertiary courses. Mo

When you enrol, the ‘Logbook Professional’ program is accessed through the same application but with a broader and deeper level of applicable self-learning elements, structured learning content and on-line courses. Individuals not actively working in the healthcare industry or post-career have the option of maintaining Affiliate Membership

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IHEA ANNOUNCEMENT

that does not incorporate the Continuing Professional Development, if that is preferred. The ‘Logbook’ app provides you with a full SelfDirected Learning experience. Capture all learning activities, both formal and informal at the time when the learning occurs. Much of our learning and professional development in today’s fast paced world occurs in the workplace – at in-house workshops, in meetings and whilst on the job. So much of our learning and professional development evidence can be overlooked, forgotten or lost because many existing learning regimes are rigid or not available in real-time.

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Any on-line learning activities, Webinars, Workplace Training, Meetings, Review of Technical Journals & Bulletins, Conferences and State Meetings all have components of professional growth, new knowledge being acquired, or new skills learned. These items can all contribute to CPD points under relevant sections of your ‘IHEA Logbook’ program. Keep all of your learning and development records, achievements and evidence in one place, where it’s always available for update, review and reference. Members can upload and record any relevant learning activity based on the table of CPD points which will be sent in your welcome package and will also be made available on the IHEA website. For example; a self-learning activity of up to 1 hour records 1 point. This might be reading the setup manual of a new piece of equipment that is being commissioned in your workplace or reading a relevant technical article. Teaching someone else in your team for 2-4 hours earns 3 points. Attendance at the IHEA Annual Conference earns 15 points. By capturing and recording one short learning activity a week within the Logbook criteria, you will routinely achieve the required CPD points to maintain full IHEA membership. This new program will benefit members who need evidence for any Enterprise Performance Management systems that specify CPD amongst Key Performance Indicators.

IHEA ANNOUNCEMENT

The IHEA program has defined a number of Entrustable Professional Activities – EPA’s. These are categories of learning; eg Human Resource Management, Financial Management and Engineering Systems. There are 25 EPA categories and members will spread their activities over at least 15 different EPAs with a limit of 20 points in any one category. This ensures the natural bias to one’s core qualification or professional discipline is balanced with broader, new knowledge, skills and competencies. “Push” your learning activity and experience by uploading to ‘Logbook’, “Pull” short training activities from the online application. You can also choose from some mobile learning activities including short videos and audio segments.

With ‘Logbook Professional’ you can gain recognition as an ‘Endorsed IHEA Professional’ and advertise your new status on emails, letterheads, business cards and your resume with the ‘IHEA Professional’ post-nominals. Graduates of the IHEA Professional Certificate will gain valuable Recognition of Prior Learning (RPL) toward higher tertiary courses which are being developed for future announcement. What have you done for your Personal Development this week? Logbook it! You’ve done much more learning than you realise! Karen Taylor – CEO

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BRANCH REPORTS

QLD BRANCH REPORT Recent Activities – Country Meeting and PD seminar.

ur Townsville Country Meet held on the 29th March was a huge success.

Our host, Mark Fasolo, Chief Engineer for the Townsville Hospital & Health Services (THHS) was congratulated for his hard work in setting up and coordinating this event. The event was well attended by the North Queensland Healthcare sector with attendees travelling from as far afield as Mackay to the south and Cairns to the north, including a contingent from Brisbane. We were happy to welcome a number of members including Sarah Bailey who flew in from Perth WA. Our program consisted of:

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• Opening address from Kieran Keyes, Chief Executive, Townsville Hospital & Health Services and welcome to country from a very entertaining Mick Illin, Team Leader, Indigenous Liaison Unit. • Indoor Air Quality in Health Care & HVAC in Tropical Climates presented by Craig McClintock, ME Group, on relations of relative humidity and mould who spoke to a case study involving the Palliative Care centre HVAC upgrade and mould remediation. • HVAC & Mould Remediation treatments and techniques, presented by Arthur Melnitsenko, Technical Advisor for Air Restore on Ductwork Sanitisation & Mould Remediation, Case Study from the Ipswich Hospital. • Water Quality Infrastructure & AS 4187 Compliance presented by Alycia More, Manager for Veolia Water Technologies.

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• A presentation on a Case Study of the THHS Redevelopment Project entitled “Striving for AS4187 Compliance” by Mark Fasolo, THHS Facilities Engineer Townsville Hospital Central Sterilising Department. • “Asset Management, Lifecycle Planning & Modelling”, presented by Steve Lyons, CEO, SPM Assets and Amy Matamua, Project Engineer, GHD • Townsville Hospital High Voltage Reinforcement Project, Electrical Infrastructure Systems Automation and Resilience presented by Ian Ribbons, Manager for Welcom Technologies The Technical tour included a visit to the THHS Central Energy Facilities & the recently refurbished Central Sterilising Department that featured in the plenary sessions. We closed the day off with a networking event and trade show function.

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I’d like to take the opportunity to pass on our appreciation to Mick and his staff for their hospitality and the experience of country hospitality.

• Energy Demand Response – “Is the diesel dead?!”

To the speakers and sponsors we express our thanks for their part in presenting a rewarding and professional program and we thank you for your commitment to the IHEA.

The event will include a round of golf, a trade and networking event and dinner. Keep an eye out for more details as they are confirmed.

Special General Meeting and Midyear PD Seminar

Committee of Management President

Brett Nickels

Vice President

Adrian Duff

Treasure

Peter white

COM

Scott Wells

COM

Scott Summerville

The proposed program will include presentations on the following themes:

COM

Kevin Eaton

COM

Stuart Hentschel

• Critical Infrastructure in a Live Hospital – electrical infrastructure upgrades within a live hospital discussing GAP Analysis processes, auditing and risk identification, maximising opportunity for future works, programming construction works and negotiating impact management plans with Facility Executive and Clinical stakeholders.

COM

Todd Marshman

COM

David Smith

COM

Alex Mair

COM

Christopher Ansley Hartwell

COM

Mike Ward

To be held over two days 18th and 19th July at the Victoria Park Golf Club Theme: Contemporary Challenges in Healthcare Engineering

• Breathing Life into an Aging Asset – Chilled Water & Ventilation program within a live hospital detailing site wide mechanical upgrades in a fully occupied facility including performance testing, laser scanning, point cloud and Microbiological air quality sampling for comprehensive and welldesigned mechanical services within a Hospital • Air Quality Management Plan for Mould Control • Hear About the latest developments on AS4187 and the challenges in meeting compliance • Digital Readiness – what does this really look like?

• Case studies on the complexities of operating and maintaining a healthcare facility in the country.

Our loyal treasurer and secretary Jason Ward has moved on due to work commitments and we wish him well and express our thanks for his services to the QLD branch over recent years. To contact the QLD Branch please email ihea.qld@ ihea.org.au Brett Nickels President, QLD Branch

BRANCH REPORTS

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

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

GOLD SPONSORS

Sponsor & Exhibitor Opportunities Available Sponsoring or exhibiting will provide an excellent opportunity to promote your organisation and to maintain a high profile within the Health Industry. Visit www.HFMC2019.org.au to view the available opportunities. Contact the Conference Organisers Iceberg Events Phone: +61 7 3876 4988 Email: bella@icebergevents.com.au

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

#HFMC2019

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

CONFERENCE PROGRAM

This year’s conference theme is Game Plan for the Future of Healthcare Facilities which aims to give delegates an overview of current and future trends in emerging technologies which are already impacting on operational requirements of Healthcare Services. The future roles of Healthcare Engineering & Facility Managers will be pivotal in ensuring these current and new upcoming technologies are implemented effectively from both a technical and strategic perspective. It is essential that Healthcare Engineering & Facility Managers have a strong and informed voice in ensuring that contemporary and emerging technology is incorporated into all facets of Healthcare Facility design. The conference will feature two engaging keynote speakers:

Louisa Hope

Private Damien Thomlinson

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

TECHNICAL SITE TOURS

The congress will feature four technical site tours as part of the program: • Olympus • ANZ Stadium • ICC Sydney • Westmead Children’s Hospital

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

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

BRANCH REPORTS CONFERENCE PROGRAM

DAY ONE: WEDNESDAY 9 OCTOBER 2019 9.30am - 2.30pm

Registration desk open for Masterclass attendees Location: Ground Floor, Novotel Sydney Olympic Park Address: 11 Olympic Blvd, Sydney Olympic Park

10.00am - 1.00pm

Optional Masterclass Workshop & Lunch Please note: This workshop is an additional cost. Location: Parklands Room, Ground Floor, Novotel Sydney Olympic Park 3D Printing Workshop Presenter: Wojciech Wawrzyniak, 3D Printing Technical Specialist, Konica Minolta

From 2.00pm

Optional Technical Tours Tickets required. Delegates must have pre-registered for a technical tour. Technical Tour 1 - Olympus Technical Tour 2 - ANZ Stadium Technical Tour 3 - ICC Sydney Technical Tour 4 - Westmead Children's Hopsital

5.00pm - 7.30pm

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

5.30pm - 7.30pm

Welcome Reception & Trade Night Location: Exhibition Area (Millennium Room) Dress: Smart Casual

Sponsored by

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

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

8.15am - 3.00pm

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

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

Conference Welcome & Housekeeping Conference Emcee: Paul Chippendale

8.40am

KEYNOTE ADDRESS Private Damien Thomlinson

9.40am

Gold Sponsor Address Q-bital Healthcare Solutions

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

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

10.10am

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

10.30am - 11.00am Morning Tea & Exhibition 11.00am

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

11.30am

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

12.00pm - 1.00pm

Lunch & Exhibition

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

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

1.30pm

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

2.00pm

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

2.20pm

2020 Conference Presentation

2.30pm

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

2.45pm

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

BRANCH REPORTS

WA BRANCH REPORT Country Conference – “The Changing Face of Country Health” May 3rd – May 4th

he 2019 Country Conference was held in the West Australian country town of Manjimup, showcasing the new Warren Health Campus located in the Southwest of WA. The $37.6 million project was part of a $300 million capital works program delivered by the WA Country Health Service to improve hospitals in 37 towns across the Wheatbelt, Great Southern, Midwest and South West regions. The new hospital has improved technology to support clinicians and patients alike. Telehealth-enabled consultation rooms mean that more patients can access the care they need from specialists without travelling great distances.

Telehealth-enabled consult room

The Warren Health Service has been designed and constructed with a contemporary information and communications technology system, including a new wireless network for staff. The wireless network will allow staff to be more mobile throughout the hospital, enabling them access to contemporary healthcare technology, helping the delivery of high-quality patient care. The new hospital has also helped attract more doctors to Manjimup, with a total of 14 local doctors now visiting the Warren Health Service. Friday evening saw 40+ delegates enjoy the ‘meet and greet’ event, held at the Gateway Motor Hotel. The social occasions provided the opportunity for

members to network with colleagues, reacquaint themselves with old friends, and establish new friendships with their country members. The Conference was held at the Manjimup Wellness and Respite Community Centre. Fred Foley, our MC for the morning, ensured an engaging session, encouraging delegates and speakers to ask questions and share experiences consistent with this year’s theme, “The Changing Face of Country Health”. Jodie Omodei, Acting District Manager, and Jeremy Higgins, Operations Manager, were our first speakers. Jodie and Jeremy shared their experiences, taking us through the early planning stages of the new health campus, and the involvement community stakeholders and health professionals had, to deliver the $37.6 million country health service. Some of the challenges included the transition from the old hospital to the new, re-orienting staff, providing training with new technologies such as telehealth conferencing, and working in a ‘state of the art’ facility. Their address was especially appreciated for illuminating the particular challenges that face those who work in the WA Country Health Service. Jodie and Jeremy’s professional expertise, and the delivery of their presentation, was well received by all. The Institute appreciates the support and commitment they provide our members through their professional insight, and in helping to energise and rejuvenate our member community. As the morning Conference continued, Fred introduced Logan Joyce, from Pindan who talked the delegates through a video presentation of the construction of the build. Pindan were awarded the project via an open tender process. Their scope, in consultation with architects Silver Thomas Hanley, Community and stakeholder user groups, was to deliver a new Health Care Facility and portions of the parking and roadways, site works and service upgrades. Logan’s presentation provided the delegates with a comprehensive insight into the construction of the Health Campus, from start to finish. Following Logan’s presentation, delegates and Corporate Members broke for morning tea. Morning tea extended to an informative tour of the Manjimup Wellness and Respite Community Centre, hosted by Liz Lockyear, Manager Home and Community Care. The Centre is a multi-purpose facility encompassing Manjimup Community Home Care and other offices, a day centre, consulting rooms, respite, dementia care, therapy, meeting rooms and conference facilities.

BRANCH REPORTS

Delegates and Corporate Members re-convened after morning tea. Fred Foley then introduced a number of Corporate Members who presented across a wide range of topics. The presentation by Sean Lansley, from Eco Jemms, gave delegates an informative insight into the challenges of meeting infection control guidelines, specifically in relation to transporting reusable medical devices between country health care facilities that do not have their own sterilising services. Alex Foster, from Foster’s Services, provided delegates with an informative session on compliance with Australian Standards, particularly relevant to Hospital, Healthcare, and Specialist Healthcare areas. The morning conference concluded with a presentation from members John Pereira and Andrew Waugh, from Serco/Fiona Stanley Hospital. John and

Andrew provided an insight into the complexities and challenges that can present when there is disruption to the power generation and distribution at WA’s flagship healthcare facility, Fiona Stanley Hospital, by external circumstances out of their control, such as a crane working outside the hospital environment “taking out power lines”. After an excellent lunch at the Wellness Centre delegates took part in a tour of the new Warren Health Campus. David Bower, Facility Manager, and Jodie Omodei, Acting District Manager, proudly showcased their new facility, answering a number of questions and giving delegates a good insight into “The Changing Face of Country Health”. Paul Matthews, from Steens, Gray and Kelly, provided delegates with answers to technical questions, including HVAC systems, and interfacing Mechanical and Electrical Services with the Building Management System.

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The WA IHEA would like to acknowledge presenters and sponsors Pindan, ECO JEMMS, Schneider Electric, Enware, and Steens, Gray and Kelly. Our appreciation is also extended to Dave Bower for hosting, and Jodie Omodei and Jeremy Higgins for their time, and allowing the IHEA WA Branch access to their new Health Campus.

Conference Delegates

Special thanks to our conference committee Angela Te Haara, Alex Foster, Phillipe Tercier, Fred Foley and to all members for taking the time to travel to Manjimup, in the WA Southwest, to support our successful Country Conference. Branch Reports February: Men’s Health – Prostate Cancer

The 2019 WA IHEA Country Conference closed that evening with an excellent dinner held at the Tall Timbers Restaurant, which was well attended by 40+ members and partners.

Transparent and ethical with a passion for customer satisfaction. ECO JEMSS is a truly independent Western Australian company that prides itself on reliability, openness and ethical service to all our clients. We specialise in the Healthcare industry be it from the smallest laboratory washer to the largest CSSD steriliser. We include amongst our clients: Public and Private Hospitals; Day Surgeries; Public Pathology; Medical and Dental Practices; Clinics and Universities. Our services include: Sales and installation of sterilisers, washers, heat sealers and all associated CSSD equipment and consumables; maintenance, servicing and repair of this equipment; water testing; steam analysis; logistics transport of sterile and soiled Reusable Medical Devices between facilities; and all your electrical requirements. Our water testing and logistics service complies with the latest amendment to AS/NZS 4187:2014 so please contact us with all your queries at: info@ecojemss.com.au or alternatively visit our sites at: https://www.ecojemss.com.au https://linkedin.com/company/eco-jemss

This was the first branch meeting for the year and was held at the 5D Clinic, Robotic Radiosurgery Cyberknife Unit. Members enjoyed a very informative meeting listening to presenter John Pereira, who described his personal account dealing with prostate cancer, and his experience as the first patient in Australia to be treated using virtual brachytherapy. Professor David Joseph, Oncology expert, and Peter Podia, Medical Radiation Therapist, provided members with an understanding of how the technology uses robotics to deliver treatment and the building specifications required to house and enable this new technology. March: St John of God Hospital, Murdoch. The meeting was hosted by Maintenance Manager John Bose, of St of God Hospital Murdoch, and sponsored by “Invisible Systems”. Their presentation demonstrated how “Invisible Systems Realtime Online” will improve the quality of Legionella monitoring and water hygiene, whilst notably reducing the cost of condition testing and compliance reporting. April: AppTegral This branch meeting was held on the 4th April and was hosted and sponsored by AppTegral. AppTegral’s Ali Baygi and the AppTegral Team presentation, “Bringing Innovative Technologies to Healthcare Maintenance Servicing”, focused on an introduction to smart maintenance technologies, and how users can leverage off advantages the cloud base data storage provides, to create user-friendly experiences for Technicians. The presentation inspired a great deal of discussion and questions for AppTegral. The meeting was held at The Penthouse, Level 51, 108 St Georges Terrace in the Perth CBD – once home to entrepreneur and WA business man Alan Bond. May: Country Conference as outlined above.

BRANCH REPORTS

UPCOMING IHEA WA EVENTS June: Karen Taylor, IHEA CEO will be a guest at the June branch meeting to present the National IHEA “Learning and Development Programme”. The meeting will be held at The Industrial Foundation for Accident Prevention (IFAP) on Thursday 6th June, and will be sponsored by Electrical Data & Security Services. (EDSS) July: The WA Branch will host its “Annual Special General Meeting”. The CoM will be seeking nominations for office bearers and executive positions.

contribution the late Alan Hale brought to the institute of Healthcare Engineering (Vale Attached). We would also like to thank Angela Te Haara, Committee of Management member and Journal Representative, for the number of contributions she has made, on various sub-committees, to bring successful conferences and social occasions to our members. Angela has relocated to New Zealand and will no doubt strengthen the IHEA relationship between the two countries. Angela Te Haara and Fred Foley

August: Friday 9th is the WA State Conference. Promaco Conventions will assist the CoM to organise and run the State Conference. September: TBA October: National Conference Sydney November: Social Sundowner TBA January 2020: WA CoM is seeking feedback from members who would be interested in taking part in cruise from Fremantle to Esperance and back. The cruise would berth at Albany and Esperance, and take on local tours that would include Albany and Esperance hospitals. Please contact Fred Foley via ihea.wa@ihea.org.au Membership WA CoM will undertake a country membership promotion for 2019/20. The aim will be to promote the National Conference, and with the help of Country Regional Facility Managers grow our country membership base. The WA Branch will also be using new technologies to invite members to live stream Branch Meetings via Zoom Webinar. Actions

Committee of Management

WA Branch is calling for nominations for the 2019 WA Branch Achievement Awards, categories Tradesperson, Apprentice and Facilities Manager/ Engineer of the year.

Peter Klymiuk Greg Truscott Fred Foley Rohit Jethro Fred Foley Peter Klymiuk Alex Foster Philippe Tercier John Bose

The Special General meeting in July gives members the opportunity to nominate, or be nominated for the WA Committee of Management. CoM is seeking nominations for committee members and executive office bearers.

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

Acknowledgement

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

On behalf of the Committee of Management and WA members I would like to acknowledge the

Peter Klymiuk WA Branch President

BRANCH REPORTS

NSW/ACT REPORT Activities

he NSW/ACT branch Professional Development day was held on March 22 at Coffs Harbour Hospital, with a theme based around contractor management. The event was well attended with a large contingent of local engineers and managers as well as intrastate members from as far afield as Young. The day’s program offered an interesting mix of presentations including a thought provoking talk around employer obligations from SafeWork NSW, practical applications of management models and some local health project case studies. The day rounded off with an open discussion on relevant topics and a feedback session from members on future content for these events. These discussions will now be part of the standing agenda for future PD events as the opportunity to interact and share knowledge with a like minded group is an important part of the event objectives. The Branch Committee of Management has received very positive feedback around the style and delivery of the presentations and I’d like to express our thanks to John Miles and team for the event’s overall organisation and also to JCI Australia for providing some useful information around the latest building management system developments and for providing the catering at the PD function – everybody agreed that the food was exceptional. Following the success of this regional event, there is a strong commitment to hold similar events at least annually and the attendance and positive feedback from members indicate that there is definite value in continuing with these activities.

Planning is now being finalised for the next IHEA Professional Development Day to be held at the John Hunter Hospital in Newcastle in late November/ early December with the theme to focus on Fire Safety and Compliance. Planning for the IHEA National Conference is now well advanced with abstract submissions recently closed and the partners program and technical tours almost finalised. The master class is also confirmed as a very special 3D printing workshop hosted by Konica Minolta. Please visit the IHEA website for further details or contact any of the CoM members regarding these events, we also welcome and encourage suggestions from members for future subjects of interest for PD activities. A branch special general meeting was held at Liverpool hospital on 10th May 2019. The proceedings included reviewing submissions and subsequent voting for positions on the Committee of Management. Some major changes have been realised in the leadership group with Rob Arian being elected as incoming NSW/ACT President and Jason Swingler to become the NSW/ACT Vice President. Long standing committee member Brett Petherbridge is standing down from the CoM this term and we all extend our gratitude for Brett’s commitment to the IHEA at both state and national levels and his valuable advice and assistance to the other members of the team. This will be my last article for the journal as branch president and would like to thank the current and past CoM’s for their support and enthusiasm for ongoing growth and development of the IHEA and our industry

BRANCH REPORTS

in general, and wish the new executive team all the best for the future. I will remain on the branch CoM. AS2896 Update AS2896 Medical gas systems—Installation and testing of non-flammable medical gas pipeline systems. The draft for this standard is now open for public comment Membership

What’s lurking in

Membership growth continues to be a challenge however interest from both industry groups and health facility management practitioners is increasing and it’s been great to see some new corporate members joining recently. The CoM is discussing a variety of strategies on an ongoing basis. Committee of Management Office holders

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Robin Arian

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Mal Allen

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John Miles

CoM

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VIC/TAS BRANCH REPORT

including objectives, benefits and program of works moving forward

The site visit showcased The Royal Melbourne Hospital Intensive Care Unit, New Stroke Unit, CSSD & Clinical Simulation Centre, and a chance encounter with a number of the instrument robots.

PD1 – Thursday 16 May 2019, The Royal Melbourne Hospital he presentations included:

Yimelo, Simplified data collection: A single source of truth, presented by Anthony Johnston. Yimelo develops mobile-first web applications that health services use to improve productivity and decision making with data technology. These tools increase efficiency and ease the burden of compliance on organisations of all sizes. This includes software packages involved with ESM records, TMV record keeping and contractor management. Computer Facilities Management Software, Melbourne Health, Corporate (non-clinical) digitalisation project, presented by Adriana Stormont, Project Director. Adriana gave a great overview of the development of the project

Upcoming Activity: Webinar 1 - 26th June 2019 at 12:30pm, Biofilm controls at basins Innovative bacteria and biofilm control, for the health engineering professional. Questions that will be considered will include: • Do you need more information and education about legionella design and control? • Where does legionella come from and what conditions promote growth? • How it is transmitted from your reticulated system to your patients. • Where are the risks? • How can risk be reduced? • What is your action plan? “Before it’s too late”. Gentec Australia will run through the new technology that assist’s with bacteria and biofilm controls at basins preventing aerosol release onto hands and surrounding areas, thus reducing risk associated with legionella. They will also consider the Building Automated Control System that connects wirelessly to monitor your buildings TMV’s and tapware at the point of use, including hand wash log options. Sustainability Forum, Monday 23 September 2019, Sunshine Hospital Call for nominations to the Vic / Tas Branch Committee of Management

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This is a great opportunity for entry into the governance and management of IHEA. Vic Tas branch members will shortly receive an e-bulletin calling for nominations. If you are interested and would like further information, please contact the current branch committee members (details below) via email: ihea.victas@ihea.org.au. Membership The Committee of Management will continue to attract potential members from Private Hospitals, Aged Care, and Public Private Partnership Facilities Managers.

BRANCH REPORTS

Branch Committee of Management 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

Committee of Management

Howard Bulmer

Macutex Property

Committee of Management

Sujee Panagoda

Monash Health

Committee of Management

Simon Roberts

CETEC Consultants

Committee of Management

Mark Hooper

Echuca Regional Health

Committee of Management

Roderick Woodford

Castlemaine Health

Michael McCambridge

Melbourne Health

Mark Hooper

Echuca Regional Health

Meeting Convenor

Communications Nation Board Reps

The Committee of Management meet monthly via teleconference and at the end of each Professional

Development activty. Your input and involvement is welcomed. Michael McCambridge â&#x20AC;&#x201C; VIC/TAS Branch President

BRANCH REPORTS

SA BRANCH REPORT Recent Activities:

hrough the generous support of long time supporter of IHEA, NHP Electrical Engineering Products, the Branch in April organised a wellreceived information and networking evening on topical issues in electrical engineering. The first presentation provided insights into the impacts of the current transition from the internal combustion engines to electric vehicles, which are expected to have an impact on all organisations. The presentation reviewed the current state of play and discussed the infrastructure implications of a future where electric vehicles make up a significant proportion of the national vehicle fleet. This presentation was given by Ross De Rango, NHP Product Development Manager, who has an extensive background in technical support, product management, business development and team management in industrial automation, machine safety and hazardous area portfolios. Previously, Ross was an associate lecturer in robotics at Deakin University, Victoria. Wes Gladigau, NHP Technology Specialist in Power Distribution, then presented to the attendees on Switchboard Modernisation: Maintaining Critical Switchgear. Using some case studies and examples, Wes made the case for maintaining existing electrical infrastructure and addressing safety and reliability risks, prior to moving to implement new electrical technologies.

Through our collaboration with CIBSE and related organisations, we have been able to offer our members a range of other professional development opportunities over the last 3-4 months. These included information evenings, seminars and site visits covering: • An insight into the roles and expectations placed on the various stakeholders involved in the construction industry in relation to the approval and certification of installations from concept through to occupation, and ongoing maintenance of Essential Safety Provisions thereafter. • Cyber security for building management systems. • Site visit to a new CBD building to explore the Journey to Deliver and Manage a High Performing Building. • Changes to the requirements for Essential Safety Provisions (ESPs) encompassed within recent Planning Development & Infrastructure legislation and new fire sprinkler systems requirements prescribed within the NCC Volume 1 BCA 2019 edition. Future Activities: Planning is currently underway on a number of PD events. The first of these is planned for July on the subject of the Future of Nurse Call Technologies. The

BRANCH REPORTS

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focus of the PD session would be on near- and midterm innovation of these systems that we rely on so heavily in our healthcare facilities. It is planned that the seminar will address the following questions: • What technologies are around the corner? • How will they integrate with our existing facilities? and • What do we need to think about to future proof our new builds? It is also hoped that a “Meet the Office of the Technical Regulator” event can be organised in coming months in which OTR representatives will address their role as an industry regulator, and current issues and priorities for healthcare project managers, engineers and facility managers. Future events arising out of our collaboration with CIBSE and others include: • Calvary Hospital site visit • U-City Development site visit • Fire Safety Verification Methods

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• Thermal Storage Developments • BIM Revisited The Branch can look forward to a further significant step forward in enhancing the professional status of IHEA and its members with the looming introduction of the IHEA Learning & Development Program. For SA, this new program will be launched at our State Special Meeting on June 20th and it promises exciting additional benefits for members to obtain the recognition of their achievements throughout their career, to recognise and capture learning experiences achieved throughout their working day / lives, to enhance career opportunities and, possibly, to pre-empt future requirements for mandatory qualifications.

The nurse wears either an Entry Pass or Invisalert to respond. This cancels the alarm.

Membership: Again, through the efforts of our keen CoM members, new members continue to join our ranks. I am pleased to welcome Chris Penn (Norman Disney & Young) and Alistair Turner (Turner Vale Projects) as new members over recent months. CoM members continue to identify potential new members and to follow these up as necessary. To facilitate our promotion of the benefits of membership, we have developed membership information packs which provides potential members with ‘why join Institute of Healthcare Engineering Australia” brochure along

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BRANCH REPORTS

with previous copies of our journal, supplementing the material available through our website. Administration: The Branch continues its successful informal relationship with CIBSE and other related professional membership organisations, jointly planning and sharing our PD events for the benefits of members of all these organisations. While still a developing relationship, we have recently also started to share details of PD events with the Australian Institute of Project Management (Health Community of Practice) which we expect will offer members exposure to an even wider range of professional development opportunities. The Branch Committee of Management meets regularly to manage the professional development activities, finances, professional affiliations and membership status for the Branch.

Details of the current Committee of management are provided below: Elected Person

Position

Peter Footner

President

John Jenner

Vice President

Peter Footner

Treasurer

Michael Scerri

Secretary

Peter Footner

National Board Rep

Vince Russo

Committee Member 1

Darryl Pitcher

Committee Member 2

Tony Edmunds

Committee Member 3

Michael Frajer

Committee Member 4

Ross Jones

Committee Member 5

Richard Bentham

Committee Member 6

The State Special Meeting (SSM) for the SA Branch has been set down for June 20th. Apart from the opportunity for members to network with current and recent members, the SSM will finalise the composition of the Branch Committee of Management for 2019/20. Pleasingly, there are indications that a number of members will step forward / step up to roles on the new committee.

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As mentioned above, the new Institute of Healthcare Engineering Australia Professional Development Program will be launched to SA members at the SSM. This is an exciting advancement for the Institute and will assist in enhancing the professional status of the organisation and its members. In advance of the election of a new Committee of Management and new office holders, I would like to express my thanks to the current committee members for their support and assistance to me as President and to thank them for their contribution to the demonstrable growth of the Branch throughout the last year. To contact the SA Branch, please email us at ihea. SA@ihea.org.au Peter Footner President, SA Branch

VALE

ALAN ‘HAVE A CHAT’ HALE 26/04/1954 to 28/09/2018

By Fred Foley, WA Branch Vice President

want to tell you a story about a gentleman, a colleague and a friend. I met Alan by accident. I remember it was over 30 years ago at Royal Perth Hospital and there was a problem with the oxygen supply. Alan and I were the team tasked with solving the problem. From that moment on, he became my colleague and friend. Alan qualified as a HVAC Engineer in the UK 1974, migrated to Australia with his wife Lyn in 1980 and began working with CIG in Subiaco. He worked as a service installation technician and in 1986 he moved to the Medical Division and never looked back, Alan had found his niche. From 1989 to 1996 Alan was a valued member of the RPH Anaesthetic Technicians education program. As with a lot of people in 1997, Alan found himself unemployed when CIG dissolved their Medical Division, typical of Alan this was not to stop him and so A&M Medical was founded. Under his special brand of mentorship A&M Medical grew into the solid business it is today. The medical gases of WA would not be what they are today if it wasn’t for Alan and those like him.

Alan was never one to settle with mediocrity, with Alan it was passion personified. Whatever Alan turned his mind to, it was all or nothing. Whether it was learning, teaching, his hobbies of cars and bikes, even as a member of the IHEA WA branch Alan, gave all of himself without question. Alan loved people and people loved Alan but he always saved his best for his family. He often would speak of the lovely times he would spend with Lyn up in the north west of WA and on their overseas trips. He would tell of their adventures with a sparkle in his eye. When Alan arrived on site you could always guarantee there would be a story or two or three. I miss our talks, the world seems just a bit quieter today. Alan loved to teach, everything I know about medical gases came from Alan. As a Hospital Engineer having Alan as a fall back option gave me a great sense of comfort. Alan took the time to impart his knowledge to me and to my health care colleagues as well, and not asking anything in return, it is us who owe him a big debt. Thank you Alan, you are greatly missed, Rest in Peace my friend.

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TAKING CONTROL OF YOUR BUILDING MANAGEMENT AND CONTROL SYSTEMS AND DELIVERING THE ‘NEW DIGITAL PROMISE’ By David Oakeshott, Leader – Technical Advice (QLD), A.G. Coombs Advisory

ike most technology products, Building Management Systems are undergoing a seemingly endless cycle of change. The demand for fast, reliable and dependable information is rising with a multitude of new systems feeding on the data gathered from the field and an abundant number of providers are beginning to fill our buildings with new and diverse sensors. End users are also becoming more educated in interacting with their buildings and are expecting more from systems which were traditionally back of house.

HOW HAS BMCS TECHNOLOGY EVOLVED AND WHERE ARE WE TODAY? Recent BMS History Unlike most computer systems, the memory and processor requirements haven’t changed too significantly in the field BMS controllers, but the data being gathered and the scrutiny applied to it is ramping up. In many ways he evolution of the BMS in the past has followed closely behind IT trends. The rate of current development demonstrates that this does not appear to be changing. From his book The Road Ahead (Penguin Books, 1996), Bill Gates saw a trend in tech development – “We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next 10. Don’t let yourself be lulled into inaction.” This is particularly true for the development of BMS. Looking back some 25 years ago to the year 1995 and the dominant marketing material for BMS vendors was generally around converting text based “green screen” DOS BMS user interfaces to Colour Graphics in Microsoft Windows environments. This was the moment BMS suddenly came to life.

Fast forward 5 years and there was significant investment in the upgrade of BMS as the Y2k bug spawned a flurry of activity to protect our assets from the perceived new millennial threat. The promise of “Open systems” was established about 15 years ago. This gave the opportunity for standard devices to sit on the same networks, however this unfortunately was not the beginning of the era of “vendor independence’” that many had hoped for. IP based controllers and systems began to emerge as RS485 networks struggled to pass the volume of new data. Around 10 years ago, a web compatible and mobile compatible BMS had become expected. Most vendors provided a solution to appease expectations, but the uptake was mixed. In Australia there was a skills shortage as mining exports more than tripled over the 10 years to 2012. Many consultants, engineers and technicians moved to better paying mining jobs, vastly reducing the amount of manpower available to spurn development in the BMS industry. Following the downturn of the mining industry 5 years ago came the firm establishment of automated analytics and intelligent buildings in the Australian market with mixed results. The marketing promise of reduced operating costs from Data Driven Maintenance was not as conclusively realised by building owners and managers as first thought, with some platforms being rushed into deployment and others under serviced. Today Today, the BMS market is met with an explosion of new market influences. Buzzwords are abundant; IoT, AI, hyper-connectivity, cloud solutions, information driven maintenance, data lakes, Fog computing, big data, framework, multi-platform systems. Information is being demanded on an unprecedented level, and there is

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a clear expectation for fast reliable information. There are a massive number of devices and companies with interests in measuring and controlling all aspects of a facility. For example, Augmented Reality (AR) and Virtual Reality (VR) technologies are becoming more widely used in healthcare from the operating theatre to the boiler room. The construction industry – historically slow implementers of technology – are now commonly using VR combined with 3D drawings and precision laser pointers to lay out equipment and install hangers inside concrete slabs before they are poured. Service organisations are also beginning to use AR to see through walls to the services network of pipes and ducts to diagnose systems. Some mechanical service providers are streaming live (and historical) BMS information to their technicians to aid them in the servicing plant and diagnosing building system issues. BMS information is even being used to assist in equipment lifecycle planning. The runtimes of equipment obviously contribute to the wear of the machines, likewise the number of starts per hour and the additional stress on under-sized machines contribute to the shortening of equipment life and reliability. Third-party devices are also being applied to measure the vibration or sounds from major plant to predict equipment failure. Energy, water and other performance measurements are seeing greater demand with increased scrutiny. The current generation has grown up in a world where “all” information is at the tip of their fingertips through connected mobile devices. Because of this, it is anticipated that the expectation for meaningful, secure, interactivity with systems will only increase with time.

Sadly, being locked into a single manufacturer’s platform usually means: • High maintenance costs • High repair or upgrade costs • Dependant on vendor for advice As such, one of the most frequently asked questions is “which BMS should I choose?”. This however doesn’t have a simple answer, as most platforms provide similar hardware and software features. Sometimes the larger companies offer improved support – but at what cost, and have they been able to retain the skilled staff you want to turn up on the next service call? Smaller companies often have a greater level of customer service but can lack the diverse skill sets required for modern projects. Some offer “open programmability” inferring that other vendors can extend, repair, service or upgrade the system, but there are still ways to lock down even these systems. New players to the market are offering “controllerless BMS” where they use Internet of Things sensors which are combined in logic on either an edge device or in the cloud. Some of the BMS Skills required in today’s market: • Programming language (specific to the vendor and sometimes multiple vendors) • Graphics and human interfaces • Trends and historical reporting – managing controller capacities and databases • Mechanical design

WHAT DOES THIS MEAN FOR THE HOSPITAL ENGINEER TRYING TO MANAGE THE BMS?

– Hydraulic / liquid flow

The reality for many hospitals means considering the existing installation and potentially significant investment in their BMS. In many cases the BMS vendor is the only source of technical advice for the client. Unfortunately, this provides an obvious biased opinion and is not likely to result in a more innovative approach to the solutions required in today’s market. On the other hand, the BMS vendor usually has a good knowledge of the idiosyncrasies of the facility and the ability to provide excellent supporting information to an upgrade which they are involved in.

– Control loops

– Airside – Chillers and staging – Energy management – Sensor selections and proper locations – Control device selections • Electrical systems and power analysis • Cabling design – sensor and signal electromagnetic interference, RS 232 / 422 / 485 and IP network cabling designs and limitations • Protocols • Databases • Other vendor integration • Data presentation

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The answer to the question “which BMS should I choose?” is therefore about who is programming the system and the level of support offered postinstallation. The most important consideration is where technical advice is sought from and how the BMS is policed. A detailed specification is required for small changes to the system or even a service contract. The BMS work needs to be periodically verified to ensure compliance with the specification. BMS vendors often see the BMS specification as a “guide” rather than a contractual document. This has usually come about because of poorly written specifications in the past. In some facilities “analytics” engines have been added, overlaying the BMS with a promise of cheaper maintenance, improved energy efficiency, reduced reactive works or even to police the BMS. While some platforms are achieving some of their goals, often the reality involves more alarms (now coming from the original BMS and the analytics engine), duplication of systems to license and service at additional cost to the building manager, conflict between multiple vendors with competing interests and even downstream BMS networks being overloaded and crashing. It is clear that analytics have a place in the modern system, but just like the BMS, they need to be carefully specified and verified to ensure they achieve the targeted goals. In the past, when it came to issue resolution there used to be a BMS contractor and a services provider (usually mechanical services) standing in a plantroom pointing the blame at each other, now there is a new player in the room offering more confusion. Often analytics providers are not integrating to the desired levels and do not implement nor sometimes understand, the hierarchal relationships between the plant and equipment which service the facility. When implemented correctly, this can provide very powerful insights into the interconnected systems, but too often these are underdeveloped and “simple” rules are applied which are not much better than a well configured BMS alarm regime. Another legacy issue many hospital engineers face is poor documentation. As-built data is often unavailable, out of date or incomplete. Many construction projects deliver separate systems which are expected to provide a seamless user experience, but often fail to achieve the desired level of integration. A recent count of programmed control systems in the central plant of a modern hospital saw over 70 disparate systems. From generator and

HV control systems, right down to stand alone pump controllers, there were over 6 different Windows operating system versions required and countless vendor software packages and proprietary connector cables to manage. In fact, most of the systems were not networked to each other and only a handful had some level of basic integration. Before the audit, the plant operator only knew of 6 of the 70 installed systems, exposing the hospital to significant risk should any of these systems fail. During the review, it was identified that most of the control systems did not have backups for their program or had ever been serviced. In another review of a recently constructed site, it was revealed that there was incomplete commissioning data. While this initially may not sound significant, further investigations identified that the BMS programmers had mislabelled sensors and actuators, failed to connect some devices, fed redundant systems from the same power source or were controlled by the same hardware (causing a single point of failure) and had created graphics that were not matching the physical installation or schematics. In totality, these issues can be compared to a ticking time bomb which is waiting to flare up, usually at the worst possible time. Compounding the seriousness of the situation, the service provider was unaware of these issues and had no plans to test the functionality of the critical systems. Post-installation, poor documentation also led to the inability of the end user to monitor, control, understand or change the BMS. The BMS training for the operators was inadequate and often referred to non-specific generic literature. The user interface was not properly accessible for graphics, reports, alarms and was not intuitive or an accurate representation of the reality in the field. While the previous example was of a greenfield site, often the biggest issue with older facilities is change management. Recent projects have required a significant and expensive re-commissioning process due to well-intentioned technicians who have reprogrammed the BMS to address physical issues, made changes based on poor information leading to an incorrect diagnosis, remotely conducted maintenance without verifying the result onsite or have used the BMS to “fix” other physical issues without addressing the root cause. Many of these changes were undocumented. Older facilities over time undertake projects to expand or reconfigure spaces into alternative uses. It is often overlooked that the BMS requires modification to

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match the requirements of the new space and best serve its needs. Whilst an older facility will plan for the lifecycle replacement or upgrade to the mechanical services, the upgrade or replacement of the BMS is commonly underestimated or poorly planned. Easy energy efficiency gains can be realised by replacing mechanical services, however these gains can be compounded by ensuring that the controlling equipment is current and capable of providing the full extent of control required. Whether maintaining or upgrading an older facility, it is important to consider the fire, power and other life safety functions controlled by the BMS. Neglecting the BMS and leaving these functions untested and unresolved can lead to compliance issues during mandatory full function (power and fire) testing. Within the health facility world, uncontrolled or poorly understood changes to the BMS programming have recently been associated with mould issues, creation of single point of failure and the inability to diagnose problems because the BMS graphical information was no longer valid. All of these situations lead to a significant increase to patient care.

THE FUTURE FOR BMS IN HEALTH CARE FACILITIES Having demonstrated the potential pitfalls in a poorly implemented and maintained BMS, the goal for the modern BMS user is to create a managed, well documented, intuitive system serviced by a competitive environment where the most suited vendor is selected, and price is reasonable. Where practical, convergence with IT should be sought to leverage systems and architecture already provided in a reliable and controlled manner. Analytics can be used to support a well configured BMS and provide valuable insight into issues which would take a trained operator a significant amount of time to manually diagnose. Finally, the system should have a lifecycle plan for progressive upgrades and be future proof. The facility should also consider other input sources to their data model including BIM and any other construction modelling. New facilities or expansion project data can provide valuable information about the relationships between equipment and the spaces they serve, while existing facilities can benefit from point mapping and retrospective drawing uploads to build-up the information when required. To achieve a reliable and high performing BMS, the follow suggestions are provided:

• Prior to undertaking a BMS project, engage a vendor independent BMS specialist consultant to assist throughout the course of the project. Having a third-party specialist assist with identifying the primary requirements of the BMS and provide guidance in writing specifications will greatly improve the odds of a successful outcome. This will also help prevent being drawn into a single manufacturer’s platform and the accompanying pitfalls. • Consider a separate technology package to sit parallel with the mechanical, electrical, communications and security contractors. The BMS shouldn’t be an afterthought, but rather an extensive, planned technology installation. • Create a clear specification for mechanical, BMS and analytics services post construction. This should be targeted on proactive, performance-based maintenance outcomes to ensure that the product has been installed correctly and is operating to its best ability. Savings will be realised in reduced temperature complaints and energy usage. • From the outset of a project, specify the targeted analytics of the new system: o I mmediate alerts – separate to BMS alarms, these alerts are used for multi-faceted events where the equipment is detected to be operating incorrectly. Conversely, ensure there are appropriate inhibits are built to prevent false alarms as over-alerting can lead to lax response times. o S hort term trends – equipment is failing to perform the required outcomes over a period of a few hours or days. o L ong term trends – equipment is repeatedly out of service or desired conditions over a long term. This can also be used to support a lifecycle analysis of the underlying plant and equipment. oD evelop comparative sensors to cross-check readings. oD evelop exercise routines for plant, actuators and end devices. oC onfigure data to feed into a larger dataset which can provide source information to other services in a secure structured method. • Establish clear change management expectations by conducting regular change management meetings with defined responsibilities and deadlines. • Establish a programme to conduct risk management reviews, including physical installation, contractor performance, end user requirements and compliance testing.

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CHRONIC CLADDING DISORDER:

DIAGNOSING AND TREATING THE RISK OF HOSPITAL FACADE FIRES By Panyawat (Oat) Tukaew, Blair J. Stratton – RED Fire Engineers Pty Ltd, Australia

ABSTRACT

ecently, there have been numerous high-profile building fires worldwide involving combustible façades. Often, these fires spread very quickly where lightweight aluminium plastic core composite panels are involved in the fire. This issue has been found to involve all types of buildings including hospitals. In Australia, most states have approached this potential problem by conducting a survey to identify buildings with combustible composite cladding or other combustible wall components. Once identified, fire engineers are often engaged to inspect these buildings and carry out detailed fire risk assessments. This paper outlines the fire safety engineering assessment process; from the initial identification of potentially at-risk buildings, to identifying possible ignition sources, estimating the likelihood of different fire scenarios and determining the facade fire risk. Once determined, recommendations for remediation can be made to lower the fire risk using a special purpose framework. This framework enables risks to occupants and vital assets to be consistently assessed and either minimised or eliminated. The paper will present six case studies of actual hospitals; illustrating the utility of the framework.

INTRODUCTION Recent high-profile building fires worldwide has raised concerns regarding the risk involved with having combustible building products as part of the building facades. Fires involving combustible façades often spread rapidly along the building exterior. In some cases, the fire spreads from the exterior to the interior, overwhelms the fire safety systems in the building and compromises life safety of the occupants. Despite modern building codes requiring most buildings to have non-combustible external walls, the wall components are often found to be noncompliant. The issue of combustible façade has been found to involve all types of buildings

including hospitals. Fires involving hospital facades are potentially catastrophic due to the vulnerable occupants and typical emergency procedures that involve ‘defend in place’ or ‘progressive horizontal evacuation’ strategies. Neither of these strategies are appropriate to defend against external fires. In hospitals, occupants such as those who rely on life support systems may not be ready to be moved without first establishing a place with the appropriate equipment to receive them [1]. Occupants in hospitals such as newborn babies, occupants with infectious diseases or compromised immune system are also more susceptible to heat and toxic products of fire.

THE PROBLEM In order to begin addressing the risk associated combustible façade on buildings, the problem must first be identified. Combustible façade is a broad description used to described combustible elements that form the building external wall. Some façade systems are installed ancillary to the external wall for aesthetic reasons while others function as the external wall itself. Combustible facades often include two major categories of products: Aluminium Composite Panels (ACP) and Insulated Sandwich Panels (ISP). Combustibility of other wall components such as insulation, sarking and timber noggings can affect fire spread along the external wall. Figure 1 – Aluminium Composite Panel (ACP) consists of two layers of aluminium and a layer of composite material in the centre

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ACP typically consist of a composite material between a thin layer of aluminium on each side, as shown in Figure 1. ACP are typically 3-6 mm thick. The composite materials used in ACP typically consist of lightweight polymer such as polyethylene (PE). Some products use a mixture of PE and non-combustible fillers to enhance the fire performance of ACP. The core material in ACP make them extremely lightweight and cheaper compared to solid metal panels. ACP are available in a wide range of colours and surface finishes, which can aesthetically transform and old buildings into a modern version of itself.

Once identified, fire safety engineers are often engaged to inspect these buildings and carry out detailed risk assessments. Figure 3 shows the risk assessment process. Figure 3 – Risk assessment process

Figure 2 – a hole drilled in an insulated sandwich panel during an invasive inspection showing an EPS core

Typically, a physical site inspection is carried out to determine the extent of the cladding and identify characteristics of the subject building. During a site inspection, a fire safety engineer identifies potential ignition sources such as nearby parked vehicles, adjacent buildings, openings and electrical outlets in the external walls, smoking areas, etc. Figure 4 – vehicle parking in close proximity to combustible ACP.

Insulated Sandwich Panels have similar components as ACP but are often much thicker due to the insulation material that form the core of the product, as shown in Figure 2. The insulation material can vary between products; some consist of non-combustible materials such as mineral wool, whilst the more common products use lightweight polymer such as expanded polystyrene (EPS) and polyisocyanurate (PIR) as the core material. ISPs come in a wide range of thicknesses from 20 mm to 300 mm. ISPs are often used as the main component of external walls on buildings to meet insulation performance requirements.

RISK IDENTIFICATION In Australia, most states have approached this problem by conducting a survey of all their assets to identify buildings with combustible composite cladding or other combustible wall components.

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Figure 5 – combustibles stored in a room with louvres which open to the external wall with combustible ACP.

Figure 4 shows nearby parked vehicles in close proximity with combustible façade on an acute services building at a large hospital. Although the combustible façade are installed on the exterior of buildings, it is necessary to carry out an inspection of the interior as well. Figure 5 shows a room originally intended for liquid nitrogen storage being used as a general storage room. Since this room was originally intended to store gas cylinders metal louvres were provided in the external wall for ventilation purposes. However, the general storage of combustible increased the risk of fire occurring and the louvres provided a direct pathway for fire to spread to the combustible façade. A fire originating from this room was one of the fire scenarios assessed for this hospital. During a site inspection, it is often beneficial to make a preliminary determination whether or not the façade system has a polymeric core, which would indicate that it is likely to be combustible. Figure 6 shows photographs from a site inspection where exposed core materials of the façade were found. (a)

(b)

Figure 6 – (a) area with exposed ACP core and (b) close-up photograph showing aluminium and core layers

Immediate and conservative interim measures can then be implemented while material testing is carried out to gather more information regarding the façade system. Information regarding the combustibility of the cladding material is required in order to determine whether or not ignition of the cladding is possible and the extent of flame spread. It is important to understand that small-scale testing of the cladding material cannot provide accurate information regarding how a fire involving the façade system will behave. If more information regarding expected behaviour of façade system is required, large-scale tests are recommended. However, this can be difficult without a supply of approximately 30 m2 of the original cladding and external wall materials. Where ACP is installed as part of the wall, the combustibility of insulation and sarking will influence how a fire will behave. Unless the cladding is installed on top of a non combustible or fire rated wall system, it is important to assess the combustibility of individual components such as the insulation and sarking materials that make up the external wall as well. In addition to information regarding the potential ignition sources and façade system, it is also important to collect information such as the building fire safety systems.

RISK ASSESSMENT After information is gathered from a site inspection, a risk assessment can be carried out. The overall risk level is determined by the likelihood and consequence of several credible fire scenarios. The likelihood is determined by identification of the

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ignition sources near the combustible façade. Any fire safety features in the building such as an automatic sprinkler system will also affect the risk of ignition from interior of the building. Ignition of façade containing combustible components can be generally characterised as follows [2]: • Interior fire spreading to external façade via openings such as windows, internal cavities and concealed spaces. • Exterior fire impinging on the surface of the external façade. • Exterior fire nearby igniting the external façade through radiant heat only. The consequence of a fire involving the façade is a complex process that requires an assessment by a suitably qualified fire safety engineer. A combustible façade system installed on a building does not always result in high risk rating. The extent and orientation of the façade system are important aspects to consider. During the risk assessment, it is important to use the test results from the laboratory testing and other relevant information to assess whether or not the façade system is combustible. The composition of the material

may help inform a fire safety engineer the expected fire behaviour of the façade system when ignited. A risk assessment of the façade system should assess whether or not a fire involving the combustible façade could result in catastrophic loss of life having regards to occupant characteristics. Hospital buildings may have occupants in neonatal intensive care unit, occupants with infectious disease and other immunocompromised occupants. These occupants are expected to be non ambulant or not readily ambulatory. Occupants on life support would require prolonged pre-evacuation time because they are not able to be evacuated until a facility has been set up to receive them in a safe area. For some occupants, toxic gas and heat exposure from the fire can impair their egress. Due to the extended evacuation time expected, a fire involving the façade could spread extensively on the exterior and internally, which may overwhelm the building fire safety systems before all of the occupants have been safely evacuated. Table 1 shows examples of case studies, principle characteristics used in the risk assessments and corresponding average risk rating.

Case

Building use

Façade Type

Number of storeys

Principal characteristics

Average risk rating

Acute care building

Combustible ACP

Four

• Extensive combustible cladding around all sides of the building.

Extreme

• Special care nursery and infectious disease ward inside the building. • Multiple vehicle parking spaces at Ground Level.

Acute care building

Combustible ACP

Thirteen

Medical research

EPS insulated sandwich panels

Eight

• Disconnected cladding from podium levels to main tower.

High

• High-security ward • Office and laboratory use.

High

• Occupants expected to be alert and awake. • Connected walkway to adjacent building. • Vehicle parking in close proximity to façade at Ground Level.

Acute care building

Combustible ACP

Acute care building

EPS insulated sandwich panels

Ambulatory care

EPS insulated sandwich panels

Three

• Current building is a podium for planned hospital tower

Low

• Only one storey is occupied • Combustible façade extends around all sides of the building.

Extreme

• Vehicle parking in close proximity to the façade. • Façade installed near exits.

Seven

• No overnight occupants. • Outpatient services only • Maximum of 3 non-ambulant occupants (under sedation) • No combustible cladding at Ground Level • Long delay between detection and alarm.

Table 1 – Summary of building characteristics of risk assessment cases

High

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REMEDIATION WORKS Once the risk levels for each identified fire scenario have been determined, recommendations can be made regarding the necessary remediation measures to either minimise the risk or eliminate it completely. Risk mitigation works are often carried to ensure that the level of safety is mitigated either so far as is reasonably practicable (SFAIRP) or as low as reasonably practicable (ALARP). The difference between the two approaches is subtle but extremely important [3]. For critical infrastructures such as hospital, an ALARP approach may not be appropriate. It is important to note that risk mitigation does not imply compliance with the local building regulations. Additional steps may be necessary to obtain building approval to demonstrate compliance with the local building regulations. In Australia, this is achieved by following the process described in the International Fire Engineering Guidelines [4] to demonstrate that the requirements of the National Construction Code are met [5]. Often these remediation measures are massive undertakings and require design, planning and funding. As a result, the remediation process required to lower the risk to an acceptable level often takes time. Therefore, it is recommended that the remediation process be implemented in stages. Table 2 shows a sample list of cases where combustible façade has been identified, assessed. The average risk level at the of various remediation stages are shown. Stage 0 risk level represents the risk at the time the building was first inspected. The risk levels are determined as a result of likelihood of an event and its severity. Remediation measures are often carried out to reduce the likelihood of a fire scenario and/or severity as a result of that fire scenario. However, as shown in Cases 1, 2 and 5,

remediation measures carried out in stages do not always result in a linear reduction of risk. Remediation measures are often restricted by time and feasibility of the remediation measures. Work is now underway to deal with the recommendations. Urgent works include short-term measures were carried out to immediately reduce the risks. Procurement is underway for permanent replacement of high-risk materials, as well as full-scale façade fire testing. Short-term/temporary remediation measures For example, Case 1 involves an acute care building, which has extensive ACP with combustible core installed extensively on all sides of the building. The building has neonatal intensive care occupants and occupants with infectious diseases, whom are not readily ambulant. A fire involving the façade could have resulted in catastrophic consequence. Due to the size of the building, removal of all the ACP was not feasible in a short amount of time. Therefore, the risk of ignition was reduced through temporary measures such as removal of nearby vehicle parking spaces. Permanent remediation measures Permanent remediation measures take time to implement as they often require funding, planning and approval. Some remediation measures can be implemented in relatively shorter time frame than removal of the external façade. Removal of the external façade, if necessary, can also be done in stages. Since most ignition sources are often found at Ground Level, removal of combustible façade from the ground up would progressively increases the separation distances between the combustible façade and ignition sources. The first stage of remediation can often be carried out in as little as a few weeks. During this time, planning can be carried out for the rest of the remediation measures,

Case

Building use

Façade Type

Stage 0 risk level

Stage 1 risk level

Stage 2 risk level

Stage 3 risk level

Acute care building

Combustible ACP

Extreme

High

Low

Acute care building

Combustible ACP

High

Moderate

Low

Medical research

EPS insulated sandwich panels

High

Moderate

Low

Acute care building

Combustible ACP

Low

Acute care building

EPS insulated sandwich panels

Extreme

High

Low

Ambulatory care

EPS insulated sandwich panels

High

Moderate

Low

Table 2 – Summary of risk assessment outcomes in various hospital buildings

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which may take several months to implement. Building owners and responsible stakeholders should not wait until the completion of the prior remediation stage before planning the rest of the required works. Permanent remediation can differ greatly between buildings due to the fire scenarios, risk level and stakeholders’ objectives. For example, removal of combustible façade is not necessary in all situations. In Cases 3 and 5, only the combustible façade at Ground Level were recommended for removal due to proximity to vehicle parking spaces that cannot be permanently removed. In Cases 1 and 2, all of the combustible façade were proposed to be removed. This is largely due to the high number of non-ambulant occupants inside. In Case 6, no façade removal is necessary to lower the risk level. In the Stage 1 remediation, ignition sources such as vehicle parking spaces were removed from close proximity of the combustible façade installed on Level 1. In Stage 2, a new programmable fire detection and alarm system is recommended in order to remove the long delay between the alert tone and evacuation tone in the existing building.

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EFFECTS ON OTHER CAPITAL DEVELOPMENT PROJECTS It is important to note that the risk arising from combustible façade has potential to impact not only current hospital operations but future capital development works as well. In Case 1, the hospital had a planned capital development project, which included installation of solar panels on the roof of the acute care building. The planning, funding, approval and installation for this project were obtained and completed prior to identification of the combustible cladding. The system were installed and de-energised for several months while a risk assessment and risk mitigation measures were carried out. In Case 4, cladding has been identified in an acute care building, which has been designed to form the podium levels of a much taller tower, which is expected to be constructed in the future. The risk assessment outcome indicated a ‘Low’ risk rating due to the current building being largely unoccupied. Future works planned for this building is expected to affect the risk rating. This may have significant impact on the final design of the building.

CONCLUSION The risk assessment process discussed in this paper, from the initial identification of potentially at-risk buildings, to identifying possible ignition sources, estimating the likelihood of different fire scenarios and determining the facade fire risk can be used to address the combustible façade risk. Once the risk is determined, recommendations for remediation can be made to lower the fire risk using a special purpose framework. The framework for fire risk assessment is recommended to enable risk to occupants and vital assets to be consistently assessed and either minimised or eliminated.

REFERENCES [1] T. Wigmore, “Evacuation of the ICU due to fire,” The Intensive Care Society, pp. 281-282, 2014.

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[2] N. White, M. Delichatsios, M. Ahrens and A. Kimball, “Fire hazards of exterior wall assemblies containing combustible components.,” MATEC Web of Conferences, 2013. [3] R. Robinson and G. Francis, “SFAIRP vs ALARP,” in Conference On Railway Excellence, Adelaide, 2014. [4] ABCB, International Fire Engineering Guidelines, Canberra, ACT: Australian Building Codes Board, 2005. [5] ABCB, NCC 2016 Building Code of Australia: Volume One (Amendment 1) – Class 2 to Class 9 Buildings, Canberra: The Australian Building Codes Board, 2016.

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KEEPING A FIRST WORLD HOSPITAL AFLOAT â&#x20AC;&#x201C; LITERALLY By John and Sue Clynes

When all lives matter, how can we tolerate the poorest of the poor? How can they join us at the table of life? How can they build sustainable healthcare foundations?

n many ways you are the unsung heroes, every single one of you, behind the scenes building on sustainable foundations. You make healthcare look good. You make surgical teams look great. You make patient outcomes the best there is. Unsung heroes we salute you. It takes a team effort for everything to run together smoothly. We understand who you are and identify with you because of who we are. Allow us to introduce ourselves. We are John & Sue Clynes from engineering and theatre nursing backgrounds living in New Zealand.

So what if we crammed all your jobs and equipment into a floating vessel and turned it into a first class, first world floating hospital? A sustainable foundation floating platform geared to deliver healthcare and healing to the third world. Enter the Africa Mercy, a state-of-the-art floating hospital. Currently in the port of Conakry, Guinea, she is tied up against a wharf for 10 months at a time. In days past ships came to their shores intent on rape and slavery and even today the locals think we have come for the same thing.

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This Mercy Ship is the world’s largest nongovernmental hospital ship. Powered by love and driven by hope, the faith-based charity works against incredible odds to provide healing in demanding conditions. We cannot right all the wrongs but we can do something to restore their dignity as fellow human beings. Formerly a Danish railways ferry, the 16,000-tonne vessel was converted by Mercy Ships into a self-sufficient surgical hospital and an hotel for a crew of 450 professionals from every field. At 152 metres long she is hungry for power with 4 x MAN 950 kilowatt generators to keep the air-conditioning, lights, 5 operating theatres, x ray and CT Scanner and crew quarters running 24/7. The Africa Mercy even produces the hospital’s 95% purity oxygen needs with a concentrator located by the ship’s funnel.

heroes to make other people look good. Great patient outcomes are our highest priority. The Lancet Commission on Global Surgery estimates 5 billion people do not have access to safe affordable and timely surgery. In sub Saharan Africa the access percentage per population is much lower. The ratio of qualified medical doctors here is the lowest in the world. Any medical condition here in these parts is life threatening and often prove to be an early death sentence. Hope deferred makes the heart sick but a dream fulfilled gives you the tree of life. So what can we do about it sitting here in the conference of our lives trying to predict where technology will take us into the future and what skills will we need to bring to the next generation of sustainable healthcare? We need to be hands-on, sleeves rolled up, engineering a better way fighting the inequality of life. A sea-change in attitude is needed.

SO HOW DID WE GET THERE? We sailed from the Canary Islands to the Congo. I was not keen on going myself due to past bad sea going voyages. I thought we were in for a rough ride but I was reassured with the knowledge that the ship is tied up against the wharf for 10 months every season. My wife Sue, a theatre nurse, fulfilled her lifelong dream to work in this unique environment.

Built in 1980 at a gross tonnage of 16572 tonnes, her main engines are 4 x B&W Alpha V16’S turbocharged 4000 hp, each runs on diesel. The AFM has a flat bottom not designed for open sea passages, and is known to roll across the Atlantic Ocean. So where does this floating hospital sail to? If we narrow our focus down to the sub-Saharan West African countries, this is where the poorest of the poor live. These are among the lowest ranked countries for poverty in the world. Hidden behind such people groups and tribes are those suffering even poorer health conditions. Marginalised there are hidden faces kept away in hiding, ashamed, cursed and die miserable lives. How can they join us at the table of life? How can they be given a chance to even participate in their own community already suffering a marred identity of just subsisting from one day to the next? As engineers and healthcare facilitators, the thing we have in common is that like you, we too are behind the scenes. We are also the hidden faces often unsung

What a pleasant surprise smooth sailing is! GPS 0 DEGREES the Prime Meridian is a special honour not many in the world get to see. Those who cross it at 0 degrees latitude and longitude are known as Diamond Shellbacks and Sue and I are Royal Diamond Shellbacks sailing on three occasions past this buoy in the middle of the Atlantic. The married quarter’s accommodation is bigger than a camper van. Singles have their own bunk space and shared room. We lived in this cabin for 2-1/2 years and it even has a Starbucks on board. Coffee is only a dollar $1.00. Life on ship was great belonging to a community with purpose. Kiwi and Australian crew are known as a golden thread through the rich tapestry of Mercy Ships. Per capita Australian and New Zealanders are the highest number onboard of people volunteers in the world. Total crew persons on board number 450 from 50 different nationalities. American, Dutch and English make up the majority. Did I say volunteers? In fact you have to pay monthly for food and accommodation and work a full 40 hour minimum week as Malta registered crew. Sue and I paid approx USD $800 a

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month to stay. Great business model and that is how Mercy Ships are able to deliver free essential surgery to the poorest of the poor. Our Gurkha Security team kept us safe, manning the gangway 24/7 They know everybodyâ&#x20AC;&#x2122;s first name by heart, all 470 crew including families within 24 hours of arrival. Word gets out about surgery offered that is usually unobtainable. Screening lines at the beginning of a field service typically numbers over 6,000 hopefuls. And we start to see the hopeful forgotten poor desperate for a life-giving operation. Club feet can be repaired using the Ponsetti method. Cleft lip and palette is an easy fix done at an early age in the West, but in developing nations do not get the opportunity for repair at any age. Some extreme examples present themselves with benign facial tumours.

A broken local healthcare infrastructure with unreliable electricity, inadequate operating theatre conditions and a lack of trained BioMeds creates a tenuous surgical environment. What happens when the autoclave steriliser is beyond repair and no one knows how to fix it? An operation may be a success, but the risk of infection escalates. When Mercy Ships first arrives in a country, many are initially suspicious the same risk factors may occur. Mentoring local bio medical technicians and teaching theatre nurses about infection control are part of the lasting legacy. Hope and healing is the desired outcome that brings a smile to patients and healthcare teams alike. We were due to go to Benin as next country after another dry dock in the Canary Islands but with porous country borders our ship would become a magnet as Ebola raged. Amazingly the Government of Madagascar invited us to their country. Normally setting up protocols takes years. They did it in 2 weeks! In the Indian Ocean we hoped we would be safe while Ebola raged and took over 4000 lives. On the way to Madagascar we sailed into South Africa for a promotional tour, resupply, rest and recreation for 2 weeks. The same things presented themselves in Madagascar with similar medical conditions is known as the disease of poverty with no hope of a future.

12 year old Kaltoumi has another chance at life as hope and healing begins

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You are already unsung heroes, the best in the business. Why not join us for a season of your life when you are ready to go? Hope you had a great time during the conference as you heroes build sustainable foundations wherever you choose to live, work and play.

ABOUT MERCY SHIPS

Sambani walked for 5 days out of the bush, heard on the radio we were in port. Sambani had a 7.4kg benign facial tumour for 19 years grew to the size of 2 newborn babies. Sue was circulating nurse for the 15 hour operation that saved his life. All the crew were blood donors during his long ordeal to remove it. It takes a dedicated team of mariners to bring hope and healing and we need technical crew. Minimum safe manning for marine operations require some qualified ticketed seafarers. There are several families on board and their children all attend school in our Academy with a full complement of teachers. The Africa Mercy has since been to Benin and Cameroon and is now against the wharf in Conakry till June 2019. We need you short term and long term. Sue and I can vouch for a season of our life story. It was humbling to be a part of it and very rewarding. We were part of building a sustainable healthcare foundation not only on the ship but also in each country we served. We are always on the lookout for volunteers particularly skilled technicians from any field. Whether single or married or even with a school age family and a sense of adventure doing something very fulfilling and worthwhile. The Africa Mercy is possibly the most secure and safest way to work and travel in a remote part of this world.

Mercy Ships is a faith-based charity which uses hospital ships to deliver free, world-class healthcare services, capacity-building and sustainable development aid to those without access in the developing world. Founded in 1978, Mercy Ships has performed more than 100,000 life-changing or life-saving surgical procedures such as cleft lip and palate repairs, cataract removal, orthopaedic procedures, facial reconstruction and obstetric fistula repairs. Services and materials valued at more than NZ$2.33 billion have directly benefitted more than 2.71 million people in 70 nations. Each year, around 1,000 volunteers from up to 40 nations, including New Zealand, serve with Mercy Ships. Professionals like surgeons, dentists, nurses, healthcare trainers, teachers, cooks, seamen, engineers and teachers donate their time and skills to the effort. Mercy Ships New Zealand, one of 16 international support offices, is based in Auckland. For more information click on www.mercyships.org. nz or go to Making a Lasting Impact https://vimeo. com/259097666 to watch a short clip. All images are courtesy of Mercy Ships.

â&#x20AC;&#x153;My hope is to leave the world a little better for having been thereâ&#x20AC;?. Jim Henson

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Compliance

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Carl Kaeser opened his machine shop in Germany in 1919. 100 years later and KAESER is now a global supplier of compressed air solutions that remains true to its origins. In fact a rich history of tradition and innovation to this day allows us to continue to push the boundaries of compressed air technology!

manufacture, it has been developed for optimum efficiency, reliability and ease of maintenance, with an energy savings potential of up to 30 percent*. And, all KAESER products are ready to take advantage of the future-orientated benefits of Industrie 4.0. The result; more compressed air and more savings!

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SOMETIMES THE BEST ASSETS ARE THE ONES WE SIT ON

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

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

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

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

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

Use your head, look for a brand with commercial history who give no less than a 10 year warranty, multiple seat and hinge options, as well as direct representation on the ground Australia wide.

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THE REHABILITATION AND UPGRADING OF MULAGO NATIONAL REFERRAL HOSPITAL, UGANDA By Authors: Eng. Sam. S. B. Wanda/Eng. Joel Aita/Eng. Isaac Ilukor

1.0 BACKGROUND

he Government of the Republic of Uganda received a loan from the African Development Fund (AfDB) and the Nigerian Trust Fund (NTF) towards the cost of the Improvement of Health Services at Mulago Hospital and the City of Kampala Project. The Rehabilitation and Upgrading of Mulago Hospital is aimed at improving the Health Services Delivery at the Hospital. The rehabilitation and upgrade is intended to enable the Hospital effectively perform its mandate of providing super-specialised healthcare, training and conduct research in line with the health sector requirements and policies. A part of the projectâ&#x20AC;&#x2122;s funding was applied for the review of design drawings, detailed design drawings, specifications and Bills of Quantities for Medical equipment, supervision of the construction works. The funding was divided over three lots for Kawempe General Hospital, Kiruddu General Hospital and Lower Mulago National Referral Hospital amounting in total to USD 88 million. Mulago Hospital was founded in 1913 as a treatment centre for venereal diseases and sleeping sickness. Over the years, more facilities and functions were added as need arose but with limited systematic planning. In 1962, the six storey new wing of Lower Mulago was established to cater for the increasing number of patients. At the time of commissioning of Lower Mulago, the population of Uganda was only 7 million, but the population has now grown to 38 million. This further demonstrated the need for re-planning to cater for the increased demand for health services. With the rehabilitation and upgrading of Mulago Hospital it is aimed that there will be improvement of Health Services Delivery at the Hospital. The Hospital will be able to fulfil its mandate of providing superspecialised healthcare, training and conduct research in line with the requirements of Ministry of Health. The hospital was designed to have a maximum bed

capacity of 1.500 beds but had reached a capacity of 1.790 beds with several floor cases which increased the risk of spread of infection thus lowering the quality of health services provided. This rehabilitation and upgrading will lower the bed capacity to 900 beds so as to improve on infection control and health service delivery. The decongestion of Mulago will be aided by the constructed Kawempe Hospital, Kiruddu Hospital, China Uganda Friendship Hospital, Naguru and the recently completed Specialised Women and Neonatal Hospital. The general issues that are addressed by the Mulago hospital rehabilitation project include: (i) I mprovement of inter-relationships between facilities and departments; (ii) Overhauling and modernising of the electromechanical facilities; (iii) Establishment of an Organ Transplant and Dialysis Unit; (iv) Providing ICT connectivity to the facilities at the Hospital; (v) Expansion of areas such as the Pathology Department, Operating Theatres, ICU, Radiology to cater for the increased population in the region (vi) Improving of the internal and external works; roviding appropriate finishes (vii) P

2.0 METHODS OF PROJECT IMPLEMENTATION 2.1 DESIGN REVIEW (PRE-CONSTRUCTION PHASE) A consultant was contracted to perform 6 specific tasks for the Design Review and Supervision for Rehabilitation and Upgrading of Mulago Hospital. These 6 tasks were:

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Installed Philips 128 slice CT Scanner

Pathology Department

1. To review the existing designs, bills of quantities and other documentation for remodelling Lower Mulago complex and proposing necessary improvements, in consultation with users; 2. T o develop and prepare detailed designs; working drawings and building plans for the revised remodelling; and rehabilitation and upgrading schedules; 3. T o prepare specifications, bills of quantities and tender documents for the proposed rehabilitation works; 4. T o supervise the construction works to ensure that works are procured and executed in accordance with the contract specifications, drawings, terms and conditions; 5. T o monitor the works under the defects liability period expected to take 12 months. 6. T o review the existing bills of quantities, specifications and bidding documents for the required equipment. List the required revisions and additions to be made to this set of documents, so to improve upon these documents. Specific areas of concern during the consultancy work included 1. E nsuring provision for Medical gases, Vacuum, ICT facilities and Privacy for patients in wards; 2. I mproving circulation zones and optimising movement distances of staff and patients by positioning the related functions in close proximity. Reinstating all areas at the time occupied by patient beds that were intended for tutorials to allow for cross-ventilation; 3. I mproving interior design/aesthetics to enhance the general ambience of the hospital; 4. E lectro-mechanical systems; designing for “state of the art” facilities for lighting, sound-control / proofing, ICT, emergency response, security and public-

Autopsy Tables in the Pathology department

Renal Unit after the Rehabilitation Works

address system. Including reviewing the design of lift systems to match modern technology; 5. Providing for office and relaxation space for personnel on call preferably on each floor and located close to the work stations; 6. Reviewing the general layout of the work station in wards. Work stations should be equipped with appropriate communication equipment and hand washing facilities; 7. Designing new systems for managing and controlling human traffic to restricted zones such as Theatres, Accident & Emergency units and the Wards including separating inpatient from the outpatient areas as per modern planning and management principles; 8. Appraising of the structural strength of the main support system and examine possibility of adding additional floors or the need for structural improvement for the mortuary and ICU; 9. Reviewing the water reticulation and sewerage system of the pipe work’s encased in concrete columns, without provisions of inspection areas to examine the possibility of simplifying maintenance. 2.2 CONSTRUCTION PHASE The scope of works in the construction phase included: 1. Civil works 2. Mechanical, Electrical and Plumbing Works (MEP) 3. ICT Works Civil Works included: • Construction of a complete Organ Transplant unit on level 6A with 2 Operating Theatres, 2 ICU rooms, 1 HDU and 36 Dialysis Beds (Kidney Transplant, Liver Transplant, Bone marrow Transplant and Cornea Transplant services will be offered) • Expansion of the Centralised Operating Theatres (From 7 OTs to 18 OTs)

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Fast facts.

Destroys Bacteria

Baxx is an environmental pathogen and air-borne pollutant removal system. The Baxx cold plasma technology kills Bacteria, Virus, Moulds & Fungus spores by disrupting the metabolism of their cell walls – no toxins, no chemicals, no radiation. There are neither filters to replace nor consumables – no servicing and requiring only an occasional clean. Install it and let it do the work. Ceiling or wall mounted. 220v -240v. 3 year 24/7 warranty - continuous running.

As used in UK and European hospitals, and now fast being adopted in stainless steel versions with resin fan motor for the food manufacturing industry as well.

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

Protection for Residents & Staff.

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

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9 bed Step-down Adult ICU after the Rehabilitation works

18 bed Adult ICU

Installation of Dental Chairs under the Rehabilitation Project

• Expansion of the ICU above the Private Out Patient Department (POPD) (Capacity increases from 8 beds to 27 beds)

• Provision of drinking water points on each ward

• Expansion of the A&E department

• Replacement of all sanitary fittings at the hospital

• Expansion of the Radiology department (Provision of rooms for MRI, CT scan, Ultrasound etc.)

• Replacement of all internal drainage pipes

• Expansion of the Pathology Department (Mortuary from Current Capacity of 10 bodies to 160 bodies; Creation of Histopathology labs) • Remodelling of wards (Each bed separated by curtains and connected with Oxygen, Medical Air and Vacuum) • Construction of VVIP rooms • Construction of training facilities that include a resource centre, Studio and Lecture rooms • Creating a road strictly for ambulance services to the A&E ward Relocation of the Administration Block to Block • G level 6 from Block E level 4…. • Construction of a 250 seat Conference hall

Medicine and Private rooms on level 6 using solar water heaters

• Overhaul of the sewerage system • Provision of split units and Variant Refrigerant Systems for air conditioning designated areas such as OTs, ICU, Nuclear Medicine, Lecture Rooms, Conference hall • Installation of fire protection systems • Installation of New Lifts (10 No.) • Decommissioning of the Steam Generation Plant • Improvement of the Kitchen to a modern facility • Provision of medical gases to all the 900 beds • Replacement of the High Voltage Panels • Replacement of all the electrical wiring • Provision of standby backup power generators and inverters

• Improving the air circulation in wards by opening up the areas that were blocked by construction to increase the ward space

• Provision of external lighting with sensors to reduce on the power consumption

• Repairing the existing flooring by grinding and wire brushing the terrazzo

• Provision of lightening protection

• Provision of fire detection and alarm systems

• Painting the external façade of the hospital

ICT WORKS INCLUDED

• Cleaning the external mosaic façade of the hospital

• Providing an infrastructure backbone around the entire hospital to ready it for ICT (100km of cable)

• Rebuilding the Main Entrance Gate • External works that involve creating a healing environment that includes green zones and fountains. • Improved road network at the hospital Mechanical, Electrical and Plumbing Works included; • Installation of medical gases to all beds (Medical Air, Vacuum and Oxygen) • Replacing of Cast Iron piping with HDPE piping for fresh water supply from the tanks to the hospital • Provision of hot water supply to a few units such as the OTs, ICU, Burns Unit, Casualty ward, Nuclear

18 bed Adult ICU

• Expansion of the server room • Installation of routers to provide wireless internet around the hospital • Telemedicine will be enabled • Teleconferencing and Tele Consultations will be enabled • Video feed from all OTs to Lecture rooms will be enabled • CCTV camera surveillance in and around the hospital

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Installed Laundry Equipment under the Rehabilitation Project

Generators as for backup power

2.3 MEDICAL EQUIPMENT PLANNING AND INSTALLATION The project incorporated the planning and installation of medical equipment and followed the processes as laid out below; 1. A n equipment audit was carried out that took the following into consideration; a. The present state of the medical equipment and hospital plant b. The type of equipment, quantities available, acquisition and installation period, current estimated value, equipment condition c. T he establishment of a standard list of specialised medical equipment suitable for the Hospital d. The available human capacity and capability to effectively use and maintain the specialised medical technologies recommended for the hospital e. The ability to establish effective mechanisms to predict or anticipate demands, putting forward workable alternatives for specialised medical technologies and equipment acquisition 2. Equipment Planning that took into consideration a. The need for specific equipment b. The available technology and possibility of software or hardware upgrades c. T he kind of service contracts and warranty periods offered by vendors d. The price, training required to manage the equipment and whether the vendor provides the training (as well as TOT services)

High Voltage Panels in the Power House

Laundry Equipment for Drying, Ironing, Folding and Packing

e.g. National Advisory Committee on Medical Equipment (NACME) and WHO

3.0 RESULTS OF THE PROJECT The consultant performed the functions of Project Manager and was generally responsible for the overall supervision of the Contractor on behalf of the Ministry of Health. The consultant was responsible for, but not limited to: (a) Checking that all preliminary documents (e.g. sureties, construction program, and guarantees, staffing schedules etc.) that were provided by the Contractor were submitted and were in order; (b) Ensuring that a proper arrangement was drawn up between the Hospital Management and the Contractor to ensure that the Hospital operations continued during the construction period with minimum interruptions; (c) Briefing the Contractor and arranging for him to take possession of the site and examining and approving his programs; (d) Supervision of the Contractorâ&#x20AC;&#x2122;s performance to ensure that the works were progressing according to the contract including provision of all necessary construction details; (e) Approve the setting out of the works and giving appropriate instructions to the Contractor; (f) Maintaining site records, correspondences and diaries;

f. Ease of maintenance

(g) A dvising the need for and ensuring that special inspection, testing, etc; were done by the contractor;

g. The capacity of the hospital to share a pool of equipment

(h) Conducting site visits as required during the progress of the works;

e. Brand value

h. The lifespan of the equipment, and equipment guidelines as provided by medical authorities

(i) Calling and chairing of site meetings on a monthly basis and as when the need arose;

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Setting out of the Operating Theatres building

Superstructure Works of the Operating Theatres

(j) Submitting monthly progress reports, indicating the progress of the project as measured against the contractorâ&#x20AC;&#x2122;s work program. (k) Preparing interim valuation and payment certificates for works done by the Contractor at regular intervals. (l) Assessing claims submitted by the Contractor as well as potential claims. Advised the Ministry of Health on the appropriate actions that needed to be taken. (m) Liaising with key stakeholders of the project and ensuring that they regularly participated in the supervision and monitoring of the works. (n) Checking and ensuring that the Contractor took suitable measures with regard to the safety and health care of his workers, authorised visitors to the site and the general Public. (o) Ensuring that the Contractor obtained and submitted all approvals from the local authority and statutory body to the Client. (p) Ensuring that the Contractor adhered to the Environmental Impact Assessment report recommendations during implementation of the works.

b. Civil Works Technical Subcommittee c. Medical Equipment Subcommittee d. Project Management Unit 2. Mulago National Referral Hospital (Users) 3. Kampala City Council Authority The Rehabilitation of Mulago Hospital will result into the Government of Uganda obtaining a Super Specialised Hospital that will improve the Healthcare service delivery of the country and minimise referrals abroad. It is important to note the challenges faced during the rehabilitation of healthcare facilities to adapt to the emerging Health Technologies include; 1. Remodelling of rooms designated to fit specific medical equipment is costly and thus the project budget shoots up 2. MEP requirements for emerging Health technologies always leads to modifications in the hospital facility 3. Passage of some medical equipment into the hospital facility require demolition of walls in order to fit the medical equipment in their right locations

4.0 CONCLUSION

(q) Ensuring that all Medical Equipment supplied conformed to the standards specified and supervising their installation.

The Rehabilitation and Upgrading of Mulago Hospital will improve the Healthcare service delivery in Uganda and minimise the referrals abroad.

The progress of works ending 17th August 2018 it is estimated that 93% with most of the Medical Equipment and furniture already installed and training of the user staff ongoing.

The Research, Development and Training facilities incorporated at the hospital will lead to advancement in healthcare.

Stakeholder involvement in the project was key to the success of the project and this was achieved by stakeholders attending monthly site meetings and technical meetings during the project execution. The Project Stakeholders included; 1. Ministry of Health a. Project Steering Committee

Specialised Women and Neonatal Hospital is close to the Rehabilitated Hospital

It would be more cost effective to carry out New construction works of Hospitals as compared to Rehabilitation works taking into consideration the emerging Health Technologies. Aligning medical equipment procurement with the pre-installation works requirements is very important for project planning in order to minimise on costs of the projects.

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

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

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

Some of our health projects include: • Royal Darwin Hospital Chemotherapy Wing & Cyclotron Building • Royal Darwin Hospital CT & PET development • Royal Darwin Hospital Main Entry & Outpatient Developments • Darwin Private Hospital Mental Health Wing • Darwin Private Hospital Nurse Call System Replacement • Prince Charles Hospital Paediatric & Emergency Ward • St Andrew’s Hospital Toowoomba EndoAlpha Operating Theatre • Baralaba Hospital Site Redevelopment • Narrabri Hospital Site Redevelopment • Winton Hospital Site Redevelopment • Mt Morgan Hospital Site Redevelopment • New Ingham Hospital • Mackay Base Hospital Outpatient Facility • Bowen & Moranbah Hospital Capital Infrastructure Planning Studies • Toowoomba Hospital Operating Theatre Suite Upgrade & New Theatre 7 • St Andrew’s Hospital Toowoomba Cancer Care and Radiation Therapy Centre • Toowoomba Hospital 3 Tesla MRI Facility CONTACT: Brisbane, SE QLD & NSW Darren Cardy 07 3510 8888 Toowoomba & SW QLD Brian Kenny 07 4512 6070 66

North QLD Wayne Benson 07 4722 4333 NT/WA/SA Graham Heaslip 08 8942 0585

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

REMOTE HEALTH ENGINEERING:

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IMPLEMENTING PROACTIVE MAINTENANCE AND COMPLIANCE METHODS THAT WORK By Duncan Stegmann and Andrew White

INTRODUCTION

ustralia is a country renowned for its vast remote area. With the majority of residents living in coastal areas, remote Australia covers about 85% of the country’s land mass, mostly in northern and central Australia (Standing Council on Health, 2012) and including large portions of Queensland. According to the Australian Bureau of Statistics, as at June 2015 only 2.21% of Australians lived in remote or very remote areas (ABS 3218.0 – Regional Population Growth, Australia, 2014-15). The below figure illustrates the remoteness of various regions of Australia. Figure 1: ARIA+ 2011 (The University of Adelaide, 2013, The University of Adelaide, 2018, Queensland Government Statistician’s Office, 2018, and Queensland Government – Queensland Health, 2015) Table 1. Summary of Queensland regional health facilities. Source: (Queensland Government, 2016)

Region

Area serviced

Number of facilities

Population serviced

South West

319,800 km² (18.42% of Qld)

4 hospitals, 11 health service centres and two aged care

26,722

North west

253,700 km² (14.6% of QLD

32,615

Central West

382,800 km² (22.1% of QLD

5 hospitals and 10 primary health care centres

12,428

Torres and Cape

130,238 km² (7.5% of QLD)

4 hospitals and 31 primary health care centres

25,498

Cairns and Hinterland

141,600 km² (8.2% of QLD)

247,380

Townsville

149,500 km² (8.6% of QLD)

18 (including the only tertiary hospital in North Queensland) and two aged care

241,318

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In this paper we will look at how these remote areas are serviced by their regional health providers, using rural and remote Queensland as a case study of the maintenance and compliance practices in use. In Queensland, health facilities are generally provided by the Queensland Government via Queensland Health. Table 1 presents the Queensland Health regions that cover the remote areas of Queensland, the number of facilities available, and the corresponding population serviced by these facilities. Table 1 shows that there is a large number of regional health facilities that service small, sparse populations. While Metropolitan hospitals have, and are expected by the community to have, the latest health technology, the latest equipment, efficient work layouts and host a range of specialists, economically, based on patient numbers, such facilities cannot be justified at regional hospitals and health facilities. As such, the current approach in regional Queensland is for regional health facilities to be front line services. In addition to the limit on facilities available, enticing specialists to regional locations is also an ongoing issue for these facilities (Roufeil & Battye, 2008). Budgets are allocated per capita and since rural and remote hospitals serve much lower populations than city hospitals, budgets allocated for development and maintenance do not allow services to match those in cities. Unfortunately, it does not make financial sense to have specialist doctors at each location, nor to have fully operational and staffed operating theatres at these hospitals. In the south western region of Queensland, it is generally more cost-effective for health services to transfer patients requiring complex procedures or specialists from the hospital to the local airport, which is typically several minutes away, for transfer to metropolitan hospitals in Toowoomba or Brisbane using the Royal Flying Doctors. Since rural health sites have limited funding, many contain ageing infrastructure that doesn’t meet current standards and are approaching the need for major upgrades. However, the extent to which a particular site may need upgrading is subjective and will be influenced by many factors including: district population forecast, plans for other new or refurbished health infrastructure to serve the area, and political influences relating to budget availability.

CURRENT STANDARDS IN QUEENSLAND What are the current standards? When referring to the ‘standard’ of facilities, we are referring to one or multiple of the following: mandatory and non-mandatory standards, guidelines, and regarded industry best practice, as well as the expectations of employees, patients and the general public. Current standards and guidelines include Australian Standards, Queensland Health’s series of documents ‘Capital Infrastructure Requirements’ (CIR), Australasian Health Facility Guidelines and NSW Health’s Technical Series TS11, which is drawn on by the CIR and facilities designers. Australian standards are revised every few years and include a range of mandatory and non-mandatory requirements. Queensland Health developed the CIR documents to provide a consistent and standardised approach to health capital infrastructure planning and design in Queensland. They also assist in the preparation of project design briefs for all Queensland Health facility types, including project extensions, expansions and refurbishments of existing buildings, as well as work related to new builds. The CIR may be viewed as a control measure to ensure that facilities are maintained and upgraded in accordance with required Australian standards listed in the CIR and executed according to specific processes. The CIR stipulates compliance requirements for areas marked to be redeveloped (Queensland Government – Queensland Health, 2017). Because so few standards are retrospective, upgrading of facilities to current standards is not prioritised unless other factors determine it to be a priority. With limited funds available, people in positions of authority must decide what is more important; to meet current design standards or to meet community and healthcare professional’s expectations. In what ways are sites not currently meeting the standards? When facilities do not meet standards, it is often community expectations not being met rather than technical non-compliance with standards current at the time of installation. However, one aspect of equipment the public is often not aware of is the extent to which much equipment is on the verge of failure. The lack of maintenance dollars available and the sheer age of equipment is often not recognised

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until equipment does fail, at which time reactive repairs take place. This is not the fault of facility managers, just the reality of limited funds available. As long as standards fall in to several categories including mandatory, recommended and best practice, there will be confusion and subjectiveness as to whether a facility is ‘meeting standards’. Why sites are not meeting the standards The age of building-infrastructure in rural health sites is a key contributor to sites not meeting current standards, with some hospital and clinic buildings constructed in the 1920s and 30s. From our experience, sites which are not ‘compliant’ with current standards are so merely because they were designed and built to standards that have since been superseded. Although best practice may have been implemented at the time, knowledge and technology has moved on but has not been implemented at those sites. Other key contributors to sites not meeting the standards include: • Haphazard retrofits and patch-ups due to obsolete components and the cost limitations of a full upgrade. • Temperature extremes of some regional Queensland sites increasing the deterioration rate of equipment housed externally. There are many and varied reasons for the disparity in standards of rural and regional facilities versus their metropolitan counterparts. Ultimately, the vast majority of reasons boil down to economics and limited funding. There will always be factors, political or other, which will be considered when deciding where money will be spent, however, even then it’s the limitation of funding which results in lowerstandard facilities. Risks of not meeting the standards From a purely numbers perspective, the risks from a regional hospital not meeting standards are not the same as for a city hospital. Regional hospitals service a much lower number of patients, and generally lower risk patients as higher risk patients and those requiring specialist operations are transferred to city hospitals. The types of operations and equipment at regional hospitals is limited to those procedures that can be performed by a skilled doctor or by one under the guidance of a specialist via Telehealth. It is presumed that these hospitals initially determine the extent of care required as soon as a patient is admitted, which

is why many of the regional hospitals are equipped with x-ray facilities. Continued development of technology complicates matters. For example, having more low voltage equipment plugged into patient bedsides can, if faulty, affect patient monitoring equipment or even jeopardise patient safety in the event of an electric fault. Measures now need to be in place to limit the effect of electrical faults within patient locations on the facility as a whole, and being able to immediately determine problematic equipment.

RELIABILITY ISSUES Downtime of essential services is inconvenient and usually very costly. There is a direct relationship between the level of inconvenience and cost, and whether the outage was planned. Reliability problems in rural health sites require additional consideration due to the remoteness of sites, and the limited availability of tradespeople and replacement parts relative to city areas. Some examples follow showing how air conditioning, generator and switchboard failures are often handled. Air conditioning When an air conditioner breaks down in summer, the need for reinstatement of the service, and the limited choice or availability of parts and service-people, often requires expensive and incorrectly sized units to be installed. The operational pressures of installing conditioners that are either too large or too small can result in a significantly shortened life of the unit. Undersized units are overworked, and oversized units can operate incorrectly. Generators Generators are often out of sight and out of mind, but are expected to work seamlessly when the main power fails. However, to ensure this happens they require regular testing. It would typically take a hospital electrician several hours per hospital to conduct routine testing of hospital backup generators as there is no one-stop feature where they can test the functionality of generators without physically simulating a power failure. Testing of the entire system should be conducted, whereby tripping the mains supply at the main switchboard would simulate mains failure. The electrician would need to make their way quickly through the hospital to verify whether generator power is available to all intended areas. This

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approach puts the hospitals at risk if there is indeed a problem with the generator or infrastructure. In the recent refurbishment of some remote hospitals, a one-stop generator testing feature was installed on the new main switchboards to allow a single push button to simulate a power failure without affecting the hospital power. Not only does this drastically reduce the risk to the hospital but it also saves the electrician time by only needing to press the button and verify whether the generator is active and indicators are healthy. Switchboards The failure of an aged and overloaded switchboard can take down the power supply to the whole site, and possibly require the temporary closure of a hospital. Old switchboards frequently contain obsolete components and retrofitting may not be feasible. If suitable parts are available locally, or even in Brisbane, prices are likely to be exorbitant, and the resulting fix is a patch-up job. Once up and working again, budgetary constraints may put the switchboard lower down the maintenance list, while at the same time increasing the chance of another failure.

approaching end of life. However, there is not enough equipment installed in each remote region for operations managers to build statistical performance data and be able to conduct predictive failure analysis, and it’s uncertain how much data the regional managers share and collate. Hospitals in major cities have the volumes to be able to conduct the above analysis and more accurately predict when hardware will likely fail. While particular pieces of ageing hardware in regional hospitals may not appear to be failing any time in the near future, it may be worth considering upgrading such hardware to benefit from efficiencies and features. Operators also need to review the overall requirements to keep sites operating effectively and efficiently, from both a high and low level. For maintenance plans to work they must be comprehensive and contain: • up to date as-installed documentation. • clear and easy-to-use documentation for maintenance and repairs. • records of all plant and equipment, including (as a minimum) the date of purchase, preventive maintenance schedule, location and serial number.

Reactive measures such as the purchase of a generator are also likely to be at a high cost.

• details of routine and preventive maintenance performed for each item of equipment and plant, including electromedical equipment.

The lead-time for the purchase of a new switchboard can be in excess of eight weeks (plus design time), so a new switchboard is not an immediate solution in itself. Proactive maintenance, and keeping switchboards up-to-date, is important.

• records of dates when equipment is regularly tested to ensure its readiness, including information relating to generators and battery backup.

PLANNING AND MAINTENANCE Forward maintenance planning – prevention is better than cure On a positive note, based on our observations, many of the changes needed are starting to be implemented. The main driver of this change is that many people have realised that forward maintenance planning and proactive management does work. Benefits of forward planning include: • minimising the risk of equipment and systems failure. • meeting current recommended standards and bestpractice. • ultimately cost savings are realised. Operators would typically keep abreast of the latest technology, thereby being able to target hardware

Reactive corrective measures can be prohibitively expensive and if issues can be addressed in a progressive way then the facilities can realise cost savings in the long term which can be spent elsewhere. Proactive maintenance Forward maintenance planning will greatly reduce the reliability issues at a remote health site, but unplanned breakdowns, such as to air conditioners and switchboards, will still occur. Equipment and systems failure is a genuine threat, particularly with long time periods elapsing between either planned maintenance or technicians who by chance happen to notice signs of deterioration or impending failure of equipment. Some equipment may indeed require invasive testing and be labour-intensive, but some condition-checks may be done by almost any technical employee. Even better would be to automate error reporting

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where it is economically feasible. For example, emergency lighting systems, to provide light in the event of a power outage, have had self-monitoring and reporting systems for decades. Rather than either having lights that do not work, or people routinely checking them, every site should gradually be migrated to a self-reporting system.

Service-Standards-Guide-for-Multi-Purpose-Services-and-SmallHospitals.pdf Accessed 27 August 2018.

As sites age, they inherently become less compliant with contemporary standards and best-practice. Although many Australian Standards are not mandatory to comply with, best-practice would imply keeping ageing sites up to date with the “most important” standards.

Queensland Government – Queensland Health, 2015. Map of rural and remote health facilities. [Online] Available: https:// www.health.qld.gov.au/clinical-practice/engagement/ networks/rural-remote/rural-facilities/map Accessed 27 August 2018.

Proactive maintenance means finding the root causes of failure and therefore avoiding breakdowns caused by underlying equipment conditions (Accelix Community, 2018). Proactive maintenance relies on the collection of data and ongoing tracking and trending of data to resolve problems before they become failures that take out entire pieces of equipment. As mentioned above, it is difficult to trend data for equipment at regional hospitals as there aren’t enough instances to build data from. Therefore, in using the term ‘proactive maintenance’, we intend it for regional hospitals to mean upgrading or replacing aged equipment with the latest available equipment. Case Studies We’re aware of some sites at which a more proactive maintenance regime has been introduced and it appears to be reducing the requirement for reactive repairs and the associated costs. We’ll report in more detail at the IFHE presentation in October 2018.

REFERENCES Accelix Community, 2018. What is proactive maintenance? [Online] Available: https://www.accelix.com/community/ proactive-maintenance/what-is-proactive-maintenance/ Accessed 27 August 2018. Australian Bureau of Statistics, 2008. Population distribution, Australian Social Trends, 2008 (Cat. No. 4102.0). Canberra: Author. [Online] Available: http://www.abs.gov.au/AUSSTATS/ abs@.nsf/Lookup/4102.0Chapter3002008 Accessed 27 August 2018. Australian Bureau of Statistics, 2018. Regional Population Growth, Australia, 2016-17 (Cat. No. 3218.0). Canberra: Author. [Online] Available: http://www.abs.gov.au/ausstats/abs@.nsf/mf/3218.0 Accessed 27 August 2018. Australian Commission on Safety and Quality in Health Care, 2017. Guide for Multi-Purpose Services and Small Hospitals. [Online] Available: https://www.safetyandquality.gov.au/wpcontent/uploads/2017/11/National-Safety-and-Quality-Health-

Commonwealth of Australia, 2012. National Strategic Framework for Rural and Remote Health. [Online] Available: https://www. aci.health.nsw.gov.au/__data/assets/pdf_file/0004/178852/ National-Strategic-Framework-Rural-Remote-Health-2012.pdf Accessed 27 August 2018.

Queensland Government, 2016. Chief Health Officer reports: Raw data. [Online] Available: https://publications.qld.gov.au/ dataset/2016-chief-health-officer-reports Accessed 27 August 2018. Queensland Government – The Department of Health, 2015. Telehealth. [Online] Available: http://www.health.gov.au/ internet/main/publishing.nsf/content/e-health-telehealth Accessed 27 August 2018. Queensland Government – Queensland Health, 2017. Capital Infrastructure Minimum Requirements (CIMR). [Online] Available: https://www.health.qld.gov.au/chrisp/resources4/capital_works Accessed 27 August 2018. Queensland Government Statistician’s Office, 2018. Accessibility/ Remoteness Index of Australia. [Online] Available: http://www. qgso.qld.gov.au/about-statistics/statistical-standards/national/ aria.php Accessed 27 August 2018. Roufeil, L. & Battye, K. 2008. Effective regional, rural and remote family and relationships service delivery. Queensland Government – Australian Institute of Family Studies, AFRC Briefing No. 10. [Online] Available: https://aifs.gov.au/cfca/ publications/effective-regional-rural-and-remote-family-andrelationship#issues Accessed 27 August 2018. State of Queensland – Queensland Health, 2013. Remote Health Project – Guidelines for planning health services in remote communities. [Online] Available: https://publications.qld.gov. au/storage/f/2014-06-06T00%3A40%3A08.725Z/remote-servicesguidelines.pdf Accessed 27 August 2018. The University of Adelaide, 2013. Accessibility/Remoteness Index of Australia (ARIA+), 2011. [Online] Available: http://www. spatialonline.com.au/ARIA_2011/default.aspx Accessed 27 August 2018 The University of Adelaide, 2018. Hugo Centre for Migration and Population Research, 2018. [Online] Available: https://www. adelaide.edu.au/hugo-centre/spatial_data/ Accessed 27 August 2018

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WHY SHOULD RETICULATED CLEAN STEAM BE CONSIDERED FOR STERILISATION? With many Health Service Organisations (HSOs) looking at making the change to clean steam for sterilisation, the question becomes; what is the best way to implement clean steam? Replacing existing sterilisers with ones which have onboard steam generators is an easy option, however there are also advantages of considering the use of standard sterilisers supplied by a reticulated clean steam system. The merits of the latter are explored in more detail below. Reticulated clean steam would usually mean installing one or more Clean Steam Generators (CSGâ&#x20AC;&#x2122;s) in a nearby plant room and reticulating the clean steam to the sterilisers in the CSSD (and possibly also to the Theatres to provide clean steam for humidification as well). A standalone CSG, while compact in design, does not have the same size constraints as an on-board generator, which must fit within the confines of the steriliser framework. This can be an advantage when considering the design features that help to produce the steam quality required. Steam dryness is largely down to the generator steam disengagement design, which includes adequate water surface area for steam release, enough distance from water surface to steam take-off and effective moisture and droplet separation in the take-off. A standalone CSG, which has less constraint on size, and thus can use a larger generator vessel, is more able to take all these factors into consideration and be sized and designed to deliver steam with high dryness. In addition the larger vessel holds more water and acts as an energy store that helps maintain a more constant steam pressure under the high peak steam demands of the steriliser (EN 285 and ISO 17665 recommend that steam pressure should not vary by more than 10%). Non-condensable gases (NCGâ&#x20AC;&#x2122;s) are controlled by degassing of the feedwater. An adequately sized heated and vented feedtank, with sufficient elevation to prevent feedpump cavitation, is more easily incorporated into a standalone CSG to provide effective degassing of the feedwater. Space in the CSSD is limited and sterilisers tend to be installed very close together with minimal distance between adjacent units. This can make inspection and maintenance of on-board steam generators difficult and possibly even a risk (confined and awkward working space, hot surfaces and electrical and control equipment are but a few considerations). A standalone CSG installed

in a plant room, where there is generally more space available, makes the CSG more accessible and also means that inspection and maintenance of the generator are done in the plant room, rather than in the confines of the CSSD. This will result in less disruption to the CSSD area and of course eliminates the risk of hazards and potential contamination within the CSSD, in particular clean and sterile areas, due to any maintenance and inspection work done on the generators. Further the plant room climate control is less critical, and often done by ventilation, whereas climate control of the CSSD is critical and the heat load that results from the operation of on-board generators adds to the CSSD air conditioning requirements and running costs. Steam quality and purity testing needs to be done as part of IQ or OQ, and there after annual purity testing is required (EN 285 and ISO 17665, which are normative references to AS/NZS 4187, also recommend annual steam quality testing). This means that test points must be installed, and if the testing is to be done in accordance with EN 285, the test points must be within the requirements of the standard (for example 400mm straight horizontal pipe before the dryness pitot tube insertion point). On-board generators tend to have compact pipework, for which installing suitable test points can be a challenge, and sometimes not possible (if done in accordance with the standard). Also each on-board generator is a separate steam source so will need annual testing, meaning multiple tests need to be done each year. With reticulated clean steam the pipework can be designed to incorporate the test points at point of use, and as the steam system is supplied from a common source (even if multiple CSGâ&#x20AC;&#x2122;s are used), annual testing could involve as little as one test at point of use. Less tests means lower costs and less disruption in the CSSD, when the tests are done. If existing sterilisers are compliant then upgrading to clean steam can be done without replacing the sterilisers, as a reticulated clean steam system can be used to supply existing sterilisers. In general, the expected life of a steriliser is likely to be less than that of a robust standalone CSG, so for on-going steriliser renewal / replacement, a steriliser using reticulated clean steam will be lower cost to replace compared to a steriliser with an on-board generator. For more information, please contact Spirax Sarco on 1300 774729 (SPIRAX) or info@au.spiraxsarco.com

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