Healthcare Facilities Winter 2020 by Adbourne Publishing

PP 100010900

VOLUME 43 I NUMBER 2 I JULY 2020

HEALTHCARE

FACILITIES

FEATURED INSIDE:

COVER – NIGHTINGALE MANCHESTER EMERGES IN JUST 2 WEEKS COVID-19 CRISIS – INNOVATIONS AT WORK THE FALKLANDS – COPING WITH CORONAVIRUS

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CONTENTS REGULARS

FEATURE ARTICLES

Editor’s message

National President’s message

23 Tuning building systems in the near future

CEO’s message

84 News BRANCH REPORTS 10 QLD 12 VIC/TAS 15 WA 17 SA 19 NSW/ACT

33 Innovations at work during COVID-19 crisis 37 How flexible solutions can improve the resilience of healthcare delivery 40 Virtual Power Plant participation a hand-in-glove approach for Echuca Regional Health 46 Clinical Engineering: How biomeds make hospitals safer 59 Just do IoT

VALE 20 Philip Douglas Hanbury

INTERNATIONAL

21 Tribute to Tony Blackler

65 How to build an emergency hospital in two weeks

76 Coping with Coronavirus in the Falklands

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

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

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

76 ADBOURNE PUBLISHING 18/69 Acacia Road Ferntree Gully, VIC 3156 PO Box 735, Belgrave, VIC 3160 www.adbourne.com ADVERTISING Melbourne: Neil Muir T: (03) 9758 1433 F: (03) 9758 1432 E: neil@adbourne.com Adelaide: Robert Spowart T: 0488 390 039 E: robert@adbourne.com PRODUCTION Emily Wallis T: (03) 9758 1436 E: production@adbourne.com ADMINISTRATION Tarnia Hiosan T: (03) 9758 1436 E: admin@adbourne.com

Adbourne PUBLISHING

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

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REGULARS

EDITOR’S MESSAGE

e are all aware of how brutally disruptive the past few months have been, and perhaps you, dear colleague, most likely involved in the healthcare sector, have been as disrupted in your workplace as many others. To be fair, perhaps your workplace has not seen the negative impact of financial downturn caused by COVID-19 that has devastated many other sectors, but I’m confident you’ve felt the disruption. I’ve talked to a number of healthcare engineering professionals around the world, in my role with IFHE, and with connections on a number of continents – the stories are repeated. Some have experienced the most confronting personal impacts of staff losing multiple family members to Coronavirus – and to them we extend our heartfelt condolences – but I’m sure you will agree there have been many other impacts. In this edition we explore the amazing feat of how Manchester Central – a massive open indoor convention space – was converted into a 650 bed COVID-19 specific hospital in Manchester, UK – in just over 2 weeks. We also look at how the Falkland Islands prepared for the invasion of COVID-19 and how they responded to their own unique challenges. In every part of the world, necessity is driving innovation and we share with you some innovative options being used to address the emerging needs related to the present pandemic. It’s at times like this I am reminded of how privileged we are in Australia – with government and

industry leadership, that has helped us weather the storm better than many other communities. As Healthcare Engineers – you ought all be proud of the work you have undertaken in supporting the response to the current crisis, and helped our country respond so well. It is therefore the right time to be raising your profile and that of this sector, and of your peak body – IHEA. As membership renewals will soon be circulated, please encourage others to join you and look out for ways you can share your experience and learning with others. I encourage all of you to contribute to this publication and share it with the professionals and companies you work with. As a result of financial pressures on a number of our supporters and stakeholders, it has been agreed that this and the next edition of Healthcare Facilities are online only, to minimise costs associated with printed copies. I’m aware many may think this is the way of the future – and some may be diametrically opposed to this – either way, I’d be please to hear what you think about the new e-Version layout and if you think a hard copy Journal is still warranted in 2020. I hope you enjoy this edition of Healthcare Facilities, and if you have any experiences or solutions that you feel we could share with others nationally and globally, please get in touch with me at ihea.editor@ihea.org.au Regards Darryl Pitcher – Editor

REGULARS

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REGULARS

NATIONAL PRESIDENT’S MESSAGE

t has now been more than four months since the COVID-19 pandemic has been acknowledged as a major health crisis. The public health measures that have been implemented at both a local entity level and state wide to address the spread of the virus have seriously affected our workloads as healthcare engineers and facility managers. This unprecedented event has caused all of us in the industry to reset our previous thinking on how “business as usual” will look in the post pandemic environment. Social distancing, online learning and web based meetings will likely be the new normal and we as healthcare facility professionals have had to become more agile and adaptable in our approach to service delivery. In line with this, the IHEA is continuing to pursue various issues ranging from embracing technology to provide training and professional development opportunities via the LDP program, increasing our online presence by improving the IHEA website and introducing the Young Professionals Group on social media. Working towards broader engagement with the Commonwealth and State Governments and specific healthcare agencies. We will continue to keep members informed in this regard. In other news, members may already be aware that Karen Taylor, former IHEA CEO, has resigned to take up a new position in the education sector. Karen has worked with the IHEA for the last 5 years and has been instrumental in improving membership engagement and connecting IHEA in a more contemporary way via social media. Karen’s leadership and broad knowledge of corporate functions has enabled a high level of professionalism to be introduced into the operation of the IHEA and she leaves a legacy that positions the board well to take our

organisation into the future. I’m sure you will all join me in wishing Karen all the best for the future. Given the current situation with COVID-19 the IHEA board has taken the decision to appoint Clive Jeffries as interim CEO. Clive has worked with the IHEA recently in a marketing and business development role and has a proven track record in senior management. Recruitment to fill the position on a longer term basis will be considered after we have settled into the post-pandemic environment, and we are in a better position to attract the best candidate for the role. Due to the current uncertainty around interstate travel the national conference has been postponed until 13 – 15th September 2021, please check the website for updates around this important event, but for now mark this date in your diaries. The Conference will be held in Perth, WA as planned for this year and we look forward to the opportunity to get together again in person. In closing, I would also like to draw members’ attention to a series of very useful documents and technical papers specific to the international response to COVID-19 published by our partner organisations IFHE and IHEEM. The informative bi-weekly newsletters can be accessed by visiting the IHEEM website at www.iheem.org.uk and navigate to COVID-19 International Response. You can also sign up to receive these newsletters direct to your inbox every fortnight. Astute members will recognise the current IFHE president and IHEA board member Darryl Pitcher appearing in the first issue. Yours truly, Jon Gowdy – IHEA National President

REGULARS

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REGULARS

CEO’S MESSAGE

“Successful associations facilitate communication between themselves and between members to enable the creation of relationships that increase the ability of members to create value for themselves and others” (Belinda Moore SMS).

embership organisations are facilitators of communication, conversations and meaningful connections between and for our members. I have been genuinely heartened by the level of commitment and passion I have witnessed from the National Board. Communication and engagement is absolutely alive and well at the IHEA. This level of engagement and connection, combined with the great foundations already established over many decades, provides an outstanding environment in which together we can take your association to the next level. That was how I started my first journal report in mid-2015. Five years later I sit down to write my farewell journal report and still believe very strongly in the words above. The value placed on members and the desire to provide an outstanding service for them is central to the IHEA philosophy. Associations need to be instigators of meaningful conversations and connect members in a way that provides positive outcomes. IHEA certainly achieves this in spades. Over the last 5 years we have grown from an organisation that was nice to be part of to a truly professional membership organisation with a full Learning and Development Program with more to come!

Membership organisations face significant generational, cultural and economic challenges over the coming decade. Those which choose not to innovate and adapt will decline into obscurity. IHEA is well placed to not just tackle these challenges but to grow and prosper from. The current COVID-19 pandemic has highlighted how critical IHEA and its members are to sustaining and delivering a truly world class healthcare system in Australia. I have been privileged to work with you all and honoured to represent IHEA and Healthcare Engineers both domestically and internationally. Thank you all for the insights into your world. For allowing me to learn that what you all do every day is so valuable to the healthcare services provided around the country. The current pandemic has highlighted to others in the healthcare world the criticality of the role that you all play. Your new CEO, Clive Jeffries, has the right skill set to leverage off this and ensure that Healthcare Engineers continue to be recognised now and post pandemic. I will be watching with interest to see the great strides IHEA continues to make and importantly the increased recognition and acknowledgement the healthcare engineering profession so rightly deserves. Karen Taylor – CEO

BRANCH REPORTS QLD BRANCH REPORT

he current Covid-19 pandemic has seen significant changes in our workplaces, and many of the new ways of working are likely to become the ‘new norm’ moving forward. One of the technologies being applied more commonly is the use of video conferencing technology. Within my own Health Service, my team has been using this technology for over 2 years now, and whilst the technology does not replace face to face contact, it has provided increased efficiency and ability to get things done without the need for travel. With current restrictions in place and lead times for planning conferences, the Queensland Branch has elected to cancel the upcoming Queensland Branch Conference and replace it with a State Special Meeting and PD session to be hosted virtually. This event is scheduled for 23 July 2020 and further details will be made available in the near future. Please mark this date in your diaries.

Membership The Queensland Branch would like to welcome new members: • Andrew Doolan and Steve Garden from SEME Solutions • David Gray and Nick Coffey from Uniting Care Health Committee of Management President

Adrian Duff

Vice President

Brett Nickels

Treasurer

Mike Ward

Secretary

Danny Tincknell

National Board Rep

Brett Nickels

COM

Scott Wells, Artur Melnitsenko, Kevin Eaton, Darren Williams, Todd Marshman, David Smith, Cliff Pollock, Christopher AnsleyHartwell, Peter White

Moving forward, I am working with the Queensland Branch committee to review and propose a new schedule of PD sessions taking advantage of both face to face and video conferencing technologies and I will present the proposal in conjunction with the PD seminar in July.

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

Branch Activities

Adrian Duff – President, QLD Branch

After further discussions and assessment of current travel restrictions, the Mackay Country Meet originally planned

for March 2020, has been deferred to a date yet to be confirmed in March/April 2021. The Committee would like to acknowledge both members and sponsors who had committed time and resources to this event and we will continue dialogue in readiness for the new timing.

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BRANCH REPORTS

VIC/TAS branch Report

embers of the IHEA Vic-Tas branch, along with Health services across the Loddon Mallee Region of Victoria and Health Purchasing Victoria, jointly entered into a cluster sourcing purchasing agreement to provide 12 installations of solar photovoltaic (PV) systems across 11 regional health services. We are proud to be part of this project that has created so many opportunities and positive outcomes for our hospitals, communities, government and the environment in which we live. Solar Photovoltaic Systems â&#x20AC;&#x201C; Loddon Mallee Region Background. The solar PV installations will form an aggregated solar capacity of 1,637 megawatt-peak (MWp) from the solar

panels to be installed across the 12 sites. The largest installation is at Echuca Regional Health Service, which will ultimately have 1386 solar panels. The installed systems will provide a projected 15.7% of the hospitalsâ&#x20AC;&#x2122; combined electricity requirement ranging from 6% for a large hospital site, adding to an existing system, up to 27% for one of the rural hospitals. There will be a reduction in operational energy costs by a conservative estimate of $550,000 per annum, once fully operational which includes around $397,000 in solar production value and further savings in reduced demand and LGC values as determined at the time contracts were awarded. The systems will reduce greenhouse gas emissions by approximately 2,266 tonnes CO2-e per annum.

BRANCH REPORTS

The Regional Health Solar Program is a Victorian state government initiative which allocated $10 million in loan funding in 2017-18 and 2018-19 to assist regional health services to install solar PV systems to reduce their energy costs and greenhouse gas emissions. This funding will purchase sufficient solar PV to self-generate more than 14 gigawatt-hours (GWh) of renewable electricity annually, replacing 3% of state-wide hospital electricity consumption – and up to 30% of the electricity required by some of the regional hospitals. The first tranche of tender offers was released in April 2018, following a successful pilot with health services in the Gippsland region. Three further rounds of tender offers during 2018-19, conducted in the Grampians, Hume and LoddonMallee regions. Key messages • The ‘cluster sourcing’ approach collectively delivers the best value outcome, taking into account criteria encompassing financial, environmental, and regional benefits. • The approach aligns with Victoria’s social procurement framework policy objectives towards sustainable Victorian regions, and implementation of objectives of the Victorian Climate Change Act. Learnings from this programming that may help others planning similar projects. • Make sure you get a dilapidation and structural report of the buildings. • Check the panel type Mono or Polycrystalline, Mono have the greatest efficiency. • Does the system have shaded areas? Installing panel optimisers will increase the efficiency of the system, as a whole string of collectors are not adversely effected by one poor performer. Table of contracted systems Health Service

Solar PV capacity (kilowatt-peak)

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200

Echuca Hospital

500

Heathcote Hospital

Inglewood Hospital

Kerang District Hospital

Kyneton Hospital

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• Check on warranties for major equipment like Cat scanners when using solar. • Generators … most solar generation systems are shut down when on site back-up generators are used on mains failure. Innovative technology is available to synchronise the solar and back-up generator systems, but will require further controls and financial investment. • If power is to be exported to the grid, make sure you know the requirements, limitations and the costs involved. • The photo shows one of the logistical challenges we faced when having to utilise crane lift to place solar panels in place. Check out the boom length. Roderick Woodford Member IHEA Vic, Tas Reference list: HPV; Sourcing Indirect Products and Services. www.hpv.org.au

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BRANCH REPORTS

WA BRANCH REPORT

he Western Australian Branch celebrated the opening of 2020 with a successful professional development meeting at St John of God Hospital in Midland. At the same time on the far horizon the threat of the COVID-19 virus was beginning to make itself known. By the beginning of March it was having an impact in Western Australia. The March branch meeting hosted by Western Power’s Mr John Righetti had to be scaled back to accommodate the emerging COVID-19 restrictions. The original agenda included a site visit the Western Power State Control Centre, sadly this had to be abandoned at the last minute to protect these essential workers from potential infection. Nevertheless, our attending members were thoroughly enthralled with the delivery of two excellent presentations. The first was a reflective overview of a bush fire event that threatened Perth’s power supply network in January 2020. The presenter Mr Malcolm (Mal) Basketter (Network Control team Leader) lead us step-by-step on how Western Power manage network emergencies. From being aware of threats, how they responded, and in greater detail how they managed a number of critical power network events in recent history (bushfire, generation failures, storms) – so as to maintain power supply to customers across the South West Interconnected Network (SWIN) of Western Australia. The members responded with a deluge of questions and discussions that could have easily consumed the rest of our meeting time.

In addition to value of the first session, our members were privileged to be the audience of Western Power strategic development and planning team’s Ms Mel Mercer Royce (Senior Strategy Analyst) & Richard Barnett (Senior Planning Engineer / Grid Solution) who shared Western Power’s future directions and plans to meet Perth’s growing power requirements. We were shown an informative presentation of Perth’s power demands and how Western Power intends on meeting the future, with network supported micro grids that supplement with solar power and battery banks.

Meeting chair and State Secretary Mr Andrew Waugh thanked Mr John Righetti and his team for such an informative and entertaining evening by presenting them with a bottle of Hand Sanitiser (at the time more valuable than gold). Thank you to Andrew for arranging this excellent meeting.

During general business State Vice President Mr Fred Foley presented member Mr Len Mumme with his 10 year certificate. During Len’s response, he enlightened us with his observations on when he joined the IHEA and how the IHEA WA has grown into the professional body it is today without losing its personal touch. As the COVID-19 restrictions tightened in Western Australia it was clear that it was no longer possible to hold safe

BRANCH REPORTS

branch meetings, resulting in the WA Committee deciding to suspend all branch meetings until it was considered safe to resume. To continue with our Professional Development strategy the State Committee set out to hold branch meetings via the digital media ZOOM®. This posed the challenge; how do you teach the more senior members how to use digital media? The answer – “solicit the assistance of the younger members of your family!”. Past State President Mr Greg Truscott has taken on the portfolio of “Digital DJ”. May, saw 17 members attend our first ZOOM branch meeting. The meeting was chaired by Mr Greg Truscott and hosted by Mr Alex Rodgers, Norman, Disney and Young’s Group Health Director. Alex presented an informative insight into COVID-19 titled “COVID-19 Engineering Preparedness and Myth Busting”.

Alex’s professionally researched delivery was informative, triggered questions and prompted open discussion around how Healthcare Facility Managers deal with the growing demand of containing the COVID-19 virus in a Healthcare environment. The presentation offered professional opinions from the world’s FM and Heath consortiums to bust some of the COVID-19 misinformation that Healthcare Facility Managers are faced with. The presentation contains many valuable reference links and is available for members on request. The meeting provided an opportunity for members to share their experiences and challenges they faced preparing for and managing COVID-19 – from the short notice to stand up a COVID Clinic, to the Just-in-Time adaptation of patient rooms to achieve negative pressures for building pandemic patient capacity ahead of the curve. For our first digital branch meeting, it has deemed to be a great success. Thanks to Mr Alex Rodgers who set the presenters bar high, to Mr Greg Truscott (aptly support by his son James) for tying this all together and not forgetting Executive Assistant Ms Sarah Trinidad who supported Alex.

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June 4th at 7:30pm saw our second ZOOM branch meeting with Mr Neil Armstrong from CHUBB providing a professional development session on infra-red thermal camera technology, and the latest applications including body thermal measurement (with live demonstration) providing healthcare facilities with further tools to assist in managing our current issues. July will see our annual State Special Meeting. We are looking to holding our first face to face meeting since the lockdown in March 2021. Nominations are called for all IHEA WA Committee of Management positions. Fred Foley – WA State Vice President

BRANCH REPORTS

SA BRANCH REPORT

ow the world has continued to change rapidly since our last report, and importantly the healthcare industry (and its engineering specialties) has never been more front of mind in the world around us. We have all experienced significant business disruption as we grapple with the rapidly changing environment. Your SA/NT Committee of Management has had to place many of our plans on hold. But with further relaxation of restrictions in the coming months, we are resuming planning for face to face PD events - and we are looking forward to reconnecting with all our members.

be hosted in Adelaide in 2022. We welcome any thoughts, ideas and feedback. In the coming months we will also host our State Special Meeting so please give serious consideration to joining the Committee and directly contributing to your local IHEA branch. If you have any queries about SA/NT branch activities or would like to offer any suggestions please email ihea.sa@ ihea.org.au. The Committee is always happy to receive feedback and understand how it can deliver greater value for members. Committee of Management

We offer a special welcome to new members Mark Leo and Edward Lyons.

President and National Board Representative

Michael Scerri

Vice President

John Jenner

In my last report I noted that the committee was starting to consider planning for the 2021 National Conference in Adelaide. Since then, you will have received advice that the 2020 Perth Conference has been deferred by 12 months, and accordingly the National Conference will now

Treasurer and Secretary

Peter Footner

Committee Members

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

Michael Scerri â&#x20AC;&#x201C; President, SA Branch

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BRANCH REPORTS ACT/NSW Branch state conference

NSW/ACT BRANCH REPORT President's Report to National Board June 2020

lanning is underway for next NSW Professional Development Day in Q4 2020. The event will be held in ACT with the exact location to be determined. Theming for the day will be around COVID-19 and Bushfire Preparations and once details are locked in programs will be distributed in due course. The commitment to hold these events in regional and nonmetropolitan areas at least annually will now be ongoing and the attendance level and interest from members in these areas indicate that there is definite value in this approach. ANZEX Due to COVID-19 travel restrictions both NZ and AUS national conferences were postponed till 2021, so this exchange program will be deferred until the next National Conference.

The State conference was organised to be held in May 2020 at Coffs Harbour NSW, however due to COVID-19 travel restrictions it has been put on hold until further notice. ACT/NSW Special Branch Meeting A special branch meeting was convened on 22/5/2020 and the CoM was confirmed as per below. Membership Interest from both industry groups and health facility management practitioners is increasing and it’s been great to see some new corporate members joining recently. The CoM is discussing a variety of strategies on an ongoing basis. Committee of Management Name

Position

Robin Arian

President

Jason Swingler

Vice President

AS2896 Medical Gases

Mal Allen

Treasurer

IHEA member Mal Allen (NSW/ACT) has attended several meetings with the Standards Australia Working Committee to review public comments on the draft publication noting the process has had to deal with over 500 comments. Given the large number of responses this work is ongoing and a draft document will be sent out again for further public comment with the revised standard due for finalisation by end of 2020.

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Jon Gowdy, John Miles, Dean Benke, Darrell Milton, Greg Allen, Brett Petherbridge

Committee Member

To contact the IHEA NSW-ACT branch please email: ihea. nswact@ihea.org.au

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Family, friends and work colleagues are deeply saddened by the sudden passing of Phil Hanbury, who was known amongst many to be a real gentleman.

early loved husband of Lorraine, much loved father and father-in-law of Terry, Ian and Michael and loving grandfather of Samuel and James.

Phil, spent the first 24 years of his working life at Comsteel, then moved into health taking on the role of Chief Engineer at Calvary Mater Hospital from 1991. In 2008, Phil took up the position within Hunter New England Local Health District as Manager, Compliance, Essential Services & Contracts. During his time in Health, Phil became involved with the NSW-ACT Branch of the IHEA and has been a member for over 15 years. Phil loved his job and he loved interacting with people, whether it was work colleagues, contractors or patients. No-one could ever question his work ethics or passion for

the role he played within HNE Health. The health system is a better place for the years of dedication that Phil gave, especially to the Mater. The Mater was Philâ&#x20AC;&#x2122;s second home, and some of the people that work there, he thought of as part of his family. Phil was well loved and will be dearly missed by all; he was definitely one in a million. Phil was a great bloke, never short of a word and would openly speak his mind and we were so lucky to have him in our lives. Rest in Peace Mate Mal Allen ACT/NSW Branch Treasurer

VALE

TRIBUTE TO TONY BLACKLER PAST PRESIDENT OF NZIHE AND NZ ANZEX COORDINATOR

First published in the Canterbury DHB CEO Update, 18 May 2020

t is with a heavy heart that we announce the passing of Tony Blackler on Monday 5 May. He was 71 years of age.

Tony’s engineering career started with an aircraft avionics apprenticeship before he moved to the North Canterbury Hospital Board as an electronics technician and then as Assistant Engineer. In the 1980s the precision mechanical technicians came under his leadership and the name of the department changed to Technical Services. As the clinical engineering lead for Canterbury DHB, Tony’s work included many aspects of the technology management of clinical equipment and its association with clinical service delivery. He had many years involvement with standards development in the clinical engineering field and had been at the fore in clinical engineering activity at a national level. Tony chaired South Island Alliance work group, the National Clinical Engineering Advisory Group and a New Zealand Standards coordinating committee. He was awarded life membership of the New Zealand Institute of Healthcare Engineering and was Executive of the New Zealand Hospital Engineers Association. Former Clinical Engineering Charge Technician Nigel Cross says from humble beginnings Tony had the vision to create Clinical Technologies supporting the clinical and procurement team into what it is today. Neonatal Intensive Care Unit Clinical Engineer Gary Stevenson says Tony was instrumental in getting the first

Infant Air Transport setup in New Zealand with the Air Force and Air New Zealand, transferring ventilated infants with heart problems. In the early 2000s he was awarded one of the first Meritorious Service Awards for his involvement with standards development within the field of clinical engineering. The Sterile Services Department was included under Tony’s management in the early 1990s and Tony also oversaw Mobility Services and Medical Illustration, leading a team of about 80 staff. Tony was actively involved in the Territorial Army Brass Band and on school committees, serving as Treasurer at St Martins Primary School and Chairman of the Board of Trustees at Linwood High School. He was a board member of the Christchurch YMCA for many years, taught Business Management part time at the former Christchurch Polytechnic, served on the Board of Managers and Session of St Martins Presbyterian Church for 43 years and was a keen member of the Christchurch South Rotary Club. Everything Tony strived for within health, whether it was improving national standards relating to electricity, Sterile Services, assisting Procurement or working with other DHBs, it was always driven by patient safety and care. Tony completed 46 years at Canterbury DHB prior to his retirement in April 2019. On his 40-year work anniversary Tony said one of the best things about the job is the people he works with.

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TUNING BUILDING SYSTEMS IN THE NEAR FUTURE By John Bourne, Project Engineer, A.G. Coombs Advisory

ABSTRACT Building tuning is an important part of delivering high performing new buildings with lower operating costs and higher rental yields. It is also a ‘must have’ on existing buildings that are looking for significant improvements in energy efficiency, HVAC system performance and occupant satisfaction. Tuning currently relies heavily on data collected via Building Management and Controls Systems (BMCS). As Operational Analytics, Internet of Things (IOT) devices and cloud computing capabilities become common practice the amount of information we have increases exponentially and the way in which we tune buildings will evolve. This step-change in technology will have a flow-on effect to other aspects of building operations, including maintenance services and life cycle asset management.

INTRODUCTION

his paper presents an overview of the building tuning process and how it is evolving with the introduction of data-driven analytics, IOT devices Building Information Modelling (BIM) and cloud computing capabilities within buildings. The building tuning process involves a number of stakeholders, including the building owner, facility manager, maintenance staff, design engineers and installation contractors. The objectives of the tuning process revolve around improving tenant satisfaction, reducing energy and water consumption and improving plant stability. Ultimately, from a building owner’s perspective, building tuning is about reducing operating costs and increasing the capital value of a building asset. For new buildings, tuning often commences following practical completion. This can be a requirement of an environmental rating (e.g. Green Star) or driven by the owner as a project requirement. For existing buildings, building tuning can be undertaken at any time. There are various inputs into building tuning, including energy and water metering data, tenant feedback,

maintenance reports, condition audits and data collected from a BMCS. As operational analytics platforms flood the market, building owners are receiving an overwhelming amount of information about their buildings. The challenge for a building tuning process is to filter this data and tune the algorithms such that the most relevant items are identified and prioritised. Too much unstructured information can be paralysing. Building tuning is now also able to be completed across multiple building assets and portfolios. Using dashboards to present large amounts of data collected from multiple different sources downstream, in a clear and consistent manner, enables comparison of our building systems and equipment at a much greater scale. Buildings are becoming smarter. IoT devices, able to be quickly and easily added and interfaced with our buildings, are also increasing the breadth of data we’re collecting from our buildings. This is particularly beneficial for condition monitoring and sub-metering applications. As more third-party devices are added to buildings

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relates to an improvement in the capital value of the asset[1] and an increase in rental yields.

NABERS Energy/ Water Rating Indoor Environment Quality

Reduced Operating Costs

There are also additional rating tools (WELLS and NABERS IEQ), which have a focus on indoor environment quality. These tools are also starting to become a focus within building tuning programs. 1.2 Who is involved?

Improved Equip Lifecycle + Reduced Maintenance Costs

Building Tuning

CIBSE Soft Landings

Tenant Satisfaction

Green Star Design and As-Built Rating

Figure 1 - Why do we tune buildings

the communications infrastructure supporting them is also changing, to facilitate high-speed interfaces and seamless monitoring from a central dashboard. The outputs of building tuning can also inform decisions around lifecycle replacement of equipment and proactive maintenance activities to optimise/prioritise capital vs operational expenditure.

1. BUILDING TUNING 1.1 Why do we tune buildings? Building tuning is primarily undertaken to reduce operational costs and improve the financial value of a building asset (rental yield and capital value). This is achieved by targeting the following objectives: • Reduce the energy and water consumed by the building (energy and water) and compare actual consumption to what was predicted. • Optimise the performance of plant and equipment in order to improve stability and reduce operational stress. • Improve tenant comfort and satisfaction. Often the requirement for tuning is dictated by the requirements of an environmental rating, such as CIBSE Soft Landings or Green Star Design and As-Built. However, it can also be driven by building owners and facility managers looking to reduce operating costs and improve their NABERS (Energy and Water) or Green Star Performance credentials. Aside from reduced operating costs, it has been shown that an improvement in NABERS Energy Rating

Building Tuning for new buildings requires input from the facility manager, the client/building owner, head contractor and services subcontractors (in particular, the controls sub-contractors), the services designers, the Independent Commissioning Agent (ICA) and commissioning manager (if appointed). For existing buildings, building tuning also involves maintenance contractors, tenants and a technical services specialist. 1.3 When does tuning take place? Building Tuning can commence immediately following practical completion and continue throughout the operational life of the building. Typically, for new buildings, there will be a minimum requirement for building tuning for between 12 and 36 months after practical completion. For existing buildings, tuning can commence at any stage. It is important for building tuning to encompass whole year/s of climatic conditions. Many symptoms of poor building performance are masked by seasonal changes or caused by operational upgrades and fitouts. For this reason, it is also recommended that a building tuning program commence after any modifications to the building (e.g. upgrades and fitouts). 1.4 What does building tuning involve? At a high level, building tuning is about continuously monitoring and improving the performance of a building. The scope of building tuning can vary widely between buildings. The objectives and extent of building tuning should be clearly specified by the client. The scope will typically include the following items as a minimum: • Collect and review tenant feedback/satisfaction. Where there is dissatisfaction, investigate whether there is an underlying issue or whether a change can be made to improve the level of tenant satisfaction without compromising other targets. • Review the energy and water usage periodically and compare to the predicted usage. This should be completed on the building as a whole and using end-use-breakdowns and sub-metering data. The total building energy and water use should also be correlated with utility bills periodically.

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• Validate the performance of control systems under various conditions (occupancy, seasonal changes, etc.) to ensure they are achieving their design intent. This can involve verifying the conditions (temperature, humidity, CO2 etc.) are within design tolerances. It also involves verifying control loops, such as chiller staging and reset strategies to ensure they are operating optimally. 1.5 How do we tune buildings? The building tuning relies on data collection and analysis in order to make informed decisions about potential improvements. Most buildings now incorporate a BMCS, providing the ability to extract information about a building’s performance and identify opportunities for improvement. This relies heavily on accurate documentation within controls functional descriptions, operation and maintenance manuals and the original design intent/ criteria. For new buildings, energy models are also used as a reference for building performance. The relevant experience of personnel is also important in making fact based tuning decisions. BMCS’s use a large number of input and output points, combined with control loops, to monitor and control our building systems. Comparing and correlating all this information to identify improvement opportunities can be a difficult task. It is also difficult to accurately predict the impact that any changes will make on the overall system performance. For example, a BMCS can trend the COP of a chilled water system. When we compare this to an energy model, or another trend log, we need to factor in the ambient temperature and humidity, the operating load of the chillers and cooling towers and any change in plant condition or recent maintenance activities. There are now additional tools that are available to building tuning teams to collect and analyse performance data. Operational Analytics packages and smart IoT devices are becoming more prevalent in modern buildings. Building tuning in the future will need to understand and make use of these tools to ensure they are accurately and purposefully driving performance improvements.

2. NEW TECHNOLOGIES Analytics is often promoted as a silver bullet to improve the performance of buildings. References are also being made by some suppliers in the industry to artificial intelligence and virtual engineers. Some of these statements can be misleading. The sections below provide an overview of some of the available technologies.

Systems put into automatic operation

Implement changes to system operation

Investigate anomalies and develop opportunities for improvement

Collect Data on system performance

Review Data and identify anomalies

Figure 2: Building Tuning Process

2.1 Operational analytics Operational Analytics encompasses a broad range of products with an even broader range of implementation strategies. At its core, operational analytics uses rule-based algorithms and data collected from sites to determine when a condition or system has broken the rules. Data is often ‘crunched’ off-site, using cloud computing to process the vast amount of information. This can greatly increase the ability of building tuning teams to diagnose and address less obvious performance issues. If the analytics packages are relying on BMCS data, the information must be setup and stored in a logical manner. Operational analytics packages are often sold with the promise of maintenance savings and reductions in energy use. It is difficult to quantify and verify the claims. Identifying issues is only one first step in the building tuning process. There is also an argument to be made about the BMCS being used to provide ‘analytics type’ feedback on system performance. Equally, it is often assumed that the BMCS is able to provide adequate, structured information to the analytics package for processing. The other area where operational analytics is being used is to analyse performance of equipment/systems within buildings across portfolios. Using dashboards to display information in a consistent format drawn from any number of different sources enables fast and direct comparison of performance.

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2.2 Where does the BMCS stop and operational analytics begin? The line between what a BMCS provides and what an Analytics package should provide is still blurred. There are multiple levels of analytics, ranging from alarming and fault identification to dynamically monitoring, correlating and reporting on system efficiencies and the effectiveness of control loops such as reset strategies. We believe that a BMCS should be used to manage and control plant on an “if this, then that” basis. This includes provision of setpoints to plant and sub-systems, conditions for resetting setpoints, monitoring of plant status and general conditions inside and outside a building. The BMS is well suited to providing instant alarms, such as equipment faults. Analytics packages can then collect and use historical data as inputs into algorithms to identify where opportunities exist for improvements. Each algorithm is comparing the multiple sources of processed data to a set of rules (defined by users) over extended periods of time. It is critical that the objective of the rules is understood so that anomalies and spurious alarms can be identified and dismissed, enabling refinement of the rules to more accurately satisfy the tuning objectives. 2.3 Artificial intelligence and machine learning There has been much hype about analytics engines using machine learning and artificial intelligence. Machine learning is the next evolution of rules-basedalgorithms. Machine learning is based on algorithms automatically refining themselves based on experience (large quantities of data)[2]. In the context of building services, it is the evolution of understanding what is normal or abnormal. This evolution can take several forms, which are sub categories of machine learning: • Supervised learning • Unsupervised learning • Reinforced learning There are a several examples of machine learning in practice within the HVAC&R industry presently, but it is not as advanced as in other markets. Machine learning examines data to find patterns and anomalies. Once identified, human interaction is usually required to act on the data presented. Artificial Intelligence is a much broader and more objective term, often having connotations to human intelligence. AI is often categorised into “Applied Artificial Intelligence” and “Artificial General Intelligence”. The former better describes current AI applications with the HVAC industry, where we have specific goals (e.g. energy

optimisation). AI is able to make assumptions, test the assumptions, learn and then act autonomously in the same way a human would. AI is about automating judgements[3] and can rely on all three types of machine learning. The implications of AI will be significant; however, its use is not as widespread in our industry as are led to believe (under this definition). Sophisticated automation is often confused for artificial intelligence. 2.4 Asset analytics Unlike operational analytics, asset analytics is focused on specific assets (and families of assets) within building systems. This includes information about the make and model, location, age, condition and capacity of the equipment. Asset analytics also feeds into life cycle plans, which are used to determine when an item of equipment should be scheduled for replacement. Historically, life cycling planning for asset replacement has been based on generic lifespans nominated in technical guidelines (such as CIBSE Code M). More recently, however, asset analytics and performance data (which can come from operational analytics) is starting to be used to provide a more accurate assessment of an asset’s condition and the proposed timeframe for replacement. 2.5 Internet of things (IoT) There is a rapidly increasing number of third party devices that can quickly and easily be installed and interfaced to existing systems in our buildings. Wireless IoT devices, such as clip-on current transformers, can be easily retrofitted for sub-metering and interfaced with existing monitoring platforms (or displayed via online portals). Another example is the Movus condition monitoring device. This wireless device uses multiple sensors, including a microphone, accelerometers (for vibration), temperature and pressure data to determine when a rotating piece of equipment is operating abnormally. The machine learning component of this device tunes the definition of what is considered abnormal, based on how often equipment operates at specific duties. By adding new types of sensors in the field, the data set available for operational analytics expands and can also feed into asset analytics and drive proactive, conditionbased maintenance. With the increasing uptake of environmental rating schemes focusing on indoor environmental quality, IoT devices can facilitate flexible remote monitoring of air quality. Additionally, the uptake of hotdesking in our offices has opened up opportunities for occupancy sensing and the use of setback conditions for air conditioning and ventilation systems.

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The infrastructure in our buildings is having to evolve to accommodate these third-party devices. Buildings are now being specified with Integrated Communication Networks (ICNs), which provide a common, high-speed backbone to interface directly to third party devices directly over IP. Additionally, BMCS’s are also following suit and providing more downstream devices with IP communications capabilities. As our buildings fill with these devices, consideration needs to be given to who owns the data captured by the devices. Can the engineering tools and algorithms be interrogated and modified by facility managers and engineers or is this functionality restricted to the supplier? The definition of ownership is also unclear (especially regarding machine-generated data) and currently only legally defined in specific contracts rather than in legislation[4]. 2.6 Virtual engineers Another idea that has been promoted with the implementation of analytics packages is notion of a ‘virtual engineer’. The theory is that the analytics package performs the role of a (human) engineer in the building tuning process. It is important to understand that there is a difference between identifying potential issues (carried out by virtual engineers) and interrogating them to determine the appropriate course of action. Building Tuning includes both of these actions and should also include tuning of the Virtual Engineer! 2.7 BIM and the virtual twin BIM is currently still falling short of its true potential. Good progress has been made in some areas (for documentation and digital construction), however the focus has been on the build phase of projects. BIM for Facility Management (FM) and for use as an engineering tool are still not fully developed. This space is changing rapidly. The ability to transfer knowledge from the design and construction phase to the operational phase of a building is greatly improved with the use of BIM to FM. Building owners are now starting to drive this requirement rather than passively receiving whatever documentation is provided at completion of the construction phase. The goal is to create a digital twin of the actual building. The digital twin takes input data from the design, fabrication and commissioning process, as well as realtime performance data from various sources. Doing so allows us to create a digital ecosystem for operational management. From a building tuning perspective, we can diagnose performance deficiencies faster, accurately simulate proposed tuning activities to assess

the outcomes and develop more granular end-usebreakdowns for energy and water systems to benchmark their performance. Existing buildings, without BIM models, are often where the greatest opportunities lie for building tuning. There is an increasing trend for existing buildings to have their records digitised and managed through cloud based document management systems. Existing buildings can also be scanned and modelled in the virtual world with relative ease, where performance parameters, commissioning results, condition audits and operation and maintenance data can be stored and used. Consideration then also needs to be given to storage and maintenance of this data.

3. TUNING BUILDINGS IN THE NEAR FUTURE In the near future, how we tune buildings will evolve to include tuning (or sharpening) the tools we use, as much as it will be about tuning building performance. Analytics algorithms and data management will become much more common methods of measuring and assessing building performance. However, in the near future, these tools will still be used to identify symptoms of poor performance. Building Tuning as a process will continue to be about diagnosing the root cause of the symptoms, developing a solution and monitoring the impact of the change. Further into the future, as machine learning develops, some aspects of this process may also become automated. In addition to current building tuning objectives, there will be a shift towards analysing and comparing building performance on a much larger scale, across multiple assets. The ability to import and display data from different controls systems is expected to be common practice for building portfolios and will enable direct comparison of whole buildings against each other. Tuning will also increasingly feed into asset life cycle programs and proactive maintenance strategies. With more information available, digital twinning and predictive models for energy and water usage will edge closer to actual usage, enabling more accurate forecasting of operating costs and CO2 emissions. As cloud computing increases the capacity to crunch data collected from site, there is an increasing need to ensure that the BMCS’s and analytics packages, as part of a tuning program, are implemented in a logical manner that does not burden the existing network and provides clear and logical information for building owners and facility managers. We are starting to move away from using the BMCS to monitor all our equipment and will instead use high speed interfaces, IP enabled devices and

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integrated back bones to facilitate interfaces to a range of sub-systems. In order to accommodate this change, the following will need to be considered: • Specifying ICN backbones and communication protocols, allowing for vendor independence. • Naming conventions. • BMCS/EMS and IOT data structured and stored in a logical manner to enable easy interrogation by third party packages. • How and where will information be stored and processed - edge computing or cloud servers. • Who owns the data.

[2] Mitchell, T, “Machine Learning”, McGraw-Hill, P1 (March 1, 1997) [3] Moore A, “When AI Becomes an Everyday Technology”, Harvard Business Review (June 2019) [4] Van Asbroeck B, et al, “Big Data & Issues & Opportunities: Data Ownership, Bird&Bird (March 2019), Accessed 29/7/2019, https://www.twobirds.com/en/news/articles/2019/global/ Big%20Data%20and%20Issues%20and%20Opportunities%20 Data%20Ownership

BIBLIOGRAPHY • AIRAH: AIRAH DA27 Building Commissioning Application Manual, Australian Institute of Refrigeration, Air Conditioning and Heating (2011)

We recommend considering the accuracy of the underlying data (is the BMS data real?), how different data sources are merged and engaging proficient advisors who can help deploy, manage and verify the systems and architecture to achieve good management of the facility.

• AIRAH: AIRAH DA28 Building Management and Control Systems, Australian Institute of Refrigeration, Air Conditioning and Heating (2011)

It is also likely that building tuning in general will become more common in the near future, potentially being nominated as part of facility management and maintenance contracts. In order for this to be successful, there must be clear objectives and a building tuning scope of work.

• CIBSE: CIBSE Commissioning Code M, Chartered Institute for Building Services Engineers (2003)

CONCLUSION

• Smith, A; “Using Analytics for Improving Building Performance”, A.G. Coombs Advisory – Advisory Note (2016)

The overarching objectives of building tuning will largely remain unchanged; however, changes are expected to come from the tools that we use in order to diagnose symptoms and identify opportunities for improvement. In order to utilise these tools to their full effect, the scope of building tuning will need to extend to include tuning of the algorithms and the devices we rely on to identify performance issues. With the exponential increase in data, the benefits of thorough building tuning will also be to feed into life cycle planning, financial performance metrics, portfolio-scale comparisons and more accurate forecasting of energy consumption. The current wave of digital technology, including as BIM to FM and digital twins, will give us even more information about our buildings. In order to continue effectively tuning buildings in the near future, an understanding of how these tools are facilitated by building infrastructure and how they can be applied is critical.

REFERENCES [1] IPD: Department of Industry NABERS Energy Analysis, Investment Property Databank Ltd (2013)

• ASHRAE: ASHRAE Commissioning Guideline 1.1-2007 American Society of Heating, Refrigeration and Air-Conditioning (2007)

• HVAC HESS: Heating, Ventilation & Air-Conditioning High Efficiency Systems Strategy (September 2013) • Smith, A; “Building Tuning – Getting your Buildings to Work Properly”, A.G. Coombs Advisory – Advisory Note (2015)

• Iriondo, R:“Differences between AI and Machine Learning and Why it Matters”, https://medium.com/datadriveninvestor/ differences-between-ai-and-machine-learning-and-why-itmatters-1255b182fc6 (2019)

‘This paper was presented at the AIRAH 2019 Future of HVAC conference and first published in the November 2019 of Ecolibrium’.

ABOUT THE AUTHOR John is presently employed as a project engineer for A.G. Coombs Advisory. John has over 12 years’ experience in the building services industry, having performed a diverse range of roles ranging from design of mechanical HVAC systems and trigeneration systems, ICA, building tuning, commissioning management and energy audits. John has also been heavily involved in post completion issue resolution, requiring detailed investigation and complex analysis of systems including laboratories and energy plant. John’s primary area of focus currently is commissioning management and Independent Commissioning Agent roles.

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INNOVATIONS AT WORK DURING COVID-19 CRISIS

FLEXIBLE MEDICAL GAS PIPING SPEEDS UP DEPLOYMENT OF MEDICAL GASES As part of the nationwide response to the COVID-19 situation, Healthcare Engineers, Contractors and Medical Gas Installers are under extreme pressure to construct temporary hospitals in record time. As the majority of these temporary hospitals require an oxygen pipeline infrastructure which although temporary must still adhere to national and international standards engineering teams are utilising a revolutionary flexible medical gas tubing product, comprising of a pliable corrugated stainless steel or copper alloy tube with an external polyethylene cover, supplied on easy to handle disposable drums in long continuous lengths. The flexibility, long lengths and the ability to bend the product by hand to a tight radius allow the piping to be quickly installed within temporary hospitals from external supply tanks or manifold directly to a patient’s bedside. Unlike typical rigid copper gas pipe, installers were able to simply unreel and pull the piping through the facility, around corners, up floors and down corridors, until the final connection. Thanks to its quick assembly fittings, the piping was attached using only basic hand tools and with little to no brazing. This was an invaluable asset to the medical gas installers on site and who’s remit was to install a medical gas piping network from bulk tanks to bedhead quickly and safely in a matter of days rather than weeks.

he flexible medical gas piping was used in Cleveland Clinic in Ohio, and in New York City’s Javits Convention Centre and Central Park temporary field hospital. The field hospital, Javits Centre and Cleveland Clinic sites were rapidly constructed to support the on-going pandemic and relieve other area hospitals of patient overflows. Although a relatively new product to the US market, MediTrac flexible medical gas piping has been installed within hospitals in Europe since 2005 and more recently within hospitals in Africa.

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The Cleveland Clinic facility, to be called Hope Hospital, will initially include 327 patient beds for lowacuity COVID-19 patients. The four-

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story, 477,000-square-foot building can accommodate up to 1,000 hospital beds. Flexible medical gas piping was used for the rapid connection of new portable headwalls into the piping system. The installers used long continuous runs of the piping in the finished areas for a quicker, cleaner and a flame-free installation. The entire project was completed without using any hot work inside the existing facility. One of the deciding factors to utilise flexible medical gas piping within these temporary hospitals was that it allowed a much faster installation (up to 5 times faster) on site than rigid copper pipe, since far fewer joints are required along the length of the pipeline using up to 70% fewer fittings. The joints which remain, such as to connect the pipe to valves and terminal units, required little to no hot work or inert gas shielding, and far less time to complete than traditional brazed joints in copper pipes.

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The piping was delivered to site with internal cleanliness for oxygen service, supplied end capped and labelled as medical gas pipe, the end fittings were cleaned and degreased for oxygen service, and were packed and labelled as medical gas fittings. The piping offered a number of economic and technical advantages over traditional copper pipework, however in this instance the main criteria was speed and safety. There was little to no hot work or inert gas shielding required, eliminating purge gases and hot work permits. In addition to this the piping and fittings could withstand a minimum of 30 minutes at 840ºC without leakage in the event of a fire. The product’s speed of installation and flexibility of use made it uniquely suitable to meet the current demands imposed on healthcare facilities reacting to the daunting challenges of the COVID-19 pandemic.

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MediTrac was developed and manufactured by Omega Flex, Inc. Backed by over 40 years of excellence, MediTrac relies on years of product design, engineering and testing to assure long-term durability and reliability for a variety of medical gas and healthcare uses. MediTrac flexible medical gas piping has been specially designed to conform to HTM 02 01, and the corresponding European and International standard BS EN ISO 7396-1:2016, and can be manufactured and supplied listed to UL1365 and in full compliance with NFPA 99 :2018. OmegaFlex CEO Kevin Hoben recently stated “OmegaFlex is committed to supporting its customers and communities through the unprecedented COVID-19 pandemic. We are redeploying our resources to meet the needs of customers by moving engineering and manufacturing personnel to the MediTrac business and prioritising the supply of MediTrac products. We are proud of the quick and nimble response of all of our employees as we work through the difficulties imposed by the COVID-19 crisis in supplying this much needed solution to our most urgent global problem.” To learn more about the unique features and benefits of MediTrac® please visit the OmegaFlex website, www.meditrac.us, or email info@meditrac.us

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Installers were able to unreel and pull the piping through the facility in long continuous lengths. When a change in direction was needed, the installer could simply bend the pipe by hand in a tight radius without any tooling. The pipe was cut by hand with a wheeled pipe cutter and the end fittings were assembled on site quickly and simply with a spanner.

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HOW FLEXIBLE SOLUTIONS CAN IMPROVE THE RESILIENCE OF HEALTHCARE DELIVERY As the coronavirus has demanded responses from health systems across the globe, we have seen a number of temporary hospitals housed in converted conference or sports centres take shape, including in Italy, Spain, Brazil, UK and the US. Closer to home, a temporary hospital was built in Canberra, with sites in major capital cities around the country considered in case a need for additional capacity emerged.

ecent developments have demonstrated how quickly a temporary solution can be made operational in an emergency situation. The NHS Nightingale in London was completed in only nine days, using the vast space that already existed within the Excel Centre, and an exhibition centre in Milan was converted into Italy’s largest intensive care facility for coronavirus patients in just ten days. Of course, the current situation with COVID-19 is exceptional. It is severely testing the resilience of healthcare systems around the globe, and major action is needed to ensure lives are saved. However, we are already in the midst of a crisis, and the rapid deployment of these facilities has depended on direct support from Governments and the military, along with access to almost unlimited resources.

In Australia, a third of all intensive care capacity is in the private hospital sector, and we’ve seen public sector healthcare capacity also boosted by additional bed spaces requisitioned from the private sector. At the end of March, the Government entered into an agreement that would ensure over 30,000 private sector hospital beds and over 100,000 staff would be made available to strengthen the Australian COVID-19 response, and preserve the sector’s capacity to resume hospital services after the epidemic. However, while the large scale, temporary hospitals are getting most of the headlines at the moment, a huge amount of work is also going on behind the scenes at hospitals across the country to improve resilience on a local level. These have been ordered to free up significant capacity by discharging as many non-critical patients

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as possible, and by temporarily ceasing all planned and elective procedures. Hospitals that were already under significant pressure with bed numbers; staffing pressures; and myriad competing demands, have responded in a Herculean manner to the challenges posed by the COVID-19 outbreak. But in a number of cities and regions, healthcare leaders have been concerned that it might still not be enough, depending on which of the forecast paths were used to predict the number of cases and admissions, or have been facing other challenges in converting existing facilities into areas suitable for treating COVID-19 patients. As a result, some hospitals have turned to temporary solutions using prefabricated modular units, or mobile clinical facilities that can be deployed rapidly to extend a hospital’s capacity or be deployed away from the main hospital site. There is a big difference between something that’s designed for permanent use and that meets all the standard specifications, and facilities deployed very quickly for emergency use – such as the temporary hospitals housed within conference centres.

During the ongoing crisis, a number of operators who provide temporary infrastructure have reported being inundated with requests for wards and isolation units, very few of which are sitting in a yard somewhere waiting to be deployed. It makes sense for healthcare planners to think about future events such as the current crisis, and work with operators to develop more resilience and flexibility within the broader healthcare system. The expertise and the willingness is there; the strategic forward planning needs to bring it together.

Additional capacity should form part of hospital’s contingency planning, and regardless of the outcome of the COVID-19 crisis, it’s clear that healthcare providers, and governments, need to rethink their resilience for future pandemics and other crises, and be more prepared.

Preparation is key. There is a real threat of a potential second wave of the Covid-19 outbreak, and waiting until then, or until a new pandemic occurs, could result in losing valuable time and delays in the implementation of suitable solutions.

Flexible healthcare infrastructure can be part of this resilience upshift. A number of healthcare providers worldwide are already using flexible infrastructure in a planned way, often to provide additional capacity to cope with expected shifts in demand; or to provide replacement capacity for planned refurbishments or to help choreograph a series of complicated changes to a hospital site.

To find out more about how mobile or modular healthcare facilities can work for you, email Q-bital on info@q-bital.com

As mobile and modular wards, operating theatres and endoscopy procedure rooms already meet the relevant standards, they can be rapidly repurposed to provide additional bed spaces. They also meet infection control standards, through a number of well-thought-through design features. Many healthcare providers and hospital leaders already see mobile or temporary modular units as a valuable extension of their permanent estates and facilities, and as key to surge planning within their facilities, helping to optimise their use of resources. The use of flexible infrastructure allows hospitals to better choreograph their changes in order to provide uninterrupted care for patients in a situation that is changing daily.

Mobile and modular infrastructure can also easily be removed or relocated, or very quickly be repurposed to support hospitals in clearing the inevitable backlogs in surgery, diagnostics and other procedures that have been postponed during the crisis, or to provide continuity during refurbishment or other temporary disruption. For example, Q-bital Healthcare Solutions recently provided a portable operating theatre to The Alfred hospital in Melbourne after a storm had damaged one of the hospital’s primary theatres. The unit was used for open heart surgery and saved many patients from potentially waiting weeks or months for these vital procedures.

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VIRTUAL POWER PLANT PARTICIPATION A HAND-IN-GLOVE APPROACH FOR ECHUCA REGIONAL HEALTH By Stuart Darragh, Enel X with Mark Hooper, Echuca Regional Health

Echuca Regional Health is widely recognised throughout the region for its holistic and progressive approach to energy management and sustainability, with a proven innovation track record. The hospital is using a new approach to its backup generator testing with Virtual Power Plant (VPP) participation, where it tests its redundancy systems under true emergency conditions, and earns new revenue for supporting the power grid.

chuca Regional Health features one of the largest solar thermal arrays in Australia, providing not only heating but also absorption cooling to the hospital’s high efficiency HVAC system, 1.2MW of thermal energy storage which is utilised for peak demand management, and a new 500kW solar photovoltaic array that is currently underway. In addition, the hospital has been utilising its backup generators to participate in a Virtual Power Plant (VPP) – a collection of distributed energy assets including backup generators, batteries, and

flexible loads that work together to provide additional dispatchable capacity to the grid – since 2017. Mark Hooper, Executive Project Manager at Echuca Regional Health said VPP participation is a natural fit for the hospital, helping it to enhance site resilience in the face of a weakening grid, and earn a significant new revenue stream which can be reinvested into backup power infrastructure to further enhance system reliability.

PROTECTION FROM UNPLANNED GRID DISRUPTIONS The rapid uptake of renewable energy and retirement of coal fired power plants is impacting grid reliability. Now more than ever, the grid needs additional flexible capacity from alternate sources such as VPPs to help stabilise the grid, reduce power prices and prevent broader power outages. For hospitals, VPP participation provides a unique benefit of advanced notification of potential grid disruptions. Hooper said, “We expect the grid to be reliable and clearly it’s not. We need to ensure our facility is available for its core purpose of providing primary healthcare 24-7-365. With participation we get advanced warning of instability on the grid, which is an advantage because it means we can prepare for a grid event and don’t have to experience a break in power if an outage occurs.” “We view VPP participation as another way of keeping our patients safe, because there’s not going to be an

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interruption to power if we know that there’s a response request coming. It allows us to fire up our generator and get off the grid.”

Echuca Regional Health VPP performance charts 31 January 2020 - Emergency Grid Support Event 1,200

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ACHIEVING A NEW STANDARD OF EMERGENCY PREPARATION

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“A benefit is that you run your generators during a time where you’re likely running a hefty load anyway. But, the key is, you’re being asked to run your generator when the grid still has power. It’s an excellent tool for testing and ironing out any assumptions that are made around that reliability at a time where you wouldn’t normally run your generator,” said Hooper.

Electricity price $/MWh

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By participating in a VPP, Echuca Regional Health is able to regularly test its backup power capabilities at times and in conditions when grid emergencies are most likely to occur, providing the truest test of emergency preparedness and resilience to grid disruptions.

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“We have full site generator backup for the hospital and can synchronise with the grid to take ourselves offline. This means we have a seamless transition where the site doesn’t experience unscheduled interruptions. The fact that joining the VPP allows us to also get paid to respond to those events, gives us a win-win scenario for our facility,” he said.

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“The reality is that if the grid fails, it’s probably going to be on a hot summer day right when you don’t want it to. VPP participation gives us the strength of conviction to know on a hot day where we’re running a high load, that our generators can do the job.” “There have been events this year where through this program we’ve found some issues we didn’t know existed, and the consequence has been far less than had it occurred at a time when we’d lost power. So, ironing out those problems means that when you don’t have power and you

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need to run your generator sets, you know the resilience is there, because you’ve got all those issues sorted.” “We’re required to run our generators on load anyway, so if we’re doing it already as part of VPP participation, then we can then defer our weekly test, because we’ve already proven that we’ve met the requirements of the Australian standards to test them on load. Another benefit to us is that we also get a payment,” Hooper added.

PROTECTING SENSITIVE EQUIPMENT VPPs respond quickly to deviations in the grid’s frequency when a large power station or transmission network suddenly fail, to prevent cascading grid failures. Echuca Regional Health participate in this program, which also helps the hospital to protect its sensitive equipment. “When there’s a frequency event, the VPP sends a signal which automatically switches the site straight to our generator. We have a lot of electronic equipment that’s sensitive to things like voltage spikes and frequency deviations. If the grid doesn’t meet the parameters it’s supposed to, then we trip off. This helps us because we don’t have groups of interruptions that destroy our sensitive electronic equipment, by short sharp interruptions to power. The hospital was already doing something similar, so it made sense to join this program and get paid for it,” Hooper said.

A NEW REVENUE STREAM TO FURTHER ENHANCE RELIABILITY Hooper said that VPP participation became a hand-in-glove approach for the hospital, where they could be paid for something they were already doing, which could be reinvested into ensuring they have best-in-class redundancy systems.

“Our business model is based on continual improvement, and the one element that we always run short of is cash. We generate revenue, and engineering departments are not generally revenue generators. It’s nice to get revenue out of assets we already have in use. Participation allows us to meet all elements of continuous improvement, and generate cash, in a really nicely rounded program,” Hooper said. The hospital is now looking to further increase its demand response capacity by seeking approval from its network service provider to export the site’s excess generation capacity to the grid during VPP events. “We’re currently working on the grid export program which will be a real benefit for us. Exporting our generation capacity to the grid will create an income stream to support those assets. We’re driven towards it because we have certain things we’re mandated to do with running our generators – so if we’re doing that anyway, and can be paid for it, we’ll certainly look at it as an opportunity,” Hooper said.

VPPS ARE A WIN-WIN FOR HOSPITALS AND OUR TRANSFORMING GRID Echuca Regional Health is providing what the Australian Energy Market Operator (AEMO) has stated is

an urgent need for new forms of capacity on the power grid. VPPs are an obvious and cost-effective solution to this problem, and using existing assets means they can be built quickly, providing for a more efficient use of resources and avoiding the need to build expensive new gas peaking power plants. Hooper said, “We’re a small user, the VPP is about a lot of one percenters coming together to help out. I’ve been encouraging my colleagues to participate because most of our sites have generators and have to test them anyway, so we might as well run them and get paid for it.” “The benefit adds to other factors around resilience and knowing your systems work, and you can use the income to improve your systems and other physical elements to ensure you’ve got a reliable generation set.” “I know some have used their income to increase the size of their fuel supply. Others have used it to install automatic switching or upgrade their PLCs. It’s a win-win because the reliable capacity that we can provide to the grid is improved by putting the money back into improving the reliability of our own backup systems,” Hooper said.

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ACHIEVE A NEW STANDARD OF EMERGENCY PREPARATION BY PARTICIPATING IN A VIRTUAL POWER PLANT HOSPITALS ARE ELEVATING THEIR BACKUP POWER TESTING PRACTICES, AND GETTING PAID FOR IT

he electricity grid is not as reliable as it once was, with the transition to renewable power posing new risks to both reliability and the cost of power. The grid is operating with greater uncertainty, variability and a tighter supply-demand balance. This is driven by increased renewable generation, an aging thermal generation fleet, and unexpected retirement of capacity which is increasing the risk of forced outages (AEMO). Now more than ever, there is a stronger need for hospitals to ensure they have working redundancy measures in place and the confidence they can continue to support patients in the event of a grid trip or failure. Hospitals across Australia are raising their standard of emergency preparation by using an innovative new approach to testing their backup power infrastructure – participating in a Virtual Power Plant (VPP). A VPP is a collection of distributed energy assets (backup generators, batteries, flexible loads) that work together to provide additional dispatchable capacity to the grid. They are called on when large power stations suddenly fail, when demand is extremely high relative to supply, or when climatic events threaten grid stability. Participating in a VPP provides a compelling new way for hospitals to enhance their emergency preparedness by testing backup power systems under conditions which simulate true emergency situations. This achieves a new benchmark for best practice testing standards. Hospitals typically participate by switching to backup generation when required, which can be done safely and without interrupting hospital services. By temporarily reducing demand during critical grid events, hospitals can earn a significant new revenue stream. This can be reinvested into backup power infrastructure upgrades, further enhancing system reliability. Where

hospitals require an infrastructure upgrade to achieve uninterrupted load transfer, in many cases this new revenue stream will quickly pay off the investment, which can be externally financed.

ROUTINE TESTING PRACTICES HAVE SHORTFALLS Common testing practices often fail to fully simulate the response required during a grid power failure. While load bank testing can exercise the generator under load, it doesn’t test the full load transfer sequence using automatic transfer switches and ancillary circuit breakers, and loads are not representative of actual hospital operations. Another practice, black start testing, tests all system components, however it’s not often done under true emergency conditions such as during a hot summer afternoon when an outage is most likely to occur. This approach doesn’t account for the effects of elevated ambient temperatures, increased building loads, and generator de-rating on system performance. By participating in our VPP, hospitals can thoroughly test their backup power systems whilst having the safety net of grid power to switch back to should any potential issues be identified. Ken Herman, Engineering Services Manager at Swan Hill District Health, said, “During testing we discovered that one of our generator circuit breakers operated intermittently and wouldn’t always close. This meant that when both of our backup generators were required to supply hospital demand, the hospital’s supply redundancy could have been compromised if the breaker didn’t close. Once the fault was identified, the ‘sticky’ breaker was replaced.”

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ELEVATING YOUR BACKUP POWER TESTING PRACTICES Only VPP participation provides the truest test of emergency preparedness by calling upon your backup generation infrastructure to support actual hospital loads, testing the full load transfer sequence, and often in conditions when grid emergencies are most likely to occur, all the while still having grid power available to maintain supply redundancy. All system components will be tested thoroughly – from your generator fuel, air, battery and cooling systems to programmable logic controllers, automated transfer switches, ancillary circuit breakers, monitoring and alarm systems. More frequent full-load testing will optimise generator performance and enhance life expectancy. VPP participation provides advanced notification of possible grid events, enabling hospitals to proactively switch to backup power in anticipation of a grid outage. This allows switching in a controlled environment with mains power still available, reducing the chance of an unplanned disruption. In the event of a real emergency, you’ll have much greater confidence that your backup power systems will reliably power your facility as expected. Responding to a critical grid event can also meet routine test requirements where they overlap – meaning a site can effectively be paid to test its backup power systems. Mark Hooper, Executive Project Manager at Echuca Regional Health, said “As we’re running our generators on load [in VPP participation], we can defer our weekly test for another week, because we’ve proven that we’ve met the required standard to test them on load.”

PROTECT YOUR EQUIPMENT FROM POWER QUALITY DISTURBANCES Our VPP automatically responds to deviations in grid electrical frequency, to avoid any cascading failures on the power grid. Many hospitals already have systems in place to ensure frequency deviations don’t negatively impact sensitive electronics and critical equipment. “We have a lot of electronic equipment that’s sensitive to things like voltage spikes and frequency deviations. We set parameters on our incoming equipment, so that if the grid’s frequency deviates, we switch to our generator. VPP participation became a hand in glove approach for us, it meant we were able to get paid for doing the same thing we already were,” Hooper said.

JOIN A VPP IN TIME FOR NEXT SUMMER As the next critical summer period fast approaches, grid reliability issues and the threat posed to healthcare operational resilience will continue. Participating in a VPP will enable your organisation to achieve a new standard of emergency preparation, whilst accessing a new revenue stream. A small to medium size hospital with 50 to 100 beds can earn on average $20,000 to $50,000 per annum, whereas larger hospitals with 200 to 500 beds can earn revenue in the order of $150,000 to $250,000 per year. At Enel X, we operate the largest VPP in Australia (Bloomberg New Energy Finance), and have been aggregating hospitals’ energy load to support the grid since 2009. We’ve had a number of learnings that help our participating hospitals enhance their operational resilience year-round. We understand each hospital has unique operations and infrastructure needs. To upgrade your testing practices and emergency preparedness before the start of the upcoming summer – the time where outages are most likely, and where you can earn the most revenue – it’s important to get started immediately to allow enough time to integrate your site into our VPP. To learn more about this opportunity, get in touch with our healthcare consultant Stuart Darragh stuart.darragh@enel.com, or download our guide which explains our VPP technical solution.

Upgrade yourADVERTORIAL backup power testing practices by joining a Virtual Power Plant At Enel X, weâ&#x20AC;&#x2122;ve worked with hospitals since 2009 to enhance emergency preparedness, with Virtual Power Plant participation and Demand Response programs. By switching from grid power to backup generation during a critical grid event, hospitals can: Test backup power systems under true emergency conditions Earn new revenue which can be reinvested into equipment upgrades Receive advanced warning of possible grid events and proactively respond Protect the grid against outages and reduce energy prices for all consumers

1 Bloomberg New Energy Finance, 2019

enelx.com.au

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CLINICAL ENGINEERING:

HOW BIOMEDS MAKE HOSPITALS SAFER By Michael Brown

The city of Christchurch is located on a broad plain, geographically located between the Pacific Ocean and the Southern Alps of New Zealand. Locals sometimes brag that it is one of the few places in the world where you can go skiing and surfing on the same day. Based on an agricultural economy, it is a city with a growing population, currently at just under 400,000 people.

s many of you may know, Christchurch has been through some significant events in the last few years.

Of most relevance to us today was a 6.2 Richter scale earthquake that occurred on 22 February 2011. 185 people died as a result of the earthquake, and the face of the city was changed forever. I must confess that when putting this talk together, I was going to show some slides of Christchurch right after the earthquakes, but whilst there was no shortage of images to display, looking at them now, even 8 years later, is something I struggle to do. This photo is of the National Earthquake Monument, constructed to remember those killed by the earthquake. I was personally fortunate not to be harmed as a consequence of the quake and aftershocks that followed. My family were safe and my home sustained very minor damage. However, no one living in Christchurch was left unaffected by the earthquakes. The thing that probably affected me personally in the greatest way were changes at my place of work, Christchurch Public Hospital. I can recall as clearly as yesterday walking to work several weeks after the main earthquake, and two minutes before arriving at my workshop, receiving a call on my mobile. It was my supervisor, who, in his casual, laid back manner instructed me not to enter our work building. When I enquired as to why not, his jocular but accurate reply was â&#x20AC;&#x2DC;because the roof might fall on youâ&#x20AC;&#x2122;. We were quickly moved to a new work area, significantly smaller than our original workshop.

Since the quakes, living in Christchurch has been a struggle. Constant roadworks, building repairs and staff relocations have been frustrating at best. There were times when the traffic routes across the city would change on a daily basis due to roadworks; sometimes when visiting medical centres as part of my work duties, I would not be able to take the same route across the city twice in as many days as routes changed. Hospitals and medical centres have moved, rebuilt or shut, and the staff I work with have been relocated as many as four times, to list just a few frustrations. And, of course, the city itself was stuffed, or to use the colloquial phrase of the day, Munted.

Christchurch Hospital

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Cathedral Square, Christchurch

Fortunately, while the recovery has been long and painful, things are now improving. The city centre, or CBD, was for many people, a place where you would not normally go unless you had to. Before the earthquakes, I could count on one hand the number of times I visited the city centre in the 10 years I had lived there. One of my favourite quotes that came out shortly after the quakes was from a well-known New Zealand property developer, Bob Jones, who is claimed to have said that â&#x20AC;&#x2DC;the earthquakes did not kill Christchurch, the city was already deadâ&#x20AC;&#x2122;. Whilst I feel that may have been true at the time, I am pleased to say that the city has turned a corner in the last year or two. New buildings have been rebuilt to replace old structures, and new roads and pathways have been rebuilt throughout the city. New facilities, such as Hoyts EntEX movie theatres and Turanga, the City Library, or the huge Margaret Mahy Playground have reopened in the Central

City, and along with other construction currently underway, the city centre is turning into a dynamic, exciting place to visit. I think many would agree with me that the city is now a better place than before the quakes destroyed the city. One of my favourite things to do on the weekends nowadays is to walk into the city centre with my girls, taking in the sights and sounds of the inner city, before checking out a new cafe, the gallery, museum or the Margaret Mahy Playground. I am based at Christchurch Public Hospital, as a Biomedical Services Technician. A tertiary hospital with 550 beds, Christchurch Hospital is the largest teaching and research hospital in the South Island of New Zealand, with over 4000 staff on site. It provides a full range of emergency, acute, elective and outpatient services. In addition, Christchurch Hospital has the busiest Emergency Department in Australasia, treating more than 83,000 patients a year. On average, 300 patients pass through the emergency department every day.

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Itâ&#x20AC;&#x2122;s an organisation that I enjoy working for, and I love being able to apply my skills to assist in patient care. As a Biomedical Services Technician, I am a member of a team that currently consists of 31 members, making it the largest clinical engineering department in New Zealand. Out of the 31 members, our department is broken down into smaller sub-groups, comprising of a dedicated dialysis service, mobility services, school and community dental, theatres, labs and several other hospitals. Our department also manages equipment over more than 50 sites, from private hospitals through to small medical centres.

When people ask me what I do as a Biomed, I tell them that I service and repair anything that plugs into a patient and a wall. A colleague once described it this way; if all the clinicians moved to a new building, we would go with the doctors and nurses, whereas Facilities Maintenance would stay with the building. The main part of my job is maintaining and repairing medical devices however, the position is much broader than this. All medical centres and hospitals in New Zealand must comply with the AS/ NZS3551 standard for managing medical equipment. In Australia, I understand that this standard is considered best practice whereas, in New Zealand, compliance with the standard is mandated by legislation; New Zealand law dictates that we must comply with this standard. AS/NZS3551 is my bible, and most of what I do is prescribed in the document.

Itâ&#x20AC;&#x2122;s important to recognise that the Clinical Engineering department is not just about repairing broken things, which is how many staff appear to see us. These images are recognisable to most biomeds.

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the hidden force within the hospital, working behind the scenes of surgical and emergency departments. Not only do we provide a safety analysis on equipment, we calibrate and inspect equipment to see if a component is wearing out. Then we replace it, preventing the need for emergency repairs that always seem to occur outside of normal working hours.

I read recently that the space shuttle Challenger that exploded in 1986 resulting in the loss of seven lives and a billion dollar space shuttle, was caused by a faulty $2.00 O-ring. It reminded me of a piece of advice that an old colleague and NZIHE board member, Nigel Cross, gave to me. He told me that whenever I worked on a piece of equipment, I should remember that the next person to be attached to that equipment could be me, my wife, or one of my children.

Clinicians and hospital managers tend to relegate biomeds to lower ground floors, external buildings and out of the way places. Even in my own hospital facility where I work, we are on the lower ground floor, just down the hallway from the mortuary. We sometimes joke inhouse about how handy it is given the age of many of my colleagues. And without getting sidetracked, the ageing workforce in Clinical Engineering is something I feel our organisations, the IHEA and NZIHE, need to address..

Medical equipment is essential in running a hospital. I was recently in a conversation with some nurses, and while I repaired their ECG monitoring system, the tired nurses coming to the end of their night shift joked about how wonderful it would be to work in a technology-free hospital. Where there was no equipment that could break down, and they would just guess at what a patient’s vital signs were. Obviously, this is never going to happen, and hospitals need clinical equipment to operate.

A recent article on the AAMI website was titled ‘When Disaster Strikes, How HTM rises to the occasion’, and I thought to myself, when disaster strikes, it should be business as usual as the biomeds should have already been prepared.

Although we repair and maintain medical equipment, our job is much more than walking around with analysers on a cart, making sure that equipment ‘works’. We are

After the main Christchurch earthquake, I can recall sitting at my bench testing intravenous fluid pumps, which is the bread and butter of what we do, and thinking that there

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must be something better that I could be doing to help out at the hospital during the time of crisis. In hindsight, this is probably how things should work in Clinical Engineering. It’s an indication that our equipment held up well during a period of extraordinarily high use. As the clinical engineer in my hospital responsible for the maintenance of the equipment located in our emergency department, it is a source of honour to me that my work supports and enables the clinicians who are doing the real lifesaving work. This is particularly fitting, given the mass casualty incidents that we have experienced over the last ten years, such as the previously mentioned earthquakes, or more recently, the mosque shooting that occurred earlier this year in Christchurch, resulting in 49 gunshot victims arriving at our Hospitals Emergency Department with the space of an hour.

information as WAND, which is New Zealand’s medical equipment database operated by the New Zealand government, and ARTG inclusion documentation, service manuals and the like. To this, the response from the supplier is sometimes ‘no one has ever asked for that before’, despite the requirements being a statutory ones.

According to 3551, the equipment must also have the correct markings, such as the Manufacturers name, supply voltage and ratings, and other markings. Biomeds are responsible for ensuring that equipment complies with these basic standards.

In today’s throw away society, biomeds work to keep equipment working like new in hospitals, clinics and laboratories, saving our organisations millions of dollars every year. Biomeds have an extremely important role to play regarding not only the repair and testing medical equipment, but other important aspects also. Here are some examples of other activities biomeds are involved in: Managing equipment from install to disposal: Pre-purchase planning I suspect that every Biomed has had a crate turn up in their workshop that they were not expecting, and that have known nothing about it. Upon excitedly unpacking it, they have found a piece of equipment that they have never seen before, minus manuals and statutory paperwork, and in the odd case, with power cables fitted with the wrong country plug. As a consequence, the Biomed has had to go back to the supplier, requesting such standard

Pre-purchase planning is not just about ensuring that the equipment to be purchased is of high quality and fulfils statutory requirements. It also requires ensuring that there is adequate service backup and that the cost of ownership has been considered. I once had to tell a client that their $2000 defibrillator required a $700 battery. Needless to say, my client now wishes they had purchased a different brand of defibrillator. If they had asked a Biomed like me what I thought prior to purchase, I would have been happy to point them in the right direction. This is just one small example where a customer was not aware of the true cost of ownership; I have been involved in far more expensive

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and serious issues where our advice was ignored and consequently our healthcare system has suffered. Involving biomeds in equipment purchasing also leads to hospitals standardising on equipment. Multiple monitoring systems result in the need for additional training to be given to clinicians, and of course, a greater range of consumables must be stocked to suit each brand.

Ultimately, clinical engineering involvement can prevent the hospital from purchasing junk. The costs involved with servicing healthcare equipment is massive, and Biomeds have the potential to make or break a hospital’s budget. Interconnectivity with IS In most hospitals, computer networking services are separated from clinical engineering, however the demarcation lines are starting to get fuzzier. We are now in a situation where we have increased software support verses hardware support. Consequently, my hospital has been upskilling biomeds in the area of computing networking.

Biomeds are more frequently required to work with a hospital’s IT staff as an increasing amount of equipment is becoming interconnected to the hospital’s data network. This is huge growth in this area at the moment, and we are seeing more and more equipment that requires networking or that can enhance patient care by being connected to the hospitals network. Here are just three examples of where Biomed’s are working closely with Information Services, as they are known in our hospital: 1. We have intravenous fluid pumps at our hospital that have wifi built in or wifi tags attached to them, and thus, we can use software to track the pumps whereabouts within the hospital. In my hospital, pumps that are used in our emergency department travel all over our main campus, and sometimes even to other hospitals. Using wifi, we can find these pumps wherever they are within our hospital wifi system, and this has resulted in huge savings in man-hours looking for pumps when our ED has run out of them. This has been a huge help to those involved in running ED. The same system also enables us to remotely monitor drug fridge temperatures using the same tags. If a remote temperature gauge located inside a fridge goes out of range, an alert is raised in our telephone office, and the telephone operators will call the department involved to inform them. This has resulted in the prevention of thousands of dollars worth of drugs being damaged. 2. Our newest AEDs, The Lifepak CR2, is a wifi-connected device that is capable of not only sending email alerts when it is not in a ready state, it is capable of providing first responders with real-time ECG data remotely. For example, our ED staff can be observing a patient’s arrhythmia tracing while the patient is receiving CPR at a remote location, such as a rural hospital or medical centre. And as a biomed, I regularly receive notifications when a defibrillator has been used, and not immediately returned to a state of readiness.

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3. ECG’s taken on mobile ECG carts are now being automatically uploaded to the patient’s electronic medical records. Our newest monitors, such as the Welch Allyn CSM and CVSM, are capable of transmitting basic patient vital signs, such as heart rate, blood pressure and temperature directly to the medical network and the patient’s electronic medical records. This removes the need for the nurse to manually enter data into a PC or Notebook PC, and hence, removes the opportunity of errors while freeing up the nurses time.

Ongoing improvement requires good relations with clinical staff. Biomeds are typically siloed from clinical staff. One of my previous roles involved paying regular visits to a local but somewhat unloved hospital, just for a routine walkaround. During my visits, it was not uncommon to hear the old ‘oh wait Michael, while you are here…’ Likewise if I see a nurse struggling with a piece of equipment, it’s an opportunity to help. One of the most crucial relationships that exists in a hospital is that which exists between the nursing staff, who work on the front lines, and Clinical Engineering, who are responsible for the reliability and safety of the equipment upon which they rely. When that relationship is strong and the needs of nursing, and by extension, the needs of patients are quickly addressed, everyone benefits. Almost everything nurses do depends on the information that they get from medical devices, and Clinical Engineering staff are responsible for these devices. A colleague once told me that a misreading tympanic thermometer, a very common issue due to dirt build up on the ear probe, could result in a patient having an unnecessary overnight stay in a hospital. I discussed this with some clinicians, who assured me that a temperature reading on its own was not enough to admit a patient, however, it was something to think about.

Ongoing in-service improvements and education

Managing Device Incidents

Alarm fatigue has been a hot topic for some time, and has been highlighted for several years as one of ECRI’s top ten healthcare hazards. In my own hospital, with clinical consultation, I have been involved in helping to make the ED a quieter place to work, by altering alarm protocols. This is just one example of where I as a biomed have been able to make ongoing improvements to the equipment that we manage.

There are many reasons why a device may fail, potentially resulting in patient harm. A defibrillator could fail to deliver a shock, an infusion pump could over deliver or under deliver a drug to a patient.

Fully understanding a root cause for a device related incident requires full knowledge about the device, patient, building, infrastructure, clinical procedures and numerous other factors. Good communication with clinical staff is vital to getting to the cause of an incident.

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There are several steps involved in understanding a device incident, and without going too deeply into it, here are the basic steps: 1. Clinical staff should ensure that the patient is safe. 2. Clinical staff should notify clinical engineering of a device incident. 3. The device should be removed from service, and clearly marked as being faulty. 4. And the one thing that clinical staff most often forget, all accessories, disposables and packaging should be preserved. Clinical Engineering then work with the clinical staff and whoever else is required to establish the cause of the fault, and how to prevent it from happening again. Swiss Cheese

A commonly used metaphor for understanding safety incidents is ‘Reason’s Swiss Cheese Model’. To summarise, in a complex system such as healthcare, hazards are prevented by a series of barriers. Each barrier has unintended weakness or holes, hence the Swiss Cheese analogy. However, in reality, unlike swiss cheese, the holes are ever changing size and moving. This adaptation of Reason’s model specifically for the management of medical equipment encourages a focus on three main factors that we should pay attention to: 1. Identifying and eliminating or minimizing potential threats 2. Improving the effectiveness of processes, procedures, people or equipment, represented by the slices of cheese. Effectively making the holes smaller 3. Proactively seeking and plugging holes or weaknesses in barriers.

Clinical Engineering literature is full of examples, case histories and horror stories involving device-related injuries and deaths. Many devices apply energy to the patient, be it pneumatic, mechanical or electrical. While continuing improvements in device design can and has reduced the incidence of such injuries, these devices, by their very nature, remain intrinsically dangerous. As such, users need to rely upon the development and use of appropriate and pragmatic barriers to ensure patient safety. Recalls During the life of a product, the manufacturer may issue device upgrade notifications, advising of changes that may be necessary to keep a medical device running optimally. ECRI Institute regularly send out notifications of recalls and upgrades to equipment, as do equipment manufacturers and vendors. It is absolutely vital that the recommendations are carried out, as failure to do so can result in patient harm. I was once involved in an incident in a remote hospital, where I was required to test an AED. The AED had two battery bars showing, so I felt confident that I could test it and leave it with sufficient battery capacity after I had completed my tests, should it be required for therapeutic use. However, one 360 Joule shock was sufficient to flatten the battery. To compound the issue, I did not have a spare battery on me. In some ways it was fortunate that the unit stopped working while I was testing it, and not while on a patient, however I had left the hospitals only AED useless while we sourced a replacement battery. A few months later, the agent for the defibrillator announced a software upgrade, as I was not the first person to encounter this issue. So this has just been a bit of an insight into how biomeds like me help make hospitals safer places for patients and staff alike. I love what I do, and the fact that I am able to use my technical and engineering skills to assist in patient care.

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JUST DO IoT By Rogier Roelvink, customer strategy director, Oracle Construction and Engineering

Internet of Things (IoT) is everywhere these days, with people referring how they are planning for, talking about or developing for it. With the prevalence of IoT, what does it mean for construction and property management in the healthcare space/facilities? Will it actually provide real benefits and efficiencies or is its value yet to become apparent?

ith the fourth industrial revolution (Industry 4.0) in full swing, technology advances mean that new, smarter, safer and better ways have come to market to plan build and operate health assets. The Internet of Things (IoT) is one of those technology advances that have been around for about two decades. Since then its definition has been subject to some change, however fundamentally it refers to the connectivity to the internet of objects that generate data for the purpose of making the data available and connectable.

stakeholders and contractors by way of notification and work order requests with the aim of minimising disruption and optimising operational expenditure.

Although threats of cybersecurity and protection of privacy make IoT a potentially scary proposition, society is already filled with IoT objects: mobile phones, smart watches, remote security systems, lighting in our homes, and even baby monitors all connected to the internet, demonstrating how IoT is here to stay. What does IoT mean for construction, facilities and asset management in the healthcare space?

Data overload

THE PROMISE OF IOT There is an inherent conundrum associated with IoT devices in the construction and property industry. On the one hand, manufacturers forge ahead with providing connected devices and in some cases there is no longer an unconnected alternative available. Connected devices are touted to have great benefits for businesses in and associated with construction and property, but can stated benefits like ‘early warning’, ‘remote monitoring’ and ‘continuous data collection’ be quantified within a health organisation to the extent that they warrant change or investment? Smart buildings and assets A facility with devices connected can make buildings and assets ‘smart’. Critical systems and assets could be connected to the internet and if they are underperforming or even off-line, notifications could be sent to the relevant

In most cases it is difficult to attribute direct and immediate cost savings to internet connectivity functionality. Areas to consider for a business justification to invest in IoT devices could for example be to focus on risk avoidance and reduction, reduced down time and disruption, all of which could potentially be quantified.

Another reason why IoT devices are still sceptically regarded in construction and property is that the industry is currently experiencing a constant and ever-increasing influx of data, information and records. The influx of data and devices that can collect more and more data is leading to a data overload in the construction industry that is spending less than one percent of its value on technology. The construction and property industry may simply not know what to do with the data and how it can support productivity and efficiency gains and reduce safety incidents and risks. There is however great potential with the advent and introduction of more IoT devices in construction and property especially when combined with advances in artificial intelligence, machine learning and analytics.

ARTIFICIAL INTELLIGENCE AND MACHINE LEARNING Artificial Intelligence (AI) and machine learning provide valuable insights in performance when combined with IoT devices and analytics. Machine learning and AI in simple terms is probably best explained as automating data analysis and formulating corrective courses of action. By way of example: sensors, access systems data, room temperature, energy use are all combined to determine

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whether a floor is still occupied at 6:30 p.m. or not; and if not, the building management systems will be automatically directed to turn off the lights, switch off heating, ventilation and air conditioning (HVAC), switch the security system to night mode and activate the alarms. No longer will these operating parameters be either set for predetermined times at facility commissioning or conducted through a ‘manual’ action; now the facility accommodates to the user needs, providing a better user experience whilst optimising energy efficiency and without compromising on security. Combining multiple, currently or seemingly unrelated data sets will significantly increase insights in performance. For example, combining HVAC performance data with weather patterns and space occupancy might provide insights that could predict how HVAC assets perform under certain circumstances. Furthermore, through running variable scenarios, historic data could provide insights that are able to forewarn of adverse situations and even suggest suitable action to be taken when conditions manifest themselves. Imagine if a facility could ‘learn’ to recognise the work patterns of its occupants to the extent that working hours are prolonged in the lead up to the end of the financial year and it could schedule additional kitchenette cleans to accommodate for users being in the facility longer or delay the cleaning shift so as not to disturb the users in their activities. Technology, based on analytical insights derived from AI or machine learning, can advance assets and systems to have learned to the extent that it is able to ‘automatically’ take pre-emptive action when parameters change. The challenges currently faced by construction and property industries are: • Technology – Artificial Intelligence and machine learning are not yet commonly available or accessible for these industries; and many IoT devices need to mature in terms of their functionality and connectivity in order to provide useful insights or be shared across platforms and systems. • People – Digitisation, future delivery and operating models have not yet been sufficiently articulated by industry or organisations, partly because within these industries the full potential of IoT technologies is yet to have compelling articulation and operating models. • Process – Many industry processes stem from a time before digitisation and have not yet undergone wholesale change and re-visitation, i.e. processes are being enhanced and improved, however not necessarily questioned about their purpose and true functionality. The connectivity, functionality and availability of IoT devices for the built environment including properties in the health

sector is likely to continue to grow. In order for any health organisation to be able to benefit from the technology advances, IoT devices should be embraced now and data collected and structured ready for AI to use it to learn.

CALL TO ACTION Just do IoT. Connected devices are not going to go away, AI and machine learning are subject to continual advances, which means soon the technologies will connect and become available without having to incur great expense. In order for health organisations to be able to benefit from IoT devices and analytics it is suggested to: • Collect data – AI and machine learning will only be useful to an organisation if the technology can ‘learn’ from historic data, detect patterns and outcomes within it. Data should be collected consistently in a structured manner (Technology). • Embrace change – Inherently people and organisations are sceptical of change, yet in order for health organisations to reap the rewards from technology, IoT devices and for people to achieve fulfilment in their roles, it is critical that individuals accept change as the only constant and start to think outside the box (People). • Challenge – The status quo reflects the past; processes, regulations and work practices currently in use are based on historic events, activities and improvements. Technology provides an opportunity to redesign today’s practices, an opportunity to move away from incremental improvements to wholesale step changes. (Process) A word of warning though, when embarking on an IoT program, security and privacy has to be paramount. Making sure that the connected devices are secure and respect and protect privacy so as not to expose the organisation to malicious outside influences. Security must be considered from end-to-end when deploying IoT devices. Including endpoint security, security of communication between endpoints, management and monitoring, data distribution and secure storage. Without security being the highest priority any perceived economic advantages from IoT devices could be at risk of being diminished by the damage that malware attacks could do to the business. Approach technology advances with an open mind with security front and centre, always look for capability improvements that could be achieved by enabling organisations to improve productivity, safety records, user/ staff/client satisfaction to exceed current performance standards and change the way the business is being delivered. Work practices standardisation and governance is an essential element of successfully achieving improvements. Consideration can be given to the amount and type of data to collect on a construction project

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or in operating a facility that can be used to make sure that systems and processes are set up to capitalise on data captured to allow businesses the flexibility to quickly embrace IoT where it will realise measurable benefits in construction and operation.

ABOUT THE AUTHOR Rogier Roelvink works at Oracle Construction and Engineering as the ANZ customer strategy director. He has 19 years’ management consultancy experience across Europe, the UK and Australia. Rogier has a particular interest and expertise in strategic facilities management with a passion for informed decision making. Rogier is actively involved in a number of industry associations and working groups to advance this industry including as chair of FMA’s Digital Technology & Information and the Members & Marketing Portfolio Groups.

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ABOUT ORACLE CONSTRUCTION AND ENGINEERING Asset owners and project leaders rely on Oracle Construction and Engineering solutions for the visibility and control, connected supply chain, and data security needed to drive performance and mitigate risk across their processes, projects, and organisation. Our scalable cloud solutions enable digital transformation for teams that plan, build, and operate critical assets, improving efficiency, collaboration, and change control across the project lifecycle. www.oracle.com/constructionand-engineering.

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CLINICAL PRECISION DRIVES HOSPITAL EMERGENCY LIGHTING EXCELLENCE Medical facilities and hospitals are the bastions of safety and demand emergency lighting solutions up to the task of meeting the most stringent safety requirements.

et against this backdrop, ABB’s Stanilite® Platinum range is in a league of its own, providing measurable value against the priority criteria of these facilities. With more than 150 hospitals across Australia featuring Stanilite emergency lighting, it is the go-to choice of safety-focused facilities managers.

Operational medical buildings demand the utmost in performance, reliability and compliance to Australian and New Zealand standards. Stanilite’s integration of the latest in LED technology – in the Platinum range exceeding 100,000 hours of lamp life – and lithium iron phosphate battery technology, delivers every time. Where reliable, fast egress is a priority, quality is a point of no compromise. ABB’s Stanilite Platinum range now offers the Nexus RF Infinity® monitoring system, an upgrade from the previous Nexus RF system that is available to all existing clients through backwards compatibility with no need for additional hardware. “Key medical facilities often manage time-sensitive operations and a higher duty of care to the security and sensitivity of the patient experience,” said Stephen Charlton, Global Product Manager, Emergency Lighting. “That makes remote monitoring and efficient maintenance far more than a ‘nice to have’. They become vital.” Nexus RF Infinity allows luminaires to be tested in groups, providing flexibility and efficiency to hospital maintenance staff as it prevents the possibility of luminaires not having enough back-up battery power in the event of a power failure shortly after an emergency light test. It also gives teams the ability to schedule testing to avoid impacts on end users, such as avoiding interrupting clinical procedures. The combination of high-quality hardware and industryleading software results in whole-of-life value, such as reduced need for replacements and other maintenance, with the least disruption to day-to-day activities.

Hospital upgrade success turns into campus-wide scope Queensland’s Princess Alexandria Hospital demonstrates the benefits available to clients who choose ABB Stanilite. With the facilities management team concerned at emerging issues in the emergency lighting system, such as inaccurate test reports, hard-to-procure spare parts and growing expenses, they set about finding a new solution. In 2010, ABB won a discrete package of work to refit the emergency department – a 6-storey structure with more than 700 emergency light fittings selected for their compatibility with the then Nexus RF monitoring system. The gains were so immediate and significant, the hospital expanded ABB’s Stanilite scope to the entire hospital campus – more than 6,000 fittings. The facilities management team is able to run diagnostic tests and commission fittings remotely, reducing the impact on daily hospital operations – a significant win for an active and sensitive medical environment. With Nexus RF also integrated into the building maintenance system, the team can assess performance and drive greater reliability with maximum efficiency and safety assurance. The value has been so demonstrable that the hospital has begun to roll out Nexus RF Infinity. When safety is not only paramount but life-saving in more ways than one, ABB’s Stanilite Platinum range with the new Nexus RF Infinity is the unquestionable leader. The number of state and private health departments and aged care facilities moving to rollout Nexus RF Infinity underscores its value. With ABB’s continued commitment to research and development, building on an impressive 45 years of engineering history, the medical sector can only look forward to future innovation in safety.

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INTERNATIONAL STORIES

HOW TO BUILD AN EMERGENCY HOSPITAL IN TWO WEEKS By Garry Bowker, Regional director of Integrated Health Projects (IHP) and VINCI Construction UK How do you build a 650-bed hospital in two weeks? Garry Bowker, Regional director of Integrated Health Projects (IHP) and VINCI Construction UK, tells the ‘behind-the-scenes’ story of the NHS Nightingale North West in Manchester.

HP (the VINCI Construction UK & Sir Robert McAlpine joint-venture) have extensive healthcare experience and capacity in the north-west of England delivering ProCure framework projects out of the VINCI Construction UK offices in Widnes. On 27 March IHP was advised by the Department of Health & Social Care and NHS England / NHS Improvement (NHSE / NHSI) that the new Manchester Nightingale hospital emergency facility was to be delivered under ProCure22 and Alan Kondys, IHP Framework Director, offered our services for immediate mobilisation. The NHS Nightingale Hospital North West experience began for me at 11am on Saturday, 28 March, when we were given the green light by NHSE/I to by deliver the project, and we were ‘all systems go’.

AN UNPRECEDENTED EXPERIENCE What followed was like nothing else I have ever been involved with, in all my years of healthcare construction and support services. We needed to address three priorities – sorting out key experts, lining up our supply

Garry Bowker, Regional director of Integrated Health Projects (IHP) and VINCI Construction UK: “Right at the beginning we did not know the full scale of the task we faced.”

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chain, and organising a team to manage the design and installation of the works. The weekend became a blur of phone calls, organising colleagues and partners to put together the right team. Straight after getting the ‘go ahead’ from Alan Kondys, my first call was to Ged Couser, Architect Principal for BDP in Manchester. I knew that BDP was already working on the NHS Nightingale Hospital London at the ExCeL conference and exhibition centre, and had worked with him and his team before. Even better, like me, he is a Manchester man through and through, and I knew that he would not just be professional , but also passionate. After speaking to Ged Couser, I next called it Paul Aulton, Regional director at NG Bailey, to ask him to lead on the M&E delivery. Next was to think about the flooring. Even before there was a plan drawn up by BDP, we knew that around 14,000 square metres of vinyl flooring needed to be laid. That meant a very frank conversation with Horizon, our flooring contractor. How fast could it get materials, and how quickly could it finish? This conversation is a good example of what followed, because as politely as I could, I said: ‘Thanks, but can you do it in a third of that time please?’

RELEASING THE RIGHT PEOPLE FOR THE JOB As this was a VINCI-led IHP project, I worked with our Regional managing director, John Roberts, to release the right people for the job – even if it meant pulling them away from existing work. I also called upon the combined strength of the IHP JV, and requested two people I knew within the Sir Robert McAlpine team to play key roles: Paul Jackson as senior Design manager and Caroline Mulholland as Clinical liaison. Meanwhile, still on the Sunday, other members of our team were walking the site accompanied by the Army. “Garry Bowker, from IHP, called me at about 11am on the Saturday,” explains Ged Couser, a healthcare specialist. “He outlined what NHSE/I had requested, and asked me to get myself down to the Manchester Central site on the Sunday, which is exactly what I did.” When he arrived there, Ged Couser met representatives from the Army, Manchester University NHS Foundation Trust, Andy Kelly, FM director at the Manchester Central Convention Complex, and Martyn Frackleton, Project Principal at Mott MacDonald. The idea was to walk around the space and assess how we were to deliver what was required. “We were taken around the site by Major Matt Fry of the Royal Engineers and his colleagues, who had been on site for a few days,” Ged Couser explains. “ They had already sized up what was going to work and what wasn’t,

At one point there were in the region of 20 people spaced out around what amounted to a test bed bay.

checked the logistics and done a basic layout, and estimated the likely bed capacity. This gave the rest of us a great starting point.”

A ‘HELICOPTER OVERVIEW’ That starting point was very much a helicopter overview. So, one of the next tasks (because so many things were already running in parallel) was bringing all of the designers and specialists together to refine that initial plan. At this point, everyone involved was also still pulling their own teams together. This was made easier because each person or organisation contacted did not hesitate. This says an awful lot for the culture of P22 and the construction industry, because no one knew what would be required, or indeed if they might have to stay away in isolation. As Ged Couser puts it: “It’s not the kind of project where you can just click your fingers and point at people. We needed volunteers who understood the urgency and were prepared to drop what they were doing.” BDP had a team of around 10 people on the project, focusing on the architecture of the hospital. This began with three on site with Ged Couser, and five working at home, and then another two on site towards the end of the project. Working alongside the architects was the BDP M&E design team of 10 people, led by Principal, Building Services Engineering, Rob Ferry. This dovetailed with the other teams; Mott MacDonald started off with four people and this moved to eight, while NG Bailey began with 11, with the number rising to over 120 technicians by the end of week two. Overseeing this was our IHP team, largely based on site, and supported by others working from home. At peak we had around 1,000 people working around the clock.

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Integrated Health Projects is a joint venture between VINCI Construction UK and Sir Robert McAlpine that operates under the ProCure22 Framework. The Department of Health & Social Care and NHSE/I approached IHP and other ProCure22 providers in late March to discuss the likelihood of field hospitals being delivered. The IHP team in the North West put its name forward for the work proposed at the Manchester Central Convention Complex.

POSITIVE FROM THE START Right at the beginning we did not know the full scale of the task we faced. On the Monday, 30 March, when the initial team gathered on site, the reality was spelled out by Major Matt Fry. Paul Aulton of NG Bailey takes up the story: “All of our preconceptions were stripped bare by the briefing by the Army. It was made clear that whilst things looked like a mess now – my words, not theirs – we would succeed in opening this hospital”. John Fowler, VINCI Construction and IHP Contract manager, recalls: “It was clear that this was going to be like no other project, let alone any hospital we had worked on before. As an emergency hospital, it was going to be a totally different proposition.” John Fowler, VINCI Construction and IHP Contract Manager, remembers” “That joint briefing set the tone to focus the mindset of everybody on the project. My role was to ensure that we all stuck to that mindset, and we did. The team focus was on solutions, speed, and delivery, and to keep on thinking differently to get the job over the line on time. One of the key messages was; ‘Forget all you know about normal healthcare construction – this is about constant problem-solving.’”

SPLIT INTO WORKING GROUPS Following the briefing, we split into working groups, each focused on a specialisation. In these workshops, which probably lasted a few hours, concerns were graded and narrowed down so we identified the big-ticket items, or ‘big levers’, as Major Matt Fry called them. Among many key issues two are worth focusing on: the overall design, and the bed bays. Building on the initial foundation from the Army, it was important for the design team to really understand the constraints and potential of the Manchester Central Convention Complex. That meant working very closely with the site FM team, as well as the NHS Trust, and it also meant challenging and testing the brief, so that everyone was sure they were working in the same direction to deliver what was required. “One of the scary things was that while we were doing what we need to in terms of refining the brief and developing drawings, construction had already begun,”

explains Ged Couser. “We were on a tight timescale, and some elements of the build could not wait. While we were working on designs with NG Bailey, Archus, and the clinical teams, the IHP team, led by John Fowler, IHP Contracts manager, was preparing to lay flooring throughout the convention centre before a line had been drawn on the grid.”

‘ALMOST LIKE REVERSE ENGINEERING’ The problem for the designers was that they could not work as normal. Just like all of us, they needed to adjust. It was almost like reverse engineering. It was not design and build, but instead more like ‘build and verify by design’. John Fowler and I knew the flooring had to go down, so by Monday we had the material delivered and work had started. “Meanwhile we had not agreed the bed bay set-up, let alone the overall layout,” say Ged Couser. “This was critical to moving the build forward. Flooring was one thing, but we needed to agree the exact proportions of the bed bay to know the capacity and overall floor plan.” It was thus good to know that NG Bailey team was ahead of the game. Its team had already been working on the Harrogate Nightingale hospital, and knew the likely requirements for bedhead trunking, sockets, switches, and wiring. “We opened up our off-site factory on Sunday, and had begun to collate the materials we anticipated might be needed based on what we had learned from Harrogate,” explains Paul Aulton. “That experience, and the fact we had already been working with BDP, gave us an edge.”

A MOCK-UP OF THE BED BAY To agree the bed bay we needed a mock-up, which was a critical stage of the design process. The beds were a standard size, and we knew approximately the dimensions needed by the nursing team. What we also needed was a partition fit for purpose. Feedback from the London ExCeL Nightingale Hospital was that the system used there was not ideal – so we opted for a temporary hygiene system that the VINCI team had used before. Samples of product arrived on Monday, and on Tuesday NG Bailey brought the kit fabricated in its factory and the mock-up bed bay was assembled. “At one point we had in the region of 20

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people spaced out around what amounted to a test bed bay,” says Ged Couser. “The overall configuration was checked to allow for IT services at every bed, with provision of handwash facilities and nurse space talked through. It was live beta testing of a full-scale working model, and it worked.”

A PROCESS OF ADJUSTMENT This meant that the design, procurement, and construction could move forward. It was an example of how the drawing stage needed to adjust; whereas on a normal project designs might be created, and mock-ups provided over months, this happened in hours. However, flexibility through the project remained fundamental. What we came to know as ‘the new normal’ at the Manchester Nightingale gained momentum. Decisions began to flow. This was due to a clear hierarchy, but not one that was rooted in any notion of one leader. Ernst & Young worked alongside the NHS; its requirements were checked, and then conducted down a ‘funnel’ by Mott MacDonald and Archus to the IHP design and delivery team. It was an organic system that allowed individual specialists to focus on solutions. “While commercial concerns, contract paperwork, and pricing, were not the driver on this job, we still needed to track what was going on,” explains Martyn Frackelton, Project Principal, Mott MacDonald. “Yes, we needed to crack on – see a problem, develop an answer, test it, build it – but we needed a paper trail too. Timesheets, materials, and orders, all had to be auditable. That’s part of our job as project managers, as well as being the interface with the client team.” The light touch from the project management team gave the authority and flexibility to deliver the solutions needed. It meant that John Fowler could rapidly organise the supply chain, and team members from NG Bailey, BDP, and other suppliers could liaise seamlessly with IHP.

GO-BETWEEN, TRANSLATOR, AND FIXER “Clinical liaison means you are the go-between, the translator almost, and the fixer joining up the thinking of the clinical teams and contractors,” says Caroline Mulholland, Clinical Liaison manager at Sir Robert McAlpine. “I’ve been involved in healthcare contracting for 30 years, but this was unique – indeed special. My job is to ensure that the

Across the whole team, there was ‘a shared desired outcome, a sense of purpose, and real clarity about roles and responsibilities’.

NHS teams make their concerns heard and understood. In this instance they always got what they needed, but in a different manner to usual, because all the contractors were focused on the field hospital concept.” Someone like Caroline Mulholland is key on project such as this, because her experience means she understands the clinical drivers and questions to ask. “I worked closely with the clinical team, BDP, and NG Bailey to make sure nothing was missed,” she explains. “It was easy to focus on bed bays, and to overlook issues like patient flow, infection control, and issues like donning and doffing – where the clinicians change in and out of PPE.”

VISUALISING THE ‘POINTS OF DETAIL’ To visualise the points of detail, the layout was marked out on the floor with tape. It might have looked like basic stuff from the design team, but it worked. The aim was to create three zones – Red for COVID-19 infection – where staff wear full PPE; the Amber zone as the ‘breakout area’ for all staff, with the requirement here for minimal PPE, scrubs, and the Green zone for all support services – the delivery of all supplies, food, materials, and medicines, where no PPE is required. The challenge is how to have each zone operating, and for nothing to come into contact with the Red zone. For example, movements in and out of the Red zone must be able to occur without crossing the Green and Amber areas. The fourth zone

NHSE/I commissioned NHS Nightingale North West via Manchester University NHS Foundation Trust, as the client which runs the hospital. The Client project managers were Mott MacDonald, alongside Archus. Integrated Health Projects was the principal contractor, with BDP as architect and M&E designer. IHP engaged NG Bailey as M&E installer, and other suppliers from the experienced IHP supply chain.

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was the 100-bed mortuary. All these factors were covered through true and rapid collaboration. John Fowler, IHP Contracts manager, says: “The discussions needed to work out these solutions were much easier on this scheme, because we were all not just in the same location, but able to see and speak to each other instantly. It’s unusual for specialists to be working in conjunction with contractors and the client in such a hands-on way. It allowed us to focus on the issue and deal with it them.” “In many ways,” adds Ged Couser, “ it felt like a series of scenes from Apollo 13. We knew had a problem – only certain materials to work with and limited time – so, we just got on with it.” Paul Aulton says: “It was not unusual for us to come together as a small group, identify a challenge, and then someone would literally sketch out an answer with pen and paper. We’d then agree it and make it happen.”

NEED FOR A VIE By Tuesday evening it had been agreed that the site needed at least one vacuum insulated evaporator (VIE) unit – in effect a giant thermos flask which almost all hospitals have located outside their buildings. BOC then can re-supply easily. For us that meant assessing the

THE KEY PROTAGONISTS Garry Bowker – Project director, IHP and VINCI Construction Regional director. John Fowler – Contract manager, VINCI Construction. Caroline Mulholland – Clinical liaison manager, Sir Robert McAlpine. Ged Couser – Design lead. Architect principal and healthcare lead, BDP. Martyn Frackelton – Project manager, Mott MacDonald, Project principal. Paul Aulton – M&E provision, NG Bailey Northwest director of Engineering.

loading bay to the rear of the convention centre. “The service yard was ideal, but very close to the Hilton, live rail lines, and above the arches of the car park,” explains Paul Aulton. “Bear in mind also that the building is grade II listed. The space was surveyed by a structural engineer. Then,

Building on the initial foundation from the Army, it was important for the design team to really understand the constraints and potential of the Manchester Central Convention Complex.

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overnight, a concrete base had appeared, so we could set up the 12 m high tank and then set about working out how to pipe the oxygen into the field hospital and around the wards.” The NG Bailey team set about constructing a pipe framework offsite in its factory, while the design team and builders formed four access holes through the external fabric of the building – after appropriate consultation with the local planning authority. “Oxygen was just one of the ‘external’ issues that if we got wrong would limit the operational capability of the hospital,” explains Martyn Frackelton. It was a reminder that we could build something, but it all needed to be connected to run the facility. That meant we needed to check that what we did was not going to impact upon movements of patients, supplies, and staff in and out of the building. It also meant that we needed to allow for teams from the ambulance and fire services and their needs.” The oxygen cylinders, air-handling units, and generators, all eat into valuable operational space outside of the hospital. So, the closer we came to completion, the more important those details and conversations with the client became.

PACE OF DELIVERY HEATED UP John Fowler explains, “From the middle of the first week the pace of delivery heated up. Flooring contractors across the North West worked together to complete the 14,000 m2 of flooring to be finished inside the first week. As they completed, the partition teams followed. Site closures in Manchester meant we could access labour more readily than normal, and 3,500 metres were erected within days, with over 50 men in two shifts working 24/7. In fact, by the middle of the first week, the whole site was working 24 hours a day.”

Pressure was now on – literally – the NG Bailey team to complete the oxygen framework. “Our big concern was a lack of available specialist pipework and then, once we had it, we were nervous about finding the qualified technicians to finish the work,” says Paul Aulton. “Understandably, the demand for this material and expertise was high right across the NHS, but our suppliers came through.”

SIX LORRIES MAKING A CIRCUIT At one point NG Bailey had six lorries making a circuit collecting pipework, delivering it to its factory, loading up a finished framework section and taking it to site, and then returning to the supplier to begin again. Then the six-metre frames of four pipes were installed. “In the second week we had a team installing 30 metres of medical gas pipe every 150 seconds,” says Paul Aulton. “Once we had a rhythm of repeatability, we were good – by Thursday all the beds were done.” The pipework still needed brazing, jointing, and testing at high pressure by a specialist team. The nature of the test meant the main hall had to be clear of all workers at a critical stage – but it also indicated that the finish line was insight. However, as close as we were, it was no time to relax. In fact, we did the opposite. John Fowler set up a meeting of all the key managers to critically assess all of the key issues and robustly challenge what might go wrong, what needed checking, and what was outstanding. It was typical of the mindset that the Army had instilled in the whole team. No one left that room until we had finalised a plan to reach completion on schedule.

The beds were a standard size, and the team we knew approximately the dimensions needed by the nursing team.

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AN ACHIEVEMENT TO BE PROUD OF We started on site on 30 March, and the Nightingale NW Hospital was ready for use on Monday, 13 April. At one point during the two weeks around 1,000 people were working on the project. It was an amazing achievement, and one that every member of the team should be proud of. Martyn Frackelton caught the mood: “Knowing what we had achieved – sitting in the auditorium at the official opening – it was humbling to be part of something so special.” The teamwork, culture, and commitment is a lesson about what can be achieved. The solution drove the process and everything else followed, and this freed everyone up to deliver. Across the whole team – NHSE/I, the Trust, Mott McDonald, IHP, BDP, NG Bailey, and the extended supply chain – there was a shared desired outcome, a sense of purpose, and real clarity about roles and responsibilities.

GREAT CLIENT AND STAKEHOLDER FEEDBACK Ged Couser says: “It’s easily the hardest, but also the most rewarding project I’ve been involved in. It is amazing what can be achieved so long as no one wants to take credit.” There was great feedback too from the client and key stakeholders. The Chief Executive of NHS Nightingale Hospital North West, Michael McCourt, for instance, said: “Building this hospital in just a couple of weeks has taken the determination and boundless energy of people from many organisations who have come together to ensure that our NHS has the necessary capacity during the pandemic, in what is an unprecedented response to an unprecedented crisis.” Tom Myers, Regional Delivery director NW, NHS England and NHS Improvement, meanwhile, said: “Just heard that everything has been signed off and approved for opening tomorrow. Absolutely great work guys, a great team effort, and thanks for the brilliant job you and your teams have done.” “Everyone involved in this fantastic facility is a historymaker, and you will always have our respect and admiration, added Andy Burnham, Mayor of Greater Manchester Alan Kondys, IHP Framework Director said: “The seriousness of the COVID-19 pandemic is putting pressure on the NHS, its clinicians, and key staff. IHP had no hesitation in responding to the call to deliver the Manchester surge facility, and we are working collaboratively under ProCure22, which is supporting this initiative nationwide.” VINCI Construction’s John Fowler summed up: “NHSE/I and the Army set P22 and the construction industry a test in the shape of the Nightingale hospitals. Manchester is just one

It was agreed that the site needed at least one vacuum insulated evaporator (VIE) unit.

example where both P22 and the industry passed that test. How? Because we set preconceptions and egos to one side and worked with a single, common purpose. In our discussions with the Army guys at the opening event they stated how impressed they were with IHP’s immediate start, organisation, efficiency, speed, and supply chain engagement. It was a privilege to be a part of it.” This article first appeared in the June 2020 issue of Health Estate Journal (www.healthestatejournal. com), the monthly magazine of the UK’s Institute of Healthcare Engineering and Estate Management (www.iheem.org.uk).

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CASE STUDY

Company: Medisch Centrum Alkmaar Contact: Ruud van Toornburg Position: Head of technology services Customer since: September 2001 http://www.mca.nl

HOSPITAL

With more than 600 beds, 3,500 employees and two hundred specialists, the Medisch Centrum Alkmaar (MCA) is one of the largest hospitals in the Netherlands. The hospital focuses primarily on the Noord-Holland Noord region, an area with more than 600,000 residents. ‘The MCA is spread across various locations, together representing a gross floor area of more than 100.000 m2’, says Ruud van Toornburg, Head of technology services.

‘The air quality inside a hospital has to meet strict national norms.’ Ruud van Toornburg, Head of technical services MCA.

‘Our systems use some eighty different kinds and sizes of filters. AFPRO Filters can deliver all of these, so that we can work with just one supplier‘, Ruud van Toornburg, Head of technology services of the MCA AFPRO Filters deliver a very complete package of air filters A hospital thus not only places very high requirements on the air quality, a hospital also has different zones for which different norms apply. This makes air circulation complex and the use of different kinds of filters necessary. For one zone, a HEPA filter is necessary, while inside another zone, a carbon filter is more suitable.

Hospital sets high requirements for air quality ‘Inside a hospital, high requirements are set for air quality. The air inside an operating room must, for example, meet strict, nationally applicable norms in the area of presence of certain particles, temperature, pressure and strength of the airflow. This places high demands on the air filters. We therefore use, among other things, HEPA filters that capture 99,995% of the most difficult to filter particles. Special attention is further devoted to humidity. Filters have to be able to function within a relative humidity of 40-75%‘, according to Van Toornburg. Strict norms also apply where air quality is concerned for the intensive care department and for the laboratories. For other locations like offices and waiting rooms, these are somewhat less stringent, but the air quality is just as important. Every location thus has its own, specific requirements. In hundreds of different air treatment cabinets, the air is filtered, brought into the correct condition and then guided to the correct location via a duct system.

The air filtering within the MCA is extra complex. Van Toornburg: ‘The MCA in Alkmaar is located in buildings of different ages, which requires extra attention with respect to the air circulation.

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We therefore work with different air filter systems, which have the consequence that we use nearly a hundred different sizes and kinds of filters. Van Toornburg: ‘The biggest advantage of AFPRO Filters is the very broad selection. Due to the different systems that we use, we need many different kinds and sizes of filters. AFPRO Filters deliver all of these, so that we can work with just one supplier. That is a very big advantage for us. We now have one contact point, and they know our systems and requirements. They can thus advise us very well. The filters from AFPRO are Eurovent certified and manufactured with formaldehyde-free glue. Van Toornburg is also very satisfied with

You have to take the various conditions into account. An operating room, for example, always has to remain available during the day, and the parts of cooling equipment have to be replaced before summer. Next to the replacement itself, critical systems also have to be extensively measured and tested manually. This requires good planning, not only from us, but also from our supplier.

the quality: ‘We have not been working together since 2001 without reason. The quality of the products is great, and I am very satisfied with the service and delivery time as well. Our complex and highly varied orders are generally delivered quickly. For custom work, the delivery time is longer, but that is logical. Should a disaster happen, then they are immediately on site. That makes AFPRO Filters a reliable partner for us as a hospital.’

AFPRO Filters make certain filters entirely to order. In four years, Van Toornburg expects that the hospital will have relocated to a new location: ‘Then we will be working with the most modern and most efficient systems in the area of air filtering. Due to the use of typical equipment and standardization, the delivery times will decrease even further.’ Finally, the head of technology services wishes to emphasise again how very satisfied he is with his supplier: ‘Dissatisfaction over price and service are the primary reasons for us to change suppliers. There has been absolutely no sign of that in recent years.’

Replacement of filters requires good planning All air filters have to be replaced regularly. ‘The operating rooms alone count more than 200 filters that we replace twice yearly. We replace other filters at least annually. In all, we are talking about hundreds of models.’ The replacement of a filter takes about 15 minutes. ‘But you are not even done yet with that.

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COPING WITH CORONAVIRUS IN THE FALKLANDS By Martyn Barlow, Estates and Engineering manager at the Falkland Islands Government’s King Edward Memorial VII Hospital (KEMH)

Martyn Barlow, Estates and Engineering manager at the Falkland Islands Government’s King Edward Memorial VII Hospital (KEMH), describes some of the particular challenges for he and his team with the outbreak of the COVID 19 epidemic –including maintaining a sufficient oxygen supply for wards, and general clinical use, protecting elderly and especially vulnerable patients, and reconfiguring or isolating ventilation supply and extract systems as a new ‘zoning’ system was implemented to keep those with COVID-19 away from other patients.

ocated in the Islands’ capital Stanley, the King Edward Memorial VII Hospital is used to dealing with whatever comes through the door, and usually has the ability to evacuate the seriously ill or patients who need specialist care. This all changed when the COVID-19 epidemic started, as international borders closed, and flying to other countries became more difficult. The staff at the KEMH are bracing themselves to

A ‘Cold’ ambulance with drive-in swabbing space.

receive patients exceeding 300% of what the hospital is designed for, with limited support. There are 14 British Overseas Territories in various locations around the world, one of which is the Falkland Islands, located in the South Atlantic Ocean, and lying some 8,000 miles from the UK. The KEMH is a small 29-bedded hospital that serves a small civilian population of about 3,000 people, as well as a significant number of military UK Ministry of Defence (MOD) personnel who are based

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A bottle filler at the hospital – one of the prime concerns of the Engineering team was the resilience of the medical oxygen system.

The rear of the King Edward Memorial VII Hospital in Stanley from the air.

35 miles from Stanley at RAF Mount Pleasant. Patients who require specialist care are generally flown to either Chile or the UK, and in the event of some acute cases, emergency evacuation or ‘Aeromed’ will mean that if a Civilian Air Ambulance is not available then the RAF will fly those patients to Uruguay. In such cases KEMH will provide clinical and engineering support to meet patient and equipment needs.

SAMPLES MUST BE FLOWN TO THE UK KEMH does not have the facility to carry out testing for COVID19 (although this is likely to change in the near future), so samples must be flown to the UK for analysis. With flight disruption, followed by transit time, and the time to process samples, this has at times meant a delay of up to 10 days in some cases. This means patients who present symptoms expected of the pandemic victims must be treated as confirmed coronavirus patients until proven otherwise. As the engineering team started to look at the extra resource requirements needed to support COVID-19 patients, it became quickly evident that, due to the numbers of expected patients, we should expect to lose team members as they become incapacitated. The impact of such a scenario is potentially even more significant due to the small number of trained engineers at the hospital; key staff loss in such a small team could mean an inability to maintain life- supporting systems such as medical oxygen plant. To mitigate this risk, engineers with previous hospital engineering experience have been drafted in ready to replace critical team members on an emergency call-out basis. Other individuals with high levels of technical competence and engineering aptitude have joined the team and trained on various systems and

procedures, the intention being that they will augment the main engineering team for the duration of the COVID19 threat, thus allowing any reduced engineering capacity due to sickness to be absorbed by these extra members of staff.

NEED FOR EXTRA MEDICAL EQUIPMENT The structure of the KEMH means that procurement of medical equipment is an engineering responsibility, alongside our remit for Capital Projects. However, all such projects remain suspended at the moment. It was clear early on that in order to meet the threat of COVID-19, the KEMH needed to secure extra medical equipment such as bottle regulators, Continuous Positive Airway Pressure (CPAP devices), ventilators, portable concentrators, and all their associated consumables to name a few. It was also anticipated that some of these items would either be difficult to source, or that there would be significant lead times due to demand. One of the issues for the Falklands is logistical supply given the vast distance from the UK, so things are usually transported by sea, but this is a 6-8 week process, and that is also dependant on the items being shipped being available right away. The MOD greatly assisted the Falklands Health Service, with a priority stores route established to allow us to fast-track critical items relative to COVID-19 straight to the islands. The UK Military need to maintain an operational capability wherever they are deployed, and this includes the Falkland Islands. If any of the tri-service personnel based in the local military base become ill, they could would require hospital support, and to that end, elements of the British Army 16th Medical Regiment were deployed to the Islands and stationed in the KEMH, augmenting the civilian staff; with them came extra medical equipment, increasing KEMH’s capability further. This opened up another potential logistical supply

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route, and with access to previously unavailable military equipment, the British Army staff and their equipment would be used to treat any patients irrespective of whether they were civilians or members of the armed forces.

ZONING IN TO ‘HOT AND ‘COLD’ As contingency planning continued, it became evident that without the ability to confirm that patients were free from the virus, it grew increasingly unlikely that the critical Aeromed evacuation could be relied on. This opened up the possibility that the hospital would need to treat more seriously injured patients, as well as for caring for those showing signs of coronavirus. The hospital was immediately zoned into ‘Hot’ (C19 patients) and ‘Cold’ (non-C19) areas. The normally resident, elderly care patients were moved to another location, where they remain shielded, to protect them, and free up space within the KEMH. The area they had occupied now became the Cold Ward, while the existing area dedicated to secondary care became the Hot Ward. Further planning for escalation of the Hot Ward was also considered and put in place. Part of these plans required taking over a detached house normally used for sheltered housing and converting it to act as the Cold Ward, should the Cold Ward need to be moved.

SUPPLY AND EXTRACT SYSTEM ADJUSTMENTS As the hospital was zoned, the ventilation requirements were considered, and supply and extract systems reconfigured or isolated as required. A main consideration was reducing the potential for contamination, while another was to maintain air supply for the Hot Zone care workers, as there was a potential for staff wearing PPE

A ‘Hot’ ambulance with COVID assessment path and signs.

to overheat. Most of the dedicated ventilation systems remained in the ‘Cold ‘areas of the hospital. However, the ‘general vent’ supplies both the Hot and Cold wards, as well as other areas, and so careful consideration was required. One of the prime concerns of the Engineering team was the resilience of the medical oxygen system. Due to logistical challenges, the KEMH manufactures medical oxygen via two identical O2 concentrator plants. This is directly piped to the various areas that need it, which totals 39 points. The system is designed for one concentrator to run with the other in standby, with extra resilience afforded by two banks of three J-size bottles, which are independently switched. There remains an extensive supply of J-sized bottles held in reserve for the emergency bottle bank, and by chance an extra supply of medical oxygen bottles was already ordered when the pandemic started. The plant also has a small compressor, which can be used to charge medical O2bottles, but as a small such unit, charging one J-size bottle takes over two hours.

PHE PATIENT MODELLING When the KEMH received the Public Health England (PHE) COVID-19 patient modelling, it painted a very bleak picture of needing to cater for 300 per cent more patients than the hospital was designed to hold, with the Falkland Islands Chief Medical Officer confirming that the only patients being admitted would be those requiring oxygen. This created a huge problem, since as things stood, there was no way of delivering a sustained oxygen supply to that many patients, and it was not lost on the staff that

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The air separation plant – cryogenic plant which will take liquid oxygen and fill gaseous medical oxygen into either J- or W-size bottles – had to be flown 8,000 miles to the King Edward Memorial VII Hospital in two specially laid-on aircraft.

they would probably know most, if not all, of the patients being admitted, which potentially included colleagues and family members. With no possibility of an Aeromed, and no chance of sending patients to another hospital, any breakdowns of critical systems would need to be repaired by the Engineering team, since site support from manufacturers was not possible. With the PHE modelling in mind it was clear that the oxygen production on site was inadequate to support such numbers, even with a stockpile of prefilled bottles. With both concentrators running in parallel, if one plant became defective, the bottle charging capability would be lost, and the resulting loss in pressure would ultimately mean insufficient oxygen being delivered to patients. Technical support for the concentrator plant is usually provided by the manufacturer once a year; it undertakes planned preventative maintenance (PPM).

A LOGISTICAL CHALLENGE TO GET ENGINEERS ON SITE However, organising engineers to attend is a logistical challenge, and it can often take a number of weeks from the placing a first call to a manufacturer, to their staff arriving – even for emergencies. With the Falklands lagging behind the UK in terms of effects of COVID-19, there is an

additional 14-day quarantine period in force for anyone coming off the South Atlantic Air Bridge (the UK MOD flight from the UK). Given that any technical support staff we do get are likely to be stuck on the Islands – increasing the likelihood of no on-site support, we soon realised that any engineering issues would need to be addressed by our ‘inhouse’ team. If the oxygen manufacturing plant remained operational, there would only be a constant supply of oxygen for 54% of expected patients, even taking account the extra capacity provided by the newly supplied portable oxygen concentrators. The stockpiled J-sized bottles are expected to last 12 hours each, supplying 10 litres per minute, and with both plants running close to capacity the ability to re-charge medical oxygen bottles would be lost.

RISK OF CONTAMINATION There is a sizable cache of empty industrial oxygen bottles on the Islands waiting for return to the UK, but while it was confirmed that the KEMH does have the capacity to fill these bottles via its ‘bullnose’ connections, any contamination in the bottle cannot be verified. As medical oxygen is a pharmaceutical product, it is a drug administered by a doctor, and the risk of potential contamination was deemed unacceptable. BOC in the UK is, in fact, currently converting W-size bottles and supplying

INTERNATIONAL STORIES

Engineering team has been forced to consider actions they would not have think about normally, raising issues in areas that were previously unknown, as well as successes in other areas. Our next focus will be to how to support the hospital if the current pandemic requires us to maintain this higher level of day-to-day activity for a sustained period. Our strategy here is to put arrangements in place so we can wind down to effectively carry on as normally as possible, and then simply revert to the higher operational tempo in short order.

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Spare beds ready in the ITU.

the NHS to make up the shortfall of J-size bottles, but the turnaround for getting emptied bottles to the UK, filled, and returned to us in the Falklands would be too long. At the time of writing, the MOD has negotiated for a substantial number of converted W-size medical oxygen bottles for immediate issue, and is currently investigating flying the bottles to the South Atlantic. The UK MOD has secured an air separation unit (ASU) – a cryogenic plant which will take liquid oxygen (LOx) and fill gaseous medical oxygen into either J- or W-size bottles (or any other-sized bottles). This is a significant piece of machinery, and will require three civilian engineers to install and commission, and a further five military personnel to operate on a shift basis. The capability uplift the ASU represents is considerable, as it can fill eight bottles simultaneously (both pin- indexed and bullnose), it has enough LOx for 600 charges. The ASU itself will be installed at RAF Mount Pleasant, enabling the installation and operational crew to remain in quarantine on the base – eating, sleeping, and working separate from all other personnel, thus negating the need for the 14-day quarantine. The UK MOD, in conjunction with the Falkland Islands Government, will then look to ferry lorry loads of bottles to Stanley and the KEMH, where emergency bottle caches have been set up, as required.

LUCKY THUS FAR In reality the Falkland Islands have been lucky thus far, as the number of COVID-19 patients has been relatively light. This has allowed clinical and engineering staff to draft new procedures for this unprecedented situation, and to see if they work, thereafter altering them as required. The ‘Plan, Do, Check, Act’ approach has allowed us to review and improve systems we have put in place – a luxury many countries have simply not enjoyed. The Achilles heel for the KEMH will always be logistical supply; however, we have enjoyed strong support from the UK MOD in this area. The

Martyn Barlow is the Estates and Engineering manager at the King Edward Memorial VII Hospital (KEMH) in Stanley on the Falkland Islands. He has been in post as the head of Hospital Engineering for 15 months, having, as he puts it,‘been succession planned in’ from his previous role as deputy Engineering manager position. In addition to his engineering management role, he also runs all the Health Department Capital Projects. Initially a Royal Navy weapons engineer – a role with a heavy electrical control engineering bias – he left the Senior Service after 17 years while serving in the Falkland Islands in 2007, working as an electrical technician in the private sector before being recruited to a facilities management role with the Falkland Islands Government (FIG) Civil Service. While with the FIG, he worked in the tertiary education sector for three years, heading the Falkland Islands Apprenticeship Scheme. This role included promoting engineering careers to young Falkland Islanders, such as in hospital engineering, and guiding workplaces on how to balance vocational and academic requirements to meet the expectations of local industry. He was invited to join the KEMH engineering team in 2018. Alongside his hospital engineering responsibilities, he continues to teach, and assesses for the local college. He is studying for a BSc (Hons) in Management of Healthcare Engineering, Technologies and Facilities at Eastwood Park, although this course is currently in stasis due to the pandemic. This article first appeared in the June 2020 issue of Health Estate Journal (www.healthestatejournal. com), the monthly magazine of the UK’s Institute of Healthcare Engineering and Estate Management (www.iheem.org.uk).

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OA COMPACT AND ROBUST MEDICAL COMPRESSED AIR SYSTEM: KAESER LAUNCHES THE I.COMP TOWER T SERIES Kaeser Compressors has recently launched the new i.Comp Tower T series all-in-one compressed air systems which are ideal for medical applications. Featuring a completely new compressed air supply concept, the i.Comp Tower T series delivers an efficient and reliable supply of oil free compressed air from a compact, robust and service friendly package. The i.Comp Tower T series from Kaeser Compressors is an all-in-one compressed air station comprising a reciprocating compressor, refrigeration dryer and optional filters all within one robust housing and assembled on two compressed air receivers. With the i.Comp series Kaeser has introduced a genuine world first for reciprocating compressors. Robust, compact and perfectly in tune with the operators needs, the i.Comp series impresses with its brand new drive concept; The i.Comp series reciprocating compressor features a specially developed high performance permanent magnet motor with integrated control electronics. This particularly efficient motor operates at a 90 percent efficiency rate. In addition, the motor’s in-built frequency converter minimises switching operations and energy losses. This makes the i.Comp series extremely efficient in all load phases, delivering the exact amount of compressed air actually required at any one time. In addition, these compact powerhouses have considerably better specific performance than conventional piston compressors (up to 18 per cent lower). Ideal for the medical sector, the i.Comp Tower T series feature single stage 100 percent oil free compression reciprocating compressors, able to deliver up to 570 l/min at pressures up to 11 bar. The compressor block does not contain any oil and these complete compressed air supply systems deliver constantly dry compressed air at a pressure dew point of + 3 ° C, with any condensate reliably drained off. To ensure the right levels of quality are achieved consistently Kaeser manufactures every one of its single stage 100 percent oil free compression reciprocating compressor blocks in house. Using the best quality materials available all components are assembled,

tested and installed with the greatest care and attention. The result is an extremely durable oil free compressor block that offers high levels of air delivery and cost efficiency. Optimised flow paths and highly effective cylinder cooling keep wear and tear to a minimum whilst ensuring maximum efficiency. The cylinders combined inlet area helps to minimise intake air losses. The reduced size crank drive guarantees a smooth operation. Optimising the motor and compressor performance serves to reduce stress on both mechanical and electrical components minimising wear and tear. Thanks to a unique design, state-of-the-art technology and highly effective cooling air flow, the new i.Comp Tower T series compressed air systems can easily manage ambient temperatures of up to 45oC. What’s more, low vibration bearings and a sound-insulating PE hood, make these units astoundingly quiet. The i.Comp Tower T series are compact with a footprint of less than one square metre. Designed to allow full access to all service relevant components, this compact powerhouse can be installed right up against the wall. Because the PE enclosure opens upwards multiple units can be installed side by side to save space. The i.Comp Tower T series from Kaeser delivers a reliable and energy efficient source of oil free compressed air. Ideal for medical applications, these high quality plug and play compressed air supply systems are both quiet in operation and compact in design. For more information visit au.kaeser.com or phone 1800 640 611.

Featuring a 100 percent oil free compression reciprocating compressor, the i.Comp Tower T is the ideal solution for medical applications.

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FULL STEAM AHEAD STEAM GENERATION – THE COMPLETE PACKAGE In the previous edition, we considered the thermal benefits of heat exchange technology in relation to hot water loops along with reducing legionella risk and the need for on-site storage. In addition to these concepts, this article will consider why steam systems enable reduced individual assets within a HSO, gain reliable processing and still contribute to thermal efficiency targets. “Condensate (liquid form) still retains up to 10% of the energy required to produce steam (vapour)” The old rule of thumb “for every 6 degree rise in boiler feed water temperature, can result in a 1% saving in fuel” still very much stands today however in some ways choosing thermal generating plant and how to best utilise it, has never been so confusing. Today HSO’s need to consider primarily what’s best for staff and patient outcomes whilst achieving compliance quality and process sustainability and added into the mix is reducing building energy and waste targets, carbon free producing plant rooms and constantly evolving technologies around renewables. There is an abundance of considerations, so here’s some facts for reference: • Healthcare facilities present a major sustainability challenge as their energy intensity is twice and water usage is around six times that of commercial office buildings (2) • In general, heating and cooling together constitute 44-47% while lighting constitutes 24-27%, equipment energy consumption is 22-27% for health facilities (2) • The healthcare sector alone is responsible for 4.1 Mt of greenhouse gas emissions per year which accounts for 13% of the total building sector (1) Striving to achieve “zero energy buildings” certainly has its place however this needs to be considered whilst still operating and maintaining a hospitals core functions. Whilst some may argue generating steam from industrial boilers adds to the energy intensity, this in part is true however this should also be considered in relation to the flexibility of steam as a heating medium comparing any substitute methods as a whole and this may not be an even playing field when it comes to the final result. Steam plants have a future in advanced buildings designs if designed correctly so let’s explore some basic uses and concepts for both Plant and Clean steam.

PLANT STEAM 1. Steam heat exchange can generate both LTHW & MTHW which can be in combination with renewable energy systems, reducing energy intensity and removing the need for additional hot water boilers 2. Flash steam recovery systems can be utilised to reduce energy intensity (Refer Fig 4) 3. Plant steam can be used for humidification of general air streams reducing load on air reticulation plant 4. Modern boilers and efficient steam using principals reduce plant room real-estate and have a long life-span resulting in a low total cost of ownership 5. Steam plants can be easily automated, reducing the need for supervision

CLEAN STEAM 1. Plant steam is utilised as the primary heating medium via thermal exchange so the condensate produced, can be saved and re-used 2. Cold RO make up can be pre-heated by returning condensate via plate exchange 3. The clean steam delivered to the autoclaves jackets, can be retuned to the boiler house for re-use 4. CSGs are energy efficient, utilising only a small amount of electrical and compressed air for operation in comparison to integral units 5. Thermal capacity of a central plant CSG far outweighs integral generation autoclaves allowing for consistent, traceable sterilising conditions under all load conditions Access, maintenance and validation of steam quality can 6. be done outside CSSD processing, reducing interruptions and compromising sterile environments Upgrades of autoclaves to pass-through systems, evolving 7. process flows does not need to include additional generating equipment that requires further maintaining 8. Can be utilised for surgical air flow humidification Whilst thermal and cooling plants constitute around 45% of a typical HSO’s energy intensity, utilising steam in a efficient manner in combination with renewable technologies needs to be considered in modern designs. Steam remains versatile and if managed effectively, can help HSO’s reduce energy consumption and meet the demands of both building services and hospital quality processes.

REFERENCES 1. Australia Government 2020, Energy Consumption and Greenhouse Gas Emissions - In Commercial Buildings in Australia, Department of Industry, Science, Energy and Resource. 2. Rajagopalan, P & Elkadi, H 2014, ‘Energy Performance of Medium-sized Healthcare Buildings in Victoria, Australia- A Case Study’, Journal of Healthcare Engineering, vol. 5.

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UVC ULTRAVIOLET STERILISATION With the recent worldwide health concerns surrounding the COVID-19 pandemic, a lot of attention has been directed towards UVC sterilisation. Germicidal UVC kills or deactivates microbial organisms by altering the structure and molecular bonds of their DNA (Deoxyribonucleic acid), destroying its ability to reproduce. Germicidal UVC has been available used over the last 40yrs. But what exactly is it? How does it work? Does Sunlight work? And is it expensive?

Does Sunlight work? So, if UVC is emitted by the sun, and has virus destroying properties, does exposure to sunlight kill viruses? Not quite, UV-C is the most effective wavelength at killing viruses, however, it is completely filtered by the atmosphere and does not reach the earth’s surface. Is it expensive?

What is UVC?

In most cases, Steril-Aire UVC pays for itself.

Electromagnetic radiation comes from the sun and transmitted in waves or particles at different wavelengths and frequencies. This broad range of wavelengths is known as the electromagnetic (EM) spectrum. The spectrum is divided into seven regions, radio waves, microwaves, infrared, visible light, X-rays, gamma-rays and ultraviolet (UV).

With Increased airflow, coil pressure drop reduction and increased cooling capacity in some installations the return on investment (ROI) has been achieved within a year.

UV is divided into three sub-bands, each emitting a different wavelength, measured in nanometres (nm) UVA - (315-400 nm) UVB - (280-315 nm) UVC - (180-280 nm)

And it’s not only a financial return, but CO2 emissions are also significantly reduced too. Hotel (Brisbane) ROI: 14.2 months Carbon emission reduction: 18.1 tonnes of CO2-e Commercial Building (Brisbane) ROI: 15.2 months Carbon emission reduction: 10 tonnes of CO2-e

How does it work? UVC targets the RNA & DNA of microorganisms destroying their cells and making replication impossible. And how effective is it? At the correct output over 99% effective on almost all microorganisms including moulds, bacteria, fungi, viruses and coronaviruses and that’s in just one pass through your air conditioning system.

Shopping Centre (Brisbane) ROI: 12.3 months Carbon emission reduction: 151.7 tonnes of CO2-e And after you achieve your ROI, you are simply saving money, improving our environment by leaving less of a carbon footprint and creating a healthier building leading to a reduction in occupant sickness. For more information or more detailed case studies please contact Clean-Air today.

OXIVIR FIVE 16 AND VIREX II The Therapeutic Goods Administration (TGA) has recognised disinfectants as critical in preventing the spread of COVID-19. Following our previous announcement that Oxivir® Tb had gained TGA approval for a COVID-19 label claim, Diversey Australia and New Zealand are proud to announce Oxivir® Five 16 and Virex® II are now approved with the label claim ‘Kills SARS-CoV-2 (COVID-19 virus)’. This new claim is in addition to the current comprehensive list of claims under ARTG 286618 for Oxivir® Five 16 and ARTG 153031 for Virex II. “We are pleased to announce our Oxivir Five 16 and Virex II ranges have now gained TGA approval for a claim to kill COVID-19. This added claim offers confidence to our valued customers during this uncertain time. As a global company, Diversey continues to work tirelessly in product development, sourcing and testing to assist in controlling the spread of COVID-19.” Said Wayne Hill, Managing Director, Diversey ANZ. Oxivir Five 16 is an Accelerated Hydrogen Peroxide® (AHP®) based hospital grade cleaner disinfectant effective against a wide variety of pathogenic micro-organisms including viruses, bacteria, antibioticresistant bacteria, fungi, mould and mildew. Oxivir Five 16 kills pathogens including VRE, MRSA, Klebsiella, Acinetobacter, Pseudomonas, E.coli, Norovirus, Hepatitis B, Influenza A, RSV, Human Coronavirus 229E. Kills SARS-CoV-2 (COVID-19 virus). Oxivir Five 16 delivers fast, effective cleaning and disinfecting performance in one step. Virex II is low odour quaternary based hospital grade disinfectant cleaner that provides broad spectrum germicidal activity and kills SARSCoV-2 (COVID-19 virus), HIV-1, HBV, VRE, MRSA, Avian Influenza Type A, Human Coronavirus 229E, controls mould and mildew and more.

“As cases of COVID-19 grow, the demand and urgency for cleaning and disinfection requirements has reached unprecedented levels. It was important we worked with the Australian TGA to add the COVID-19 claim to our Oxivir Tb, Oxivir Five 16 and Virex II range of products. It was also important we communicate this information to our valued customers. Whilst we celebrate this announcement, our stock level challenges persist due to unprecedented demands. We ask for patience as we service multiple essential services including healthcare and aged care facilities”. Noted Debbie Walker, Marketing Manager ANZ Diversey has been, and always will be, a pioneer and facilitator for life. We constantly deliver revolutionary cleaning and hygiene technologies that provide total confidence to our customers across all of our global sectors. For more information visit diversey.com

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Healthcare Facilities Winter 2020

Articles inside

News

Coping with Coronavirus in the Falklands

How to build an emergency hospital in two weeks

Just do IoT

Clinical Engineering: How biomeds mak e hospitals safer

Tuning building systems in the near future

Virtual Power Plant participation a hand-in-glove approach for Echuca Regional Health

T ribute to Tony Blackler

Innovations at work during COVID-19 crisis

How flexible solutions can improve the resilience of healthcare delivery

Philip Douglas Hanbury

NSW/ACT

S A

WA

VIC/TAS

Editor ’s message

National President’s message

CEO’s message