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2013 Anzex Delegate Report Sick Ducts Global Vision PP 100010900
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IHEA National Board of Directors National President Darren Green National Immediate Past President Mitch Cadden National Vice President Brett Petherbridge National Treasurer Peter Easson (State Elected – WA) National Secretary Scott Wells (State Elected – QLD) Membership Registrar Alex Mair (Nationally Elected) Standards Coordinator Steve Ball (Nationally Elected) Asset Mark Coordinator Mark Stokoe (Nationally Elected) CHCFM Coordinator Mark Turnham (State Elected Vic/Tas) Communication Darryl Pitcher Chief Executive Officer Jim Cozens Secretariat/Website Administrator Heidi Moon Finance/Membership Lynden Smith Editorial Committee Mitch Cadden, Darryl Pitcher, Scott Wells IHEA Mission Statement To support members and industry stakeholders to achieve best practice health engineering in sustainable public and private healthcare sectors.
CONTENTS
BRANCH NEWS
5
Message from the President
9
Message from the CEO
10 State Branch Reports 18 SPECIAL FEATURE: 2013 ANZEX Delegate Report
TECHNICAL PAPERS
22 Infection Control Strategies 25 Lighting the Way 27 Unlocking Information in Your Hospital 36 Designing For the Ageing Population in Acute Care Environments 40 Sick Ducts. 47 Water Quality in Healthcare Facilities TOPICS OF INTEREST
50 The Next Generation 53 Clear Communications
58 Paper for Visions Conference 2013 60 Preventive Care for the Planet 65 Global Vision 69 Cooling Water Systems Corrosion Monitoring Audits
ADVERTISING
74 Product news
Adelaide: Robert Spowart T: 0488 390 039 E: robert@adbourne.com PRODUCTION Emily Wallis T: (03) 9758 1436 E: production@adbourne.com Administration Robyn Fantin T: (03) 9758 1431 E: admin@adbourne.com
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56 Overcoming ‘Technophobia’ Helps the Office Embrace New Solutions
Adbourne Publishing 18/69 Acacia Road Ferntree Gully, VIC 3156 PO Box 735, Belgrave, VIC 3160 www.adbourne.com Melbourne: Neil Muir T: (03) 9758 1433 F: (03) 9758 1432 E: neil@adbourne.com
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Cover image shows an Aerial shot of Sunshine Coast Hospital
The views expressed in this publication are not necessarily those of the Institute of Hospital 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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THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
Message from the President Introduction
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warm welcome to all readers of ‘The Australian Hospital Engineer’ (our IHEA Journal), I am sure you will agree that this edition brings to you a collection of meaningful updates and information specific to our organisation and the Health Care Sector. In more recent times we have watched the quality of the Journal articles reach new levels of technical detail and provide insight into IHEA National Board and Branch activity. Concentrating our efforts centrally through our CEO, Jim Cozens has been a pivotal step in this journey. Additional to this, the international relations we are now strengthening between the IHEA and Members of the International Federation of Hospital Engineering (IFHE) will continue to produce value to our members with greater access to modern technology, information, trends, education and contacts. I congratulate each and every contributor to this edition of our Journal and encourage all readers to consider submission of a technical article or story, one of many, we all have to share!
IHEA Surveys/Strategic Planning Since my last Journal report the Board and our CEO have now commissioned, completed and collated both IHEA Member and National Board Surveys. The main focus of this work is to better understand our current position, strengths and weaknesses and to develop new and improved business practices. Over the coming months more detailed information will be provided to our members through E-Bulletins, this Journal and various other IHEA forums and communiques. Most recently was the summary of survey findings presented to all members via an E-Bulletin. I would like to convey my thanks to all members who participated in the survey and those who continue to assist in developing and implementing better business practices, member services and governance models.
February Board Meeting Update I believe it is, and will continue to be crucial that the Board keeps IHEA members fully informed of issues, representation and tasks being undertaken on their behalf. Over the course of my tenure it is my aim to provide accurate and current information to our members. As such I would like to summarise the main topics of discussion and outcomes from the February meeting which was held in Melbourne on the back of Branch Treasurer Training, a Strategic Planning Workshop and National Board of Directors
Name
Position
Darren Green
National President
Mitch Cadden
Immediate Past President (IPP)
mitch.cadden@gsahs.health.nsw.gov.au
Brett Petherbridge
Vice President (VP)
brett.petherbridge@act.gov.au
Scott Wells
Secretary
scott_wells@health.qld.gov.au
Peter Easson
Treasurer
Peter.Easson@health.wa.gov.au
Alex Mair
Membership Registrar
ama58500@bigpond.net.au
Jim Cozens
Chief Executive Officer (ex officio)
ceo@ihea.org.au
Mark Turnham
Director
mark.turnham@dhsv.org.au
Mark Stokoe
Director
Mark.Stokoe@health.wa.gov.au
Darryl Pitcher
Director
d.pitcher@bethsalemcare.com.au
Steve Ball
Director
STEVE@BarwonHealth.org.au
Kevin Tan
Director (Co-opted)
Kevin_Tan@health.qld.gov.au
Executive Committee
darren.green@gsahs.health.nsw.gov.au
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Annual Directors Training. Broadly summarised the 1 ½ day meeting revolved around the following points: • The Board Director training, three (3) yearly Strategic Planning workshop, self-assessment and Member’s surveys. • Governance and policy reviews included; The Delegations Manual, Travel, Member Reimbursement and Social Function Policies. • Commitment and progress for a fresh and easily navigated IHEA Web site. • We will explore and introduce contemporary means of electronic communications for better access for our members. Examples of the media opportunities are LinkedIn Facebook Twitter DropBox SurveyMonkey Goto Meeting icloud and YouTube . Further work on individual applications and suitability will remain subject to ongoing review. It was agreed that Kevin Tan, Darryl Pitcher and Jim Cozens would progress this body of work. • There was further discussion around the use of GoToMeeting and the Board is continuing the trials prior to broader implementation to Branches. • The Board has committed to monthly electronic meetings to ensure momentum of the face to face meetings is maintained. This presents an effective low cost means of collaboration between our geographically challenged Board members. • The Board has introduced an electronic calendar of events which will ultimately be shared with Branches to better coordinate key activities and events. • National Conference updates; 2013 Sydney ‘wash-up’, 2014 Brisbane and 2015 WA Planning were all presented. • The WA Branch sought Board endorsement for their 2014 Branch conference to be held in Bali in May. Based on Branch self-funding, cost effectiveness and previous success it was supported on the basis there be no associated liability to the IHEA. • The refreshed AssetMark product was discussed and given unanimous ongoing support of the Board. • There was considerable deliberation around membership gradings and review of the constitution to bring it into line with current organisation and business requirements. Members will have transparency of all proposed amendments and this will be placed before an AGM in due course. • A review of Honorary Members is currently being undertaken and is subject to a final report to be presented to the May Board Meeting. • The Board received an update from the 2013 ANZEX Delegate, Steve Ball; and Mitch Cadden presented on the revised ANZEX Agreement. • Branch Reports were received and spoken to via state branch representatives.
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Photo taken at the International Federation of Hospital Engineering (IFHE) Council Meeting hosted by Biomedical Engineering Association Malaysia (BEAM).
• Portfolio reports on Standards, Membership, Communications, Heritage, CHCFM, were also tabled for discussion.
International Federation of Hospital Engineering (IFHE) As per previous Journal Reports, members should be aware there is a commitment from the National Board to evaluate benefits and risk of hosting an IFHE International Congress in 2018. Leading up to the February 2014 Board Meeting there was a range of activity and meetings held between Board Members, The Brisbane Convention & Entertainment Convention and Iceberg Events. Subsequently a submission was presented at the February Board Meeting and the Board have requested greater detail on investment based on minimum attendees. Currently the revised cost estimates are being prepared in readiness for our next meeting in March. It is hoped a decision will be made at this time and members will be advised of the outcome of this decision. The IHEA Board through attendance at the Annual IFHE Council Meetings has continued to forge and strengthen international ties. Most recently there has been agreement to cross fertilise publications and share technical papers and articles. There are further plans to hold electronic meetings with the President and CEO of Institute of Healthcare Engineering & Estate Management (UK) (IHEEM) and ourselves to actively promote and foster progress of key areas of shared business. Last September I was fortunate enough to represent the IHEA in Malaysia (Kuala Lumpur) and present a report on activities and direction of the IHEA. The report was well received and our key development areas connected closely to that of other ‘A’ Member Countries and like organisations in attendance. Following the IFHE Council meeting we had opportunity to attend the two (2) day Biomedical Engineering Association of Malaysia (BEAM), International Hospital Engineering Conference which was officially opened by the Malaysian Prime Minister YAB DATO’ SRI MOHD NAJIB BIN TUN ABDUL RAZAK. The theme of the conference was ‘Empowering Facility Management in Healthcare Engineering’ and focused on
contemporary and topical issues being faced globally. There was also a strong focus on the ‘shift’ from BEAM’s original beginnings as a Biomedical Engineering organisation to that of one now engaging in the Asset and Facilities realm. I am also happy to advise that our former National President and IPP, Mr Darryl Pitcher continues his role on the IFHE Executive Council and was also in attendance representing both IHEA and IFHE. Our ongoing presence and participation in the international arena is also creating new opportunities for the IHEA. Some of these opportunities have revolved around topics such as, management principals of not for profit organisations, governance models and structures, future directions, membership services, benchmarking and communication strategies. It was also pleasing to see reciprocal visitation to the IHEA National conference in Sydney from a representative of the Malaysian Ministry of Health, Datuk Chin Goo Chai who attended our conference and commented on the quality and success of the event. IHEA will continue to participate in international forums and partnerships, further evidenced by the recent IHEA and IFHE co-sponsored Indonesian visit presented by Darryl Pitcher in this Journal.
Summary In closing I would reiterate the alignment of the key findings from our member’s survey closely link to the Board’s key focus areas which are broadly summarised as:
• Marketing and communication strategies • Professional Development, including Certified Health Care Facility Manager (CHCFM) Program • Conferences and networking opportunities • Use of electronic media such as webinars • The IHEA Journal and more technical information for members • Member’s engagement, benefits and surveys • Developing stronger National & International ties & partnerships • Benchmarking programs such as the IHEA AssetMark I look forward to sharing future progress and information on these topical and important matters and continue to encourage members to get involved and be active in the IHEA. Please click on the link below to access our webpage or look us up on LinkedIn or Facebook. Regards Darren Green M.I.H.E.A., C.H.C.F.M. Adv Dip Eng Tech, Dip Proj Mgt, Adv Dip Mgt. IHEA National President www.ihea.org.au
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THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
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Message from the CEO
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he New Year has begun where the old one finished – on a very positive footing. Reflecting on 2013 the foundations laid by the Board are beginning to have an impact on the 2014 year. Leading this charge is the launching of AssetMark as on line management tool specifically targeting the health sector. State Branch Management Committees have agreed to work with their respective State Members to gain an appreciation of the benefits and encourage utilisation of the system as an effective asset management benchmarking and comparative analysis system. Your Institute has invested Member funds to develop AssetMark with it put to Members that what has been developed is unquestionably an internationally acceptable leading edge Asset Management system worthy of Member and Australian health sector agency support and acceptance. Also, that the investment outlay identifies the IHEA as an industrious contributor to health sector asset management. Take up of the system has commenced with it anticipated that it will steadily increase across Australia and be introduced to the Asia Pacific Region during 2014. A further positive from 2013 flowing into 2014 is the outcome of the Member Survey conducted during December 2013. The outcome of this survey has been thoroughly analysed and made available to Members as an E-Bulletin. Further to the survey analysis, cognisance by the Board of the issues raised has led to the categorisation and development of strategies that will address the most significant, which was primarily communication between the Board and Members and Member understanding of the role of the Board. This matter has been earnestly discussed at Board level with Members being assured that the matter will be addressed through a number of mediums including regular E-Bulletins, social media utilisation and audio visual
technology to deliver member information, technical and professional forums in the form of webinars and more frequent meetings of the Board and Executive and enhancement of the IHEA Website including the capability for Member access to their membership data for amendment and/or correction and on-line payment of member fees. Based on the positives that have been communicated through the Member Survey further information will be forthcoming relative to the progressive modernisation of your Institute keeping in mind that communication is a two way stream with, on this basis at State level Members are encouraged to get behind their respective Committees of Management to support communication and other initiatives being put in place by the National Board to serve the Membership in the spirit of the mission and vision of the Institute now actively in play. Board deliberations for 2014 were launched on the 6th of February through a full day planning workshop conducted by Susan Benedyka, a most competent facilitator. This activity preceded the first Board Meeting of the year held on the 7th and 8th of February at the Royal Melbourne Hospital. The planning day has resulted in the development of the first iteration of a 2014-2017 Strategic Plan. It is scheduled for the Board to finalise the plan prior to the May Board Meeting to enable the strategic direction for 2014 and 2017 to be presented to Members at the earliest opportunity. I look forward to the 2014 year unfolding in the context of Member participation in State Branch programs and activities. Also, the generation of enhanced communication at all levels of the Institute that takes us all forward culminating in the Institute advancing to be the peak health sector asset management organisation in the country. Regards Jim Cozens Chief Executive Officer
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BRANCH NEWS
Queensland December
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he Queensland Branch slowed just a little over the Christmas period. We had a very successful PD in December sponsored by Austco/Sedco Nursecall, Bosch Security systems, and Vodoke Communication Systems. The event was held at Fitzy’s Convention Centre, Loganholme and 10 members attended with 20 guests. After the PD there was our end of year dinner with partners at Southbank and about 20 attended. We were delighted to have Brad Murphy and Maurice Maloney from EPT join us for the event.
February Branch activity recommenced in February with the Annual Jock McCoach Memorial Race Day. This was by far the most difficult weekend to organise this year. Having finished work in Toowoomba last year I needed to rely on the local guys to assist and the preplanning went really well. As the day approached many for the state team were not available for a variety of reasons and just at the last minute our key contact at the Turf Club, broke her hand and was on leave. As it turned out, despite the difficulties, modern communication with mobiles and emails allowed it all to come together with a mighty effort from Brett. This does demonstrate an important business lesson, that planning early makes the execution easy, when the wheels start to fall off.
happens very little from the maintenance team. They had conventional laboratories with fume cabinets and work benches, but also some hi-tech camera and projection equipment for teaching a well. Each bench is provided with air, oxygen, gas and water. The Backflow valves were not evident and access to the central duct under the benches was not as easy as it could have been. Then we went to the clinical simulation labs, where they have several small wards set up for clinical training on the dolls. Finally we went to the roof and looked at the plant. It was mostly the outdoor units for the many split systems in the building. Next we looked at part of the library building and the focus area was the meeting place. This space was designed as a space where students could meet and have access to computers 24/7. It is adjacent to the commercial food
As usual the activities started with a dinner on Friday night, this year and Pandan delight. 15 were in attendance and had a great night. Many thanks to Becker Pumps who picked up the bar tab for the night. On Saturday we started at the University of Southern Queensland with coffee and then a general meeting with 10 in attendance and it was especially pleasing to see our newest member Jerome Sodomio made the trip up to Toowoomba just for the meeting. After the meeting we met Renee, the Facilities Manager and she took us on a tour of several of the campus buildings. The first was the Corporate Archives building. This is a fairly new purpose built structure containing not only the usual corporate records, but also all the student records for active students. The active store looked a lot like medical records, but then they retain those records after graduation for a period of time. They also hold financial, HR and other records as well as various historical book collections and other memorabilia from the University, because they don’t have a museum.
We were at the finishing post with our name in lights
The next building we looked at was the Sciences Block and here we focussed on the clinical sciences – Nursing is the main course. This was a building that has seen several refurbishments and it looks really nice. There has been a lot of input from the faculty into the design, but a usually Retired members Graeme Clark (Ex Mater Private),Wall Freyling (Ex Toowoomba Base), and Don Fewquandie (Ex Nambour)
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BRANCH NEWS outlets, the bookshop and the library. There were some clever design features and good ideas for creating the space. Of special interest were the green walls and the fishpond. (Check out the new IHEA Facebook page for the pictures). The final part of the visit was to the Japanese Garden. Unfortunately the garden is suffering a little from the ravages of drought, but not too badly. This garden is one of the 2 largest Japanese gardens in Australia and has over 2 km of pathways and includes hills, ponds, quiet areas and rocky shores. Overall it is a very tranquil place and one that provides an ideal escape from the bustle of University life. It was recently featured in an episode of Home and Gardens on commercial TV. Some of the group at the end of the night listening to stories about Jock The race meeting started early this year and so we met at the Turf Club at 2 pm and had attendance and it was a nice way to finish a very enjoyable a very enjoyable afternoon with the last race weekend of social, and a little bit technical, activities. at about 6.30 pm. We finally left about 8 pm. During the evening our betting syndicate was not as successful as usual 2014 National Conference and at the end of the night we only had a bit over $225 and this will be donated to the Chemotherapy unit at Planning for the national conference is now well underway Toowoomba Hospital for use in the paediatric area. with the conference and dinner venues now secured. One of the keynote speakers has been secured and others will be During the evening Wally Freyling regaled us with some confirmed shortly. The call for papers has gone out and all memories of Jock Mc Coach and each of these his wife Ethel members are encouraged to submit an application to present. was able to confirm. Wally had been the Engineer and the The social programmes are being prepared. Our aim is to General while Jock was the Engineer at St Vincent’. allow registrations from the end of May so watch this space. Just a word of warning: we are using the same venue as Jock in his younger days had been an avid cyclist riding G20 which follows our conference in November. Many many miles each week. He was to have been awarded of the delegates and the support teams will be arriving early an OBE, but because of his families fierce Scottish heritage, so close accommodation may book fairly early. Delegates and therefore dislike of English royalty he was not allowed to the IHEA conference would do well to book their to collect it. accommodation EARLY. Wally was approached by the management at St Vincent’s Alex Mair to help them select a suitable engineer. He was asked to give QLD Branch President them some ideas for a role description. Wally suggested that they were wasting their time and they should just appoint the Laundry Manager. After some discussion they realised that Jock was not just a Laundry manager but had actually been involved as a engineer building the washing machines and that he was a very capable man, unseen, right under their noses. Jock was appointed. He went on to lead one of the best maintenance teams of the time with many early adoptions, including BMS, security, central lighting systems, energy management and CMMS using BEIMS.
Our thanks go to our sponsors for the evening Programmed Property Services for the function room and catering and EPT for the drinks. On Sunday the activity continued with a late breakfast at the Metro Café. This was in a private room upstairs overlooking the old Toowoomba Railway Station. About 15 were in
THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
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BRANCH NEWS
NSW/ACT Introduction
Next COM 4th March 2014
Welcome to all IHEA members across Australia to the latest edition of the IHEA Journal. It has been a frantic start to the year with temperatures across NSW soaring to an average around the 35°C mark for the last few months. The prolonged high temperatures have created a strain on resources and building infrastructure. Locally this has raised the issue of the Phase out of R22 refrigerant and the burden on financial resources moving forward, re upgrading commercially unviable plant or potential retrofitting suitable equipment to R438A or other available options.
COM meeting/phone conference for Tuesday 4th March 2014. On the agenda will be the NSW Branch Conference as well as Professional Development Opportunities available to IHEA NSW, following contact from Transfield Services, Johnstaff and Schneider in regard to Professional Development Opportunities (PDO) to be an agenda item for the COM and then collaboratively with other NSW members and State Branches.
With a change in the weather the COM’s focus will be on our NSW State Branch Conference that will be upon us in a matter of months. Access for members to this year’s conference will be of highest importance.
The next twelve (12) months will see a strong focus on engagement of all NSW members with planning for the 2014 NSW Branch Conference that will no doubt be upon us very quickly. I again encourage all current and prospective members to become involved at a State level to take advantage of PDO’s available.
A
Summary
Current Committee of Management
VACUUM SOLUTIONS AUSTRALIA Thanks for visiting us at:
Name
Position
Phone
Peter Lloyd
President
0428 699 112
peter.lloyd@gsahs.health.nsw.gov.au
Peter Allen
Vice President
0408 869 953
peter.allen@hnehealth.nsw.gov.au
Mitchell Cadden
Secretary
0408 228 419
mitch.cadden@gsahs.health.nsw.gov.au
Brett Petherbridge
Treasurer
0418 683 559
brett.petherbridge@act.gov.au
Mal Allen
Member
0467 761 867
mal.allen@hnehealth.nsw.gov.au
Steve Dewar
Member
0428 119 421
steve.dewar@gsahs.health.nsw.gov.au
Darren Green
Member
0418 238 062
darren.green@gsahs.health.nsw.gov.au
Helmut Blarr
Member
0411 152 898
helmut.blarr@sswahs.nsw.gov.au
John Wilson
Member
Glen Hadfield
Member
0409 780 228
glen.hadfield@swahs.health.nsw.gov.au
jfw006@yahoo.com.au
Trevor Stonham
Member
0414 899 363
trevor@sah.org.au
Rob Bampton
Member
(02) 6205 9495
robert.bampton@act.gov.au
Peter Lloyd M.I.H.E.A., IHEA NSW/ACT Branch President Senior Engineer-Eastern | MLHD Asset Services Operations Edward St, Wagga Wagga NSW 2650 Tel. (02) 6938 6141 Fax. (02) 6938 6506 Mob. 0428 699 112 Email. Peter.Lloyd@gsahs.health.nsw.gov.au
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TECHNICAL PAPERS
THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
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BRANCH NEWS
Western Australia Western Australia IHEA branch activities over the summer period
IHEA Branch PD meeting Bethesda Hospital November 2013
regard to this. This PFD meeting was held at the IFAP training centre just south of Perth and was well received as valuable professional development by attending members.
WA State Branch Member Survey In an effort to better understand the expectations and wishes of the WA branch members, the WA Committee of Management distributed a survey in October 2013.
The first professional development meeting was held at Bethesda Hospital and included a presentation Mr Llew Withers, Senior Advisor for the Environmental Health Directorate Department of Health WA on the Legionella issues/risks in Hospitals and Aged Care Facilities.
WA Annual Country Conference 2014 – “Destination Bali Awareness” May 2014
A total 35 responses was received from WA members with 65% of the responses coming from Health Care Facilities Managers/Engineering Managers. Perth city based members represented 91% of all responses. The most common request from WA members was for an increase in Professional Development (PD) meetings which will meet their expectations for ongoing CHCFM IHEA requirements. The WA members were also given the opportunity to suggest suitable PD topics for future meetings. The Committee of Management WA has taken a proactive response to survey results by compiling a list of suitable topics as advised by the members and PD meetings has now commenced. In addition to PD topics, there was notably strong support for: • More joint meetings and/or events with other institutes such as the FMA. • Developing communication links between the Committee and Members. • Building the IHEA brand awareness with industry. These areas will also become a focus for the Committee of Management along with other submitted suggestions. Following the WA member survey the National Board of Directors IHEA conducted a similar National survey of all IHEA members and the results were distributed to all members during February 2014.
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Peter Easson IHEA National and WA Treasurer followed with a few words on his own experiences on common practice in the UK on the management Legionella. Nominations were called from WA members to form a working party to assist and advice on updating the current WA DoH policy for Legionella management. The working group now consists of Peter Easson, Mark Stokoe, John Doherty, Michael Della Franca, Alex Rodger, Peter Holder, Stephen Gaffey, Peter Klymiuk and Llew Withers. The evening concluded with a sponsor presentation by Lamp Replacements WA on LED lamps and their use in a health care environment.
IHEA Branch meeting Osborne Park Hospital December 2013 The last meeting of the 2013 calendar year was a breakfast meeting held at Osborne Park Hospital which was well attended by members. Tarkett Flooring the morning’s sponsor provided and outline of their products and services followed by general networking meeting of all members.
IHEA Branch meeting IFPA February 2014 The February branch meeting 2014 was a PD meeting on Confined Space as per AS2865.2009 in accordance with the Australian Standards and members were presented with an excellent insight in to meeting the obligation requirements with
THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
The WA IHEA Committee of Management has agreed to hold this year’s WA Annual Country Conference at an international destination. This year WA IHEA country conference will be held on the island of Bali Indonesia. With an estimated 450,000 tourists travelling to Bali from Western Australian last year the decision to hold the conference in Bali at just over 3 hours flying time from Perth and is expected to be well attended by members. Please see the designated article and further details of this year’s WA IHEA country conference within this edition of the “The Australian Hospital Engineer” journal.
IHEA WA Branch Annual Country Conference 2014 “Destination Bali Awareness” Sanur Paradise Plaza Hotel. Sanur, Bali 16th, 17th & 18th May 2014 The WA Branch of the IHEA will be holding the 2014 Country Conference in Sanur, Bali. The theme is “Destination Bali Awareness” with the attention on what Australian Surgeons are doing in Bali to help the local people. All delegates who wish to attend will be responsible for booking their own accommodation and air fares. Delegate’s partners are invited to attend the conference. The conference will be based in Sanur at the Sanur Paradise Plaza Hotel and it is recommended that accommodation should be sourced in the area. A local Bali based events planner has been recruited and a registration fee of
BRANCH NEWS Saturday 17 May 2014
$75.00 per person applies to cover the cost of the Bali Event Planer. The registration fee applies to each member and accompanying partner and covers cost of transport to and from venues and lunches during the conference period. Attending members will need to make their own hotel bookings from many of the travel agencies available on line or directly with the hotels in Sanur Bali. Members may also avail make a booking directly with the Sanur Paradise Plaza Hotel Bali who are offering a discount on accommodation for IHEA delegates. When booking rooms please email sc@sanur.pphotels.com and quote ‘IHEA Conference’. The IHEA WA Branch is canvassing for sponsors for this event. Each sponsor will be given the opportunity to present a short presentation on the Friday evening opening of the conference as well as afforded company profile in a subsequent edition of the “The Australian Hospital Engineer” journal. For more information on opportunities to sponsor this excellent and exciting WA IHEA Country Conference 2014 in Bali, please contact conference organising committee member; Craig Aggett email: craig.aggett@sjog.org.au Members and sponsors are advised that any surplus funds generated by the
conference in Bali will be donated to the foundations on behalf of the IHEA. Further details including the registration form can be obtained on the IHEA website under the WA branch portfolio http://www.ihea.org.au/page/ western_australia_branch_meetings.html
12pm – Lunch Bus to the Siloam Hospital (new Hospital) with tour of the facility
The Conference Registration closes – 4th April 2014. Please completed your registration form and send to: Craig Aggett craig.aggett@sjog.org.au
7pm Dinner
Sunday 18 May 2014 8.30am – Meet at the Sanur Paradise Plaza Hotel reception Visit the John Fawcett Foundation, Cleft Lip Clinic
On receiving the completed form an invoice for payment will be sent via email to your nominated email address on the registration form.
12pm – Lunch Transport to Puri Rahayu Hospital (Old Hospital)
WA IHEA Annual Country Conference 2014 – Brief program of events
5pm Conference Close at Sanur Paradise Plaza Hotel The WA State President and National Board member; Mr Mark Stokoe FIHEA on behalf of the WA CoM said, “I look forward to seeing as many WA members as possible in Sanur Bali and on behalf of the WA Branch of the IHEA also extend this conference invite to all members across Australia and the Australasian region”.
Friday 16 May 2014 6pm – Conference Open & Presentations at Sanur Paradise Plaza Hotel Presentations made by Mr Leroy Hollenbeck (Foundation CEO), Mr John Fawcett, Mr Tim Cooper Surgeon and by our Sponsors. Evening Cocktail party – Bali Style
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THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
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BRANCH NEWS
South Australia As we entered the new year, the SA State Branch Committee continued to meet on a monthly basis, continuing our planning themes from last year – development of a dynamic, valuable program of performance development opportunities for our members, and growing our membership base.
O
ff the back of the successful professional development/ seminar program of 2013, we are looking to do even better in 2014. We have focussed our recent planning efforts on the development of a relevant, interesting and rewarding program of events for our members. We are currently finalising a draft program of events covering professional development (PD) sessions, seminars, conferences and social functions which we think will provide great benefits to our members. Early planning for PD events has focussed on developing a series of presentations around a number of themes – emergency management & business continuity planning, water themes/issues, and energy efficiency. We shortly plan to host a member event to release and promote our 2014 program of events – and to look for member input on the content of the program and future events that members would like to see the Branch Committee pursue. As part of our efforts to increase membership (see below), we are increasingly looking to open up our PD program to non-members from within the wider healthcare field and from other potential corporate members – both to increase the networking opportunities for members and to expose potential members to IHEA and its benefits. The Branch Committee believes is highly important that we grow our membership base for a number of reasons. Firstly, we acknowledge that our member numbers are quite low, with only a regular core group attending most Branch events. We believe that there are many in the facilities management (FM)/ healthcare engineering areas who would benefit from the collegiate
nature of our organisation, from the networking opportunities that would come with a growing membership base, from the wider pool of ideas to be put forward, from improved opportunities to access performance development opportunities and exposure to the wider benefits of belonging to IHEA. We also acknowledge the shift in the FM field that has been occurring over recent years within the public health system with a shift from a public health employee base to outsourced service providers as SA Health has progressively moved into the Across Government Facilities Management Arrangements. There has been a quantum shift of facility managers and healthcare engineering staff from the public sector to these service providers. Amongst a number of areas, the State Branch needs to focus its efforts to grow
our membership by targeting these new FM players in our hospitals. We also believe there are opportunities to gain more members from allied healthcare engineering managers within the aged care industry. Finally, greater involvement of our corporate members is also being pursued to give both corporate and regular members the benefits that greater numbers of each bring to the other. More members from across a wider range of healthcare organisations and wider industry/supplier sectors are seen to provide mutual benefits to all. The SA Branch Committee looks forward to a worthwhile and productive year and encourage all of our members (and future new members) to get involved in the activities being developed for South Australia.
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SPECIAL FEATURE
2013 ANZEX Delegate Report Steven Ball I MIHE
I
n November 2013 I visited New Zealand as the ANZEX Delegate on behalf of the IHEA. This award provided the opportunity to visit various hospitals throughout the South Island, gain an insight into the operations of the District Health boards, inspect the earthquake damage in Christchurch, spend a few days as a tourist in Queenstown and understand the challenges faced by hospital engineers in New Zealand. The visit also allowed me to develop some valuable professional contacts and ongoing friendships. After a pleasant flight across the Tasman Sea I arrived in Christchurch in the early afternoon and was greeted by Nigel Wing (Secretary of NZIHE). I felt like a V.I.P as Nigel lead me around the airport to find maps, organise mobile phone service and get me to my hire car. Once I had the car and a map, finding my way around Christchurch to the Hotel was a pleasant experience. The city is not too big, well laid out and clearly signposted.
Sterilising units are air conditioned by package units with the wards only receiving heating. It was a bit of a culture shock especially considering how staff who are used to facility wide air conditioning react when conditions fluctuate by a couple of degrees. Following my tour of the Hospital I was introduced to Mark Anderson the Maintenance Manager. Mark had only been employed at Timaru for a short period and definitely had a solid long term plan to develop the 1970’s infrastructure into a modern facility. Throughout the next hour or so Mark shared the master plan for the hospital facilities with me and his enthusiasm was infectious (no pun intended). If Mark gets his way, which I think he will this hospital will be a very different facility in five years’ time. That night Ian, Mark and their partners took me out for dinner which was typical of the hospitality that I was soon to become accustomed to from our colleagues in New Zealand.
The following morning I drove south down the East coast to visit the Timaru Public Hospital which is covered under the South Canterbury District Health Board. This facility comprises approximately 130 beds and 4 operating theatres. Medical services provided are mainly general medicine as well as mental health and a range of clinical support services. Upon my arrival I was greeted by Ian Ward, the Maintenance Supervisor. Ian took me for a tour of the facility and the first major point of difference I noticed is that the hospital was still using coal fired boilers. This was something that I learned I would see all over the South Island since it does not yet have reticulated gas. Another major point of difference was the absence of central air conditioning. Only selected areas of the hospital such as Theatres and Central
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THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
The following day I headed further South down the East Coast to Duneeden.
This is a truly picturesque city surrounded by mountains and a huge inlet from the Ocean bounded by the Otago Peninsula.
SPECIAL FEATURE There were also many examples of tap ware, bed stoppers and other small items that gave me a wealth of ideas to bring back. That afternoon I travelled from Duneeden to Queenstown. Since it was Friday night and I was not leaving till Monday morning I quickly changed into tourist mode. Amongst a weekend of relaxing by the lake with long lunches I also took the gondola to the top of the mountain and went for a blast on the Shot over jet boat. In Duneeden I met Doug Moller, the president of the NZIHE and owner of a local company that services medical and dental equipment. Duneeden is a university town with many of the buildings in the CBD being occupied by the University of Otago. On this occasion Doug took me for a tour of the Faculty of Dentistry. In this building they seem to either teach or do most things associated with dentistry. The building is equipped with large banks of dental chairs set up in individual simulated surgical rooms for the training of dental students.
The weekend passed all too quickly and before I knew it I was travelling back to Queenstown via the Lindis Pass which is surrounded by snow-capped mountains and was a fantastic experience. That night after a great dinner with Nigel Wing I was about to go to sleep when I heard what sounded like a train coming towards the hotel. Seconds later the whole room shook for about three seconds. This was my first experience of an earthquake which registered 4.2 on the Richter scale.
There are also various workshops and laboratories dedicated to the manufacture of dentures and implants. That night I found the time to take a drive down the Otago Peninsula which had scenery and views that were absolutely fantastic. There were also a lot of sheep! The next morning I met Doug for breakfast after which he arranged a tour of a newly renovated section of the Duneeden Hospital which had not yet been handed over. The standard of project management was extremely high with a finish that we would all aspire to. There were several innovative approaches to building a facility that can be kept in good condition and maintained into the future. Some examples that impressed me were all fire walls were clearly marked above the height of the false ceilings and all penetrations in fire walls have a label and are recorded on a central register.
The next morning I made my way to the Christchurch hospital which is part of the Canterbury District Health Board and was greeted by Nigel Cross. Nigel took me for a tour of the main campus including the tunnels under the building. This is where I started to get some idea of the damage that the earthquakes had caused. The problems I observed on this section of the tour were large scale cracking of the concrete walls of the tunnels which were constantly subject to water flowing into them through the cracks because the earthquake had caused the water table to rise. The only solution to this was to constantly pump the water out.
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SPECIAL FEATURE The engineers had developed many innovative solutions to problems that we will hopefully never face, amongst these were temporary fire pumps and large water storage tanks in a car park and temporary boilers and heat exchangers on the outside of buildings. In the afternoon I was introduced to Allen Bavis who took me for a tour of the external parts of the main campus, some outlying buildings and the boiler plant. During this tour I gained an appreciation of the large scale damage caused by the earthquakes as Allen pointed out large cracks in many of their buildings and their multi story car park. These buildings had been vacated and were awaiting demolition. The damage bill for the Christchurch hospital is estimated at $1 Billion whereas the insurance coverage is capped at $750 million leaving a considerable shortfall. On the following day I met Nigel Wing at Forte Health where he occupies the role of Facilities Services Manager. This is a new private facility that was approaching the commissioning stage and therefore we were able to tour all areas at will. This new building has been designed and constructed with the latest technologies to make it earthquake resistant. There are select panels on the exterior of the building that can be opened to inspect the pivot points and dampers that connect the steel superstructure and provide a level of flexibility for the building.
In the event of an earthquake the internal plaster walls will crack but this would represent only cosmetic and not structural damage. In the afternoon I briefly visited the Christchurch city council building to inspect their open plan office arrangement and get their perspective on the earthquake damage and solutions employed. While there the maintenance manager took me around the plant area, a highlight of which was their backup generator that was fuelled by methane gas from the waste disposal centre, the only example of reticulated gas I saw on the South Island. For the rest of this day and the following day I had the opportunity to tour central Christchurch. It is no exaggeration to say that this is a city that has been completely devastated by the earthquakes. Many of the buildings that have not already been demolished are vacant
and awaiting demolition and the only comparison I can draw is with a bombed out city we see on world war two documentaries. To spite this, the locals show an amazing resilience and this is still a functioning city. The innovation required to achieve this is highlighted by a shopping centre constructed from shipping containers which worked really well. From here it was onto the conference at Lincoln University. On the first night of the conference I met Tony and Allison Blackler along with many other people and was made to feel most welcome at the opening Barbeque. The conferences and NZIHE in general encompass Facilities Management as well as Clinical Engineering which provides a wide range of information, speakers and trade displays. The topics covered by speakers ranged through the rebuilding of Christchurch, the Canterbury District Health Board rebuild, sterile service department design, project management, facilities and equipment procurement, stakeholder involvement in facilities design, energy management, dialysis unit design and medical gas safety. The trade night was well attended by both NZIHE members and sponsors. The atmosphere was relaxed with a dinner provided. There was ample opportunity to talk to sponsors pick up a few freebies and get some great ideas about new products becoming available. The annual dinner on the following night had a country and western theme and was fancy dress. I have never been very enthusiastic about fancy dress but must admit that once I got over the unusual experience of wearing a cowboy hat I had a fantastic time. The food and company were great, there was a
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SPECIAL FEATURE mechanical bull to hurt ourselves on and Doug Moller made a grand entrance complete with a ten gallon hat and spats. By the time the night concluded I really did feel like part of the crew in New Zealand and although missing home must confess a slight pang of sadness at leaving new found friends the next morning. This is a trip that I absolutely enjoyed both at a personal and professional level. I have taken away many fond memories and a wealth of experience about how our colleagues in New Zealand manage their health system and deal with the unique challenges they face. I would like to thank the IHEA, NZIHE and all members for this opportunity and would highly recommend this experience to any prospective ANZEX candidate.
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TECHNICAL PAPERS
Infection Control Strategies Elizabeth Gillespie I CICP MPubHlth(Melb)
Hand hygiene It is now well recognised that hand hygiene is the primary measure for infection prevention. When performed well, it reduces transmission of microbial pathogens both in the community and in the healthcare setting.1 In Victoria, hand hygiene projects have been in place for several years. With the Hand Hygiene Australia initiative, hand hygiene education and auditing is becoming a national strategy to reduce hospital acquired infections.2 In addition to monitoring healthcare worker compliance with the 5 moments of hand hygiene3 (a process measure), Staphylococcus aureus bacteraemia data are also collected as an outcome measure. Infection control strategies to raise the profile of hand hygiene and improve compliance: • Make sure alcoholic chlorhexidine is available at the end of patient trolleys, fixed to equipment trolleys, at the entry and exits to departments, cubicles and clinical rooms. • Quiz colleagues on the 5 moments of hand hygiene and when to apply alcoholic chlorhexidine hand-rub.
A clean environment Many studies have described transmission of pathogenic organisms through contact with contaminated surfaces.4 Multiple-drug resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) are of concern because infection is associated with increased length of stay, increased healthcare costs and increased mortality.5 Adequate cleaning requires sufficient removal of pathogens to minimise patients’ risk of acquiring infections from hospital environments.6 Specific VRE cleaning following discharge of patients
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colonised with VRE involves 2 steps; cleaning with detergent and water followed by disinfection with a weak hypochlorite solution (bleach). This process has been used since VRE was first identified in the 1990’s.
• Trial a range of safety devices and choose the device most appropriate for cost, useability and accessibility.
There is evidence demonstrating that appropriate cleaning assists in preventing the transmission of VRE however this special cleaning technique is only used when it is known that a patient is carrying VRE.7,8
• Ensure there is an appropriate occupational exposure management protocol in place should an injury inadvertently occur; promote its availability and the value of reporting injuries.
Infection control strategies to keep your environment free of microbial pathogens: • Make sure your department is visibly clean, conduct cleaning audits with your cleaning staff and promote their role in the health team. • Credential cleaning staff in special cleaning techniques such as those used when patients, colonised with highly resistant organisms (e.g. VRE), are discharged.
Safety engineered medical devices Safety engineered medical devices are now well recognised as one strategy to assist in reducing the risk of percutaneous injury to healthcare workers.9,10 Other important strategies include the placement of sharps containers, education about preventing sharps injuries and management of occupational exposures.11 Many jurisdictions in the developed world now advocate the use of safety engineered devices. Safety devices cost more than non safety devices and are introduced to reduce the risk of acquisition of a bloodborne virus in healthcare workers. Some studies report that the degree of under-reporting of sharps injuries can be as much as 10-fold.12 Infection control strategies to keep your staff free of percutaneous injuries:
THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
• Educate staff about the importance of preventing percutaneous injuries and promote their health as a priority.
Health-care worker immunisation The Australian Commission on Safety and Quality in Healthcare report that the most important preventive strategies to reduce and prevent hospital acquired infections include hand hygiene, the appropriate use of antibiotics and immunisation of health-care workers (HCWs). Healthcare workers who are not immunised place patients at risk of acquiring vaccine preventable diseases, and more effort is needed to help staff and employers to reduce this risk.13 It is well recognised now that up to 59% of HCWs can have subclinical influenza and potentially cross infect patients. Reductions in mortality of elderly patients have been demonstrated when HCWs have been vaccinated.14 Infection control strategies to improve HCW immunisations • Ensure a system is in place for HCWs to be vaccinated on employment. • Devise a catch up program encouraging HCWs to have their immunisation status updated. • Prioritise HCW immunisation by using declination forms, i.e. for influenza vaccination. Studies have shown that the use of declination forms improve influenza vaccination uptake and assist dispelling the myths by informing staff.15
TECHNICAL PAPERS References 1. Pittet D. hand hygiene: It’s all about when and how. Infection Control Hosp Epidemiol 2008;29:957-59 2. Russo P. Hand hygiene Australia: synopsis. Healthcare Infection 2009;14:11 3. World health Organisation. About Save Lives: Clean your hands – My 5 moments in hand hygiene, last accessed August 2009 4. Zachary K, Bayne P, Morrison V, Ford D, Silver L, Hooper D. contamination of gowns, gloves and stethoscopes with vancomycinresistant enterococci. Infect control Hosp Epidemiol 2001;22:560-564
intensive care unit rooms. Infect Control Hosp Epidemiol 2008;29:593-599
devices. Occup Med (Lond) 2006;56:566-74 Epub
7. Puzniak L, Gillespie K, Leet T, Kollef M, Mundy L. A cost-benefit analysis of gown use in controlling vancomycin-resistant enterococcus transmission: is it worth the price? Infect Control Hosp Epidemiol 2004;25:418-424
13. Cruickshank M, Ferguson J, editors. Reducing harm to patients from health care associated infection: The role of surveillance. Australian Commission on Safety and Quality in Healthcare, 2008. Last accessed August 2009
8. Ray A, Hoyen C, Taub T, Eckstein E, Donskey C. Nosocoamial transmission of vancomycin-resistant enterococci from surfaces. JAMA 2002 ;287 :1400-1401
14. Elder A, O’Donnell B, McCruden E, Symington I, Carmen W. Incidence and recall of influenza in a cohort of Glasgow healthcare workers during the 1993-4 epidemic: results of serum testing and questionnaire. BMJ 1996;313:1241-2
9. Zanni G, Wick J. Preventing needlestick injuries. Consult Pharm 2007;22:400-2
5. Siegel J, Rhinehart E, Jackson M, Chiarello L. Healthcare Infection Control Practices Advisory Committee. Management of multidrug resistant organisms in healthcare settings, 2006. Atlanta: Centres for Disease Control and Prevention, 2006 6. Goodman E, Platt R, Bass R, Onderdonk A, Yokee D, Huang S. Impact of environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in
10. Sohn S, Eagan J, Sepkowitz K, Zuccotti G. Effect of implementing safety-engineered devices on percutaneous injury epidemiology. Infect Control Hosp epidemiol 2004;25:532-42 11. Tuma S, Sepkowitz K. Efficacy of safety-engineered device implementation in the prevention of percutaneous injuries: a review of published studies. Clin Infect Dis 2006;42:1159-70 12. Elder A, Paterson C. Sharps injuries in UK health care: a review of injury rates, viral transmission and potential efficacy of safety
15. Ribner B, Hall C, Steinberg J, Bornstein W, Chakkalakal R, Emamifar A, Eichel I, Lee P, Castellano P, Grossman G. Use of a mandatory declination form in a program for influenza vaccination of healthcare workers. Infect Control Hosp Epidemiol 2008;29:302-308
Contact Elizabeth Gillespie Sterilisation and Infection Control Co-Director, Southern Health, Victoria Phone: 03 9594 2964
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THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
TECHNICAL PAPERS
Lighting the Way Dean Farnsworth I Group Environmental Engineer, St John of God Health Care
S
t John of God Health Care (SJGHC) operates 13 hospitals, pathology, home nursing and social outreach services in Australia, New Zealand and the Asia-Pacific region. The organisation is Australia’s third largest private hospital operator and fourth largest provider of pathology services. Through our Mission, we are committed to demonstrating ecological concern and respect for the earth. The SJGHC Board requires all areas of the organisation to have a focus on environmental stewardship with the aim of reducing the environmental impact of our everyday activities.
In excess of 80 percent of SJGHC’s total CO2 emissions are attributed to electricity consumption. Studies have demonstrated that lighting accounts for approximately 20 percent of total energy consumption in a hospital. This information resulted in Senior SJGHC management endorsing a strategy focused on reducing the energy consumption resulting from lighting. In 2009 approval was received to undertake research and trial potential benefits relating to energy savings which could be achieved by utilising Light Emitting Diode (LED) lighting. The goal was to evaluate a suite of LED lights to determine suitable replacements for as many traditional lighting types as possible. LED lights were sourced and evaluated to replace fluorescent tubes, compact fluorescents, halogen down lights, oyster lights, bayonet cap/edison screw lights, high bay lights and flood lights. By the end of 2011 over 100 LED units of varying type and brand were being trialled across all of our hospitals.
A key component of the trial was to measure the energy consumption of the traditional light being removed and compare that to the energy consumed by the proposed LED light replacement. This information allowed us to calculate the electricity consumption reduction by light type. Energy reductions of between 37% – 82% were recorded depending on the light type being replaced. The next stage was to count and categorise all the lights in a chosen facility and estimate the total hours of operation of the lights per day (by area). From this information the potential outcome of implementing a total light replacement across an entire facility could be estimated. From the study, it was calculated that energy consumption could potentially be decreased by more than 10% across an entire facility. The light intensity of the LED lamps was also tested as part of the trial to ensure compliance with the Australian Standard for interior lighting. It is purported that LED light fittings have a much longer life span than traditional light fittings, for example a standard Fluorescent tube can last up to 12,000 hours and some LED linear tubes manufacturers claim that their product will last for 75,000 hours. Given that 75,000 hours is equivalent to 8.5 years it was not practical to completely test this claim, however selected LED units were left on 24/7 for many months as a form of fast track testing. While some units did fail, the units supplied by the eventual preferred supplier worked faultlessly, and continue to do so.
Figure 1: Electricity consumption at Bendigo hospital base line and 2012 actual during measurement phase.
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TECHNICAL PAPERS Figure 2: Outcome of LED projects undertaken so far.
At the end of the trial period Specialised Lighting Solutions (SLS) were selected as the preferred supplier for LED lighting for SJGHC. The supplier was selected because of the quality of their product, product range, long establishment in the lighting industry and the size of their organisation. Findings of the trials were presented to SJGHC Senior Management who subsequently approved an expanded trial to one full facility. The facility chosen was St John of God Hospital at Bendigo, a 122 bed hospital. The project began in June 2012 was completed in August of the same year. The Bendigo project resulted in 98% of the traditional lights being replaced. A total of 2661 LED lights were installed. Total cost of the project was $285,000. Following completion of the project electricity consumption data analysis showed that total electricity consumption dropped by 12% across the facility. Figure 1 demonstrates the reduction in electricity consumption at Bendigo hospital as the traditional lighting was replaced. The blue line is the base line value (an adjusted average of the two previous year’s data) and the pink line is the 2012 actual electricity consumption data. The graph shows the electricity consumption for the six weeks prior to the commencement of the project through to 1 September 2012 (three full weeks after the project was completed). Feedback from staff, patients and visitors was and continues to be very positive in regard to the light level and quality of the LED
Facility Bendigo Frankston Dandenong Warrnambool Berwick Wendouree Burwood Total
Number of units installed 2661 1212 1064 1808 2333 347 1042 10467
Percentage of reduction 12 11 7 20 15 15 11 Ave 12.97
savings per annum Kw/H 281,864 96,187 44,855 387,676 259,874 19,253 82,695 1,172,404
Tonne Co2-e 344 117 55 473 317 23 101 1,430
fittings. Based on the results of the project at Bendigo, SJGHC Senior Management endorsed the project being rolled out to six more SJGHC locations at a total cost of $1,000,000. Between October 2012 and May 2013 a further 7,806 LED lights were installed in SJGHC hospitals/facilities at Frankston, Dandenong, Warrnambool, Berwick, Wendouree and Burwood. Electricity consumption data was also analysed for each of these facilities both before and after the lamp replacement and demonstrated that the overall average reduction in electricity was 12.97%. Figure 2 provides additional information in regard to the outcome of the projects. To date $1.3 million has been spent on this project across SJGHC. With the information gathered it is possible to calculate that the overall electricity consumption across the facilities involved in the project has reduced by 1,172,404 Kw/H per annum which has reduced our CO2 emissions by 1,430 tonnes per annum. Using the assumption that an average tree absorbs 6.82kg of CO2 per annum this initiative is equivalent to planting 209,726 trees. Other benefits of installing the LED lighting include: • The LED lights operate at a lower temperature compared to traditional lights. This reduces the thermal load of the building which reduces the load on the air conditioning units producing a secondary reduction in electricity consumption. • Many existing traditional light fittings have ventilation holes in them to reduce the build-up of the heat that they generate. These ventilation holes allow conditioned air (heated or cooled) to escape into the ceiling space which intern puts more load on Air conditioners/heaters. Conditioned air does not escape through the LED units as they are sealed. Sealing these holes also assists in maintaining positive/negative air pressure in certain areas of the hospital. • All LEDS last significantly longer than traditional lighting which will reduce the amount of energy used in manufacturing replacement lights and results in lower maintenance costs associated with light replacement • LED lights are mercury free. The traditional lights that were replaced as part of this project have been recycled. This includes the metal bodies of the fittings as well as the lamps, which were recycled by CMA EcoCycle.
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THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
TECHNICAL PAPERS
Unlocking Information in Your Hospital Paul Dearlove BE(Hons) I MIEAust, GAICD, Technical Director, IBMS Pty Ltd
Hospitals have numerous control and monitoring systems. In large hospitals this can be upwards of fifty different control systems. One of the major difficulties in managing these disparate systems is that key data is often trapped in proprietary systems.
G
aining access to this data is crucial to be able to manage a hospital effectively. More information on the operation of a hospital is demanded more frequently. The ability to make decisions is affected by the quality of information available to the operations and management team. As an example, a study undertaken by the European Commission – Intelligent Energy Europe programme demonstrated that having automated utility monitoring systems you can assist in reducing consumption. An Integrated Extra Low Voltage System (IELVS) provides a practical solution for accessing untapped data sources using common ICT infrastructure and open standards for software. An IELVS design provides a platform to consolidate data from various systems in the hospital and present it to facilities staff in a consistent manner. Another key aspect of an IELVS design is ensuring that, now this data is available, it is accessible by other management systems in the facility. In this paper, we will look at the IELVS solution that is being rolled out at the Queen Elizabeth II Medical Centre (QEIIMC) and Sir Charles Gairdner Hospital (SCGH) and how it is being used to gain access to this previously inaccessible data. One of the information solutions built on the IELVS platform at QEIIMC is to take data from a range of metering sources across the site along with a number of systems in the new Central Energy Plant. Using this open data repository, the
utility management software provides a range of management reports including billing, consumption league tables and sustainability performance.
Traditional Systems Within hospitals and buildings there are a range of control systems that deal with the control and monitoring of a range of building services. This usually includes mechanical air-conditioning, power and lighting, lifts and security. Traditionally, these systems have been installed as separate stand-alone silos of control. The Building Management System (BMS) is the most common solution seen in hospitals for mechanical systems and is often extended into monitoring energy consumption and other services. Most BMS are based on a complete proprietary solution of hardware and software from a single vendor. This has led to many problems with traditional control systems, one of which is the difficulty in accessing and sharing data from these systems to generate meaningful management reports. As the demands for sophisticated energy and greenhouse gas data has grown in recent times, this has highlighted the limitations of traditional BMS. There are a number of possible reasons that this can be attributed to: 1. The worldwide Building Automation and Controls Market is valued at approximately US$30b1 (includes
HVAC, Security, Lighting, etc.). This market is controlled by four major players (Johnson Controls, Siemens, Schneider, Honeywell). Acquisition of smaller BMS companies by these larger ones has reduced competitive pressures. 2. Product development has stagnated. The major vendors current product lines date from the 1990’s and were all built from proprietary architectures. 3. T he “promise” of open protocols in BMS providing flexibility and competition has not been realised. Although the product lines have been enhanced to accommodate open protocol hardware, BMS are still promoted as a “closed” solution with both software and hardware. In addition, most other industries (electrical, fire, security) have adopted other protocols instead of BACnet or LON, which dominate the BMS industry. 4. A ustralia is a fairly unique market where the majority of BMS can only be supplied, installed and maintained by the original manufacturers. This further strengthens their control over customers. 5. T he performance of traditional BMS controls has not been satisfactory in recent times. A number of studies in the US have shown that they don’t deliver on the promise of optimising building performance.
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TECHNICAL PAPERS • Research by the UC Berkley Center for Building Environment found that only 11% of buildings meet ASHRAE criteria that 80% of occupants be comfortable.2 • A study funded by the California Energy Commission found that 64% of economy cycle were not operating correctly.3 • The Lawrence Berkeley National Laboratory determined that 90% of buildings have HVAC controls and systems that don’t work properly in the first year of occupancy.4 These factors have led to the development of alternative solutions that can offer a more satisfactory result.
Trends in Technology Before we look at an integrated alternative to traditional control systems, it is important to look at, the Information and Communications Technology (ICT). In comparison to the traditional controls industry, ICT is much larger, dynamic and changing rapidly. Software and technology development in this market is rapid and has a major impact and business and consumers. Ethernet networks have already replaced the proprietary backbone networks of most control systems for good reasons. They are much faster, cheaper to install and maintain and also more resilient. Similarly, software developments in the ICT world are starting to impact the controls industry with newer entrants to the market providing improved software solutions in comparison to the traditional offering. Two examples would be the adoption of web based graphic displays and embedded web browsers in controls equipment, although the traditional vendors have been slower in adopting web solutions.
location up to running applications on servers in a remote data centre. Cloud computing offers the possibility to run applications on a pay-per-use model rather than having to purchase expensive hardware and software up front. Security and Access Control Systems are now being offered in the US as cloud based services. 2. Internet of Things. Control devices are being released with IP connectivity on-board. This allows these devices to be directly connected to the broader hospital ICT network rather than having a dedicated network. Meters, cameras, door controllers and chiller controllers are just some of the examples of the devices that have been fitted with IP connectivity. Combined with open protocols, this offers flexibility to interconnect more devices that will improve monitoring, control and management of these systems. It also introduces new issues such as security, system performance and management responsibility. 3. Big Data/Analytics. With the advent of cheap, fast mass storage and simple replication, collecting, storing and manipulating large amounts of data is no longer cost prohibitive. Tools are now available to help develop complex rules that can be applied to data sets to identify problems and opportunities that previously would have gone unnoticed because the data was too difficult to obtain or to analyse.
Figure 1: IELVS Functionality
Recent trends in the ICT industry are informative in that we can expect to see them influencing the way we interact with machines and process data. Some of these recent trends: 1. C loud Computing. Cloud computing is a broad term that generally refers to computing being run on distributed machines over a network. It can range from storing data in a remote
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4. M obility. Mobile devices such as smartphones and tablets have become ubiquitous. Users expect to be able to access the same information that they can get on their desktop via a mobile device. The additional features in a mobile device (movement sensors, GPS, cameras) allow for the information presented to a user to be more context sensitive. 5. Next Generation Web. New web technologies, such as HTML5, are improving the richness and performance of the web. Users expectations are growing. They now expect meaningful presentations with quality information presented in a number of ways (text, video, animation). Web displays will be faster and allow more interaction from the user.
An Integrated Approach Given the ease with which we can access a wide range of information using standard computing technology and the Internet, the question is why we can’t achieve the same with our hospital control systems. A different approach is to build the control systems use more flexible techniques than a single proprietary solution. Following the design approach used for ICT infrastructure, control systems can be built up using open protocols and communications.
Australia’s number one provider of integrated health solutions
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Hills Health Solutions have brought together industry leaders Merlon Technologies and HTR (Hospital Television Rentals) to become Australia’s number one provider of interactive patient care. We are Australia’s most trusted brand with more than 40 years industry experience providing integrated health solutions including IP Nurse Call, WiFi, communications and entertainment systems to healthcare and aged care facilities. In over 40,000 beds across 300 hospitals and aged care facilities nationwide, we are the one seamless integrated solution for your healthcare needs.
hills.com.au THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
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TECHNICAL PAPERS An IELVS design also uses a single ICT network to connect all systems together. The network is installed on structured cabling using industry standard equipment. The consolidation of networks removes the expense of separate networks being installed by each system contractor. The ICT solution is typically a more cost effective, reliable, bettersupported solution with redundancy and reliability that is superior to traditional control systems. The IELVS contractor becomes the single point for all network management, connectivity, security and provides the servers or virtual servers for all contractors to use.
Figure 2: Typical IELVS Network
One such approach is Integrated Extra Low Voltage SystemsTM (IELVS). This approach takes the various systems using their native communications methods up to a central infrastructure. From this point, the data gathered can be collated, stored and analysed used a range of techniques. This contrasts with the traditional approach where numerous data conversions must be done and the data is then left in a ‘proprietary’ format.
What is an IELVS? An Integrated Extra Low Voltage System (IELVS) is a new approach to designing and integrating the disparate control systems in a facility to improve the operation of that facility. IELVS ensures every system connected communicates and shares all of its data via an industry standard open protocol. IELVS also ensures the data collected from every system is made available for other client application to use.
• One data storage area for all historical data for trending and reporting for every system.
How Does it Work? The primary design principles of an IELVS are Open Communications and Open Data. IELVS works by obtaining data using multiple industry standard open protocols. This data is used within IELVS and can also be exposed for other applications to use. IELVS communicates directly to field devices, plant equipment and open gateways into each system to obtain, store, diagnose, display and expose data from each system. Figure 3: IELVS Architecture
IELVS supplies an independent user interface that monitors and controls every system from a central location and over the web, as opposed to a traditional path of multiple workstations with different log ins and applications. • One set of graphics for all systems. • One alarm console to display, acknowledge and dispatch alarms from all systems. • One set of time schedules used by all systems.
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Traditionally, all data from each system is either not available or stops at a proprietary BMS. An IELVS solution makes the data available as live, real time values or historical records. This allows clients to freely choose different applications that are fit for purpose. Open data allows applications such as maintenance packages to obtain information about equipment such as runtimes, alarms and warnings to aid with predictive maintenance options. Energy applications have access to all meters and ambient conditions for detailed reporting. Client specific applications can be used to monitor key performance indicators in real time.
TECHNICAL PAPERS Open protocols allow for greater depth of information to be obtained from a wider range of equipment at lower costs. For example, at the Fiona Stanley Hospital under construction in Perth there are over fifty (50) different control systems and equipment that have been connected to an IELVS system using five different open protocols.
Mechanical
Electric and Absorption Chillers, VSDs and Soft Starters, Fume Cupboards, Boilers, DDC Controls, Freezers and Coolrooms, Water Pressurisation System, Radiant Panels
Electrical
Load Shed Control, HV and LV Switchgear, Electrical Metering, Power Factor Correction, UPS, Diesel and Gas Generators, Power Distribution Units, Tri-Generation Controls, Surge Diverters, Cathodic Protection, Diesel Fuel Systems
Hydraulic
Sewage, Stormwater and Waste Water Systems, Reverse Osmosis Plant, UV Sterilisation, Hydrotherapy Pool, Radioactive Waste Management, Irrigation Control, Water Meters, Gas Meters, Domestic Hot Water Systems, Leak Detection (Gas, Water and Diesel), Isolation Valves, Filtration
Lighting
Lighting Control, Emergency Lighting
Security
Access Control, Intrusion Detection, CCTV, Intercom, Help Call Points, Real Time Location*, Car Park Management*
Clinical Equipment
Autoclaves and Sterilisers, Specimen Fridges, CT and MRI monitoring, Laboratory Equipment, Hyperbaric Chambers
Transport
Lifts, Pneumatic Specimen Transport, Automated Guide Vehicles*
Communications
Lift Information Display, Unified Communications System, Master Clock, Digital Video Systems*
Fire and Life Safety
Fire Detection, VESDA, Evacuation Warning, Fire Pumps
Utility Monitoring
Patient Support
Medical Gases, Medical Breathing Air, Assistance Call
Management Systems*
Patient Management, Catering Rethermalisation, Maintenance, Bed Allocation, Venue Booking, Kitchen HACCP Monitoring
How can IELVS help to provide improved management information?
*Systems to be connected in the future. Table 1: Fiona Stanley Hospital – Extra Low Voltage Systems
The Open Data principle simplifies the integration of other applications that need to access data from any ELV systems. These applications could include: • Tenant Web Portals • After Hours Booking and Scheduling Systems • Room Scheduling Systems
all closed proprietary formats that carry the risk of becoming obsolete. New systems that become available in the future will be able to integrate into an IELVS design because of the specified open standards.
At Fiona Stanley, over 70,000 objects connected to the IELVS from simple temperature sensor to a large piece of equipment like a chiller with over 200 items of data.
NSW Health is the largest NSW Government budget dependent agency consumer of energy in buildings taking 52% of the government’s total building energy. The annual consumption for the top 20 hospitals is shown below:
Figure 4: NSW Health – Top 20 Energy Consuming Hospitals5
• Remote monitoring, maintenance and repair of systems • Energy Management • NABERS Reporting • Maintenance and Asset Management • Advanced Fault Detection and Diagnostics • Predicative Maintenance Scheduling • Energy and Performance Diagnostics The Open Communications principle allows the installation of different systems for the same area. Expansions, upgrades and variations can be supplied from different suppliers allowing a competitive tender process to take place. Since the communications to each system is governed by industry standard protocols, to IELVS, there will be are no differences between systems. Open Communications, Open Data, relies on open and documented formats, standards and specifications and avoids
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TECHNICAL PAPERS Reviewing the utility bills for each hospital would be adequate to collect this level of data. The numbers may suggest that there is an opportunity to achieve some savings – but where to start? The obvious choice is to focus on the areas of the hospital that is consuming the most energy.
• Energy cost savings in industrial applications is the main motivation for Energy Monitoring and Targeting. Cost savings are typically 5-15% and can be as high as 25%9 Whilst these studies focussed on buildings other than hospitals, the lessons learnt from these studies are readily transferable to a health facility.
QEII Medical Centre – Utility Metering
Figure 5: Shewart Cycle
The 28-hectare QEII Medical Centre (QEIIMC) is the largest medical centre in the southern hemisphere. It includes Sir Charles Gairdner Hospital (SCGH), which is one of Australia ‘s leading teaching tertiary hospitals. The hospital has over 600 beds and employs approximately 5,500 staff that treat over 420,000 patients every year.
• Maintaining a high power factor • Identifying power quality issues with electricity delivered to critical equipment • Managing the expansion of the site. It was not possible to manage the site effectively just from the utility bills. Previously, the electricity consumption was measured using a combination of manually read meters along with some meters connected to the site BMS using pulse inputs. This presented a number of problems: • The coverage of metering was inadequate to fully cover all consumers on site. • Manually reading meters was too time consuming given the size of the site. Recording errors were also an issue given the range of meters.
Most people are familiar with the Shewart Cycle from quality management systems. It was popularised by W Edwards Deming6 and is sometimes referred to as the Deming Cycle. One of the four key elements in managing and improvement process is to “Check”. In energy and power quality management this means having adequate metering in place to record key data points including consumption, demand, maximum current, power factor and voltage fluctuations.
Originally constructed in 1958, the site has expanded to include over 40 organisations. These organisations are housed in over 30 different buildings providing 300,000sq.m of floor space. The site is undergoing major redevelopment and construction that will a new 274 bed Children’s Hospital added to the site along with a new building for the Western Australian Institute of Medical Research and a new Mental Health Unit.
• Pulse meters combined with BMS controls are not reliable. BMS controllers will miss pulses and meter values are lost when the controller loses power or is reset.
“If you can not measure it, you can not improve it.” – Lord Kelvin
The site electrical load is expected to rise from the current 12.5 MVA to 27.5 MVA by 2020.
• It was difficult to obtain meaningful reports from the existing BMS system, as the reporting tools were cumbersome to use.
Having good metering infrastructure in place will lead to savings, as observations will quickly identify opportunities to minimise wastage. Various studies in Europe have demonstrated savings from the installation of smart meters with displays. • In residential applications savings were generally around 3%, with savings of up to 11%. The savings were found to be generally durable, rather than short-term.7 • Further research carried out in the UK, indicated savings from direct energy feedback to range from 5-15%. Savings are typically of the order of 10% for relatively simple displays.8
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The site also distributes other utilities to buildings and tenants including potable water, chilled water, heating water, purified water and natural gas. Energy management on this site is a significant issue. Wastage on the site can make up for a large cost as well as having an impact on the Greenhouse gas emissions from the site. Some of the issues that the hospital facilities management team have to deal with on the site include: • Billing tenants for utilities • Controlling wastage • Minimise peak load demand to avoid excessive demand charges from the supply authority
THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
• Pulse meters can only provide one or possibly two parameters vs. a smart meter, which can supply a complete range of values. • Pulse meters do not cope with exported power that occurs with many large machines such as lift motors.
To overcome these issues, and to allow us to drill down to analyse the energy consumption at the building level, smart meters were installed on the main low voltage feeders to each building. These meters were connected directly to an Ethernet/IP network around the campus. The meters are able to transfer numerous measured values using Modbus protocol over IP. From here the data is stored in an open SQL database running on a virtual server that is part of a consolidated server farm used for the majority of the control systems on the site. The current range of meters on the site is listed in Table 2.
TECHNICAL PAPERS
Meter (Protocol)
Quantity
Electrical (Modbus and OPC)
96
Potable Water (MBus)
41
Natural Gas (MBus)
6
Chilled Water – Thermal (Modbus)
8
Heating Water – Thermal (Modbus)
5
Table 2: QEII Metering
Different meters are used depending on the application. For instance, where tenant billing is required, a pattern approved meter complying with the NMI is used. In the Central Energy Plant, energy data is extracted directly from the main switchgear. The ability to mixand-match meters to suit the application provides flexibility without being tied to a single vendor solution. In addition, other meter types are used for different services. For the hydraulic meters, the MBus protocol was used, as this is a more commonly available protocol for hydraulic meters. The flexibility of using open protocols allows the best product for the application to be selected.
Figure 6: Electricity Consumption League Table
Figure 7: Greenhouse Gas Consumption League Table
Data from the SQL database is then available for two different applications supplied by two different vendors • A reporting package that collates billing information and also provides monthly summaries on energy consumption • A web based graphical tool that can display all of the values from the meters as well as normalised energy consumption data and greenhouse gas production on a per building basis. A sample of the fifteen (15) monthly reports is displayed below. These reports are automatically generated each month and e-mailed to a number of recipients. These reports are customised to provide different information including raw consumption and greenhouse gas production data, normalised data based on floor area and league tables to identify buildings with unusual operating patterns. The reporting system also includes a set of analytics routines that detect unusual operation of the meter including meter resets, lost data or significant imbalances in consumption. These analytic tools have helped identify meters that weren’t
Figure 8: Normalised Electricity Consumption League Table
commissioned correctly and unmetered supplies.
Conclusion By removing the energy data collection from the BMS and manual processes, better quality data can be more reliably gathered, Report generation, system analytics and web based graphics have been provided using a combination of products from numerous vendors. This
has been done in a cohesive manner and ensures that ongoing support for the various products can be achieved without having to resort to a single vendor, which was the case previously. Using the open design philosophy of IELVS, the same software platforms have also been expanded to provide the primary user interface into the new Central Energy Plant. This provides
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TECHNICAL PAPERS operators with access to more than a dozen control systems including mechanical services, HV and LV switching, trigeneration plant operation, lighting control, emergency lighting and access control. Future expansion of the system is planned as new buildings come on stream and additional equipment is connected to the network. Because any open protocol metering device can be added to the system, this allows the system to expand at the lowest possible cost. Devices such as variable speed drives, that include energy metering as a standard function, can be connected to the system to provide detailed information about the operation of pumps and fans. As operators identify and resolve issues, this knowledge can be captured into the analytics and provide a continuous process to monitor all meters and ensure that the site runs in an optimal manner.
References 1. “Building Automation & Controls Market (2013 – 2018): By Product (Lighting, Security & Access, HVAC, Entertainment, Outdoor, Elevator Controls, Building Management Systems (BMS)), Application & Geography (Americas, Europe, APAC, And ROW)“ Markets and Markets Research Report http://www.marketsandmarkets. com/Market-Reports/building-automation-controlsystems-market-408.html 2. “Air Quality and Thermal Comfort in Office Buildings: Results of a Large Indoor Environmental Quality Survey” C. Huizenga, S. Abbaszadeh, L. Zagreus and E. Arens. Indoor Environmental Quality (IEQ), Center for the Built Environment, Center for Environmental Design Research, UC Berkeley 2006 3. California Energy Commission Nonresidential Compliance Manual – Second Draft 2013 Building Energy Efficiency Standards 4. “Out of Control Controls” P. Rumsey, Green Source Magazine, September 2011
5. NSW HEALTH Environmental Sustainability Strategy 2012 to 2015 http://www0.health.nsw. gov.au/pubs/2012/env_sus_strat201215.html 6. “Out of the Crisis” – W Edwards Deming 1982. ISBN-10: 0262541157 7. “Smart Grid projects in Europe: Lessons learned and current developments 2012 Update” – European Commission Joint Research Centre Institute for Energy and Transport http://ec.europa.eu/energy/gas_electricity/ smartgrids/doc/ld-na-25815-en-n_final_ online_version_april_15_smart_grid_projects_ in_europe_-_lessons_learned_and_current_ developments_-2012_update.pdf 8. “The effectiveness of feedback on energy consumption – A review for DEFRA of the literature on metering, billing and direct displays”. S. Darby, Environmental Change Institute University of Oxford, April 2006 9. “Guide to Energy Efficiency in Manufacturing” J. Huddelston, ETSU for the UK Energy Efficiency Office -Department of the Environment, 1994
Ecas4 Technology
E
cas4 technology is based on an electrochemical procedure regulated by a special four-chamber electrolytic cell (to which two international patents apply). This device ensures neutral pH values, constancy of redox potential of the solution produced. Thanks to the optimization of these values, hypochlorous acid, the principal component of the Ecas4 solution is much more efficacious in its action than other commercially available chlorine based products (sodium hypochlorite). Within the sector of disinfection of water, Ecas4 disinfectant is an avant-garde biocidal agent. It ensures a virtuous equilibrium between hygiene and eco-compatibility. Produced where and when needed by means of an electrochemical reactor – which passes electricity through a water solution of a few grams of re-crystallised salts per litre – Ecas4 disinfectant does not require any special storage procedures. Hypochlorous acid is the biocide produced by the cells of the immune system in all superior organisms (including humans).
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As opposed to commercially available sodium hypochlorite, electrochemically produced hypochlorous acid is a neutral molecule very similar to the hydrogen peroxide molecule but of non-toxic nature (it is therefore capable of interacting with pathogen cell membranes with 80 times the efficacy). Furthermore, the required result can be attained with less contact times (ten-fold reduction) and with smaller quantities of disinfectant agent, conserving the quality of the water treated.
Ecas4 Disinfection & Sanitisation systems Water Ecas4 Water Distribution System can be installed to automatically dose into hot, warm or cold water systems to eliminate pathogens including biofilm where legionella grows and becomes problematic. System can be monitored off site. Air and Surfaces Ecas4 Nebulisation-dry fog application, capable of disinfecting all hospital rooms, operating theatres safe on all electrical equipment like MRI machines, walls
THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
and ceilings surfaces. Ecas4 Anolyte Nebulisation system is nontoxic, nonhazardous and extremely effective against pathogens such as MRSA. We believe Ecas4 technologies challenge all current systems in the area of health and hygiene that is completely safe for all humanity; it is non-hazardous, non-corrosive and has positive impact to our environment. Ecas4 Patent Reactor technology produces superior antibacterial properties similar to our human natural defence mechanism that our immune system relies upon. Our equipment and systems are easy to work with, fully automated and able to be electronically monitored.
Proudly supporting in 2014 • 25th Annual ASID “Infectious disease” conference South Australia • PIX – Queensland • Foodpro – Melbourne • IHEA Healthcare Facilities Management Conference Brisbane
TECHNICAL PAPERS
Engineering for Health & Hygiene
TM
A highly efficient, non-toxic disinfection solution that eliminates both pathogens and biofilm. Ecas4-Anolyte production is entirely automatised by means of an electrolytic procedure that does not require the use of toxic, harmful or dangerous substances. The Ecas4-Anolyte solution has a minimum content of chlorine and a high redox power and is genuinely pH neutral and non-corroding due to our unique patented 4-chamber system. Ecas4-Anolyte solution is: + pH neutral + 100% effective for 48 hours + non-toxic + 100% biodegradable
How Ecas4-Anolyte compares to other purification and disinfection systems Barrier Effect
SYSTEM
Deposit Effect
Disinfection with No Corrosion
No Halomethane Formation
Biofilm Elimination
Cost Benefits
Thermal Treatment Chlorination Chloride Dioxide Copper + Silver Positive Ions
Not compatible with zinc surfaces
Ozone Filtering Ultraviolet Rays Ecas4-Anolyte HIGH
MEDIUM
LOW
Ecas4速Anolyte Registered as a Broad spectrum Disinfectant / Sanitiser
T + 618 8122 7165 | E info@ecas4.com.au | www.ecas4.com.au THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
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TECHNICAL PAPERS
Designing For the Ageing Population in Acute Care Environments Joyce Polhamus and Alexis Denton
We knew a major shift in healthcare design was afoot when a major provider asked us: “How is your design of this hospital senior-friendly?” As lines between models in the care continuum begin to disintegrate, designing for acute care means looking to the strategies used in post-acute environments.
T
here’s no doubt that aging is a hot topic. The elderly consume healthcare services at a disproportionate rate compared to other age groups. And as baby boomers begin to swell this patient segment, providers are focused on reducing readmission rates and efficiently managing care across the continuum, making design that’s sensitive to older generations a priority. In post-acute environments, the patient stay is longer, so one goal is to create a living environment where they can have a high quality of life, staying socially connected and feeling in control. With acute care, on the other hand, the objective is to deliver high-quality care in an efficient manner and to discharge the patient as soon as possible. Although there are major differences between acute and post-acute environments, the two settings can be compared when three main spaces are considered: corridors, the patient/ resident room, and support spaces. While many of the strategies suggested on the following pages are specific to the elderly, ultimately these are design moves that benefit everyone, regardless of age. In times of illness or rehabilitation, every element that brings physical healing, mental stimulation, and emotional support contributes to holistic wellness.
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Corridors In post-acute environments, one of the goals is to get patients out of their rooms so they can participate in rehab and social activities. The corridor becomes more than just a space to move through; it’s an opportunity for spontaneous social interaction, a place to be. In post-acute corridors, seating or other destinations, spots of interest, etc., should be provided at short intervals (for resting, or as a place for conversation)and artwork and views to the outside should be included, to encourage patients to be up and out of their rooms. The acute care corridor is more of a space for visitors and staff than for patients because patients are less likely to leave their rooms. It’s more of a movement space and less of a social space. Elderly visitors can benefit from some of the post-acute care strategies for designing corridors, specifically the inclusion of places to stop and rest spaced at short intervals and visual clarity for ageing eyesight. Both post-acute care and acute care corridors benefit from small-scale design moves to aid with visual impairments. For example, the base colour on the walls is often designed to match the flooring, which can make it difficult for an elderly person to tell where the wall and floor meet. Contrast between the handrail and the wall is also important. High
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light levels from a variety of sources, not just overhead, benefit the aging eye. Additionally, flooring patterns that stay within similar tones will help lessen the appearance of holes in the ground. In both settings, elevators should be easily identifiable, have call buttons that accommodate assistive devices, and be large enough to include room for sitting.
Acute care corridors • Bold floor patterns to highlight nurses’ stations are great for wayfinding, but the colour contrast can cause the elderly to think it’s a step or hole. • Floor and wall colours should be different to distinguish the two planes. • Handrails need a contrasting colour to be easily distinguishable and create a feeling of security. And often, equipment is parked in front of handrails. • There’s a heavy reliance on signage for wayfinding since patient visits are shorter. To accommodate aging eyesight, the letters need to be large and easily readable, and at lower heights where possible. • Corridors are typically double-loaded for efficiency, so there’s little to no natural light. This is not easily mitigated because acute care settings are designed for staff efficiency. Singleloaded corridors are an alternative in post-acute settings because mobility
TECHNICAL PAPERS is encouraged and nursing is not as intensive. • Hard-surface flooring such as linoleum, rubber, and vinyl makes glare more likely. Subtle patterns, gradient colours, darker tones, and wood-grained flooring create texture that softens the traditional institutional white floors with bold patterns. The paradigm shift is still a challenge for staff, administrators, and patients who need to be convinced that flooring does not have to be shiny and white to be clean. • There are typically no places to stop and rest. Small built-in benches out of the exit path or at the end of the corridor by a window can be incorporated. Often, lighting comes from one source only—typically bright overhead fixtures. High light levels and a variety of sources are needed for the elderly eye.
Post-acute care corridors • Handrails are easily identifiable, continuous, and smooth to the touch (to protect delicate skin). • Natural light and windows are ideal in post-acute care to encourage mobility for rehab patients and movement/socialisation for the elderly. • There’s less dependence on signage and more on visual cues at walls and room entries for cueing and wayfinding. The signage that exists is placed lower because the elderly tend to look down. • Flooring is generally carpet: softer, quieter, and less institutional. While this is not an appropriate material in acute care, a textural or wood-grained look in the floor in acute care is desirable. • Corridors are designed for multiple functions such as socialisation and rehabilitation. For example, distance markers can be applied through
subtle floor or wall patterns to aid in rehabilitation; interesting features on the wall (artwork, niches, displays, etc.) and lighting variations can encourage activity and movement. Clear floor space free of obstacles (such as equipment) and destinations at the ends with seating and views promote socialisation.
Patient rooms Storage, display, and personal control are central themes in the post-acute care patient room. Since the patient may be there long-term, a significant amount of storage in the room and bathroom is desirable. The ability to adjust the lighting, shades, television, acoustics, and personalisation of display provide control over one’s own environment. Difficulty sleeping is a common problem for the elderly, so night-time control is especially important. There’s very little patient storage space in the acute care room; typically, the
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TECHNICAL PAPERS storage is there for the staff. There’s an opportunity to hide equipment that may look scary with attractive casework. In post-acute spaces, there are common areas in which to socialise with visitors. This is not the case in acute care: Socialisation occurs in the patient room. A designated space for visitors with furniture that’s senior-friendly (easy to get in and out of, not too low, sturdy arms) is important. In both post-acute and acute care rooms, there’s an opportunity to encourage bedside wellness. Space should be provided for the patient to get up, use an assistive device that’s adjacent to the bed, and move around. Elderly people lose strength faster than younger people, so being in bed for long periods of time is especially detrimental to their health. In both settings, high-contrast furniture can help a patient identify his or her bed, bedside table, and other furniture against the floor to reduce fall risk. Other strategies to reduce fall risk in both settings include a night-light that can be controlled from the bed and a handrail from the bed to the bathroom to help guide the patient. The patient bathroom is another area where acute and post-acute care design has differed, but that’s beginning to change. In post-acute settings, the focus is on fold-down grab bars for independent or assisted toileting. Acute care spaces are now incorporating those features, as well, since the majority of patients are older and it can be too labor-intensive to rely on the nursing staff to assist.
Acute care patient rooms • The room is often designed for a range of acuities and includes lots of equipment that may be frightening for the elderly, even if not being used. Hiding this behind casework so that it
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can be visible only when needed can lessen an institutional feel. • Patients are less independent and less mobile, so the room is focused on bedside care. Typically, the rooms are tight and difficult to manoeuvre with mobility devices. • There’s little patient storage and minimal personalisation because patients may be there only for a short amount of time. Even small opportunities for personalisation, such as shelving opposite the bed, can help make the room feel more residential. • Visitor interaction occurs inside the room, so there should be a dedicated zone for family and visitors.
Post-acute patient rooms • Stays are longer, so space for personalisation and storage in the room are incorporated. • Finishes provide a residential feel. A wood-grain flooring look is preferred, although carpet is also appropriate to make the room feel residential. • Independent toileting is emphasised with direct visual access and fold-down grab bars. • Larger rooms allow for patients to be out of bed. • Barn doors with door pulls create wider access into the rooms so patients with mobility devices can easily manoeuvre on their own.
Nurses’ stations Support spaces in post-acute settings have long been the key to creating a residential environment. Current trends decentralise nurses’ stations into smallscale work areas, often no more than a desk in a common space, such as a living room or family-style kitchen. Other support spaces are designed to be part of the background – doors are virtually hidden from view. An on-stage/off-stage approach is taken so that patients see
THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
as little equipment as possible (while it’s beneficial for patients to see staff, seeing equipment isn’t desirable).
Acute care nurses’ stations • Nurses’ stations that are highlighted with bold floor patterns can be too confusing for the elderly. Nurses’ stations can be highlighted with lighting and vertical materials instead of flooring. • Generally, nurses’ stations are highly active and noisy, and can be unwelcoming to elderly visitors seeking information about their loved ones. A concierge-style nurses’ station can be more welcoming. • There’s more equipment out in the station. Putting equipment away when not in use can make station feel more approachable.
Post-acute care nurses’ stations • The nurses’ station is designed to look like a concierge desk so that it’s welcoming for patients and visitors. • Equipment is hidden in rooms or within casework when not in use. Nursing functions are incorporated into residential features such as kitchens near the dining area, through smallscale workstations that blend into the residential environment. Joyce Polhamus, AIA, EDAC, LEED AP BD+C, is vice president of SmithGroupJJR (San Francisco) and leads the firm’s senior living and healthcare interiors practices. She can be reached at joyce.polhamus@smithgroupjjr.com Alexis Denton, AIA, LEED AP BD+C, is an associate with SmithGroupJJR (San Francisco) and holds graduate degrees in architecture and gerontology from the University of Southern California. She can be reached at alexis.denton@smithgroupjjr.com
TECHNICAL PAPERS
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TECHNICAL PAPERS
Sick Ducts
Don’t let your HVAC system become a patient REBECCA PHELAN I GENERAL MANAGER, KLEENDUCT AUSTRALIA PTY LTD
Hopefully I now have your full attention with the two photos above. How many of you have already guessed that they were taken within the ducts of two separate hospitals? When I considered how or even if to write this article, I was nagged with the thought that no-one wants to read another article about duct cleaning! But when photos like these come across my desk, I’m so horrified. I know I really must share in an effort to educate those holding the purse strings as to how critically dangerous it is to neglect the budget for the maintenance of the HVAC system within a hospital.
O
f all the maintenance activities within a hospital the HVAC system must be considered the most important. It seems a pointless exercise to treat patients in hospital where the very air they are breathing is putting them at further risk. We are all aware of the difficulties involved with a large scale duct cleaning operation within a hospital; isolation of a whole section, ward, department or floor especially when beds are so short, lack of budget, noise. So, the aim is to not let it become a large scale exercise in the first place.
Inspection and monitoring The key here is constant inspection and monitoring of the system. This can be done in house or by any reputable duct cleaning company, most of which have some pretty impressive visual inspection tools. When budget is an overriding issue, then focus on your filters. Properly maintained filters
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will save your money in the long run and are a critical component in the health of the system. The next most important focus is on any area producing moisture, as unattended IT can lead to fungal contamination. Putting an inspection plan in place is a must in every special use system. Inspection points can be through the existing openings (return air grille, supply air grille etc), although you may need to install extra openings. If so these should
be installed near to any component within the duct such as dampers or fans or where the duct changes direction. You should map the inspection points on a copy of the building plans. Next you need to understand the Definition of Hygiene Levels (table 2.1) and comply with HVAC Systems Hygiene Inspection Frequency (table 2.2) and Minimum Acceptable System Hygiene Standard for Special Use Systems (table 2.3).
*Table 2.1 DEFININTION OF HYGIENE LEVELS Hygiene Level
Description
1. Clean
No visible dust, debris or other contamination
2. Light
Only slightly visible layer of fine general dust consistent over the component surface with little to no variations in density. Component surface remains visible beneath the fine layer of dust.
3. Moderate
Visible levels of general dust with varying density and limited areas of accumulated fine debris. Component surface is still visible in some areas beneath the fine dust but in isolated sections may not be.
4. Heavy
High levels of visible dust, debris, fibres or any other contamination that cover the component. Component surface is barely if not at all visible beneath the contamination.
*Source: AIRAH HVAC Best Practice Guidelines
THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
TECHNICAL PAPERS
Clean
Light
Moderate
Heavy
*Table 2.2 HVAC SYSTEM HYGIENE INSPECTION FREQUENCY HVAC System Components
Minimum Inspection Intervals
Air handling units
Monthly
Supply system – moisture producing equipment
Monthly
Air intakes and exhaust outlets
Monthly
Supply air systems
Annually
Return air systems
Annually
Outdoor air systems
Annually
Exhaust air systems
Annually
Evaporative coolers
Quarterly
Non-ducted air conditioning
Monthly
Incorporating the tables into an inspection plan will go a long way to preserving your system in good health and will extend the life span of all components. Sadly your system may already be contaminated and therefore you will have no alternative but to take corrective action. The rules here are clean it. If it can’t be cleaned, fix it. If it can’t be fixed replace it. Some reasons why your system may need cleaning:
*Source: AIRAH HVAC Best Practice Guidelines (AS/NZS 3666.2) *Table 2.3 MINIMUM ACCEPTABLE SYSTEM HYGIENE STANDARDS HVAC System Classification Special Use Systems
HVAC System or Component
Minimum Hygiene Level (Table 2.1)
AHU
Clean
Supply system – moisture producing equipment
Clean
Air intakes and exhausts
Clean
Supply air system, or return air system or outside air system
Pre-filtration – Light
General dust and particulates
Post-filtration – Clean No filtration – Clean
Exhaust air system
Moderate
Non-ducted refrigerated a/c
Clean
Evaporative coolers
Clean
*Source: AIRAH HVAC Best Practice Guidelines Biological contamination
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TECHNICAL PAPERS
Kleenduct Australia delivers outstanding duct cleaning services to existing and prospective customers throughout Australia. Our company offers 24 hour, 7 day a week servicing 363 days of the year. This ensures that we are in a position to promptly and efficiently meet the demands of our customers.
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Kleenduct Australia has the depth and expertise to fully service all duct cleaning requirements on a national basis, and we hold many national contracts with key organisations in Australia. In utilising Kleenduct as a maintenance provider our customer has the opportunity to draw from the extensive experience and comprehensive range of services we provide.
DUCT INSPECTION
Advanced camera system has a articulating eye with a full colour camera head and lets you take a closer look at horizontal and vertical ductwork…
Super bright wide TFT monitor provides brilliant picture quality.
Connection cable 60 to 80 metres.
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info@kleenduct.com.au
TECHNICAL PAPERS
Left: Bacterial contamination
Fungal contamination
Asbestos
Above: Viral contamination
Deteriorating non-porous surfaces
Deteriorating porous surfaces and linings
Fire and smoke damage
Water damage
Choosing the right contractor If a clean is needed there are a couple of considerations as to the contractor you chose for the project. You need as an absolute minimum • Proven ability to perform the task at hand (ask for references), • A commitment to quality and safety,
• A comprehensive scope of works that should include; o Areas/components to be cleaned, o A project management plan, o Capability to provide full reporting that includes digital or video imagery, • Fully insured, • Trained duct technicians (ask for proof of training),
Above: Building or renovation contaminants Right: Odours
• Appropriate PPE, • MSDS and SWMS/JSA.
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TECHNICAL PAPERS You need to have good communication with your chosen contractor and you should make your objectives clear from the beginning. A great deal of planning will have to go into the project to ensure the least disruption to patients and every day operations. Ensure that your contractor has the correct equipment to contain whatever is removed from the HVAC system. This would normally be a negative air unit fitted with HEPA filters. You may need to employ the services of a HVAC mechanic in conjunction with your duct cleaner for the purpose of rebalancing and checking air flows etc on re-commissioning of the system. Once your system is cleaned and with your inspection plan in place you can expect to dramatically improve indoor air quality and occupant health and well-being. Operations should run more efficiently and you may even reduce your energy use and extend the operating life of your HVAC system.
Clean it, fix it or replace it
represents. Now we just have to educate the guys with the purse strings and get them to fully understand the consequences of a poorly maintained system.
Remember; 1. Focus on filters and any moisture producing components. 2. Clean it. If it can’t be cleaned fix it. If it can’t be fixed, replace it. And lastly when looking for funding prepare yourself with good images of the dirty components and with sound facts. AIRAH’s HVAC Hygiene Best Practice Guidelines is an absolute must have for any one maintaining HVAC systems and particularly a special use system. The guide contains well sourced and excellent information and references to other guides and Standards in the case of unusual circumstances such as asbestos. We all know the importance of maintaining these systems and the very real benefits a well maintained system
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TECHNICAL PAPERS
Water Quality in Healthcare Facilities: Are you prepared? Jack Noonan I CETEC Vyt Garnys I CETEC
M
uch publicity has been generated regarding the Guidelines for Managing Microbial Water Quality in Healthcare Facilities, released in late 2013 by Queensland Health. Although the Guidelines apply to Queensland healthcare facilities, they have been recognized as best practice nationally and are being used as a framework for facilities in other States. Furthermore, it is now a directive for healthcare facilities in Queensland to develop a Water Quality Risk Management Plan (WQRMP) and Figure 1: A multi-disciplined approach is required for a WQRMP utilising both internal and external resources. undertake ongoing monitoring and sampling of the potable water systems. for many facilities. It important to identify these gaps in This approach is also recommended for healthcare facilities in knowledge and experience and source external advice early. other states in order to control and manage microbial risks and prevent further Legionella outbreaks. The process is site specific, What’s required for a WQRMP? requires a multi-disciplined approach, and can be challenging. Every facility will be different and, as such, the inputs for a This article will discuss some of the major considerations of a WQRMP will differ. Nonetheless, some important considerations WQRMP in order to control these risks.t utilised for the Risk Management Framework should include:
Formation of a Water Quality Team
In order to prepare and manage a WQRMP, a Water Quality Team is required. A water quality team should be made up of a combination of internal and external resources. Every healthcare facility is different and the positions and titles allocated in Figure 1 below may not necessarily apply to all facilities. However, it is important that the internal resources (and subsequent responsibilities outlined in any WQRMP) cover more than just an engineering component. A Legionella or microbial outbreak will have significant impacts on a wide range of hospital groups and any treatment methodologies, such as chlorination or others, can also impact these groups. The guidelines acknowledge that external assistance is likely to be required for both the formulation of a WQRMP and its ongoing monitoring. Internal knowledge regarding the hydraulic systems of a facility may be well known, however, the interpretation of microbial test results, applying these to determine level of risk and response, ongoing treatment options, human resources and outrage management, and consideration of the system in a holistic sense may be a significant challenge
• Collation of available and relevant hydraulic, engineering, and maintenance information • Sampling and monitoring program • Clinical risk assessment • Control and responsibilities for the team • Clear response plan, including consideration of obtaining rapid results during a crisis • Human resource strategies • Outrage and media management The WQRMP is a live document. As changes occur to infrastructure, patient profiles, clinical risk, water quality, and microbial test results, so too should the WQRMP. The Water Quality (WQ) team should respond to the changes and revise the Plan as required. Changes may include, but not be limited to: • Maintenance • Moving patients between wards
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TECHNICAL PAPERS • Changes in clinical risk • Wards and rooms that may not be occupied
LEgIoNELLA RIsk MANAgEMENT FoR ovER 25 yEARs
• Change in microbial and/or chlorine results • Change in water system risk • Interruption to supply and/or quality of water by the provider
Some important inputs – Hydraulic Infrastructure
For your hospital or aged care facility our team of consultants are experts at providing formal preparation of:
“ Water Quality Risk Management Plans for Healthcare Facilities” CETEC also provides: • Water system expertise
As hospital engineers and maintenance managers would now be aware, the hydraulic infrastructure within a healthcare facility has the potential to house microorganisms that can be potentially harmful to human health. Consequently, a detailed and documented understanding of the hydraulic infrastructure is critical. It is also important to acknowledge that this is not just a warm water issue. Recent research by the team at CETEC has found significant contamination within cold water infrastructure within facilities, including within storage tanks and both cold inlet and warm outlet points of thermostatic mixing valves (TMVs). Furthermore, the wide ranging Australian climate means that cold water temperatures have often been measured above 30°C, which coincides with the optimum temperature for microbial growth.
• Novel and proven disinfection cleaning method for hospital water systems • Rapid onsite microbial screening for mould & bacteria – using Mycometer® / Bactiquant® • Indoor Air Quality (IAQ) testing and investigations • Hospital design & dangerous goods risk assessments • Corrosion and materials assessments
CETEC clients include: • Uniting Care Health • QLD Department of Health • Epworth Private Hospital • Charleville Health Service • VIC Department of Health • Liverpool Hospital • Canberra Hospital • Southern Health (VIC) • Frankston Public Hospital • New Bendigo Hospital • New Royal Children’s Hospital
• Alexandra District Hospital • Children’s Hospital Academic & Research Facility, QLD • Charles Perkins Centre, University of Sydney • Ramsay Healthcare - Beleura Private Hospital, St John of God Hospital, Warringal Private Hospital, Linacre Private Hospital, Donvale Rehabilitation
www.cetec.com.au CETEC Pty Ltd | ABN 44 006 873 687 info@cetec.com.au (03) 9544 9111 | (07) 3857 5531 | (02) 9966 9211 *CETEC are the Australian exclusive distributor for Mycometer® Figure 2: Area where a coffee machine was removed. The hydraulic infrastructure remained and resulted in a dead leg risk.
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THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
TECHNICAL PAPERS An understanding of hydraulic infrastructure for a WQRMP should include (but not limited to): • Detailed and current hydraulic documentation • Changes to the system over time • Identification and planned removal of dead legs • Unused outlets • Fittings and maintenance regimes
Figure 3: Summary of sampling and monitoring requirements. More detail is provided in the Guidelines.
• Presence of TMVs and any traditional warm water loop systems • Investigation of the system for potential to house microbials • Water storage on site • Temperatures of cold, hot and warm water • On-site treatment of potable water (if applicable) • Water flows through the system Figure 2 shows an example of a change to the hydraulic system at a facility over time. The area was previously used for a coffee machine with water being supplied to it via a branch off the nearby ward. When the coffee machine was removed, all the plumbing remained and a new and very long dead leg of the water system was created. This leg had never been flushed since the removal of the coffee machine several years earlier.
Some important inputs – Water Supply Engagement with water suppliers is critical to properly assess the reliability of quantity and quality of water supply. It is important to acknowledge that the water that is being provided to healthcare facilities may be compliant to the Australian Drinking Water Guidelines, but is not sterile. Some residual disinfection is likely to have taken place at the treatment plant; however, by the time it has arrived at your facility, the residual may not be sufficient to limit the effect of microbial growth. Key questions to consider may include: • Who is your water provider? • Where does your water come from?
Some important inputs – Sampling and monitoring of the water system Sampling of water from the system is critical, however, it can be complex. Figure 3 shows what should be sampled and the tests required, however, every system is different and representative outlets may include multiple water systems. This should be identified in the WQRMP and external advice can assist in this regard. Furthermore, frequency should be dependent on the system level risk, which is detailed in the Guidelines. It is important to use a NATA accredited laboratory and, where required, engage a scientific consultant to properly assess the implications of the microbial and chlorine results.
Are you prepared? There is no single approach or solution for dealing with water quality issues within healthcare facilities due to the complexities and nature of these facilities. The key is to start engaging with relevant parties and putting the necessary controls in place. A WQRMP is essential for protecting patients, staff, and the brand of the hospital in the event of a microbial outbreak, which may include Legionella. Jack Noonan is the Queensland Manager and Dr Vyt Garnys is the Managing Director for CETEC who were members of the Technical Advisory Panel for Queensland Health, which developed the Guidelines for Managing Microbial Water Quality in Healthcare Facilities (2013). The CETEC team has been conducting water risk assessments since 1987. The team can be contacted on 07 3857 5531 or at www.cetec.com.au
• Is it treated? • How is it treated? • To what extent is it treated?
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TOPICS OF INTEREST
The Next Generation
Succession planning helps teams to build for the future Deanna Martin
A
career day at a local high school may include doctors, nurses, teachers, police officers, bankers and maybe even an engineer. But not many schools feature hospital facility managers or health care planning, design and construction professionals.
fire, where the air conditioning comes from, what happens when a hospital loses commercial power or how surgical instruments are sterilised. He noted that facility professionals have a very important job: keeping critical systems running to protect vulnerable patients in hospitals.
bachelor’s degree in building construction management with a health care specialty.
“We’ve flown under the radar for a long time,” says Tim Adams, FASHE, CHFM, CHC, director of leadership development at the American Society for Healthcare Engineering (ASHE). “Most people who are currently in the field didn’t really follow a defined career path – they either worked their way up through health care facilities or came from another industry.”
“Without us, the hospital would shut down,” Stephens says. “They never thought about that. They were enthralled.”
Other colleges and universities are considering new health care specialties in existing programs or new degree programs in health care, according to Adams. “Universities are seeing that there’s an opportunity here,” he says. “And there are going to be more opportunities in the future as our seasoned, experienced leaders are retiring.”
But attracting young people to the field is increasingly important as many senior leaders prepare to retire. A 2012 salary survey by Health Facilities Management and ASHE found that 40 percent of managers were older than 55 – an increase from 35 percent in the 2009 survey. As this aging workforce enters retirement, there will be a greater need for developing succession plans. Developing the next generation of health care facility professionals is a complex task that involves a wide range of activities such as exposing young people to the field, ensuring that college students receive the knowledge and experience they need to succeed, furthering the career of current facility professionals and helping hospitals to prepare succession plans that will leave them well-situated when experienced leaders leave.
Preparing young people ASHE’s President-elect Philip C. Stephens, CPE, CHFM, FASHE, recently visited a high school to present information about the field. He asked students whether they’ve ever considered what protects a hospital against
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Students also are drawn to the high salaries that many facility managers earn. The 2012 salary survey found that facility managers earned an average of more than $95,000 a year, with bonuses topping $8,000. Professionals responsible for construction and projects averaged salaries of more than $110,000 a year with bonuses of nearly $15,000. The health care facility field can be attractive to students with a wide variety of interests. Students who are more interested in technical careers can become an HVAC technician, electrician, and carpenter or develop another technical skill through community colleges, trade schools and apprenticeship programs. These skills are also very much in demand in health care. For those who want a degree, several colleges have begun offering programs related to health care facilities. ASHE is working with some institutions to help develop curricula to ensure that students are learning skills needed in the real world. They include: Owensboro (Ky.) Community & Technical College. The school is establishing a two-year associate degree program in health care facilities leadership. Classes are expected to start in January and all classes will be available online. Purdue University, West Lafayette, Ind. The university’s department of building construction management offers a
THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
Brigham Young University, Provo, Utah. The university’s bachelor’s degree in facility and property management includes optional health care courses.
In addition to helping universities create appropriate programs, ASHE also works directly with college students. Each year, college students from several universities attend the ASHE Annual Conference and the International Summit & Technical Exhibition on Health Facility Planning, Design & Construction. Students participate in the conference, learn about the industry, compete in a student challenge and conduct research projects.
Transitioning to work Internships are a valuable tool to help college students transition to the field. ASHE has teamed up with Schneider Electric, Palatine, Ill., to expand an internship program that provides students real-world experience before they apply for jobs. Several hospitals and universities participate in the program. Some college students working on degrees not specific to health care may land paid internships in hospitals and learn about new options for their degree. That has been the case for several interns with whom ASHE has worked in the past, according to Adams. “Health care really wasn’t on the horizon until they did an internship,” he says. “Then they fell in love
TOPICS OF INTEREST with the work we do and our mission. It’s resonated with a lot of students.” For Brittany Griner, a Purdue University graduate who recently interned with Advocate Health Care, Downers Grove, Ill., the internship helped her land a job as an assistant manager of plant operations and maintenance in an Illinois hospital. “I wouldn’t be where I am today if it weren’t for ASHE’s sponsoring those internships,” Griner says. “I know that for a fact.” Hospitals also benefit from hosting interns. “Hosting interns is an effective way to recruit highly qualified and talented students who may take on a permanent position at the hospital in the future,” says Stacy Kimbell, health care segment market manager for Schneider. “In addition, interns free up employees’ time to focus on pressing projects, and also lend a fresh perspective from enthusiastic, talented, and technology-savvy young people. These interns are excited to work for an organisation whose mission is to help people heal, while learning real-life skills from an experienced facility manager.”
Certification and education Attracting young people to health care facility management is an important part of succession planning, but it is also critical to help advance the careers of those already working in the field so they are prepared to take on new roles as senior leaders retire. Certifications such as the Certified Healthcare Constructor (CHC) and Certified Healthcare Facility Manager (CHFM) designations are among the ways facility professionals can demonstrate their expertise. The programs have three components: eligibility requirements that blend education and experience, a certification exam and a renewal requirement. Those who have earned the CHC and CHFM designations are considered the elite of the field, and they also tend to earn greater salaries. The 2012 salary survey found that CHFMs earned an average of $10,000 more than other facility management professionals. More information about these programs is available at www.aha.org/certifcenter, and information about preparation classes is available at www.ashe.org/learn.
To advance to more senior positions, such as vice president of facilities, professionals need more than technical expertise and management skills. Communication skills also are vital, according to Adams. “They’re going to need to be able to communicate with organisational leadership at the C-level,” he says. “They need to develop very good communication and business skills to go along with the other skills they may have.” The senior (SASHE) and fellow (FASHE) programs at ASHE help to move members toward improving their communication skills. Both FASHE and SASHE recipients must contribute to the field through published articles, research or presentations. More information about the FASHE and SASHE programs is available at www.ashe.org/about/designations. Finding a mentor also can help. Stephens, FMG/senior specialist at Carolinas HealthCare System, Charlotte, N.C., says that if he had a senior mechanic come to him and say, “Someday I want your job,” he would sit down with him and outline what it takes. Understanding the requirements needed to advance, planning to gain those experiences, and creating a timeline can turn goals into reality.
first step is for facility leaders to work with the human resources department to review job positions and determine whether they make sense. Once job descriptions are accurate and up-to-date, leaders should look at all the positions in their department and consider the hard and soft skills needed for each one. Consider the incumbents currently holding the jobs: What are their goals? How long will they be around? Would they fit well into a larger role? Are there people ready to take their places? “You can look at every position and develop a gap analysis,” Stephens says. “Then you start working out how you are going to fill these positions.” Stephens wrote a detailed article showing how to develop succession plans in the first quarter 2012 edition of Inside ASHE magazine, which is available to members on the ASHE website. Stephens said the best health care organisations do the following when succession planning: • Obtain buy-in from the C-suite; • Look at future health care trends; • Develop a formal succession planning program;
“You have to have a plan,” Stephens says.
• Attract, recruit, retain and mentor the next generation;
Creating a plan
• Develop upward mobility for the best of the best in the organisation.
While the health care facility field works to develop a pipeline of qualified, experienced professionals, hospitals must do the same thing for their own positions. Succession planning is a critical component of facility planning and can make a huge difference when someone retires or leaves. If a hospital has a detailed succession plan, there may be someone in the wings prepared and ready to move into a new role when a position opens. In this case, filling a vacant position could take as little as a week, Stephens says. If a hospital hasn’t done proper succession planning, the process could linger for a year. “I’ve seen positions stay open for a year and the department loses a tremendous amount of continuity and productivity in the meantime,” Stephens says. “Things just stop.” Creating a succession plan involves several departments. Stephens says the
A robust plan By planning for the future, hospitals and health facilities professionals can ensure that the health care physical environment will continue to be a safe, healing one for patients. Creating a robust succession plan keeps a hospital humming even when senior leaders leave. “Every hospital has its own idiosyncrasies, and you want people who understand how that hospital works so you can quickly help when something goes wrong,” Stephens says. Based on the demographics of the field, more and more retirements are on the horizon and succession planning is more important now than ever. Deanna Martin is senior communications specialist for the American Society for Healthcare Engineering. She can be reached at dmartin@aha.org
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TOPICS OF INTEREST
Clear Communications
Using mass communication systems to improve operational efficiencies Claudia Dent I vice president of product management for Everbridge
Mass communication systems are becoming commonplace in most health care organisations across the globe. With their ability to deliver messages across multiple contact paths, the growth of mobile applications and an increasingly connected workforce, employees are utilising these systems, originally intended for emergency notification, to lower costs through increased day-to-day operational efficiencies.
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hether using the system to enhance code-calling and STelevation myocardial infarction (STEMI) alerts, allowing emergency department (ED) charge nurses to quickly and efficiently communicate with their staff to fill open shifts and automate staffing processes, or communicating across multiple facilities in the case of a regional emergency or natural disaster, health care organisations are increasing their use of mass notification systems for critical communications.
Five examples Here are five examples of how these systems have become go-to solutions in improving the daily operational efficiency of leading healthcare organisations: 1. Accelerating code-calls and operational communications. Code calling and STEMI alerts are common ways to communicate critical and time-sensitive information in health care settings. Traditionally communicated through pagers and public address (PA) systems, modern technology has afforded organisations additional and often more efficient ways to broadcast this vital information. When selecting a mass communication system for a health care organisation, it is important to ensure it supports multiple contact pathways, including mobile voice, landline, short message service (SMS), pagers, email, social media and more to ensure the information gets to the desired individuals as quickly as possible.
“We regularly use our mass notification system to quickly communicate colourcoded events and STEMI alerts to all key personnel,” says Kelby Hill, preparedness coordinator at Texas Trauma Service Area. “Additionally, we have found that the multiple contact paths and easy group building capabilities allows us to effectively organise meetings, whether planned or unplanned.” Mass communication can easily increase efficiencies and reduce time and cost required for operational procedures. Whether organising meetings on the fly or communicating the initiation of key operational procedures in minutes, a robust system with two-way communication capabilities can provide increased return on investment on a daily basis. “During a critical power failure in our region, we utilised our mass communication system to quickly gather all key personnel into a single location to mitigate the situation,” says Stephen Monteiro, capacity and emergency management director at Boston Children’s Hospital. “Without a mass communication system we may not have been able to gather all the required employees in an unplanned meeting on short notice. By being able to assemble these people so quickly, we were able to easily disseminate information that lead to the successful management of what could have been a crisis situation.” 2. Quickly filling shifts with qualified staff. Manually staffing in a health care setting can be costly, time-consuming and frustrating.
Provide instant status on employee safety.
Traditionally, staffing operations require the consideration of complicated requirements to dictate which employees may or may not take an open shift. With a robust mass communication system, this entire process can be automated and the employees responsible for staffing operations are able to complete the process quickly and efficiently, saving time and money. “Our system was initially deployed to communicate with our entire employee base in the event of large scale incidents such as severe weather disasters and regional emergencies, we’ve found it is equally useful in our everyday staffing operations,” says Tim Klippert, emergency preparedness manager at University of
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TOPICS OF INTEREST Colorado Health. “Every ED charge nurse on our team is trained on the system, and it can be used on the fly to fill open shifts or positions in critical areas such as ED staffing.” 3. Communicating critical information during emergencies. Emergency notification is often the driving force behind the acquisition of mass communication systems, though this is rapidly shifting as organisations realise the potential operational benefits of these platforms. Still, emergency situations are often one of the most critical uses of mass notification and interactive communication systems. They allow the rapid and efficient broadcast of critical information to key personnel in dangerous situations and crises. During the second wave of the H1N1 influenza crisis, Boston Children’s Hospital was faced with a unique situation that required a rapid and strategically time response for which their mass communication system offered the perfect solution. It was proven that the children who were most at risk of contracting the illness were those who had already been sick or hospitalised. Due to an unexpected prioritisation from the state, Boston Children’s Hospital was suddenly granted a large portion of the available vaccines. “In order to get these vaccines to the people who needed them most, we devised a unique strategy based around mass communication,” says Monteiro. “We ran a filter through our record keeping system that extracted the phone numbers of the parents or guardians of at-risk children without revealing any personal information. We then easily and quickly input that information into our mass communication platform and grouped the contacts into waves. By sending out notifications of the available vaccines at our ‘Just-In-Time’ flu clinic in waves, we not only got the vaccine to the people who needed it most, but we were able to do it in a way that did not overwhelm our staff or capacity for treating these individual.” 4. Reporting and analytics. Modern mass communications systems should come with advanced reporting and analytics features. These features not only allow administrators to review and analyse the success and key areas of improvement for broadcasts, but additionally grant organisations the ability
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This system provides for situational intelligence in a single dashboard by scanning social channels, such as Twitter, to help organisations better respond to an incident.
to report on their communication practices for compliance purposes with local, state and federal regulations. When broadcasting information to employees in a health care organisation, it is often critical to get confirmation that the message has been received and the information has successfully communicated. “Another key item to consider is the idea of accountability,” says Hill. “Through our reporting and analytics capabilities and confirmation of message receipt, we make our employees accountable for their responses. This helps guarantee a response if we are sending a polling notification (i.e., ‘what is your estimated time of arrival?’) and increases our response rate by a very large factor. Additionally, if we ever have a poor result from a broadcast, we can turn to the reporting and analytics feature to determine why.” 5. Monitoring social media activity for situational intelligence. Breaking news today often spreads across social networks before any other traditional communication pathway. It is a significant force in public opinion and the spread of information, and if it is ignored can become a liability to your organisation. The general population now expects real-time news with updates throughout an event. One large hospital experienced an unexpected surge of visitors, crowding emergency rooms and reception areas, complete with local news helicopters hovering the sky. Unfortunately for hospital officials, they had no idea why their hospital had just become so crowded with people who seemed not to need any medical care. This complicated their ability to continue to provide services as expected. If they had been properly monitoring social media and filtering the data, they would
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have seen the rumours circulating that a celebrity was planning to visit the victims of the Aurora, Colo., movie theatre shooting hours in advance and been able to properly prepare for the surge in visitors. Additionally, monitoring social media can give organisations the ability to mitigate and derail any untrue rumours or misinformation that spreads through avenues such as Twitter. “We see great value in being able to monitor social media to ensure that the proper information is being communicated to the public, especially in the incident of an emergency or pandemic of any sort,” says Monteiro. “Additionally it allows us to gauge whether or not our critical and strategic PR efforts are penetrating and getting to the public at large during important incidents.”
An essential platform Compliance requirements, code-calling and even day-to-day staffing needs make mass communication systems an essential communications platform for running a successful health care facility. These systems help organisations instantly communicate with key personnel, mobilise emergency responders, transmit vital staffing information to employees, and communicate with the patient community – all while maintaining detailed reporting compliance. Whether it’s an unforeseen crisis or a need-to-know situation, health care organisations are increasingly adopting these strategic communications platform to make better decisions to protect patients, staff and vital infrastructure. Claudia Dent is vice president of product management for Everbridge, Glendale, Calif. She can be reached at Claudia.dent@everbridge.com
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TOPICS OF INTEREST
Overcoming ‘Technophobia’ Helps the Office Embrace New Solutions Elizabeth Dukes
Facility Management Workplace Technology
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ne main problem that facilities managers face is “technophobia” – in short, reluctance from some people to embrace new computerised solutions they’re not familiar with.
making process will lead not only to a successful outcome but can strengthen the employees’ commitment both to their own job function and to the overall aim and aspirations of the organisation,” Maclachlan writes.
Facilities departments today have countless reasons to introduce new software packages around the office. Doing so can help them optimise their workspace, improve efficiency, track data better and ultimately improve workforce productivity. Unfortunately, though, implementing new facilities management solutions isn’t always easy.
With that in mind, you should set out to defeat technophobia. Here are a few tips that should help.
One main problem that facilities managers face is “technophobia” – in short, reluctance from some people to embrace new computerised solutions they’re not familiar with. When you roll out new software, you’re likely to encounter a wide variety of reactions. Some people will embrace the new way of doing work, but the technophobes will resist it. Your job, though it might be challenging, is to get all of these people to come together. According to FM World, it’s hard to change the minds of the technophobic, but it’s not impossible. Iain Maclachlan, an independent consultant who advises FM companies on implementing new technology, says it must be done. When you roll out a new solution, you need everyone on board. “A well-run project that takes into account all the concerns of the end users and fully engages them in the decision-
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Connect with people early If you want everyone on your team to be on board with your new software solution, you should make sure to engage with people early and often. Be sure to communicate with the team as soon as possible about the software you’re deploying, what it does, and how it will be an improvement over the old system. You should also provide a forum for people to share their questions, comments and concerns. This might take the form of face-to-face meetings, email bulletins or chats via social media. In any event, people need an outlet to discuss any problems they might have with new technology.
Start from the bottom up There are two different ways to unveil a new solution. One is the “top-down push,” where you start with the people who are most eager to accept change, and then let the rollout trickle down from there. The other approach is the opposite – going from the bottom up. The latter will probably work better. This way, you
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tackle the toughest technophobes first, and the rollout becomes easier as you move up the ladder to people who are more and more accepting.
Train people effectively If you want people to accept your new technology, you must train them well to use it. Robert Heverly, assistant director of Albany Law School’s Government Law Centre, told the Albany Business Review, that teaching well is the best solution to people’s reluctance. “Getting employees over their technophobia is essential to remaining competitive in the modern marketplace,” Heverly stated. “Using training, giving employees an opportunity to learn about the new technologies, supporting them in that use, and committing the entire office to the new technology may help employees jump the phobia hurdle and help your office move to the front of the technology-use pack.”
Stay continually engaged Keeping people aware of new technology is not a one-time project. You can’t just introduce a new solution and then walk away – you need to continually engage with people. It should be an ongoing effort to make sure people understand the software, know how to use it and are able to maximise productivity.
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TOPICS OF INTEREST
PAPER FOR VISIONS CONFERENCE 2013 David Randall, B.Sc., B.Eng.(Hons.), DipBus, DipMgt, M.I.E.Aust.,C.P.Eng., C.F.S.I.A., R.S.P.(Aust.), RABQSA Certified Auditor, JP(Qual) I MANAGING DIRECTOR, DRA Safety Specialists Pty Ltd
Topic: Reasonable Practicable – Pre and Post Incident Abstract
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ith the definition of “Reasonably Practicable” defined in Legislation but not yet tested in court, there is still uncertainty in its meaning and application in a defence of a breach of a work health and safety duty. This paper provides a Consultant’s view on the interpretation of “reasonably practicable” and what must be done proactively by organisations to meet their duty of care both pre and post incident.
Introduction The Workplace Health and Safety Act of 1995 imposed an absolute obligation on a person conducting a business or undertaking (PCBU). The PCBU was required to ensure the safety of workers and other persons at their workplace. In short, if an incident occurred and a person was injured, the PCBU could be prosecuted for breaching their obligation. Irrespective of what level of compliance to the legislation occurred with regard to training, work practices, appropriate machine guarding etc., the fact that an incident occurred demonstrated a breach of the absolute obligation. Furthermore this problem was exacerbated by the reverse onus of proof requirement placed upon the PCBU. Although it was rare for organisations who had put robust safety management systems in place to be prosecuted, there were instances where political pressures were applied and companies were prosecuted, in my opinion unfairly. With the advent of Harmonisation, the Safety Profession pushed for a fairer system which resulted
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in the term “reasonably practicable” being included into the general duty of care, refer section 19 WHS Act 2011.
Work Health and Safety Framework The WHS framework includes the Act, Regulation, Codes of Practice and other guidance material. The WHS Act being the policy document passed by Parliament defines the requirements and duties in relation to Work Health and Safety, and penalties for non-compliance. The Regulations generally provide information on the physical requirements to meet the duties of care with regard to hazardous work activities. Both the Act and Regulations are mandatory and have little flexibility other than the interpretation of the wording which may be contested in court cases. Codes of Practice provide practical guidance, and allow a PCBU flexibility in its application, however, where a Code of Practice applies to a PCBU, then they must be able to demonstrate that they have either met the Code or achieved a safety standard equivalent to that expressed in the Code. The Code of Practice can be used as evidence in proceedings for breaches of WHS duties. Unfortunately, there are many persons telling PCBUs that they must complete certain activities to comply with the WHS Act 2011, when in fact the requirement may only be a “should”. For example, First Aid suppliers have consistently told PCBUs that they must have First Aid kits
THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
in their workplace that have a minimum set of contents, when in actual fact the Regulation only requires that First Aid facilities be readily available. It is up to the PCBU through a risk assessment to determine the First Aid facilities suitable for the types of injuries that may occur within their business. In an office environment, this may only require a box of bandaids and a cold pack rather than a very expensive First Aid kit which contents expire and are never used. This is the start of the application of “reasonably practicable”.
Risk Management Risk Management is the cornerstone of the Work Health and Safety Legislation. Safety professionals are working tirelessly pre-event to identify organisational failures that may result in a release of energy which causes an undesirable outcome such as a near hit incident, serious injury or property damage. The legal profession, on the other hand, generally will react after an incident has occurred where organisational failures may present themselves through a detailed incident investigation. The question that is then asked is, “Was the risk reasonably foreseeable to the PCBU at the time of the incident? This is a further application of the definition of “reasonably practicable”. The definition of “reasonably practicable” as defined in the WHS Act 2011, s 18 is stated as follows: Means, was reasonably able to be done in relation to ensuring health and safety,
TOPICS OF INTEREST taking into account and weighing up all relevant matters; • Likelihood of the hazard or risk; • Degree of harm that might result from the hazard or risk; • What the person concerned knows or ought to know about the hazard or risk, and ways to eliminate or minimise risk; • Availability and suitability of ways to eliminate or minimise risk. • After assessing the above, the cost associated with ways of eliminating or minimising the risk and whether the cost is grossly disproportionate to the risk.
Risk Assessment When looking at the definition of reasonably practicable, it is obvious that when examining the first two elements of likelihood and degree of harm, that this is fundamentally a risk assessment of the situation. When applying these two matters pre-incident, if the likelihood of the incident occurring is low and the most probable outcome of the incident is minor, then the risk will be low and it may be the decision of the PCBU to take no further action to mitigate that risk. Post-event, the legal profession will then analyse that risk assessment and challenge the determination of likelihood given the event occurred. The harm that may have resulted from the incident may have been more severe than that predicted, and it is up to the PCBU to then explain their prediction based on their experience. The error often made in these risk assessments is that the outcome of the incident is categorised as the degree of harm, when in actual fact, it may be an aberration and not the most probable outcome. For example, when a person trips over in the workplace, the most probable outcome if the person regains balance is no harm caused. If however, they trip and break their arm, the legal profession is quick to state that a serious injury was the most likely outcome because this is the event that happened.
Foreseeability The third matter in the definition of “reasonably practicable” looks at what a person concerned knows or ought to know about the hazard. This
in effect is asking whether or not the risk is foreseeable. Companies must have excellent industry networks and safety alert systems which will direct their attention to any incidents that may occur within their business. Where incidents within their business or other like industries occur, then they may be considered foreseeable and should they occur again, the defence of “reasonably practicable” may fall over. My concern as a Consultant is that the legal profession may after the event conduct a Google search using key parameters of the incident to identify that something similar has occurred somewhere else in the world. Will the courts determine that an incident that occurred ten years ago in some far away country that was found using a Google search was reasonably foreseeable. If this judgement occurs, a new industry will be created within businesses for individuals to search the world wide web for potential incidents that could occur within a business so that proactive measures can be undertaken. Let’s hope that this is not the case and reasonably foreseeable is limited to our industry groups within Australia.
Cost
Controls
There is good case law now evolving from our high courts regarding what is “reasonably practicable” and I would recommend that cases such as Baiada Poultry Pty Ltd - v - The Queen be reviewed.
The fourth relevant matter considers the availability and suitability of ways to eliminate or minimise the risk. In many cases, hazards that exist with equipment may not have suitable engineering controls yet designed to manage the risk. For example, a student in a Home Economics class at a school sews his finger whilst not paying attention when using a sewing machine. Although the risk assessment may indicate that this is a low to moderate risk and it is foreseeable, there is no guarding system yet designed that will differentiate the human finger from a piece of material when it passes through the needle. The control is administrative in that the student is trained, assessed as competent and then is required to exercise due attention when using the equipment. Given that there is no current safe guard that would prevent this incident, a PCBU may rely on the defence that it was not “reasonably practicable” to guard the equipment as the technology to prevent the injury is not commercially available.
The last matter in the definition of “reasonably practicable” looks at whether the cost is grossly disproportionate to the risk. For large organisations with multi-million dollar turnovers, the legal profession will undoubtedly state that there will be no defence on cost, however, as a Safety Professional I would have to disagree. If a risk is assessed as low or event moderate based on good statistical data and history then it may not be worth spending a disproportionate amount of funding on further mitigating that risk when other greater risks within the organisation exist. The old argument of “if it saves one life” should be put aside as good practitioners of risk management will clearly state that every decision made must be made with balance i.e. balancing safety with environment with quality, economics, publicity etc. In simple terminology, there is risk in everything we do, and spending millions of dollars to reduce all risk may make us unviable as a country in a competitive world market.
Case Law
Conclusion Safety Professionals in industry require to have a comprehensive understanding of the definition of “reasonably practicable” when advising their clients or employer on whether or not to spend further resources in mitigating existing risk within their business. The test of the definition of “reasonably practicable” will occur in our courts where safety professionals with experience in risk management will go up against the legal profession who will be working with the advantage of hindsight. Prediction is always more difficult than reviewing the past and hence the safety professional’s challenge is to ensure that their decisions are based on the best available facts presented to them at the time and are presented in a well documented format.
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TOPICS OF INTEREST
Preventive Care for the Planet
Climate change is bad for your health (and your community’s). You can do something about it.
David Ollier Weber
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n Saturday afternoon, Aug. 10, 2013, a small fire was reported on the middle fork of the American River, deep in Tahoe National Forest near Foresthill, Calif. By Monday it had grown to 800 acres. A brilliant plume of white smoke billowed like a giant thunderhead against the limpid blue sky to the northeast of our farmhouse, 30 miles away. On Tuesday, my wife and I awoke to the throat-rasping pungency that is a familiar reminder of summer jeopardy to those of us living on the W side of the WUI – the “wildland-urban interface.” The early morning light had an ominous orange cast; the hills to our west were invisible, cloaked in a low-hanging haze so thick you could almost feel the ash collecting in your lungs. In the weeks that followed, the growing American Fire, as it was called, consumed more than 27,000 acres – 43 square miles – of mixed conifers. At its peak, 1,500 firefighters aided by helicopters and aerial tankers battled to create containment lines. Pockets are still smouldering as I write in October. Meanwhile, sparked only a week later by a carelessly tended campfire, the giant Rim Fire burst out of control at the edge of Yosemite National Park, 100 miles to our south. It raged across 400 square miles of ridges and canyons, and for most of a month – depending on which way
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the wind blew – we inhaled the charred residue of one or the other of two blazing national forests. Only a couple of summers earlier, the choking pall over California from a widespread complex of lightning-struck wildland fires had become so oppressive that my wife and I – tired of stinging eyes and raw craws – suddenly packed up and fled, on the excuse of visiting our son in Flagstaff, Ariz. Driving along the eastern slope of the Sierra, we could barely make out Mono Lake through the eerie, acrid haze that lingered far into Nevada. We were approaching Las Vegas before we could see a sharp horizon.
Up in Smoke Fire has always been an essential element in the ecology of the West. But in the mid-1980s, a tipping point was crossed, and wildland fires have mushroomed in frequency, intensity and duration. Between 1986 and 2003, according to a research paper by scientists at the Scripps Institution of Oceanography in San Diego; the University of California, Merced; the U.S Geological Survey; and the Laboratory of Tree-Ring Research at the University of Arizona, Tucson, a climate cycle of reduced winter precipitation, hotter springs and summers,
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earlier snow melt and drier (increasingly diseased) vegetation has been directly responsible for adding 78 days to the historic Western wildfire season. By the end of that 17-year period, four times as many major conflagrations were breaking out every year, and the total area blackened each season was six and a half times larger. The forestland of the American West is an enormous carbon sponge; it sops up as much as 40 percent of the nation’s output of the principal greenhouse gas-trapping terrestrial heat, carbon dioxide. But if wildfire trends continue, the scientists warned, “the forests of the western United States may become a source of increased atmospheric carbon dioxide rather than a sink, even under a relatively modest temperature-increase scenario.” Which, in fact, looks like about the best scenario we can hope for. “Warming of the climate system is unequivocal,” the Intergovernmental Panel on Climate Change declared in its recently released 2013 report, “and since the 1950s, many of the observed changes are unprecedented over decades to millennia. The atmosphere and ocean have warmed, the amounts of snow and ice have diminished, sea level has risen, and the
TOPICS OF INTEREST concentrations of greenhouse gases have increased”. “Global surface temperature change for the end of the 21st century is likely to exceed 1.5°C [almost 3°F] relative to 1850 to 1900,” the IPCC concluded. “Warming will continue beyond 2100 [and] it is virtually certain that there will be more frequent hot and fewer cold temperature extremes over most land areas on daily and seasonal timescales as global mean temperatures increase. It is very likely that heat waves will occur with a higher frequency and duration. Occasional cold winter extremes will continue to occur.”
Implications for Human Health Fires are deadly. Four of my former neighbours’ were among 25 people killed and 150 injured as they fled a wildland-urban firestorm in the Berkeley hills in 1991. It wiped out 4,000 dwellings, including the one I’d lived in and helped save from a previous fire as a volunteer on a hose line. Nineteen elite young firefighters died in a massive Arizona blaze earlier this year. Air tankers crash, engines and bulldozers tumble over smoke-shrouded precipices, chainsaws gouge human as well as arboreal limbs. And then there’s the civilian toll. Smoke inhalation, burns, evacuation, fear, stress, loss, homelessness – these are adverse side effects of natural disasters with obvious negative implications for a community’s well-being. Fires denude hillsides. When the rains come – increasingly in deluges predictable in association with climate change – runoff water sluices into creeks and riverbeds along with soil that would have been retained by the lost vegetation. Almost 12,000 people were evacuated from flood and mudslide-ravaged communities along a 200-mile swath of Colorado’s Front Range in September, when almost half a year’s normal rainfall descended in just 15 hours. Smoke from wildland fires, dust blowing off parched ground, ozone accumulations in simmering cities, and pollen from
weeds and grasses exacerbate asthma and respiratory diseases. The very young and the very old are most at risk when air quality is degraded, but athletes, too, are considered highly vulnerable and warned to stop jogging outside and practice lightly inside on days when smoke from California forest fires hangs thickly over the Central Valley. Fifty million Americans suffer from allergic symptoms that can be triggered by air pollution: conjunctivitis, hives, eczema, dermatitis... Smoke from wildland fires may be laced with urushiol, the toxic ingredient in poison oak. That’s another scourge, along with its eastern cousin’s ivy and sumac, proliferating and becoming more potent as the climate warms. Some 350,000 cases of toxicodendrondermatitis are reported to doctors nationwide each year, and plant scientists expect the toll to rise. Oh, and critters that bite and sting: They, too, are flourishing and moving into new habitats as the world simmers. Reptile and spider venom can kill. Nips from insects can transmit diseases like flea-borne pulmonary Hantavirus and tick-borne Lyme disease, or trigger anaphylactic shock in sensitive individuals. Mosquitoes once unknown in temperate climates have found comfortable niches in the United States, bringing diseases that used to be confined to the tropics – West Nile viral encephalitis, yellow fever, dengue fever, for example – to North Americans.
Gloom and Doom A wildland fire is just one type of natural disaster whose occurrence fits into a pattern consistent with planetary warming. (Note the huge fires that have scorched rural France, Greece, Russia and Australia in the past few years.) Natural cataclysms have always been with us; none can be said to have been “caused” by climate change – it takes a spark, whether from a match or lightning, to ignite a forest, after all. But the environment is primed for such events by climatic conditions. Hurricanes, tornadoes, floods and earthquakes threaten far more widespread devastation as the world’s
thermometer climbs. Rising sea levels give storm-driven ocean surges and tsunamis ever-greater destructive power. When floodwaters recede, survivors may be injured by debris or sickened by mold, contaminated drinking water supplies or food crops tainted by overflowing sewage systems. Heat waves will get hotter and longer, especially in cities. Dehydration and heat stroke, the most common causes of weather-related morbidity and mortality, are forecast to take up to seven times as many lives in Los Angeles at the end of the century as they do today. Meanwhile, physicians along the northern tier can anticipate more heart attacks, injuries from falls, and frozen extremities as cold snaps worsen snow and ice storms. In the U.S. heartland, aquifers are being drained. Drought is reducing food production. Demographics are changing as young people move to urban areas – the population of 80 percent of the counties in the Great Plains is older than the national average. So, yes, climate change poses a host of tangible threats to human health – leaving aside the likelihood of mass migrations and wars as islands are engulfed, coasts erode, deserts spread and nations vie for possession of natural resources. Not a comforting picture. What are we going to do about it?
The Precautionary Principle Unfortunately, politically, the answer would appear to be, “Not much.” Our elected representatives worldwide cavil, deny, procrastinate and plead the economic hardship of accommodation... while mining, drilling, refining and burning of hydrocarbons continue apace – even though, the IPCC warns, “most aspects of [today’s] climate change will persist for many centuries.” Health care providers answer to a higher call. “Given that healthcare is underpinned by an ethical imperative to ‘first, do no
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TOPICS OF INTEREST harm,’” write Gary Cohen and Jeffrey Thompson in a recent Skoll World Forum/Forbes editorial (they are, respectively, the founder and president of the international organisation Health Care Without Harm, and the CEO of Wisconsin’s Gundersen Health System), “it has a responsibility to reduce all of its pollution and lead our society toward renewable energy, energy-efficient products, local and sustainable food systems, safer chemicals and other mitigation efforts that support healthier people in healthier communities.” The health care industry is remarkably energy-intensive. University of Chicago researchers determined in 2009 that the constellation of hospitals and clinics, medical research labs and drug/device manufacturers and distributors nationwide accounts for some 8 percent of U.S. carbon dioxide emissions. That makes health care equivalent in climate-change impact to agriculture. Thus, argue Cohen and Thompson, health care organisations have an ethical duty to reduce their damaging carbon footprint. And the beauty is that energy conservation is massively cost-effective: You get a clear conscience and a better bottom line. Cogeneration, for example, can shave 35 percent off the huge heating, ventilation and air conditioning, lighting and hot water bills that make a hospital almost three times as expensive to operate as an office building of the same dimensions, they note. Gundersen Health System is saving $1.3 million annually through energy conservation at its six hospitals, 27 regional medical clinics, four nursing homes and other facilities in three states. Maine’s York Hospital reports $100,000 in savings each year for the past decade through reliance on renewable sources for 90 percent of its energy needs. Kaiser Permanente is installing solar panels at many of its 648 hospitals and medical clinics throughout the country and purchasing wind energy with a goal of reducing emissions 30 percent by 2020. Kaiser even has appointed an environmental stewardship officer to
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oversee organisational adaptations to climate change.
Future-Proofing Littler things can mean a lot, too. For instance, planting a healing garden on a hospital roof not only reduces the facility’s heat-island effect, it soaks up atmospheric carbon dioxide – while helping patients to recover faster. Hospitals are often the biggest employer in a community; they can set an example and contribute to cleaner air by offering incentives to staff to walk, bicycle or ride public transportation to and from work. Even more basic than helping to slow climate change through responsible energy stewardship is assuring that hospitals survive to succor the sick and wounded when disasters spawned by planetary warming recur. The vulnerability of poorly designed, older facilities was manifest when Hurricane Katrina took out all but one of New Orleans’ 11 hospitals in 2005. Hurricane Sandy ousted patients and wrecked three key New York hospitals seven years later. A deadly tornado gutted a nine-story regional medical centre in Joplin, Mo., in 2011, killing a visitor and five critically ill patients whose ventilators failed because of a faulty emergency generator. “Hospitals should be the last buildings standing,” maintain Cohen and Thompson, “rather than some of the first to go down.” Spaulding Rehabilitation Hospital, they note – a new 132-bed teaching institution in Boston – was designed with such “future-proofing” features as rooftop electrical equipment, a raised ground floor and a landscaped protective “reef” in case of flooding. Windows are triple-glazed and can be opened manually in case of an air conditioning breakdown. These “climateproofing” measures added all of one-half of 1 percent to the total building costs, Spaulding reports. What’s more, say Cohen and Thompson, health care organisations and the 5 million doctors, nurses, technicians, researchers and administrative support staff they employ ought to become a forceful chorus in support of “a global campaign to kick people’s addictions to fossil fuels and toxic chemicals. They can
THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
become climate champions... and critical spokespeople at the local, state, national and global levels for actions, laws and treaties to rein in climate change.” Smokey Bear, the U.S. Forest Service cartoon mascot, will turn 70 next year. Both the terminology in his famous admonition – “Only you can prevent forest fires” (it’s now “wildfires”) – and the message (periodic fires are now acknowledged to be necessary to the health of a forest) have been muted. He’s in semi retirement. Maybe this is the time for his grown cubs – the one who became a doctor, the one who became a nurse – to step forward, point a finger and growl, “What are you doing to prevent climate catastrophe?” David Ollier Weber is a principal of the Kila Springs Group in Placerville, Calif., and a regular contributor to H&HN Daily.
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M
alone Hospital Services is an Australian owned Quality Accredited company which has been involved in the healthcare industry since 1993 with Phil Malone (Managing Director), who was involved in the early inception and manufacture of thermal disinfecting equipment, having over 40 years industry experience. Malones prides itself on the attention it offers to its customers and its employees, this is evident in employee servicing ranging from 10 years to Grant Brooks (Manager) with over 25 years in the industry. What Malones offer their clients is unparalleled professionalism with their service, knowledge of cleaning and thermal disinfection requirements and ability to tailor equipment to specific needs. Malones have been at the forefront of changes in the industry and continue to evolve to support the health systems ever changing needs.
KEN HYGIENE SYSTEMS Our partnership with KEN Hygiene Systems who have established themselves as world leaders in the area of washing and disinfection is now over 10 years.
KEN bedpan washer disinfectors are machines designed for non critical patient care equipment not involved in medical procedures. These machines have been clinically designed to comprehensively clean and disinfect, thereby destroying all pathogenic bacteria in accordance with AS4187.
Malones can tailor a preventative maintenance proposal to suit the customers’ needs. Preventative maintenance ensures that the equipment is serviced to the manufacturer’s recommendations, ensures that problems with operation can be identified and resolved early.
KEN A/S is an innovative company with over 60 years of experience within the development, production, sales and servicing of disinfecting washers, bedpan washers, trolley washers and laboratory washers as well as dishwashers for industrial kitchens and washers for the food industry. We offer a wide range of standard solutions and can also provide special solutions to meet individual requirements.
To complement preventative maintenance, Malones also provide same day breakdown service, after hours service and technical phone support.
SERVICE As Malones is a service company who sells equipment we deliver a level of service in line with what our customers expect. We believe the only thing better than good service is “great service”. We provide specialised service with cleaning and thermal disinfecting equipment as well as drying cabinets and warming cabinets.
EQUIPMENT • Various ranges of equipment to suit all requirements. • Fully programmable, meaning each cycle can be tailor made to suit individual facility. • Complies with all Australian Standards and ISO:15883-3. • Netcom available for remote monitoring of cycle information and fault history. • Major savings in energy and water consumptions. • Pass through options available for isolation areas. • Automatic door operation for easy use. • Space saving with wall mounted options. • Double temperature sensors for optimum control.
Malone Hospital Services Pty. Limited PROUD PARTNERS WITH KEN HYGIENE SYSTEMS WORLD LEADERS IN THE SUPPLY OF EQUIPMENT FOR WASHING AND THERMAL DISINFECTION KEN 736
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For full range of equipment go to www.malones.com.au HEAD OFFICE 24 TATHRA ST WEST GOSFORD NSW 2250 PH: 0243 239731 FAX: 0243 239001
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TOPICS OF INTEREST
Global Vision
Design teams learn valuable lessons from foreign hospital projects Amy Eagle
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raig Beale, FAIA, FACHA, FACHE, LEED AP, executive vice president and director of health care at architecture firm HKS Inc., Dallas, travels overseas so frequently he has had to insert extra pages into his passport. Twice. “U.S. companies are going where the work is,” says Jason Schroer, AIA, ACHA, LEED AP, associate principal, senior vice president and senior designer, HKS. Increasingly, that means going abroad. Emerging markets and a desire for U.S. health care design expertise have created a thriving international industry for U.S.based health care architects. Working outside the U.S. system is “a synergistic learning experience,” says Jean Mah, FAIA, FACHA, LEED AP, health care global practice leader, Perkins+Will, Los Angeles office. “There’s always room to learn from other places. It’s not a oneway street. We can actually do great work if we collaborate with each other.”
Teamwork required International projects involve a great deal of collaboration. U.S. firms generally partner with local firms that understand local regulatory processes and construction methodologies, which “vary, and sometimes vary dramatically, from country to country,” according to Donald R. DeBord Jr., AIA, NCARB, senior vice president, RTKL Associates Inc., Baltimore.
presented by the international health care market. Singapore-based Parkway Pantai Ltd., for example, reports it has 18 hospitals located in the Middle East, India and Asia. Some major U.S.-based health systems, including Partners HealthCare, Boston, and Cleveland Clinic, have branched out overseas. As a result of the number of stakeholders involved, multinational project teams can be complex. The Royal Children’s Hospital, Victoria, Australia, was delivered by a P3 team that included three architecture firms — Billard Leece and Bates Smart, both from Australia, and HKS from the United States — plus a contractor, a facilities management firm and a funds and asset management company. HKS is working on a commission that involves an agreement between Trinidad and Tobago and is being funded and built by a Chinese firm. “We actually took a trip to Shanghai for a project that’s in Trinidad,” Schroer says. Overseas projects require spending substantial time in person in country. In addition, multinational teams can become adept at using technology to enhance project delivery. Bill Roger, AIA, ACHA, senior vice president and director of
health care, HOK, San Francisco office, says two of his firm’s recent hospital projects in Singapore, Mount Elizabeth Novena Hospital and Ng Teng Fong General Hospital, “were a training ground for learning to do it efficiently and, to some degree, remotely.” For these projects, HOK’s Singapore office was outfitted with high-definition video-conferencing equipment that allowed team members an ocean apart to interact, share graphics and modify drawings. The efficiency of this process went beyond saving jet fuel, Roger says; it saved time, too. “I think there’s a possibility for that here,” he adds. “We need to work with the building community as well as the client community to say, ‘What’s the best way to move this bus along?’ It’s possible to be more efficient in terms of how we organise ourselves and do the project. We’re finding in the United States that our clients are saying, ‘We need to be efficient about how we deliver.”Efficient” processes can produce cost savings that can be invested in improving hospital buildings, systems and the overall patient experience, says Roger.
Government-based projects may be delivered through public-private partnerships (also known as P3s), which entail public funding for private facilities, often with a long-term lease back to the government. Privately held hospitals may involve developers and operators who have embarked on projects in several countries, in recognition of the opportunity
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TOPICS OF INTEREST Reimbursement and cost issues Health systems differ around the world, but efficiency and cost are universal issues. “Every country is different in specific ways of how [health care] is reimbursed, how it’s delivered and how the medical practices affiliate and connect with each other,” notes DeBord. Working in a variety of national systems teaches American architects how these differences impact design and project delivery. With public or P3 projects, “there’s almost a myth that cost is not an issue because it’s paid for by the government or some entity that is working for the government – which is false, because economy is everything in those systems as well. They still have to balance their books. They still need to produce efficient facilities,” says Beau Herr, RIBA, vice president, RTKL. Some public projects, particularly those in the developing world, lack reliable population data or a business case for planners and architects to use in establishing, for example, the number of inpatient beds needed at a facility, Schroer says. This has heightened his appreciation of how the business side of the health care industry affects design decisions, he adds. “As architects and designers, we’re not always really that interested in the business side. We just want to get a general understanding, jump in and start designing a beautiful project. But, I think what I’ve learned is that the business side is part of the context of how you need to approach your design work, and not to take it for granted.”
At the other extreme are projects with specific, unbending requirements. In some cases, by the time a project is approved by a country’s ministry of health and reaches the competition stage for architects, “there’s no latitude for innovation to be inserted into the process,” says Herr. “It’s much harder to integrate an innovative, new operational methodology in a very prescriptive model,” DeBord says. For example, in certain regions, such as Asia and South America, reimbursement is bed-based, making it unlikely in the near future that a 500bed hospital will be replaced with anything less than a 500-bed hospital, he explains. “It’s made us rethink the best way to bring our knowledge and experience to benefit these design processes.” All providers want to offer their patients the best medical technology, but budget constraints do not always allow for this, says Schroer. International projects may include the installation of used equipment or equipment built by non-mainstream vendors. “We find it to be a little more challenging to coordinate in those instances, because those companies don’t tend to have the same design support mechanisms that we’re used to,” he says. The design team may need to conduct additional research to determine the infrastructure requirements of older or atypical equipment. Other projects are on par, technologically, with U.S. facilities, and some have surpassed the United States, especially in regard to the use of electronic health records. “In Korea and Japan and Taiwan there’s a much more
sophisticated medical records system, which ties everything together. These are truly paperless hospitals,” says Herr. “That’s something we can learn an awful lot from.”
Cultural impact Understanding the daily lives of the people who will be using a facility is particularly important in health care, because “you typically don’t come to a hospital for just 30 minutes. You’re going to be there for a day, or days on end,” says Scott Rawlings, AIA, FACHA, LEED AP, vice president, RTKL. “Working globally is always a challenge, [because] if you really don’t understand the culture all the way to the core, then you’re going to have a hard time doing a really good building.” Cultural differences affect designs in many ways. “In Toronto, where we’re working on some P3, they deal with a culture base that I would say is much more diverse than what we see in the United States. They’re dealing with 15 languages,” says DeBord. “In some cultures, the fact that you can’t open a window is a bad thing. So we have to figure out ways to allow them to have that natural ventilation,” keeping in mind the impact on infection control, says Schroer. “In most cases, we recommend that the windows are fixed in isolation rooms and protective environment rooms,” he explains. In typical patient rooms, sensors attached to the windows detect when they are open and shut off the air to the room. “That is certainly something that we’re bringing back to the United States — to try to do more natural ventilation where we can in our health care facilities,” says Mah. Perkins+Will’s design for the new Spaulding Rehabilitation Hospital in Boston features operable windows. In South America, patient rooms generally need to include space for large families. “You have to take into consideration that it’s not going to be one person around a patient’s bed, it’s going to be a dozen,” says Herr. Semiprivate rooms and patient wards are common in some countries. “We’re still seeing many multibed configurations,”
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TOPICS OF INTEREST says Mah. “They can be semiprivate or four-bed wards, six-bed wards, eight-bed wards,” depending on local norms and the hospital’s staffing and operations budget. While working on Mount Elizabeth Novena Hospital, HOK architects learned of a local superstition against pushing someone across a threshold feet first; patient rooms were designed to allow beds to be moved into the room headfirst, then turned into position on the headwall. Because fresh food is culturally important, each floor of the facility has its own small kitchen, instead of simply a nutrition room, to supplement the hospital’s main kitchen. Mount Elizabeth Novena features four different patient room designs, ranging from a Class A room, a basic private room for $373 a night, to a regal suite that runs $8,440 a night. A separate,
private driveway, entrance and elevator are provided for VIP patients. “If the Sultan of Brunei shows up, he’s not going to go in the front door,” Roger notes. In several parts of the world, high design and high-end amenities are used to establish health care brands and draw patients from a larger region. “They are looking to attract business from surrounding countries,” Rawlings explains. Different cultures express themselves differently in terms of aesthetics. “In some places, more decoration or more colour, more texture, more patterning is preferred,” says Mah. “We’re trying to incorporate those elements and motifs that are indigenous, but also to incorporate them in a way that’s timeless and modern.” She adds that the visual elements of a culture extend to spatial qualities like scale, proportion and how people
interact in large and small groups or public and private spaces. Perkins+Will’s design of Kenya Women and Children’s Wellness Centre in Nairobi features outdoor courtyards, for example. “That’s part of the culture, to have a common gathering space, so these areas are very much needed,” Mah says. “Doing work internationally certainly changes your perspective on the cultural aspects of design in general,” says Schroer. “As architects, we take pride in designing contextually. And when you have a radical difference, it heightens your sensitivity to that.” As a result, stateside facility designs become less “anywhere USA,” and more reflective of and responsive to the unique needs and characteristics of a community, he says.
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Traditional pre-coatings still showing traces of the original epoxy
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THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
Coil after 5 years of Blygold treatment
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TOPICS OF INTEREST
Cooling Water Systems Corrosion Monitoring Audits Steve Powell I Victoria/South Australia Account Manager, Independent Monitoring Consultants (IMC)
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aintaining a constant satisfactory balance between microbiological control (especially Legionella) and metal wastage by corrosion in cooling water systems is not an art – it is cold-blooded science, with possible dire consequences if control of the balance is lost even for relatively short periods. The two processes are interactive – for example, some biocides are aggressive to metals commonly found in cooling systems – and corrosion product is a Legionella food source. On the other hand, and apart from Legionella control, Microbiologically Induced Corrosion (MIC) is to be avoided.
Small organisms found inside a tubercle. Each is about 0.13 cm high. The organisms have segmented, fibrous stalks and bivariate heads.
Measuring the absolute values and assessing the trends of corrosion is not just a valuable tool in assessing the overall performance of a chemical supplier – nor is it just another Key Performance Indicator (KPI); it is a Critical Management Strategy (CMS) for assessing the average life expectancy of cooling water systems whilst being proactive with equipment performance and, at the same time, providing a biologically safe working environment and surrounds.
Corrosion and corrosion product deposition profoundly affects equipment performance – especially heat transfer efficiency. Given that the relationship between the heat transferred (Q) through a chiller tube for example is the product of the Coefficient of Heat Transfer (U), the Heat Transfer Area (A) and the Temperature Difference (∆T) across the heat transfer surface (Q = UA∆T) the only variable is U. Add a layer of corrosion product to the bare chiller tube wall and heat transfer efficiency suffers.
Real Time Corrosion Measurement The linear polarisation-resistance (LPR) technique utilises electrode behaviour to rapidly indicate corrosion upsets. The most usual type has two electrodes – one being mild steel (anode), the other a copper based alloy (the cathode) between which is passed a very small voltage of 20mV. The resulting current generated from this applied potential difference gives a measure of the general corrosion rate in the vicinity of the electrode.
Retrospective Corrosion Measurement
Tubercles are mounds of corrosion product and deposit that cap localised regions of metal loss.
This picture shows perforation at a dish-shaped depression – a large tubercle capped the depression but was dislodged during tube sectioning. (Courtesy of National Association of Corrosion Engineers)
Practical corrosion monitoring techniques are classified as either real-time measurement or retrospective over time, and each category offers pros and cons of cost verses expense, ease or otherwise of installation and maintenance of monitoring equipment – and relevance of data. Either way, the objective is to avoid un-necessary cooling system plant internal inspections. Rather, practical monitoring “flags” a developing problem long before pipe wall perforation, allowing an audit to be conducted and corrective action to be taken.
Coupon corrosion studies are inexpensive and simple to perform. This is the most direct method, aside from inspection of the actual plant equipment, to determine the efficacy of the water treatment chemical program. Coupon evaluation allows simple comparison between different alloys which provide visual examination for localised attack, such as pitting, crevice attack, dealloying, or any other form of non-uniform attack, such as MIC. Pre-weighed and surface prepared coupons are highly susceptible to corrosion. A corrosion coupon is not a heat transfer surface; cleaning the coupon to make it more susceptible to corrosion helps compensate for the fact that it is not a heat transfer surface operating at elevated skin temperatures. Exposing the corrosion coupon to a
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TOPICS OF INTEREST cooling water stream for a known length of time for usually 90 days, and by then calculating the difference between the initial and final weight it is possible to express average corrosion rate per year for that system. The time of exposure for corrosion coupons in cooling water must be considered in the evaluation of any results. In summary, the shorter the period of exposure, the higher the corrosion rate will be.
which reflect high corrosion rates in a corrosion free system are being subjected to too severe a condition assuming that the coupon environment is representative of the heat exchanger design parameters of flow and temperature.
Typical Corrosion coupon rig
rig flow rates correspond to the heat exchanger flow rates. Coupon rig exit flows that are high will usually result in cleaner coupons than the system metals. Excessive corrosion and fouling may result from low flow rates.
Mild Steel (top) and Copper (bottom) coupons ready to be cleaned and evaluated.
The rate of corrosion represents an average metal penetration based on total weight loss and assumes 100% general attack. In many cases the type of attack or appearance of the coupon can provide more useful information than the actual corrosion rate obtained by weight loss. Even if the calculated average corrosion rate is low and all the attack is localised at one point on the coupon, the rate of penetration at that point could be 4 to 5 times the average rate of corrosion. Heavy deposits and tuberculation are sure signs of unstable corrosive water, regardless of the corrosion rates. Furthermore, coupons covered with heavy deposits cannot reflect system corrosion rates, due to the deposit covering the coupon. Some types of deposits will cause an increase in corrosion while other types will form a protective coating. For a corrosion coupon to provide useful data, it must be placed in a representative location in the system. Generally the best place is on the effluent stream of a critical heat exchanger (critical with respect to corrosion). Corrosion coupons installed on a common return line seldom are representative of critical system heat. It is important that the corrosion coupon
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Locating the corrosion coupon rack in the cooling tower pond recirculating loop mans that the coldest water in the system is flowing over the coupons – this is not duplicating the “worst case” scenario taking place in the hottest part of the system. As a general rule, each 8oC increase in temperature doubles the rate of chemical reaction.
Acceptable corrosion levels for mild steel should be less than 3mil and copper less than 0.5mil per year. Typical limits are mild steel 0.15mm, stainless steel 0.005mm (no pitting) and copper 0.005mm per year. (Imperial unit “mil”, one thousandth of an inch (1mil = 0.0254mm) The ability to successfully control water quality in cooling towers depends on the monitoring and analysis of the system on a continuous basis.
The Auditing Process The auditing process precedes corrective action and involves identifying the type and location of unacceptable metal loss and assessing the influence of all contributing variables, including: • system operational information • system metallurgy • best estimates of mild steel and copper surface areas in contact with system water • plant history • biological loading • corrosivity of make-up and system water
As a general rule, each 8oC increase in temperature doubles the rate of chemical reaction.
A flow rate which is representative of system conditions is the only flow rate which will provide meaningful information. Corrosion coupons are a useful and meaningful evaluation tools which, when used on an ongoing basis and in combination with plant and equipment inspections will provide invaluable information on the chemical treatment programme and the level of protection that it offers. Coupons that indicate acceptable corrosion rates in a system which is experiencing severe corrosion are not properly installed or subjected to severe enough conditions. Coupons
THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
• seasonal variations in make-up water analyses • system water soluble and total corrosion products content • the lead-lag duty cycles if more than one cooling tower system is involved • the calibre of water treatment provider service reports • a review of any mechanical significant mechanical services performed, including tower cleans • a review of biological sampling results • a review of the chemical programs and control ranges • a review of dosing and control equipment • validation of any questionable data such as pH, free available halogen, cycles
INDEPENDENT MONITORING CONSULTANTS – AUSTRALIA
INDEPENDENT MONITORING CONSULTANTS Head Office: 23–25 Daking Street North Parramatta NSW 2151 1300 131 405 (02) 9890 5067 New South Wales/ACT: Ian Hartup 0411 109 353 Queensland/NT: David Curry 0408 368 921 Victoria/South Australia: Steve Powell 0431 503 194 THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
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TOPICS OF INTEREST • a review of the current and preceding Risk Management Plan and Audit The auditing process should be a co-operative effort involving the key stakeholders – facility management, the water treatment provider, mechanical services – and the auditors. Generally, observations and recommendations indicate dynamic data is necessary and that involves: • Installation and removal of corrosion coupons monthly for three consecutive months • System water analyses monthly • A review of identified critical factors and changes to the same (controller settings, inhibitor level maintenance, pH etc) • Monthly reporting Modern technology allows us the opportunity to see the inadequacies in past control methods and understand and realise what is really important in maintaining a successful water treatment programme. What we now consider as the most important tools are reliable control, data recording of information and alarms to ensure benchmarks are maintained and confirmation that systems are treated proactively through a uniformed analysis of past performances.
The selection and implementation of the correct control equipment with effective and professional management is pivotal to success. Characteristics of such equipment should include: • Linear Polarisation corrosion of two metal monitoring, logs and alarms • Automated velocity control to set point • Conductivity measure and automated bleed control • ORP measure using APL control, with time control if required • pH measure using APL control • Secondary biocide with pre-bleed and bleed lockout function • Inhibitor dosage control via water meter or other mode selections
Information plays a huge part in the total care used to provide both a safe, effective and efficient cooling system. This allied with technologies that allow for a complete picture on a 24/7 basis using effective control methods and the monitoring of their affect on plant while introducing direct action capabilities through alarms and remote control coupled with professional management allow for a much improved and responsible management of treatment, water and energy. Several things can occur in a cooling systems treatment which can jeopardise control without notice and include:
• Dispersant dosage control via water meter or other mode selections
• Contamination via exterior source
• Water Usage including Makeup, bleed and Backwash
• Water loss
• 4-20mA input for external instrument with programmable ranging and alarms
• Changes in make-up water quality
• Data logging of all measures and outputs • Remote control via GSM modem and Aquarius software • 4-20mA output card for building computer connection of 8 measures and relay status
Steve Powell is a Chemical Engineer specialising in industrial water treatment processes. He has held senior research and sales/marketing positions in multinational water treatment and speciality chemical companies operating within Australian and he brings considerable practical experience to address clients risk management security. Based in Melbourne he is currently Independent Monitoring Consultants (IMC) Victoria/ South Australia Account Manager. Steve says,”IMC is aware of all of the impairments to quality service and servicing. IMC is a privately owned Australian company providing quality services since 1992, and was the first to introduce full independent sampling and testing to help clients manage the control of Legionella, system corrosion, Risk Management & Audits, indoor air quality, OH&S and duty of care obligations. These securities are all important to international hotel chains, major shopping centres, hospitals, and key Property Managers and Owners. IMC was the first full microbiological laboratory in Malaysia, and the first to be accredited by Standards Malaysia for both sampling and testing of environmental waters, indoor air quality, and food. IMC technical expertise and proficiency has been perfected during the past 20 years through our national and international experience, and with a combined total of more than 150 years of water treatment knowledge and experience in our senior staff IMC is the perfect partner”.
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• Measure alarms, safety alarms with ORP and pH lockout alarm
THE AUSTRALIAN HOSPITAL ENGINEER I MARCH 2014
• Equipment failure • Empty chemical treatment tanks Modern day property owners and managers are now recognising the need to better manage all parts of their business and are employing modern day technology to maximise performance and minimise costs.
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PRODUCT NEWS
Product News Pangolin Associates expands to include ACA and CFI carbon management National energy and carbon management firm Pangolin Associates welcomes Dr Sam Phua to the team. Dr Phua is a Registered Greenhouse and Energy Auditor. He brings extensive energy and carbon services experience, and uniquely in Australia, the Airport Carbon Accreditation (ACA) program. Pangolin will now offer the verification service to airports in the Asia Pacific region. Joint Managing Director Iain Smale says: “With Sam on board Pangolin will become
the go to carbon management specialist for airports. Sam will also help us meet the increasing demand for a range of verification and assurance services that make up a significant part of our business.” Pangolin services include mandatory and voluntary schemes such as the National Greenhouse and Energy Reporting (NGER) Act, Energy Efficiency Opportunities (EEO), the Carbon Disclosure Project (CDP), and the National Carbon Offset Standard (NCOS).
and landowners for carbon credits created through actions such as sequestration and avoided deforestation. Dr Phua is an expert in carbon origination establishment projects such as CFI. He is the lead author for one of the world’s first Improved Forest Management-logged to Protected Forests Methodology (IFM-LtPF) under the Verified Carbon Standard (VCS). He has also authored numerous scientific papers on climate change and various government and community environmental schemes and projects.
H I Smale adds, “We are excited about new services in 2014, particularly as Sam leads us into new offerings under the Carbon Farming Initiative (CFI).” CFI is a carbon offset scheme set to continue under the Coalition Government. The scheme remunerates farmers
Dr Sam Phua will be situated in Pangolin Associates’ office in the Brisbane CBD. For enquiries, email info@pangolinassociates.com or call 07 3103 2000.
Energy & carbon management specialists
Talk to us about workplace energy efficiencies, cost savings and compliance. Our services include: • Energy Audits • Carbon Assessments & NGER • Strategic Energy & Emissions Management • Carbon Neutral Certification (NCOS) • Carbon Offsetting
P S
www.pangolinassociates.com info@pangolinassociates.com
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Australia wide | Government registered auditors | Cross industry accreditations
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