Hospital Engineer Spring 2014 by Adbourne Publishing

VOL 37

NO 3

SEPTEMBER 2014

the australian

engineer HOSPITAL S

Engineering for Health & Hygiene

Technology System Commissioning Structures: Hospital Towerâ&#x20AC;&#x2122;s Lifeline Systems Integration: Why it Matters PP 100010900

Chillers for hospitals and medical equipment Locally designed, manufactured and serviced

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/ CHCFM Coordinator Scott Wells (State Elected – QLD)

CONTENTS

BRANCH NEWS

National President’s Message

National CEO’s Message

16 State Branch Reports

SUSTAINABILITY

Membership Registrar Alex Mair (Nationally Elected)

26 Environmental sustainability in health care – why do it?

Standards Coordinator Steve Ball (Nationally Elected)

Asset Mark Coordinator Mark Stokoe (Nationally Elected) Director Kim Bruton (Interim State Elected Vic/Tas) Communication Darryl Pitcher Chief Executive Officer Jim Cozens Secretariat/Website Administrator Heidi Moon 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.

INFRASTRUCTURE

30 Technology system commissioning 36 Structures: Hospital tower’s lifeline

TECHNICAL PAPERS

42 Improving project efficiency 48 Operating Room Air Quality 56 Energy efficiency could increase hospital risks

58 Conducting facilities assessments 62 The Townsville Hospital Redevelopment A Health Engineering Overview 70 Hospital Commissioning and the Building Surveyor

HERITAGE ARTICLES

76 A System of Training & Instruction for Hospital Maintenance Staff 78 IHEA Heritage Adbourne Publishing 18/69 Acacia Road Ferntree Gully, VIC 3156 PO Box 735, Belgrave, VIC 3160 www.adbourne.com

ADVERTISING

Melbourne: Neil Muir T: (03) 9758 1433 F: (03) 9758 1432 E: neil@adbourne.com Adelaide: Robert Spowart T: 0488 390 039 E: robert@adbourne.com PRODUCTION Emily Wallis T: (03) 9758 1436 E: production@adbourne.com Administration Robyn Fantin T: (03) 9758 1431 E: admin@adbourne.com

TOPICS OF INTEREST

82 Systems integration: why it matters 85 Modern Duct Cleaning PRODUCT NEWS

89 Product news

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

TECHNICAL PAPERS

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THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

National President’s Message Introduction

t is with great pleasure I write my Spring Report, a time which typically brings spirits of motivation leaving behind frosts, colds and winter confinement. The Board has been active since my last journal update and the following report will hopefully provide further insight into our collective work and direction. Of special note, I must report that our long term business partner (IHEA Accountant) and close associate (friend to many), Mr Lynden Smith has ‘closed the books’ and announced his semiretirement. We have been fortunate to have had the services of Lynden for some sixteen (16) years, his expertise and interment working knowledge of the IHEA will be sorely missed. On a brighter note we have engaged a replacement to Lynden and I welcome Mr Jeff Little as the new IHEA accountant. There has now been a formal handover between Lynden and Jeff, with our Treasurer Peter Easson and CEO, Jim Cozens closely involved. Jeff most recently attended our August Board meeting in Melbourne and participated in the formal proceedings. The Board is keenly looking forward to accessing Jeff’s accounting expertise and I’m sure you will all join me in welcoming Jeff on board. I would also at this time tender my apologies for the upcoming National Conference in Brisbane. As reported previously the IHEA members and National Board has supported bidding for the 2018 International Federation of Hospital Engineering (IFHE) Congress and a small contingent including Darryl Pitcher, Jim Cozens and myself will be attending this year’s IFHE Congress in Buenos Aires to present our bid. Unfortunately dates have clashed with our National Conference and Brett Petherbridge (VP) and Mitch Cadden (IPP) have agreed to undertake formal proceedings on my behalf in Brisbane. National Board of Directors

Name

Position

Darren Green

President

Mitch Cadden

IPP

mitch.cadden@gsahs.health.nsw.gov.au

Brett Petherbridge

brett.petherbridge@act.gov.au

Scott Wells

Secretary

scott_wells@health.qld.gov.au

Peter Easson

Treasurer

peter.easson@health.wa.gov.au

Jim Cozens

CEO (ex officio)

ceo@ihea.org.au

Alex Mair

Membership Registrar

ama58500@bigpond.net.au

Mark Turnham

Director (resigned May 2014)

mark.turnham@dhsv.org.au

Kim Bruton

Director (engaged May 2014)

Kim.Bruton@nhw.hume.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

Summary of Key Activity Throughout the last period the National Board has continued to develop and deliver members services and organisational activities, broadly summarised as: • 2014 National Conference Planning – Brisbane October • 2015 National Conference Planning – Perth September

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

• 2018 International Federation of Hospital Engineering Congress Bid – Brisbane; • Marketing IHEA benchmarking program – AssetMark; • Compilation of the Annual Report;

ACTION PLAN – YEAR ONE (1) – 2014/15 Membership Strategies

• Market to facility engineers with benefits of joining 

• Professional Certification via the Certified Health Care Facility Manager (CHCFM) Program; • New and refreshed marketing and communication strategies; • Commenced an operational business needs and resource analysis process; • A review of Membership grades inclusive of Honorary Membership; • Refreshing the ANZEX Agreement and NZ partnerships.

• List of facilities  • List of membership benefits  Build and Maintain membership base and, provide value for membership

IHEA Journal

Through the most recent additions of the IHEA Journal we have watched the quality and technical substance reach new levels of reading pleasure. The Board has supported our CEO’s submission to renew the current contract with Adbourne Publishers for the following twelve (12) months and build further on the value of our publication.

Strategic Planning As all members should be aware were are progressing through Year One (1) of our three (3) year Strategic Plan. The Board spend some time deliberating over progress and we will continue to report on our achievements. Below is a summary table providing indicative ranking against the target activities and actions. Ranking is between one (1) and five (5) stars, five (5) being the highest. The below scores represent an average overall ranking of approximately 50% of targets at the half way point of Year One (1).

• List of activities (PD/Conferences etc.)  • Contact with individuals  • Advertisements in Hospital Engineer  • Targeted invitations to professional development  • Broaden membership base, e.g. trades, aged care, mental health  • Expand Use of IT for PD, Website, Webinar, YouTube 

• Market testing external support to review and refresh the IHEA Website; • Further exploration of electronic communications for better access for our members, predominantly LinkedIn Facebook SurveyMonkey Goto Meeting icloud and YouTube .

Activity/Actions

• Cleanse members database  • Contact with contracted service providers 

Communications and Marketing Strategies

Activity/Actions • Develop educational/training programs  • Establishing and maintaining a PD program 

Improve communication and marketing

• Continue and enhance CHCFM program  • Trade competency assessment accreditation  • PD specific to members’ needs  • Customised Short courses and seminars Online 

Summary In summary I would like to acknowledge the work carried out behind the scenes by the National Board, CoM, Conference organising Committees and our business partners. I thank those who have served for the betterment of the IHEA and our Members. I personally look forward to our upcoming events and meetings, and the continuing successes of the IHEA. Finally as per our constitution and in preparation of the AGM in October we will be seeking nominations to fill one (1) National Board vacancy. I would encourage all members to consider input at a National level and should any members require further information around the roles and responsibilities of a Board Director or Branch committee member please do not hesitate to contact us. Regards Darren Green M.I.H.E.A., C.H.C.F.M. IHEA National President

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Steam - The Modern Day Energy Medium

Regular testing and maintenance of steam traps is fundamental to maintaining the efficiency of the system. Steam trap condition needs to be measured using suitable modern techniques such as ultrasonics and thermal imaging, and the results recorded in a computer based system that can report trap failures, estimate energy losses and recommend follow-up remedial action. Continuous monitoring of steam traps can be implemented for real time steam trap condition reporting (especially for critical steam traps, or steam traps in difficult to access locations). The development of acoustic signatures enables accurate diagnosis, and combined with wireless technology allows for the simple and effective implementation of a modern continuous steam trap monitoring system.

Wireless steam trap monitoring system Steam has been around for a long time and it is not by accident that it is still used as the energy medium to both generate power and provide heat energy directly to processes needing heat input. Its unique properties make steam a modern day energy medium and with the continued development of new technologies steam will continue to be widely used with ever increasing efficiency and control. Keeping steam systems up to date with the technological advances and new designs is imperative to maintaining an effective and efficient system, and while just a few examples have been given in this short article, there are many more. Contact your local Spirax Sarco office for more information and for help with keeping your steam system up to date.

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recommendations. The service of your equipment at regular intervals includes testing, maintenance repair, parts replacement and tuning.

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With our broad Qi Medical Gas Services portfolio, BOC can help you meet the considerable challenges of compliance and safety in today’s healthcare environment. At the same time, we provide balanced insight and flexible tools to improve control and coordination of medical gases throughout your facility. Ask us how we can help you manage your servicing needs with a tailored servicing and repair plan for best practice preventative maintenance for: – Breathing air testing – Gas manifolds – Air and vacuum plant – Medical gas alarms – Medical Gas Devices – Zone isolation boxes – Medical gas outlets

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Depending on the design of your individual system, BOC can customise a program that includes 12 monthly service and maintenance of your hospital’s medical gas reticulation system, including surgical tool control units, medical gas pendants, regulators, flow meters, compressors, vacuum plant and other medical gas related equipment.

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National CEO’s Message • Strategy has become important • People management is now pivotal • Leadership is evolving

he year has progressed I believe steadily and upwards in terms of my role as your Chief Executive. The most significant has been the introduction and actioning of the 2014 -2017 Strategic Plan. In this context and in progressing the deliverable outcomes associated with the strategies developed by the Board a prime activity has been personal consultation with New South Wales, Victoria, South Australia, Queensland and Western Australia State Branch Committees. Arising out of these meetings is recognition of the re-shaping of the health sector through in most states the outsourcing of facilities management by the introduction of Public Private Partnerships between respective state government departments and the private sector. Furthermore, it is acknowledged that the impact of these changes on the corporate and facilities management of health agencies and are recognised by the IHEA as an opportunity to become directly engaged with those companies and government agencies contracted to manage services that in the past were undertaken by directly employed health services personnel. The major change relative to Members is the current transition from a technical and operational management discipline model to one that identifies the broader management and leadership structure that is required to support facilities management in the modern era. Arising out of my discussions at State Branch level, which are in effect the front line of the Institute relative to Member engagement and participation is a model (Figure One) arising out of the PD Seminar conducted by the Victorian Tasmania State Branch on the 11th of July illustrates that a greater emphasis is being placed on the need to understand that: • FM responsibilities have increased • Duties have expanded • The scope has broadened • Technology has increased/changed

In this context, Figure two: Identifying Core Competencies is presented to illustrate the Institute’s recognition that a wider range of skill sets is required to effectively manage and meet the associated resource constraints that are being applied to Health Services Facilities Management in Australia.

Through consultative meetings in Queensland and South Australia over the past two months the Institute is encouraged to engage with government the corporate sector, kindred organisations and professional bodies to develop partnering relationships. The strengthening of such relationships are anticipated to be the way forward to progress the knowledge, skill levels and effective management of health sector capital assets and facilities by IHEA Members and potential members arising from partnering more particularly with both government agencies and the private sector vested with the responsibility for such undertakings. The prime objective is to ensure that personnel that have been entrusted with the major responsibilities of managing and operating the infrastructure, environments THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

and facilities in which clinical services are delivered are at best practice, well informed on contemporary practices and statutory compliance are well versed technically and enjoy the benefits that IHEA can bring to core competencies at all levels of health engineering and facilities management. It is envisaged that the establishment of IHEA partnerships with the private sector and government agencies will contribute to a sustainable membership base providing professional development opportunities for personnel working within health sector facilities management. Also, it will contribute to the awareness, at the enterprise level and site level, of current asset and facilities risk management, quality improvement and benchmarking asset management between agencies however managed. In addition, partnerships will provide the opportunity to contribute to the development, application and compliance assessment of relevant ACHS and SAA/NZ Standards across all facets of health sector management responsibilities. A further matter of significance is the opportunity for personnel to participate at IHEA state and national professional development forums and conferences, the benefits of which will enhance industry knowledge and peer networking. These aspects of IHEA, private sector and government agency partnering are presented as adding value to health services operational facilities management in particular and to the health sector generally. It is on these bases that the future relevance of the

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

IHEA is being structured by the Board to ensure that Membership of the Institute is of benefit to Members in particular and the health sector generally. It is acknowledged that in modern times, time management and life balance are of significance. In this context I encourage members to consider the professional benefits that accrue through supporting and participating in IHEA activities particularly at State level. Also, to give consideration to the value of the National Conference on an ongoing basis. I contend that the future represents challenge but also considerable opportunity for all to share the Boardâ&#x20AC;&#x2122;s vision by supporting your respective State Branch activities and programs. It is pleasing to be aware through my current involvement with State Branch Committees their dedication and commitment in association with the National Board to plan and conduct events that provide learning but just as importantly to work toward establishing health sector partnerships that will enable collegiate forums for technical and professional interchange, networking and most importantly friendship. Regards Jim Cozens BHA, FCHSM, CHE, Dip Eng. (Mech.), MIHEA, MSBE Chief Executive Officer

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THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

BECOME A MEMBER OF

IHEA

INSTITUTE of HOSPITAL ENGINEERING, AUSTRALIA SUPPORTING

HEALTH

FACILITIES

MANAGEMENT

Membership of the IHEA provides significant benefits for those engaged in Hospitals and Health Care Engineering and Facilities Management, Capital Planning, Project Management and Contracting. The Institute is actively engaged in professional development programs, asset management benchmarking, regular technical forums, national, state branch conferences, quarterly Journal – The Australian Hospital Engineer all of which promote and provide networking opportunities with colleagues, government departments and the commercial sector. Membership of the IHEA is available to all individuals and companies who are associated with Hospitals and Health Care Engineering and Facilities Management. Membership grades are Fellow, Member, Corporate Member, Associate and Student. New individual members are awarded the grade commensurate with their qualifications and experience. •

Annual subscription for individual membership is $320.00 per annum inc. GST.

•

State corporate membership entitles the company to nominate two (2) individuals in the state of preference.

•

National corporate membership entitles the company to nominate two (2) individuals in each state.

The annual subscription for State Corporate Membership is $670.00 per annum Inc. GST. The annual subscription for National Corporate Membership is $2575.00 per annum Inc. GST. Further information and Membership Application forms are available on the IHEA Website www.ihea.org.au Initial enquiries are welcome at ceo.@ihea.org.au or by telephoning our CEO Jim Cozens on 0417 835 229.

IHEA

CHCFM Certified Healthcare Facility Manager

CERTIFIED

IHEA NATIONAL CONFERENCE 15th TO 18TH OCTOBER 2014 VISIT www.HFMC2014.org.au THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014 15

STATE BRANCH REPORTS

State Branch Reports All State Branch Reports in this edition have been duplicated from the IHEA annual report.

WA branch IHEA Country Conference 2014

corrective surgery, cleft palates, facial disfiguration etc. Much of this work is been dependent on a number of Australian and overseas Doctors and Surgeons who freely give their time to train and teach local doctors surgeons and other medical staff new techniques. One of the surgeons we had the pleasure of meeting and who gave freely of his time and insight to the support and care needed was Dr Tim Cooper.

n May 2014 the WA branch of the IHEA Country Conference was held in Bali. The theme of this conference was destination Bali Awareness with the auspices of seeing the works of Australian Surgeons with their Balinese counterparts. The conference venue was the Sanur Paradise Hotel and was opened by Craig Aggatt with a welcome to delegates their partners, sponsors and speakers. Craig then invited one of our sponsor’s Wood and Grieve engineers to give a presentation. Kylie Harrison (Raulands Australia) then presented a short brief and Kylie then invited the John Fawcett CEO Mr Le Roy Hollenbeck to give us an overview of the company and nurse call systems, a brief history of the foundation which is an Australian registered incorporated organisation that works in Indonesia under its Indonesian arm. It was interesting to know that the foundation grew out of a number of Rotary projects established by John Fawcett and is probably best known for its sight restoration and blindness prevention. Although the foundation carries out other projects that include children’s

We were privileged enough to attend John Fawcett foundation clinics and witnessed children with facial disfiguration being assessed by Dr Cooper. Over the weekend we also witnessed eye surgery in the mobile clinics which was held in a local village and some of us attended a cataract operation. It was a very humbling experience when we received a very warm welcome for the villagers and the Foundation staff who gave us the privilege of seeing the clinic and staff in full operation. After the village visit a number of us attended the John Fawcett workshop in Sanur and met with the staff and technician’s, this is where all the mobile units and equipment was serviced, and stored, The facilities were basic but all equipment was very well maintained and the technician advised that he has had training in Australia. We visited the Siloam hospital and had guided tour of the facility all of which was very interesting and although it may not have been up to Australian standards it was a high quality facility. We also visited Puri RaharJa Hospital this was one of the older hospitals. We were met by the directors and senior staff and were given a very warm welcome and all attendees were furnished with a small gift box. Craig was then presented with a Plaque which was humbly accepted by Craig on behalf of the Institute. We were then given a tour of the hospital it was very basic with minimal services however; the staff were most attentive and professional, it was in this hospital that a few of us witnessed a reconstructive facial operation carried out by Dr Tim Cooper and ably assisted by his Balinese colleagues and nursing staff. The theatres were very basic with no HEPA filtration, laminar flow or sterilisers and the equipment in use was old however, functional. The instruments were sterilised in a VAT and then

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

STATE BRANCH REPORTS

The conference dinner was held in a restaurant in Sanur and was well attended by members, sponsors and partners. During the evening members were asked if they would like to pledge a donation to the foundation and I believe a considerable sum was raised by our members. Our National treasurer arranged for this to be organised via the institute.

In closing

placed in a very old dryer, placed in wraps, and then into a cabinet. I asked DR Cooper about infection issues , he advised that in the time he has been doing such work any infections were treated purely by penicillin. This is interesting when you consider the infection control we have in Australia it also raises the question are we over engineered? (Something worth pondering)

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The experience was welcomed by all parties and gave us a good insight to the works Carried out by The John Fawcett Foundation and the wonderful support of the JFF staff who are all very dedicated to the cause. The visits to the village hospitals and workshops were very interesting; a lot can be learned by all parties. I would also like to thank Craig and Kylie for organising this event. A special thanks to JFF and in particular to Dr Cooper, John Fawcett for his vision and others who allowed us to see the wonderful work that is being carried out by the surgeons and Drs in what can only described as a most worthwhile cause which is bringing back sight and hope to the Balinese people who can least afford this treatment. Andy Smyth Regional Facility Manager West Australian Country Health Service Great Southern

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STATE BRANCH REPORTS NSW/ACT Branch Report – Peter Llyod, State Branch President Introduction

• NSW Health Tririga implementation • An ongoing request for member journal papers and discussion suggestions

Committee of Management Elections

National Conference Sydney Oct 2013

Branch Notes

n behalf of the NSW/ACT Branch I would like to acknowledge the continued support of the NSW/ACT IHEA Branch Committee of Management (COM), all Branch members, National Board and our many and varied sponsorship partners, all of whom have contributed to another successful quarter for the NSW/ACT Branch. Highlights below.

The IHEA National Conference was held in Sydney Oct 9-12/ 2013, the conference theme was planning for the future, with keynote and other presenters capturing the theme and enhancing each other’s presentations over the 3 days. Our MC for the event Paul Wade provided an interesting personal viewpoint on hospital engineering and the behind the scenes positive impact our profession provides to the facilities, staff and clients.

Wollongong Technical Day 20th – 21st June saw IHEA members attend a 1.5 day technical day at Wollongong hospital, with presentations via Schneider, Web FM, Soft Logic and Noel Arnold, all presentations were well received and provided for open discussion re opportunities available, especially in relation to Professional development, Capital works management and documentation re compliance Hazardous materials and critical goods storage.

Site Tour Wollongong capital works project

A special mention and thanks for Tony Grainger, Vince Desantis and the local Catering staff for making the group most welcomed with spectacular views to the mountains from the level 8 conference venue.

Saturday morning saw a construction site tour of current extension works on site at Wollongong Hospital.

The NSW/ACT IHEA branch held its monthly COM, General and AGM at Wollongong on the 20/6/2014 President’s report included: • The 2014 Branch Conference

The 2013-2014 Branch Committee formally dissolved the 2013/14 Branch Nominations received and accepted as follows:

nationally and at a state level.

Jim Cozens provided an informative presentation on IHEA National Strategic direction, with a view to engaging all current and prospective members and to invigorate the institute

NSW/ACT Branch COM meets monthly on the first or second Tuesday, with Secretary Mitch Cadden developing a meeting calendar for distribution to all NSW/ACT members. I would encourage members where possible to dial into Branch General Meetings as they arise to keep updated re current and planned events

2014 Branch Awards This year’s award presentation ceremony was included in the Tech Day @ Wollongong with Awards in four categories: 1. E ngineer of the Year:- Anthony “Tad” Larkin – Goulburn Hospital, 2. E ngineering Manager of the Year:- Matthew Taylor – Wagga Wagga Hospital, 3. Tradesperson of the Year:- Neil Diggins – Junee Hospital, 4. A pprentice of the Year:- Chris Contarin – Wollongong Hospital, photos opposite. Congratulations to all recipients, who were all most deserving of respective awards. The COM look forward to future awards nominations across NSW/ACT Hospital facilities.

End of year function NSW/ACT COM is now planning for an end of year function, information for distribution early September.

• The 2014/15 Budget

2015 NSW/ACT Branch Conference

• Membership

The NSW/ACT COM will be soon confirming a planning committee for next year’s NSW/ACT Branch Conference, and would encourage involvement and ideas from all NSW/ACT members

• Call for Papers to the 2014 National Conference • Upcoming Energy Conference submissions • 2014 ANZEX Delegate Nomination to be called

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

STATE BRANCH REPORTS As NSW/ACT Branch COM we are focused and committed to actively engage all NSW/ACT members, and welcome any ideas or opportunity to improve our communication and uptake.

Summary In closing on behalf of the NSW/ACT branch members and the National Board I wish to acknowledge the continued work carried out by the NSW/ACT COM over the past 12 months.

Apprentice of the Year Chris Contarin

Engineering Manager of the Year Matthew Taylor

Tradesperson of the Year Neil Diggins

Engineer of the Year Tad Larkin

Participants, Wollongong Conference

2013 National Conference Delegates

The NSW/ACT COM is focussed on planning events to encourage participation of members in professional development and networking. We are all busy balancing day to day FM, Capital works etc., however opportunities to discuss issues via membership to the IHEA and networking at events provides rewards to all who participate. The IHEA has a wealth of knowledge via our retired members and we should actively seek this knowledge to enhance our own work.

OPPOSITE: Pictorial Account of NSW/ACT Branch Activities during the Year

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

STATE BRANCH REPORTS Queensland State Branch Report – Alex Mair, State Branch President

his last year has presented many challenges. Our principal employer, Queensland Health has continued with restructures within the Hospital and Health Services (HHS) and this has generally resulted in an increased workload. This has been coupled with a very ambitious funding program that has caught a number of HHS slightly short of staff as the program is rolled out. The result is that many of our members are finding it difficult to devote time to the Institute and to their Professional Development. Later this year we are also hosting the National Conference in Brisbane. This has been an ambitious task because we have decided to conduct the proceedings in Brisbane rather than the traditional option of the Gold Coast. We felt that Brisbane has much to offer, a fantastic venue in the Brisbane Convention and Exhibition Centre and far less travel issue for those from interstate. The National Conference has been a focus this year and as a result there is no State Conference. Despite these difficulties the Branch has continued with its usual level of activity with 3 Professional Development sessions being conducted through the year. The May session was cancelled due to other commitments. July Mid-Year Conference. This year the conference was held at the Victoria Park Golf Course. Many of us had been to other functions at the golf Course and it was felt that this might be a good venue that was very central, without the attendant cost of CBD parking. The conference was quite well attended and the sponsors and exhibitors were very happy with the outcome after the previous conference at Noosa. The program was quite varied and included presentations from Glenn Rashleigh on the future direction of Queensland Health, Jennifer Hands spoke about the hospital of the future, Jamie Hayes and Catherine Baudet spoke about the engineering and architectural design aspects of a facility. Ricky Luke presented some of the challenges in up skilling the workforce to maintain the hospital of the future and Sue Brandis spoke of some of the challenges faced at the Gold Coast University Hospital in meeting these requirements. Nicola Burton highlighted some of the issues surrounding the transition to retirement that our older workforce faces and finally there were technical papers from Mark Collen, Nazir Jai and Conrad Van Rooyen. October technical workshop on Nurse Call and Security. This was a technical workshop organised with Austco, Bosch Security and Vodoke and held at Meadowbrook. The session was quite well attended and provided a lot of useful information to the attendees as well as an introduction to some new technology.

February General Meeting, PD & Memorial Race Meeting The traditional ‘weekend away’ followed its usual format with a dinner on Friday night, this time and Pandan Delight.

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

The General meeting was held at the University of Southern Queensland and only 11 attended. The technical Tour was in 4 parts. The first was the Archives Building, a purpose built building to house the University’s considerable number of records. The second part was one of the science blocks. This particular building is used for Health Sciences and as well as the traditional laboratories included some small wards. The building has recently been refitted to suit its current purpose and there were signs of the buildings limitations for the purpose, nevertheless great facilities were available to the students. The third part of the tour was the student centre with retail and recreational facilities and a new interactive computer centre. Finally we visited the Japanese Garden. This is a world class facility and reflects the best aspects of Japanese garden design. It is also one of the largest Japanese gardens in Australia. The race meeting was brought forward so that it became an evening meeting, rather than a twilight meeting and so we all finished the night quite early. Once again the proceeds from the betting syndicate were donated to the Oncology Unit at Toowoomba Hospital. Breakfast on Sunday morning was at the Metro Café and after Breakfast the members dispersed to take in activities on their way home. National Conference. The Institute has engaged Iceberg Events to be the Conference manager and the Conference Committee has been working closely with them to bring together a good program with some exceptional speakers. This year the conference is in Brisbane and so we are looking for a great deal of support from all members for this conference because of the absence of the need for accommodation for local members. We have also offered scholarship monies to assist country members, but the uptake has been quite poor. This year I particularly need to thank the committee who have supported me through what has turned out to be a difficult year personally as I sampled the Healthcare system from the other side. Thanks to Kevin who organised the Technical Workshop and most of the Toowoomba Weekend, to Brett who has kept us on track and prepared all of the flyers that go out, to Jason who has actually sent out all the flyers and managed the information flow, to Peter who this year not only has been our Treasurer, but also took on the very considerable role of Conference Convener. I need also to make not of Scott, and Stuart who have supported both the PD program and the conference planning as their time permits. Finally I need to make mention of Jim Cozens our CEO who has provided advice and oversight as required through what has been a challenging year. Looking forward we need some new members on the Committee of Management. Most of the Committee have been there for a number of years and some will be retiring this year, so new energy is needed to ensure your State operation keep on happening.

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STATE BRANCH REPORTS

SA State Branch Report – Peter Footner, State Branch President

he SA Branch Committee of Management has met regularly throughout the year and has focussed its attention on the development and implementation of a varied, informative and helpful professional development program of benefit to our members. One of the early outcomes of the Committee’s deliberations was the development of a dynamic calendar of events to reflect all events of interest to the branch – be they seminars, site visits, committee meetings, conferences or social events. In a future development, we hope to publish this schedule online for easy access by members and other interested parties.

Professional development (PD) activities were an early priority for the Branch Committee and a number of successful events were held in the second half of 2013. The Committee’s intention was to develop and publish a rolling program of PD events, aiming for 3-4 major seminars /presentations throughout the year (one of which was planned as a multi-day event in the country area for the specific benefit of country members – and would-be members). Other lesser events would be arranged/supported to supplement these. A highlight of the program was a site visit in October to an iconic, leading edge facility in Adelaide – the South Australian Health & Medical Research Institute – shortly before it was officially

opened and occupied. The attending group were treated to an early exposure to this very interesting facility which is to be one of the jewels in the SA healthcare scene and also gained an understanding of the innovative technologies and facilities engineering challenges that exist in the facility. Some photos of the facility destined to become known as the Pine Cone, the Beehive or the Cheese Grater are attached below (with acknowledgements to SAMHRI). Another successful event was a site visit to, and presentation by Schneider Electric, at their impressive manufacturing facility on the northern outskirts of Adelaide. This event was well attended and well received by participants. The Branch also alerted members to arrange of training events and seminars, not organised by the Branch but which were deemed to be of interest to members. Moving into 2014, the Committee added a range of PD events to the program and arranged a launch for early April. Disappointingly, and despite inducements, only one member was able to attend, along with most of the Branch Committee. The Committee subsequently decided to continue with event but changed the focus to a membership recruitment activity by inviting representatives of current and potential FM service providers to join us. Fruitful discussions were held with senior managers from these organisations which the Committee believes will hold the SA Branch in good stead as we move to attract new facility managers to our ranks.

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

STATE BRANCH REPORTS

The poor showing from members for this event strengthened the Committee’s focus on activities designed to retain current membership levels and, importantly, to attract new members to the Branch. A significant proportion of membership in the SA Branch had historically come from hospital engineers and facility managers employed by hospitals within the State public health system. In recent years, a major change to the model for the provision of public hospital engineering services has occurred. Progressively, hospital building & engineering services departments staffed with public sector employees have been transitioned across to existing contractual FM arrangements applying to the rest of the SA public sector, with the incumbent contractors taking over the FM functions. In-house services were typically replaced by an outsourced service provision model. From an IHEA membership perspective, this meant that we had to retain the previous hospital engineering managers (now in a new contract management role) while attracting the site-based facility managers and technical staff employed by the service provider organisations. The Branch developed a membership plan which acknowledged this seismic shift in the way that public health FM services was arranged and set about pursuing strategies to gain new members. In developing a plan to respond to this particular shift, the Branch Committee also recognised it needed to become more active in attracting new members from industries such as the private hospital and aged care sectors, as well as trying to increase membership from the Northern Territory. The initial focus has been on gaining support from current and future service providers involved in current/future SA Government contract for provision of FM services across all public hospitals and health units. A range of meetings have taken place during July & August this year with current service providers (Spotless and the Government’s Building Management Facility Services), as well as some of the current tenderers for the new FM contract which will come into effect in July 2015. The Branch received welcome support and assistance from the IHEA CEO, Jim Cozens, and we

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

feel that our messages were well received with some indications that service providers would be willing to support corporate membership and individual membership for the site-based facility managers. They were generally also interested in some of the services provided by IHEA (AssetMark and CHCFM) and would consider sponsorship of Branch and National events. Unfortunately, we may need to be patient and await the outcomes of current procurement/contracting process to establish new FM contract from 1 July 2015 – it is hoped that the successful tenderers will be known by the end of year and we can then move to firm up membership and other relationships with these companies/organisations. One important outcome of these discussions has been the identification of the need to establish corporate membership arrangements that meet the requirements of these companies and we will take up the debate about more flexible (e.g. sliding scale) membership arrangements with the National Board, through the CEO. Another required enhancement, the development of a current membership pack, will also be discussed further with national office. Further actions have been identified to generate more members and these will be pursued over coming months, including: • Contacting key executives within SA Health and across the various Local Healthcare Networks to gain their support for IHEA membership for health employees/managers involved in the management of the FM contract. • Contacting all former members to see what can be done to encourage the renewal of their relationship with IHEA. This exercise will also include getting membership records up-to-date. • Identifying and engaging with FMs/engineering staff from across the aged care & private hospitals sectors. • Engaging with potential members from across the Northern Territory. • Identifying potential corporate supporters and discussing opportunities for their future involvement in Branch activities.

STATE BRANCH REPORTS The SA Branch has noted the development and release of Board’s Strategic Plan and supports the strategies aimed at ensuring that IHEA has a sustainable future. The Branch particularly supports the objectives of growing the membership base as this is the most critical issue facing the SA Branch. We also support the plans to enhance the organisation’s education and training programs as this is an area where a small branch like SA requires assistance – any efforts at a national level to support PD activities at a state level (e.g. webinars, central pool of educational resources, and improved delivery of material via IHEA website) would be most welcome. The Branch also welcomed the national initiative to survey members and believe that the outcomes of the surveys will assist to guide the provision of services that are valued by the membership. The SA Branch has been somewhat disappointed at the drop-off in membership and membership support for events that have been organised for the benefit of members. However, we have taken this as a call to redouble our efforts to retain existing members and

VIC/TAS State Branch Report – Kim Bruton, State Branch President

his year since our last AGM has seen the branch members very busy within the Victorian Health system. The uncertainty of the threatened federal government budget cuts before clarification and finally not being implemented left many engineers without sufficient funding or guidance. The 2014 President, Mark Turnham and Secretary/Treasurer Steve Ball have had a busy year, with the branch committee consisting of Howard Bulmer, Simon Roberts, Craig Marshall, Peter Crammond and Michael McCambridge being very supportive. The Annual Branch dinner 2013 held at the Royal Melbourne Hospital saw many members enjoy each other’s company and the presentation of the Victorian/Tasmanian Rising Star award, this year presented to Steve Ball from Barwon Health for his outstanding service to Barwon Health and demonstrated ambition to succeed in the Health industry. I would like to welcome all of the new members, EP&T Global (state corp) and Transfield (national), that have joined our branch and the IHEA brotherhood this year. I would also like to pause and remember those members who have passed on. The professional development program for the branch this year has been strongly supported with the third to be held in conjunction with the AGM on 16 August 2013. The program for the year 2013/14: • PD 3 2013 – held at RMH titled “Project and risk management”. • PD 1 2014 – held at RMH titled “Programs and initiatives”. • PD 2 2014 - held at Plumbing Industry Climate Action Centre titled “Looking Forward”.

to attract new corporate and individual members. This will ensure we are a viable entity supporting the pursuit of excellence in the provision of facilities management/engineering services across all streams of the healthcare industry. We acknowledge that growth in membership alone is not enough – our best chance of retaining and growing our membership base is to provide an interesting, appropriate and accessible program of professional development activities, formal training programs and networking opportunities that will keep our members coming back for more. Membership and PD programming will continue to be a core focus for the Branch as we move forward. In closing, I would like to thank the Branch Committee of management members for their valued support throughout the year. I know all of us found it difficult to free ourselves from the challenges and changes confronting us in our normal working lives but I have been extremely grateful for their past and ongoing efforts to move our branch forward.

• Annual Dinner at the Rising Sun Hotel will be held on Friday 5 December 2014. The branch was fortunate enough to have the new IHEA CEO Jim Cozens once again present his “The future direction of the IHEA” during a visit to PD 2 at the Royal Melbourne Hospital. We all know Jim has been heavily involved with the IHEA for many years; he and the National Board clearly have a huge agenda to work through. Finding speakers and sponsors for PD’s is always difficult with our first PD for 2014 being held on 11th July at the Royal Melbourne Hospital, sponsored by Lehr Consulting International and we thank them. Entitled “Where to next” guest speakers included: • James Cozens, CEO IHEA – “What is happening at the National Level of the IHEA?” • Howard Bulmer, Executive Lead, Strategic Services Division, Leighton’s – “Contemporary expectations of facility managers in an organisational context”. • Simon Witts, Principle Lehr Consulting – “BIM - this is an area of great misunderstanding in the market”. • Sujee Panagoda, Senior Engineering Manager, Monash Health – “Expectations of a Facility Manager”. • At the same time Jim Cozens was presented with his 40 years’ service award, well deserved. Other Branch members who have reached the 40 year milestone include; Sergio Adofaci, Bruce Gilpin, Vernon Nipps, Albert O’Neill, Kenneth Sinclair and Dirk Tealinger, congratulations to you all. I welcome the incoming Committee of Management knowing they will carry on the ideals of this wonderful peer group into the future with enthusiasm and vigour. THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

SUSTAINABILITY

Environmental sustainability in health care – why do it? Chris Hill I Director of Environmental Sustainability, Mater

The priority of our team at Mater Health Services will always be the delivery of exceptional care to patients. That raises the question “Why focus on sustainability?”

for one believe the two are not mutually exclusive, and in fact often ask why you would not focus on this area, which can return financial savings that can be reinvested into patient care. These savings also translate to broader benefits – from an environmental perspective through decreased consumption, and also the often hard-to-measure behavioural change. The journey for me at Mater has evolved significantly over the past few years as our Sustainability at Mater program gained momentum within our group of almost 7600 staff. Our program commenced in 2008, initially driven by legislative requirements for the Clean Energy Act and associated Smart Energy Savings Program from a state-wide perspective, and the Federal National Greenhouse and Energy Reporting Act 2007. What was predominantly implemented to ensure adherence to these policies has grown into a key area of focus for Mater and seamlessly integrated into “normal business practice”. To support the implementation of various campaigns and tactics associated with the program, a multidisciplinary committee, comprising executive directors and senior directors from across Mater, was established. This process really began from scratch, with no existing platform to refer to regarding how to successfully implement our ideas across

our health care environment for the best possible outcome. Recognition of the environment in our strategic plan was crucial for the implementation of our program in the key areas of focus – energy, water, waste, facilities design, procurement, transport and stakeholder engagement – from which 126 initiatives were identified. The implementation of initiatives began with those that provided tangible results, so that staff could “see” the changes and therefore more easily align to the program. Examples included dual printing (with more than 6 million pages saved to date), the installation of 24 water tanks across our South Brisbane campus, increase to bike parking (90 spaces, each with a locker) and a commitment to recycling across numerous areas. A comprehensive communication and engagement plan was developed in-house with Mater Marketing to develop an easily identifiable design to be consistently used for all communication related to the program. The plan also articulates aims and objectives, key messages, stakeholders and communication tools. A behavioural study undertaken with Griffith University and The University of Queensland, supported by results from an all staff engagement survey, indicated waste was a priority of staff in terms of tangible environmental sustainability.

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

This was translated into practice, with changes such as supporting co-mingled recycling in non-clinical office areas and changes to clinical waste disposal processes. There are now 11 recycling streams in place across areas of the campus and during the last two years, this has increased recycling by more than 115 tonnes per year and has reduced clinical waste by more than 80 tonnes. This program is planned for expansion across the entire organisation. Other programs targeting behavioural change involved direct engagement with staff. A “turn it off” campaign was delivered in conjunction with the universities to encourage staff to turn off lights and appliances when not in use. Mater-branded “keep cups” were also made available within cafes. This costneutral campaign has resulted in sales of almost 3000 cups since 2011. We have also linked to external campaigns, with great success. During MobileMuster in March 2013, more than 40 kilograms of mobile phones and accessories were donated by staff, supporting the positioning of permanent collection points. National Ride to Work Day also attracted more than 50 participants who were treated to a free end-of-ride breakfast. During a Friday File Fling in November 2013 to support National Recycling Week, more than five tonnes of material was collected by Mater’s waste team for recycling (or shredding, for confidential material).

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

SUSTAINABILITY Staff education is also now incorporated into a variety of programs coordinated by Mater Education Centre. Mater’s behavioural standards handbook and new staff orientation sessions reinforce Mater’s commitment to environmental sustainability by setting out expectations for responsible stewardship from the commencement of employment. While staff support of the program is essential to its success, the ability to demonstrate organisational savings – both financial and environmental – is not only required for the program’s future, but also aids in it becoming a component of “business as usual”, rather than an additional program drawing from other priorities. Energy initiatives such as installing energy efficient lighting into Mater car parks has reduced energy use by more than 30 per cent, with a less-than-two-year payback. As part of our commitment to the Smart Energy Savings Plan, a $1.9 million chiller replacement program was delivered. It has decreased energy use, and air conditioning scheduling continues

to be monitored to ensure its use during core periods.

measurement, volatile organic compoundfree paint and green waste shredding.

The implementation of a campus-wide temperature policy to regulate summer and winter temperature levels is also expected to contribute to a reduction in energy use. Electricity contract negotiations in partnership with an external energy broker have delivered substantial financial savings for the 2013-14 financial year and current renegotiation to a “flexible” wholesale price is expected to deliver further savings from January 2015. We are also investigating the appointment of an external contractor to develop an energy management plan for Mater that will recommend and cost payback periods for a number of initiatives, to allow for inclusion in our capital budget process.

All initiatives, big or small, support Mater’s goals within the area of environmental sustainability.

Mater has delivered many other initiatives which have contributed to Sustainability at Mater. These include fleet and fuel reduction, reduction in the use of plastic water bottles for patients, miscellaneous lighting upgrades, carbon footprint

Chris Hill is Mater’s director of environmental sustainability. He can be contacted via chris.hill@mater.org.au

To summarise, in my opinion, the success for environmental sustainability across an organisation must include the following components: • You must have top management support for this to be successful. • Multiple contributions from all areas do make a difference. • Embed these changes into “business as usual” and there are more dollars available for patient care. • Environmental sustainability integration is transferable across all industries.

This was first published in Catholic Health Australia’s Autumn 2014 issue of Health Matters

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INFRASTRUCTURE

Technology system commissioning

A comprehensive approach to high-level communications Ted Hood

Building systems, medical equipment and information technology (IT) devices all have unique operational needs.

owever, basic vendor testing and standard punch lists do not address the configurations required to meet the operational needs of health care technology systems. Defining the operational configurations, functional testing parameters and commissioning requirements for these diverse technologies and complex integrations is required.

Industry drivers An overabundance of new medical technologies and systems are flooding health care facilities and most have complex setup, configuration and testing requirements. Special building systems such as sound monitors, room status devices, real-time locating systems (RTLSs), integrated nurse call systems and integrated closed-circuit television (CCTV) solutions require detailed implementation plans and rigorous start up testing. Several of these health care technologies such as nurse call, access control, code blue and infant security have some limited vendor commissioning requirements and standards. However, most health care technologies deployed today have ownerdefined operational configurations, interoperabilities and integrations that bridge multiple systems and infrastructure. These include integrated surgical video, nurse calls, interactive televisions, RTLSs,

distributed antenna systems, telemetry, patient beds, physiological monitoring, automated medication dispensing and wireless telephones. Many of their integrations are often mistakenly assumed to be plug-and-play, but those assumptions may create serious operational and patient safety issues that can result in death. For example, the 2014 Top 10 Health Technology Hazards list by ECRI Institute, Plymouth Meeting, Pa., names alarm hazards as the No. 1 risk. Many of these risks are created by false alarms and nuisance alarms generated by failed integrations and improper configurations. Commissioning of these many complex technologies requires a specialised focus.

Commissioning challenges Traditional commissioning doesn’t fully address health care technology, leaving the owner with incomplete solutions. Commissioning is focused only on contractor-furnished items and typically ignores the necessary integrations with owner-furnished medical technologies and the clinical requirements necessary for full functionality to meet staff needs and expectations. Many assume medical technology vendors address these needs but the vendor functional testing requirements do not address operational intent. Vendor testing ensures that the light comes

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

Interactive television systems can be integrated with nurse calls, electronic health records and other systems. PHOTO COURTESY OF TELEHEALTH SERVICES

on and data are transmitting, but on the vendor’s end only. Their contracts typically do not span the multiple systems needed to meet the hospital’s functional requirements. Owners now should begin incorporating detailed commissioning requirements into vendor requests for proposals (RFPs) and purchasing contracts to help ensure proper implementation and activation. Facilities and design teams are accustomed to evaluating operational requirements and total cost of ownership for energy management systems. Unfortunately, this process is not being applied to the many complex technologies in hospitals today. In a recent health care construction project, a facility discovered a year after

INFRASTRUCTURE opening that it had spent $240,000 on an RTLS that was being accessed only by three people in the biomedical department to find equipment to be serviced. The technology champion that led the RTLS charge during the project design phase to maximise staff efficiencies was no longer at the facility, and only a generic specification for the system was developed during his tenure. The contractor turned over a fully tested solution as it was specified, but no operational configurations were required by specification so the system configuration defaulted to the biomedical department to determine and utilise. The original operational intent was to maximise staff workflow through the system’s tracking capabilities, but the necessary complex software solution was not implemented as planned. Defining the proper commissioning requirements early in the design would have helped to avoid under utilising the technology and would have maximised the return on investment. Detailed operational intent often is overlooked in medical technology planning. Assuming that this has been addressed by somebody else, such as the design team, contractor, vendor or IT department, creates a negative impact to staff workflow and patient safety. Facilities must move beyond selecting technology and devices. Similar to building management system planning, they must spend time early in the design process defining the overall operational intent for the health care technologies to be implemented. This process and its resulting documentation are needed to ensure that operational intent is incorporated into the owner’s RFPs and specifications as required. Medical device integration is another daunting challenge with which most facilities struggle. These integrations can have extremely complex and diverse requirements. For instance, a smart bed can provide wired and wireless capability to auto populate the electronic health record (EHR) with patient information, incorporate clinical protocol reminders on separate software and integrate with the nurse call system, television system and wireless phones to assigned caregivers. Likewise, some

ventilators will auto populate the EHR through bedside gateway devices by a middleware vendor, as well as utilise separate clinical software with alarms sent to the assigned caregiver’s wireless telephone. Additionally, physiological monitors and telemetry integrate with the EHR, sending waveforms to wireless devices utilising the hospital’s wireless local area network, which can ride on a shared distributed antenna system.

facilities professional must determine the department heads, consultants and vendors who will configure the entire solution to meet the operational intent. Next, the professional will need to assign responsibilities to those who will test the individual items in order to provide a complete solution, and select the people who will manage medical equipment interoperability so that it aligns with the clinical goals.

Each of these examples touches multiple systems, implementation teams, departments, users, contractors and vendors that must be carefully orchestrated during the design process — not when the system goes live. Assuming that medical devices are plug-and-play or that the biomedical department or IT department is solely responsible for the devices has caused many failed implementations. Building commissioning addresses the cabling infrastructure, but doesn’t tackle the clinical requirements of medical devices. Facilities must embrace a comprehensive integrated health care technology activation philosophy and a plan that spans well beyond commissioning.

The facilities professionals also should define who will ensure that the complete solution across multiple building systems, technologies and medical devices is finetuned before, during and after the system goes live. Finally, a specialised team focused on health care technology will need to be formed to achieve real success and avoid gaps that many projects overlook. Given the multifaceted technology requirements, this team must engage and incorporate key project leadership from the design team, general contractor, biomedical department, IT, facilities department, security and administration.

Strategies and solutions Health care technology commissioning requires complex planning from the beginning of the project. It must begin with a detailed health care technology master plan that incorporates the facility’s technology vision for the future. Hospitals and health systems often overlook incorporating these goals into overall facility master planning, which creates substantial strains on project start-ups that missed the operational needs. This approach helps to reduce the technology surprises that many new projects face.

Traditional nurse call system commissioning requires testing to confirm visual and audible communication of patients and staff, but not integrations with other systems. PHOTO COURTESY OF RAULAND-BORG CORP

Team responsibilities often are assumed when it comes to health care technology planning and commissioning. Facilities should determine the gaps early in the design stage so that roles and responsibilities are defined clearly.

Traditional commissioning plans for contractor-furnished items primarily focus on energy management systems and basic building systems to achieve substantial completion and meet the overall building’s functional goals. A specialised technology team also must handle the complex owner-furnished medical technologies that fully address the operational and clinical goals.

Defining who provides the systems, infrastructure, medical devices, IT devices, telecom devices and special systems is only the beginning of this process. The

Many of these technologies, special systems and medical devices offer excellent clinical solutions that support staff efficiencies and better patient

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

INFRASTRUCTURE outcomes, but must be set up and configured to meet operational requirements. Something as basic as a touch-screen nurse call staff terminal offers custom event-driven workflow solutions that must be programmed to meet each unit’s specific needs, which can range from rounding reminders to roomclean notifications, security alerts and blood-draw requests with electronic health record integration for lab result notifications. Another consideration is determining which IV pump alerts should be selected for routing through the nurse call system and to which assigned caregivers. Each of these examples requires clinical input to develop proper configurations. Facilities should establish focused userconfiguration meetings to define and develop operational narratives as well as workflow and device configuration diagrams that align with the overall health care technology vision. This detailed information should be incorporated into an owner’s vendor RFPs and project construction documents to avoid the typical scope gaps that challenge most installations. These items become the

foundation for developing the technology commissioning plan and help to narrow down the integrations that need to be addressed. Technology integration management is a critical part of technology commissioning. Some of the hundreds of medical technology integrations that must be managed include infusion monitoring to wireless telephones; interactive televisions to the health information system; physiological monitoring to wireless devices; nurse call systems to wireless telephones; pharmacy robotics to the medication management system; and RTLS to wireless telephones. The specifics for these integrations will have been captured during the user configuration meetings. It is important that facilities professionals evaluate these technology integration points and manage progress and vendor changes up to opening day. Ongoing health care technology commissioning meetings should be established proactively to help manage these integrations, equipment and systems, including determining required software interfaces, managing middleware requirements, coordinating systems and

equipment with EHR for direct data capture, testing interfaces, achieving vendor certification, capturing network ports, obtaining Internet protocol addressing requirements and identifying IT security requirements. A project technology integration map should be developed to give the team an overall perspective of scope that can be reviewed as potential changes occur. The shelf life of medical devices, IT devices and special systems is short, and technology utilisation changes quickly. Thus, reviewing submittals for hospitalpurchased technologies is extremely important in coordinating the integrations as new versions or software updates are released. These items should be reviewed by the specialised team for compliance with project vision and with the agreed commissioning standards. Regular technology commissioning team meetings should be established to track schedules and the progress of implementation for owner-furnished technology, proactively coordinating contractor infrastructure and integration requirements. Facilities professionals also should consider establishing periodic technology steering team meetings to help ensure that

Devising fixes after occupancy During a post-occupancy assessment of a small community hospital that had recently completed new construction, it was discovered that the nurses detested the real-time locating system (RTLS), nurse call system and wireless phones. Issues included dropped calls, incorrect patient room alerts to wrong caregivers, excessive alerts and notifications. Evaluation determined that the systems had been programmed and configured incorrectly to meet the facility’s needs. The nurse call system was receiving workflow reminders from the RTLS, but call escalation times had been modified to provide quicker response to patient care. It was discovered that the nurse call system was programmed with durations so short that, in most instances, the nurse was physically unable to get to the room in which the call was initiated before another reminder alert was sent. In addition, if the nurse was caring for a patient, the system would escalate the alert to nurses on the floor within minutes, creating unnecessary staff frustration. Simply adjusting the duration by three minutes resolved the issue. The staff also complained that the nurse call system and wireless phone communications to patients were not working. Dropped calls and incorrect calls from unassigned patients in other units were occurring daily, even though the phone system was working correctly. The issues were twofold. First, wireless phones were occasionally being shared between units, but not all patient rooms were unassigned from previous units, causing calls to be misrouted. Laminated wireless phone assignment cheat sheets were provided at each nurse master console, which immediately limited improper phone assignment issues. Second, it was determined that the dropped call issues were related to the owner’s wireless local area network settings. Simply adjusting the system to prioritise wireless phone traffic resolved the problem. By Bill Miles, PE, project manager at GBA, Franklin, Tenn

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

A.G. COOMBS

Advisory

Tech-ni-cal, adj. Having special skill or practical knowledge. A.G. Coombs Advisory provides practical advice and ongoing support for building systems throughout their lifecycle: Air conditioning and mechanical Electrical power, UPS, standby and co-generation Lighting technologies and controls Fire suppression and detection Building automation and controls

Tapping into 70 years of experience in designing, delivering and maintaining our technical specialists will assist with: System troubleshooting Building tuning Energy efficiency advice and management Technology change management Energy supply alternatives Design reviews Independent Commissioning Agent BIM model management and planning

Disegno g C COO1 O 452 526

Scan the QR code for full details on A.G Coombs Advisory. For further information please contact Bart Taylor at A.G. Coombs Advisory to discuss your requirements btaylor@agcoombs.com.au +61 3 9248 2700 or visit agcoombs.com.au

+ PRACTICAL TECHNICAL SERVICES ďż˝ ALL BUILDING SYSTEMS THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

INFRASTRUCTURE the defined integrations and technologies still align with the facilities’ overall technology vision. Ultimately, the final stages of activation bring the biggest challenges in health care technology commissioning. Clear definition of final vendor testing and documentation expectations helps to soothe implementation woes. Medical technologies and special systems have specific requirements for proper testing, and operational intent must be incorporated into final vendor testing, documentation and system configurations. In addition, emergency mode procedure must include all health care technologies. The technology is not necessarily functional just because the power re-engages it. The multiple layers and overlaps in infrastructure shared by health care technologies must be properly sequenced and tested to ensure proper start up when power is lost. Facilities professionals must develop a rigorous testing plan for all technologies that go beyond basic functional testing.

Thorough training and orientation is another key factor to the successful implementation of these intricate technologies. Many facilities professionals default to the standard contracts for training needs, but that typically only covers minimal requirements. Many of these medical technologies should include a series of training events from initial orientation to on-site training to postoccupancy, follow-up training. Both staff and maintenance team training is needed for medical technologies. The technologies maintenance team should include superusers who can support clinicians on the units on a daily basis, including coordinating pertinent manufacturer certifications. Ongoing staff requirements and resources to properly maintain and service the technologies also should be discussed. This will ensure that staff training for proper technology utilisation not only meets accrediting agency requirements, but also meets overall operational goals.

Ensuring success Building system commissioning has been an industry standard for years, but the complexity of health care technologies and the corresponding operational configurations now demand more specialised commissioning as well. Medical equipment, IT devices and special systems require long-term planning and complex project management processes for proper implementation. In addition to the standard commissioning agent, a team dedicated to technology commissioning will help to ensure project activation success and maximise the facility’s return on its technology investment. Ted Hood is senior vice president and chief operating officer at GBA, a health care technology consulting firm based in Franklin, Tenn. He can be reached at ted.hood@gbainc.com

Integrating new technologies with legacy systems A recent patient tower addition project integrated an existing wireless phone system with the new nurse call system and physiological monitoring. The goal was staff efficiency through direct patient communication and alarm notifications to assigned caregivers. The contractor was providing the nurse call system and structured cabling, the hospital’s information technology (IT) department provided the wireless local area network access points, the hospital’s biomedical department provided the monitors, and the hospital’s telecom team provided the wireless phones. Each thought its vendor had the rest under control, but no one thought about who would test the system from monitor through the nurse call system to the wireless phones, and who would configure the operational settings on each technology. During activation phase, these assumptions created last-minute scrambling of the entire team. Eventually, they understood that an integrated approach was required and they were able to adjust quickly. They determined that the existing wireless phone software system was unable to transmit the physiological monitoring and nurse call alerts. Although this caused additional project costs and rework, they were able to coordinate an integrated implementation to provide a working solution in time for opening day. After the system went live, however, new challenges arose. The technology was functioning, but system configuration omissions and improper alerts were causing disruption in patient care. The entire team regrouped to assess the issues. Although each team member had discussed his or her individual configurations with the clinicians, they hadn’t clearly conveyed the complete end-toend solution to the users. They determined that a comprehensive team configuration planning effort with the users was needed to fine-tune the system. Once they realised the clinicians’ expectations, it only took a couple of days to make the final configuration adjustments to meet the operational needs. By Ted Hood, senior vice president and chief operating officer at GBA, Franklin, Tenn.

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

Sidco IHEA Exhibition 2014

supporting Telecommunications, Defence, Finance, Information Systems, Manufacturing, Datacenters, Hospitals, Dairy and the Industrial sector. Sidco’s methodology of Discovery – Solution – Implementation provides our clients with an effective process whether their site is a new installation or an expansion of an existing facility.

Sidco provides the Hospital sector with specialist electrical services including Investigations, Solutions and Implementations. We achieve best value results through an effective engagement process, incorporating a collaborative approach with our customer to define clear objectives.

Sidco’s measurement systems utilise embedded technology to monitor power disturbances such as sags, swells, surges, flicker, neutral currents, neutral voltage, harmonic current and voltage distortion, Negative and Zero phase sequencing, Rate of change of Voltage, Current and Frequency within the operational environment.

• Monitoring of threshold occurrence excursions indicate breaches of electrical limits that have been exceeded in the facilities electrical power system. These provide spot condition reports of what just happened and is part of the analysis process for detailed reporting.

The Sidco Investigation model delivers outcomes for our clients in a structured and detailed approach, facilitating an effective resolution time. Sidco’s solution outcomes are supported through years of experience and understanding of complex Electrical systems

• RMS sampling and long term trending is also used as a part of the historical analysis process providing longer term information on key electrical parameters. • Ongoing periodic Power quality surveys and Impact studies should be conducted during the life cycle of the facility to ensure efficient and effective operation. Sidco flexibility provides effective solutions to complex situations.

ElEctrical PowEr invEstigation sErvicEs For over 30 years Sidco has been providing power quality solutions to the Telecommunications, Defence, Finance, Information Systems and Manufacturing industries.

Secondary Power

Circuit Monitoring

UPS Backup System

Primary Power

InvestIgatIon • analysIs • ImplementatIon • solutIon

E: info@sidco.com.au • P: 1300 133 897 • F: 1300 133 879

www.sidco.com.au

ADVERTORIAL

ospital equipment is sensitive to power system disruptions. Power quality events cause electronic equipment to degrade leading to less than expected equipment life and intermittent downtimes plus lost data or settings. Clinical equipment may also not meet treatment efficacy simply due to poor power.

Sidco’s PQ reporting to stakeholders is effective and efficient, in formats that save time for all aspects of operations and management. Access to information in a sophisticated environment is crucial to operations.

INFRASTRUCTURE

Structures:

Hospital tower’s lifeline Margo Cole

A competition-winning team has come up with a novel solution for recladding a 1960s hospital on a very congested site - without disrupting operations inside. Margo Cole reports.

The East Wing houses a range of hospital activities, including wards for heart patients and operating theatres. It sits cheek by jowl with other buildings on a congested site, almost touching the adjacent Evelina London Children’s Hospital built in 2005.

ollowing the triumphant design and build of the 2012 Olympic Games velodrome, the team behind it, which has drawn accolades including ICE London’s team of the year, are no strangers to acclaim. And so construction firm ISG, architect Hopkins and engineer Arup joined forces once more to scoop another high-profile design competition for a very different public building project on the opposite side of London. This time, the three firms set out to forge an innovative solution to a problem that has plagued St Thomas’ Hospital for many years: a leaking building. The hospital’s 11-storey East Wing building, which sits across the Thames from the Houses of Parliament, was built in the 1960s and has a T-shaped plan. Its unusual teak, stainless steel and slate façade has never been great at keeping rainwater out – to the extent that it has been covered in scaffolding for over a decade. Aware of the complexity of carrying out construction work on the congested hospital site, client Guy’s & St Thomas’ NHS Foundation Trust opted for a contractor-led design competition under the auspices of the Royal Institute of British Architects (RIBA). We assembled a team of designers that we have a great working relationship with, in the form of Hopkins Architects and Arup,” explains ISG regional engineering director Tim Sullivan.

New for old: New steelwork is fixed to the existing concrete frame, while the old cladding stays in place

St Thomas’ Hospital from the Thames

“RIBA had never done a contractorbased competition before, but it was the right way to do it because the client wanted a high-quality design solution – but not a high-quality design solution that couldn’t be built. And they wanted a team approach.” “Arup spent a long time making sure they were comfortable putting the new loads through the building. We are putting massive stress into the existing concrete frame”

Tim Sullivan, ISG

The client’s brief was deceptively simple: prevent the ingress of water through the existing façade and provide two new bed lifts. However, there were two major constraints; the team had to consider the implications of the location, and also provide a high-quality design solution that could be built within a live hospital environment with the building fully occupied. The trust also gave an indicative price for the work of £27M.

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

As the tallest building at St Thomas’, it also stands out, looming above the hospital’s low-rise river frontage buildings. It is highly visible from the Houses of Parliament, which put the design team under added pressure to come up with an attractive – as well as practical – solution. At the heart of the competition-winning entry was the decision not to remove the existing cladding, which the team deemed to be too noisy and disruptive for staff and patients. The designers also felt the existing materials had architectural merit. “Some of our competitors were trying to get rid of the façade, but our approach Façade: Glazing hangs from roof-level steelwork

INFRASTRUCTURE was about utilising what we’ve got already,” explains ISG engineering manager Jay Munoz. Hopkins project architect Thom Kilvert adds: “We asked ourselves can we recover what’s there. It’s good quality slate, teak and stainless steel.”

Glass box

The new ETFE atrium roofs are also designed to reduce solar gain, with all the south-facing panels being opaque so that light, but not heat, is let in.

The result was, effectively, to enclose the entire building in a glass box. On the river-facing west façade, this takes the form of a glass wall that hangs from the roof, with a gap of 1m from the existing façade. At the back of the building, the new glass walls span diagonally between the corners of the T-shape, creating two large enclosed atriums, each triangular in plan. The atriums begin at secondfloor level and continue to the top of the building, where they are topped with ETFE roofs. “Rather than taking the existing cladding off, we are keeping it on and over-cladding it,” says Sullivan. “We felt we couldn’t take it off because there are patients in there, so we are making the existing fabric of the building more energy efficient. And at the same time, we are creating diagonal atriums on both sides, which gives [the hospital] new space that they can occupy and use.” “Some of our competitors were trying to get rid of the façade, but our approach was about utilising what we’ve got already”

does not perform very well, contributing to solar gain in the summer and heat loss in the winter. “With a new façade we could put in solar control glazing to prevent overheating, as well as natural ventilation on both the west façade and the atrium,” explains Kilvert, adding that the building would no longer cool down as quickly in winter.

Jay Munoz, ISG

The existing cladding system includes a fairly early form of double-glazing that

The design addresses the trust’s need for two new bed lifts by incorporating a completely separate lift core on what is currently the external wall of the building. This will ultimately be enclosed inside one of the new atriums. “When it is ready, we will just break into the existing building at each floor level,” explains Sullivan. “So our scheme avoids any real interfaces with the internal workings of the hospital.” It also gives the trust the flexibility to remodel the interior of the building in future. “They have in mind that they want to refurbish the existing building, so there are a lot of areas where we have created risers with nothing in them, that in future can house new plant and equipment,” says Sullivan.

Collaboration: Getting the green light from the trust In opting for a contractor-led competition for the East Wing external refurbishment, Guy’s and St Thomas’ NHS Foundation Trust sent out an important signal as to what it was looking for. The trust wanted a team whose members were already comfortable with each other, with buildability high on its list of Support: The atrium walls are supported by 30m-long trusses

New for old: New steelwork is fixed to the existing concrete frame, while the old cladding stays in place

priorities. The trust also made it clear that it would work closely with the winning team to make sure day-to-day disruption of the hospital’s working was minimised. “This is a critical building for us. It houses cardiac theatres, in-patients and high dependency units, so any disruption is going to be a major problem if it impacts on our ability to operate,” says the trust’s program manager Chris Moriarty-Baker. “We need to minimise any disruption as much as we possibly can.” Before work could begin, the design and build team and the trust’s project board agreed a brief that stated how key aspects of the project would be dealt with such as working adjacent to areas where radiation is present in hospital equipment, and liaising with staff and patients. They also agreed key times during the day when the team could not make any noise that might be heard inside the tower. “We held a ‘noise day’, when we made lots of noise-simulating construction activities – like skip lorries coming in and bringing in scaffolding,” explains ISG regional engineering director Tim Sullivan. “Trust staff stood in lots of places with noise monitors and told us what was acceptable.” As a result, the site team came up with some alternative methods such as using diamond drilling to cut into the tower’s concrete frame, rather than percussion drilling. The design and build team and the trust also developed a ‘traffic light’ system for potentially disruptive activities.

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

INFRASTRUCTURE were suitable for the new loads that will be added to the structure from the cladding and atrium floors.

From the air: The central London site is very constrained

“Anything that we know is going to be disruptive is red, and we have to have a dummy run beforehand so everyone knows exactly how it’s going to work,” explains Sullivan. “Amber activities have to be done at set times, and green can be done at any time. “At end of the pre-construction phase, in tandem with the trust, we had de-risked the job for the client, and they knew what the risks were in advance,” he adds. Due to the site’s congestion, inevitably the space alongside the East Wing that will now be within the footprint of the new atriums was being used for storage and plant. Some of this has been relocated elsewhere on the site, including within a new plant room that ISG has built on the roof of the tower. However, there was not much room for manoeuvre on major installations, including a substation and three oil tanks holding a total of 150,000l of oil. This is why the atriums begin at second floor level, and cantilever out over the large plant items. These have been moved slightly to enable segmental flight auger (SFA) piles to be installed, and a new tank built outside the footprint. The piles support columns that will carry the loads from the cantilevered atriums, including Y-shaped columns beneath the long edge of the atrium floor.

“Arup spent a long time making sure they were comfortable putting the new loads through the building,” he adds. “We are putting massive stress into the existing concrete frame.” These stresses include a 1.2MN load at the corner of the cantilever floor. “To get to the stage where we could start to construct was a whole exercise in itself”

Fraser Tanner, ISG

The glass atrium façades are supported by 30m long steel trusses positioned diagonally between the wings of the building at alternate floor levels. Each truss is delivered in three 10m sections. The sections are then welded together on site, and the completed truss is lifted onto three scaffold towers, then welded to plates fixed to the existing building. “There is quite a lot of steel, but it is quite an efficient design,” says Kilvert. “There are only five columns.” A basement beneath the west façade made it impossible to build foundations for the new glass wall on that side – hence the decision to hang it from new roof-level steelwork. This new steelwork will form the roof of an extra storey that ISG is adding on this section of the tower, replacing temporary accommodation the trust had been using as offices for many years. The façade itself was erected using mast climbers. Once piling for the atrium foundations was complete, ISG built what it calls a ‘dance floor’ – a platform at second-floor level, from which it has been carrying out all the construction activities for the atriums.

The new floor itself is made from reinforced concrete, in filled with glass blocks.

“We needed to be up on the second floor, so we put up flights of scaffolding and put a platform all round,” says ISG senior project manager Fraser Tanner.

“The piling was very close to some of the existing plant,” says Sullivan, explaining that ISG had to expose the tower’s existing piles and pile caps to confirm that both their size and location

The dance floor also gave the contractor somewhere to store materials – something that would have been impossible at ground level with space in such short supply.

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

“To get to the stage where we could start to construct was a whole exercise in itself, but we always knew that the only way we were going to manage this job was to get it up to second floor and create a designated area to work from,” says Tanner, who explains that a total of 50t of scaffolding – made up of 30km of tube and 26,000 fittings – has gone into the temporary works. The congested site also means there is only enough space for one tower crane – a 500t crane with a 60m jib that was erected this time last year – over the May bank holiday weekend. This involved building a base that had to span some existing structures, resulting in very high eccentric loads. Of the 34 SFA piles installed, four were for the tower crane base. In the subsequent 12 months, that crane has been put to good use, with the new west façade now complete and the new atriums and lift core well under way. The work is scheduled to take a total of 78 weeks, and should be finished in the autumn.

TECHNICAL PAPERS

I CAN ALWAYS COUNT ON YOU —

I always do my best.

A IN

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THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

TECHNICAL PAPERS

Engineering for Health & Hygiene

Legionella prevention: How to effectively remove Legionella from drinking water. In this edition we continue to reveal the efficacy assessment of the Ecas4 ® Water Disinfection System, through real life cases of reduced Legionella contamination in the drinking water heating systems of St. Marien Hospital in Bonn.

Case Study 2: St. Marien Hospital in Bonn Public Health and Hygiene Institute at Bonn University, WHO Collaborating Centre for Health Promoting Water Management & Risk Communication, Bonn, Germany.

Efficacy assessment of the Ecas4 Water Disinfection System - related to the decrease of Legionella contamination in a drinking water heating system. Background: The highly ramified and extended water piping of St. Marien Hospital in Bonn had been periodically inspected for Legionella in the past. The concentration of Legionella found in the hot water system repeatedly exceeded the recommendations contained in DVGW W 551. In order to temporarily reduce the concentration of Legionella, the hot water systems were periodically heated to higher temperatures; the issuance of hot water (over 70°C) from all taps in order to eliminate all contaminations was not possible for logistic reasons. Since continuous temperature increase was not feasible for economic and technical reasons, it was chosen to install an Ecas4 Water Disinfection System (WDS) positioned in the cold water station of the hospital to lower the concentration of Legionella to beneath the recommended threshold of 100 cfu/100 ml. Methods: According to the manufacturer’s indications, the Ecas4 WDS produces an active ‘Anolyte’ substance which is injected in a concentration by volume of 0.3-0.8% directly into the water subjected to the treatment. This Ecas4-Anolyte is produced on-site via an electrochemical process from a 0.5% sodium chloride solution (a saturated solution of salt and softened water). The Anolyte is collected in a back-up container and then injected into the pipes by a piston membrane dispensing pump in proportion to the

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

amount of water subjected to the treatment. The dispensing operation is monitored by a contact water meter. By means of the implemented control functions (electrical conductivity, electrical current constancy), the manufacturer ensures the correct operation of the 0.5% sodium chloride solution and production of Ecas4-Anolyte.

TECHNICAL PAPERS Results: A decrease in the concentration of Legionella at all taps was found immediately after installing the disinfection system in the drinking water heating system of the central building/paediatric ward. Follow-up measurements taken after one month and after three months confirmed the success of the intervention. It was suggested to keep the Ecas4 WDS running in the building in the future and to monitor system efficiency at longer intervals. The positioning of the system in the cold water station was too far away from the target, i.e. the drinking water heating system of the central building/paediatric ward. As per §11 of the “Trinkwasserverordnung 2001” [German Drinking Water Code], the required concentrations of Ecas4 Anolyte in the cold water would not be allowed on in the long term. Alternatively, a possible treatment with a lower concentration of Anolyte for a longer time was deemed not advisable due to the waiting time and the high concentration of Legionella. After starting up the Ecas4 WDS, efficiency with considerably lower concentrations of Anolyte was obtained, supporting the initial hypothesis of being able to provide appropriate metering by using two separate systems.

Conclusions: As this analysis shows, it was possible to considerably decrease the concentrations of Legionella bacteria in the hot water piping of the central building/ paediatric ward by means of 0.2 - 0.5 mg/l concentrations of Ecas4-Anolyte (measured as free chlorine).

A decrease in concentration is currently in progress to ensure a maximum value of 0.3 mg/l of free chlorine at all taps as determined by the “Trinkwasserverordnung 2001”. According to our experience, this objective is feasible: long term success will be validated by further controlled monitoring.

Table: Results of Legionella monitoring in St. Marien Hospital during the installation of the Ecas4 Water Disinfection System (Sampling temperatures 43-58oC)

Start up of the unit on the general cold water supply

Transfer of the unit to the hot water circulation line of paediatric ward

25000 Central building 4th Floor Hildegard 3rd Floor Elisabeth

20000

Ground Intensive

cfu/100ml

3rd Floor Michael

15000

2nd Floor Josef Building Antonio Sterilization

10000

3rd Floor Winfried Technical Room General Circulation

5000

Circulation Ped.

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Proud Gold Partner & Exhibitor at the 2014 IHEA Healthcare Facilities Management conference October 15-18, Brisbane QLD. Visit us at Booths 37-38. T + 618 8122 7165 | E info@ecas4.com.au | www.ecas4.com.au THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

TECHNICAL PAPERS

Improving project efficiency

Putting prefabrication and modularisation intro practice Michael Austin

Prefabrication and modularisation bring many of the same advantages to health care planning, design and construction projects.

oth methods help to maximise return on investment for health care organisations’ performing new construction or renovation projects by reducing waste and improving speed of construction. Both also are well-suited for creating the complex, yet repetitive, components that populate health care facilities, such as vertical and horizontal mechanical-electricalplumbing (MEP) systems, patient rooms, bathrooms, clinical spaces and envelope systems. Additionally, both methods rely on sophisticated 3-D building information modelling (BIM), which encourages consistency and collaboration among all project team members. However, the two methods also have significant differences, and knowing about them will help health facilities professionals to select the most appropriate one for their particular project.

Prefab vs. modularisation Prefabrication is the process of assembling building components, such as bathroom pods, to a complete state and transporting them to the project site for installation. Prefabrication is more readily used and accepted in the health care industry, especially because it involves building elements that are easy to prefabricate, such

as combined-service MEP racks and risers, patient headwalls and footwalls, exterior skins, exterior enclosure systems, electrical rooms and medical gas-zone valve boxes. The repetitive nature of prefabrication units produces less above-ceiling clutter and provides hospital maintenance staff with a more efficient model for future modifications. Modularisation refers to a finished unit or “mod,” such as an entire patient room, that is transported to the construction site ready for assembly in a specific order to create an end product. The process is similar to putting together a puzzle. Modularisation is newer to the industry than prefabrication. Although the method is beginning to be used on smaller and simpler buildings, such as outpatient treatment centres, modularisation also is well-suited for work on multistorey patient towers. According to the Modular Building Institute, the method removes approximately 80 percent of the building construction activity from the site location and significantly reduces site disruption.

Making the decision The decision to use prefabricated or modular elements in a health care construction project depends on a number of variables. Key among these is the design of the project itself, the parties involved with the project and logistical considerations.

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

A bathroom pod being installed on-site during a hospital expansion. PHOTOS COURTESY OF SKANSKA USA

The role of design. To ensure that all elements are suited for constructability and the chosen method of construction before a project gets off the ground, the project’s design is tested and analysed for specific application to either prefabrication or modularisation. Prefabrication and modularisation should be driven by the design as opposed to the other way around. To confirm that a design will work with either method, health facilities professionals must have a vivid end goal that allows them to commit and communicate up front the design decisions that will guide the 3-D model. With modularisation, the units arrive at the job site from the manufacturer in their completed form. The units have extremely specific constraints on height, width, weight and configuration, which all need to be incorporated into a project’s 3-D model from the beginning. Teams collectively discuss and decide on specific details,

TECHNICAL PAPERS such as the type of toilets or floor tiles, early in the project’s process to establish the project design’s workflow. The planning and collaborative decision-making enables the team to vet design decisions working together from the project’s onset and, as a result, this integrated process reduces the likelihood of changes on project specifics further into construction. Prefabrication requires extensive, collaborative up-front planning as well. Ultimately, prefabrication projects incorporate design specifics, such as the number and location of outlets in a given patient room; however, a project team requires less specificity on smaller details to conceptualise and plan for prefabrication. When the project reaches the point at which those details need to be determined, the entire team convenes to make those decisions. With each method, the team must analyse a project’s design to determine workflow. The right method to use depends on the detail available in the earliest part of the project’s design versus what might come later. However, the repetitive nature of both construction methods increases speed to market and also can deliver maintenance advantages for a facility’s staff once the project is complete. Owner involvement. Prefabrication and modularisation drive transparency between the owner and the entire construction team. For example, at the Nemours/Alfred I. DuPont Hospital for Children in Wilmington, Del., team members often visited the facility to observe the prefabrication work, which gave them the opportunity to verify compliance with the contract documents and ensure that quality standards were being met. For prefabrication, BIM allows the construction team to track a project’s process and predict the direct impact of changes during the course of a project. As a result, teams work with the owner to make informed decisions that consistently add value. If an owner decides to change 50 percent of a facility’s prefabricated headwalls, the construction team can use BIM to illustrate how that change will affect other elements of the job and its overall schedule.

While performing prefabrication work for the construction of University Medical Centre in New Orleans, for instance, a team worked with the owner and designers to make design refinements based on user group needs prior to commencing fabrication. The team detailed out spaces based on the project’s design, constructed mock-ups for user groups to view, and incorporated their feedback into the project plan to align with its overall workflow. At the onset of any project, a team should think deeply about how prefabrication or modularisation will bring value to the owner’s project, including decreasing the amount of construction noise at the job site as well as a reduced overall impact because much less work is taking place on-site. Location. The location of a health care facility also can drive the decision on whether to prefabricate or modularise elements of a project. If the project is located in a part of the country that tends to experience unpredictable and intense weather, modularisation and prefabrication can keep a project on schedule by allowing off-site work to continue. If a project is located in an extremely remote location with a limited workforce, prefabrication and modularisation can confirm that the project has the workforce needed to maintain its schedule as well as the resources to complete it.

Managing the process Aside from the level of design, which must be established at the project’s onset, the differences between managing prefabrication and modularisation processes are small — the assembly, transport and installation are essentially the same, yet approached differently, starting with design.

to make decisions on design finishes, including user groups. This reduces the likelihood that changes will be made throughout the project’s course. As design progresses, the construction team works hand in hand with the project’s architects, major subcontractors and representatives from the facility’s team to collaboratively study and identify the different scopes of the project to prefabricate or modularise. Next, the team determines how to manage the prefabrication or modularisation process. This includes identifying the subcontractors who will be responsible for performing the work necessary to complete the mods or prefabricated elements of the project. Subcontractors and tradespeople often are sophisticated with BIM. The construction manager responsible for managing the entire project team should integrate each of the project’s 3-D models to form one model that syncs all work and ensures uniformity. The elected prefabricated modules (i.e., bathroom pods and MEP racks) and modular elements (i.e., full patient rooms and bathrooms) are then integrated into the project’s 3-D model by the construction team to ensure just-in-time (JIT) delivery, so the modules arrive at the site exactly when they are needed for installation and the project can remain on schedule. To watch inventory control and monitor the schedule, construction teams sometimes attach radiofrequency identification tags or bar codes to each prefabricated or modularised unit to coincide with a specific location on the job site. This process also helps to determine what is required on the job to accomplish JIT delivery, allowing the construction team to better manage resources and the supply chain throughout the project.

Once the construction method is selected, it’s time to perform the up-front work and planning. The health care organisation must be able to provide the architect with a vision to produce a design, which the construction team will then convert into a 3-D model for all project members to use. The model will include the level of detail needed to support the project type.

Once the 3-D model is complete and work is delegated, the construction team reviews the prefabrication or modularisation plan with local authorities having jurisdiction (AHJs) so they are familiar and comfortable with the methods needed to complete the project. The warehouse environment offers AHJs the opportunity to inspect the project’s prefabrication and modularised elements before they are installed on-site, minimising the chance of changes in the field.

In a modular project, the team needs to collaborate with all project members

Next, it is necessary to identify a warehouse where the mods will be

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

TECHNICAL PAPERS constructed and prefabrication work will take place. When choosing a warehouse location for prefabrication and modularisation, it is important to consider distance from the job site and traffic routes for delivery and installation. For modularised projects, teams must pay close attention to mod size when finalising a shipment, entry and installation plan. Mods can be quite large, so they require an extremely specific plan for entry. Delivery methods for both prefabrication and modularisation projects follow a consistent sequence of workflow, which the team establishes at the beginning. All prefabricated or modular components are installed in a sequence that does not impact the work on the job site or the overall project schedule. If the project is a renovation, the team also needs to understand how prefabricated and modularised elements fit in with existing units. That means asking a few questions: To get components into the building, do

panels need to be removed from the exterior walls? Can teams build around the MEP equipment that is already in place or does it need to be removed? Does piping need to be relocated? Will prefabrication cause any other changes to the space due to size of the components? Once these questions have been answered, construction on the project’s mods or prefabricated components begins at the selected warehouse. The construction manager or general contractor is responsible for managing the work of the subcontractors at the warehouse. As the team completes construction of the mods and prefabricated elements off-site, each piece is tested to ensure it is ready for shipment and installation at the project job site. The shipment and installation processes for prefabrication and modularisation projects are similar and tracked in the project’s 3-D model. Prefabrication and modularisation

projects answer to one overall construction schedule. Prefabrication and modularised components arrive on-site exactly when they are needed to integrate with the construction of the project’s site-built elements.

Bringing the benefits Prefabrication and modularisation represent the future as the construction industry continues to be focused on driving value to health facilities and offering a solution that respects current operations throughout construction. As the health care industry begins to adjust to the reality of reform, more prefabricated and modularised projects likely will increase speed to market and continue bringing care to those in need at a faster rate. Michael Austin is regional prefabrication director, Skanska USA Building, New York City. He can reached at Michael.Austin@skanska.com

Benefits of advanced construction techniques Prefabrication and modularisation offer health care planning, design and construction teams many benefits over traditional construction methods. These include: • Operations. A large portion of construction work for prefabrication and modularisation projects is performed off-site and delivered to the site via a specific, predetermined sequence, which decreases job-site traffic and congestion. As a result, prefabrication and modularisation can be extremely beneficial for projects at active facilities, because they reduce the impact of construction work. An existing facility in the midst of renovation or expansion can conduct business as usual and continue to deliver both care and a peaceful healing environment to patients. • Quality. Prefabrication and modularisation use a production line system in the warehouse, similar to that of an auto assembly line, which makes the work more repetitive in nature. The repetitive process improves consistency, leading to fewer mistakes and less rework, all of which result in a higher-quality facility. • Safety. Safety increases as a result of the warehouse environment required for prefabrication and modularisation. Dedicated crews are not performing work outside in the intense cold of winter or the extreme heat of summer. Instead, they work at bench height with 360 degrees of accessibility to intricate systems — a view that is safer but unavailable at the job site. Traditional construction methods require workers to use ladders or access parts of the project from platforms. • Schedule. Prefabrication and modularisation projects see significant savings in time and efficiency. Because both methods require extensive up-front planning and collaboration among all of a project’s stakeholders, prefabrication and modularisation projects usually experience fewer change orders. Because the construction team can complete a building’s structure on-site, while construction on that same building’s prefabricated, internal components takes place off-site in a warehouse, projects have shorter schedules. Prefabrication can shave an overall average of 30 percent off of a project schedule. The use of building information modelling on these projects also assists with inventory and supply management, allowing construction teams to track modules using radio-frequency identification tags or bar codes to confirm just-in-time (JIT) delivery. JIT delivery reduces the cost of warehouse space and improves a project’s overall efficiency by transporting completed modules to the project exactly when they are needed. • Sustainability. Finally, the use of prefabrication or modularisation increases a project’s environmental sustainability. The up-front decisions these projects entail enable teams to determine the exact size and amount of materials needed to construct the prefabricated and modularised units, mitigating the amount of excess materials produced.

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

TECHNICAL PAPERS

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

TECHNICAL PAPERS

How healthy are your walls?

Withstands general clinical cleaning cycles.

In order to meet facility requirements, clinical environments require a higher frequency of cleaning with especially harsh disinfectants. This raises a challenge for facility administrators, architects and specifiers as these harsh cleaning regimes place a greater emphasis on coatings to deliver a hardwearing, chemical resistant finish, without sacrificing the aesthetics or low odour/low voc requirements. In Australia most current systems are delivered via conventional paints without specific testing to meet hospital requirements. As part of the Dulux innovation program, we have worked to deliver this dedicated range of products targeted at clinical environments. These have been thoroughly tested against harsh cleaning regimes to ensure we meet the expectations that come with being the market leader in this space. Dulux Professional SteriGuard Durable Acrylic Low Sheen is a premium, hard wearing and chemical resistant interior water based product designed to withstand general cleaning cycles in clinical environments. Developed through customer insight and in close cooperation with global hygiene experts, Dulux Professional SteriGuard is ideal for common use areas in clinical environments. The low VOCâ&#x20AC; , low odour formula ensures quick return to service with less disruption. Dulux Professional Steriguard contains Bio-PrufÂŽ Technology, which when combined with clinical cleaning programmes, helps assist in the protection against mould and bacteria to keep surfaces clean and help maintain good indoor air quality.

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

SteriGuard delivers the following key benefits:

TECHNICAL PAPERS

High chemical & scrub resistance This will help to keep facility walls looking clean and fresh for longer compared to standard water based products and will ensure that costs are kept down given less need for re-paint/coat. Easy to clean This will therefore complement existing healthcare maintenance cycles at the facility. Optimised sheen level For ease of clean while producing an attractive subtle sheen for public areas. Bio-Pruf® Technology To help reduce the growth of mould and mildew on the painted surface. Low VOC / Low Odour Helps ensure reduced shutdown time, quick return to service and less disruption to clients. Hard wearing Withstands general cleaning cycles in clinical environments

Testing and technology: SteriGuard has been thoroughly tested to withstand common chemicals used in healthcare cleaning programmes. A full list of chemicals can be found on the web sites listed below. Furthermore, Dulux has engaged global chemical and heath care expertise enabling our use the Bio-Pruf® technology. SteriGuard Durable Acrylic Low Sheen 15L: The general purpose SteriGuard range is recommended for common use areas that undergo frequent cleaning and should be used on broadwall areas across both new and repaint work. Broadwall areas in general clinical environments include areas such as receptions, waiting rooms, nurse stations, general wards in hospitals, veterinary and dentist practices, prisons, aged care facilities, medical centres and sports facilities. General clinical cleaning cycles can include the use of harsh cleaning chemical agents such as chlorine. “The Dulux range of SteriGuard coatings includes products suitable for healthcare settings which are designed to facilitate environmental hygiene work practices including rigorous surface cleaning and disinfecting schedules” Glenys Harrington - Infection Control Expert Contact us on 13 23 77 dulux.com.au/specifier dulux.com.au/trade dulux.com.au/steriguard

Bio-Pruf is a registered trademark of Dow Chemical Dulux worth doing, worth Dulux and Professional, are registered trademarks of the DuluxGroup Australia Pty Ltd. + VOCs (volatile organic compounds) contribute to atmospheric pollution. This product is low VOC meaning it contains less than 16g / L (untinted and tinted) of VOCs.

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

Operating Room Air Quality Scott Summerville I BSc, Opira P/L Kevin Moon I Dip Eng, Luxira P/L Dale Howard I BScApp(Phys),MBA,GDipSc, Opira P/L

The link between postoperative infection and operating room (OR) air quality has been well established.1 This link has seen the development of not only intelligent OR design but also a move to less invasive surgical procedures where possible.

he risk from airborne micro-organisms is minimised in the ventilation of conventionally ventilated ORs in three ways:1

(1) by filtration of supplied air; (2) by dilution of contaminated air in the room;

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

(3) b y preventing entry of contaminated air from areas outside the room. This paper focuses on the above principles in respect to conventional operating room air quality and in particular, why it is important to validate the air quality over the table or in the critical zone and what other parameters need

TECHNICAL PAPERS TABLE 1: Selected airborne particulate cleanliness classes for cleanrooms and clean zones.

ISO Classification number (N)

Maximum concentration limits (particles/m3 of air) for particles equal to and larger than the considered particle sizes shown below. 0.1µm

0.2µm

ISO Class 1

ISO Class 2

100

ISO Class 3 ISO Class 4 ISO Class 5

0.3µm

0.5µm

1 000

237

102

10 000

2 370

1 020

352

100 000

23 700

10200

3 520

832

237000

102 000

35 200

8 320

293

ISO Class 7

352 000

83 200

2 930

ISO Class 8

3 520 000

832 000

29 300

ISO Class 9

35 200 000

8 320 000

293 000

ISO Class 6

1 µm

5 µm

AS/NZS ISO 14644.1:2002 Cleanrooms and associated controlled environments, Part 1: Classification and air cleanliness.

assessing to ensure the air quality over the table is fit for purpose. Globally there are a number of recommended air quality parameters to be achieved in conventional operating room design. In Australia, there is a mixture of Australian Standards such as AS1668.2, The use of ventilation and air conditioning and buildings Part 2: Mechanical ventilation in buildings as well as State Health department guidelines

which vary from state to state.2 Some of these guidelines are in the form of capital works guidelines for building and refurbishment and some may be for ongoing maintenance of critical areas in health facilities.3,4,5 While there is general consensus for some design parameters such as air change rates, air velocity, HEPA filtration and location of return and exhaust grilles, there is little emphasis on room pressure and the air cleanliness class of the air

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

TECHNICAL PAPERS

Schedule

Required maintenance and testing

Service interval

Pressure gradients

Test, verify and report operating room pressure gradients to AS1807.10 . Minimum ∆P OR-corridor of 10 Pa.

12 months

Air change rate

Test, verify and report conventional operating room air change rate. Minimum of 20 air changes per hour (ACH) with filters at maximum pressure drop and around 37 ACH in preparation rooms used for laying up of sterile instruments or around 11 ACH if room used as a sterile pack store

12 months3

Air velocity and flow characteristics3,

Test, verify and report operating room air velocity to AS1807.3. Air velocity should be a minimum of 0.2 m/s at 1 m from the floor or operating table height.

12 months

Operating room particle concentrations validation (room class)3,6

Conventional operating room-test, verify and report operating room particle concentration (class of room) to AS/NZ ISO 14644.1 , CLASS 7 All test performed in “at rest” state.8

12 months

HEPA filter validation3,7

Test, verify and report operating HEPA filter integrity. HEPA filter installations should be in accordance with AS1807.6 and should be validated and certified annually in accordance with AS1807.69.

24 months * Accepted practise is annually.

2,3

within the operating room. If we were to design a room and test the air cleanliness class in accordance with AS/NZS ISO 14644 2002 Cleanrooms and associated controlled environments, what is the actual quality of air we are striving for? What class of room do we need? This paper seeks to highlight the necessity for a national design standard that nominates the air cleanliness level required for a particular class of room. A recent unpublished research project conducted on behalf of the IHEA has indicated that conventional operating room design could meet an ISO class 7 and we will explore this further.6 This paper does not cover microbiological commissioning and monitoring of ORs as undertaken by the infection control department. The Hospital Infection Society reference 1 provides good resource material for those interested in this topic. This paper also excludes ultra clean ventilation systems (UCV) maintenance, commissioning and revalidation. The focus of this paper is to inform the hospital engineer with the responsibility of maintaining systems associated with a high-risk environment such as the conventional OR, taking into account the fact that on the one site the ORs may vary in age and performance. They may have been designed to meet current standards and the commissioning records may still be available. In other cases there is limited design and commissioning data available. In fact all over Australia the age, design intent and the on-going maintenance and testing requirements are different and varied, between states and between public and private hospitals. A risk based approach to ongoing testing and maintenance is explained considering the plethora of available information and how to establish a set of benchmarks for your operating rooms. Operating rooms should have maintenance and testing programs that reflect the fact that there is high risk of harm to patients due to hospital acquired infection from invasive procedures. Unfortunately most hospitals do only a limited amount of testing, and that testing does not measure how clean the air is. Hospitals commonly test HEPA filters on an annual basis in accordance with AS1807.6 -2000, Determination of integrity of terminally mounted HEPA filter installations. While this is an important part of the testing regime it does not tell you anything about the air quality in the operating room. The level of air cleanliness should define air quality in the operating room, thus determining the room class. For conventional operating rooms, research has shown

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

that an ISO Class 7 can be achieved in most existing rooms and could form part of on-going testing and maintenance.6 The table below indicates the air cleanliness classes. There are a number of other very important air quality parameters to be monitored some of which have a critical influence on the air cleanliness level achieved. A number of years ago an IHEA sponsored research project set out to determine if operating room ventilation systems could be designed, commissioned and annually validated to ISO 14644 cleanroom standards Class 7 air cleanliness for conventional operating rooms and Class 6 air cleanliness for ultra clean ventilation (UCV) rooms.6 A total of 52 operating rooms were assessed and 45 were considered conventional operating rooms. Without going into great detail of the methodology and the results, a number of outcomes and observations are worth mentioning: 1. A wide variation of airborne particle size and concentration was measured for rooms of similar design, construction and age. In all cases the ventilation systems adequately controlled airborne particles in the 0.5µ range to meet the standards for ISO Class 7. 2. I n around half of the conventional ORs, the 5.0µ airborne particles were not adequately controlled and exceeded the limits for Class 7 cleanrooms. 3. P ressure differential (∆P) was determined to have a significant impact on the control of airborne particles in the 5.0µ range. 4. I t was established with a reasonable level of certainty that pressure is not a key factor in controlling 0.5µ particles. 5. T he study team could not find significant relationships between either air change rates (ACH) or ∆P and 0.5µ counts at the wound site or operating room. 6. T here is a strong relationship between pressure and 5.0µ particles at the wound site. When pressure decreases, 5.0µ particles increase. 7. T he study team found a strong relationship between ACH and 5.0µ particles at the wound site. When ACH decreases, 5.0µ particles increase.

HOW DO YOU KNOW IT IS SAFE TO OPERATE? TECHNICAL PAPERS Benchmark your operating room air quality

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TECHNICAL PAPERS 8. The study showed that existing designs provided good control over 0.5µ particle but only average control over 5.0µ particles. The results and observations summarised above for a limited sample of 45 conventional operating rooms are reasonably significant. It tells us that HEPA filters located above the operating table are successful in filtering particles to a submicron particle size. The results also highlight the significance of room pressurisation and air change rates at different particle sizes. Where conventional rooms failed to meet an ISO Class 7, experience indicates is that is at locations around the perimeter of the room, rather than directly under the HEPA filters. The study results also indicate that HEPA filters are very good at controlling the 0.5µ particles but that a minimum ∆P of 5Pa and 20 ACHR are required to control the 5.0µ particles Given the detail above to help us understand what parameters can be measured and what results we can expect from a limited sample of operating room testing it is now important to think about the operating rooms under your control. If we are only testing HEPA filters how do we know the air is actually clean? There is a need for further testing if only to establish how your rooms perform against some widely recommended parameters. Many conventional operating rooms should be able to achieve the following parameters with some minor modifications to the current air conditioning. The table below also suggests the service interval and has been compiled from accepted industry practise and recommendations from a selection of State Government Health Departments and Australian and ISO standards where applicable. The method of test has also been referenced. • Maintenance standards for critical areas in Victorian health facilities states 24 months however we believe this to be an editing error. • Queensland Health has a task description that HEPA filters be tested annually. HEPA filter testing is an

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

TECHNICAL PAPERS optional test to certify a cleanroom in accordance with ISO 14644 at suggested 24 month intervals however based on 20 years of experience I find it hard to understand why testing HEPA filters would not be a common sense and mandatory precursor test before verifying room cleanliness. If the HEPA filter fails so will the particle count so you should always check the HEPA filter integrity first. Now that we have had a discussion around the air quality parameters and what can be reasonably expected for many conventional operating rooms, it is important to develop an air monitoring and testing program based on all of the above. Even if your ORs fail to meet the recommended air quality benchmarks, there is value in knowing the current performance level for each parameter. Conversely, if your OR fails to meet the minimum design standards, how do they perform on air cleanliness tests. For example if air change rates are low, pressurisation is poor and particle counts high then you can investigate what changes are possible to improve these parameters. Sometimes operating room performance testing is not all about meeting generally accepted benchmarks but purely to see what you can do to improve the air quality in the operating rooms you are responsible for. For example, if you have commissioning records that say there was supply air of 1700 l/s at commissioning and you measure supply air now

at 1000 l/s then clearly there is scope to improve the parameter and create a new benchmark for your operating room. As an example, letâ&#x20AC;&#x2122;s say your operating rooms are 10 years old and are in need of refurbishment or tidy up. You may replace air handling units, or more likely, change pre-filters, clean coils and ducting and replace HEPA filters. Any major work is an ideal opportunity to measure and rebalance the system to achieve as close to the air quality benchmarks detailed as possible. At this point the recommissioning test results become your reference point for annual operating room performance testing. The operating room monitoring and maintenance plan should consider how to manage risk and patient safety with the minimal amount of downtime per room. The plan should consider the tests to be performed, the order of testing methods and any remedial action based on the results achieved. Plans will vary between hospitals due to location, number of operating rooms available for use and the type of surgical procedures undertaken at the site. Keep in mind that location is an important factor as hospitals that experience hot and humid conditions will be much more susceptible to mould, and this will have a major influence on the type and frequency of testing.

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TECHNICAL PAPERS

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THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

9/09/2014 4:48 pm

TECHNICAL PAPERS In conclusion, some general items worth considering are: • HEPA filter integrity testing – If a HEPA filter fails then spares should be available on site to allow immediate replacement and certification. • Air volume and velocity testing -– Changing pre-filters or cleaning coils may be required. • Air pressure testing – air balancing or fan modifications may be required.

11. S tandards Australia. AS 1807.8 Cleanrooms, workstations, safety cabinets and pharmaceutical isolators – Methods of test – Particle counting in work zone by automatic particle counter. Australian Standard Sydney 2000. 12. S tandards Australia. AS 1807.10 Cleanrooms, workstations, safety cabinets and pharmaceutical isolators -– Methods of test – Determination of air pressure of cleanrooms and pharmaceutical isolators. Australian Standard Sydney 2000.

• Air cleanliness testing (particle counting) is to be performed after the tests above. • Regular recommissioning of operating room air handling and ventilation systems should form part of your planned maintenance program. This regime should enable optimisation of performance of operating rooms whether or not compliant with recommended guidelines to achieve minimisation of risk to patients.

Bibliography 1. J ournal of Hospital Infection (2002) 52: 1-28 Working Party Report Microbiological commissioning and monitoring of operating theatre suites A report of a working party of the Hospital Infection Society, P. N. Hoffman, J. Williams, A. Stacey, A. M. Bennett, G. L. Ridgway, C. Dobson, I. Fraser, H. Humphreys. 2. A S1668.2 The use of ventilation and air conditioning and buildings Part 2: Mechanical ventilation in buildings 3. M aintenance standards for critical areas in Victoria health facilities; Victorian Government Department of Health, Melbourne, Victoria 2010. 4. C apital works guidelines; Building and Refurbishment: Infection Control Guidelines January 2002. 5. Q ueensland Health-Infrastructure Design Guidelines Volume 4 Engineering and infrastructure 2012. 6. A pplying ISO standards to operating room ventilation system design, commissioning and validation to control airborne particle concentrations to maintain control of air quality. Kevin Moon, Simon Evans, Mark Berends, Lester Partridge and Brian Berry (unpublished). 7. A C15 Air conditioning task description; HEPA filters best practise mandatory testing, Asset Management Services Unit, March 2012 Queensland Health. 8. S tandards Australia. (2002). AS/NZS ISO 14644.1:2002 Cleanrooms and associated controlled environments – Classification and air cleanliness. Australian Standard Sydney. 9. S tandards Australia. AS 1807.6 Cleanrooms, workstations, safety cabinets and pharmaceutical isolators – Methods of test – Determination of integrity of terminally mounted HEPA filter installations. Australian Standard Sydney 2000. 10. S tandards Australia. AS 1807.7 Cleanrooms, workstations, safety cabinets and pharmaceutical isolators – Methods of test – Determination of integrity of HEPA filter installations, not terminally mounted. Australian Standard Sydney 2000.

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Energy efficiency could increase hospital risks University of Leeds U.K. 2013

The chance of infection in some NHS wards varies dramatically based on whether the nurses leave the windows open, according to research from the Faculty of Engineering.

team led by the School of Civil Engineering studied airflow in a “Nightingale” ward—the classic NHS ward that traditionally accommodated two rows of up to 30 beds—using tracer gases to simulate how airborne infections spread.

Lead investigator Dr Cath Noakes, from the University of Leeds’ School of Civil Engineering, said: “These wards are still in operation and, although they have often been subdivided into smaller areas with 6-8 beds, their ventilation and structure is still fundamentally the same.

They found ventilation in the ward was generally good when windows were left open, keeping the danger of airborne infection low. But risks increased fourfold when the windows were closed.

“We found that when you operate them properly, with natural ventilation from the windows, they perform as the Department of Health would like them to. But we also asked what happens in the winter if the windows are closed? “There is a big push on energy in buildings and it worries many of us who work on indoor air quality. People are being told to seal up their buildings to save energy. We found, if you do that without alternative ventilation systems, you could be increasing the airborne infection risk significantly,” Dr Noakes said. “Some of these wards were designed by the Victorians, and our results show that they knew what they were doing. But there is a danger that we could be adapting our buildings to improve efficiency without thinking how it might affect patients,” Dr Noakes said. The study, conducted jointly with the Bradford Teaching Hospitals NHS Foundation Trust in a disused ward at St. Luke’s Hospital in Bradford in summer 2010, used carbon dioxide as a tracer gas to represent potentially infectious exhaled breath. Carbon dioxide detectors were positioned where beds might be placed in a working ward and the gas was released by popping carbon-dioxide filled balloons. “By measuring the concentration of the gas over time, we were able to quantify the exposure at each bed and therefore the potential risk to a patient in that bed,” said Laura Pickin, one of the members of the research team. “We were also able to use the same data to measure the overall ventilation rate in the ward.” The Department of Health recommends that a ward should be ventilated at six air changes per hour, which means replacing the equivalent volume of air in the room six times every hour. “When the windows were left open in the ward, we recorded ventilation rates that were either satisfactory or better than the

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

TECHNICAL PAPERS NHS standard” said Dr. Carl Gilkeson, a Research Fellow who worked on the project. “When the windows were closed, the measured exposure to infection was typically four times higher, equivalent to a ventilation rate of only 1.5 air changes an hour.” The researchers found mechanical ventilation systems to be an effective alternative to natural ventilation. The installation of small extractor fans, similar to a domestic bathroom ventilator, beside each bed had a marked positive effect on ventilation, reducing risks to a comparable level to opening the windows. The study also looked at the effect of partitioning an old “Nightingale” ward to create single bays, a common solution to the problems of privacy posed by traditional designs. Although partitioning slightly increased risks to people in the immediate vicinity of an infected patient, it reduced risks elsewhere in the ward. The findings indicate that it is feasible to partition wards to create a better patient environment without significantly increasing the overall risk of infection. “These wards still exist and in the current economic environment they are likely to remain for some time. However, we have

43693_LIP_Asset Mouse Mat.indd 1

shown that they can be modified and that their ventilation can be good if they are managed correctly,” Dr. Noakes said. “Introducing simple mechanical ventilation to supplement the airflow in the winter, could be an effective approach to ensuring good ventilation year-round, without the energy costs of a full air conditioning system”. Co-author Dr Miller Camargo-Valero, Lecturer in Water and Environmental Engineering at the University of Leeds, said: “These simple, low-energy and low-cost solutions could also be of significant benefit for hospitals in the developing world, particularly in countries where airborne diseases such as tuberculosis are a major concern.” Measurement of Ventilation and Airborne Infection Risk in Large Naturally Ventilated Hospital Wards” is published in the Building and Environment Journal. The research was funded by the Engineering and Physical Sciences Research Council (EPSRC).

Further information Contact: Chris Bunting, Press Officer, University of Leeds; phone +44 113 343 2049 or email c.j.bunting@leeds.ac.uk

3/07/12 12:47 PM

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TECHNICAL PAPERS

Conducting facilities assessments

Determining where capital dollars should be invested Aran A. McCarthy AIA, NCARB

Health care delivery in the United States is undergoing substantial changes as health systems across the country now begin to feel the full impact of the Affordable Care Act. Health systems are merging and partnering at all levels, which requires combining, updating and repurposing existing facilities as well as creating new ones.

n this environment, successful health systems face an increasing need to plan accurately for future capital expenditures. It’s imperative that they prioritise bottom-line efficiency to capture and control market share in their demographic and deliver world-class affordable and accountable care. With multiple requests for investments, some more urgent than others, it’s crucial that administrators choose where to invest based on accurate data and thorough analysis.

efficient patient care. Health systems must position their facilities as pre-eminent, cutting-edge institutions at the forefront of emerging technologies in every sector — from radiology to interior finishes to patient room comfort. Managing all of these priorities while staying within a predetermined capital budget and preserving existing revenue streams is an ongoing challenge.

A facilities assessment is a process in which a health system retains a team of experts to survey and evaluate its real estate on the basis of condition, investment needs,viability for reconfiguration and other factors. Assessments can focus on a single building or an entire system of buildings. In-depth assessments address space utilisation, occupation factors and business growth models.

Facilities assessments also help administrators decide which buildings should be updated, and which should be demolished and replaced. If an old building requires constant maintenance and renovation, replacing it may be more cost-effective than maintaining it over the long term. In many instances, buildings have reached their effective service life. This may be a result of aged or outdated infrastructure, an inability to reconfigure the space in a cost-effective manner, floor-to-floor heights that make serving the spaces too expensive, a column grid layout that is not conducive to an efficient floor plan layout, or simply too many prior reconfigurations. Not all buildings are suitable for reconfiguration without considerable capital investments and many times it does not make economic sense to renovate.

Modern and well-maintained health care facilities are important for safe and

When hospitals merge or acquire new systems, they take ownership of new

A facility assessment delivers this data and analysis, helping administrators invest their capital strategically today and craft an effective plan for projected expenditures over the next decade.

In-depth evaluation

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

Surgical suite updates can present significant operational ramifications. PHOTO © KEVIN CHU/KCJP

buildings and real estate — both major acute care centres and the outlying outpatient network. These facilities are often aging, poorly maintained, inefficient or visually dated. When real estate holdings increase, acquiring systems may not know what condition the new properties are in. As a system grows or contracts, capital budgets change. Systems need continuous investments across the board. A capital budget must cover new equipment, updated infrastructure, changing clinical delivery models, aesthetic upgrades for patient satisfaction and compliance with new codes, among other items. The results of the facilities assessment will prioritise a system’s strategic investments, helping administrators to use the resources at their disposal for maximum impact.

TECHNICAL PAPERS Navigating the process

comparisons. The team defines the parameters of the assessment according to the following criteria: • Size and age of the facility; • The age and condition of expansions and additions;

Selective infrastructure upgrades should be scheduled to reduce clinical flow impacts. PHOTO © CHRIS COOPER

The first step in a successful facilities assessment is to quantify the effort and the outcome. Health system administrators must define the objectives, focus and the targeted final outcome. This process then proceeds with the selection of a qualified assessment team. Administrative champions make up a key component of this team. They shepherd the process, facilitate access to the facilities and explain the process to individual building administrators. These team members act as conduits to senior leadership, keeping them informed of progress, milestones, challenges and results. The rest of the team should consist of qualified professionals to undertake the work, including architects, engineers, program managers and cost estimators. The architect should lead the team and serve as a primary point of contact. Preferably, these professionals should be known to the health system and already have worked on the facilities that will be studied. This promotes efficiency, saving the time and cost of familiarisation. It also allows the team a running start because they may be aware of pre-existing conditions. A collaborative process is key to the successful delivery of an assessment because multiple professionals will have multiple places of focus. Once the team is assembled, members define the deliverable and the work process. They ask and answer questions that help them determine which facilities should be assessed, what major challenges must be overcome, and how deep the study must go. Each system calls for a different level of survey. Older buildings may need extensive review, while newer ones may need only code

• The physical condition, including the condition of structural, mechanical and electrical systems; • Systems serving information technology, nurse communication, emergency notification and similar functions; • Level of code or guideline compliance; • Facility functionality, such as department adjacencies; • Facility energy-efficiency and infrastructure conditions; • Overall aesthetics of the facility; • Site parameters, expandability and parking capabilities. Once these parameters have been established, the team should agree on the level of detail required to record the conditions. A simple rating system on a scale of one to five can be helpful. This can be used to evaluate and document the aesthetic appearance of a facility, the conditions of internal finishes, and the condition of infrastructure, air handlers, electrical systems and all of the components being assessed. This rating system establishes priorities and makes it simple to understand a critical need vs. a deferred maintenance issue. Moreover, assigning a colour to each numerical rating easily communicates needs — with green as the best condition and red as critical. This colour system then can be carried throughout the final reports, including all the assessment sheets, floor plans and even the executive synopsis. After completing the recording parameters, the team establishes a timeline for completing milestones such as the physical survey, draft findings, date of delivery to the cost estimators and final presentation to senior leadership. The project manager is responsible for maintaining open and collaborative lines of communication and ensuring that the assessment remains on track from inception to completion.

The team then visits, surveys and documents every single space. Using iPads can help to document the findings, make notes in real time on the plans provided, update spreadsheets and record changes or inconsistencies with the documentation before the survey. This may include previous floor plan changes or air-handler replacements completed by the facility at the local level. Using advanced technology facilitates a streamlined and accurate recording system that can be shared by all team members. The engineering teams associated with the specific buildings should undertake a similar survey. Their task is to assess the existing building systems, their life expectancies, how critical the system is to the immediate function of the building, and whether the system is the appropriate and efficient solution to the space. Hospitals and medically related facilities are estimated to consume 11 percent of all power generated in the United States, so their systems and equipment need to be highly efficient to be cost-effective. Upgrades to equipment like refrigerators and magnetic resonance imaging machines have been known to yield an 18 to 29 percent reduction in electrical consumption. Likewise, mechanical, electrical and plumbing systems must operate efficiently. Once all the spaces have been assessed, the compilation of data begins. The team creates individual sheets for each room or space, noting deficiencies, aesthetics or code items. Here, again, colour coding of the plans for each department is helpful. The complete data set then is delivered to the cost estimators, who evaluate the capital expenditures required for the recommended changes. The construction manager assigns costs to each element of the assessment and assists the team in determining year-over-year project cost escalation. In addition, this allows health system administrators to project capital cost expenditures over several years and create a projected investment schedule to fit their budgets. As they decide what updates to prioritise, administrators also should consider

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

TECHNICAL PAPERS the impact a project will have on a functioning unit or facility. For example, if a new surgical pavilion can be completed without interruption to the existing surgical suite, no revenue will be lost. While renovating the same suite may cost less, it also may take operating rooms out of service, resulting in lost revenue. In some instances, though, a system’s immediate needs outweigh the long-term outlook. In this Band-Aid approach, the system then will require a short-term investment, knowing that these costs cannot be reclaimed in the future. For example, one cancer centre installed trailers that remained on-site for more than three years so that patient care could continue during the demolition of current facilities and construction of new facilities. With rapid changes in technology, especially the growing efficiencies in mechanical and electrical systems, current systems investments must be weighed carefully against the future, but often waiting is not an option.

Results and reports When a facilities assessment is finished, the team presents hospital administrators with a book that contains an executive summary of findings, including coloured floor plans and spreadsheets showing the data gathered by the team. Ideally, administrators can easily reconfigure the

spreadsheets to show campus allocations, building allocations, health system priority allocations or service line costs, such as total investment proposed for acute care facilities. Each budget also should contain hard and soft costs, capital costs, equipment and infrastructure and, again, escalation costs. These detailed facilities assessment reports enable the health system to determine the best allocation of their resources by distinguishing between needs and wants. The data contained within the reports will tell them if it makes more long-term financial sense to build or replace an existing building than to continue to invest in capital project upgrades. One key to publishing a successful report is to make sure it appeals to a broad group of recipients. If the report can be understood only by one group of professionals, it will be relegated to a backroom shelf. The challenge is that not all hospital administrators think alike. If the document, or its synopsis, reads like an engineering report, only the facilities folks will use it. If it is full of complex strategies for phased projects like a master plan, only administrators will be drawn to it. To succeed, the report must strike a balance.

Using the data contained in the reports, health system administrators can strategically plan for maintenance and growth, projecting expenditures for the next five to 10 years. With data from the reports, administrators can decide whether to replace current buildings before systems fail or to invest in newer and more efficient facilities.

Smart investment Committing the resources to a facilities assessment is a smart investment in the future of a health system. The findings of the assessment report can act to spotlight deficiencies that need to be addressed immediately, sometimes before other clinical investments can be made. Aran A. McCarthy, AIA, NCARB, is a principal for health care in the Philadelphia and New York City offices of Francis Cauffman. His email is amccarthy@franciscauffman.com

A recently produced 300-page project report opened with a first-page overview that instantly told administration which of

Achieving efficiencies of scale A health facilities assessment gives hospital administrators a clear understanding of the state of their spaces and the ability to group potential projects together. This can improve financial efficiency in the following ways: • Coordinating projects. Traditionally, after identifying the need for a renovation or additional space, a health system searches for the best location without always considering the optimal infrastructure. Engineering upgrade projects can run parallel to aesthetic upgrades or more extensive renovations, and sometimes funds are wasted because renovations are not coordinated. For example, when an aesthetic upgrade project requires removal and replacement of a ceiling, it makes sense to install a sprinkler system at the same time. If the ceiling replacement is completed first and a sprinkler system is required later, a facility may need to destroy a good ceiling to install the piping.

its six facilities needed to be replaced. The page used a graphical, coloured chart, with a red triangle representing worst cases and a green circle indicating those in good condition. Readers who needed more detail in support of the recommendations could flip to the appropriate section. Colour coding and photography also were used.

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• Determining suitability of space. If an institution is considering multiple investments in the same location, the facilities assessment will inform decisions about whether these investments are valuable. Why invest in a cosmetic upgrade of a space if the mechanical systems servicing the area won’t be able to support it? The facilities assessment gives administrators the foresight to understand not only what can be seen, but what is behind the scenes. This leads to better decisions and more strategic investments. • Increasing purchasing power. The assessment also gives administrators the ability to package projects of a certain type to reduce overall project costs. Whether they’re aesthetic upgrades or air-handler replacements, the health system gains greater purchasing power based on size and scope if they are undertaken together. In an industry that is currently experiencing unprecedented collaboration and merger activity to increase purchasing power in the marketplace, taking the same approach to capital expenditures makes sense.

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

TECHNICAL PAPERS

The Townsville Hospital Redevelopment A Health Engineering Overview Michael Ward, Jeffrey Turner & Mark Fasiolo

1 Background

he Townsville Hospital (TTH) is a tertiary referral hospital located in Townsville, Queensland. Opened in 2001, it provides the very latest in cardiac, obstetric, gynaecological, paediatric, neurosurgical, orthopaedic, cancer, mental health, neonatal, allied health, anaesthetic and intensive care services to the many communities of North Queensland. It is also a major teaching hospital for James Cook University’s Schools of Medicine, Nursing and Allied Health. Needless to say, TTH is a critical piece of health infrastructure in the state’s north and is a post disaster referral facility for North Queensland. Supporting such healthcare requirements makes TTH a very complex and services intensive structure including such things as fire engineering, active and passive fire protection systems, high voltage distribution from central energy plants and critical services distribution. TTH is fast approaching the end of a $470 million redevelopment which commenced in 2009 and effectively doubled the size of the complex. Stage 1 saw the highly successful construction of North Block, a four story cyclone-rated and self sufficient building with emergency department, maternity unit and intensive care unit. Stages 2 & 3a comprised a new neonatal department fit out and theatre expansion. The Theatre Block expansion, also cyclonerated and backed up by North Block’s stand-alone (island mode) functionality, features two specialist theatres designed for conducting cardio thoracic and heart bypass surgeries in one and major orthopaedic surgeries in the other. The

building, just like North Block required interfacing on all 4 levels with the existing acute building structure. Stages 1, 2 and 3a were completed in 2011. Stages 3 & 4, due for total completion early 2015, includes an expansion to the existing Pathology and Cancer centres, and also the existing South Ward Block. It also included the construction of a new four-storey Clinical Services and Support Building and a new Central Energy Facility known as CEF2. CEF2 is an essential component of the site’s redevelopment as it provides the hospital with the extra capacity required to support the newly constructed buildings with critical services. CEF2 was completed August 2013. From an engineering perspective the design, construction and commissioning of this CEF2 facility was vital to providing the

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existing and new hospital infrastructure with the required services critical to continued operation.

2 Design Overview – Services Infrastructure For the TTH redevelopment project, there were a number of stakeholders that were involved in close consultation throughout the design process. These stakeholders included the design team, project delivery team, THHS Executive, clinical users and Building, Engineering and Maintenance Services (BEMS) support staff. Having such a large number of stakeholders involved from the start of the design process proved to be beneficial for obtaining a successful outcome but at times proved to be a difficult exercise to manage, as each party had differing priorities. Apart from

TECHNICAL PAPERS the project being driven by time and cost restraints, other priorities such as public perception, compliance, clinical operability and functionality, system maintainability and life cycle costs were also given due consideration based on the involvements of all these stakeholders. From a BEMS engineering perspective, the main requirements centred on a few key focal points, which were: • Expand and integrate existing site services infrastructure and control philosophies where possible – continue and expand what works • Procure new plant and equipment consistent with existing site infrastructure where possible – to achieve maintenance efficiency and minimise complexity • Where existing systems were approaching end-of-life (i.e. >12yrs) and required upgrade for compatibility and to achieve integration these were to be included and upgraded as part of the project (i.e. Site generator controls and CEF 1 Master PLC) • Where there was a defined product progression from existing systems these were specified to be incorporated to allow seamless expansion of the existing systems and single centralised control (i.e. Dry fire protection system – Ziton existing detectors were able to be retained and connected to new GE Edwards system designed for the new facilities) By having an input in the design process and using these focus points mentioned some of the key system design decisions were made as part of design. For example the design incorporated “single site solutions” for such systems as BMS, Fire, PLC, Nexus Emergency Lighting, Nurse-call, Security and Medical Gas Monitoring. This allowed for seamless integration to existing site services and single point of control and maintenance support. One of the key components to the redevelopment of the Townsville hospital was the design, integration and expansion of the central energy facility to support the new hospital infrastructure. BEMS was heavily involved in this design process to provide extensive knowledge of the existing on-site systems to the design team with the insight required to successfully integrate this

key infrastructure with minimal disruption into an operational hospital. Extensive discussions and various options studies were conducted over the location and construction of this energy facility and what options provided the best “long-term” value-for-money. Most of the discussions centred around whether to expand the existing central energy facility (CEF1) in its current location (both vertically and/ or horizontally) or to provide a new single satellite central plant facility separate from CEF1. Other sustainable design initiatives for the central services systems were also investigated, including Thermal Energy Storage and Cogeneration. However these items were deemed to be non-viable options for this site within the project scope and budget. One of the key foundations for provision of efficient health service delivery is the provision of reliable, efficient critical infrastructure that is: • Able to be properly and efficiently maintained over the life of the equipment • Has built in redundancy to accommodate immediate and unexpected service increase or plant failures • Able to be replaced at end of life or upgraded to meet capacity requirements with newer technology plant as it becomes available • Able to be expanded to meet service delivery growth over the medium & longer term • Located in a central facility to maximise the benefits and efficiencies of maintenance and synergies across different systems Based on these parameters it was decided that a “Central Plant” philosophy would be most suitable for the site to maximise efficiency. However physical space restrictions for future expansion and hospital operational requirements made a single plant location (i.e. expand CEF1) cost prohibitive. This option also posed an increased risk to the hospital operations as the potential for extended disruptions to existing critical services during construction would be very difficult to manage. The solution to this problem was to provide a second, separate, multi-storey central plant (CEF2) that was integrated and

Figure 1: CEF2 3D Computer Model

controlled by central systems, thus creating a “virtualised” central plant. This essentially means that the critical infrastructure was physically separated by location but linked and integrated to the point where the central plant control and production output appears that they are in the same facility. The benefit of this solution was that the capital expenditure for the construction of this satellite central energy plant (CEF2) provided additional redundancy to support whole site instead of just supporting new infrastructure stand alone. Where N+1 redundancy per building is required this can be reduced where multiple units are integrated across site and can support failure of one unit in the system. (i.e. N+1 across site). Central energy plants also have the added benefits of providing: • Increased efficiency obtained by ability to select the most efficient plant configuration depending on load and environmental factors • Ability to access plant downtime for maintenance without affecting reliability of supply or Clinical operations • System resilience – ability to sustain a plant unexpected failure without reducing reliability of supply • Physically separated location reduces risk of common failure affecting all plant at the same time • Lifecycle maintenance costs reduced due to single service contracts and consistent equipment selection As with most options, there were a number of drawbacks associated with this design solution that had to be individually managed. The main point of concern for this option was the increased capital costs

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

TECHNICAL PAPERS associated with upgrading the existing systems to allow site integration and also the additional costs to allow the intricate interconnection of services across site. This area was addressed through a value management workshop process to reduce the cost to within budget limitations; for example an accessible tunnel from the existing underground services corridor across to CEF2 was omitted from the final solution in lieu of underground buried service corridors. Another limitation of this central plant design proposal was the fact that the design team did not have extensive knowledge of existing systems and their operation. This was managed by ensuring BEMS staff was actively involved in all stages of the redevelopment to provide the necessary on-ground assistance and advice from their health engineering knowledge and experience throughout the planning and construction. Another major drawback with all the design solutions put forward was the risk of connection and commissioning services in an operational hospital environment. This required careful planning and close management during construction to address this issue.

3 TTH New Services Infrastructure From this extensive design review process, the TTH services infrastructure requirements were established. To simplify the complexities associated with this construction, a 3D model of the new buildings was created during design. This allowed full coordination of structural and services components during design to minimise onsite coordination clashes and also allowed a “virtual tour” of the internal and external structures and services orientation prior to construction Subsequent to this design process the infrastructure and services layouts were finalised and agreed upon by all stakeholders. 3.1 North Block This stand-alone, post disaster building was designed to operate in isolation form the rest of the facility, whilst still being interconnected to the existing hospital services infrastructure. The building was designed with a dedicated services plantroom on the top level which houses a 1MW generator and three 660kWr air-cooled chillers. North Block’s chilled water network was designed such that the

current central chilled water pumping system capacity was able to support this new building, thus allowing both chilled water systems to be interconnected and operate as a single system. North Block’s generation system utilises synchronising governors to allow seamless transition between utility supplied power and generation power, facilitating connect-ability into the existing electrical reticulation system. 3.2 Central Energy Facility 2 (CEF2)

Figure 3: CEF2 HV Switchboard

Figure 4: CEF2 HV Generator Room

points throughout the new and existing hospital site. Figure 2: CEF2 New Construction

This three storey facility was located on the far eastern side of the site and housed the extra electrical and chilled water plant required to meet the new site services demands. High voltage plant was designed and implemented for this building as a value management solution to minimise the required footprint size of the facility. This high voltage equipment negated the need for step-up and stepdown transformers and other intermediaries that would have been required had low voltage plant been specified. There was also an additional maintenance savings associated with minimising the number of additional components installed. In order to cope with the site’s increased demand of electricity a new 6MW emergency Ergon feeder was installed in addition to the two existing feeders (6MW and 3MW accordingly). The Hospital now operates on a “two of three” High Voltage supply arrangement with a HV interlink cable installed between CEF1 and CEF2 to allow integration of the HV network and backup generation. Two 11kV rings-the existing north ring supplied from CEF1 and the newly installed south ring supplied from CEF2 supplies TTH with power through 11 distribution substations located at strategic

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Backup generation for CEF2 is provided by two 11kV 2MW generators which have the ability to connect and load share with the existing CEF1 and North Block generators, increasing the total site emergency back up power to 8.3MW. This generation connected by HV between CEF 1 and 2 was configured with dynamic group control to allow either stand alone operation or combined synchronised control to power the whole site. In addition, a conditional connection agreement with Ergon allows the operation of the generators whilst maintaining a parallel connection to the mains power grid. Restricted to a minimum import of 250kW, the hospital is able to take advantage of market trends and operate generators for network demand response in times of peak electrical demand. As part of the new design philosophy the site-wide load shedding systems needed to be altered to ensure connected loads do not overload the available generator capacity. CEF1, CEF2 and North Block were required to have individual eight step automatic load shedding controls (approx 300kW steps for stand alone operation). However when the CEF’s and North Block are interconnected operating as one complete system, a global load shedding control was created which meshed the

TECHNICAL PAPERS areas/services depending on time of year and building loads).

4 Construction

Figure 5: CEF2 HV Chiller Room

individual systems together to create a 16step global load shedding system for site wide emergency power generation. The building also houses two new high voltage water-cooled chillers (4.4MWr each) on level 1 with their cooling towers located above on level 2. This brings the total site chilled water cooling capacity, inclusive of north block, to just over 21MWr. These new Chillers in CEF2 are linked to the site chilled water network with common primary headers which traverse underground and connect into CEF1 with isolation points to allow either stand alone operation or in unison as one complete system. From there, two secondary chilled water loops from CEF2 and two secondary loops from CEF1 extend out and provide the required chilled water to the entire hospital site. CEF2 has been designed to facilitate TTH master planned expansion by being constructed in such a way that allows removable concrete panels on its western façade to be removed to allow the building to be extended when required in the future. This will allow CEF2 to be expanded to incorporate CEF 1 plant capacity as it reaches end of life. The integration of these systems (CEF2 and North Block) into the existing hospital infrastructure provided the benefit of ensuring the site services network could be supported by either North Block, CEF1 and/or CEF2 even though their physical locations are on opposites sides of the campus. Countless times this ability to ‘back feed’ has proved its worth for many shutdowns/isolations attributable to maintenance or redevelopment activities, and has provided the hospital with a last resort option to restore services, site-wide, in the event of an unplanned outage (the extent of which is severely limited to critical

The construction of the new buildings across site has been ongoing since 2009. The fact that the majority of these new constructions were actually extensions onto and include refurbishments of existing buildings with direct interface connections with operational hospital areas made managing the construction process critical. Particular attention was given to service expansion and interconnection points. The physical boundaries between construction areas and existing operational hospital areas had to be carefully defined and managed and be sufficient so as not to cause disruptions to operations. Such things as maintaining compliant access/egress for staff/patients, managing noise and vibration during demolition, maintaining operational services in adjoining areas and ensuring correct pressurisation and sealing

of construction areas so as not to create infection control issues across adjoining areas were of paramount importance throughout the construction phase. BEMS role in the construction phase was extensive and crucial to ensuring positive outcomes resulted and risk to business continuity of hospital services was minimised. In stages 3 & 4 especially, on site construction was occurring on a major scale, with significant works simultaneously impacting the facility across three separate areas. This proved to be complex to manage and put a great deal of strain on BEMS and project resources. Regular walk throughs and surveillance of construction areas was utilised as a risk mitigation strategy. Incident reporting and investigations were also completed for continued improvement of the risk mitigation strategies being implemented. BEMS participated in construction update meetings and technical discussions run by the managing contractor to assist with

Figure 6: Aerial view of TTH 2010 Redevelopment (Stages 1,2, 3a)

Figure 7: Aerial view of TTH 2013 Redevelopment (Stages 3 &4)

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

TECHNICAL PAPERS identifying any activities that could cause issues to the service delivery to the existing hospital. Whenever any activity was flagged as a potential high risk activity, a Construction Impact Review was conducted by the Managing Contractor with all relevant stakeholders present (including clinical staff) so that it could be discussed in depth and procedures put in place to coordinate, manage and minimise its impact. As construction was taking place in an operational healthcare facility, risk management was of crucial importance to the success of the project. Our focus during the construction phase was to minimise disruption to business continuity for hospital operations across the whole of site. Risk was managed on a daily basis using a number of procedures including: • Construction impact review – Managing contractor – requested for med-high level risk activities • Work permits • Where the managing contractor was required to take possession of a portion of the Hospital site this was granted via a request including a possession of site permit detailing the site boundary and any identified Hospital requirements and risk management control measures. • Where any other works were being conducted in existing hospital areas not under possession, The BEMS permit to work system was utilised to control contractor activity, services interruptions and allowed BEMS to keep track of works in progress across site at all times. • RAMP’s & BCP’s – Risk assessment and management plans (RAMP) signed off by executive committee for any works that were of very high risk to the hospital operations. If required Business continuity plans (BCP) were created detailing how specific departments cope with a prolonged services interruptions. In addition to the above, BEMS also provided assistance to the external site representatives by conducting defect inspections on the services being installed in the new constructions, reviewing technical variation requests and scope changes as well as reviewing manuals and asbuilt documentation. BEMS was actively

involved in this process to ensure quality control of technical services, handover of sufficient documentation and transfer of staff knowledge through commissioning and training to allow continued maintenance of these systems once construction has been completed.

5 CEF2 Commissioning – pinnacle of services integration

of prolonged unplanned outages during the commissioning of this CEF1-CEF2 automatic HV Generator controls integration was initially unacceptable, a Business Continuity Plan was also developed to assist each specific department with procedures on how to cope with prolonged power outages. A key risk mitigation strategy outlined in the commissioning plan involved ensuring all key stakeholder parties were involved throughout the entire process and present on the days of testing. The core commissioning team onsite was lead by the PLC controls contractor, and comprised of representatives from the following groups: • BEMS engineering and trade staff – act as a liaison with Hospital clinical staff and Ergon, and to attend to and rectify faults, trips and restore normal operation following each planned interruption.

Figure 8: CEF2 Commissioning Day

The control system commissioning of CEF2 and its integration with the existing CEF1 was probably the most difficult and rewarding component of the construction process to date, as for most, this was a new experience. High level tests needed to take place to verify if the facility’s electrical and mechanical systems would respond appropriately under certain conditions and different modes of operation. Most notable were the ‘black start’ tests which involved opening the incoming feeders to verify if the Electrical Monitoring and Control System (EMCS) could restore power via alternative feeders and/or back up generation within specified time frames. This involved tremendous amounts of planning and consultation with key stakeholders to blackout an operational tertiary hospital on multiple occasions to ensure complete commissioning of electrical systems. To ensure this commissioning process went as smooth as possible, a predefined commissioning plan for the sequence of tests was created to ensure automated system responses matched the intended design. Thorough contingency measures and fallback strategies were in place in the event that the automated system response failed and power could not be automatically restored. This fallback strategy centred on disabling all automatic controls and manually restoring power. As the risk

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

• Managing Contractor Rep • Electrical Design Engineer • Independent Witness Engineer – oversee testing from a quality control perspective • Biomedical Technology Services – monitor and assist the critical clinical areas (e.g. ICU, Theatres, etc) • HSIA/IT Services – monitor and attend to any issue relating to data and voice networks. To complete the commissioning testing successfully, active involvement and close liaison was also required with Ergon switching crews and control room operators. The Schedule of proposed testing was created to ensure the complete commissioning of services whilst minimising the amount of disruption to the operational Hospital. Only three planned service interruptions were scheduled for each day of testing over a number of weekends. This number was selected as it was determined from previous experience that it takes approximately two hours to attend to and rectify faults, trips and restore normal operation in a facility of this size following a planned electrical interruption. Even with this extensive prior planning in place, the timing of these tests still required close coordination between commissioning team and critical clinical departments (e.g. ICU, Med Imaging, ED, NICU, OT), and quite often planned interruptions were delayed due to clinical emergencies.

TECHNICAL PAPERS have an affect on hospital operations being identified at the end of the project. • Project and hospital resourcing limitations – gaining access for design and project consultation to clinical and hospital support staff that have normal duties to attend is vital for a successful outcome however, this time is rarely backfilled or identified as a project resource. Figure 9: CEF1 Control Room

Figure 10: CEF2 Control Room

As to be expected, in the initial phases of testing, the automated system controls did not always respond as they were intended and on a number of occasions manual intervention was required. This, coupled with the unavoidable delays due to clinical requirements resulted in the commissioning of CEF2 being a rather lengthy process. However despite the complex nature of the task and the number of unsuccessful tests, no unplanned outages were experienced by the hospital throughout the CFEF2 commissioning process. The final commissioning of CEF 2 integration spanned four weekends, across three months and rectification of several identified issues before all tests were completed successfully.

6 Lessons Learnt Having now been through a significant hospital redevelopment project, there are a number of lessons from our experience that we would offer to others to consider when contemplating similar projects in the future. These include: • Change control management is important – changes in design/construction scope will be required from time to time between design and handover, these should be logged, consulted and agreed with stakeholders to avoid issues that may

• Staged handovers – delineation between construction and handover areas and plant/equipment was often difficult to manage and define. Commissioning of staged handovers also proved challenging requiring increased interruptions to services that traverse handover boundaries. • Decant planning – Project handover dates were required to be provided many weeks in advance to allow recruitment of staff, decant planning and supply of FFE equipment. Changes to decant dates due to project slippage is very undesirable due to the impact to hospital service delivery, incurred costs and planning. It is much wiser to allow some slippage (at least 2 weeks) between PC date and go live dates for training orientation and construction slippage. • Independent Commissioning Agents (ICA’s) and Independent consultants – should be engaged and report to the client (not the managing contractor) for improved quality control measures.

and active involvement of key stakeholders including executive, clinical and maintenance staff throughout all stages of the design, construction and commissioning process. From a BEMS perspective this philosophy centred on the incorporation of standardised and established technologies and a consistent approach to expanding the existing infrastructure of The Townsville Hospital. Where existing infrastructure or system was obsolete, careful selection of modern equipment and product line upgrades were included to enhance the overall functionality, longevity and redundancy of the site’s building services framework. This integration of old and new, of multiple technological dimensions and engineering system layers was and still is a challenging and delicate balance. There is little doubt that these considerations have achieved an outcome that is optimal, one that provides flexibility and reliability and one that has reduced past and future impacts to hospital services and operations – all of which are primary objectives of any healthcare engineering team. As the project’s end draws near we can rest assured that the stress endured, disruptions experienced and set backs suffered by the hospital staff and project team over the past 5 years was well worth the end result. The redevelopment journey has provided long term confidence that the facility is able to continue to provide excellent healthcare to the people of Queensland.

• Maintaining intellectual knowledge – changes in the design team and project team personnel throughout the duration of the project (design to construction) as knowledge of past dealings and decision making reasoning becomes ambiguous. Although this is difficult to foresee and is usually unavoidable and outside the client’s control it needs to be managed. • As-built documentation – Incorporating alterations to existing facility drawings such that on completion of any works affecting an existing area, an accurate set of updated existing drawings are issued with the manuals. Essential for continued maintenance and infrastructure planning.

7 Conclusion The key to TTH redevelopment expansion project’s ongoing success can be directly linked to a conscious design philosophy

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has never been easier or more efficient. Medical Suction is the most commonly installed utility in any medical facility. The recent acquisition of Edwards (world leader in ultra-high vacuum) by Atlas Copco, has resulted in a tremendous growth of knowledge, technical advancement and superior product offering. Current requirements are met with the Atlas Copco mVAC Range of complete medical suction plants for new installations and a range of vacuum pumps for pump replacements. However, there are whispers of a new innovation in vacuum that will change the way we think about medical vacuum installations. Advanced control and monitoring is becoming more prevalent for all plant installations in medical facilities. This is one of many arias where Atlas Copco excels. Not only does all equipment offer the same interface,

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

making it easy for facility staff to interface with various plants, be it medical air, vacuum or tool air, but standard features and options can provide full high level interface. This is done with internal lead lag control, volt free contacts, Modbus or Profibus and LAN amongst many other options. The use of central controllers to control all equipment, compressors, dryers, pumps is another option. There is so much more about Atlas Copco and how they can assist with technical and medical specific requirements. Whether you require advise, minor adjustments or major plant replacements, talk to your local Atlas Copco representative. Do you “really” know Atlas Copco? Stop in at the Atlas Copco booth at the IHEA Conference 2014 and find out more. You can also find out more information at www.atlascopco.com.au/auus/

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THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

TECHNICAL PAPERS

Hospital Commissioning and the Building Surveyor Greg Payne I General Manager, Hendry Group Pty Ltd

For project managers and hospital engineers, the successful delivery of a complex facility project on time, on budget and according to plan can be a process fraught with difficulties and challenges. Chief among these challenges is to integrate all the newly designed and constructed elements of the project into a commissioned whole.

he coordination and oversight of facilities commissioning are also important issues from a building surveyor’s perspective, since complex projects can be time consuming and can be difficult to approve and sign off when changes have occurred during construction, or when inadequate documentation is provided at the end of a project. One primary concern building surveyors are confronted with is the growing gap between the role, functions and responsibilities of the building surveyor when compared to those of the designer, consultant, contractor, owner and builder or project manager. At the core of the concern is the fact that project contractors including architects, designers and construction firms are typically paid on a fee for service basis and may have limited supervision roles during construction. With supervision responsibilities being constrained, there is little or no incentive to take responsibility for the final outcomes or learn from the project’s shortcomings. Tight project deadlines, increasing cost constraints and competing resource and time demands also place increasing pressure on the effective supervision of the project and as a result of all these factors, building surveyors are often called upon to manage construction changes or departures from codes, after the event.

The following provides an outline of a building surveyor’s role and obligations when inspecting and signing off a project.

Role, Responsibilities and Legislation The power, role and responsibilities of a building surveyor are set out in an Act of Parliament and subsequent Regulations in each State and Territory. Some states such as South Australia and New South Wales have a combined Development Act and Regulations, whilst in Victoria there is a separate Act and Building Regulations applying to planning and building. The building surveyor’s role therefore comes from a legal perspective, since their functions are carried out pursuant to some form of law. This imposes a community interest and duty of care obligation on the building surveyor and makes them responsible to ensure hospital facilities are safe, generally comply, are built to the applicable Standards as shown in the building permit/ approval or construction certificate issued, and are suitable to occupy. The legal obligations empowered by the legislation in turn sets out a hierarchy of control on a development through the legislation. The requirements of the legislation can sometimes be at odds with industry best practice or the use of newly issued codes or overseas codes such as

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

the (American) National Fire Protection Standards. Building Code of Australia (BCA), Australian Standards (AS) and Approvals Building control legislation in Australia is structured as follows: 1. Acts 2. Regulations 3. Building Code of Australia (BCA) 4. Australian Standards (AS) Acts provide the framework and outline the intent of the legislation, whereas Building Regulations generally detail how the intent of the Act would be applied in practice. Furthermore, it is the Building Regulations that may or may not call up (or adopt) specific sections of the Building Code of Australia (BCA) and (to a lesser degree) specific Standards. Since new or improved products and practices are continually coming onto market, these products are subjected to the compliance requirements demanded by Standards. The Standard’s testing and compliance requirements in turn, are developed by committees that may be represented by industry, technical testing bodies and government. Building regulations are generally updated regularly with a full revision

TECHNICAL PAPERS usually every ten years. The BCA in turn, is updated every year, but may or may not call up new or revised Standards to meet it’s deemed to satisfy provisions for building integrity and occupant safety. Being a performance-based Code however, the BCA is open to the application of Alternative Solutions where it can be demonstrated that the Alternative Solution meets or exceeds the existing BCA deemed to satisfy provisions. Therefore while industry might say that they should also be designing to the latest Australian Standard or internationally recognised Standard, the BCA states which Standard one should use in the design, and the BCA may well be calling up an earlier version of a particular standard. Adoption of non-referenced standards can result in a departure from the BCA which needs to be properly considered and addressed and can lead to misunderstandings if the building surveyor is unaware that the designers have used a Standard that is not nominated in the BCA. A recent example was a designer who was designing to the latest Standard for air conditioning AS 1668.2: 2002, while the building surveyor was checking to the 1991 Standard which is called up by the current BCA. The use of the 2002 Standard was not immediately made aware to the building surveyor and so for a short period of time the building surveyor and designer were at cross purposes. In essence, the 2002 Standard provided advantages to the designer. These were accepted, and the adoption of the 2002 Standard was ratified through an Alternative Solution based on equivalence to the DTS (deemed to satisfy) provisions. Most competent building surveyors will accept an Alternative Solution to adopt Standards other than those specified in the BCA, but they must be informed early in the design process. It is also important to note that where an Alternative Solution applies because of the adoption of a different Standard to that specified in the BCA, the long term affect could be reflected in the ongoing essential safety measures maintenance regime for a building following the issue

of a final certificate, occupancy permit, or certificate of classification etc. at the end of the project by the building surveyor. An Alternative Solution acceptable to the building surveyor could also have an impact on the commissioning of an installation, factors which need to be made known to the contractor.

Design Compliance and Construction In the increasing high technology building environment, designers and contractors need to become more involved with the intricacies of a performance design or referral authority approved departures prior to lodging a building permit application with the building surveyor. This is of particular importance during the construction phase where typically, what is being built is not necessarily what is reflected in the original building surveyor approved design which make up the permit documents. Facilities and buildings such as shopping centres, places of public assembly, hospitals and multi storey buildings are particularly at risk of as built changes, since they are required to have complex fire safety features that are included in passive construction or active systems, as set out in the originally approved design/ building permit by the building surveyor. Building surveyors and others who have spent an enormous amount of time and effort to have a design documented to an approval stage, often find changes made during construction which have a negative impact on the original design intent. To overcome this, it is important for Design Consultants to be engaged to supervise, inspect and approve installations progressively during the construction of a building and for contractors, particularly Design and Construct contractors, to constantly ensure that their installation complies with the original approval. Further approvals and permits by a building surveyor must be put in place should a design be changed, well before the installation is commissioned at the end of the project. Building surveyors see this as being an area of concern when consultants are not

adequately engaged to inspect the work relative to their expertise, and invariably causes the building surveyor to escalate their due diligence when faced with the completion phase of a project.

Inspecting and Commissioning Inspecting and signing off a project can be a time consuming and complex task. Unfortunately from a building surveyor’s perspective, too little regard is given to progressively documenting the actual construction and testing of an installation during a project, resulting in embarrassments and time-driven contract pressures not allowing sufficient resources to be devoted to commissioning at the end of a project. The building surveyor considers the signing off of a project as being a separate “permit” in its own right. For example, this is presently the case in Victoria at the moment as an applicant must submit a Form 5 “Application for Occupancy Permit”. Consequently, an acceptable level of documentation will be demanded by the building surveyor. Provision of as built plans will most likely be required and a delay can be expected for the as builts to be re-examined. This means that if there has been a failure to collate evidence of the installation during construction or the approved plans have not been followed, significant delays will be faced and there will be a need to back track and explain what was installed in order to update the permits. An experienced building surveyor is well versed with this important step in the project and they will also liaise with the relevant authorities such as the Fire Brigade. Fire Brigades are also becoming increasingly diligent in this area and will want to inspect and witness commissioning tests. In New South Wales and Victoria for example, if a Fire Engineer has been originally engaged to issue an Alternative Solutions report, the Building Surveyor and the Fire Brigade will require a sign

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

TECHNICAL PAPERS off on the completed project by that Fire Engineer. So with the scene set, what are the expectations for the Hospital Facility Commissioning and how should this be achieved? When considering this aspect, one could consider two types of projects: • One that is in essence an alteration to an existing installation, or • Two, new installations, whether simple or complex. It is likely, when dealing with alterations to an existing installation, for the building surveyor to accept Contractor statements, commissioning reports and consultant inspection reports together with their own inspection regimes. The building surveyor will also check that the original permit documents have been complied with. Independent verification could be required for some installations. For new work, in particular complex installations, the building surveyor will require consultant statements outlining their supervision of the work, Contractor statements and independent verification by a suitably qualified and experienced person, together with documentary evidence for the work done by the Contractor. An independent person could be one that is listed by the Australian Fire Safety Practitioner Accreditation Board or other Registered Practitioner. The building surveyor will also wish to witness commissioning tests and may require several tests to be carried out. The Australian Fire Safety Practitioners Accreditation Board has a list of practitioners who are accredited to have proficiencies in certain key categories. Typically, these are: • Hydrants and hose reels. • Automatic sprinkler systems. • Detection and alarm systems. • Portable fire equipment. • Fixed suppression systems. • Emergency warning and evacuation. • Smoke exhaust systems. You will note that air conditioning zone, smoke, or stair pressurisation systems are not listed, therefore the person or

organisation to provide the independent verification for these systems will need to be approved by the building surveyor. Their credentials and experience would need to be established and accepted. If one considers a typical hospital multi storey facility, the hospital facility commissioning will usually involve the key steps outlined below. (The same philosophy will apply to other projects, while the level of complexity may vary). Contractors and Consultants would be expected to follow the same logical sequence of procedures prior to the Building Surveyor or a Fire Brigade attending site. Step One – Commissioning Phase • Checking and verification of installation compliance with the approved plans or if not, amended approvals are in place. • Carry out commissioning of individual installations by the contractor. • Document commissioning. • Inspection and report by relevant consultant. • Independent certification. Step Two – Verification Phase • Inspection of installations by the Fire Brigade and Building Surveyor. • Witness of tests by Building Surveyor and the Fire Brigade. • Integrated testing of complete installations. • Fault rectification and certification. • Re-inspection and testing. Step Three – Sign Off Phase • Labelling, identification, signage, tactical fire plans etc. in place. • Submission of test reports, component information, as built drawings, commissioning reports, consultant reports and independent certification etc. to building surveyor. • Inspection and report by the fire engineer. • Submission to Fire Brigade. • Fire Brigade approval and sign off. • Building surveyor final approval leading to project sign off.

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

• Witness that on site documents are provided. So specifically what does all this mean? Historically, building surveyors were comforted in the knowledge that projects were being well supervised, inspected and that safe guards were in place to ensure projects were completed in compliance with the approved plans. Traditionally this happened through the understanding that the Consultant was knowledgeable and doing regular inspections, the Contractor performing the work was competent, the Project Manager had measures in place to validate the work and the Owner had their Clerk of Works on site. Today, there is more reliance on Design and Construct where Contractors need to operate as if they were Consultants. This means that the building surveyor must place more emphasis on proving the compliance of installations towards the end of a project and their commissioning. Consequently, a building surveyor will require an Owner or Builder or Project Manager to furnish a significant amount of documentation to prove the installation complies. This in turn means that consultants (who may not be engaged sufficiently during the project) and the contractors must more adequately document and provide evidence of what is being installed as they go. Doing catch up from a list of final inspection issues by a building surveyor at the end of project may be too late. The philosophy outlined above will apply equally to other installations in a building such as: • Smoke and thermal detection systems (includes VESDA) and occupant warning systems. • Smoke exhaust systems (arcades, atriums, large buildings). • Hydrants, hose reels, fire mains, pump sets and static water supplies. • Sprinkler systems. • Emergency lights and exit signs (too a lesser degree when they are a single point unit). • Stair pressurisation. • Lifts (including emergency lifts).

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• Kitchen exhaust systems. • Emergency warning and intercommunication systems. • Fire rated switchboards, sub boards and cabling. It needs to be emphasised that where facilities contain complex multi-faceted active fire safety systems, where each contractor does their own bit, it is mandatory that a number of integrated fire alarm tests be conducted. This is usually based on a fire alarm being triggered via a number of inputs and the reaction of each installation is witnessed for correct full system function operation. Fire alarms would be triggered through various smoke detectors for example and one would note whether the smoke detector locations are correctly displayed at the fire indicator panel. Similarly, sprinkler activation would be simulated and the response of the installation recorded and measured. Air handling system operation can then be established concurrently.

The building surveyor would expect this testing to be properly documented and presented as a report and certification. One may question why the building surveyor would go to such lengths of requiring adequate proof of operational compliance of installations in buildings. It is important for Consultants, Contractors and Project Managers to note that the Building Surveyor will issue a list of Essential Safety Measures applying to the facility or the building work either at the issue of an approval or at the issue of an occupancy permit etc., depending on your State or Territory requirements. By law, it is incumbent on the Owner to maintain the items listed to the standard and frequency specified in the schedule. However, if an installation is poorly installed, or does not comply with the approval or does not perform as required, how is an Owner expected to maintain the installation to the specified standard?

The discovery of poor quality or non compliant installations leads to litigation and practitioners will be disciplined for their inappropriate actions by the relevant State/ Territory Regulatory Boards. The flow down consequence is that there is a duty of care obligation on the building surveyor (putting aside negligence) and this means that the building surveyor will not sign off a project unless completely satisfied with the compliance and performance of its installations. Compliance in this case means compliance with the BCA and the approved documents. Whilst this might sound overwhelming, experienced Contractors, Consultants and Project Managers will foresee these issues and plan their installation and commission phases to incorporate establishing proof of compliance and demonstrable operational compliance early in the completion phase of a project.

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

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THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

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HERITAGE ARTICLES The following is the first of a series of articles that will be published in subsequent editions of the Australian Hospital Engineer. The intent of articles is to present items of historical significance that portray past involvement and engagement of the IHEA in the Australian and International Health Sectors that inform members of the history of the IHEA.

The first of this series is presented by our historical buff Jim Meldrum to whom, on behalf of all Members, we express appreciation for his contribution to the IHEA over many years. In particular, for making available a copy of a Paper presented 27 years ago at the 1987 Conference of the NSW Hospital Engineers & Maintenance Supervisors held at the Campbell Hospital, Coraki, NSW.

Contributions to this segment of the Journal are welcome.

A System of Training & Instruction for Hospital Maintenance Staff

A paper presented to the 1987 Conference of the NSW Hospital Engineers & Maintenance Supervisors held at the Campbell Hospital, Coraki, NSW Jim Meldrum I Kempsey District Hospital

Introduction

his talk of mine today will give you an insight as to how a group of Engineers – such as ourselves right here & now – got together & devised a system of training & instruction for Hospital Maintenance Staff.

The Need The need arose inexorably out of a general squeezing of the funds to our hospitals, a reduction in the amount of equipment that was being allowed

to ‘outside contractors’ for repair & a general burdening of more maintenance to be done with no corresponding increase in staff. In other words, everybody realised that savings could be made by using ‘in-house talent’ if a lessthan-speedy level of maintenance could be accepted.

The Planning As almost every Hospital Engineer in Victoria is a member of the Institute of Hospital Engineers, Australia (I.H.E.A.) & a normal monthly meeting attracted, then,

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

at least 35 of us, it was ‘no problem’ to chat around & of course, find out that your problems are common to us all. Out of this grousing & griping, voices were raised to suggest that instead of wasting ‘hot-air’ on the Dept. Health, we should take the initiative & see what we could do to remedy our troubles in a positive manner. A sub-committee of 5 people was formed & their brief was to establish what was feasible (bearing in mind the economic climate) for the Branch Members to do.

HERITAGE ARTICLES Some months later the sub-committee produced their recommendations to the Branch who subsequently adopted them.

Administrative Back-up One glaring obstacle to show itself was the lack of an ‘Administrative Centre’ which would carry-out the ‘co-ordination function’ necessary for us (the Engineers) to accomplish what we wanted to do. Victoria has such an institution in the innerMelbourne suburb of Hawthorn. Known as the ‘Mayfield Centre’ it exists as a residential tutoring building for interested persons employed across the whole spectrum of the health care field. People from all over Australia attend the ‘Mayfield Centre’. Everyone from Ambulance Officers/Dieticians/Infection Control Staff/C.S.S.D. Staff/etc. The list goes on… The Centre readily agreed to take on the Admin side of things & then we knew that we were onto something big! With the Dept. Health’s backing a series of meetings were held, Calendars checked, dates set & a series of advisory letters sent out to all C.E.O.’s of all Victorian Hospitals. To say the response was immediate would be to tell an untruth. Our ‘grapevine’ informed us that most C.E.O.’s never acknowledged the fact that they had ever received such a letter about such a subject. You would think that they collectively were trying to brush it under the carpet! “Why would they want to do this?” you are asking me. They have so much to gain with so very little outlay. After all it’s only one-weeks wages paid to an employee who happens not to be at his normal place of employ, plus a $10.00 per day accommodation fee! It’s just like someone being on annual leave to me. Isn’t it to you? When Engineers fronted their respective C.E.O.’s they generally seemed to defer comment. Anyway, the sub-committee carried on & being battlers all, we carried the day.

The Course Content Much thought was given to the compiling of a syllabus that would be meaningful to all of the Maintenance Staff be they ‘Tradesmen’ or ‘Trades Assistants’. The questions of “What should be included”

& “To what depth of explanation the course participants could digest”, all had to be sorted out. The sub-committee laid out the course content as a whole & with sub-headings in particular & then passed it on to the Tutors. I should point out that up to this stage in the proceedings I was blissfully unconcerned by the whole thing. I was running my hospital with staff who had settled-in & none of us had any intention of leaving. Most of the maintenance work had been done before by at least one of us & right alongside of us was a major building project being built & full of its own headaches. The sub-committee reports & recommendations didn’t really interest me in the slightest & not until someone’s casual enquiry as to “How my papers (plural) were coming-on” did I realise the depth on my involvement. I had been ‘dobbed-in’ way, way back even to the extent of the two different lectures I was supposed to do, their position in the great order of things, dates, times, venue, etc. “Oh! Er! Yes I’m sorry about that but we had to give names for the printing at short notice – You should have received an official letter asking if you would be interested in giving these lectures – Why you didn’t get one I really don’t know”! Anyway; the deed was done & the first unit of the first course was not long away. I had to get out my text books & put pen to paper. One of the troublesome things to me was the unknown level of understanding of the course participants. Later on, we Tutors received a ‘breakdown’ of all the participants - which included details of their hospital’s plant, the work that they did & their hobbies, qualifications, etc., but I was ‘flying blind’ so to speak for this initial unit. Our Papers had to be submitted sometime prior to the commencement date so that they could be bound together in the form of a book. The Course Participants were each given this book on day # 1 & could follow the lectures word-for-word. Subsequent courses commenced at the Austin Hospital, Heidelberg, & none of the ‘starters’ had their books with them because those resident at ‘Mayfield’ had left prior to the office opening & the other

half lived locally & had come straight to the ‘Austin’. That’s just an example of breakdown in communications. We had the session at the ‘Austin’ because the lecture following mine (which was on ‘Fuels’ for boilers) was about boiler’s burners. When I found the list of ‘starters’ had people from hospitals with no boiler plant I was a bit disenchanted after the amount of effort that I had put into the preparation of my papers. My ‘other talk’ was about ‘Boiler-House Safety’, so you can see that my seething was justified. I was still a ‘bit anti’ about the whole thing even though I had put my own Fitter/Plant Operator through this pilot course. Remember what I said about C.E.O.s being reluctant to let their staff go. On with the story. The book being bound made us stick to much the same format no matter who we were talking to, but we laboured some points if the level of ability of the participants seemed to be able to digest it. We had everyone from Engineers/Fitters/Electricians/Plumbers/ Handymen/Gardeners & Odd-job men although the courses were advertised at either ‘Tradesman’ or ‘Handyman’ level. My personal feelings were that none of these two groups would contain people who would readily grasp a week-long barrage of technical information given to them straight out-of-the-blue, but that the book alone would give them something to refer to when they returned to work. Question times are a fair enough way of obtaining feedback or a measure of interest & I used to get very little. At the end of each unit the course participants were asked to answer some questions written previously by each lecturer. The answers were of a ‘true/ false’, ‘yes/no’ nature & were done just to ensure that they had gained some knowledge to justify their having attended this course. They were also asked to comment on the actual presentation of each talk e.g. “Was it interesting”? “Did the lecturer make himself understood”? Etc. It was heartening for me to have received a few ‘excellent’ on each occasion.

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

HERITAGE ARTICLES Some of the lecturers ‘seconded’ experts in the field to give part of their papers – one that comes to mind is a representative of a company marketing ‘Mechanical Shaft Seals’. We were never asked to become experts overnight, although after researching prior to standing-up & giving a one-&-one half hour talk on any subject, we were very up-to-date with knowledge pertaining to our own topic. Hence we were of more use to our own hospitals who allowed us, the lecturers, time off to deliver these papers. As a bonus for doing all this work we were paid by the ‘Mayfield Centre’ at the rate of $20.00 per hour out of their own budget.

The Papers Most of the papers were for a one-&one half hour duration. This was a fairly long time for both speakers & audience but few, if any, talks finished before their allotted time. The nature of the talk was usually to explain the function of the item, or the definitions of items attached or integral

with a machine or process, then having set the stage we followed up with the ‘nitty-gritty’. Both of my papers were entirely academic. Other lecturers had topics which had ‘hands-on’ experience as part of the talk.

Observations & Conclusions At the time that I left Melbourne the courses had established themselves as a means of giving information to Hospital Maintenance Staff in such depth as to make the written ‘hand-outs’ very valuable documents. For anyone aspiring to the dizzy heights of ‘Hospital Engineer’ this was THE set of documents to read. Having read the book you gained a valuable insight as to what an everyday life of a ‘Hospital Engineer’ was all about. It was not always possible for us to be present to give our papers personally & so ‘stand-ins’ were employed. This was sometimes the other Engineers who were speakers already & sometimes newer

Engineers. All of them used the notes done for them by the initial speaker. There would be no reason why speakers from the ‘Commercial Sector’ could not give the papers on their own particular subject as long as it was not a ‘Commercial’ presentation. Most conferences draw speakers from outside of the hospital field after all…! Ideally we would have liked to have seen an institution similar to that at ‘Falfield’ in England. Here they have a permanent workshop set-up. All manner of equipment pieces are available for participants to study & fault-find on. It may be that we here should commence saving our scrap items of equipment (old autoclaves/steam traps/pumps/ whatever/) so as to be able to show newcomers to ‘Hospital Maintenance’ what they need to look for. Actually some form of Central Store’ for each Region wouldn’t be a bad idea – especially for ‘hard-to-obtain’ items.

IHEA IHEA Heritage

In the context of IHEA heritage, two major events that were conducted by the IHEA on behalf of the International S U P Federation PORTING are reflected upon through extracts on the following 2 pages from past IHEA

Journals. The events being the 1984 and 2000 International Congresses.

considered to host the 2018 Congress in Brisbane. Our track record in hosting such an event has been clearly demonstrated and trust M ANAGEM EN T that if successful IHEA will meet the challenge as was met in 1984 and 2000.

TITUTE of HOSPITAL ENGINEERING, AUSTR

H These E A L Ttwo H events F A C were ILITIES

milestones in terms of IHEA history. Linking them to the current era IHEA is being

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

This document relates to the 1984 International Congress hosted by IHEA in Melbourne. There is a current bid to the IFHE for IHEA to host the 2018 IFHE Congress.

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

KONE opens the door to streamlined medical care

“KONE is the market leader in hermetically sealing doors for the healthcare sector” says John Wilson, National Manager KONE Building Doors Division. “The KONE Hermetic Door efficiently and economically maintains over and under pressure, one of the basic demands of an operational theatre. The automatic door is no-touch, and with no special casing or sill it can’t harbour contaminants – this is all vital when infections and viruses could compromise a successful patient outcome.” He says the new KONE Gliding Door is also the only product of its type available in Australia and ideal for hospitals as well

as aged care facilities. “There are no rollers – the linear panel is held by magnets, so it can be opened and closed with a finger tip. It also uses much less space than a swing door, so it gives you precious space back to optimise efficiency – while still maintaining privacy, such as on a patient ward.” Its unique design means it’s also the only sliding door in the market that allows a permanent patient carry rail to be installed, so a patient can be lifted from bed and transported into other rooms efficiently and quickly. John says KONE is typically known for its elevators, but it is also one of the leading building door suppliers in the world, thanks to its cost-effective, reliable products and dedicated field support. “KONE globally is the second largest maintenance service provider in the Building Doors Access industry, and has been ranked by Forbes as one of the most innovative companies in the world for the fourth year

in secession. We also have 23 locations around Australia – making KONE the only truly national service provider for the hospital sector.” KONE Gliding Door allows for permanent

KONE’s head patient rail to be installed. office in Sydney will be the first building in Australia to use KONE’s two new doors. While they might not need the extra radiation-proofing that lead shielding would add, the new hermetic doors will reduce noise, save on power – and save valuable workspace. For more information contact KONE Elevators: Call: 1300 362 022 Email: customerservice.au@kone.com.au Website: www.kone.com.au KONE Elevators operate branches Nationwide – contact KONE for the location of your nearest branch

ADVERTORIAL

n a busy operating theatre, laboratory or clean room environment, hygiene can make all the difference to patient outcomes. Noise reduction, air-pressure control and accessibility are also essential. So KONE has developed a unique hermetic door specifically for the needs of medical facilities.

A successful hospital visit begins at the door SAfE, hygiENiC AND rEliAblE As one of the world’s leading providers of doors, KONE understands your hospital’s unique operating environment. Globally, we are a technology leader when it comes to managing the smooth flow of people throughout buildings. And now, our two most innovative door products are available in Australia. Hermetic Doors –ideal for operating theatres and X-ray rooms, they reduce the risk of cross-contamination and offer high noise reduction and constant air pressure. Gliding Doors – save up to 15% of the space in a patient ward with linear technology that allows you to open or close with a finger tip. KONE’s industry-leading maintenance program includes 24/7 Customer Care and 100 specialist Door technicians around Australia. We’ll keep your doors operating efficiently throughout their lifecycle.

Call 1300 362 022 to find out more.

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

TOPICS OF INTEREST

Systems integration: why it matters

Val Jovevski I Sales Director – Major Projects, Honeywell Building Solutions (South East Asia, Pacific, Middle East & India)

Hospitals, much like any organisation today, are under ever-increasing pressure to reduce operating costs through streamlining work processes, creating efficiencies and improving sustainability.

t the same time, facility managers play a critical role in creating safe operations that protect staff and patients, by running effective building management and security systems. The traditional role of hospital engineering is evolving as a result. The rise of integrated technology means that the value a facility manager can bring to the business reaches more touch points than ever before. Integration platforms, such as Honeywell’s Enterprise Buildings Integrator, are not only improving efficiencies and creating new capabilities, they are also improving outcomes for facility managers’ customers: hospital clinical staff and patients.

The value of integration Many facility managers will be familiar with the concept of a systems integrator. In fact, most hospitals in Australia today will already have some sort of integration system installed. An integration platform effectively allows facility managers to bring together a number of disparate systems – such as HVAC, security, fire, water and environmental controls. It gives users a single point of access and consistent view of information and resources to enhance their ability to monitor, manage and protect a facility. Combining multiple systems helps to improve operational efficiencies, optimise asset performance and maximise existing

investments – allowing facility managers to do more with less. But while a number of hospitals have these capabilities at hand, our experience has shown that facility managers can be doing more to take advantage of the functions of their integration platform.

The way forward: new technology To improve their performance, facility managers can benefit from a greater understanding of the latest enhancements to integration technology, which will help them to navigate an increasingly cost conscious and lean staffing environment. Today’s enterprise integration platforms empower the facility manager to take advantage of mobility tools, which provide the right information to the right people at the right time. For example, our latest release introduces tablet-based connectivity in addition to smartphone access, to replicate the interface of a traditional workstation. With cloudbased services, systems can be remotely monitored and information gathered in real-time from anywhere. Integration platforms are also becoming both increasingly powerful and more user friendly, with automation engines that put the power in the hands of the user – allowing them to make changes on the fly, write their own scripts and simplify everyday tasks. And with more facility managers becoming attuned

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

to the user experience, systems now also offer visitor management to streamline the administrative workflow around visitor-related activities.

Integration across the hospital Beyond just providing facility managers with an ability to do their jobs better, integration platforms are becoming increasingly relevant to the clinical side of the hospital environment, particularly for improving the patient experience. Today, integrators are no longer just responsible for the building management side of the business. Instead, clinical and non-clinical systems are being brought together to improve the capabilities of clinical staff as well as patient outcomes. Patient administration, medication and hospital information systems can be linked with mobility devices, RFID, and security systems to streamline processes, improve monitoring and accountability, and minimise errors. Given the complexity and scale of a hospital, administrators need to bring together large amounts of data and multiple systems, from a range of sources, and translate that into a workflow that makes the most of available resources. Making sense of all this information is crucial, and that’s where integration comes to the fore. When done well, integrated data and building management helps to keep costs under

TOPICS OF INTEREST unacceptably high levels of dosing errors, the hospital implemented a barcodingenabled, point-of-care solution primarily for medication administration, to ensure the “5 Rights” of patient safety (the right patient receives the right medication at the right time in the right dose via the right route). Today, more than 80,000 medication doses are administered per month using the solution, and medication administration errors have been reduced to zero.

Facilitating a conversation: why it’s important These kind of applications mean that from a facility manager’s perspective, the benefits of an integrated system not only helps them to create efficiencies in their own work processes, but to demonstrate increased value to clinical staff as well as the executive and management team.

control, allocate resources appropriately and free up staff members’ time, so that they can focus on clinical care, not administration. This might work as follows:

• The medical staff locates the necessary equipment for the procedure through RFID tags, while remotely controlling the temperature required in the operating room.

• A patient scheduled for surgery logs on to a secure website and confirms their time for a procedure.

• The patient’s identity card is used prescribe and administer medicines. The pharmacy dispenses the prescription, then cross-checks it with patient’s ID and record, significantly reducing the potential for medical errors.

• When the patient arrives, a wireless device allows her to register and an identity card is generated. • That event triggers a workflow, which in turn prompts a clinician to come and greet the patient, while a bed is allocated.

One example of where integration has improved the patient journey is a children’s hospital we have worked with in the USA. When faced with

Having said this, we know that generally in Australian hospitals, this technology is not yet being used to its full potential. Stakeholders from a range of departments – procurement, project management, facility management, IT and clinical care – could all benefit from an increased understanding of what a systems integrator can do, and how they could leverage their existing investment more effectively. It’s important for facility managers to get involved in conversations with relevant people across the business for a better understanding of what can be done. In many cases, Honeywell will work with customers to facilitate these discussions, bringing together as many people as possible to share experiences and requirements. The key to success is to genuinely understand how a hospital works, break down all processes and systems behind it, and then make sense of this data. From that point, we can focus on process design improvement, bringing disparate systems together under one master integration tool. This is particularly important as hospitals’ IT systems become more complex, medical records become digitised and cost pressures demand the highest levels of utilisation for resources – from beds through to consumables.

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

TOPICS OF INTEREST Creating shared benefit In the hospital of the future, facility managers will no longer be able to operate in a silo. Clear benefits can be derived not only from an integrated approach to systems management, but open communication channels between different groups across the business. Integration empowers facility managers to improve outcomes for clinical staff, while also giving them a better understanding of the operating environment to improve their own day-to-day tasks. Ultimately, reaping the benefits of this approach requires both facility managers and clinical staff to consider how to do things smarter, by using the technology thatâ&#x20AC;&#x2122;s available. Taking a step back to look at all the moving parts of a hospital network can create new opportunities to work collaboratively, and better utilise the integrated technology that underlies it. access control - HE ad (AU) 2.09.14_Layout 1 03/09/2014 09:35 Page 1

access control

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THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

TOPICS OF INTEREST

Modern Duct Cleaning REBECCA PHELAN I Kleenduct Australia

Examination

Air Handling Unit

beneath the fine dust but in isolated sections is not.

odern video inspection cameras are creating a whole new world when it comes to duct cleaning because they are completely illuminating misrepresentation. The possibility of over charges and under-performance is rapidly declining. Those of us who have a long term vested interest in the industry embrace these changes and fully promote the use of high resolution video inspections.

Still images of video footage

Heavy – High levels of visible dust, debris, fibres or any other contamination cover the component. Component surface is barely if not at all visible beneath the contamination. Critical – Build-up of visible dust, debris, fibres completely covers the surface and poses a serious risk to health Filters – type of filter bank and condition of filters including build-up,

Dampers

Coil – condition of coil, Fans – condition of fans Rigid Ductwork (supply, return, outside or exhaust air) The days of “before and after” photos are slowly but surely receding and with good reason. Inspection cameras are “live” and simply cannot be manipulated.

Free of damage (operation and maintenance should be carried out by a licensed Air Conditioning Mechanic)

Some important advantages are;

Flexi-duct (suppy, return or exhaust)

• You can narrow down the areas that need attention and spend your money more wisely, • Early detection of mechanical or bacterial problems.

Diagnosis With modern equipment, any reputable duct cleaning company should be able to carry out a thorough inspection of your ductwork pinpointing exactly what is going on inside the ducts. A video report and testing of HVAC components will lend weight to your funding submission for this vital but all too often overlooked maintenance. A good report should include the following as a minimum;

Clean – no visible dust, debris or other contamination Light – slight 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. Moderate – Visible levels of general dust with varying density and limited areas of accumulated fine debris. Component surface is still visible in some areas

Clean – no visible duct, debris or other contamination Light – slight 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. Moderate – Visible levels of general dust with varying density and limited areas

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

TOPICS OF INTEREST of accumulated fine debris. Component surface is still visible in some areas beneath the fine dust but in isolated sections is not. Heavy – High levels of visible dust, debris, fibres or any other contamination cover the component. Component surface is barely if not at all visible beneath the contamination. Critical – Build-up of visible dust, debris, fibres completely covers the surface and poses a serious risk to health

Free of damage and secure in place Area surrounding register is free of build-up Visibly clean Visible build-up Heavy build-up Extreme build-up

Registers

Treatment Despite advances in inspection technology, the actual cleaning of ductwork is often tricky. Caution should be exercised with the use of “robots”. In my experience good old fashioned hands on labour is still the most effective method of cleaning ducts. The use of a negative air unit is essential in special use systems and this process can be assisted with the use of a “whipper”. This is a nylon brush attached with cabling to a motor and is used to “whip” the surfaces of the duct loosening dust and particles which are then collected with a negative air unit. Air handling units need particular attention. Filters should be clean and free of damage and inspected on a regular basis. Coils have the potential to generate bacteria and also rust and scale and should be inspected regularly along with condensate trays. Fans need to be free of build-up and moving freely.

Well Being

ZELBRITE FILTER MEDIA TICKS ALL THE BOXES Better Filtration - Down to 2 Microns Saves Water - Up to 50% Saves Chemicals - Less Top Up Water to Treat Saves on Heating - Less Top Up Water to Heat It is NOT a recycled product & has a far smaller foot print than glass.

Does your current filter media offer you the same savings? Does it come with all 3 of these approvals?

For More Information, Contact Peter Rabbidge on (02) 4651 2377 or 0407 078 075 | www.zelbrite.com

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

A well maintained HVAC system in a hospital is vital for all occupants and forms part of OH&S and WH&S obligations to provide a healthy environment and it is not difficult to achieve. Video inspection cameras are slashing costs by allowing you to focus your budget EXACTLY where it’s needed. With a reputable duct cleaning company on your team, you can start making inroads into the maintenance of HVAC and what might have seemed an impossible task suddenly becomes attainable. Your chosen duct cleaning company should have the following attributes as a minimum; • Appropriate level of resources. • Evidence of experience and training and a record of previous work. • Appropriate insurances and licences. • Informative reporting system. • Quality, environmental and safety management systems. The proven ability to provide high-level reports is very important, especially at inspection stage. 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.

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.

ATTRIBUTES 

Accurate tender estimation



Management of complex and extended projects



Efficient handling of all administration requirements from SWMS/JSA to invoicing, follow up reporting, customer service and ongoing support



Networked nationally with full IT support



State of the art reporting



Up to date with Industry Standards, regulations and best practices



Fully insured

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.



Waterproof high resolution 360° pan and 180° tilt camera head gives an inside view into air ducts.



State-of-the-art battery packs provide 6 hours continuous operation.

We offer a wide range of services to an even wider variety of customers. We are extending our operations to include Fiji and New Zealand and will be an international company by mid 2014.

SERVICES 

Duct cleaning



Air Handling Unit Cleaning



Inspection & reporting



Kitchen Exhaust Cleaning



Filter Exchange



Mould Remediation



Video inspection



Production cleaning

1300 438 287

www.kleenduct.com.au

info@kleenduct.com.au

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

The Hospital Sensor TECHNICAL PAPERS

PD4-M-2C-DS

‘At the heart of lighting control’ One sensor, two separate lighting circuit supplies Minimises failure of lighting control in the event of circuit malfunction Shared pushbutton switch activation for two lighting circuits 360° detection

Remote Programmable

www.iautomation.com.au 1800 225 063

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

24M range

Product News Hospital Sensor’ – Simpler, Safer Essential Lighting

H I

Since the release of the Australian-designed ‘Dual Phase Hospital Sensor’ earlier this year, managers and designers of healthcare facilities have embraced it as a mainstay of their essential lighting systems. Most advanced hospitals and healthcare facilities in Australia make provision for essential lighting services at all times, usually by means of a generator-powered standby system that activates in the event of an interruption to grid power supplies.

While back-up power generation has certainly overcome most lighting problems associated with mains power outages, an unwanted sideeffect has been the clumsy duplication of wiring and associated hardware related to lighting motion sensor systems. In fact, it is not uncommon to find individual hospital rooms and corridors equipped with two motion sensors, two sets of switches, as well as two conduits of wiring, all connected to two separate distribution boards. This medley of duplicated hardware, which is both costly and hazardous, prompted Melbourne-based company iAutomation to design the Hospital Sensor: a far simpler and more efficient solution to dual-phase sensor lighting. Hospital Sensors (model PD4-M-DS) are manufactured in Germany by BEG Bruck Electronic Gmbh in full compliance with all relevant international standards, and have a range of up to 24m.

HOW IT WORKS

The genius of the Hospital Sensor is, in effect, to dispense with much of the duplication of traditional lighting motion sensor systems. It achieves this, says iAutomation’s Co-managing Director Craig Dentry, by connecting both regular and standby power supplies directly to the sensor, delivering essential and non-essential lighting from a single unit. “Furthermore, an extra low-voltage connection to the switch plate means the system can be controlled with a single switch – a huge time-saving feature that also reduces installation costs significantly,” Dentry says. “Contractors like it because they don’t have to throw as much wiring down the wall.” This reliable, simple and affordable solution has won plaudits in healthcare facilities across Australia, appealing to lighting designers working on both new and existing facilities.

RECENT APPLICATIONS

In recent months iAutomation Hospital Sensors have been installed in numerous prominent hospitals, including Gold Coast Private Hospital, Queensland; and Busselton Hospital, Western Australia.

Almost 35 Hospital Sensors have been used in the Gold Coast Hospital project, which is a new construction designed to accommodate essential and non-essential lighting in all corridors.

“Originally the expectation was to use traditional-style sensors in the corridors,” Dentry explains, though practicalities soon motivated the specification of Hospital Sensors.

“If we had not used Hospital Sensors, the contractor would have been required to put in an additional enclosure with contactors to control essential and non-essential circuits through the sensors; it would have been a mess in the risers.” Hospital Sensors minimised the complexity of the installation dramatically. An important ongoing bonus is more streamlined maintenance, as less cluttered boards and conduits present fewer opportunities for wiring mishaps or labelling confusions.

The newly enlarged Busselton Hospital has also benefited from the installation of Hospital Sensors, with 500 of the devices featured throughout the entire complex. The use of Hospital Sensors means this hospital will not only benefit from reliable standby lighting in the event of primary power interruptions, but it will also enjoy reduced operational costs by retaining state-of-the-art motion sensor detection at all times.

CUSTOMISATION IS KING

Members of iAutomation’s in-house engineering team are always happy to work alongside professional lighting consultants to make sure appropriate products are specified for individual projects. This ‘hands-on’ approach, Dentry advises, is necessary to ensure correct sensor placement and selection in the context of associated lighting requirements.

NOT JUST HOSPITALS

I P

A T

The simplicity and high quality of Hospital Sensors make them ideal for a broad range of facilities, according to iAutomation’s Engineering Manager Jason Wong. “We have had demand for these sensors in police and fire stations, detention areas, mental health units – anywhere that needs both essential and non-essential lighting,” he says.

Full data sheets and manuals for the Dual Phase Hospital Sensor can be downloaded from the iAutomation website.

For more information, visit the iAutomation website at www.iautomation.com.au or call 1800 225 063.

N I

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

Product News Three heads are better than one: Energy saving features of Hitachi Scroll Air Compressor

H I

Depending on the size (2.2 kW to 22 kW), Hitachi scroll compressors have one to four heads. Each compressor head consists of an oil free compression chamber with a scroll element, generating compressed air. In the event that one of the compressor heads is taken offline, the machine is able to continue operating with the remaining heads. Thanks to the innovative design, the scroll life is extended.

Hitachi Scroll compressor offers two modes of the operation – standard pressure control (similar to conventional pressure switch) and multi-drive control mode. Under pressure switch control (P-mode), compressor stops operating when reaching the maximum pressure, and restarts when the pressure drops to the specified Recovery Pressure. In multi-drive mode, operation of the compressor heads is modulated automatically, matching air supply to the need of compressed air. The delivery pressure is controlled by the quantity of the working heads, meaning that pressurising to the maximum pressure is not necessarily required and energy is saved. As an example, 15 kW unit, running at 50% capacity, will use 36% less energy compared to unload type. Other nice features of scroll compressors:

• Space saver – can be installed flush on back and right hand sides • Easy to operate – electronic control

• Extended service intervals and low life cycle cost

• Low noise and vibration – depending on the size, scroll compressor can be compared to people whispering or talking • Option of 1 MPa discharge pressure in selective models

• Oil-free – better air quality, no headache with used oil disposal. Suitable for ISO 14001 factories

For more details or a quote, please contact Hurll Nu-Way on 1300 556 380 or visit us on www.hnw.com.au

THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2014

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G IE T a top Looking for N I E solution? IL C

A F

Delivering innovative valve solutions

Zetco’s T4 Top-Entry ball valve for medical gases has all the required features:

 Full bore entry design  Top allows service and maintenance of seals

Phone 1300 659 639 Email enquiries@zetco.com.au www.zetco.com.au

body is cleaned  Internal and ready for installation

 Sizes 15mm to 50mm 91

High grade durability. Minimal disruption. Professional finish. Withstands general clinical cleaning cycles.