Hospital Engineer Vol 37 No 4 Summer 2014 by Adbourne Publishing

VOL 37

NO 4

DECEMBER 2014

the australian

engineer HOSPITAL S

National ANZEX Coordinatorâ&#x20AC;&#x2122;s 2014 Report Operating theatre ventilation system review A new utility: Medical grade wireless PP 100010900

SUMMIT MATSU CHILLERS, FOR CRITICAL OPERATIONS matsu.com.au 1300 CHILLERS 2

IHEA National Board of Directors

CONTENTS

National President Darren Green (NSW/ACT)

BRANCH NEWS

National President’s Message

National CEO’s Message

National Immediate Past President Mitch Cadden (NSW/ACT) National Vice President Brett Petherbridge NSW/ACT) National Treasurer Peter Easson (WA) National Secretary Scott Wells (QLD) Membership Registrar Alex Mair (QLD) Directors Steve Ball (VIC/TAS)

10 State Branch Reports

MEMBERSHIP

17 Service Awards 2014

INTERNATIONAL CONGRESS

18 IFHE Congress 2014 Buenos Aires – Argentina

Mark Stokoe (WA)

Darryl Pitcher (SA)

20 National ANZEX Coordinator’s 2014 Report

Rod Woodford (VIC/TAS) Chief Executive Officer Jim Cozens Finance/Membership Jeff Jones Secretariat/Website Administrator Heidi Moon IHEA Mission Statement To support members and industry stakeholders to achieve best practice health engineering in sustainable public and private healthcare sectors.

ANZEX REPORT 2014

CONFERENCE

25 National Conference 2014

INFRASTRUCTURE

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 MARKETING Susan Moore E: susanmoore@y7mail.com

29 Energy alternatives

COMPLIANCE & OPERATION

34 Patient-centred construction

TECHNICAL PAPERS

38 It is what it is! What have we learned? Adbourne Publishing 18/69 Acacia Road Ferntree Gully, VIC 3156 PO Box 735, Belgrave, VIC 3160 www.adbourne.com

47 Operating theatre ventilation system review

53 Meeting Queensland microbial water quality guidelines 60 A practical approach to facility regulatory compliance 64 Keeping up with legislation whilst doing our day job 70 Driving improvement with ISO 55000

TECHNOLOGY

74 A new utility

TOPICS OF INTEREST

78 Electrical fires 82 Hospitals that don’t make you sick(er)…

PRODUCT NEWS

86 Product news

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

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

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

National President’s Message Introduction

t is hard to believe another year has almost passed and we are rapidly moving through to the festive season and into 2015. Let me start by wishing all members, families, friends and business partners a Merry Christmas, safe and prosperous New Year. For the Board 2014 has been a year of planning, exploring new ground and reflection on member’s services through our member’s survey results. The Board will have a short break after our last ‘Goto’ meeting in December before we begin preparation in January for our three (3) day Board Meeting and training sessions to be held early February in Melbourne. As per my commitment and previous reports my intent for this report to provide a meaningful insight and summary of IHEA highlights, future directions, achievements and activity. Importantly and with mixed emotions I must report that our CEO, Mr Jim Cozens has formally advised the Board that his current health issues will force him into early retirement whilst he convalesces and considers his future and well-earned plans of leisure with his family. My mixed emotions revolve around the progress and significant achievements over the past 1 ½ years with Jim at the helm as CEO and the obvious loss of his experience, skills and enthusiasm. In saying this, although Jim’s recovery will take time, Jim will continue to liaise with our Board and provide guidance as we move into new arrangements with a successor. I can also confirm, that through good planning and communication we aim to ensure a seamless transition as we review the roles and responsibilities of the CEO, links to Board Portfolios and move into a recruitment phase. The Board will keep members fully informed of progress as we undertake the review and move into the next ‘chapters’ of the IHEA. It is anticipated that we will be in a position to provide an update of this process after the February Board Meeting.

National Conference and AGM Brisbane Firstly from reports at hand it is obvious that the 2014 National Conference – Brisbane, was an outstanding success and the Organising Committee, Branch CoM and event partners should be congratulated on this. It was unfortunate there was an unavoidable clash of dates and I was personally unable to attend. This was attributed to other key IHEA business requiring Jim Cozens, Darryl Pitcher and myself presenting a competing bid to host the 2018 International Federation of Hospital Engineers (IFHE) Congress. The short of this was positive and I can confirm that the 2018 IFHE Congress will now be hosted by the IHEA, further details are available below in this report and in a dedicated Journal Article in this edition of the Hospital Engineer. I must also thank our Vice President Brett Petherbridge and Immediate Past President Mitch Cadden and the balance of the Board for discharging official duties on behalf of Jim, Darryl and myself. Subsequent to the AGM I would like to confirm the new National Board of Directors in the table overleaf.

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 was successfully held; • Bid to host the 2018 International Federation of Hospital Engineering Congress (Brisbane);

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

National Board of Directors

Name

Position

Darren Green

National President

Brett Petherbridge

Vice President (VP)

Mitch Cadden

Immediate Past President (IPP)

Email Executive Committee

darren.green@gsahs.health.nsw.gov.au brett.petherbridge@act.gov.au Mitch.Cadden@gsahs.health.nsw.gov.au

Peter Easson

National Treasurer

Peter.Easson@health.wa.gov.au

Scott Wells

National Secretary

scott_wells@health.qld.gov.au

Jim Cozens

Chief Executive Officer (retiring)

ceo@ihea.org.au

Alex Mair

Membership Registrar

ama58500@bigpond.net.au

As all members should be aware we are entering into Year Two (2) of our three (3) year Strategic Plan. The Board has invested considerable effort in our Strategic Planning processes and below is a summary of our Year two (2) key strategies, proposed actions and primary nominated responsible groups.

IHEA 3 Year Strategic Plan ACTION PLAN – YEAR TWO (2) – 2015/16 Strategy 1. Technology; and 2. Training and Professional Education

Mark Stokoe

Director

Mark.Stokoe@health.wa.gov.au

Strategies

Activities

Responsibility

Darryl Pitcher

Director

d.pitcher@bethsalemcare.com.au

Improve engagement with members, and professional development through the use of technology

Develop educational/ training programs

CEO/State Branches

Establishing and maintaining a PD program (Registered Training Organisation)

CEO/Board

Continue and enhance CHCFM program

CEO/State Branches

Trade competency assessment accreditation

State Branches/CEO

PD specific to members’ needs

CEO

Customised Short courses and seminars Online

State Branches

Steve Ball

Director

STEVE@BarwonHealth.org.au

Rod Woodford

Director

engineer@castlemainehealth.org.au

• Progressing the 2015 National Conference – Perth 9-11 September 2015; • Compilation of the Annual Report; • Financial compliance via an Independent Financial Audit; • Participation at the NZ Annual Conference; • Market testing external support to review and refresh the IHEA Website; and • Further exploration of electronic communications for better access for our members, predominantly Goto Meeting Google Drive and SurveyMonkey LinkedIn

2018 IFHE Congress Bid

During the IFHE Congress 12-15 October 2014, Darryl Pitcher, Jim Cozens and myself represented IHEA and attended the International Federation of Hospital Engineering (IFHE) Congress in Buenos Aires. As previously advised our mission was to bid for IHEA to host the 2018 IFHE Congress with competing countries comprising of Italy and the United Kingdom, both of whom presented strong bids. We were delighted to announce that after three solid bid presentations and a two round ballot process the IHEA was awarded the right to host the IFHE Congress in 2018. Therefore the 2018 IHEA National Conference will be held in conjunction with the IFHE Congress in Brisbane with the Brisbane Convention and Exhibition Centre the selected venue (Sept/Oct dates yet to be confirmed). This also means Darryl Pitcher will now step through the IFHE hierarchy, serving as 2nd Vice President, Vice President and ultimately as IFHE President for two (2) years following the 2018 Brisbane Congress. Darryl is committed to representing the IHEA in this international forum and will be supported via an IHEA organising committee. The Congress Organising Committee have also committed to deliver a quality international event of high standard and have established support from NZ Institute of Hospital Engineering (NZIHE), other kindred Australian and Australasian organisations.

Strategic Planning

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

and Continue and enhance education and training programs

By When

December 2015

Summary In closing I’m sure all members will join the Board in wishing Jim and his family kind wishes and thanks for his commitment, diligence and passion shown for the IHEA not only as CEO but through his continued support during some 40 years of membership. It is my intent to maintain a close relationship with Jim and I have personally gained much from the working relationship and friendship we have formed. I must also thank the previous serving Board members, including Kim Bruton and Kevin Tan and welcome our newest Director Rod Woodford. I look forward to joining you all during the upcoming events held over the course of 2015, culminating with the Annual Conference in Perth. Warm Wishes and Seasons Greetings from, Darren Green M.I.H.E.A., C.H.C.F.M. IHEA National President www.ihea.org.au

, A EM U EN S TR T AL IA AG

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

National CEOâ&#x20AC;&#x2122;s Message

Engineering Congress in Brisbane in 2018. It was both an honour and privilege to be involved in the preparation, submission and presentation of the bid in Buenos Aires on the 12th of October. This outcome has presented a magnificent opportunity to showcase the IHEA to our international colleagues.

The principle development at the commencement of 2014 was the 3 year strategic plan which provided the IHEA future direction taking into account the sustainability of the Institute moving forward. From this process membership has marginally increased, state branches have been active in pursuing professional development programs of relevance and interest to members, state branch conferences have been successfully conducted, revenues have increased from various sources but more particularly from the 2014 National Conference, details which are subject to further report in this edition of the Journal.

Visitation to state branches was a personal highlight during the year working with state branch committees, participating in annual conferences and annual general meetings. Also, to develop partnering arrangements with the corporate sector and government departments relative to assets management in both the private and public sectors. As an initiative to develop working relationships to enable the Institute to maintain sustainability the outcome of consultation is awaited in South Australia awaiting the outcome of tenders relative to Asset Management and Government Sector restructuring. Queensland Health is considering the adoption of AssetMark as a benchmarking tool across Queensland public hospitals The significant outcome for the year outside of member service and professional development activities was the submission of a bid to organise and host the International Federation of Hospital

Based on the positive outcomes of the current year the ensuing year is full of promise relative to the enhancement of member services, corporate and public sector partnering and a successful Annual Conference being planned by the Western Australian State Branch. I extend best wishes to all for the coming festive season and trust that 2015 is fulfilling relative to involvement with your IHEA. Regards Jim Cozens BHA, FCHSM, CHE, Dip Eng. (Mech.), MIHEA, MSBE Chief Executive Officer

Reflection brings forward the realisation of achievement in many aspects of IHEA undertakings. These have been referred to in previous editions of the Journal with it now time to evaluate the outcomes.

Awaiting the outcome of the IHEA Bid to host and organise the 2018 IFHE Congress.

ith the passing of another calendar year leads to reflect on the events of the year and to contemplate the events of the coming year.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

BRANCH NEWS

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

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

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 keeps on happening.

TECHNICAL PAPERS

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

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

BRANCH NEWS VIC/TAS branch REPORT – Kim Bruton, Immediate Past 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 new Victorian/ Tasmanian Rising Star award, this year presented to Steve Ball from Barwon Health. 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.

SA branch REPORT – Peter Footner, PRESIDENT

t the Annual General Meeting in August, the new Branch Committee of Management was elected, with the following appointments made: • State President: Peter Footner • Vice President: Mike Frajer • Secretary: John Jenner • Treasurer: Mike Ellis • National Board Nominee: Darryl Pitcher • Committee Members: Darryl Pitcher, Tony Edmunds The last few months have again focussed on membership with ongoing activity around personal and written contact with the companies contending for the new Across Government Facilities Management

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:

• Howard Bulmer, Executive Lead, Strategic Services Division, Leightons – “Contemporary expectations of facility managers in an organisational context”.

• PD 3 2013 – held at RMH titled “Project and risk management”.

• Simon Witts, Principle Lehr Consulting – “BIM – this is an area of great misunderstanding in the market”.

• PD 1 2014 – held at RMH titled “Programs and initiatives”. • PD 2 2014 – held at Plumbing Industry Climate Action Centre titled “Looking 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?” Arrangements contract (for SA Health hospital sites). Committee members have also been talking with other potential corporate members, with a number of organisations currently in the process of applying for membership. The other significant membership activity has been an exercise, currently still ongoing, to ensure our membership records/details are accurate. Planning for a number of professional development activities also continued during the last quarter with a site visit to a major CBD building which has recently undergone (and continues to undergo) major engineering services upgrades which has already delivered very significant energy savings. A major, full-day seminar around issues of water quality is being finalised and is planned to be delivered in February 2015. We are hoping to attract a good contingent from our current

• 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 Van Teulingen, congratulations to you all. PD 2 was held at the Plumbing Industry Climate Action Centre (PICAC) Melbourne and sponsored by the Vesta Group. The PICAC tour of the facilities was very interesting and provided us a comprehensive rundown of their facility. PICAC provided us with information about what they have to offer in the way of resources and training. 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.

(and future) country members to this event, given relatively recent changes to relevant legislation and the ongoing focus on water quality & Legionella controls and the introduction of new technologies for managing water quality. Several members from SA attended the annual conference in Brisbane with all attendees finding something of significant interest to them. The annual Christmas get-together for SA members is set down for 5th December and promises to be a good opportunity to catch up with members and to network about future opportunities for IHEA. The Branch Committee of Management is looking forward to significant developments in the first half of 2015 with likely significant opportunities to grow the membership base in SA and to deliver some first-class professional development & networking opportunities to members.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

BRANCH NEWS WA branch REPORT – WA Annual State Conference: September 2014 Date: 5th September 2014 Venue: Hyatt Regency Perth ‘Health Facilities and the Bottom Line’

he Western Australian State Conference was held on the 5th September at the Hyatt Regency Hotel, Perth with Mr Roy Aitken as the Master of Ceremonies for the day.

following people who have excelled in the Health Care Industry: • Health Facilities Manager/Hospital Engineer of The Year was awarded to Mr Robert Falls. Robert was introduced to Hospital Engineering a relatively short time ago and in that time has excelled in all activities related to the job. Rob has also been active in improving his knowledge, participating in professional development and actively supporting the IHEA. Congratulations on your achievement.

Mr Todd Maclean receiving the Apprentice of the Year Award

The WA Branch annual conference was well attended with the numbers in the 80 plus region with over 115 attending the conference evening dinner. Keynote speakers from both the WA Government Health Department and commercial arenas included Greg Italiano, Ann Blunden, Glenn Scott, Irina Lindquist, Don Hitchcock, Scott Yates and Justine Shute covered a range of topics reflecting the conference theme of ‘Health Facilities and the Bottom Line’.

the respect of his managers and peers. Congratulations on your achievement.

IHEA Service certificates and badges Also, a special mention and recognition to Mr Lionel Delamotte for his 10 Year IHEA Membership and service within the WA Branch.

Mr Robert Falls receiving the Engineer of the Year Award

• Tradesperson of the Year was awarded to Mr Andrew Colyner.

The conference would not have been possible without our sponsors and the WA branch would like to acknowledge and thank Atmos Air, C&S Catering, Softlogic, Tarkett, Programed Property Services, Schneider Electric, Hills Health Solutions, Waterlogic, EBOS and finally KCare for sponsoring the conference.

Andrew has not only demonstrated broad, strong skills across all areas of his trade but also demonstrated good leadership and management skills that has impressed all of his work colleagues. Congratulations on your achievement. Greg Italiano

Mr & Mrs Jethro attending the Conference Dinner

Mr Andrew Colyner receiving the Tradesperson of the Year Award

Irina Lindquist

• Apprentice of the Year was awarded to Mr Todd Maclean.

At the conclusion of the conference keynote speakers, the National CEO Jim Cozens was called upon to present the WA annual achievement awards to the

Todd is a very conscientious, confident and hardworking young man that has an excellent work ethos that has earned him

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

Mr & Mrs Falls attending the Conference Dinner

BRANCH NEWS NSW/ACT Branch Report – Peter Llyod, State Branch President Introduction 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) over the last year, all Branch members, National Board and our many and varied sponsorship partners. I would take this opportunity to wish all a happy and restful Xmas and New Year.

NSW State branch Conference As a branch our focus will now turn to the 2015 State Branch Conference to be held in Newcastle and I sincerely ask that all that can be involved support this year’s conference with ideas, planning and attendance. Next year’s choice of venue is an intentional selection to facilitate access and engagement of as many NSW/ACT Branch members as possible and would encourage involvement and ideas from all NSW/ACT members.

AFM Online The Asset and Facilities Management (AFM) Performance Improvement Program has been established to improve how the assets and facilities of NSW Health are managed to ensure they are available in the right condition, at the right time and in the right location for optimal patient care. New business processes are being introduced, along with a new IT system, which will give asset and facilities management and biomedical engineering staff the tools to manage maintenance, inspection scheduling, and testing of medical equipment and other assets and facilities in an economical and timely manner. NSW Health owns assets worth in the order of $19 billion in 220 locations throughout the state, and has an annual maintenance spend of around $320 million, including 66,000 pieces of medical equipment valued at more than $840 million. (NSW Ministry of health; eHealth).

Institute of Hospital Engineering Australia NSW/ACT Branch Annual Conference Friday 8th, Saturday 9th May 2015 Newcastle NSW Venue: Club Macquarie, 458 Lake Rd, Argenton NSW 2284 Ph: 02 4958 7033 www.clubmacquarie.com.au

2015 Branch Awards

Summary

Branch award ceremony for 2015 will form part of our Conference in Newcastle, with requests for nominations to all NSW LHD’s early next year. Please look out for these with opportunity to reward deserving Facilities Management staff in your area.

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.

Redevelopment Wagga Wagga Base Hospital Photo opposite shows recent status of a $282,000,000.00 redevelopment @ WWBH, noting the tight nature of the site, staff are looking forward to a new Acute Services Building with new maintenance challenges for our AM department.

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 active and retired members and we should actively seek this knowledge to enhance our own working lives.

For all NSW/ACT members I would welcome photos and updates on any redevelopment projects, ESD initiatives etc. for inclusion in our regular reports and general correspondence. Email contacts below. Committee of Management Contact details Name

Position

Phone

Peter Lloyd

President

0428 699 112

peter.lloyd@gsahs.health.nsw.gov.au

Peter Allen

Vice President

0408 869 953

peter.allen@hnehealth.nsw.gov.au

Mitchell Cadden

Secretary

0408 228 419

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

Mal Allen

Treasurer

0467 761 867

mal.allen@hnehealth.nsw.gov.au

Steve Dewar

Member

0428 119 421

steve.dewar@gsahs.health.nsw.gov.au

Darren Green

Member

0418 238 062

darren.green@gsahs.health.nsw.gov.au

Helmut Blarr

Member

0411 152 898

helmut.blarr@sswahs.nsw.gov.au

Glen Hadfield

Member

0409 780 228

glen.hadfield@swahs.health.nsw.gov.au

Trevor Stonham

Member

0414 899 363

trevor@sah.org.au

Brett Petherbridge

Member

(0418 683 559

brett.petherbridge@act.gov.au

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

MEMBERSHIP

Service Awards 2014 ALEX MAIR I Membership Registrar

The following Awards were announced at the 2014 Annual General Meeting:-

50 years Geoffrey Smith, WA

40 years Peter Davison, VIC/TAS John (Jack) Oswald, WA Ronald Drinnen, QLD Alan Westmoreland, QLD

30 years

Max Smyth, VIC/TAS Brian Pope, VIC/TAS Glen Flanagan, WA Peter Simshauser, NSW/ACT

20 years

Elizabeth Coe, VIC/TAS Mark Stokoe, WA Andrew Bolton, NSW/ACT Ronald Dean, NSW/ACT Klaus Schrader, NSW/ACT Ronald Fulwood, NSW/ACT Ross Taylor, NSW/ACT Stephen Miles, NSW/ACT

Mark Kirchner, SA Rick Jarvis, SA Kevin Betterman, SA David Walker, VIC/TAS Damien Parker, VIC/TAS Michael Giles, VIC/TAS Michael Della Franca, WA Sunil Korelege, NSW/ACT Gary Whatling, NSW/ACT Denis Oâ&#x20AC;&#x2122;Beirne, NSW/ACT Phillip Hanbury, NSW/ACT Ross Gibbons, NSW/ACT Stephen Dewar, NSW/ACT Brian Cusack, NSW/ACT

Congratulations to all of these members.

Your awards will be available through your respective State Branch Secretaries.

10 years

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

INTERNATIONAL CONGRESS

International Federation of Hospital Engineering (IFHE) Congress 2014 Buenos Aires – Argentina Darren Green (M.IHEA; CHCFM; Adv Dip, Eng & Mgt; Dip, Proj Mgt) Darryl Pitcher (M.IHEA; Dip Man, Bus)

Introduction

or all the different countries and health care systems across the globe, common themes, challenges and issues remain despite the cultural diversity. Far from our Commonwealth and State operated health systems are the wide and varied countries and healthcare facilities of a similarly massive continent, South America. The International Federation of Hospital Engineering (IFHE) provides a common link and bond for the Hospital Engineer, the Institute of Hospital Engineering Australia (IHEA) and our sister Organisations. This was most recently evidenced through our attendance at the 2014 IFHE Congress, held in Buenos Aires in early October 2014. It provided an excellent platform for the international gathering of likeminded people who share the passion and challenges facing the global health system. The Congress was hosted by the Argentine Association of Architecture and Hospital Engineering (AADAIH)

In this article we will outline the Buenos Aires experience and share with you some of the key topics, and learnings from the biannual IFHE Congress. Importantly the task of the IHEA bidding for the 2018 IFHE Congress was front of mind for the Australian contingent comprising Darryl Pitcher, Jim Cozens and myself. It is with great pleasure I confirm that our bid to host the IFHE Congress in 2018 was successful. More detail on this is provided as below.

The 2014 IFHE Congress The suburb of Puerto Madero was the chosen location for the 2014 Congress which also hosted the IFHE Executive Committee and Council meetings in the lead up to the Congress proper. The suburb was built on the reclaimed port area between the urban city streets of Buenos Aries and the coast of Argentina facing north east across the Rio De La Plata estuary towards Uruguay. The area supported a healthy blend of modern city apartments, commercial buildings, shops and parkland retreats. The areas surrounding the port area are attractive to walking, cycling and roller blading the wide open spaces bordering the café and restaurant strips. The Congress venue was the UCA University an

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

aptly chosen site both physically and technically catering for over 300 delegates. There were two plenary sessions running throughout the congress providing a good balance of technical papers based on the theme of “Healthcare Facilities in times of Radical Changes”. The sessions focussed on current healthcare trends in design, construction and maintenance in response to significant economic, cultural and environmental change. There was also a focus on the emerging topic of Humanisation, through facility design emphasising a holistic approach to patient centred care models. There was excellent representation and high quality presentations from Latin America, USA, Australia, New Zealand, UK, Canada, Africa, Europe and Asia among others. The global spirit of cooperation and shared learning was fostered in an excellent and supportive and engaging environment.

IHEA Bids to host the IFHE Congress in 2018 The IFHE Standing Orders mandate the rules for bidding to host this high quality and much sought after international event. The 2014 Council meeting had to decide who was most eligible to host the Congress in 2018 and for the first time ever there were three competitors with bids coming from Australia, Italy and UK. All three bids were compliant and resulted in a robust council meeting to determine the successful host country. All three countries were given opportunity to make presentations to the assembled representatives of 22 countries who were eligible to vote in the two round ballot process. As a result; • The IHEA is delighted to have been awarded the right to host the International Congress in 2018. • Therefore the 2018 IHEA National Conference will be held in conjunction with the IFHE Congress in Brisbane. • The Brisbane Convention and Exhibition Centre will be the venue with dates yet to be finalised.

INTERNATIONAL CONGRESS • Darryl is now serving on the IFHE Executive as 2nd Vice President and will become Vice President in 2016 and then IFHE President from the 2018 Brisbane Congress. • Darryl is committed to continue to represent the IHEA in this international forum and will be supported via an IHEA organising committee. • The IHEA has and will, continue to forge strong and valuable international and regional ties. • The Congress Organising Committee have committed to deliver a quality international event of high standard with strong support from NZIHE and our other close regional neighbours including Japan, Malaysia and Indonesia. Following are a few images from Buenos Aires and look forward to providing further updates as our planning progresses.

The UCA University

The Australian delegates to the IFHE Council meeting (L to R; Jim Cozens, Darren Green and Darryl Pitcher) awaiting the outcome of the voting process.

IFHE Council Meeting 2014 – represented by 22 countries. Puerto Madero – reclaimed port city, now an urban hub.

IFHE ExCo meeting prior to the Congress

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

ANZEX REPORT 2014

National ANZEX Coordinator’s 2014 Report Mitchell Cadden I IHEA Immediate Past President & ANZEX Coordinator

Introduction

am pleased to report the ongoing success of our ANZEX Exchange Program. The agreement continues to be of great benefit to both the IHEA and NZIHE membership through our long standing member exchange program providing excellent professional development and travel opportunities between our two organisations and countries.

The 2014 Exchange Program NZIHE Delegates visit to Queensland, Australia The 2014 NZIHE Delegate, Trent Fairey, Project Manager, Facilities Management from Hawkes Bay, was hosted this year by the IHEA’s Queensland Branch as part of the October IHEA National Conference. Trent was in regular communication throughout 2014 with the QLD Branch conference organisers with Scott Wells taking the lead on our behalf to host Trent’s visit. During his visit Trent had the opportunity of visiting a number of facilities in Brisbane extending out to Toowoomba, as well as attending the 2014 IHEA National Conference where he presented a paper on Seismic Risk Mitigation – A Healthcare Perspective. This topic as you can imagine is at the forefront of all new facility design as well as having an impact on mitigating earthquake risk for existing facilities. Trent’s oversight of this issue brought home to us just how lucky we are here in Australia in not having to deal with this type of risk as part of our day to day business activities. Trent has been very forthcoming in his praise for the opportunity to have

travelled to Queensland and network with Australian industry peers and it is great to know we have another great ambassador for the program. Trent wrote of his visit to Brisbane; Brisbane, Australia the Sunshine state, well it certainly lived up to its name on the exchange visit this year, last time I was in Brisbane it felt like the rainy state but this time it was dry and a rather pleasant temperature. The plan was to fly into Brisbane 3 days earlier than the conference, possibly get out of the main city and visit a few Hospitals before attending the IHEA conference. First day Friday was spent at the RBWH with Scott Wells, and his team, an overview of the main site with a very interesting tour of the recently refurbished wards, this was an internal project that looked great and had a very happy user group. Obviously the team at the RBWH work well with their staff as the camaraderie with the medical teams was evident in their friendly manner of the tour. After the weekend spent with Family and Friends it was out to Toowoomba, a lovely town inland of Brisbane. Toowoomba Base Hospital was similar to my own location, slightly smaller but had a very similar make up of old and new facility and a dedicated team trying to keep the facility looking sharp and efficient. Kevin Tan made my time at Toowoomba very stress free and informative, a special thanks to him and his team for taking the time to show me around. Tuesday was back to the RBWH with Scott Wells, this time Scott took me on the full tour of the Centralised Energy plant, a very impressive facility. If anyone is thinking of centralised plant a visit here is a must.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

Onto the Conference at the Brisbane Convention centre – fantastic venue and Conference, located on the south bank it really is a one stop location. A very well run conference with some thoughtful and interesting content. The highlight for myself being the keynote speaker titled Mao’s Last Dancer”. This was an inspiring life story of Li Cunxin, taking us from a poor childhood in rural China to international stardom as a world-class ballet dancer. Some great lessons for us all on the resilience and determination that this man had throughout his life to date, and by the sound of it he continues to take on challenges in the Queensland community. I would like to take this opportunity to thank the IHEA and the NZIHE for continuing to support the ANZEX exchange. Trent Presenting at the IHEA National Conference

ANZEX REPORT 2014 IHEA Delegates visit to Auckland, New Zealand The 2014 IHEA Delegate was, Dean Farnsworth, Group Environmental Engineer – St John of God Health Care from our Victoria/Tasmania Branch, was hosted this year by the NZIHE as part of their November Annual Conference. Dean’s visit was coordinated through the NZIHE conference organisers with Bill and Lyn McDougall and Leon Clews taking the lead on hosting Dean’s visit. Dean wrote of his visit to Auckland; Earlier this year I was lucky enough to be selected to represent the Institute of Hospital Engineering Australia (IHEA) as the Australian ANZEX delegate at the New Zealand Institute of Hospital Engineering (NZIHE) National Conference in Auckland on the 6th and 7th of November 2014. Given that I was in the Australian Army for nine years I understand and respect the close bond our two countries share and I considered the opportunity a great honour. Aside from attending the two day conference and the one day NZIHE executive meeting I was also given the opportunity to visit two Hospitals, namely Middlemore Hospital in Auckland and Tauranga Hospital in Tauranga. The public health system in New Zealand is broken up in to Boards, known as District Heath Boards,

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ANZEX REPORT 2014

Tauranga Hospital

on our organisations Energy Efficient Light Replacement Project.

hospitals in New Zealand. Annually, they admit more than 91,000 inpatients, and handle in excess of 354,000 day-patients and outpatient attendances and they employ around 4,700 staff. Tauranga Hospital provides health services to the people of the Western Bay of Plenty. With a floor area of 58,000 m2 the 349 bed hospital provides medical, surgical, paediatrics, obstetrics (including a Special Care Baby Unit), gynaecology and mental health. The hospital is also a base for a range of associated clinical support services and allied health, such as rehabilitation, speech therapy, physiotherapy, stroke and cardiac support, district nursing and drug and alcohol programmes. John Black at Middlemore Hospital and Jeff Hodson at Tauranga Hospital gave me an engineerâ&#x20AC;&#x2122;s tour of their facilities and it was an excellent opportunity to compare how things are done in our two countries. Although some things are done similarly there are certainly lots of differences with the obvious one being the extra burden New Zealand faces with the management of Seismic risk. I was invited to attend the NZIHE Executive Board meeting which was

The care I received when I was in New Zealand was first class and I would like to take this opportunity to thank everyone that was involved in the planning and implementation of my visit. From the eastern side of the Tasman Sea I would like to thank the Executive of the NZIHE, Leon Clews, Bill and Lyn MacDougall, John Black and Jeff Hodson. And from the western side I would like to thank the IHEA executive for selecting me to represent the IHEA in New Zealand. In particular I would like to thank Mitch Cadden for his efforts and support. Dean Presenting at the NZIHE Annual Conference

held the day before the conference. It was a full day and I commend the work that the NZIHE executive does in managing and running the NZIHE so professionally. The two day conference was excellent and the presentations were very informative. The trade night on the Wednesday evening show cased some very useful technologies and equipment. I was grateful for the opportunity at the conference to present my paper

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

If you are an active member of the IHEA and would like to be part of the 2015 ANZEX Exchange Program which will be held in Hamilton New Zealand during November, look out for the Nomination Form in this journal. Alternatively you can download it from the IHEA website. Applications close Friday, 30 January 2015. If you would like further information please do not hesitate in contacting me by emailing; mitch.cadden@gmail.com

ANZEX REPORT 2014

Institute of Hospital Engineering, Australia National ANZEX Delegate Nomination Hamilton, New Zealand November 2015 RSVP: No later than Friday 30 January 2015 Full Name

Position Title

Phone Numbers

Qualifications

Current Studies

Current Employer

Specific Employment Location

Brief description of achievements or contributions to the organisation

Brief outline of your interest in being the 2015 ANZEX Delegate

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

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CONFERENCE

National Conference 2014 Peter White I Convenor, 2014 IHEA National Conference

The 65th IHEA National Conference was held in typical “beautiful one day, perfect the next” Brisbane weather from 15-18 October this year. From all accounts, the Conference was well received by all who attended, impressed by the venue, delighted by the food and excited by the program.

espite tight financial circumstances in some jurisdictions, the Conference was well attended, with a little over 200 delegates covering members, health sector suppliers, and representatives of government hospitals, private hospitals and aged care institutions from around Australia. The Technical Program centred on the Conference theme: Compliance – Governance in Healthcare Facilities. It was opened by keynote speaker Ian Maynard, Queensland Health Director –General, who challenged delegates to consider new forms of governance and new infrastructure management strategies in response to changing national healthcare delivery models. The other two keynote speakers filled the plenary room for their presentations. Li Cunzin is currently Artistic Director of the Queensland Ballet, but is better known through his inspirational autobiography as Mao’s Last Dancer. He demonstrated the roles that passion, determination, perseverance, courage and hard work

Songwoman Maroochy – Welcome to Country

play in maximising opportunities in life. His experiences relate to all industries and professions. The third keynote speaker was social researcher, Michael McQueen. Some might remember Michael’s presentation on Gen Y at the 2009 Gold Coast National Conference. His presentation focussed on “Winning the Battle for Relevance”, a revealing look at why good ideas and great companies/ organisations become obsolete and what might be done to avoid that fate.

Qld Health D-G, Ian Maynard

The presenters of the fifteen (15) Technical Papers came about equally from three industry participant groups: IHEA members, sector suppliers and sector consultants. The Technical Papers will be published in the Australian Hospital Engineer in this and the next few editions. The Conference was supported by a creditable range of Partners and Exhibitors, with the Conference Committee being in the uncomfortable position of not being able to

Li Cunxin – Signing “Mao’s Last Dancer”

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Michael McQueen – Battle for Relevance

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

TECHNICAL PAPERS

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

CONFERENCE accommodate all the exhibitors that applied to participate. The Exhibition Hall accommodated 39 exhibitor booths and our exhibitors were well supported by delegates, including a “full-house” on the opening Trade Night. The Social Program, although having fewer participants than in past years, appeared to be thoroughly enjoyed by the delegates and partners who participated in the Partners Program, the Social Dinner on Friday night, and the Social Outing on Saturday (pity that the steam train broke down and we had to ride behind a diesel locomotive, but the croquet and the lunch were great).

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Dinner Sponsor – Narelle Turner, Transfield Services

The Queensland Branch thanks all those who attend the 2014 National Conference. We trust that you enjoyed your stay in Brisvegas (even the US President at the recent G20 knows our real name) and that your participation in the conference was all that you expected. My public thanks go to the Conference Committee (Alex Mair, Kevin Tan, Scott Wells, Sturt Hentschel and Jim Cozens) and last, by far from least, the staff of Iceberg Events, event managers extraordinaire. Now we can all look forward to the next National Conference, in Perth, September 2015.

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INFRASTRUCTURE

Energy alternatives

On-site power generation technologies for health care Emily Fadrhonc, LEED GA I Arash Guity, PE, LEED AP, CEM I Amy Jarvis, PE, LEED AP

As institutions dedicated to providing care and protecting public health, it is natural for many hospitals and health care systems to embrace energy-efficiency and alternative energy as complements to their core mission. Moreover, declining up-front costs, new financing models, and ever-improving technologies have put alternative energy within reach for an increasing number of health care organisations.

n addition to financial payback, these projects can have other benefits as well. They provide an excellent opportunity to engage staff, visitors and the local community. Also, by reducing dependence on the electrical grid or other fossil fuels, a hospital reduces its exposure to volatile energy commodity prices. Lastly, integrating renewable technologies offers a valuable educational opportunity for facilities professionals to stay current on the latest energy breakthroughs.

Mix of technologies The optimal mix of technology type and financing structure varies dramatically from site to site. To optimise the effect of any energy technology, the planning process should take a holistic look at the building’s energy profile, work to optimise its energy performance through efficiency, assess the viability of renewable energy solutions and seek creative ways to finance renewable projects. Alternative technologies that have been used successfully in the health care setting include the following:

Solar systems Solar photovoltaic (PV) systems convert incident solar radiation into electricity. Solar PV panels can be roof- or ground-

One national health care system recently explored an enterprise wide approach to solar PV deployment, for example. The resulting solar program includes nearly 15 megawatts (MW) of PV across multiple sites.

Photovoltaic systems mounted on structures can convert solar radiation into electricity. PHOTO COURTESY OF RECURRENT ENERGY

mounted, integrated into a roof structure, shading or other facade features. PV enjoys many federal, state and local subsidies, including a 30 percent investment tax credit for for-profit entities. For non-profit organisations or organisations that do not wish to make the up-front capital investment in a solar system, new financing options are available that reduce investment by the hospital. These include solar leases, third-party ownership arrangements, local Property Assessed Clean Energy financing programs and solar power purchase agreements. An additional benefit of PV is that it can be peak-coincident, lowering consumption during times of highest energy use. And, of course, solar panels are a highly visible way to show staff, patients and the general public a commitment to renewable energy.

Supported by the system’s internal finance department, an engineering firm acted as program manager, conducting site assessments, competing feasibility studies, obtaining necessary permits and approvals, selecting a PV vendor and securing project financing. On average, the PV systems provide 10 percent of the power used at the sites that host them, making a meaningful dent in enterprise energy consumption. The success of a solar project is locationdependent. An assessment of the amount of solar energy available at a site, as measured by direct normal irradiance, can determine roughly how much energy the system will produce. An understanding of local electric utility policies will determine how solar power can be used to offset electric bills. Both are critical during project planning. Because a solar system only produces when the sun is shining, PV cannot provide base load power unless it’s paired with an energy storage solution. As a result, solar cannot reliably be used for backup power. Another thing to keep in mind is that even with new financing solutions, PV is one of the more expensive technologies on a per-kilowatt basis. Additional costs like reinforcing the

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

INFRASTRUCTURE roof or installing new electrical service can add to project cost. To ensure a successful PV project, hospitals should commission a feasibility study from an experienced firm that can evaluate site-specific conditions and make a recommendation on whether solar is feasible. Similar to solar PV projects, solar thermal collector systems capture radiation in the form of heat, which can be used for space or process heating, fed to an absorption chiller to provide cooling, or used to produce domestic hot water or hot water preheat. While visually similar to their PV cousins, solar thermal systems have a much lower up-front cost and can be deployed in less sunny areas. Because solar thermal systems typically do not generate electricity, they do not require interaction with the electric utility, making them easier to permit and install. For instance, the dialysis division of DaVita HealthCare Partners Inc., Denver, installed solar thermal collectors on its dialysis clinic in Indiana. By adding solar thermal to its portfolio, DaVita reduced natural gas consumption by almost 40 percent, yielding significant savings and proving the viability of solar thermal in a health care setting. As with PV, a detailed site evaluation is required and federal, state and local incentives are available to reduce up-front investment.

Wind systems Wind is well-understood, reliable and cost-competitive with conventional power in many locations. Wind also enjoys federal, state and local incentives to mitigate up-front costs. The size, design and styling of wind turbines have changed dramatically over the years. Large-scale, ground-mounted turbines and building-integrated wind technologies are most applicable to the health care setting. Both technologies convert wind energy into electricity, which can be used to reduce the purchase of conventional fossil fuel power. Building-integrated wind turbines utilise natural wind patterns created by the built environment to turn turbines and create power. To maximise efficiency of these turbines, it’s essential to understand the

interaction among wind, the building and neighbouring structures. A computational fluid dynamics model may be required. Ground-mounted turbines are more established and should be sited where the wind resource is best. These are generally more efficient than building-integrated wind. As utility-scale wind farms begin to upgrade their ground-mounted turbines, a market for refurbished turbines has evolved, allowing health care facilities to procure turbines with many remaining years of useful life for deep discounts. A multifacility health care system recently committed to install and operate an on-site, 1.6-MW ground-mounted wind turbine at its southern California facility. Working closely with zoning authorities, the facility gained special approval to install the turbine on-site. When complete, the system will fully offset the facility’s energy use. Supportive utility policies, specifically the ability to net meter excess energy produced by the turbine for use during times of underproduction, were critical to the success of the wind project. A lower-than-average up-front cost by using a refurbished turbine from a wind farm, also helped to boost the project’s viability. Production from a wind system is intermittent and depends on specific local wind conditions. Wind, unless coupled with storage, cannot be used to provide base load or backup power. Also, in most parts of the country, wind is not peak-coincident, meaning that a system will produce the most at times of lower on-site consumption. Both ground- or building-mounted wind systems can trigger local building code restrictions, requiring special applications or exceptions. Above all, any wind installation must attend to wildlife concerns, flicker effects and potential noise impacts of the equipment. If owning and operating a wind turbine on-site is not a good fit, a range of off-site options is available. One is to take an ownership stake in wind turbines located in a windier area and use the power produced to offset power used on-site. This requires specialised contracting expertise, but many renewable service providers can help. Another possibility is to purchase power

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

directly from a utility-scale wind farm, if such an option is available locally.

Waste to energy Waste to energy is a broad class of technologies, categorised by using a waste to create useful energy. Waste types that can be utilised include municipal solid waste, biogas created from landfills or wastewater treatment plants, agricultural waste and others. One example of the wide variety of available waste-to-energy projects is landfill gas (LFG). LFG projects use the methane created by anaerobically decaying organic matter in municipal landfills. Unused, this LFG would escape into the atmosphere or be captured and burned, or flared off, to convert it to carbon dioxide and water. When a landfill is located close to a large user of natural gas, there is opportunity to capture and use the LFG to replace natural gas that otherwise would be purchased from a gas utility. This involves connecting the landfill to the end user via a new pipeline. The pipeline is the major capital cost for these projects, so the closer the facility is to a landfill, the better. If a health care facility is not located close to a landfill, the organisation still can pursue a LFG project. Some facilities successfully have collected LFG off-site, cleaned it to local natural gas distribution utility standards, and put that landfill gas onto the natural gas utility pipeline network. While the facility will not burn the LFG directly, the net effect of reducing natural gas consumption is the same. The effect of this relationship is akin to the renewable electricity credit system, where one site claims a renewable energy credit for renewable energy produced at a different location. In this case, the health care organisation will need to work with the gas utility to pay the applicable transmission fees and ensure that the LFG is conditioned to pipeline standards. Sentara RMH Medical Centre (formerly Rockingham Memorial Hospital) in Harrisonburg, Va., has used LFG since 2010 to provide heat and hot water to its main hospital. Rockingham County’s landfill previously flared 100 percent of LFG, wasting the energy without doing useful

INFRASTRUCTURE after codes are clarified. However, unless a fuel cell uses a renewable source of power to create the hydrogen that they use — such as biogas — it is more of an energy-efficient technology than a renewable technology.

is associate sustainability engineer for Mazzetti in Portland, Ore. They can be reached at efadrhonc@mazzetti.com, arashg@mazzetti.com and amyj@mazzetti.com, respectively.

Other technologies for hospitals to consider

The largest challenge of LFG projects is the up-front cost of creating a new pipeline to connect the facility to the source of landfill gas, or installing equipment to purify the gas up to utility standards.

St. Helena (Calif.) Hospital installed a 400-kW fuel cell in 2010 to supplement the facility’s power and heating demand. The equipment provides more than 60 percent of the hospital’s electricity needs, reducing demand on the local power grid and improving system reliability. The fuel cell’s by-product thermal energy is used to meet the hospital’s hot water and space heating demands. The system was funded in part by a utility grant program and in part by an anonymous donor. The system saves more than $100,000 in utility costs each year which, combined with utility incentives, created an attractive payback.

Using LFG to displace natural gas often requires little or no modifications to existing equipment. Facilities frequently can get good deals on the source landfill gas, because otherwise it would be wasted or flared at the landfill. LFG projects also are a good opportunity to partner with the local community to make positive use of an otherwise wasted and odorous by-product.

Many fuel cells use natural gas to create the hydrogen needed to operate. While this is sometimes a more efficient way to create electricity, it is still dependent on a fossil fuel. Also, in some parts of the country with adequate renewables, hydro and other carbon-free sources on their local electrical grid, the greenhouse gas benefits of a fuel cell can be minimal.

Finally, an LFG project is one of the most direct ways to reduce greenhouse gas emissions.

Fuel cells are a promising technology and enjoy federal, state and local subsidies to bring down their up-front cost. However, because their greenhouse gas and energyefficiency benefit depends on several local factors, a detailed feasibility study is critical to determine if a fuel cell is appropriate for a facility.

work. The facility and its team developed a system that conditions the LFG to remove impurities and pipes it 2.5 miles to the medical centre site. The county owns the pipeline and the processing equipment; the medical centre uses its existing boilers to burn the LFG. In the winter, the facility meets nearly 100 percent of its heat demand using LFG, reducing its natural gas bill to zero. Currently, the facility saves about $250,000 per year. Since 2010, the medical centre has been accessing federal funding to retrofit additional boilers and expand its use of LFG.

Great potential A fuel cell is an electrochemical energy conversion device that creates electricity. PHOTO COURTESY OF BLOOM ENERGY

Fuel cells A fuel cell is an electrochemical energy conversion device that converts hydrogen and oxygen into water, creating electricity in the process. Solid oxide fuel cells produce electricity only, while other types of fuel cells produce waste heat that must be utilised to achieve maximum efficiency. Fuel cells offer several benefits. They are compact, quiet, produce high-quality power and may be able to serve as backup power

As part of a balanced energy management strategy, alternative energy has great potential in the health care industry. When considering these technologies, facilities professionals should build an experienced team that includes engineering, policy and permitting, financing and project implementation representatives. A project will stand the best chance of longterm success with the right team, patience and a firm understanding of local conditions. Emily Fadrhonc, LEED GA, is energy program manager and Arash Guity, PE, LEED AP, CEM, is chief sustainability engineer for Mazzetti in San Francisco; and Amy Jarvis, PE, LEED AP,

Renewable energy technologies are those that directly convert a natural source of energy — sun, wind, water and biogas — into useful thermal or electrical power. Some technologies often are grouped together with renewables, but are better thought of as energy-efficient technologies. Ground-source heat pumps, an energy-efficient technology, use the earth and its groundwater as a heat source and sink for conventional heat pump systems. They are an alternative to conventional air-source heat pumps, although they are often confused with geothermal energy. Geothermal energy is relatively rare and limited to certain geologically active parts of the world, as it requires direct use of hot water or steam from deep in the earth to create heat or electricity. Cogeneration — the simultaneous generation of useful electricity and heat — also should be viewed as energy-efficient technology. Microturbines, backpressure turbines, heat-recovery steam generators and other technologies fall into this category. Energy storage, an important and emerging field, can store energy from the grid or from a renewable energy system for deployment during peak or high-cost times. These systems can improve the impact of a renewable system or simply can help to balance the daily load. While storage is critical to dealing with the intermittency of many renewable technologies, it is not inherently a renewable solution. Both cogeneration and ground-source heat pumps are incentivised by federal, state and local programs and deserve consideration as part of an energy portfolio.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

TECHNICAL PAPERS

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

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COMPLIANCE & OPERATION

Patient-centred construction

Ensuring safety during health care building projects Ed Avis

Health care facilities managers have many responsibilities when a hospital is building a new facility or renovating existing space, but a top priority is keeping patients safe during construction.

nterim life safety measures often are needed when construction interrupts the flow of a hospital or other health care facility. Brian Cotten has seen the precautions construction contractors take when renovations on a patient tower required a shutdown of the sprinkler system, including an around-the-clock fire watch. “They constantly made tours through the entire area to look for smoke or anything else related to fire,” says Cotten, PE, CHFM, FASHE, executive director of design and construction at the University of Arkansas for Medical Sciences in Little Rock. Unlike typical building projects, hospitals rarely can shut down when additions are built or spaces are renovated. And patient needs — including their safety, comfort and protection from infection — trump construction needs every time. “Figuring out how to work through the issues, how to get the project done and, at the same time, not have a detrimental impact on the patients — that is the challenge,” says Tim Adams, FASHE, CHFM, CHC, director of leadership development for the American Society for Healthcare Engineering (ASHE). “It would be great if there were a cookiecutter solution, but there is not. We have to come up with a solution for every project.”

Infection control One of the largest concerns when a hospital is being torn up for renovations is the risk of infection caused by dust and other contaminants that may flow from the construction site to patient areas. Construction zones are inherently dusty, while many parts of hospitals must be kept pristine. “Infection control is certainly one of the largest issues,” Cotten says. “Trying to keep the environment clean is always a challenge, especially during construction.” The contaminants from construction can enter patient areas multiple ways — through the ventilation system, through open doors and windows, or tracked in on the boots of workers walking through patient areas. The effects vary depending on multiple factors — a little dust in the lobby may be harmless, but fungal spores in an operating suite may pose serious consequences. A key resource in the fight against construction-related infection is the “Infection Control Risk Assessment Matrix of Precautions for Construction & Renovation,” which is available on the ASHE website at www.ashe.org/ resources/tools. The matrix provides a quick way for facilities professionals to determine the level of precautions

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

Unlike typical building projects, hospitals rarely can shut down when additions are built or spaces are renovated. PHOTO BY ACESHOT1/SHUTTERSTOCK

required based on the type of construction and the risk-level of nearby patients. One side of the matrix identifies the level of construction, from Type A (e.g., non-invasive work, such as painting or minor plumbing) to Type D (e.g., major demolition or new construction). The other side of the matrix identifies the risk to patients normally found in the area affected by the construction, from lowest risk (i.e., office areas) to highest risk (i.e., burn units and operating rooms). Matching the construction level to the risk group results in prevention-control recommendations ranging from Class I to Class IV. For example, Type C work in a mediumrisk area requires Class III infection prevention measures, such as isolating

COMPLIANCE & OPERATION the HVAC system in that area and other precautions. For highest-risk areas, even Type A work requires Class II infection prevention measures such as sealing doors with duct tape, blocking and sealing air vents, and placing dust mats at the entrances and exits of work areas. “The matrix helps us to determine what we have to do based on the area and the job,” says Cotten, who has overseen more than $500 million in construction on his campus over the past eight years, including a new cancer institute and a new patient tower. While the problems of infection control are obvious in an occupied health care facility, they also need to be considered in new construction. “There are things we can do during construction that will prevent the spread of infection down the road,” Adams says. For example, keeping a work site clean, including areas that will not be seen by occupants, such as behind walls and above ceilings, may prevent infection problems once the space is occupied. Adams remembers an ASHE training program he participated in at a new hospital being built far from any existing structures. Infection control issues seemed less urgent, because no patients were nearby. But the training emphasised that dirt left behind in hidden spaces could become problematic once the building was occupied. “The next day they asked me to inspect the work site, and every worker had a broom or a mop and was cleaning up the area,” he remembers. “They stopped all work and took a day or two to clean all the spaces before they went ahead.”

Noise and vibration Noise and vibrations also can be a problem when construction workers and patients occupy the same building. Hospitals can be noisy to begin with, but the pounding of jackhammers or table saws can be unbearable for recovering patients. Unfortunately, there are not many ways to limit construction noise and vibration. “The reality is that nobody has invented noiseless construction,” Adams points out.

“Our task is to figure out how to reduce that noise so that people are not put at risk or are in discomfort because of lack of sleep.” An especially important concern in noise reduction is in the neonatal intensive care unit (NICU). Babies need their sleep, and they don’t get it in a noisy environment. “Sometimes we have to get really creative,” Cotten says. “Maybe if the [NICU’s] not completely full, we can get the babies farther away from the area in which we’re working. We really have to work with the staff to see what our options are.” Noise and vibrations also can affect surgery. In the case of the operating room, one solution is to schedule work during downtimes, says Gordon Burrill, P.Eng. FASHE, CHFM, CHC, president of Teegor Consulting Inc., a health care engineering consulting firm based in Fredericton, New Brunswick, Canada. Another solution is to use less powerful — and less noisy — tools. This may make the work go more slowly, but it can reduce the effects of noises and vibrations on patients and staff. Even construction workers walking through patient areas can cause noise. Jangling tool belts, clunky boots and overloaded dollies rumbling down the hall can be startling to resting patients. Facilities professionals can lessen this noise by carefully considering how workers access construction areas. Rather than have them walk through the front door, Burrill suggests designating alternate entrances just for the workers. The same goes for construction vehicles. Temporary roads and lots built just for them could alleviate traffic pressure on regular hospital roads and parking lots and perhaps reduce noise and vibration in the buildings. “I think the biggest technique is simply separating the construction teams from the hospital teams as much as you can,” Burrill says. “You always look to isolate the two.”

Interim life safety Facilities professionals and contractors also must be concerned with life safety

during construction. Maintaining a safe environment in a facility housing a large number of potentially immobile individuals is a challenge under any circumstance, but it becomes especially difficult when doors and hallways are being renovated, electricity is turned off or gas lines are rerouted. “Unexpected shutdowns, such as a severed gas line, a cut cable or an electrical system shutdown are serious problems,” says Burrill. “In an office building or a school, something like that could be an inconvenience. But in a hospital, it can put people’s lives at risk.” Burrill recalls an incident when a worker in a hospital’s mechanical room caught his tool belt on the main oxygen valve and shut it half off. He wasn’t sure what to do, so he reopened the valve, but quickly shut it completely when he heard the rush of gas flowing. “That shut off oxygen in an entire patient tower,” Burrill remembers. “It wasn’t down for long, but it was long enough that the oxygen was on low pressure in some of the patient units.” Fortunately, the worker was savvy enough to realise that he could not ignore the problem and quickly found knowledgeable help. The flow was properly restored. “There was no negative impact, but the potential for negative impact was very large,” Burrill says. An essential ingredient in successful interim life safety measures is planning, Cotten notes. When hospital personnel have the time to prepare, instituting effective measures is much easier.

Planning and communication Smart planning and extensive communication play critical roles in all aspects of construction, including managing contractors during the process. “In a health care setting, we can’t just tell folks, ‘Hey, we’re doing this, so stop all your activity until we’re done,’” Adams says. “In a clinical setting, taking care of people takes precedence.” Cotten says effective planning and communication played key roles during

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

COMPLIANCE & OPERATION a recent electrical shutdown in an operating room on his campus. He said the contractor, the internal project manager and the staff went through the project step-by-step and discussed a detailed timeline. During a planned outage, electricity was provided through extension cords and alternate circuits as needed, and the operating room’s workflow was only minimally affected. “We took an outage that could have been critical and it went very smoothly,” Cotten says.

“He liaised with the hospital, all the contractors and the architects, and he was the primary contact with external agencies,” Burrill says. “There’s a cost factor to that, but they knew that somebody was responsible for channelling all the communication.” Ed Avis is an Oak Park, Ill. based freelance writer who was contracted by the American Society for Healthcare Engineering to write this article.

Even smaller issues need to be well-communicated, Cotten notes. He said a two-week notification for a minor shutdown or noise situation is typical. This allows the hospital staff to prepare for any contingencies. On major construction projects, communication involves more parties. Burrill was involved in a major project in which the contractor devoted one employee to facilitating communications among the various parties.

Health care construction training further information • Videos. ASHE has two video resources for hospital facility managers. The “Today You Are Health Care” DVD provides an overview of important issues in health care construction for workers who have not previously been involved in building health care environments. And “This New Hospital” provides an insider’s view of all phases of a health care construction project. For a detailed list of ASHE educational programs, see the ASHE education calendar at www.ashe.org/learn. For DVDs, visit the ASHE store at www.ashestore.com.

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

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Smart, green and economical Line 5000’s washer extractors and tumble dryers combine technology with green thinking and cost reducing features. They exemplify Electrolux Professional’s commitment to continued sustainability and are made to be 95% recyclable. Energyefficient, their durable, robust construction and high technology manufacturing are built to respect the environment at every point of production and usage. Line 5000 offers real benefits and improvements in three crucial areas: durability, enhanced economy, and flexibility. Line 5000 washers and dryers are built to last longer. Their heavy-duty components need less maintenance and are optimised for all kinds of operations and environments.

Line 5000’s unique, new efficiency means using less water and energy for wash and dry cycles. But while Line 5000 helps lower operational costs and cut the environmental footprint, it has not compromised on quality. The Automatic Saving System for washers adjusts the water level to the weight of the laundry, meaning up to 50% in water savings for half load, as well as energy savings due to less water to heat. The Residual Moisture Control for dryers measures the exact moisture content throughout the process, ensuring energy savings due to shorter drying time. The easy to use Efficient Dosing System, automatically calculates the appropriate detergent amount, meaning that your laundry achieves the highest quality results while still protecting skin during usage. Ideally combined with Automatic Saving System, Efficient Dosing System can mean 50% savings in running costs. The Line 5000 range contains washer extractor models starting at a weight capacity of 6kg and going up to 60kg, while the tumble dryer capacities range from 13kg to 37.5kg. For more information on Electrolux’s Line 5000, visit our website: www.electrolux.com/professional, email: sales@electroluxlaundry.com.au or call 1300 888 948.

With its Power Balance for washer extractors, Electrolux Professional’s revolutionary unbalance detection system, ensures Line 5000 washers have optimum stability: this means quieter, faster operations, better water extraction and lower drying costs. THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

TECHNICAL PAPERS

It is what it is! What have we learned? Kim Bruton I MIHEA, NZIHE, CHCFM, Northeast Health Wangaratta, Victoria

Abstract: We all, (over our time), deal with some form of failing infrastructure, inadequate investment and unplanned emergencies within the health service. This paper is a light hearted view that chronicles the first five years as the most recent facility manager at my local health service. Since 2010 I have dealt with incidents involving a failed chiller, emergency generator capacity issues, electrical main switch failures, a gas explosion, serious storm damage, a direct lightning strike, and floods. This is an attempt to demonstrate the road to recovery on each of these challenges to enable compliance and support future proofing.

Introduction

efinition: from the 1979 edition of the Concise Oxford Dictionary.

Governance – Act, manner, fact or function, of governing; sway, control. Margaret Bennett, CEO – Northeast Health Wangaratta (NHW) explains; “The governance structure at NHW has a major focus on the leadership and accountability of each department head, with accountability through to the relevant executive member and then to the CEO, who in turn is accountable through to a skills based honorary Board of Management appointed by the Minister. The Studer Hardwiring Excellence Framework is used to drive the framework of accountability, measurement, expected behaviour and organisational culture. To ensure linkage between the strategic plan and annual operational plans for the organisation, and for each team, a consistent six pillar approach is used, with Facilities and Environment being one of these pillars. The governance structure around capital works is via a Project Control Group which involves Department of Health (VIC) and Board

membership. This has been in place at NHW over the last couple of years as we developed a Master Site Plan and completed a major facility upgrade” This article explores Northeast Health Wangaratta’s (NHW) approach to good governance and the specific management of incidents that have impacted Code Yellow, OH&S and Business Continuity including how solutions to the events were managed and the policy directions provided to address each event. 2010 was a particularly busy year for natural storm events in the northeast of Victoria including lightning, high winds, floods and power. It is intended to give a brief overview of the management of these events over time to achieve the best outcomes for NHW clients, staff and visitors. Following any major event, the CEO conducts an immediate hot de-brief then in the week following the event a formal debrief is conducted with the relevant managers and staff. For a facility manager this process provides the best opportunity to review the relevant learnings, consider future needs and generate the best outcomes for NHW. Obviously events such as severe storm damage require an immediate response

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

but for issues such as electrical failures and chilled water, outcomes can take longer to develop, fund and complete.

Business continuity Electrical infrastructure was becoming a major concern when in January of 2010 during a period where I was managing both Wodonga & NHW facilities I arrived to find the Hospital without normal power, the generator running providing emergency power to only limited parts of the Hospital and the Hospital Incident Management Centre (HIMC) in total darkness. Q) How do we manage codes yellow & brown without power? A) Without light & power in the entire executive suite it is not possible for any extended time. Q) What is the solution? A) Transfer the Exec/Admin distribution board onto essential power supply. Again on 7th July 1010 the Auto Transfer Switching (ATS) failed to operate following a short supply authority outage leaving facilities to man the changeover manually. The logic had been installed in 2000 with the new main switch board but needed to be rewired due to timing conflicts.

TECHNICAL PAPERS These incidents were some of many power outages experienced and a precurser to consider the need to increase generator capacity. Ten outages varying from several minutes to hours dogged the facility over the 2 years 2010 – 2011. The outages were generally supply authority issues but were compounded during the summer season by extreme temperatures. Q) How do we continue providing a health service to the northeast without adequate emergency power, air conditioning and medical imaging? A) NHW cannot safely operate on emergency power for extended periods of time. Q) NHW is mandated to provide a health service at all times, there is no scope to by-pass or decant the hospital. What can be done? A) Provide increased generator capacity of at least 1100kVA that is able to power the entire acute campus including radiology and air-conditioning. By the end of 2011 the need to replace existing 440kVA generator had been clearly identified. Schematic design was completed early in 2012 in preparation for a funding application to be made to Department of Health VIC (DH). Funding for a new generator was received, final design, purchase and installation commenced in June 2012. The design included a new main switch and ATS. The works were to be completed over the 2012 Xmas period. However issues with the main switch continued and the need for a new main switchboard became equally as important as increased generator capacity.

On 17th June 2012, the Hospital lost power during a planned outage for the installation of a new switchboard to support the MRI installation in the Clinical Services Block. At the time, the hospital lost mains power for 30 hours. This can be directly attributed to a lack of understanding as to how the ATS function operated on this particular switchboard. The planned outage was for the replacement of a circuit breaker supplying ED, Pharmacy, Radiology and Theatre A/C. The plan included running these areas on emergency generator supply. The upstream supply isolator did not hold open and closed whilst the electrical contractor was working on the circuit breaker. The safety operator turned the main switch off immediately but when it came time to turn on the main switch, it failed to turn on?

• It is housed against a double brick wall facing north and suffers extreme temperatures radiating from the inside of the brickwork. Q) You are proposing a new switchboard for the campus but how will the current problem be addressed? A) Install A/C into the room and apply a coating of reflective paint to the east & north facing walls and roof. Q) How do we progress the idea of a new main switch board? A) Allocate funding and resources to prepare the feasibility review, schematic design and budget estimates for a new switchboard. This information was then used as the basis for funding submission to the DH. To enable the installation of the new generator, a 400 kW chiller system powered by generator and intended to provided chilled water to the campus) was hired. This investment was approved by the Executive and ensured the supply of air-conditioning to the campus during this critical period. Trauma and normal emergency theatre cases were not disrupted whilst the Hospital operated on reduced generator supply.

At 14:30 on Thursday 29th November 2012 during a period of extreme heat Wangaratta suffered over five continual days in the mid 40’C range. The Main Switch failed shutting down the entire acute hospital, when instantaneous temperatures measuring up to 60’C were experienced in the building housing the switchboard. Q) This was an unacceptable position for NHW to be in. We need to ensure that service provision is maintained at all times. What are the issues? A) A new generator will provide NHW the capacity to maintain full operations with a minimum of 48 hours of fuel storage but the current main switchboard is:

In 2013, NHW was successful in its application for $1M funding through the Rural Capital Support Fund to replace the hospital’s main switchboard. Planning commenced in early 2013 with a project completion date set for June 2014

• Poorly designed with poor access for any maintenance regime. • There is no space for expansion to meet increase in capacity due to capital works in the future.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

TECHNICAL PAPERS

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

TECHNICAL PAPERS Chiller failure On the 28th September 2010, NHW experienced a major chiller failure. One of the three chillers that supplied the acute campus failed. At the time I must admit I experienced a sense of déjà vu….. It was the same chiller that had failed just prior to my previous appointment at the Wangaratta District Base Hospital (WDBH) 10 years earlier. Failure of separation in the shell & tube exchanger had allowed water into the sump, therefore mixing oil and refrigerant, resulting in damaged internal components.

• Include the completion of the previous Building Management System upgrade into this project. Q) You are proposing that we delay the replacement but how will the current problem be addressed? A) During the planning and funding phase the installation of a 200kW hire chiller would be connected to the system. A temporary chiller plant enabled time to properly consider, design and tender the complete solution for future needs. This project was funded and the new chiller & system was completed. It has since provided reliable and economical service to the acute campus.

It also affected critical emergency infrastructure. How can these serious issues be addressed? A) There is a need to develop strategies across the impacted systems to ensure that the outcomes mitigate the risks as much as is possible. Q) What is proposed to rectify the situation into the future? A) Immediate interim resolutions to communication systems outages were needed. The risk mitigation strategy included: • Having priority phones default directly to on ramp lines. This enabled 30 lines for continued operation. • Supply 10 mobile phones that are constantly charged and on standby to be issued to the clinical or other business units as required. • Upgrade the existing direct lightning strike protection across the acute Hospital.

Q) What is the impact of this failure? A) During summer the existing plant will not be able to maintain the acute campus’s air conditioning including theatres. During periods that exceed 35”C the campus will experience major service disruption issues. Q) Are there any contingencies that can be employed to mitigate the problem? A) A like for like replacement would be an immediate solution however the greater issue of future mitigation raises more questions that should be investigated, they are; a pre-existing shortfall in capacity and a poor distribution system for chilled water. Q) What you suggesting? A) Future risk mitigation raises further questions: • How best to meet the current shortfall in chiller capacity? This shortfall would be overcome by hiring a 200kW plug in chiller plant. • What would be the budget required to meet the solution? The final proposal needs to provide 1480kW of capacity by adding a 540kW chiller and some form of storage for the chilled water loop to draw off. • Funding? This requires a feasibility study and budget estimate in order to gain the understanding and support of the DH.

Communications 24th December, 2011 Xmas Eve – a direct lightning strike main block resulted in major outages to various critical infrastructure including the VOIP phone system, fire detection system and building management systems. Also door security systems, nurse call systems and duress alarms were also impacted. Following the incident, contributory issued identified included various installations of IT and TV equipment on roof structures that were higher than the direct strike protection. The impact on the provision of services was devastating particularly in the area of communications. Post incident, the professional advice provided to NHW included the absolute necessity to ensure that the facility is covered by surge protection on the incoming power supply.

Q) This incident left NHW with no internal and external communications for a significant period of time.

• In rectifying the other system failures attempt to build in as much protection as is possible

Occupational, Health & Safety 8th February 2010, a gas explosion in the Newhaven Flats occurred when a medical registrar struck a match at the front door when he smelt gas. The medical registrar was transported to The Alfred Hospital in Melbourne by Air-ambulance. Four of the eight accommodation units suffered some form of damage and all occupants had to be relocated to motels.

Q) There was an explosion resulting in a member of medical staff receiving serious injuries. How did this happen? A) A gas leak for which the source had not been determined occurred and the medical registrar struck a match at the front door after smelling gas.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

TECHNICAL PAPERS Q) What is a solution that will ensure the safety of NHW staff using NHW accommodation into the future? The following risk mitigation strategy was developed: • Replace all electric appliances in NHW accommodation other than the domestic hot water services. • Ensure all gas appliances are tested annually with a report provided to NHW at the expense of the owners.

Energy Safe Victoria (ESV) Report: The conclusion was the 18mm high pressure line that supplied gas to 40 Green St (across the road) was leaking and the ground was carrying 100% gas.

Late on Thursday afternoon 17th June 2010 a severe rain storm with winds up to up to 143 k/h struck the region. This event took the roof off the Green Street Flats that housed medical registrars. Q) How did this happen? It could have been very serious for anyone on the ground. A) Fortunately there were no injuries or damage to other property and all the materials landed within NHW property. There was little water damage to the upstairs unit and the registrars have been relocated to temporary accommodation. It appeared that over time the roof rafters had dried out and split along the line of nails holding them down. The force of the gusts wind was able to pull the nails holding the battens and roof.

A new roof was fitted with straps over the new battens to ensure this type of incident would not happen again.

Code Yellow 8th December 2010, heavy rains were experienced across the northeast. The North East Regional Water Authority’s (NERWA) sewerage system in Wangaratta could not cope with the influx of storm water into the system. The impact on the Illoura Aged Care came from the inability to have sewage disposal, therefore creating a health issue for residents. Q) At 11:45 I indicated to the CEO, “We may have to consider evacuation on the grounds that there is currently no sewerage system to maintain a healthy environment for the residents”? A) The Executive ascertained it was not appropriate to evacuate the facility. A restriction on water usage was put in place to reduce the outfall, with only toilets to be used until further notice. Additional linen was delivered by contractor and dish washing was to be relocated to the main campus. Fortunately by 13:00 rain had eased significantly and NERWA advised that the nearby sewage pumps were now coping and the system was clearing. Q) What caused such a significant event in a relatively new high care nursing home? A) Although there was no possibility of the building being inundated, the influx of storm water into the water authority sewage system caused the sewage/storm water to back up the pipes towards the home. No sewage entered the facility. Q) What can be done to mitigate NHW from coming so close to having to evacuate 62 residents in the future? A) There is no immediate solution; basically a reflux or non return valve will need to be installed with a retention pit. The risk mitigation strategy developed: Install a reflux valve in the main sewer outfall and a retention pit of minimum 8000l. This project was funded by NHW but as work was about to commence the water authority lodged a request to manage the number of continence pads that were leaving the site and being caught in the nearby pumps. The project was able to be modified to accommodate a basket trap but managed to double the size of the pit required.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

Conclusion NHW’s currently approach to governance and employee engagement has greatly assisted with the efficient and timely resolution of these critical incidents. It has also supported management accountability, resource planning and future proofing all of which have resulted in major infrastructure improvements. The Hard Wiring For Excellence framework has enabled the provision of clear direction, enhanced employee engagement and transparency across NHW’s short and long term strategic objectives. The frame work is supported by six pillars: • Clinical Services • Quality and Innovation • People, Learning and Research • Organisational Management • Facilities and Environment • Community and Partnerships The six pillars are used by leadership team to guide the day to day operation of all departments. The pillars are embedded in the Strategic and annual Operational Plans. Each financial year, all departments are required to create an Operational Plan that supports the organisation’s annual Operational Plan which in turn supports the Strategic Plan. “Facilities And Environment” forms one of the 6 pillars of NHW’s Strategic Plan and ensures appropriate resources, diligence and attention in assigned to this important area. As a Facilities Manager, I have greatly appreciated the opportunity to participate in planning the NHW’s clinical and infrastructure requirements. A particular highlight was the opportunity to contribute to the creation of NHW’s “Site Master Plan”. The governance framework adopted by NHW has enabled this to happen. It has also supported the organisation to deliver $6M in capital works on time and within budget during the last 2 financial years.

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Tea Tree oil, one of the active ingredients in Right Air, has been used for over a century as an antiseptic, antibacterial, antiviral, antifungal and anti-inflammatory agent. In conjunction with lemongrass, Right Air also possesses deodorising properties which shut down unwanted odours. Right Air is a fresh product, one of the key attributes of its success. Right Air Gel, in most cases, is delivered to you within one month of manufacture. The airborne nature of Right Air Gel ensures it is working whenever the aircon is on. It will also inhibit spore growth in the room (not just the aircon components). In the humid climate of Darwin, Northern Territory, Right Air is fighting the mould battle successfully, proving to be a cost effective option versus the costly removal of

chillers aircon units and/ or modification of existing HVAC infrastructure. Case Study Darwin, Northern Territory A 230 room hotel, part of a large international hotel chain, identified a ‘mouldy smell’ throughout the hotel. One room was provided as a test case, as it had large clumps of mould growing through the evaporative coil, which was part of a chiller system.

airflow was again restricted as the mould grew back. Upon replenishing the Right Air Gel, airflow improved once again.

Initial maximum air flow was measured at 1.1 metres per second (m/s).

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A 500mL Right Air Gel tub was placed in the roof cavity adjacent to the filters and Right Air Instant was sprayed as a mist into the rear fans on a daily basis for 7 days. Immediately the ‘mouldy smell’ had dissipated and by week 7, airflow had improved by 120% to 2.5 m/s. Once the Right Air Gel had completely dispersed (approximately 12 weeks),

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TECHNICAL PAPERS

Engineering for Health & Hygiene

Aspecific disinfection approach that mirrors the immune defence system of vertebrates. About four billion years ago, life arose: simple microorganisms with the ability to extract energy from organic compounds or from sunlight, which they used to make a vast array of complex biomolecules from the simple elements and compounds on the Earth’s surface. The remarkable properties of living organisms arise from the thousands of different lifeless biomolecules. When these molecules are isolated and examined individually, they conform to all the physical and chemical laws that describe the behavior of inanimate matter. The smallest organisms consist of single cells and are microscopic. Larger, multicellular organisms contain many different types of cells, which vary in size, shape, and specialized function. Despite these obvious differences, all cells of the simplest and most complex organisms share certain fundamental properties, which can be seen at the biochemical level. Birds, beasts, plants, and soil microorganisms share with humans the same basic structural units (cells) and the same kinds of macromolecules (DNA, RNA, proteins) made up of the same kinds of monomeric subunits (nucleotides, aminoacids). All living cells have either a Plasma membrane nucleus or a nucleoid, a plasma Tough, flexible and selectively permeable membrane, and cytoplasm. The lipid bilayer. plasma membrane defines the periphery of the cell, separating its contents from the surroundings. It is composed of lipid and protein molecules that form a thin, tough, pliable, hydrophobic barrier around the cell. The membrane is a barrier to the free passage of inorganic ions and most other charged or polar compounds. Nucleus (eukaryotes) or nucleoid (bacteria)

The organic compounds from which most cellular materials are constructed represent the ABCs of biochemistry. Shown here are six of the 20 aminoacids from which all proteins are built (the side chains are shaded blue). Likewise, nitrogenous bases (adenine, guanine, thymine, cytosine and uracil) are the important components of nucleic acids.

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Some of the amino acids of proteins –

–

COO +

H³N

–

COO +

H³N

CH³

CH²OH

CH²

Alanine

Serine

COO

–

Aspartate –

H³N

CH²

H³N

CH² SH Cysteine

COO +

H³N

C CH² C HC

COO +

–

COO +

–

COO +

H NH +

Figure 1: Six of the 20 aminoacids from which all proteins are built with side chains highlighted.

Histidine

Tyrosine

Independently of the complex structure of the cell, the monomeric units are relatively simple molecules. In addition, most of them are characterized by the presence of specific groups (amino, –NH², and thiol, –SH), which are sensitive to oxidation reaction. Most disinfectants or biocides exert their action by damaging the cell membrane; in alternative, some neutral molecules can pass across the membrane and act against internal cell components. Notwithstanding their effectiveness, disinfectants are often criticized for possible side effects: formation of byproducts, but also induced resistance.

The Ecas4 Solution The Ecas4 approach was inspired by observing how the immune system of vertebrates (the most developed living organisms) works. Nonspecific immunity is substantially based on the activity of neutrophils and macrophages leucocytes, which engulf foreign cells. Of great importance is the action of myeloperoxidase (MPO), an enzyme that produces hypochlorous acid (HOCl) from hydrogen peroxide (H²O²) and chloride anion (Cl¯), during the neutrophils’ respiratory burst. Hypochlorous acid possesses a particularly effective cytotoxic activity. Contrary to other forms of so-called active chlorine (i.e.,

TECHNICAL PAPERS Invading pathogens Neutrophils migrate to the infection site

Blood vessel

Wound site

Neutrophils engulf pathogens

Neutrophils destroy pathogens with hypochlorous acid

Figure 2: Neutrophils release Hypochlorous acid to fight infection in the human body.

hypochlorite and gaseous chlorine), the HOCl molecule is rather unstable, and cannot be stored and used at request. To produce it, the easiest and safest synthetic path is electrochemical production, through electrolysis of a brine solution. Various approaches exist, which are all based on electrochemical cells, provided with or without a separator to avoid reaction or decomposition of products synthesized at the anodes upon contact with the cathodes. Only a few of them allow the synthesis of a biocide solution under well-controlled and reproducible conditions, and the number of useful devices is further reduced when the constraint of a product with a neutral pH is introduced. The latter is important, since it is linked with the reactivity of the active ingredient and of related chemical equilibria (i.e., conversion of the active chlorine to chlorite and chlorate). In addition, a neutral pH is safer for both the user and the target applications (e.g., minimization of corrosion problems). To meet with the above requirements, Ecas4 has developed and patented a technology that relies upon a reactor with four chambers (European Patent n. 1969159 B1). The approach represents an optimization of the technology for electrochemical activation of water originally proposed by the Russian school (V.M. Bakhir and coworkers), for the production of the so-called anolyte: a solution containing hypochlorous acid.

Benefits The benefits deriving from the use of hypochlorous acid (active chlorine at neutral pH), compared to those of using hypochlorite (active chlorine at pH > 7.5) can be summarized as follows: 1. Higher disinfectant efficacy of HOCl, with respect to ClO- (about two orders of magnitude); accordingly, lower concentrations are required to obtain comparable results. 2. HOCl apparently behaves like a source of hydroxyl radicals, rather than as a chlorine-containing oxidizing agent, thus minimizing the risk of formation of undesired byproducts. 3. A solution at neutral pH does not alter the characteristics of the treated liquid (often a potable water), and provides greater assurance concerning possible problems of corrosion for metal piping.

With a second patent application (Australian Patent n. AU 2009315640 B2; Intern. Pat. Appl. n. WO 2010/055108 A1), the technology has been further improved, borrowing the zero-gap principle, i.e. with electrode in direct contact with the separating membrane, from the fuel cell and chloralkali industries. This allows to reduce the salinity of the diluted brine (with benefits in terms of stability of the anolyte and minimization of non-active chemicals), while reducing the possible heating due to ohmic drop (in general, heat is deleterious, both from a chemical point of view as for the stability of the electrodes and of the membrane).

Summary The Ecas4 reactor mirrors our bodyâ&#x20AC;&#x2122;s defense system, allowing the synthesis of hypochlorous acid, a non-toxic, noncorrosive and non-hazardous active ingredient that can be used for a number of applications: disinfection of potable water; eradication of microorganisms from water networks; disinfection of surfaces and environments (when applied as a fog). The Ecas4 anolyte has no synthetic chemical residues, and it is effective in removing biofilms from water pipes or tanks. The Australian Water Quality Centre has recently verified Ecas4 efficacy and compliance within drinking water standards (AS/ NZS 4020). The Ecas4 technology has been widely adopted for solving problems related to Legionella, in Europe (Italy, Germany, Spain and Slovenia), and it is now available in Australia. Noteworthy, the Legionella detection limits in Australia are not as rigorous as the European standards!

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A world class solution for the delivery of clean air in operating theatres

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High efficiency air filtration Reduces airborne particulates, bacteria & viruses Modular construction Simple integration with other ceiling mounted equipment Optional perimeter return air & lighting Complies with Australian Council on Health Care Standards

Focus Ultra Clean Ventilation (UCV) Systems for Operating Theatres Focus UCV Systems significantly reduce the instance of airborne bacteria in operating theatres by providing a controlled distribution of clean air at the operating table, while reducing the risk of contamination from outside the clean zone. Focus units are constructed from galvanized and stainless steel, with powder coated or stainless steel theatre side surfaces for easy cleaning. Design targets are based on risk analysis through CFD modelling and field testing, local guidelines for air flow at operating zones and worldwide standards. Options include integrated perimeter return air grilles, duct connections and lighting. Pendant locations can be center or side mounted. Model Focus 1000 Focus 2000 Focus 3000

*Purpose ST/DP GS/O O/MS

Diffusion Size (mm) 1900 x 1900 2400 x 2400 2800 x 2800

Overall Size Nominal (mm sq) Airflow (L/s) 2200-2800 1500-1750 2800-3300 2200 3200-3420 2980

CFD modelling diagram for Focus 3000 with integrated perimeter lighting and return air grilles.

*Purpose Legend: ST=Small Theatre, DP=Day Procedure, GS=General Surgery, O=Orthopedic, MS=Major Surgery

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TECHNICAL PAPERS

Operating theatre ventilation system review Andrew Sutherland I ASC Engineers

(This paper is broken into two parts, Part 1 is has been published in this edition of the journal, Part 2 will appear in the following journal edition.)

Part 1 Introduction

he cost of construction and maintenance of health care facilities is substantial and the cost effectiveness of procedures systems and facilities is under constant review. Reduction in hospital acquired infections can have a significant impact on improved patient outcomes and minimising the cost to the health care facility for the delivery of clinical services. Strategies to improve outcomes are both clinical and engineering. One area of ongoing discussion is the role of operating theatre ventilations systems and system design to assist in the reduction of surgical site infections (SSIs). Development in microbiology has made surgery safer, but the overall instance of associated infections remains high and represents a substantial burden of disease.[1]

following table summarises the instance of infection rates prior to the use of prophylactic antibiotics and since the introduction of routine prophylactic antibiotic use [5]. Reference

Clean

CleanContaminated

Contaminated

Dirty

Prior to use of prophylactic antibiotics [6][7]

1-2%

6-9%

13-20%

~40%

Routine use of prophylactic antibiotics [8]

2.1%

3.3%

6.4%

7.1%

However there is considerable variation in each class according to the type of Surgery performed. [9]

This paper provides a review of available research and operating theatre ventilation system standards and system design.

Surgical Site Infections The recording of Surgical Site Infections (SSIs) is often based on the CDC definitions and protocols. In Victoria, there is a disciplined approach to reporting through the VICNISS Health Care Associated Infection Surveillance System. The system has been established to estimate the prevalence of Health Care associated infections. • SSIs are a real risk associated with any surgical procedure and represent a significant burden in terms of patient morbidity and mortality, and cost to health services around the world. • A multitude of risk factors influence the development of SSIs and awareness of these will help to promote effective preventative strategies. Most SSIs are superficial, but even so they contribute greatly to the morbidity and mortality associated with surgery. [2] [3]. Wound classes: A system of classification for operative wounds based on degree of microbial contamination; USNRC [4]. Four wound classes are described with increasing risk of SSIs. The

Antimicrobial Resistance for Pathogens over Time has shown a significant increase in the percentage of isolates resistant to antibiotics. At the same time the total number of new antibiotic agent development is dwindling. The epidemic of Antibiotic Resistant Infections CID 2008:46 (15 January) Clin Infect Dis (2011) May. • The CDC definition states that only infections occurring within 30 days of surgery (or within a year in the case of implants) should be classified as SSIs.

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TECHNICAL PAPERS • Despite advancements in surgical techniques and infection –prevention methods, two out of every 100 surgeries in the U.S. result in SSIs, resulting in an estimated 290,485 SSIs per year. Not all SSIs are entirely preventable. An estimated 40-60% of SSIs are considered preventable based on current medical practice and technology.[10] Report by Kaye KS et al. Emerg Infect Dis 2004:10 1125-1128 indicated that surgical site infections were significantly associated with increased mortality, length of hospital stay and cost. Identifying the causes of surgical site infections helps focus on potential areas of improvement. While hygiene-related prevention is the most practiced and proven method, airborne-related contamination control offers one area that could play a much larger role in preventing SSIs. The majority of SSIs are a result of hygiene-related factors associated with surgical personnel. With respect to bacteria transmitted to the surgical site through the air, squames or skin scales, are the primary source of transmission [11].

per hour, and one with laminar air flow theatre ventilation with 40 air changes per hour.

typical Conventional Theatre Air Quality Monitoring Measurements

Handheld LPC Data Retrieval Software Mode: Repeat

Start Time:2010-02-17 13:55:30

Stop Time:2010-02-17 15:25:06

Date & Time

Location

Status

Sampling Time (Sec)

0.3um

0.5um

5.0um

Unit

17/02/2010 13:55

180

3.96E+06

6.96E+05

1.39E+04

/m3

17/02/2010 14:00

180

3.04E+05

1.19E+05

6.95E+03

/m3

17/02/2010 14:06

180

0.00E+00

/m3

17/02/2010 14:11

180

3.45E+04

8.00E+03

8.24E+02

/m3

17/02/2010 14:18

180

2.23E+05

1.06E+05

3.88E+03

/m3

17/02/2010 14:24

180

1.24E+05

3.54E+04

4.59E+03

/m3

17/02/2010 14:35

180

5.63E+05

6.77E+04

4.36E+03

/m3

17/02/2010 14:40

180

2.06E+05

4.17E+04

2.83E+03

/m3

• According to UK National Joint Registry Report, during 20032006 period infection was responsible for about 19% failure of joint surgery resulting in revision procedures [12]. • SSIs are reported as the major cause of high morbidity and mortality among post-operative patients [13] • Statistics Related to Surgical Site Infections for the U.S. Centre for Disease Control 2008:

Location

Description

Comments

Theatre # 4 at operating table

Theatre corridor air pressure measure + 5 Pa

Theatre # 3 at operating table

Theatre corridor air pressure measure + 9 Pa

Theatre # 3 200mm below HEPA Filter

Theatre # 3 1m below HEPA Filter

Theatre store at outside door

Sterile Corridor at bench level

Theatre # 1 / Sterile corridor

Measure directly below HEPA filter

Moved during sampling due to low battery

• Approximately 27 million surgeries are carried out in the U.S. every year. • Approximately 290,000 SSIs arise each year. • An Astonishing 8,000 result in death from these infections. • Micro-organisms in the air particles settle on the wound, dressings and surgical instruments and cause infections [14] • Whyte [19] identified that contamination from patient’s skin as the cause of infection in 2% of cases and from theatre personnel in 98% cases. They also found that in 30% cases, contaminants reach the wound from theatre personnel via air and in 70% cases via hands.

Operating Theatre Air Quality • The indoor air in an operating theatre may contain particulates from a number of sources which include people, process and activities in the operating theatre. Suspended particles can act as a vector to transfer microorganisms which can settle on surgical wounds and cause infection [15].

The traditional theatre showed a high level of particle contamination, both at the operating theatre table level and throughout the theatre. The tests were carried out for three traditional theatres in the same surgical department with similar results for each theatre.

• Air borne particles are found to be responsible for about 80%90% of microbial contamination (CDC 2005).

The results of the laminar flow theatre showed a dramatic reduction in the airborne particle contamination both at the operating theatre table level and throughout the theatre. The results for the laminar flow theatre are as follows in the table overleaf:

• In 2010 we carried out a comparative assessment of the operating theatre air quality for two suites operating theatres; one with a traditional design for the ventilation system incorporating four terminal HEPA filters and 20 air changes

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TECHNICAL PAPERS

Air Quality Monitoring â&#x20AC;&#x201C; Measurements Handheld LPC Data Retrieval Software Mode: Repeat

Start Time:2010-06-24 07:12:00

Stop Time:2010-06-24 07:41:00

Date & Time

Location

Status

Sampling Time (Sec)

0.3um

0.5um

5.0um

Unit

24/06/2010 07:12

180

0.00E+00

/m3

24/06/2010 07:19

180

0.00E+00

/m3

24/06/2010 07:26

180

3.55E+02

3.53E+02

0.00E+00

/m3

24/06/2010 07:33

180

6.00E+03

2.13E+03

7.06E+02

/m3

24/06/2010 07:41

180

1.59E+04

5.30E+03

1.68E+03

/m3

Location

Description

Comments

Theatre # 1 at operating table

Measured at the centre of the table

Theatre # 1 at operating table height

Measure at 0.9m offset from the table centre line

Theatre # 1 at operating table height

Measure at 1.2m offset from the table centre line

Theatre # 1 at operating table height

Measure at 1.4m offset from the table centre line

Theatre # 1 at wall

Measure at wall at bench height Location

The assessment was carried out using a calibrated particle counter with particle counts measured and recorded in the 0.3micron, 0.5 micron and 5 micron particle size ranges. For both theatre ventilation systems the results were zero particle counts for all three particle sizes when the air quality was measured at the discharge from the diffusers below the HEPA filters. â&#x20AC;˘ The results showed significant improvement in the air quality in the laminar flow theatre compared to the traditional turbulent flow theatre. A summary of the results of the particle counts recorded are summarised in the following table opposite.

Particle Count/m3

Size 0.3 micron

Size 0.5 micron

Size 5.0 micron

Traditional theatre at 1m below the terminal HEPA diffuser

34,500

8,000

824

Traditional Theatre at operating theatre table

304,000

119,000

6,950

Traditional Theatre at the wall

563,000

677,000

4,360

Laminar flow theatre at operating theatre table

Laminar flow theatre outside perimeter of laminar flow diffuser

6,000

2,130

706

Laminar flow theatre at the wall

15,900

5,300

1,680

One interesting observation is the rapid decline in air quality below the HEPA filters in a traditional theatre with the individual HEPA filters arrangement. This is due to the entrainment of particles from the adjacent space. On comparison with clean room design principals, the turbulent flow arrangement would not be acceptable. High turbulence leads to pollution or contamination as well as surface areas [34]. One further observation was made during measurements in one of the laminar flow theatres; there were a number of staff entries to the theatre from the sterile corridor to attend to the set up for the next theatre list with activity around the perimeter of the theatre. This activity did not affect the zero results recorded at the theatre table. This system achieves two protective effects: on the one hand, no contaminated external air or air by inflow from open doors reaches the protection zone and on the other hand, contaminated air in the protected zone becomes replaced [35]. (Part 2 of this paper will appear in the following edition of the journal.)

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TECHNICAL PAPERS References 1. F inn Gottreup et al. An Overview of Surgical Site Infection: aetiology, incidence and risk factors. University of Southern Denmark; Department of Surgery: Sept. 2005. 2. L eaper DJ et al. Surgical Site Infection – a European perspective of instance and economic burden. Int Wound Journal 2004: 1 (4): 247-273. 3. D iPirio JT et al. Infection in surgical patients: effects on mortality, hospitalization and postdischarge care. Am J Health Syst Pharm 1998; 55(8): 777-81. 4. B erard F et al. Post Operative Wound Infections: the influence of ultraviolet irradiation of the operating room and various other factors. Ann Surg 1964; 160 (Suppl 1): 1-192. 5. US National Nosocomial Infection Surveillance (NNIS) System. 6. C ruse PJ et al. The epidemiology of wound infection. Surg Clin North Am 1980; 60(1): 27-40. 7. C ruse PJE. Classification of operations and audit of infection. Infection in Surgical Practice. Oxford University Press, 1992; 1-7. ulver DH et al. Surgical Wound infection rates by wound class, operative 8. C procedure and patient risk index. NNISS. Am J Med 1991; 91(3B):152S-157S. 9. F erraz EM et al. Wound infection rates in clean surgery: a potentially misleading risk classification. Infect Control Hosp Epidemiol 1992; 13(8):457-62.

27. Miner et al.;2007. Deep Infection After Total Knee Replacement: Impact of Laminar Airflow Systems and Body Exhaust Suits in the Modern Operating Room. Infection Control and Hospital Epidemiology 28:222-226. 28. Byrne AM et al; Outcome following deep wound contamination in cemented arthroplasty: Int Orthop; 2007 February;31(1):27–31. 29. Beldi G et al; Impact of intraoperative behaviour on surgical site infections: The American Journal of Surgery; 2009:198,157-162 30. Creedon, S; 2005. Healthcare workers’ hand decontamination practices: compliance with recommended guideline. Journal of Advanced Nursing, 51(3), 208-216. 31. Hughes S et al; 2009: Oxford Handbook of Perioperative Practice; Oxford University Press. 32. Hambraeus A. Institute of Clinical Bacteriology, Department of Hospital Hygiene, Uppsala University Hospital. 33. Hirsch T et. al; “Bacterial Burden in the Operating Room: Impact of Airflow Systems,” American Journal of Infection Control 40 (2012) e228-3. 34. Baumgarth S et. Al; Compendium of Air Conditioning Technology; Vol 1: Basics. 4th Ed. Karlsruhe (Germany): 2000. 35. CEN, Ventilation for Buildings – test procedures and measuring methods for handing over installed ventilation and air conditioning systems. German Version EN 125999; 2000.

ction Plan to Prevent Healthcare Associated Infections: Department of Health 10. A and Human Services; June 2009. 11. Woods; 1996. 12. NA Sandiford, J Skinner et al: Surg Technol Int; 2009. 13. JA Weigelt et.al; American Journal of Infection Control: Volume 38-Issue 2, Pages 112-120, March 2010. how T.T, Yang X.Y: Ventilation performance in the operating theatre against 14. C airborne infection: Numerical study on an ultra-clean system. J. Hosp. Infect. 2005; 59:138–147. 15. Neil; 2005. 16. National Health Service, England (NHS);1994. 17. D haran S et al; J Hosp Infect;June;51(2):79-84. Environmental controls in operating theatres; 2002.

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18. Knobben J Hosp Inf; 2006. 19. Whyte,W & Shaw BH;1973 and MRC-DHSS trials; Lidwell, O M et. al;1982. 20. S caltriti S et.al; 2007:Risk factors for particulate and microbial contamination of air in operating theatres. J Hosp Infect 664: 320–6. 21. C larke MT et.al; Contamination of primary total hip replacements in standard and ultra-clean operating theaters detected by the polymerase chain reaction. Acta Orthop Scand; 2004.;75:544-585. akwani RG et.al; The effect of laminar air flow on the results of Austin-Moore 22. K hemiarthroplasty. Inury 2007;38:820-823. 23. Brandt C et.al; Annals of Surgery – Volume 248:695-700 November 2008. 24. M emarzadeh F et al; Comparison of Operating Room Ventilation Systems in the Protection of the Surgical Site; ASHRAE Transactions: 2002: Vol 108. Pt 2. 25. Backstein D et. al; Orthopedics Today, January 2009. osanquet et al; Laminar flow reduces cases of surgical site infections in 26. B vascular patients; Ann R.Coll Surg Engl; 2013 Jan; 95(1):15-9.

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Meeting Queensland Microbial Water Quality Guidelines Alex Mofidi BSc MSc RPEQ I Water Treatment Practice Leader, AECOM Nicolas Massey I Senior Director Technical & Engineering, Queensland Health

ABSTRACT: Queensland healthcare potable infrastructure water quality is required to be actively maintained by facility managers as a result of investigations into Legionella in Queensland hospitals. These management recommendations were made by the Chief Health Officer in conjunction with newly released 2013 microbial water quality Guidelines for Managing Microbial Water Quality in Health Facilities (Guidelines). Water quality management is a challenge for facility managers as Queensland drinking waters are not required to have a residual disinfectant present in supplied water; possibly promoting water infrastructure colonisation of microbes such as amoeba and heterotrophic bacteria. Microbial communities can include human pathogens such as Mycobacterium, Legionella and others. These microbes can grow to hazardous levels under certain conditions. This manuscript describes the guidelines and recommends a way forward for implementation by infrastructure managers.

Background

wo centuries of advances in water treatment and sanitation have significantly improved public health with a range of initiatives and enhanced learning from implementation of drinking water chlorination[1,2] to discoveries exposing waterborne links to disease[3,4]. Water must not only be treated, but handled properly following treatment as it is not sterile: it is truly a product with a ‘shelf life.’ Harmful microbes can re-grow and compromise potable water infrastructure therefore active water management is needed. Water quality risk comes as a result of water exceeding its ‘shelf life;’ harbouring and transmitting of harmful bacteria and amoeba to consumers through building infrastructure[5-9]. This recently resulted in morbidity and mortality in Queensland[10]. The new Guidelines for Managing Microbial Water Quality in Health

Facilities (Guidelines)[11] recommend actions to help manage these risks.

Queensland 2013 Following morbidity and mortality from Legionellosis in a Brisbane, Queensland hospital in 2013, Queensland Health initiated State-wide snapshot microbial sampling of healthcare potable water systems. Results showed high heterotrophic plate count (HPC) levels and confirmed presence of Legionella pneumophila serogroup 1. Summarised snapshot water sampling results are represented in Figure 1; these data indicated the extent and scope of the potential health risks and supported the need for the development of water quality risk management programmes for healthcare potable water

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TECHNICAL PAPERS infrastructure. The following also informed the decision making process: • There are >170 Queensland water service providers (WSPs), some of which supply non-potable, reticulated water. • Australian Drinking Water Guidelines (ADWG) do not require disinfectant residual in reticulated water[12,13]. • Queensland has a range of conditions negatively impacting water quality, including high water temperature (20 to >40oC), Dissolved Organic Carbon (DOC, up to 15 mg/L), & storage (≥30 days).

Water Quality Numbers of bacteria and amoeba are reduced (according to what is tolerated by average healthy persons) during municipal treatment. As some of these organisms are expected to remain viable during potable water distribution, they can re-grow/replicate depending on temperature, time, and applied disinfectant[14]. Infrastructure with stored water and/or low disinfectant residuals, regardless of upstream treatment, can provide ideal breeding conditions for these organisms. As healthcare infrastructure provides for the immunosuppressed (by age or condition), it is most important to actively manage water risk. WSP-supplied potable water is not sterile, but is treated by particle removal and disinfection to meet health standards for human consumption. Key risks that healthcare facilities must recognise include:

Figure 2: A summary of selected previous research[14,15] showing how E.coli and HPC bacteria recolonise water systems when a chlorine-based disinfectant residual is absent, even if a very high dose of UV had been applied.

based upon individual facility attributes and needs.

Queensland Guidelines In response to the Queensland Snapshot Sampling, the Queensland Health Chief Health Officer recommended that healthcare facilities develop and implement programmes to pro-actively manage microbial risks in their potable water systems.[10] While documented methodologies exist for control of microbial risks associated with waterbased cooling towers, comprehensive approaches to control microbial risks in potable water infrastructure are less common in Australia.

• Residual disinfection that protects against post-treatment microbial regrowth is not guaranteed in Australia[12,13]. • Bacteria regrow in potable water systems (as seen previously[14,15] – see Figure 2) especially (for Legionella) if other microorganisms (e.g. amoeba) are present[16,17]. • Microbial risks increase with DOC, temperature, and storage time[18,19] compounding issues in Queensland. • There is no single solution to eliminating microbial risks[20], various treatment devices/strategies may be necessary

Figure 3: The 2013 Guidelines were produced in response to the Snapshot Sampling.

Guidelines developed in Queensland (as illustrated in Figure 3) apply to the control of microbial risks in Queensland healthcare potable water systems and can be applied across Australia. Guidelines for control of microbial risks in infrastructure potable water systems have also been developed overseas, with information available from the World Health Organisation (WHO)[21] and ASHRAE (American Society of Heating, Refrigerating and Air Conditioning Engineers)[22]. All these Guidelines are founded on the Hazard Analysis Critical Control Point (HACCP) methodology. These guidelines are aimed at the development and implementation of documented systematic approaches to prevention of Legionellosis and other waterborne microbial illnesses associated with building potable water systems. The approaches are always tailored to the individual facility requirements. A significant part of this new guidance is the directive for Queensland healthcare facilities to develop Water Quality Risk Management Plans (WQRMPs) – similar to what is done in other countries[23,24]. Along with development of WQRMPs, facility managers need to routinely monitor and manage water quality within their facilities. Guideline recommendations are summarised in Figure 4.

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Figure 4: Potable water infrastructure water quality management should be a continuous process

Managing Infrastructure Water Quality Facilities that develop a site-specific WQRMP will be able to determine their individual levels of risk, how to monitor those risks and implement controls to manage them, and then how to acknowledge and mitigate residual risk that may remain. The concepts in WQRMP development are based upon HACCP approaches to risk management used in water and food industries and are being applied in various locations of healthcare risk management already. HACCP approaches can find proactive, low-cost solutions for facility managers to control water quality risk and reduce adverse patient outcomes; avoiding more costly ‘cleaning’ practices. HACCP is based on three principles: risk identification, quality control point (QCP) identification, and critical control point (CCP) options. Every facility is different, and therefore WQRMPs should be developed by a diverse internal and external team that understands both water quality and hospital-specific risks.

one thing: an increase in facility maintenance data management. In this age of computer apps, there are tremendous proprietary and non-proprietary approaches to data management and dashboarding. This can allow excellent visualisation of, and ability to respond to, water quality risks (see Figure 5).

WQRMP Revision

Implement, review, and repeat. Infrastructure, risks, and your knowledge of your infrastructure may all change. Regular reviews and re-assessments of the above issues are critical.

Way Forward Healthcare facility managers should develop and maintain documented potable water quality risk management plans. As part of the application of control measures, in addition to initial physical improvements to infrastructure as required, they should also investigate recurrent CCPs. These CCPs may include addition of residual disinfectant into their potable water system, along with regular system flushing, to mitigate microbial regrowth risks exacerbated by the lack of WSP residual. Also consider the balance

of other risk mitigation such as the need for larger hospitals to store potable water for emergency preparedness. The advantages and disadvantages of various disinfection technologies that can be considered as CCPs are summarised in Table 1. Chlorine may at first glance appear to be the most practical and robust disinfection technology to protect healthcare infrastructure as it is readily available and can likely be safely added to water delivered by the WSP. Other disinfection technologies can also prove effective but may require more expertise and more stringent controls for long-term management. The facility WQRMP must identify the appropriate balance of active flushing, disinfectant application and water testing and monitoring (i.e., programme verification). These actions are required

Table 1: A comparison of various disinfectants, the advantages and disadvantages in their use, and the types of pathogens that they may best be used to control

Sampling and System Monitoring The WQRMP is validated with QCPs through sampling and monitoring. This can include monitoring disinfectant residual and general heterotrophic plate count (HPC) bacteria, as well as more exotic organisms such as L.pneumophila.

System Management System management is informed by the WQRMP and QCPs: the instructions in how to manage your CCPs. Some CCPs may be flushing – but all lead to

Figure 5: Actively manage data, possibly with visual data dashboarding techniques like what is illustrated here

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TECHNICAL PAPERS to ensure maintenance of microbiological water quality, as is rectification of any identified infrastructure contributing factors. Healthcare facility managers are encouraged to consult with experienced professionals such as certified occupational hygienists and specialised water quality engineers to gain an appreciation of how to reliably control microbial risks in healthcare potable water infrastructure in a safe, healthy and efficient manner. The best way to approach the above is to first, form a multidisciplinary team that will develop your facility’s unique WQRMP. It should include experienced water quality specialists and staff from various areas of your facility management, clinical, public health and maintenance teams. The sooner the better to ensure the level of risk is reduced to that which is manageable and clearly understood by your executive management team.

References 1. A dams F. Water chlorination experiences at Toronto, Canada. Amer Jour Pub Health 1915; V8, p. 867-869. 2. Ericson J. Chlorination of Chicago’s water supply. Amer Jour Pub Health 1918; V10. 3. Snow J. On the mode of communication of cholera. 2nd edn, London, John Churchill, New Burlington Street; 1855. 4. Pasteur V-R. Works of Pasteur. Libraires de L’académie de Médecine. Saint-Germain, Paris. Masson ET Eds; 1939. 5. Springthorpe S. The occurrence of amoebae and legionella in premise plumbing. Centre for Research on Environmental Microbiology, University of Ottawa, CAN and Amer Water Works Assoc, Water Quality Technology Conf. 2011. 6. Biyela P, Ryu H, Brown A, Alum A, Abbaszadegan M, Rittmann B. Distribution systems as reservoirs of Naegleria fowleri and other amoebae. Jour Amer Water Works Assoc 2012; 104:1:66-72. 7. R. Wang H, Edwards M, Falkinham J, Pruden A. Molecular survey of the occurrence of Legionella spp., Mycobacterium spp., Pseudomonas aeruginosa, and amoeba hosts in two chloraminated drinking water distribution systems. Jour Appl and Env Micro 2012; 78:17:6285-6294. 8. Department of Health and Hospitals, State of Louisiana. CDC confirms rare ameba in

St. Bernard Water System; 2013. 13 Sep. http://www.dhh.louisiana.gov/index.cfm/ newsroom/detail/2865 9. S. Calligeros M. Brisbane water bacteria linked to lung disease. Brisbane Times; 2014. 28 Feb. http://www.brisbanetimes. com.au/queensland/brisbane-water-bacterialinked-to-lung-disease-20140228-33r3z. html#ixzz2urSub4E7 10. Chief Health Officer (CHO) Branch, Queensland Government. Review of the prevention and control of Legionella pneumophila infection in Queensland. CHO’s report; 2013. http://www.health. qld.gov.au/legionnaires/docs/cholegionella-report.pdf 11. State of Queensland, Queensland Health. Guidelines for managing microbial water quality in healthcare facilities; 2013. ISBN 978-1-876532-20-8. http://www.health. qld.gov.au/legionnaires/docs/guide-waterqual.pdf 12. Australian Drinking Water Guidelines 6 (2011) National Water Quality Management Strategy of the National Health and Medical Research Council, Natural Resource Management Ministerial Council, Australian Government. 13. Mofidi et al. (2012) Comparing ADWG to Other International Regulations and Guidelines: What ADWG Revisions May Be Anticipated? Australian Water Association, Water Journal, Aug. 14. Baribeau & Mofidi et al. (1999) Regrowth and biofilms: evaluating effects of biological and conventional treatment on distribution systems. American Water Works Association (AWWA) Conference, Pleasanton, Calif., USA, Feb. 15. Mofidi et al. (2002) Bacterial survival after UV disinfection: resistance, regrowth and repair. AWWA Water Quality Technology Conference, Seattle, Wash., USA, Nov. 16. Roy, P A. (2003) Legionnaire’s Disease Outbreaks - Identification, Evaluation and Control, Joint Conference of the Australian and New Zealand Society of Occupational Medicine and the Aviation Medical Society of Australia and New Zealand. Auckland, New Zealand, Sep. 17. Pruden et al. (2013) State of the science and research needs for opportunistic pathogens in premise plumbing. Water Research Foundation, Denver, Colo., USA. 18. Mofidi & Linden (2004) Disinfection effectiveness of UV light for heterotrophic

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

bacteria leaving biologically active filters. Jour WSR&T – AQUA (53:8). ofidi et al. (2013) AWWA Manual 19. M of Water Supply Practices, Nitrification Prevention and Control in Drinking Water. Chapter 2, “Nitrification in Water and Wastewater Treatment.” AWWA, Denver, Colo., USA. 20. M ayhall (2012) Hospital Epidemiology, Chapter 60: Infection Control and Prevention in Hematopoietic Stem Cell Transplant Patients. 4th ed. 21. W ater Safety in Buildings (2011), World Health Organization, Geneva. 22. A SHRAE Proposed Standard 188, Prevention of Legionellosis Associated with Building Water Systems (2011), (proposed for adoption in June 2013), ASHRAE, Atlanta GA USA. 23. Q . Kozicki Z, Cwiek M, Lopes J, Rodabaugh G, Tymes N, Baiyasi-Kozicki S. Waterborne pathogens: A public health risk in US hospitals. Jour Amer Water Works Assoc 2012; 104:1:52-56. 24. W ashington Department of Health. When an institutional building becomes a water system: Hospitals, schools, colleges, hotels, convention centers; 2014. http://www.doh. wa.gov/portals/1/Documents/pubs/331488.pdf

The Authors Alex has 24 years of experience designing, operating, and maintaining, and researching microbial responses to disinfectants and other treatment processes, balancing risks and benefits of water treatment processes, developing management protocols for pipeline biofilm and corrosion control, and developing solutions to system monitoring and data management in the Americas and throughout Australasia. He is Technical Practice Leader for drinking water treatment at the global professional technical services consultancy AECOM in Brisbane, Queensland and was appointed by Queensland Health as part of the Technical Advisory Panel (TAP) that produced the Queensland Guidelines. Alex is a Registered Professional Engineer Queensland (RPEQ) with a Bachelor of Science and Master of Science in civil engineering. You can contact Alex on: Alex.Mofidi@AECOM.com Nicolas Massey is the Senior Director of Technical and Engineering within the Health Infrastructure Branch of Queensland Health. He was tasked with the formation and management of the TAP and delivery of the Queensland Guidelines.

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

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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.

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A Practical Approach to Facility regulatory Compliance Frederic Jeunet I AMEC

Regulatory compliance considerations during design, construction and commissioning stages: A case study of the practical approach taken on the Victorian Comprehensive Cancer Centre and New Royal Adelaide Hospital projects.

The Idea in Brief

he Victorian Comprehensive Cancer Centre (VCCC) and new Royal Adelaide Hospital (nRAH) projects contain highly regulated areas such as PC2/PC3 containment laboratories (regulated by the Office of the Gene Technology Regulator – OGTR), QC2/ QC3 quarantine facilities (regulated by the Department of Agriculture – previously DAFF/AQIS), cleanrooms for medicinal and blood & tissues products (regulated by the Therapeutic Goods Administration – TGA) and pharmacies regulated by the State Pharmacy Authorities. These areas require special consideration during design, construction and commissioning to ensure, with a high degree of confidence, that the specific regulatory requirements of the projects will be met, and that the regulatory approval process will be simplified. The methodology to effectively and efficiently deliver these technically challenging projects must take into account the science requirements, regulatory compliance requirements and major risks. On the VCCC and nRAH projects (and multiple other research facilities across Australia) AMEC offers as Specialist Consultant a practical and innovative approach to the completion and successful handover of these complex projects. While these two projects are some of the largest hospital projects in Australia, the methodology can and has be applied to much smaller projects

including upgrades. The focus of the approach is independent verification or “documentary evidence” for critical aspects of the facility throughout the project life ensuring documentation is available with full traceability and is adequate for use in regulatory submissions.

Approach during Design stage During design activities a risk management approach is required to provide the client with a method of identifying and tracking project risks from a regulatory compliance perspective, from a buildability perspective and from a compliance with user/science requirements perspective. In addition there is a need to scope out the regulatory compliance methodology and establish a list of deliverables needed to satisfy the regulatory requirements of each area and define who is providing them and at what time. To establish the required regulatory framework for the facility it will be necessary for the project team to understand the science required in the specialist areas and to establish a full list of the regulators having jurisdiction over those aspects, in conjunction with the Client User Representatives and the Facility Regulatory Compliance Committee. The project team will need to establish a Project Verification Plan

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or Validation Master Plan (based on the Pharmaceutical Industry validation “V” model if TGA Licensing is required), based on an agreed quality plan methodology for the facility that will carry on beyond the capital works phases and will be the basis of the facility’s ongoing compliance strategy. This will assist in defining the documentation required to support the Verification Plan and who the responsible party will be to produce and execute each document by when. Once the regulatory framework is established (as early as possible in the project timeline) a series of Risk Workshops should be facilitated with all key designers and key user representatives, where the lead designer for an aspect of the facility explains how the proposed design solution meets the requirements of the project. The facilitation team will then pose “what if” questions to the designer, from the point of view of compliance with user needs, regulatory suitability and buildability/ practicality, to promote detailed discussion of the proposed solution and identify risks that need to be managed through the design and construction. Considering the facility is the primary line of containment defence (for OGTR), quarantine defence (for Dept of Agriculture) or contamination defence (for TGA) it is imperative that the physical barrier and environmental conditions are maintained under all required

TECHNICAL PAPERS circumstances. The Risk Workshops cover failure scenarios to help determine where plant and system backup and redundancy are required. This approach ensures that design duplication and redundancy is provided only where required, generating a compliant but cost effective solution. It is important to note at this point that the regulatory compliance applications and the presentation and/or defence of applications to the regulators must, under law, remain the responsibility of the facility operators nominated/ registered “Responsible Person”. In this sense it is in the interests of the Project for that person, or persons nominated to represent that person, to be fully aware of the methodology employed on the project and to approve the delegation of responsibilities for witnessing/ execution of tasks in advance of them being undertaken.

Approach during Construction and Commissioning stage Firstly complex hospital projects such as VCCC and nRAH require a higher degree of supervision on site than a normal construction project. For the research laboratories and cleanrooms this extends to having an on-site presence, providing training for on-site supervisory staff and first point of contact during this phase for compliance issues. By providing suitably skilled personnel on the site during construction it is possible to communicate the regulatory requirements to the trade contractors and minimise the likelihood that site changes or interpretations and compromises of the design will be made without due consideration of impact on accreditation. Secondly technology intensive facilities such as VCCC and nRAH require enhanced commissioning to thoroughly test the systems. The commissioning may need to be configured not just to meet the

design performance requirements but also to address the performance at specific outer limits of the ambient conditions and also under single point failure modes associated with all services and infrastructure items. The commissioning tests in failure mode will need to: • review the building response as a whole and as individual plant equipment (e.g. power loss, communication loss, damper closure, valve failure, etc) • verify that the commissioned facility can be safely operated over the design range of controlled parameters and that there is capability to identify and act accordingly when the facility is outside the verified parameters or in failure mode The production of inspection test plans, enhanced commissioning plans, qualification protocols and the like will be an essential task in the delivery of these types of high end controlled spaces. They will set out the basis on which

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TECHNICAL PAPERS documentary evidence of compliance will be presented to meet regulatory requirements.

same space. We do not believe that separate evidence is required for each regulator.

In our experience there are a number of varying approaches to these tasks across the regulators, and the specific expectations of individual regulators can often be interpreted by facility operators in a manner that overly complicates the approach to documentary evidence that is adopted.

2. P roduce a logical set of Installation Qualification (or Verification) procedures/protocols to verify that the installed facility finishes, features, services and fitments are in accordance with the approved design.

In reality, our experience indicates that the regulators basically have the same overall goals in respect to facility construction for regulated purposes, and that is; that the operators have a system, that the system addresses the specifics of the codes and regulations, that there is rigour applied to following and reviewing the methodology, and finally that there is a proper understanding of the risks, maintenance requirements and available remedial actions that are specific to the facility. In other words, they are in control of the science and the facility and know how to react to abnormal circumstances. Therefore, set out below is the approach to these tasks that we believe are the most appropriate for complex projects of this type: 1. A dopt as a basis for qualification the minimum requirements of the most stringent regulator for each space and add to it the specific differences required by other regulators of the

3. P roduce a logical set of Operational Qualification (or Verification) procedures/protocols to verify that the commissioned facility can safely be operated over the design range of controlled parameters and that there is capability to identify and act accordingly when the facility is outside the verified parameters. Finally the execution of the agreed Installation and Operational Qualification (or Verification) protocols and the assembly of the Documentary Evidence is the most critical step in the overall approach as it will produce the reports that will be relied upon to show that the facility has been adequately tested and reviewed to assure the “Responsible Person” and the Regulators that the facility will be able to be operated and maintained in accordance with the regulatory requirements. As such it is important that the exercise be undertaken by persons experienced in the tasks. They must be adequately trained and authorised to accurately record and present information in a concise manner that properly reflects the activities undertaken to the point where the evidence is repeatable at audit if necessary (particularly where regulators require regular/periodic retesting to demonstrate ongoing compliance).

Conclusion We find that end users and scientists can sometimes have limited availability to efficiently communicate their science requirements to the design and construction teams. Some of the critical compliance and operational requirements of specific users can be missed or misinterpreted during the early design stages but through detailed consultation with the users and a series of Risk Workshops the project team can ensure that the design solutions are adequate and that the end user requirements are fully satisfied in the completed facility. Verification or “documentary evidence” of the project’s critical aspects is of prime importance in projects for controlled regulatory environments such as PC/QC laboratories and licensed cleanroom facilities. Our proposed methodology is to produce all compliance documentation under a Project Verification Plan and format it in a manner that gives forward and backward traceability of critical aspects, in addition to defining specific roles and responsibilities throughout the project stages. This approach provides a high degree of confidence that the specific regulatory requirements of a project will be met, and that regulatory approval will be simplified. It also ensures full alignment between users/scientists, designers and building contractors with a clear definition of project objectives, roles and responsibilities.

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Keeping Up with Legislation Whilst Doing Our Day Job David Evans, BSc, MTech, MBA, MIEAust, CPEng, FAIM I Strategic Asset Manager Narelle Turner I Executive General Manager, Health Sector, Transfield Services

Introduction

ith everything else going on in a health facility, how can anyone keep up to date with legislation around asset maintenance and compliance? To start with, there are a variety of asset management systems, standards and audit tools, and these can vary by jurisdiction. If we find ourselves noncompliant, then there can be serious penalties, disruption to business and services, or worse. This paper will explore the relationship between asset management, assets themselves and an organisation’s objectives. This premise is consistent whether the assets are in a hospital, commercial, retail or industrial facility. We will give you some tips on the how to and what to watch out for. We will also look at the fundamentals of an asset management plan, the various types of planning tools available and how these can be put to best use, bearing in mind ease of set-up and maintenance as well as relevance. Further, a study will be made of how to keep up with legislative changes and make sure those are adopted into your asset management plans, including where to gain support.

THE GLOBAL STANDARD (we’re all in it now) In January 2014, the regulatory world of asset management changed. International cooperation has led to the development of the ISO Standard 55000 / 01 / 02 Asset Management which is comprised of three parts:

• ISO 55000 Asset Management – Overview, principles and terminology • ISO 55001 Asset Management – Management Systems requirements • ISO 55002 Asset Management – Management Systems guidelines on the application of ISO55001 Twenty countries have participated in the development of the ISO standard, including Australia, UK, Canada, New Zealand, USA, India and a number of European countries. The ISO standard specifies the requirements for a management system for asset management as below: − Context of the organisation − Asset Management System − Strategy − Leadership − Planning − Support − Operation − Performance evaluation − Improvement Insurance companies and banking establishments are frequently at the leading edge of understanding the risk profile of organisations. Based on data presented by Don Schubert, Senior Vice President, Marsh Insurance and Risk Management, at the Meridium Conference 2010, Asset Performance Management (APM) is becoming a significant influencer in the terms and pricing of insurance which, in turn, influences banking terms.

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“Nobody takes big chunks of your risk anymore,” says Schubert. Up to 20% of an organisation’s risk profile is determined by their ability to demonstrate in a timely and straight forward manner that they are managing their physical assets well and are mitigating risk. Recent catastrophic events have only heightened insurance companies, creditors and company CFO’s views on the importance of Risk Management. Asset Performance Management is becoming a more significant percent of the litmus test for the overall health and profitability of a company. Don Schubert, made the following comments at the 2010 Asset Management conference. In today’s plant environment, the need to manifold asset management with risk management is critical as companies are required to have much larger insurance deductibles and or financial captives (money held by the company to pay for a loss). In both cases, the dollars at risk are those of the company. In the current environment, company deductibles are as high $20-30 million out of a company’s pocket before the insurance companies start to contribute to any given loss. It goes without saying that the effort to mitigate and avoid loss requires a new level of response. The question becomes this: what processes, techniques and support systems will in fact support the mitigation of loss events? There are a number of reasons why an organisation should consider

TECHNICAL PAPERS Asset Management Certification to ISO55001, including:

Licence to Operate It is considered likely that in the next few years, regulators will introduce the idea of a ‘Licence to Operate’ infrastructure/utility type assets where there is a high interface with customers. These ‘Licence to Operate’ requirements might consist of certification to ISO55001, and/or provision of professionally certified asset managers.

Managing our Asset Management obligations and risks As Hospitals provide higher complex and value-adding services, then we take on more risk associated with the integrity and the performance of the Assets we are managing. A good asset management system is the way of effectively managing that increased risk. This is in a similar manner to the adoption of health and safety, environmental and quality management systems a number of years ago. A company-wide Asset Management system will again assist in identifying and managing the risks associated with these assets.

Satisfying Senior Management and the Board Directors and hospital administrators in a major asset-owning hospital are likely to be increasingly demanding to understand the level of Asset Management risk, and the efficacy of asset management systems that are in place to manage that risk.

TIP No: 1 Acknowledge that there could be different definitions of asset management, but they all have two things in common: 1. They relate to the whole lifecycle of the asset, and 2. They relate the management and performance of the asset to the strategic and business goals of the organisation.

TIP No: 2 Conduct a desk-top assessment of your asset management system prior to considering any form of external accreditation, such as is available via ISO 55 001.

USING YOUR ASSET MANAGEMENT PLAN (making it count) The Asset Management Plan (AMP) is the best place to capture and document corporate knowledge about assets and, importantly, service delivery. The AMP aims to improve overall management through documenting standards and optimum operational performance. Adherence to the AMP is proof-positive of compliance from a practical standpoint. AMP’s deal with future demand, risk management and life-cycle management including renewal, maintenance and replacement/ disposal strategies. A typical Table of Contents of an operational, as opposed to a strategic, Asset Management Plan, is shown in the International Infrastructure Management Manual (IIMM). In summary, the structure of an AMP is as follows: • Introduction • Service levels (customer expectations/ asset performance/gaps) • Future demand (growth and impact on assets) • Lifecycle asset management (assets, their condition and O&M strategies) • Financial issues (show me the money – Opex and Capex during the design life) • Risk assessment (and mitigation) • Asset management practices (organisation and governance) A useful strategy, that will ensure upto-date compliance with legislation, is to subject the AMP to peer review through a recognised benchmarking organisation. Local Governments make use of the National Asset Management Framework (NAMF). This provides a

methodology whereby each Council, or for that matter any organisation, can self-assess its asset management capability status and monitor its own performance (improvement) over time. Each Council begins its Asset Management journey at a very basic level and steadily improves as resources are allocated and skills and knowledge develop. The model draws its key Asset Management criteria from the various state-wide asset management improvement programs, and other industry guidelines, and captures all key elements of the Federal Government’s Enhanced Asset Management Framework. The focus of the NAMF model is built around nine key criteria for asset management. These criteria fit into the Federal Government’s Asset Management and Financial Management Guidelines which then allow ready comparison to other similar organisations. 1. Asset Management Policy 2. Asset Management Improvement Strategy 3. Governance & Management 4. Asset Management Plans 5. Annual and Long Term Financial Planning 6. Organisational Capacity 7. Operational and Asset Management Processes – Data & Systems 8. Community Engagement 9. Levels of Service Each key criterion is assessed by responding to critical questions rated on a five-point scale. This rating is then aggregated under each Key Criteria heading to give a score. The maximum value is 100. By undertaking the evaluation over a period of time, each Council (organisation) can map out its progress towards achieving “Enhanced Asset Management”. This will allow each organisation to measure its

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TECHNICAL PAPERS improvement. Being a numerically based assessment framework, it allows benchmarking between Councils (organisations), between regions, within States and across Australia. Returning to the AMP and its role in demonstrating compliance, it is important to understand that the AMP is linked to the organisationâ&#x20AC;&#x2122;s corporate and strategic drivers and aspirations. The asset management policy (document) converts strategic intent into asset requirements, while the AMP converts these requirements into tangible asset actions and outcomes. The life-cycle-cost schedule, as a key section within the AMP, is an effective way of communicating the requirements for compliance with the corporate services delivery objectives.

TIP No: 3 Draw a linkage diagram that shows the connection of corporate objectives to asset management life-cycle requirements to include consulting/engineering/operations/maintenance/renewals/ disposals.

REMAINING CURRENT AND UP-TO-DATE (keeping on-side) Compliance starts with setting up, or having access to, a database of asset types and the current, relevant legislation and maintenance standards. This information is available from a variety of sources. Those typically used by us include: The Asset Management Council (AMC), Institute of Public Works Engineering Australasia (IPWEA), New Zealand Asset Management Support (NAMS), SAI Global, PAS 55 and various conferences. Once the database is completed, with current legislation and standards populated, the critical element is to have a method for distributing the data or providing real-time access for relevant personnel in the maintenance and support teams.

Figure 1: Legislation Synopsis

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Legislation Federal and State Government regulations control the design, construction and maintenance of buildings and places of public entertainment. Those regulations include the maintenance of fire safety, refrigeration, safety measures, air conditioning and heating systems to protect a buildingâ&#x20AC;&#x2122;s occupants. A synopsis of Statebased legislation is shown in Figure 1.

Figure 2: The AUS-SPEC Guidelines for Buildings

There are various standards applicable in Australian Standards for breaking up buildings into components for asset management purposes and these can be tailored to suit the complexity of the property concerned. The AUS-SPEC Guidelines for Buildings is widely used and adopts the most common break-up of component groups. Figure 2 shows a typical break-up that is adopted.

The Maintenance Standards Database Having identified the applicable asset classes, the database is structured accordingly, with current maintenance standards being accessible, and might generally be structured as per the extracts in Figure 3. The database shown in Figure 4 allows a maintenance engineer, planner or other user to locate the asset class to be maintained and follow a link to find the latest maintenance Standard.

Figure 3: Extract from Database of Standards

TECHNICAL PAPERS

Figure 4: Live Database with links to various asset classes an Standards

Figure 5: Asset definition: Chiller

Figure 5 is an expanded view of one asset class, in this case a chiller. High level information on the asset is shown and there is a link to the appropriate and latest maintenance instruction.

Keeping up with Changes The information sources shown above have advice mechanisms to alert members and registrants when new standards are being considered and are legislated. Usually, there is a reasonable period of time during which consultation takes place prior to any new standards being

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

TECHNICAL PAPERS legislated. These are well published within the asset management community. The key is to maintain the database or other record keeping system when any new legislation and standards are published. Further, having an effective communication mechanism for notification of changes to relevant operational, quality, risk and planning teams is paramount.

Case Study – Data integrity/ internally compliant SITUATION Asset data is normally captured during the early stages of the life-cycle (engineering and construction) and is available from a range of document sources such as: • As built/as commissioned drawings • Equipment/asset specifications • Process & Instrumentation diagrams (P&IDs)

TIP No: 4 Maintain a database of current Standards that is easily accessible and able to be updated and communicated.

• Operation & Maintenance manuals • Asset registers (ARs) • Computerised maintenance management systems (CMMS) • Spare parts/inventory catalogues

TIP No: 5 Connect with the various Asset Management and Compliance Associations and register for legislation and other updates as they occur.

However, during the asset life-cycle, some assets are refurbished and/or modified, some are enhanced with additional functionality or capacity, and some assets are terminated and no-longer kept in-service.

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TECHNICAL PAPERS A major utility company with 250,000 assets spread across 30 sites in NSW faced a data consistency problem. Very few of the data sources listed above contained identical data about assets. From a safety point alone, this represented a belief of non-compliance and this triggered a call for action. The company wanted to establish a single source-of-truth such that all asset related documentation, and all users of asset data, could rely on the data being consistent and accurate. SOLUTION Transfield Services proposed a comprehensive methodology comprised of: • Field-based data collection teams • Office-based draftsmen • Office-based data analysts • Maintenance planners, and • A governance structure to manage cost and timing The field-based teams were tasked to validate actual site conditions and record this information directly into the P&IDs and the AR held within the CMMS. The office-based teams converted this information onto the as-built drawings while the maintenance planners updated the O&M manuals. Interactions are shown in Figure 6. Our analysts interrogated the CMMS to ensure all job plans and work orders contained correct asset codes and hierarchy references matched back to P&ID, as-built drawings and O&M manuals. The governance team met initially weekly to establish the reporting requirements and the QA approach aimed at managing cost and time, along with staff recruitment, training, and hardware/software tools and techniques. RESULTS The magnitude of the task was weighty due the requirement to complete the assignment within 9 months. Engaged on the project were 5 field-based teams of 10 in each team, 5 draftsmen, 8 office-based staff and 4 senior staff within the governance team. Transfield Services has since been approached by other organisations, of different scales, to conduct similar data integrity projects. “Configuration management is the process for establishing and maintaining consistency of a product’s performance, function, and physical attributes with it’s requirements, design and operational information throughout its life”: (ANSI/GEIA 649:2004).

Figure 6: Field and Office interactions

CONCLUSIONS Complying with legislation has suddenly become more intense for organisations that manage physical assets. This situation is headed by the introduction of the new international standard for asset management, ISO 55 000. It will soon be convenient for the commercial industry, comprised of insurance companies and banking, to demand that asset-owning organisations demonstrate compliance to this standard. Failure to do so might result in excessive premiums and/or higher deductibles. A major principle of ISO 55 000 strongly endorses the linkage between business objectives and asset objectives. In practice, it is the service that physical assets provide that is most valued. A well-developed list of service levels is therefore fundamental for the effective management of the asset base. This means that the host of decisions about asset priority, criticality, availability, reliability, maintainability and, of course cost, can be optimised for their whole-of-life. Legislation and standards help to shape these factors, namely from safety, environment, and quality perspectives, and now also from an asset management perspective. The planning tool of most value in communicating asset management compliance is the Asset Management Plan. This plan, whether strategic, tactical or operational can be used to convey data and analytics to stakeholders and hence meet requirements to demonstrate service level and statutory compliance. The Case Study provided shows an example of data-led compliance to a single source of (data) truth. This paper has examined the vexing questions of knowing, and hence complying, with various forms of legislation and standards whilst “keeping the lights on”.

The Case Study audit demonstrates the value in keeping your data internally consistent across all possible points of access; a highly relevant compliance task that allows maintenance to occur in accordance with current Standards.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

TECHNICAL PAPERS

Driving Improvement with ISO 55000 Scott Yates I Principal Consultant Assetivity

Hospitals and health care are big business – in 2014-15, the Western Australian health budget will exceed $8b (28% of the state budget), the new Fiona Stanley has just been completed at a cost of $1.8b and the new Perth Children’s Hospital (PCH) is budgeted to cost $1.2b1. How do we make sure this massive expenditure is delivering value? Perhaps we should have spent it on maintenance and renovations rather than new facilities? Perhaps – heaven forbid – it would have been better spent outside of health altogether? These are big questions and they are extremely difficult to answer. Worse still, they persist at all levels of the organisation – just on a smaller scale. Budgets are limited, aspirations are not and it is difficult to work out the best long-term strategy.

he good news is that the health industry is not alone in this dilemma and the discipline of asset management has arisen over recent decades to address these challenges. This paper describes the latest development in this field – the release of the first global consensus standard for asset management systems – and how this might be used to assist health care facilities managers. Let’s begin by looking at the standard.

The New Standard for Asset Management Systems Firstly, there is not one new standard for asset management. What is commonly referred to as “ISO 55000” is really a suite of three documents published by the International Organisation for Standardisation (ISO) in January 2014. These three documents are: • ISO 55000:2014 – Asset management – Overview, principles and terminology • ISO 55001:2014 – Asset management – Management systems – Requirements • ISO 55002:2014 – Asset management – Management systems –

Guidelines for the application of ISO 55001 Collectively, the three documents define the requirements and provide guidance on methods for a management system to govern the practice of asset management within an organisation – similar to the roles of ISO 9000 and ISO 31000 with respect to quality and risk respectively. The titles provide a pretty good idea of the role of each document in achieving this and it is worth noting that other ISO management system standards documents will be required to follow this structure after their next update2. Regardless of the format, the ISO 55000 suite provides us with a “consensus of experts” on how to build an asset management system. Before we go any further, however, it is entirely fair to ask why we should bother. Fortunately, this is a relatively simple question to answer, with ISO 55000:2014 claiming: • Improved financial performance • Informed asset investment decisions • Managed risk • Improved services and outputs • Demonstrated social responsibility • Demonstrated compliance

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

• Enhanced reputation • Improved organisational sustainability • Improved efficiency and effectiveness I think most people would agree that at least some of these things are likely to be beneficial to any organisation – commercial or public sector. Further, these are not just empty words. According to the United Kingdom’s Institute of Asset Management – their peak body for the discipline – examples of real world benefits claimed by various organisations include3: • A 17% increase in output with a 50% decrease in operating costs (North Sea oil platform) • A 22% reduction in planned system downtime (United Kingdom National Grid) • A 29% increase in output with no additional cost (Baltimore power generator) Consequently, it is reasonable to assume that there are significant benefits to be gained in the health sector by a focus on high quality asset management. That, of course, raises the question of how, which requires some discussion of the underlying principles.

TECHNICAL PAPERS Principles of Asset Management At its core, asset management is about making asset decisions – investments, divestments and everything in between – that provide the best trade-off between the competing factors of cost, risk and benefit. This is represented in the following diagram: If an organisation is to reduce its costs (move closer to the cost axis), it must either accept higher risk (move away from the risk axis) or reduce the benefits it provides to its stakeholders (which include the public in the case of hospitals). This, of course, assumes fundamental good practices as these can simultaneously improve performance in all regards. For example, Reliability Centred Maintenance techniques generate maintenance programs that are typically cheaper, less intrusive and lower risk than traditional alternatives4.

Critical to this diagram is the acknowledgement that the asset management system does not need to cover all assets – noncritical office assets, for example, are usually excluded. Also, the role of the asset management system is clear – it sits between the organisation’s broader asset management practices and defines what will be done to the assets under management and when. In a sense, the asset management system fills the “toolbox” with the appropriate tools for a particular organisation’s needs. In addition to the consensus on asset management system requirements, there is also a separate consensus of experts on the tools that make up the discipline of asset management. These have been defined by a collective of national/continental peak bodies known as the Global Forum on Maintenance and Asset Management (GFMAM). The GFMAM has published their work in The Asset Management Landscape Second Edition earlier this year. There are 39 subjects divided into six subject groups as illustrated below:

A fourth factor not shown on the diagram is time, since organisational needs typically evolve over the years. For example, the focus for PCH should be on long-term benefits at acceptable levels of cost and risk, while the Princess Margaret Hospital, which PCH will replace, requires controlled risk decisions to maintain services while minimising cost during the transition. In order to identify the appropriate position, an organisation needs to have a clear picture of its objectives and current capabilities. This is where a structured asset management system comes in, built on the following four fundamentals5: • Value – a clear understanding of what the organisation and its stakeholders value and how the assets will contribute to delivery of that value • Alignment – processes for ensuring asset decisions at all levels are linked to the delivery of value • Leadership (and Culture) – the organisational will and discipline to follow through on the decisions • Assurance – controls and feedback mechanisms to ensure that things have been done and that the expected results have been delivered The system built around these fundamentals forms an integrated part of the overall management of the organisation, as illustrated in the following figure (adapted from ISO 55000:2014):

A full discussion of each of the above is well beyond the scope of this article, but I’d like to discuss some selected examples likely to be of relevance to health facilities management.

Asset Management Tools Asset Management Planning Perhaps the most fundamental tool in asset management is asset management planning, since this process establishes both the organisation’s objectives (its desires) and the organisation’s current capabilities. From the gaps between the desires and the current reality, a cohesive plan (or set of plans) for achieving the objectives can be developed. This typically requires a layered process of decomposing the organisational objectives into “asset management objectives” and further into “levels of service” that must be delivered by asset classes. Detailed analysis of asset condition occurs at this level, leading to specific actions to achieve the required levels of service, such as maintenance interventions, operational changes, purchases, disposals and so on. These are prioritised at each level and iterated to resolve conflicts until an optimal overall package of actions plan is achieved. The following diagram (overleaf) shows how such a planning cycle might work, linked into other organisational processes such

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

TECHNICAL PAPERS • Benefits, including: o Useful life and maintainability o Appearance and functionality Note that these will be unique to each organisation as the traffic, budget, facility life, availability and cost of labour and other elements of context that drive the decision will be unique. as demand analysis and the financial, risk and project management frameworks. To bring this diagram into context, visualise a major hospital undergoing its annual strategic planning exercise. Organisational objectives include reducing wait times for both elective surgery and emergency medicine, maintaining standards of care and reducing the cost of services. Demand analysis indicates a growing, aging population with subsequent growth in health care needs across the board, but particularly in relation to geriatric care. At the asset level, this translates into objectives to increase the number of beds available for post-operative care and to reduce the rate of hospital-acquired infections (HAI’s). At the next level down, current flooring and air conditioning are identified as the key contributors to HAI’s, and actions are established to address both of these issues. In order to fund the higher priority of additional beds, the action to improve the flooring is deferred. Asset Costing and Valuation Inside the planning process, it is critical to have a clear view of the cost dimensions around an asset in order to reduce risks around asset investment decisions. The most appropriate tool for achieving this is Life Cycle Costing. AS/

NZS 4536:1999 Life cycle costing – An application guide provides a useful reference for the topic, with additional guidance available from most state government treasuries. One of the advantages of the AS/NZS 4536:1999 approach is that it inherently recognises the need to treat cost as just one element of the inputs to a decision. This is illustrated in the diagram below, where the “other factors” will include the risks and benefits associated with each option. To again place this into the healthcare context, consider the flooring issue identified in the previous example. Selection of replacement flooring in a hospital needs to consider a wide range of factors, probably covering at least the following: • Costs, including: o Acquisition cost o Cleaning and maintenance costs, including special equipment or materials o Disposal costs, possibly including decontamination • Risks, including: o Slip resistance o Microbial control

Risk Management Most organisations these days have a reasonable understanding of the core risk management activities of identifying, analysing, evaluating and treating risks. Nevertheless, many organisations forget to clearly establish their organisational context first, leading to missed risks that can arise from factors such as media exposure (reputational risks), local labour market (cost/performance risks) and any number of others. In addition, many organisations create risk registers that are really just “shelfware” – after the initial analysis, they get left on the shelf, the actions don’t get followed up and the risks don’t get updated with new information. These types of registers simply tick a compliance box without adding any real value and the literature is full of examples of where a risk was known but was not communicated to the appropriate decision makers. If you think you might have issues in this regard, consult ISO 31000:2009 – Risk management – Principles and guidelines.

Resourcing Strategy All the planning and risk awareness in the world can’t help an organisation that doesn’t have the resources it requires. In the modern world, this means a combination of both in-house and external resources working together to get the job done and the classic conundrum is “which functions do I outsource?” This is a critical asset management dilemma – outsource the right items and you could simultaneously improve cost, risk AND benefits. Choose the wrong items and you could as easily harm each aspect. Most often, organisations seek to divide their activities into “core” and “non-core”, with anything in the non-core category a candidate for outsourcing. This approach, however, can be a little too simplistic and we recommend the following matrix:

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

TECHNICAL PAPERS For Further Information… For further information or discussion of this topic, the author may be contacted on the details below: Scott Yates, Principal Consultant, Assetivity syates@assetivity.com.au (08) 9474 4044

This arrangement takes into account the organisation’s competency as well, creating four possible outcomes: • Leverage – Convert areas of high competency and low criticality into business opportunities by selling those services to others • Retain – Keep doing those things that are important and that you’re good at • Outsource – Contract the things that don’t matter and that you aren’t good at – just make sure you have the contract management skills! • Improve – Build internal competency in anything that is important – and add these actions to your asset management plans! • Achieving Results Many of the tools in the asset management landscape are not new. The major opportunity here is to use the ISO 55001 standard as leverage for change in your organisation. If you choose to go down this path, be prepared for around two years of effort. You not only need to develop your processes, you need to bring your entire workforce on a cultural change journey to acknowledge that your assets exist only to provide value and that everything the organisation does to them should be aimed at protecting or enhancing that value.

This may seem daunting, but don’t worry – you are likely to see some benefits in asset and organisational performance within a few months of starting, particularly around identifying and managing your asset risks. In addition, you may not wish to become certified – you can get many of the benefits by simply using the standard as a benchmark and aligning your practices.

Conclusion If you’ve been struggling to justify funds you need to maintain or improve your facilities, it might just be that the ISO 55000 suite of documents is what you’ve been waiting for. With the leverage of a global consensus standard with the ISO label, you may be able to build an asset management system that will drive improvement in your organisation.

References 1. http://www.treasury.wa.gov.au/cms/ Budget-Summary.aspx, accessed 22 October. 2. ISO/IEC Directives, Part 1 Consolidated ISO Supplement – Procedures specific to ISO 5th Edition, 2014, Annex SL. 3. Woodhouse, J. What is Asset Management in 2010? Published online at www.theiam.org, 2009. 4. AS IEC 60300.3.11:2011 – Dependability management – Application guide – Reliability centred maintenance, Section 4.2. 5. I SO 55000:2014 – Asset management – Overview, principles and terminology, Section 2.4.2.

Should you follow this path, the system you build will tell you the specific tools you need to implement. The journey is not quick, but the rewards are significant.

Part of the time commitment is driven by ISO’s new approach to management system standards – you now need to produce evidence that the desired outcomes are being achieved to become certified, not just that the process is in place. Consequently, a journey to certification is likely to look something like the following:

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

TECHNOLOGY

A new utility

Medical grade wireless to become a health care necessity Tom Leonidas PE

Wireless connectivity is becoming a basic expectation in health care facilities, similar to other utility systems such as power, HVAC and water.

he ability of caregivers to roam wirelessly, access electronic health records (EHRs) and have other information delivered into their hands anytime, anywhere can create workflow efficiencies, lower the cost of care, increase access and, ultimately, improve the quality of outcomes.

Some of the many different wireless devices that must be accommodated within a medical facility include:

In fact, information technology is now considered a transformational element in improving the delivery of health care, and connectivity is at the heart of it all.

• asset tracking using a radio-frequency network;

Several government and private entities are promoting the advancement of wireless for medical use. This includes federal legislation in the HITECH Act that indirectly spurred the use of wireless by providing a mandate and incentives for deploying an EHR as well as the Federal Communications Commission’s (FCC’s) allocation of 40 megahertz (MHz) of the 2360–2400 MHz spectrum for Medical Body Area Networks in May 2012.

• two-way radios;

Leveraging that connectivity and navigating the coordination points is, however, still a developing concept.

Types of wireless Wireless is a broad term that most users think of as a single system that will allow their devices to work in a medical facility with instant connectivity. In fact, facilities have several different and discrete wireless networks that serve individual applications and devices.

• wireless data, typically called an 802.11 wireless network; • Bluetooth devices, which are wireless nurse call devices and medical equipment;

• cellular phones; • digital pagers; • fire and life safety mobile communications; • multimedia applications; • patient telemetry and other wireless medical devices. Traditionally, each of these has had its own independent wireless network so, in practice, a hospital could have four or more separate wireless systems. There is typically a wireless local area network (WLAN) that is used for data and video transport. Telemetry is a separate proprietary system. Then, there is a distributed antenna system (DAS) that is used to propagate cellular, paging and radio-frequency (RF) signals. All of these systems must be separately managed and maintained. Bandwidth and throughput are issues as well. As the demand for more wireless access and applications has grown, it has created challenges within the hospital to provide available bandwidth and

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

The ability of caregivers to roam wirelessly can create efficiencies, lower the cost of care, increase access and improve outcomes. PHOTO BY CATHERINE YEULET/THINKSTOCK

speed of delivery of the increasing data load. This seemingly unavoidable fracturing has created a snarl of wireless systems and services. Most organisations envision that wireless devices serving health care needs, such as patient monitoring, would be supported outside the hospital and between hospital and clinic health care delivery networks in a manner that supports the patient. This just isn’t feasible in the current framework of medical wireless connectivity. What is needed is a single ubiquitous network that works seamlessly with the multitude of devices within the complete health care wireless ecosystem, from inside the hospital, into the public realm and into the home. It is also desirable

TECHNOLOGY that this unified network be vendor neutral and come with a set of common and core standards.

A single network The Centre for Medical Interoperability (http://medicalinteroperability.org), a recently formed, hospital-led non-profit organisation, has taken on the task of creating a national standard for a unified medical-grade wireless network. The overarching goal is to optimise patient care by driving rapid, widespread, sustained interoperability of medical technology. Through this initiative, the organisation aims to address the connectivity challenge and elevate wireless to the level of a standard base building utility embedded in the hospital like power, water and HVAC. The key benefit of a single, open-design wireless network is to provide a managed physical wireless infrastructure that allows for deployment of virtually any wireless technology. It allows adoption and deployment without having to create alterations to accommodate new technologies. Additionally, it allows for a wide variety of bandwidth compared with multiple single systems with narrow bandwidths. A medical-grade wireless utility affords hospitals the ability to make device decisions based on infrastructure, instead of infrastructure decisions based on the device, eliminating the fractured nature of managing and maintaining separate networks. Ultimately, it provides greater future flexibility and lower long-term operating costs. Several characteristics define a wireless system as medical-grade. First, it should be a single physical wireless infrastructure that serves all wireless devices. It also must feature appropriately designed coverage and offer a consistent and highquality signal within the coverage area. It must have the capacity to support all devices within the coverage area as well as security that encompasses physical, over-the-air and digital measures to protect information. Finally, it must ensure the ability of the protocol to operate in a wireless environment.

From a conceptual standpoint, a medicalgrade wireless utility is a single physical wireless infrastructure with the following four pillars: WLAN. This is used for personal, body and enterprise data. Wireless wide area network (WWAN). This is used for mobile phones and radio traffic. Location local area network (LLAN). This is used for asset and other locationbased services. Wireless clinical data network (WCDN). This is dedicated to medical monitoring, telemetry and other medical devices. Health facilities professionals can think of it as a multilane freeway in which the lanes are dedicated to certain types of wireless traffic. For example, one or two isolated lanes are dedicated to medical telemetry and patient monitoring. They are protected securely where traffic moves freely and undisturbed by other traffic. Meanwhile, other lanes serve mobile phones, paging, voice and wireless data traffic. Medical-grade traffic has the highest priority in terms of time, criticality, security and acuity. Consumer-grade traffic, such as for mobile phones, has a lower standard in all of these areas.

For instance, health facilities professionals would want a minimum standard of 100 percent area coverage for medicalgrade traffic, but could get by with a lower minimum standard of 90 percent coverage for mobile phone traffic. The reasoning is to design to the need of each wireless element to lower initial design cost and long-term operational costs.

Hospital to home The physical design of a medicalgrade wireless network is focused on deployment of an engineered antenna structure throughout the hospital to achieve the area coverage requirements. It creates the freeway that acts as the signal transport backbone. The advantage of using the antenna as the central design element is that it can accommodate multiple wireless frequencies that serve multiple technologies. Active equipment that is specific to each wireless technology and bandwidth frequency is injected into the transport backbone at technology distribution rooms throughout the facility. This allows for powered active equipment to be centrally located in equipment rooms or in corridors (in the case of wireless access points) to be managed more easily. This provides an efficiently designed system

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

TECHNOLOGY both from a systems architecture and a spatial architecture perspective.

band for use with small-cell and database technologies.

while also giving them a bigger role in managing their own health care.

This type of design incorporates smallcell architecture, which creates small, point-located wireless and cell sites within the hospital. The advantage of small-cell architecture is that it provides performance and capacity uplift in a geographically dispersed manner, thereby lessening bottleneck issues that can occur with traditionally designed wireless systems.

Once the in-hospital wireless infrastructure is laid out, how can a bridge to the corner coffee shop and into the home be created? While still in the future, much of that is being driven by the major cellular providers’ seeking new sources of revenue. The major mobile wireless carriers are investing billions in health care, leveraging their 4G LTE networks to make them medical-grade, which will provide a seamless network and secure transmission of clinical data from inside the hospital into the home and vice versa. The vision is that hospitals would host small-cell architecture sites for the carriers, which would be part of a single carrier integrated wireless system that extends outside the hospital.

Security and privacy of data is a focal point issue in the development of connected health. Tight regulations and hospitals’ fear of HIPAA noncompliance are the most significant barriers to enabling the democratisation of data that are needed to enable connected health. Work continues to advance in terms of encryption technology that will enable reasonably safe methods of moving data.

Small-cell architecture is a primary driver for the major cellular phone providers because it provides a relatively lowcost design method that allows them to extend their edge network to get greater coverage and maintain a relatively high level of signal quality. Small-cell architecture is a crucial element in the design of the cellular provider’s longterm evolution (LTE) networks. The FCC is helping to grow the use of small-cell architecture through a recent proposed ruling that will make available 100 MHz of shared spectrum in the 3.5 gigahertz

EHR vendors, software companies and mobile wireless carriers also have developed patient-focused applications and will continue to do so. These applications will be put into patients’ hands and allow them to be monitored

Success in the field Planning for a medical-grade wireless utility in the hospital is a paradigm shift from the traditional wireless network. It is designed around antenna placement to obtain coverage, and strategic location of equipment, requiring early planning

Key drivers for successful connected health

Some barriers to connected health

In 2012, the consulting firm Accenture conducted a study titled “Making the Case for Connected Health” (www.accenture. com/us-en/Pages/insight-making-case-connected-health.aspx), which identified six key drivers of success in organisations that had successfully adopted connected health. They can be summarised as:

Barriers to achieving the vision of connected health and portability of health care data are both technological and political.

• Vision and leadership. Creating a shared vision focused on improved health outcomes and clarity on objectives; • Strategic change management. Implementing change in an organised and methodical manner that brings alignment to mission and vision; • Robust technology infrastructure. Implementing an infrastructure based on clear standards and information interoperability; • Experimentation and coevolution. Bringing about a balance between directing change from the top and allowing experimentation and innovation to occur in the trenches; • Clinical change management. Driving front-line clinical change through strategic change management at the organisational level; • Integration drives integration. Having successful organisations set up a system of continuous process improvement so that the first five drivers integrate with each other.

In the end, patients will drive down the barriers, in part by giving permission for their data to be shared, along with technology that provides safely encrypted data transfer.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

• Technology. An exchange of health information, geographically between caregivers and from caregiver to patient, requires a viable and secure network infrastructure. There is no governing standard today that is driving the health care industry toward a single focused infrastructure solution that invites open architecture and greater environmental interoperability. Additionally, electronic health records and other systems aren’t interoperable. Various technologies do exist that can tie different systems together by acting as middleware or software translators, but implementation of these translators can be complex and expensive. • Politics. Enacted in 1996, HIPAA is a double-edged sword. Its underlying purpose was to promote efficiencies and reduce errors through electronic records that allow the exchange of health care data. However, compliance has produced the opposite effect in many cases, as providers and medical centres err on the side of caution in sharing information and withholding data so as not to take a chance on being cited for privacy violation and potentially severe penalties.

TECHNOLOGY in terms of special and architectural elements. A medical-grade wireless utility can be installed either in new construction or in an existing facility. Its operational benefits include adaptability to a multitude of technologies, high coverage within a facility and the ability to deploy new technologies without having to install additional infrastructure, thus avoiding disruption of patient care operations. The long-term benefits include providing greater patient access, assuring higher quality outcomes, increasing operational efficiency and lowering the cost of health care. The investment of industry stakeholders in standards and guidance can be leveraged by health care organisations to competitive advantage. So what is the cost for all of this? A major medical centre in southern California

embraced the implementation of a singular medical-grade wireless utility in one of its new buildings and was able to achieve an 8 to 10 percent savings on initial capital cost, which included a reduction of 1,500 data drops compared with the traditional installation of separate wireless systems. In Massachusetts, another major medical centre deployed a new medical-grade wireless utility. It has been able to track long-term operational savings from not having to adjust, add or alter the wireless infrastructure as new wireless technologies are deployed. Because of the ability to put the infrastructure in and take advantage of centralised locations for equipment, the medical centre no longer needs to disrupt areas of the hospital or open up ceilings to construct wireless infrastructure when new systems are adopted.

The case for a single medical-grade wireless utility, treated as a base system in a facility, provides tremendous flexibility and overall cost savings over the life of the building. The end goal is an overall cost-reduction in the delivery of highquality health care.

Brave new world Connected health is a brave new world, and the medical-grade wireless utility is the vessel that will get health care facilities there. Tom Leonidas, PE, is executive vice president of Wood Harbinger, a Bellevue, Wash. based consulting engineering and technology firm. He also is a member of the Facility Guidelines Instituteâ&#x20AC;&#x2122;s 2014 Healthcare Guidelines Revision Committee, heading up the technology subspecialty group. He can be reached attleonidas@woodharbinger.com

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

TOPICS OF INTEREST

Electrical Fires Lionel Swift I Author of the ‘Electrical Industries Bibles’

There are more myths about electrical fires than myths about ancient Greece! The aim of this article is to unpack some of the myths surrounding electrical fires to offer a greater understanding of their true causes and explain how they can be best avoided.

ires in hospitals can be quite different to fires in residential premises, but as a starting point, a quick look at common causes of fire. Fire authorities’ records suggest the following common causes of fires: • Dropping cigarettes or matches; • Unguarded fires; • Curtains blowing into heaters; • Grease filled exhaust fans and kitchen ducts;

oil appliance suffers a fire, it is never a ‘gas’ fire. Electric clothes dryers are notorious for accumulating lint, which sometimes catches fire, resulting in another ‘electrical’ fire being recorded when in fact lack of maintenance (emptying the lint tray) is the cause.

“Real” Electrical fires

• Misuse of kerosene heaters and lamps, and candles.

Electricity can and does cause fires, and these can result from several different sources, but strangely the least likely is the most misquoted. This is the almost proverbial ‘short circuit’.

• Faulty or incorrectly used electric blankets;

1. Short Circuits

• Overheated cooking oil;

• Faults in electrical switchboards and wiring. These causes are not in any order of frequency, and it sometimes seems that any fire for which the cause is unknown is put down to a ‘probable’ electrical cause. One could be forgiven for thinking that a protocol exists: “if you can’t smell petrol, blame it on an electrical fault.” There are many causes of fires and valid reasons for an overlap, which of course include electrical causes.

Quasi electrical fires By this we mean those fires which involve an electrical appliance. Electric cookers and heaters sometimes catch fire, and an ‘electrical fire’ is recorded, but if a gas or

These usually ‘blow’ fuses, or these days often operate circuit breakers, before the heavy short circuit current can cause a fire or even overheating of electrical conductors. Short circuits occur frequently, but because of the point mentioned above, they do not often cause fires. (As a point of interest, electrical fires in cars and other vehicles are frequently caused by short circuits, but that is another subject entirely.) Short circuits can cause fires when an excessive current flows from one conductor to another in the fixed wiring, a switchboard, or in a flexible lead or appliance. However, as already stated, most ‘short circuits’ are quickly and automatically turned off by the fuse or circuit breaker, the primary purpose of which is to do

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

just that. Its secondary purpose is to turn off the power when an overload occurs, but this is intentionally a slower action, as some slight overloads occur normally, such as every time a large motor starts.

2. Overloads (overloaded circuit or wiring) This too can cause fires, but if minor or brief, the usual result is merely a slight heating up of a flex or power point. If severe and prolonged (prolonged either in hours or frequency of occurrence, or both) overloads can eventually cause fires. Sometimes a prolonged overload can cause a deterioration of electrical insulating material, or the severe softening of the insulation leading to a short circuit, resulting in a fire – technically from either cause, but of course definitely electrical! Another all-too-common overload can occur in a very long electrical flexible cord, and this can be accentuated by leaving the flexible lead in a coil, or worse still, wound on a metal drum. Thus causing heat by induction.

3. Loose connections (“high resistance joints”) We have now arrived at the most frequent cause of electrical fires in buildings. This is the most important information to take on board and remember.

TOPICS OF INTEREST Loose connections are without doubt the major cause of electrical fires in buildings of all types, domestic, commercial and industrial.

• Behind switchboards or in fuse contacts;

Their technical name is “high resistance joint” and this means that the loose connection acts like the high resistance wire in a radiator or toaster – causing intense heat. Furthermore, the heat generated very often causes an even higher resistance resulting in a ‘vicious circle’ effect.

• In electrical appliances or tools;

These loose connections can develop in any terminal which is left loose or becomes, loose. They can also occur in moving contact points which have deteriorated in switches or other devices, and it is pleasing that many electrical contacts have been replaced by electronic (non-moving ‘solid state’) switching devices, eliminating many potential fire causes.

It should be appreciated that it is the resistance (the loose connection) and the amount of current flowing through it which generates the heat.

Inherently common spots for these ‘loose connection hotspots’ include:

• At switch terminals; • At power points; • In connectors within junction boxes. Lights or lighting circuits are not highlighted as they usually carry less current than power circuits, and therefore loose connections don’t generate as much heat.

Arcing This too can result from a loose connection, or sometimes spontaneously with insulation breakdown. This is the most intense form of electrical heat and can violently melt metal. In controlled form it is used as ‘arc welding’ and in nature it’s called lightning.

Electrical fires in light fittings Although having said that loose connections aren’t as serious in lighting circuits because of their usually lower current, other factors in light fitting can certainly cause electrical fires. This can happen in several different ways:

Damage caused by loose connections includes: Carbonised insulating material This damage often occurs at a loose connection site, or occasionally through age or damage to insulation, and creates glowing carbon – a serious fire hazard.

• The old fashioned incandescent lamp operated at high temperature coming in contact with flammable material, or the use of a larger than specified lamp in a light fitting.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

TOPICS OF INTEREST • Traditional fluorescent light fitting uses ballasts (induction coils) to limit the current, and these, or sometimes the starter, can overheat, especially when the equipment is very old. This is less likely today with electronic ballast replacing the older type, and also eliminating the starter. However thousands of old style fluorescent fitting are still in service through the world today. • Old style fluorescent lights with failed starters or lamps won’t start, but flicker continuously. This is a potential fire waiting to start! Never leave a lamp in this condition just because adjacent lamps are still providing enough light. Either replace the lamp or starter ASAP or simply remove the starter or ‘tube’ so that it stops flickering. • QI ‘downlights’ with their extra-low voltage transformers (and therefore much higher current!) are notorious for causing fires. As with fluorescent fittings this can be caused by the coil winding in the attached transformer overheating. This in turn is frequently caused by ceiling insulation covering these controls or the top of the light itself. A main factor in these lights causing more fires than most others is that they are traditionally 50 watts, operating 12 volts, taking a current of approximately 4 amps. Now if this was a 50 watt lamp operating at 240 volts, the current would be only .2 amps (or 2/10th) of an amp). This illustrates the amplified effect of a loose connection in an ‘extra low voltage’ lamp, and the effect of the higher current through that loose connection.

A modern improvement in these small (dangerous) downlights is use of LED’s as a light source resulting in much lower current for the same – or better – light output, and reducing both fire potential and running cost.

Preventing electrical fires Fortunately there are several safeguards which can be undertaken to reduce the likelihood of electrical fire. These include: • Replacing fuses on switchboards with circuit breakers. Fuses and circuit breakers both protect against overloads and short circuits, but circuit breakers are far more accurate in their response. Furthermore circuit breakers don’t create molten metal in their operation as do fusible links (that’s the official name for fuses).

• Regular testing of power leads for continuity – now a mandatory requirement in a number of situations – because intermittent continuity can indicate the dreaded ‘loose connection’ and cause a fire. • Infrared inspection of known typical ‘hotspots’ such as switchboards, heavy current outlets, and other equipment. Infrared test equipment can detect the temperature rise of potential hot spots before they can be detected in any other way. • Regular testing of “safety switches” AKA ‘residual current devices’ – better described as ‘earth leakage circuit breakers’. While these devices protect only against electric shock, not short circuit or overload, inspecting and testing them often reveals loose connections in other associated equipment at the same time.

References “Electrical Industry Bible No 3” – 1986

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

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TOPICS OF INTEREST

Hospitals That Don’t Make You Sick(er)… Jack Noonan MBus(S&T), BSc, BA, ISIAQ Marketing and Relationship Manager/Senior Consultant, CETEC Pty Ltd

While interest in indoor environment quality (IEQ) continues to grow rapidly within Australian commercial office buildings, it is arguably within our schools and hospitals where the impacts of IEQ are most significant. For hospitals, research has found that poor IEQ can lead to more hospital acquired infections, longer hospital stays, more medical errors by staff, and general occupant dissatisfaction. It means that the hospital engineer needs to be aware of how they manage the indoor environment of their building and the tools available to them to create and maintain higher performing spaces. Importantly, having a ‘healthy’ hospital is not only about infection control.

ndoor environment quality, or IEQ, refers to the quality of the physical environment within our buildings. It includes indoor air quality, thermal comfort, acoustic comfort, lighting, visual comfort, cleanliness and maintenance, and building layout. The way we measure and manage these parameters vary. In some instances, we measure using qualitative methods, such as occupant satisfaction surveys, while in others, we measure using quantitative methods, such as physical assessment using scientific equipment. Irrespective of the approach, it is critical that hospital engineers have the data regarding how their buildings are performing. Without performance data, it makes it difficult to know the impacts or how to improve.

When to Measure? Many hospital engineers undertake a variation of an IEQ assessment as part of the operating procedures for infection control, HVAC maintenance or fitout projects. The latter has been an area of particular interest with the increasing need to minimise and manage dust or particulate matter generated from construction or fitout work to avoid infection on nearby sterile or sensitive areas. These assessments generally take place due to another activity taking place rather than ‘business as usual’. However, annual indoor environment quality (IEQ) assessments are becoming an important tool for hospital engineers and facility managers in their attempt to manage and audit built environment risks on their sites. The challenge is for consistency in measurement and approach. In an attempt to overcome this challenge, many hospital engineers and managers have utilised a validated office protocol called NABERS Indoor Environment, which provides a

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

consistent approach to what is measured and how it is measured.

Engagement Unfortunately, many hospitals are constructed and “handed over” to the hospital engineer without any consultation. Hospital design is an area of significant innovation within Australia and the amount of new technology can also be problematic. A “soft landings” approach is critical to ensuring high performing IEQ within a hospital following construction. Issues regarding air quality, maintaining temperatures and thermal comfort conditions, and the building management system should all be resolved prior to occupancy. While most buildings will require some degree of “tweaking” in the early stages, this should be minimised so as to not adversely affect the occupants of the hospital; many of which may be severely immunocompromised and sensitive to minor changes in IEQ.

Emphasis on Acoustics for Improving IEQ Speech privacy, intelligibility, and a greater appreciation of acoustic control is an emerging area of focus for hospitals including green hospitals. The controlling of acoustics is essential to the process of patient-centred healing (Urlich et al., 2004). Better sleep, stress, and pain are all critical to the process of healing and can have a significant effect on the comfort of patients (Press Ganey satisfaction surveys) and re-hospitalisation rates. Interestingly, in a recent limited study on the disruptive effect of hospital noises on sleep, it has been shown that

these noises disrupt sleep as they influence both cortical and cardiovascular function (Buxton et al, 2012). In relation to staff, a study by Blomkvist et al. (2005) found that staff are likely to experience less stress and strain, potentially reducing staff turnover rates. Medical errors are also less likely to occur. Berry et al. (2004) and Roy (2014) have outlined the importance of acoustics in building better buildings. Specifically, Berry et al. contend that incorporating building acoustics into design can result in a payback period of one year of operation.

New Regional Hospital Delivering High IEQ Alexandra District Hospital (ADH) is approximately two hours north east of Melbourne. In late 2011, staff and patients moved from the existing hospital, which had been in the same location for over 140 years (major rebuild in 1957 following a fire and extensive expansion in the early 1980s), to a new purpose built and Figure 2: Old ADH (top) and new ADH (bottom) sustainable hospital next door. As part of a study completed for Woods Bagot, Victorian Department of Health, and Sustainability Victoria, the IEQ was assessed at various stages by CETEC, namely: • Within the original old hospital prior to relocation (fully occupied) • Within the new hospital (immediately following construction, but prior to occupancy) • Within the new hospital (approximately twelve months following full occupancy) The results found that not only were there significant energy and water savings from the sustainable design elements, but the new hospital also improved from an IEQ perspective. The assessment conducted on the existing hospital had poor thermal comfort, poor ventilation effectiveness in a number of critical areas, inadequate lighting, areas of poor air quality, and high noise levels. Conversely, the assessment conducted on the new hospital displayed significant improvement across all IEQ parameters. In particular, air quality results improved (Figure 3). It is understood that these results are likely to reduce hospitalisation stay times and the risk of hospital acquired infection, while also improving staff performance.

Emerging Trends for IEQ in hospitals Like the significant advances recently being made in rapid assessment of microbials within water systems, emerging

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www.cetec.com.au CETEC Pty Ltd | ABN 44 006 873 687 info@cetec.com.au (03) 9544 9111 | (07) 3857 5531 | (02) 9966 9211 THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

TOPICS OF INTEREST also culture independent and as such will identify fungal fragments, dormant spores and fungi regardless of growth condition (e.g. viable but not culturable).The technology empowers the hospital engineers to make faster decisions with less time of uncertainty while waiting for results to become available.

Figure 3: Comparison of Average TVOC and Mould/Yeast Pollutants Pre-occupancy, Post-Construction and Post-occupancy

technology can also identify bacterial and fungal contamination within surface and air samples. The technology, which utilises chemoluminescence and enzymatic activity, can provide results within half an hour. This is in contrast to traditional methods that require plating and culturing of samples and can take up to five days. Further, not only does it allow for rapid reporting, but it is

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

As discussed previously, the management of dust or particulate matter has quickly become a critical issue for hospital environments. Compounded by the importance of managing dust levels, significant research coming out of the CSTB in Paris, France (as presented at the international conference Indoor Air in July 2014) has found that potentially harmful semi volatile organic compounds (sVOCs) can adsorb to normal dust particles to cause an indoor air and general contamination issue that can often be difficult to identify.

Whatâ&#x20AC;&#x2122;s next for the Hospital Engineer? IEQ is a critical consideration for hospital engineers and something which should be measured and managed. As the impacts of high IEQ performing and poor IEQ performing hospitals become increasingly measured and known, a greater responsibility will be placed on the hospital engineer/facility manager to provide spaces that promote health, wellbeing, performance and satisfaction.

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

PRODUCT NEWS

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An easy way to keep track of the many temperatures in the hotel Temperatures are symptoms of correct functioning of the plant that ensures safety and comfort. In the hotel there are many temperature points to keep an eye on. Controlling temperatures in the rooms are often left to the guestsâ&#x20AC;&#x2122; own preference with the in-room air conditioning control, but this is only a fraction of it. Food safety is an important issue, with temperature monitoring of fridges and freezers a high priority.

Hot water supply is another area where temperatures need to be looked after. The tap water must not be scalding and legionella must not have an opportunity to grow. The dining room and lobby should not be too cold, the fitness centre not too hot and the swimming pool should be just right. These facilities are very much part of the over all comfort for the guests. Just as important is staff health and welfare. If the kitchen gets too hot or the reception too cold, it may be very uncomfortable to work there and there could be complaints and high staff turnover. With T-TEC wireless loggers you can get the real time readings directly to your PC screen,all at the same time, while the loggers stay where they are. The loggers are battery powered using replaceable batteries

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2014

with a life time of about one year with normal use. This makes the system very flexible and reliable.

As well as logging the temperatures in the memory, they can also send real time updates,alarms and download their files at chosen intervals or when prompted. They can safely be read at different PCs in the building, because you can enter access control into each logger. For instance: the chef who has responsibility the kitchen region, can have the relevant temperatures on their own PC, and so can the refrigeration contractor, air conditioning contractor and the plumber, if you let them. You can organise that they can read the temperatures and see the files on their laptop, but not interfere with the logging. They just need to install the software and have a gateway available. Access to the files will make their job so much easier.

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