IHEA Hospital Engineer Summer 2013

VOL 36

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DECEMBER 2013

the australian

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IHEA 2013 National Conference Energy Efficiency Upgrades at SA Pathology Plumbing and Fire Services Systems PP 100010900

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IHEA National Board of Directors National President Darren Green National Immediate Past President Mitch Cadden

CONTENTS 5

Message from the President

National Vice President Brett Petherbridge

9

Message from the CEO

National Treasurer Peter Easson (State Elected – WA)

PROFESSIONAL DEVELOPMENT

National Secretary Scott Wells (State Elected – QLD)

10 New Courses Announced for CHCFM Pogram

Membership Registrar Alex Mair (Nationally Elected)

Standards Coordinator Steve Ball Asset Mark Coordinator Mark Stokoe (Nationally Elected) CHCFM Coordinator Mark Turnham (State Elected Vic/Tas) Communication Darryl Pitcher Chief Executive Officer Jim Cozens Secretariat/Website Administrator Heidi Moon Finance/Membership Lynden Smith Editorial Committee Mitch Cadden, Darryl Pitcher, Scott Wells IHEA Mission Statement To support members and industry stakeholders to achieve best practice health engineering in sustainable public and private healthcare sectors.

Adbourne Publishing 18/69 Acacia Road Ferntree Gully, VIC 3156 PO Box 735, Belgrave, VIC 3160 www.adbourne.com ADVERTISING Melbourne: Neil Muir T: (03) 9758 1433 F: (03) 9758 1432 E: neil@adbourne.com Adelaide: Robert Spowart T: 0488 390 039 E: robert@adbourne.com PRODUCTION Emily Wallis T: (03) 9758 1436 E: production@adbourne.com Administration Robyn Fantin T: (03) 9758 1431 E: admin@adbourne.com Marketing Tania Lamanna T: (03) 9500 0285 E: tlamanna@bigpond.net.au

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IHEA/BRANCH NEWS

11 State Branch Reports 17 Letters to the Editor 18 SPECIAL FEATURE: AssetMark 20 IHEA 2013 National Conference

SPECIAL INTEREST

25 A Talk About My Memories

TECHNICAL PAPERS

32 Infection Control Strategies 35 Air Quality Issues in Healthcare Facilities

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38 Managing Information from Building Systems

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42 Energy Efficiency Upgrades at SA Pathology 46 Campus Infrastructure Models Made Easy 48 A Surgical Hospital Should Not be Built Like an Ad-Hoc Hotel! esigning Today for Tomorrows Airborne 52 D Diseases

TOPICS OF INTEREST

55 What’s in the Pipeline 59 Optimising Your Kitchen Exhaust System Cleaning 64 Hirondelle Hydrotherapy Pool – Part 2 68 The High Cost of HVAC Corrosion 72 Plumbing and Fire Services Systems 76 Peak Performance 80 The Language of Heat

PRODUCT NEWS

82 Product news

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The views expressed in this publication are not necessarily those of the Institute of Hospital Engineering Australia or the publisher. The publisher shall not be under any liability whatsoever in respect to the contents of contributed articles. The Editor reserves the right to edit or otherwise alter articles for publication.

Adbourne Publishing cannot ensure that the advertisers appearing in The Hospital Engineer comply absolutely with the Trades Practices Act and other consumer legislation.

The responsibility is therefore on the person, company or advertising agency submitting the advertisement(s) for publication.

Adbourne Publishing reserves the right to refuse any advertisement without stating the reason. No responsibility is accepted for incorrect information contained in advertisements or editorial. The editor reserves the right to edit, abridge or otherwise alter articles for publication.

All original material produced in this magazine remains the property of the publisher and cannot be reproduced without authority. The views of the contributors and all submitted editorial are the author’s views and are not necessarily those of the publisher.

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TECHNICAL PAPERS

Qi

Medical Gas Services

Preventative Maintenance. Compliance, safety, reliability and efficiency.

With over 60 years experience providing gas solutions and support, BOC’s Qi Maintenance program’s dedicated resources are backed by the technical expertise and professional standards that the hospital environment demands.

The development and maintenance of a hospital’s medical gas system is Qi. Australian Standards (AS) and equipment manufacturer recommendations form BOC’s benchmark for service. Our routine maintenance tasks are performed to BOC best operating practice which meet these requirements.

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

BOC’s preventative maintenance program is designed to operate efficiently and improve the life of your medical gas system. Creating a robust and reliable system avoids unplanned interruptions to supply, builds system confidence and contributes towards greater patient safety.

With our broad Qi Medical Gas Services portfolio, BOC can help you meet the considerable challenges of compliance and safety in today’s healthcare environment. At the same time, we provide balanced insight and flexible tools to improve control and coordination of medical gases throughout your facility.

Ask us how we can help you manage your servicing needs with a tailored servicing and repair plan for best practice preventative maintenance for: – Breathing air testing – Gas manifolds – Air and vacuum plant – Medical gas alarms – Medical Gas Devices – Zone isolation boxes – Medical gas outlets

Maintenance plans are carried out by our skilled service technicians according to applicable standards and the manufacturers’ servicing recommendations.

For more information call us on 1300 363 109, email hospital.care@boc.com or visit www.bochealthcare.com.au

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

BOC: Living healthcare Details given in this document are believed to be correct at the time of printing. While proper care has been taken in the preparation, no liability for injury or damage resulting from its use can be accepted. BOC is a trading name of BOC Limited, a member of The Linde Group.© BOC Limited 2013. Reproduction without permission is strictly prohibited. HGD010 EQUAUS 1013 V1

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

Message from the President • Member’s engagement and surveys;

inform the process and truly act in the best interest of our members we would greatly appreciate your participation in the survey and provision of this valuable feedback.

• Marketing and communication strategies; • Governance and supporting policy and procedures;

2013 Annual Conference – Sydney

• Humanitarian aid and technical support programs; • Financial and business management, and • International partnerships.

Introduction

I

t is with great pride and pleasure I write this, my first journal report as the incoming National President. I must start by sending sincere thanks for the efforts of the previous Board, our CEO (Jim Cozens), Vic/Tas Secretariat (Heidi Moon) and our business accountant (Lynden Smith), all of which have collectively assisted to manage the business interests of the IHEA Nationally. I am confident that the incoming board and our business partners will continue to build on past achievements and I look forward to working closely with the IHEA Team. I would especially like to thank Mitch Cadden who has commendably carried out the duties of National President and now stepped into the role of the Immediate Past President.

It is quite ironic that this, my twenty first (21st) year as a IHEA member I have reached the position of National President, I hope the ‘coming of age’ will give me a sound base to continue the great work around member’s services, business development and build on our strategic directions for future growth.

AGM/National Board of Directors Subsequent to the Annual General and National Board Meetings held in conjunction with the 2013 National Conference, Sydney I would like to formally announce the 2013/14 National Board Members, see table below.

The National Board will meet for Strategic Planning, Director training and the quarterly Board Meeting the first week of February 2014. Over the coming weeks we will be asking members for input into the Strategic plans and direction of the IHEA via a national member’s survey. I would encourage all members to have a say in your organisation and assist the Board in developing strategic plans which align to member’s services and needs. The Board has a commission to represent members and support the IHEA Mission “To continually support members in their professional endeavours towards best practice in health engineering”. To

The 64th National Conference 2013 was hosted by the NSW/ACT Branch and was an outstanding success underpinned by the topical theme “Planning for the Future”. Presentations revolved around Strategic Planning and design, Health Facility and Service Planning, ICT – how this affects infrastructure planning and “future proofing”. The formal dinner was a harbour cruise hosted on the ‘Starship’ touring the iconic Sydney Harbour and was keenly attended by some 150 plus participants. On all counts the organising committee, event partners and planners should all be proud of their efforts which culminated into this great event. The next National Conference will be held in Queensland, Brisbane, 9 -12 October 2014, more information will be provided as planning for the event progresses.

International Federation of Hospital Engineering (IFHE) Members should be aware that over the past three (3) years the National Board has actively re-engaged with our international

Name

Position

Darren Green

National President

The new board will continue to develop and deliver members services and organisational initiatives and discussions to date have supported an ongoing focus and effort on:

Mitch Cadden

Immediate past President

Mitch.Cadden@gsahs.health.nsw.gov.au

Brett Petherbridge

Vice President

brett.petherbridge@act.gov.au

Scott Wells

Secretary

scott_wells@health.qld.gov.au

Peter Easson

Treasurer

Peter.Easson@health.wa.gov.au

• 2013 – 2016 Strategic Plans;

Jim Cozens

Chief Executive Officer (ex officio)

ceo@ihea.org.au

Alex Mair

Director

ama58500@bigpond.net.au

• Benchmarking programs such as the IHEA AssetMark;

Mark Turnham

Director

mark.turnham@dhsv.org.au

Mark Stokoe

Director

Mark.Stokoe@health.wa.gov.au

• Professional Development, including Certified Health Care Facility Manager (CHCFM) Certification;

Darryl Pitcher

Director

d.pitcher@bethsalemcare.com.au

Steve Ball

Director

STEVE@BarwonHealth.org.au

Kevin tan

Co-opted Director

Kevin_Tan@health.qld.gov.au

• The IHEA Journal;

Email Executive Committee

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

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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colleagues. Currently the IHEA maintains ‘A’ class membership and Darryl Pitcher one of our National Directors serves on the IFHE Executive Council. Both Darryl Pitcher and I were able to attend the 46 IFHE Council Meeting and Biomedical Engineering Association of Malaysia (BEAM) Conference in Kuala Lumpur.

Discussions over the course of events strongly revolved around common issues and solutions as well as strategic directions of the like organisations. I am pleased to inform our members that the IHEA is strongly placed as one of the leading organisations and are leading the way with business development and governance. Further information surrounding IFHE and the linked healthcare associations can be found: http://www.ifhe.info/news/reports-fromcouncil-meeting-46

Members should also be aware there is a commitment of the National Board to evaluate benefits of again hosting an international congress, similar to that which was held in Sydney 2000. This matter remains live and will be presented at the February 2014 National Board Meeting for resolution.

On a less pleasant note, I must mention the recent tragic fires particularly those in NSW where many lives were affected by the fierce situations created by uncontrollable fires.

Our thoughts and wishes for future goodwill goes out to all those who were affected.

It’s quite common that IHEA members have roles in Rural Fire and Emergency Response Services, the time and efforts provided by all emergency service volunteers is duly noted and a true reflection on the ‘stamp’ of our organisation and its members.

Summary In closing I would like to acknowledge the work carried out behind the scenes over the past twelve (12) months by National Board, National Conference Organising Committee and our business partners. I thank those who have served their term at national board level, namely Trevor Sheldon and Michael McCambridge and welcome the new board members. I personally have gained great learning and pleasure from participating at a National level and look forward to the forthcoming two year term as National President. The IHEA is well positioned to continue to flourish through our collective efforts which are channelled through our membership, Branch Committee of Management, Business Partners and the National Board.

Regards Darren Green M.I.H.E.A., C.H.C.F.M. National President www.ihea.org.au

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Why do so many of Australia’s and New Zealand’s leading hospitals use BEIMS to manage their facilities?

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BEIMS is a cost-effective, comprehensive Facilities Management System that interfaces to most major financial/ERP systems, and includes an extensive asset register.

BEIMS offers first-class operational support, training and professional consulting services especially relating to

compliance and asset management.

For further information visit www.beims.com or call +61 3 9602 2255 6

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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CMY

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TECHNICAL PAPERS

Atlas Copco - mVAC Complete Medical Suction Plant

Atlas Copco’s mVAC Medical Vacuum Systems consist of 2 to 6 air-cooled, oil-lubricated rotary vane type vacuum pumps and a central controller with an intelligent graphical user interface. They provide a highly reliable vacuum (suction) for a variety of medical applications. The mVAC system offers (multiple) backup supply in case of failure of individual functional components.

Contact Atlas Copco Compressors Pierre Matschke - 0418 401 914 pierre.matschke@au.atlascopco.com www.atlascopco.com.au/Medical

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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Message from the CEO

T

he IHEA 2013 year to date is proving to be an exciting period.

This belief is predicated on a number of factors that have been considered by the Board during the year that are coming to realisation.

The culmination of significant planning was the presentation of the Annual Conference in Sydney between October 9 and 12.

During my long association with the IHEA all of the conferences that I have attended have been memorable occasions primarily due to the quality of presentations and the support of most generous sponsors. The 2013 event highlight was the range of presentations in keeping with the theme “Planning for the Future”. What I would like to see relative to the Conference Theme is a greater number of Member presentations at the 2014 Conference to be held in Brisbane from 15th to 18th of October with the Theme: Compliance: Governance in Healthcare Facilities. This advance notice is put forward to ensure Members are aware of the Conference dates and the theme and to give consideration to preparing and submitting a paper in accord with the Conference Theme.

A further exciting happening during the year has been the development of AssettMark as an on-line Benchmarking and Comparative Analysis Tool relative to Health Services Facilities Management.

This development was launched at the National Conference and is now at the ready for utilisation by health agencies as an online system commencing on the 9th of December 2013. The benefits of the system were well documented in the September Edition of the Journal which highlighted the ease of access, user interaction, live reporting through the web interface linked through the IHEA Website. Members are earnestly encouraged to promote the benefits of this management tool to their health agencies as a positive feature capable of capturing data that presents 12KPI’s relative to facilities management activities. Further information is contained in this edition of the Journal.

Following my review of the participation rate of the CHCFM Program positive action has been taken to revitalise this most important aspect of Member participation and professional development. Further to my message in the September edition the linkage with Schneider Energy University has been formalised. The arrangement is such that the IHEA will award Continuous Professional Development Credits to its members who complete selected Schneider Electric Energy University courses, expanding the Institute’s educational and developmental material by around 80 courses. Officially endorsed by the IHEA, Energy University is Schneider Electric’s online, on-demand resource, where anyone interested in the energy industry can undertake free training courses. The courses focus on the latest energy efficient solutions and energy management practices to help save money, reduce emissions and increase business efficiency. Access to the course can be facilitated through the IHEA Website with further information contained in this edition of your Journal.

With the objective of gaining an appreciation of Member opinion relative to benefits and professional development offered by your Institute, a National Survey of Members will be undertaken during December. This undertaking is aimed at gaining an understanding of Member needs and those matters that require action by the Board that will add value to your Membership.

It is anticipated that Members will be responsive to the survey as an information input to the 2014 – 2017 Strategic Plan to be developed during February 2014.

I take this opportunity to extend Season’s Greetings to Members and families and look forward to 2014 as a year of continuing engagement with all.

Regards Jim Cozens Chief Executive Officer

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PROFESSIONAL DEVELOPMENT

New Courses Announced for CHCFM Program

T

he IHEA will award Continuous Professional Development Credits to its members who complete selected Schneider Electric Energy University courses, expanding the Institute’s educational and developmental material by around 80 courses.

Officially endorsed by the IHEA, Energy University is Schneider Electric’s online, on-demand resource, where anyone interested in the energy industry can undertake free training courses. The courses focus on the latest energy efficient solutions and energy management practices to help save money, reduce emissions and increase business efficiency.

“The IHEA greatly appreciates the opportunity to link into the Schneider Electric Energy University program,” Jim Cozens, IHEA CEO said. “The courses on offer through Energy University are highly beneficial to our members and will

enable them to increase their knowledge in the very important area of energy management. We encourage all of our 500+ members to undertake training as part of the CHCFM program, and I am sure our members will see value in accessing Schneider Electric’s expertise in this area.”

IHEA members who undertake Energy University online courses will receive recognition on completion of the course in the form of Continuous Professional Development (CDP) Credits, with different courses weighted with different numbers of credits. These credits form the basis of the Certified Health Care Facility Manager (CHCFM) accreditation, which helps to ensure the industry is continually up to date with new technologies, systems and best practices.

In addition to the Energy University courses, Schneider Electric, in partnership with the Institute of Energy Professionals,

15 - 18 OCTOBER 2014 | BRISBANE CONVENTION & EXHIBITION CENTRE

COMPLIANCE: GOVERNANCE IN HEALTHCARE FACILITIES Amongst the myriad of challenges in the healthcare facilities environment, those that fall under the general category of compliance are critical, confronting and significant. Compliance, in its many forms, may be by way of statute, regulation, performance standard, by-law or institutional requirement (eg. ACHS). This Conference will focus on: • contemporary practice • future outlook • past learnings

• compliance management, auditing and reporting • planning, technology changes, research, innovation • case studies, both successful and otherwise

The 2014 IHEA Healthcare Facilities Management Conference aims to provide both technical and practical information and tools for healthcare facilities managers and their internal and external support partners.

For more info & to receive event updates, visit www.HFMC2014.org.au

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

offers the Professional Energy Manager (PEM) certification exam. The exam is part of the internationally recognised Energy Management Diploma Program, being taught at North Carolina State University, US, and is one of only two programs recognised as being adequate training for government energy managers.

The primary objective of the PEM qualification is intended to enrich the talents and knowledge base of professional energy managers.

Courses on offer through Energy University include: Energy Efficiency Fundamentals; Energy Efficiency with Building Automation Systems; HVAC and the Characteristics of Air; and Maintenance Best Practices for Energy Efficient Facilities.

To access the courses, please visit the IHEA website at www.ihea.org.au and click on the Energy University link under Resources.

BRANCH NEWS

Western Australia Tradesman of the Year Simon Smith from Sir Charles Gardener Hospital was awarded for his strong healthcare industry knowledge in a challenging environment.

Simon is passionate about ‘customer service’ and is well respected by his peers.

WA State Conference

The conference would not have been possible without our sponsors and the WA branch would like to acknowledge Aggreko, Cortec, QED Environmental Services, Amcon Software, Schneider Electric, Softlogic, Thinc and Communications Australia for sponsoring the conference.

Technology in Health Today

T

he West Australian State Conference was held in early September at the Pan Pacific Hotel in Perth.

The WA Branch annual conference was well attended with the numbers just tipping 100 for the day. Speakers from major corporations and government departments presented on today’s technology and efficiency issues.

The conference provided an excellent opportunity for members to update on what new technologies and initiatives could impact in their health facilities today.

Engineer of the year Andy Smyth, Regional Facility Manager for the Great Southern Health Region was awarded for his strong support of the IHEA, leadership in country health facilities management and strategic asset management.

Special mention goes to our country members who came from all areas of the state to attend the conference.

The conference also provided an opportunity for our National CEO Jim Cozens to present the WA annual achievement awards to those who excelled in the Health Care Industry.

Apprentice of the year Henry Kemp was awarded for his hard work, commitment and excellent trade study results.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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BRANCH NEWS

South Australia

A

t the SA Branch AGM on August 23rd, I provided an overview to members of the recent focus of the State Committee on an active, ongoing professional development program, on membership drive activities and on the developments we hoped to see emanating from the national body’s activities. We noted, with appreciation, the efforts of our corporate sponsors during the year and particularly sought for recognition of the efforts of our long-standing valued member, Chris Ford, who passed away earlier this year. The new committee elected on the night was: President

Peter Footner

Vice President

Darryl Pitcher

Treasurer

Mike Ellis

Secretary

John Jenner

National Council Representative

Darryl Pitcher

Committee No.1

Mike Frajer

Committee No.2

Sam Martin

Committee No.3

Trevor Sheldon

The Branch Committee has continued to meet throughout the year, on a monthly basis where possible, to continue the ongoing planning to maintain and expand our membership base and to plan future professional development events. A draft membership action plan and a dynamic PD schedule have been developed by the Committee and will be further developed and enhanced as the next year unfolds. The State Committee would welcome any input from members to these meetings and any other efforts to expand the presence on IHEA in SA. Thanks to the outstanding efforts of our secretary, John Jenner, a range of PD activities have been arranged and promoted to SA Branch members and other interested participants over recent months. These have included: • Various dates (Jul – Oct): Promoted plumbing trade nights held throughout SA country areas.

• 24 October: Visit to the South Australian Health and Medical Research Institute (SAHMRI) which is nearing completion.

The SAHMRI facility will be a state of the art, purpose-built, world-class centre of research excellence located in a dynamic biomedical precinct adjacent to the new Royal Adelaide Hospital (RAH).

• 8 November: Clipsal factory tour and presentation on Victoria Health’s Greener Government Buildings Program and Energy Performance Contracts (hosted by Schneiders).

VACUUM SOLUTIONS AUSTRALIA Please visit us at Australian Healthcare Week Australian Technology Park Sydney March 25-27, 2014

Further events are planned for the new year and details will be distributed as they come to hand.

A good contingent from SA attended the IHEA National Conference in Sydney during October and those attending all got some benefit from attendance at the range of presentations provided, from the visits to exhibitors’ booths and for the associated networking opportunities that were provided.

Our congratulations go to the NSW Branch and the event organisers.

The new committee and I are looking forward to an active SA program of activities over the next year – a year when we hope to be able to boost our corporate and non-corporate membership to ensure we have a viable, active organisations moving forward.

I would like to extend my best wishes for Christmas and the New Year to the hard-working Branch Committee members, to our SA membership and to our IHEA peers interstate.

VACUUM SOLUTIONS AUSTRALIA

Leaders in Design and Manufacture of Medical Vacuum Systems

1300 733 665 www.vacuumsolutions.com.au

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

Peter Footner State President (SA Branch) Institute of Hospital Engineering, Australia W: 08 82751601 M: 0401 710 235 Peter.Footner@health.sa.gov.au

The Hospital Sensor TECHNICAL PAPERS

PD4-M-2C-DS

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

Remote Programmable

www.iautomation.com.au 1800 225 063

24M range

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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BRANCH NEWS

Victoria/Tasmania

W

ith the end of year fast approaching it has been a hectic one with many completing accreditation, refurbishments and expansions on top of our normal duties. This year has also been another very productive year for the Vic/Tas Branch.

This past quarter we had a PD on August 16th on Project and Risk Management with an excellent turnout. Some of the speakers included our own members which was great to see. IHEA’s CEO Jim Cozens spoke on Risk Management, with Vic/Tas members presenting: • Craig Marshall – Commissioning; • Mark Hooper – Benefits of pre-delivery commissioning of plant and equipment in the factory. Mark included his experiences travelling to both USA and China assessing plant before top delivery to Australia; • John Dixon – Case Study on Risk Management.

Our sponsor for the event was Softlogic Australia. Director, Nazar Jai – delivered a very informative presentation. Special guest speakers included Monika Choudray and Mark Cleeve from VMIA who gave us an overview of VMIA organisation and its services. Randal Garnham from Department of Health provided and updated the group on the Series 7 Fire guidelines.

During the PD the Branch AGM was held with it pleasing to see a good turnout. I would personally like to thank the previous Committee for all their hard work over the previous 12 months and welcome the new Committee.

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As a reminder please have a look into and participate in AssetMark and the CHCFM program which is on the IHEA internet page if you are not familiar with it.

Hope everyone has a great end of year and look forward to seeing you at the next PD, if not, next year. I am also happy for members to contact me on any matters of interest.

Your new committee members are listed in the table below.

Also in this quarter was the National Conference titled “Planning for the Future” which was in Sydney and one I will never forget. Well done to the organising committee, even the weather was perfect. It was great to see an excellent representation by the Vic/Tas Branch.

Regards, Mark Turnham M.IHEA IHEA National Board Member IHEA Vic Tas Branch President

Coming up on 29th November is the End of year Function which will be held at

0488 581 508 mark.turnham@dhsv.org.au

Position

Name

Organisation

Phone

State President

Mark Turnham

Dental Health Services Victoria

(03) 9341 1352 0488 581 508

mark.turnham@dhsv.org.au

State Vice President

Michael McCambridge

Royal Melbourne Hospital

(03) 9342 4203 0407 001 129

michael.mccambridge@mh.org.au

Treasurer

Steve Ball

Barwon Health

(03) 5260 3236 0403 607 544

steve@barwonhealth.org.au

State Secretary

Steve Ball

Barwon Health

(03) 5260 3236 0403 607 544

steve@barwonhealth.org.au

Committee

Kim Bruton

North East Health Wangaratta

(03) 5722 5291 0448 065 279

kim.bruton@nhw.hume.org.au

Mobile

Email

Peter Crammond

Wimmera Health

(03) 5381 9221 0419 821 964

peter.crammond@whcg.org.au

Rod Woodford

Castlemaine Health

(03) 5471 1552 0429 125 699

engineer@castlemainehealth.org.au

Howard Bulmer

Leighton Constructions Melbourne

(03) 9228 7250 0400 942 271

Howard.Bulmer@leicon.com.au

Simon Roberts

Registered Accom Assoc Vic (RAAV)

(03) 9527 2482 0418 359 052

wavenhoe@labyrinth.net.au

Craig Marshall

Building Energy Management Solutions

0400 236 752

bemsolutions@hotmail.com

State Elected

Mark Turnham

Dental Health Services Victoria

(03) 9341 1352 0488 581 508

mark.turnham@dhsv.org.au

Nationally Elected

Steve Ball

Barwon Health

(03) 5260 3236 0403 607 544

steve@barwonhealth.org.au

Fortunately the National Board were also at the same location and were invited for lunch which gave the branch an opportunity to speak one on one with them on IHEA matters. The Vic/Tas Committee were most appreciative of the National Board attendance.

At the conclusion of the program Members in attendance completed a survey relative to the day’s activities.

Overwhelming positive responses from Members clearly indicated that the event

the Royal Melbourne Hospital following a half day PD on Disaster Management also at the Royal Melbourne Hospital.

All IHEA members are welcome and encouraged to attend the PD at no cost.

provided opportunity to network and to become better informed on current issues and topics in health services engineering and facilities management.

Board Nominees

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

TECHNICAL PAPERS

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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TECHNICAL PAPERS

Precision cooling CRACs Coolside inrow cooling Units Air and water-cooled chillers Turbocor and centrifugal chillers Reverse-cycle heat pumps 4-pipe chillers (hot and cold together) Air-cooled condensers Dry coolers Water and fuel leak detection AHU, FCU, packaged and condensing units and more

MISSION CRITIC@L HV@C

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

BRANCH NEWS

Queensland Activities

T

he QLD Branch Committee of Management (CoM) have been fairly quiet following the mid year conference and AGM, because the major activity is the National Conference.

Queensland only had a few members in attendance, but the conference was well appreciated by those who attended.

There has been no Professional Development afternoons over the last couple of months because of the 2 conferences.

The CoM has met and prepared a Calendar of events that runs to the end of 2014. The first activity will be an afternoon with Austco at their premises

and this will be followed by our Christmas social function. Planning has started for our February meeting in Toowoomba.

as it indicates that the industry is alive and well and that the members are keen to network and develop as professionals.

We have formed a National Conference Committee and planning is well advanced at this early stage. We have secured what is arguably the best venue in Brisbane for the Conference and have also secured the dinner venue. Now comes the hard part of filling the program and we encourage all members to consider presenting at this conference.

Management

Membership Our membership has stayed reasonable constant, although there are new faces.

It seems that as members leave or retire new members join. This is encouraging

I am particularly pleased to welcome Kevin Tan to the CoM as an executive member. Kevin has taken the role of Vice President and will be a great support to me in this capacity. Kevin has also volunteered to join the Board as a coopted member to work with Darryl in the communications portfolio to further the great work he has started with Linked-In and the webinar.

Alex Mair QLD Branch President

LETTERS TO THE EDITOR

Dear Sir, I am writing to congratulate the Institute of Hospital Engineering Australia on the development of the IHEA Benchmarking system AssetMark.

(AssetMark Future Direction, The Australian Hospital Engineer, Vol 36, No 2, September 2013).

It is a lasting tribute to the farsighted 1996 initiative of the Institute and its benchmarking sub-committee (Ed Bradbury, Glenn Cottee, Col Erickson, Chris Ford, Fred Jamieson, Kevin West, Floyd Wilson and Bill Geerlings, convener) that after 17 years and 60 benchmarked hospital facilities, the benchmarking system remains virtually unchanged in all its essential aspects.

The replacement of the cumbersome interface of a consultant between benchmarking participants and the database with the internet is a natural progression which should give the benchmarking system a new lease of life well into the future.

Both BEIMS (another IHEA initiative) and AssetMark reflect the most coherent expression of the IHEA mission statement: “to support members and industry stakeholders to achieve best practice health engineering..� . They deserve the unqualified support of all health facility practitioners.

Best wishes, Bill Geerlings, C.Eng., BHA (NSW), FIHEEM, FIHEA.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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TECHNICAL PAPERS

AssetMark

Benchmarking

T

he Institute of Hospital Engineering, Australia (IHEA) seeks to be recognised as an organisation that strives for excellence in health care engineering. In order to help health care providers improve their facility management services, the Institute took the initiative of creating a benchmarking process called AssetMark.

Developed during the 1990s, AssetMark is essentially a structured continuous improvement program that offers participating health care facilities the opportunity to identify best practice. Unfortunately, due to a number of reasons, such as cost and time, use of the AssetMark system had decreased to a point of inactivity.

Understanding the value of benchmarking in health facilities management, the IHEA completed a thorough review of the entire process, and a decision was made to update the AssetMark system and bring it into line with current technology.

The new and improved AssetMark The old AssetMark process was a costly, time-consuming procedure that required a large amount of information to be physically recorded on a lengthy questionnaire. Participants filled out the questionnaire, submitted it to the IHEA for analysis and waited for the results. The entire process could take up to several months.

The IHEA, in conjunction with Mercury Computer Systems, have developed a new and improved online system. All the original AssetMark Key Performance Indicators remain, but they can now be measured much faster with easy, straight-forward, online data entry. As was the case previously, the identities of participating hospitals remain confidential and are not disclosed to others without consent.

What does benchmarking offer to hospitals?

Benchmarking can provide any industry with the opportunity to identify best practice in all types of areas, including facility management. The aim of AssetMark is to improve both the efficiency of operation and the quality of service delivery, whilst remaining within existing resource constraints and policy parameters.

In theory, as the performance of facility management in individual hospitals improves, the mean performance in hospitals improves and in time, the benchmark itself goes up.

AssetMark allows subscribers to: • Establish performance benchmarks • Monitor facility management expenditure performance • Monitor facility performance • Verify cost effectiveness • Compare current data with your own data from previous years • Develop evaluation data for ACHS accreditation

Valid benchmarking with AssetMark Screenshots from AssetMark

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AssetMark recognises the differences that exist between hospitals (even between similar hospitals in different states). These differences impact on cost structures, services and processes, and create differing parameters for benchmarking.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

TECHNICAL PAPERS

AssetMark

Benchmarking

Valid benchmarking with AssetMark (continued) AssetMark deals with these complexities by classifying hospitals by: • Geographical information Technical support for AssetMark • Service areas • Size and age of buildings/facilities is provided by Mercury’s IT Support • Hospital category team based in Melbourne.

• Facility description

The system calls on these classifications to choose from a pool of potential benchmarking partners that are similar enough to make comparisons meaningful.

The AssetMark questionnaire includes a broad range of hospital facility management performance measures, both objective and subjective, including: hospital details, hospital description & performance, hospital facility description & function, hospital facility management capabilities & competencies, hospital facility management operations, hospital facility management inputs and feedback from the facility manager.

The AssetMark process explained...

1 - The hospital representative logs onto the AssetMark system via the IHEA website and registers to participate in the program.

2 - Once registration is submitted, the application is reviewed by Mercury Computer Systems staff to verify the participant is a genuine hospital representative. This is done to uphold the integrity of the information contained in the system.

3 - Once verified, they are issued with a temporary user name and password via email. It is at this point the user can begin filling out the questionnaire. An

invoice for the initial annual subscription fee is also dispatched to the hospital.

4 - The user completes the questionnaire at their own pace. An auto-save feature ensures data is never lost. Users are free to save their progress, logout and return at a later time to complete the survey when it suits.

5 - Upon payment of the invoice and once the questionnaire has been completed, the user then has access to all the features of AssetMark, including powerful reporting and statistical analysis.

Generate more than a dozen reports online AssetMark provides the facility manager with the chance to objectively look at the operations under their control. The system produces more than a dozen different reports that show their hospital’s performance against comparable health care facilities.

The new and improved AssetMark costs just A$750+GST The reports can compare your data to: per hospital for a 12 month subscription. This provides full • The average for all records in the database; access to reports, graphs and comparative data. For additional • The average of the top 5% of hospitals; • The average of the lowest 5% of hospitals. information and service enquiries, please contact Jim Cozens

Confidential and secure

from the IHEA via email (ceo@ihea.org.au) or 0417 835 229.

Ensuring the sensitive information divulged as part of the AssetMark process remains confidential and anonymous is of the utmost importance. The AssetMark website is hosted on a secure server within Australia.

> To register for AssetMark, visit www.ihea.org.au (available early December ‘13) THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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NATIONAL CONFERENCE

IHEA 2013 National Conference Jim Cozens I CEO

The conference was held from the 9 – 12 October 2013 at Sheraton on the Park, Sydney.

The conference theme this year was “Planning the Future”.

W

ith 17 Plenary Sessions and 3 Keynote Speaker Presentations the Conference aimed to ‘unpack’ what drives health facility planning and the strategic services and asset planning strategies that underpin the facility planning process, including clinical service planning and models of health service delivery.

The Conference provided an invaluable opportunity to exchange ideas, celebrate successes and achievements and to challenge each other. It was an opportunity to make new, or re-establish existing professional and personal relationships with peers and suppliers who continue to rise to the challenge of an ever changing health care environment.

Conference Scheduling

Official Opening

Interactive Workshop

As has become a feature of recent conferences an Interactive Workshop preceded the official opening. The

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workshop topic was Operational Readiness and was presented to enable those in attendance to gain an appreciation of the purpose and application of processes that transform capital projects from planning and construction to operational readiness.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

National President Mitch Cadden formally welcomed all to the Conference followed by the Official Opening which heralded the commencement of the formal program.

NATIONAL CONFERENCE Program Members and visitors attending the Conference were well served with a quality program of technical papers and product and service information presented by our very much valued sponsors at the conclusion of each session.

HTR

The Board and Members convey sincere appreciation to our sponsors and exhibitors:

Sponsors • Platinum Emerson Network Power

• Plenary Sessions A.G. Coombs • Gold Armstrong Commercial Flooring

• Conference Dinner Transfield Services Schneider Electric

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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BRANCH NEWS • Exhibitors

Steril Aire

BOC Healthcare

Workplace Access and Safety

Vacuum Solutions Australia

Forbo Flooring Systems

Atlas Copco Compressor Australia

AFC Group

Thomas and Betts

Polyflor

Cleveland Compressed Air Services

Enware

Malmet (Australia)

Australian Medical Suction Systems by Becker

AceTek Systems Pty Ltd

Axon AP Pty Ltd

Meiko Australia Pacific

Specialised Lighting Solutions BEIMS (Mercury Computer Systems) Malone Hospital Services Ampac Technologies Integra

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Nalco, an Ecolab Company Softlogic Australia Pty Ltd AG&G Services

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

Interface • Satchel Inserts Interface

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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TECHNICAL PAPERS

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

SPECIAL INTEREST

A Talk About My Memories of Being Involved in the IHEA from 1973 to the Present Day

Delivered to the 2013 Queensland Branch Conference 25-26th July 2013 Jim Meldrum I Honorary Fellow IHEA (& Honorary Queensland member)

A

fter having served an apprenticeship as a Fitter/ Turner in a ship repair firm in London’s Royal Albert Docks, I joined the Merchant Navy in 1961 and sailed with the British India S.N.Co. Ltd. In all ranks from Junior to Chief Engineer Officer and visited 54 Countries. I was particularly taken with Australia and thought that it might be a good place to reside in.

In the fullness of time I got myself engaged to be married to a nice young lady in Melbourne and there, in 1971, I migrated.

I had to get myself a job and joined ‘Ports & Harbours’ Division of Vic. Gov. Public Works Dept. I did relieving work as 2EO on the ‘Rip’ (a WW2 warship (HMAS Whyalla) converted to a ‘Buoy Maintenance Vessel) thence the ‘Pioneer’ (a suction dredger built in 1905) and finally the ‘Matthew Flinders’ a more modern suction dredger.

Although I enjoyed it all it still meant that I was spending many days and nights away from home and, now happily married with a baby on the way, decided to get myself a job ashore. I was encouraged to become a Hospital Engineer by Jim Barry (the Chief Engineer on the ‘Pioneer’). He had actually been the Chief Engineer of Melbourne’s Sandringham Hospital, but decided he preferred life afloat better.

At that time there was no Hospital in the Melbourne Met. Area that was advertising for an Engineer, so I applied for the Engr’s job at Melbourne’s ‘Pentridge Gaol’. This was run by PWD and as an existing member of PWD I would have ‘seniority’ over any ‘outsider’. I had an interview but decided the whole place gave me the horrors and I declined to accept the position.

Next application was with Melbourne’s Children’s Mental Hospital. (St. Nicholas) This again was a PWD-run outfit. After the interview I was told that my application would be looked upon favourably (Nudge, Nudge, Wink, Wink) and I told an excited wife that I was finally coming ashore. Alas, after some weeks, I received a letter saying that someone with more seniority than me had appealed and won the job.

I was deflated, as I’m sure anyone would be, but eventually Melbourne’s ‘Essendon and District Memorial Hospital’ was up for grabs and I grabbed it! Getting to work entailed me travelling through 26 sets of traffic lights and 2 level-crossings each way!

I was ‘On Call’ every day and every night and this long drive enabled me to clear my head from sleep and consider what was causing the challenge that I was aiming to fix! My predecessor was David Hemphill – who subsequently moved to Brisbane, joined the Qld. Branch of the IHEA and ended up working at Cairncross Dry Dock.

David stayed with me at work for one week and then left me to it. I joined the IHEA after being told it was the ‘Done Thing’ for Hospital Engineers to do. People are sociable by nature. I accompanied David Marsden from nearby ‘Austin Hospital’ in Heidelberg (where I lived) to a Branch meeting in Melbourne’s S.E. Suburbs. What I experienced I liked! The camaraderie was similar to that which I enjoyed with the lads from my shipping Co. Even though I had sailed as Chief Engineer Officer, I always had the re-assurance of having a ‘Superintending’ Engineer ashore to whom I could seek advice if and whenever necessary. I found out very quickly that the Victorian Hospitals’ structure did not have this ‘Superintending’ position. Where then did the Hospital Engineer go to for advice? To whom could he turn to if not the IHEA? We were, and still are, a ‘self-help’ group.

One thing that really did impress me about joining the IHEA was that most, if not all the Senior Engineers in Melbourne Hospitals were deeply involved in it all. Eventually I was introduced to Harvey Roberts – the then Federal Secretary of the IHEA – who gave me some papers to fill in. The minute books show that I joined the IHEA on 17/031973 – my first Wedding Anniversary!

I became a regular attendee at all the Branch meetings and National Conferences and inadvertently brought attention to myself by always asking questions at my Branch Meetings. I was ‘tapped on the shoulder’ by Ken St. Clair – Chief at the ‘Royal Melbourne Hospital’ and asked to present a paper to a forthcoming Branch Meeting on the subject of ‘Baby Incubators’

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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SPECIAL INTEREST Well, after all, EDMH was a 50 – bed Maternity Hospital and delivered 1/20 births in Metropolitan Melbourne!

minimal and I let it be known that a different, if any, portfolio would better suit me.

I gave the talk, which went down well, and sometime later on the strength of my talk, was nominated to be the IHEA representative on the ‘Standards Australia’ working party ‘EL/18/5 – Baby Incubators’. This committee was Melbourne-based, but occasionally held meetings in NSW. Eventually this working group was stood down as similar work was being done overseas – especially in the U.K.

So it was then that I joined the Federal Council (now called the Board of Directors) and was given the ‘ANZEX Delegate’ portfolio. (Australia and New Zealand Engineer Exchange Scheme) This entailed me corresponding with my N.Z. counterpart to formulate a suitable itinerary for whomsoever came across the ‘Ditch’ to have a ‘Study Tour’ and attend our National Conference, as well as doing the same thing for our own man travelling to N.Z. I enjoyed all this and must have done something right because after a few years I became Council’s ‘Minute Secretary’.

Life ashore seemed a little strange to me at first! I often related as to how, when I was on a cruise ship, it was a ‘mans’ world with all the deck side and all the engine side being male. Together we would get the ship to our next port of call. If and whenever you got sick, there would be some female Nurses somewhere deep down in the accommodation who we could call upon to get fixed-up. Now, living ashore and working in a largely female environment, the Nurses would call upon me, deep down in the workshop, to fix their problems. It was a complete ‘turn-around’.

I carried on as per usual until 1979 when I received another ‘tap on the shoulder’ advising me that there would soon be a vacancy on the Federal Council / Vic Branch C.O.M. as ‘Treasurer’. At this time the Victoria Branch did not exist as a separate body. It was part of the Federal body and stayed that way until 1977! My financial knowledge, at that time, was

I’m not sure if it’s common knowledge, or not, but Council would convene about 18:00 hrs on a Friday evening in one of Melbourne’s major hospitals. The meeting would last as long as it took to work through the agenda and it was not uncommon for these meetings to last until 02:00 hrs the following day.

Interstate representatives would be accommodated at a local hotel and would re-convene later that same morning to discuss ‘Rules’.

I would spend all that weekend hand-writing the minutes and on my way to work on the Monday morning would deliver them to the then President – Bob Cottrill – at ‘Prince Henry’s Hospital’ in St. Kilda Rd. His ‘Office Assistant’ would type them ready for distribution.

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SPECIAL INTEREST Later still (1979) I took over the Federal Secretary’s role, replacing Harvey Roberts. This was the ‘Big Time’ and I relished it all.

Do You Just Belong?

Are you an active member, the kind that would be missed?

Or are you just contented, that your name is on the list?

Do you attend the meetings, and mingle with the flock?

Or do you stay at home, and criticise and knock?

Do you ever go to visit, a member who is sick?

Or leave the work to just a few, and talk about a clique?

There is quite a programme scheduled, that I’m sure you’ve heard about.

And we will appreciate it, if you’ll come and help us out.

So come to the meetings often, and come with hand and heart.

Don’t be just a member, dig in and do your part.

Think this over, members, and know right and wrong, Are you an ACTIVE MEMBER? Or do you just belong. (from the NSW President’s newsletter in 1985)

Having attended some Conferences and Branch meetings I noticed that we, as an organisation, did not have any obviously unifying sartorial garment. I proposed to Council that we should get ourselves an ‘IHEA neck-tie’. I obtained quotes based upon designs given to me and had them made in both Maroon and Navy Blue colours. Having now got them, the hard job was to get the people north of the Victorian border to purchase one and then actually wear it! Nowadays I believe that all new members are issued one as a matter of course. The design has changed, but the unification is ongoing.

These were the early days of computer-driven ‘Planned Preventive Maintenance’ and a group of Hospital Engineers in Melbourne got together and created what is now known as ‘BEIMS’.

(Building & Engineering Information Management System). Being the busy people that we all were and still are, the system was passed over to commercial interests to promote. No doubt it has ‘Morphed’ into something unrecognisable from its original format, but that system, just like ourselves, has to move with the times.

‘AssetMark’ is another product that is ‘Home grown’. It’s really an extension of the networking that happens at get-togethers just like the one we are enjoying here today. We all talk ‘shop’ and thus find out what is happening in other establishments. What works?

What doesn’t work? That’s the fundamental side of this computerdriven ‘Equaliser’.

A more ‘Up-to-date’ move is to have as many of us as possible enrol in the CHCFM (Certified Hospital Facility Management Programme). As a result of successfully completing these modules we can prove to potential employers that we are, indeed, the right person for the job. It also gives us all the opportunity to add ‘Post-nomials’ to our signatures as others are sure to do.

An initiative done by the Vic. Branch was to have us Engineers present tech papers to Hospital Trades Staff. Held at the ‘Mayfield

Centre’ I was ‘dobbed in’ without my knowledge, or consent, to give talks on ‘Fuels’. I knew absolutely nothing about my involvement until a casual question asking how my preparations were coming along, came my way! I duly did what was asked of me and hope that some of what I expounded has stuck!

Other such subjects I cannot now recall.

In 1982, when Essendon Hospital had all but completed an expansion into a 200-bed General Hospital I applied for and won the Engineer’s job at Kempsey District Hospital in NSW. My in-laws had decided to retire at nearby Nambucca Heads and Kempsey was but a one-hour drive away. It was a way of keeping the family together. I had only been employed there for a couple of months before I was off to N.Z. as our ‘ANZEX Delegate’ to the N.Z. Conference at ‘Whakatane’. My wife and I had a wonderful time and made many lasting memories on this study tour.

This was an age when communications as we accept them today, were non-existent. With the best interests of the IHEA at heart in 1983 I resigned from Federal Council and settled down to life at work and on the 25 Acre (10 Hectare) property that we were living on. Tragically for me my dear wife died in 1997 and I felt completely at a loss as to ‘where to go from here’. I attended the National Conference in 1997 and was ‘tapped on the shoulder’ by the then President – Sergio Adofaci – who advised me that the current Federal Secretary – Bruce Noseda – was working in N.Z. overseeing electrical works after the earthquake in Auckland.

The IHEA was struggling to meet its commitments and would I consider re-joining Council in my old role of ‘Federal Secretary’.

In December of that year I accepted his offer and with the promise of a computer, a fax machine plus a separate telephone line, I once more began attending Council meetings, corresponding with all and sundry and getting myself involved in matters such as ‘Energy Conservation’, Greenhouse Gas Emissions’ and the like.

In 1998 I was nominated to be the IHEA rep on the ‘Greenhouse Challenge’ committee as organised by the AHA. These meetings were held in Canberra.

In one of these roles I attended a meeting entitled ‘10th Annual Building Maintenance and Management Conference’ which was held in Sydney’s ‘Star City Casino’ Two years later I attended a meeting organised by ‘Sustainable Energy Development Authority (SEDA) at the ‘Sydney Cricket Ground’. Later still I attended the WHO South Pacific Region Conference in Darling Harbour.

I was actually representing IFHE at this meeting!

I became a regular attendee at the ‘Northern NSW Engineers and Maintenance Supervisors’ Conferences held at Coraki (near Lismore) and presented papers there. Some of your own Queensland Branch Members would also attend. This had nothing at all to do with the IHEA because a lot of our local lads were ineligible to join, but was organised by ourselves for our mutual education and benefit. Us, more knowledgeable Engineers, offered ourselves as ’Specialists’ on various topics as a means of giving a helping hand to those of us who were not ‘up to speed’ with the numerous activities being directed our way.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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SPECIAL INTEREST I also presented a paper at the 1991 National Conference held at Manly, NSW and won ‘Best Paper’ award for my efforts.

‘Y2K’ came and went without any noticeable ‘hiccups’, although I would suggest that an awful lot of us were involved in ‘Disaster Response’ committee meetings well before this. I hope some good things and new ideas eventuated.

‘Energy Performance Contracts’ were being suggested to those establishments who could perhaps, either not afford to do the things they wanted to do, or to those who had no imaginative solutions to meet the need to reduce their energy costs. It was, perhaps, unfortunate that those of us who were pro-active in such matters as energy conservation received no recognition as to the work having been done as a matter of course and as part of the reason people such as ourselves were employed in the first place!

Within my own AHS I became the ‘Energy Consumption Co-ordinator’ and gathered consumptions for all establishments, made spread-sheets, drew graphs, etc for management to keep track of and do whatever they liked with. I loved it all!

With respect to the formation of the Qld. Sub-branch.

This, according to my notes, was founded on 01/05/1974.

At that time and due no doubt to the lack of membership from Qld. 39 years ago Queensland was ‘New Territory’. It was a sub-branch of the NSW Branch. Although it worked well initially, the NSW Branch became increasingly irritated by having to do correspondence/etc. for their northern neighbours. Queenslanders had to pay their subs to NSW and became strident in their demands for the formation of a separate and distinct Branch of their own. This was granted on 01/07/1981 and Federal President – Don Reed – from W.A. flew up to Brisbane to chair the inaugural meeting.

Since that date the Qld Branch have taken their rightful place in hosting National Conferences and in having representation on National Council.

Qld Branch members admitted via NSW Branch 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

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Ron Andrew Alan Armitage Roly Border Don Bryant Leroy Dendy Ron Downes Ron Drinnen Phil Gray Ron Green Keith Hambridge R. Hartigan David Hemphill Brian Ireland Ken Pitman Keith Simpson Richard Waters Graham Wright

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

Qld Sub-Branch founded 01/05/1974.

Full Branch founded 01/07/1981.

On the north coast of NSW, at one of our ‘Coraki’ meetings – John Miles – attached to the Coffs Harbour Sector, spoke about the devotion of a lot of his own and his staff’s time being given to understanding the significance of the multitude of ‘Australian Standards’ that we are obliged to conform to. The idea behind this was to make note of the standards that would actually ‘bite our bums’ if we were found wanting after a coronial enquiry/ etc. These ‘Standards’ were classified as ‘Must Do’. It added considerably to the ‘Planned Maintenance’ component of our work, but at least, by accomplishing them, we could not be targeted by some plaintiff.

I have spent an enormous amount of time gathering the history of the IHEA and have created some equally enormous spread-sheets detailing such things as the complete membership data-base, a list of all articles published in our journal along with titles/ page numbers/volumes, etc., a list of all Conferences attendee’s names that had been captured on photographs, a review of member’s birth-signs in an effort to ascertain whether or not we all had the same birth-sign as we all enjoyed doing the same job. It goes on and on! It was, perhaps, Council’s understanding of the effort involved in doing all this that I was awarded the position of ‘Honorary Fellow’ in 2007.

Going back over a few years since the creation of the position of ‘Membership Registrar’ there have been some gross anomalies in our membership database. At first the’ ‘Membership Registrar’, on his own, would grant membership to whomsoever he thought qualified. This info was never passed on to the National Secretary, but was ‘maintained’ by himself on his own spreadsheets. In a strange way he was largely ‘unaccountable’ to anybody. This job used to be done by a three-man committee.

The creation of a CEO for the IHEA meant that someone else could dabble in this info. On numerous occasions I have said ‘Use my spread-sheet as it is transcribed directly from the minute books’.

The ‘William McMahon’ award initially suggested in 1991 and to be given to someone doing something outstanding in our field of Hospital Engineering has, to date, been awarded to only two people! Why is this? Are our ‘Standards’ too high? Are we all too busy to concern ourselves with matters like this? Does this send out any signals to the wider community?

In 2001 I wrote a series of questions that I suggested, to Branch reps on Council, that they ask of their own ‘Senior Citizens’. These questions ranged from conditions within their own work sphere to anything at all possibly connected with the IHEA. The idea behind this was to capture these snippets of information before the owners of this info ‘fell off their perches’. If my memory serves me correctly, it was your own Branch who wined? dined? and somehow got these people reminiscing, when other Branches produced nothing at all! Wally Freyling and Ian Robertson were involved! Assuming that my memory of this is accurate, I would respectfully ask this Branch to tell us sometime as to what has happened to this info?

SPECIAL INTEREST The IHEA does not want to appear stagnant in any shape or form and it was to this end that a proposed name change to ‘Health Facilities Australia’ was put to the membership in Sydney in 2002 The motion was lost and it is my personal opinion that the more ‘long-serving’ members felt that ’It ain’t broke so we won’t fix it’.

I recall that the ‘Outsider’ to whom Council was communicating with for advice, felt that out of our existing name the only words meaningful to him were ‘Hospital’ and ‘Australia’. The whole idea was to open up our membership to others than those of us who work solely in Hospitals and encourage them to check us out!

Having lost faith in the system under which I was working I retired in August 2003 and resigned as National Secretary of the IHEA at the following AGM. It was somewhat flattering when, shortly after retiring, I was asked to consider relieving at St. Vincent’s Hospital, Lismore and then another offer – this time from Kevin Bidgood, from Cairns Base Hospital,– to relieve at Thursday island for a month! I declined both of these offers as I had had a gutful and did not feel as though I could have given these jobs my best shot.

I was still living on my 25 Acre block in Dondingalong (Kempsey) and had had the pleasure of having the ‘Secretariat’ close by me in Port Macquarie. My successor as National Secretary – Mike Ellis (from S.A.) – did not consider it necessary to have all the archived material close to hand and so, when we changed Secretariats, it remained with me in storage under my own roof.

I was thus able to access all the information that I wanted to create some of the history of the Institute. I only transferred this info to Michael McCambridge at the Royal Melbourne Hospital when I downsized to Port Macquarie in 2009. I have thus lost access to this info.

I note with some dismay that at our forthcoming National Conference in Sydney, there appears to be only one IHEA Member presenting a paper! Is everyone far too busy these days? Is it lack of interest? In a few years time we might have lost our abilities, or drive, to do this! It’s up to you members active in your Branch. Give a presentation at a Branch meeting, Chair a session, organise an event… All these things lead to ‘professional development’.

The saddest thing I see is ‘Unused Human Potential’. The majority of the time we are the ones holding ourselves back from the success we deserve.

In closing I must express my appreciation to your Branch Committee for the invitation to be part of your conference and to be allowed the opportunity to stand before you all and recite some of the activities that I enjoyed during my association with the IHEA. I would encourage all of you to ‘Get Involved’.

I am leaving all the notes that I have spoken about with your Conference Organisers for them to decide whether or not they should circulate them to the membership at large, or not.

I sincerely trust though, that when they have been seen as ‘Of no further use’, and with ‘Greenhouse Gas emissions’ in mind, they will be torn up for recycling and NOT BURNED!

In 2006 I wrote some comments for our journal about the ‘Image’ that the IHEA represents and to encourage some positive feedback. I did this as a means to identify exactly who would replace us in the workforce when we retire or otherwise cease active work in Hospital Engineering.

Standards are rising and the qualifications that got you your job all those years ago will not necessarily get you your job today!

‘Continuing Professional Development’ must be pursued! How many of you now have an ‘Accountant-based’ person as the head of their Department? We should all obtain some financial qualifications; otherwise we will always be the ‘underling’.

Years ago, at State and National Conferences it was the norm to have one of our own members as ‘Session Chairman’.

Someone would do the morning stint and someone else would carry on after the lunch break. This was ‘Character-building’ and most certainly ‘Professional development’. These days our National Conferences all have ‘Professional M.C’s’ to do the job.

The fact that they do it well hides the point that we are denying ourselves an opportunity to ‘Grandstand’.

I have written papers on the topics of ‘Being a Session Chairman’ and ‘How to write a Technical Paper’. It was gratifying to see these papers printed in our own journal as well as in the N.Z equivalent.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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Since being formed Meiko Australia Pacific “MAP” who only import from the German Factory has found many owners, managers and operators have become interested in the operating costs and the advanced features our machines offer.

It is quite easy to fall into the trap of ‘its back of house and it’s just a dishwasher so let’s just get the cheapest unit we can’.

In today’s world this is not always the best choice. With the costs of chemicals, electricity, water and labour rising and the concern for

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the environment affecting decisions we make, advanced technology in dishwashing is gaining more and more interest.

Further, there have been many advances in how meal trays are stripped down and loaded into machines.

Advanced Technology such as cutlery magnets, automatic loading of trays and cutlery, automatic unloading of trays and cutlery and trolley washing machines can considerably lower operating costs and reduce labour, thereby paying for the initial costs of these components and machines and giving ongoing cost savings over the life of the system.

Meiko specialises in the design of these systems using this technology to not only lower your operating costs but also lower your labour cost. We can design a system and solution for the smallest Hospital or Nursing home right up to the largest institutions and we have examples of these right around the Country.

All Meiko machines have advanced features which make the machine cheaper to run, easier to clean and easier to service.

All the machines have self-diagnostics built in to make service easier. All Meiko under counter, hood type dishwashers and pot & utensil washers will monitor the rinse temperature and if it is not reached then it will not finish the cycle and it will bring up an error code.

An important feature for those operators that wish to be HACCP compliant.

For the larger Hospital which has a conveyorised dishwasher, these machines can be quite expensive not only to purchase but also to run.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

Our experience has shown us that purchasing a machine from our German Factory with the inbuilt advanced technology, you can save tens of thousands of dollars each year in running costs alone.

Meiko has recently introduced to the Australian market our new MiQ conveyorised dishwashers.

These dishwashers have been in development in Germany over the past 6 years.

They are the most advanced conveyor dishwashers on the market in the World today.

Some of the features they offer include: • Inbuilt water filtration and disposal of food soil from the tanks.

• Reverse air extraction thereby retaining the heat within the machine and reducing the amount of electricity required to heat the machine.

• Colour coded components to help the operators with the cleaning process.

• High pressure wash systems to save energy and reduce the amount of rejects from the machine.

• Inbuilt flushing of the entry section to assist with Hygiene.

• Inbuilt Cleaning Cycle, just push the button and the machine will do the rest.

• Inbuilt flushing of the condenser to maintain efficiency and reduce maintenance.

The MiQ dishwashers use less energy, water, chemicals and further they expel less air than any other machine on the market, and as mentioned earlier, whilst they may cost more initially, they have paid for the difference in cost whilst they are still under warranty.

You keep pocketing the savings for the life of the machine.

TECHNICAL PAPERS

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Advanced engineering features takes these advantages even further • Standard integrated blower dryer works with the airflow management system.

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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TECHNICAL PAPERS

Infection Control Strategies Elizabeth Gillespie I CICP MPubHlth (Melb)

Hand hygiene It is now well recognised that hand hygiene is the primary measure for infection prevention. When performed well, it reduces transmission of microbial pathogens both in the community and in the healthcare setting.1 In Victoria, hand hygiene projects have been in place for several years. With the Hand Hygiene Australia initiative, hand hygiene education and auditing is becoming a national strategy to reduce hospital acquired infections.2 In addition to monitoring healthcare worker compliance with the 5 moments of hand hygiene3 (a process measure), Staphylococcus aureus bacteraemia data are also collected as an outcome measure.

Infection control strategies to raise the profile of hand hygiene and improve compliance: • Make sure alcoholic chlorhexidine is available at the end of patient trolleys, fixed to equipment trolleys, at the entry and exits to departments, cubicles and clinical rooms.

• Quiz colleagues on the 5 moments of hand hygiene and when to apply alcoholic chlorhexidine hand-rub.

A clean environment Many studies have described transmission of pathogenic organisms through contact with contaminated surfaces.4 Multiple-drug resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) are of concern because infection is associated with increased length of stay, increased healthcare costs and increased mortality.5 Adequate cleaning requires sufficient removal of pathogens to minimise patients’ risk of acquiring infections from hospital environments.6 Specific VRE cleaning

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following discharge of patients colonised with VRE involves 2 steps; cleaning with detergent and water followed by disinfection with a weak hypochlorite solution (bleach).

This process has been used since VRE was first identified in the 1990’s.

• Trial a range of safety devices and choose the device most appropriate for cost, useability and accessibility.

There is evidence demonstrating that appropriate cleaning assists in preventing the transmission of VRE however this special cleaning technique is only used when it is known that a patient is carrying VRE.7,8

• Ensure there is an appropriate occupational exposure management protocol in place should an injury inadvertently occur; promote its availability and the value of reporting injuries.

Infection control strategies to keep your environment free of microbial pathogens: • Make sure your department is visibly clean, conduct cleaning audits with your cleaning staff and promote their role in the health team.

Health-care worker immunisation

• Credential cleaning staff in special cleaning techniques such as those used when patients, colonised with highly resistant organisms (e.g. VRE), are discharged.

Safety engineered medical devices Safety engineered medical devices are now well recognised as one strategy to assist in reducing the risk of percutaneous injury to healthcare workers.9,10 Other important strategies include the placement of sharps containers, education about preventing sharps injuries and management of occupational exposures.11 Many jurisdictions in the developed world now advocate the use of safety engineered devices. Safety devices cost more than non safety devices and are introduced to reduce the risk of acquisition of a bloodborne virus in healthcare workers. Some studies report that the degree of under-reporting of sharps injuries can be as much as 10-fold.12 Infection control strategies to keep your staff free of percutaneous injuries:

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

• Educate staff about the importance of preventing percutaneous injuries and promote their health as a priority.

The Australian Commission on Safety and Quality in Healthcare report that the most important preventive strategies to reduce and prevent hospital acquired infections include hand hygiene, the appropriate use of antibiotics and immunisation of health-care workers (HCWs).

Healthcare workers who are not immunised place patients at risk of acquiring vaccine preventable diseases, and more effort is needed to help staff and employers to reduce this risk.13 It is well recognised now that up to 59% of HCWs can have subclinical influenza and potentially cross infect patients. Reductions in mortality of elderly patients have been demonstrated when HCWs have been vaccinated.14 Infection control strategies to improve HCW immunisations • Ensure a system is in place for HCWs to be vaccinated on employment.

• Devise a catch up program encouraging HCWs to have their immunisation status updated.

• Prioritise HCW immunisation by using declination forms, i.e. for influenza vaccination. Studies have shown that the use of declination forms improve influenza vaccination uptake and assist dispelling the myths by informing staff.15

TECHNICAL PAPERS References 1. Pittet D. hand hygiene: It’s all about when and how. Infection Control Hosp Epidemiol 2008;29:957-59 2. Russo P. Hand hygiene Australia: synopsis.

Healthcare Infection 2009;14:11 3. World health Organisation. About Save Lives: Clean your hands – My 5 moments in hand hygiene, last accessed August 2009 4. Zachary K, Bayne P, Morrison V, Ford D, Silver L, Hooper D. contamination of gowns, gloves and stethoscopes with vancomycinresistant enterococci. Infect control Hosp Epidemiol 2001;22:560-564 5. Siegel J, Rhinehart E, Jackson M, Chiarello L. Healthcare Infection Control Practices Advisory Committee. Management of multidrug resistant organisms in healthcare settings, 2006. Atlanta: Centres for Disease Control and Prevention, 2006 6. Goodman E, Platt R, Bass R, Onderdonk A, Yokee D, Huang S. Impact of environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in

intensive care unit rooms. Infect Control Hosp Epidemiol 2008;29:593-599

devices. Occup Med (Lond) 2006;56:566-74 Epub

7. Puzniak L, Gillespie K, Leet T, Kollef M, Mundy L. A cost-benefit analysis of gown use in controlling vancomycin-resistant enterococcus transmission: is it worth the price? Infect Control Hosp Epidemiol 2004;25:418-424

13. Cruickshank M, Ferguson J, editors.

Reducing harm to patients from health care associated infection: The role of surveillance.

Australian Commission on Safety and Quality in Healthcare, 2008. Last accessed August 2009

8. Ray A, Hoyen C, Taub T, Eckstein E, Donskey C. Nosocoamial transmission of vancomycin-resistant enterococci from surfaces.

JAMA 2002 ;287 :1400-1401

14. Elder A, O’Donnell B, McCruden E, Symington I, Carmen W. Incidence and recall of influenza in a cohort of Glasgow healthcare workers during the 1993-4 epidemic: results of serum testing and questionnaire. BMJ 1996;313:1241-2

9. Zanni G, Wick J. Preventing needlestick injuries. Consult Pharm 2007;22:400-2 10. Sohn S, Eagan J, Sepkowitz K, Zuccotti G. Effect of implementing safety-engineered devices on percutaneous injury epidemiology. Infect Control Hosp epidemiol 2004;25:532-42 11. Tuma S, Sepkowitz K. Efficacy of safety-engineered device implementation in the prevention of percutaneous injuries: a review of published studies. Clin Infect Dis 2006;42:1159-70

15. Ribner B, Hall C, Steinberg J, Bornstein W, Chakkalakal R, Emamifar A, Eichel I, Lee P, Castellano P, Grossman G. Use of a mandatory declination form in a program for influenza vaccination of healthcare workers. Infect Control Hosp Epidemiol 2008;29:302-308

Contact Elizabeth Gillespie Sterilisation and Infection Control Co-Director, Southern Health, Victoria

12. Elder A, Paterson C. Sharps injuries in UK health care: a review of injury rates, viral transmission and potential efficacy of safety

Phone: 03 9594 2964

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INDEPENDENT MONITORING CONSULTANTS – AUSTRALIA TECHNICAL PAPERS

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INDEPENDENT MONITORING CONSULTANTS Head Office: 23–25 Daking Street North Parramatta NSW 2151 1300 131 405 (02) 9890 5067 New South Wales/ACT: Ian Hartup 0411 109 353 Queensland/NT: David Curry 0408 368 921 Victoria/South Australia: Steve Powell 0431 503 194 THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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Air Quality Issues in Healthcare Facilities Ms Oh I Leen I LabServices Manager, Independent Monitoring Consultants, Penang, Malaysia

G

ood indoor air quality (IAQ) is desired for a healthy indoor environment especially with reference to healthcare facilities such hospitals, medical consultancy clinics and therapy areas. Organisation as such plays an even more crucial and critical role in maintaining building hygiene to ensure healthy indoor air quality for their patients, staff and visitors. Poor indoor air quality can cause a variety of health problems ranging from temporary to long term. Health problems commonly associated with poor IAQ include allergic reactions, respiratory problems, eye irritation, sinusitis, bronchitis and pneumonia.

equipment and furniture regardless of their consistent efforts in housekeeping physical removal.

Fungal growth found on walls

IAQ problems arise in non-industrial buildings when there is an inadequate quantity of ventilation air being provided for the amount of air contaminants present in that space. Hence, IAQ and mechanical ventilating and air-conditioning systems (MVAC) are closely related.

In addition to these problems, agents derived from or that are living organisms (e.g. viruses, bacteria, fungi, mammal and bird antigen) that can be inhaled and can cause many types of health effects including allergic reactions, respiratory disorders, hypersensitivity diseases, and infectious diseases.

Accumulations of water anywhere in the ventilation system may foster harmful biological growth (bacteria, yeast and mould) that can be distributed throughout the building.

Moulds release spores and/or mycelial particles contain mycotoxins that are believed to be a cause of ill health when inhaled. Graveson (1994) found that repeated exposure to spores or other parts of fungi commonly found in indoor air could result in a wide range of health impacts. These include Type I allergies such as asthma and rhinitis; Type III allergies such as extrinsic allergic alveolitis (a group of lung diseases) or hypersensitivity pneumonitis with flu-like symptoms; ‘Sick Building Syndrome’ including symptoms such as headache, fatigue, sensation of dry mucous membranes and skin, and eye, nose and throat irritation; or organic dust toxic syndrome recognised by tightness of the chest, bronchitis and asthma.

A recent case study was performed at a prominent healthcare facility based in Asia and had proven that regulation of the MVAC system in terms of humidity levels, its air moisture contents as well as air temperature is indeed crucial in controlling microbial growth. In our case, the healthcare facility was facing extensive and heavy growth of fungi all over their building; on ceiling, walls and to the extent of their

Fungal growth on linings of storage cabinets and furniture

An indoor air sampling and assessment was performed at the facility just after the hospital’s half day operation where minimal work staff and visitors were present in monitored areas and air conditioning was also turned off in selective areas as per the facilities’ usual practice. Findings had resulted in extensive and outlier growth levels of mould found in their environmental air and from the results obtained, nevertheless, we were able to determine that the predominant problem lies with their AHU setting where room temperatures were found to be to be within the range of 22°C to 26°C mostly and the relatively high level of moisture content as well as substantial humidity of more than 70% levels were trapped and accumulated in a majority of the areas within the building. Another important point of consideration is that with the regulated air conditioning system being turned off after working hours, this elevated room temperature over time especially towards the night. Factors of such high humidity and warm room temperatures would then contribute to a favourable environment for microbial growth.

There were also other factors that we believed to have coherently contributed to this persistent problem and that included the location of the building’s fresh air inlet that was THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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TECHNICAL PAPERS very near to the kitchen area and surrounded by old trees; the fact that the most of the areas within the building is sealed up and does not have a chance to take in adequate amounts of fresh air; unused rooms which are closed and sealed that prevents air conditioned air from entering rooms and most importantly, that the air conditioning systems are turned off after office hours.

Environmental swabbing and testing on suspected surface growth patches found on the walls, ceiling, clinic equipment and furniture had also confirmed positive evidence of microorganism growth predominantly of mould. Isolation alongside purification and identification of the microbial growth from swabs also indicated the genuses of microorganisms synonymous to that yield from air testing that comprises mostly of common environmental moulds such as Aspergillus sp., Alternaria sp., Cladosporium sp., Penicillium sp. and Rhizopus sp. to name a few. Hence this is an important and relevant indication of an extensive ongoing microbial problem and proliferation due to the lack of physical environmental regulation.

Microbial problems as such cannot be left unattended and should be looked upon seriously. Negligence and failure to take the proper corrective action will result in further fungi sporulation and multiplication in environmental air that can easily contaminate furniture and healthcare equipment especially lenses, penetrable growth into building materials and worst of all pose a severe health threat to personnel and visitors of the hospital especially those with immunocompromised conditions.

With the positive evidences of microbial growth on environmental surfaces within the building, physical and chemical cleaning are highly recommended so that the microbiological levels are brought back to levels suitable for a modern health faculty and this project needs to be carried out as a matter of urgency. Adequate physical removal, selection of a suitable disinfectant and sufficient contact reactive time are crucial for an effective kill and control and therefore commonly very strong products formulated around oxidising agents such as chlorine (bleach – sodium hypochlorite), hydrogen peroxide and peracetic acid are recommended as well as the use of a qualified technical specialist on the chemical cleaning, handling and management.

Both temperature and moisture management are also equally just as critical for minimising the potential for microorganism regrowth especially when it comes to fungal contamination.

As for our case study, temperature and humidity levels are mainly controlled by the centralised air conditioning unit and are commonly switched off after clinical hours for a majority of the areas. Hence it is suggested that the hospital management needs to look into these factors to determine if there is a need to relocate the air intake of the air handling system and to upgrade duct work fittings, filtration systems or other components in a view to reregulate the system in order to fit and comply with both guidelines

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

and corporate requirements. In addition, any spills, leaks or wetting of MVAC system or components should be dried out and inspected as soon as it is practical and it is also recommended that drip pans be drained regularly to prevent excessive accumulation of water in the ventilation system.

Close monitoring is always good and essential and any signs of growth should be investigated and remediated immediately. Should the humidity problem persist, installation of a dehumidifier will be a good, recommendable option.

Scheduler changing of air filters is also encouraged and ought to be done regularly and with proper documented records in place. Regular cleaning of the building is also necessary in order to avoid accumulation of debris and particulate matter build-up.

All employees and occupants of a hospital should always be educated and be well informed, instructed and trained on the causes of poor indoor air quality and the effects to health arising from it and the detrimental effects from environmental tobacco smoke and its contribution to the overall indoor air quality. The employer should share and educate their staff regarding contents of Code of Practice on Indoor Air Quality, the identification of signs and symptoms associated with the illnesses commonly associated with poor indoor air quality and the identification of poor ventilation conditions as well as signs of deterioration in the air-conditioning or mechanical ventilation system.

A hospital should also play an important role in establishing a standard procedure to deal with complaints from patients, employees and other occupants with signs and symptoms related to poor indoor air quality. Upon receipt of a complaint, the employer has to ensure that a thorough investigation is conducted to ascertain the cause of the complaint, and a report prepared, without delay. If the complaint is found to be valid, the employer should take action to address the problem immediately. In the instance of this hospital management procrastinated for many months before taking any proper control which has resulted in the problem being far worse than if action had been initiated when the problem first appeared. A simple cleaning procedure should have been the best action but because the situation deteriorated it is now necessary to undertake extensive and thorough cleaning that will penetrate to all of the internal surfaces to avoid a reoccurrence and continuance of the current problems.

Ms Oh I Leen (Bsc in Biology and Chemistry Magna Cum Laude) is LabServices Manager of Independent Monitoring Consultants Penang Malaysia.

TECHNICAL PAPERS

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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TECHNICAL PAPERS

Managing Information from Building Systems

for Efficiency, Productivity, Compliance and Continuity of Service Irina Veiber Lindquist I Solution Architect Healthcare, Schneider Electric

Introduction

T

he healthcare sector in Australia has been long challenged by the need to improve efficiency, productivity and effectiveness in response to an increased demand from ageing population and access to multi-disciplinary quality service across the continuum of care; from acute to primary care and community care. In the context of significant budget pressures and funding constrains, the evolution of services under the National Healthcare Reform has seen implementation of patient centric models of care, underpinned by remodelled processes, and increased technology adoption.

Healthcare activities are driven by excellence in clinical care, performance standards, efficient and effective operational outcomes. Similarly, the systems and processes required to maintain buildings’ infrastructure is required to respond ensuring the appropriate environment for core activities in the context of regulatory compliance for buildings and their services.

Building services in healthcare facilities are managed through electronic systems which are monitoring, controlling or simply handling alerts and notification of operating status. Whether implemented in an integrated environment or stand alone, these systems provide the healthcare facility operator with valuable insight on building performance, status of critical infrastructure and likelihood of impact on clinical service delivery.

Applications and systems attached to building services accumulate significant amount of data which can be analysed and transformed into information, hence becoming an important decision support tool in managing the infrastructure and service continuity in the healthcare facility. Correlating information from multiple sources, consolidating meaningful cause – effect scenarios enables early identification of stress points, transparent and timely preventative actions.

Managing information from building systems does not only apply to incidents but enable benchmarking of performance over time, patterns of building operation, and changes in the environment which, in turn, affect the capacity or quality of healthcare service.

Analysing and collaboratively managing patterns of infrastructure behaviour creates visibility into potential issues and strengthen engagement with all stakeholder groups in the facility. It turns

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

a potentially daunting experience into a positive, proactive risk mitigation approach, allowing for wide recognition, shared commitment and support in required resolution.

Managing healthcare facility information creates a window into what it takes to run an efficient service, and facilitates awareness of performance beyond patients and staff through community engagement.

Discussion Similar to all other support services, the Facility Management (FM) needs to be agile, flexible and aligned to the dynamic changes in healthcare setting. The healthcare service is the heart of activities in the facility and its complexity and dynamic evolution drives changes in the building’s operating conditions.

Whether changes occur from building infrastructure upgrades, changes in the model of care or changes in service profile, FM is required to promptly respond and replicate those in reliable, sustainable, continuous and available building services and associated practices.

An agile Facility Management practice requires consolidated information and analysis of infrastructure and services performance. The facts and records accumulated in the integrated monitoring and control systems can become the evidence behind robust strategic planning for an efficient and sustainable service operation. Healthcare facilities are also asset intensive, hence triggering the need for structured practices in optimising the performance output from infrastructure, plant and equipment. The strength of information from building systems can be leveraged beyond its traditional use in daily operations and used to provide visibility into physical infrastructure performance. By managing the information and analysing its critical impact to core operational activities, results in awareness building, ownership and accountability of risk, opportunities or sustainability drivers in strong connection to healthcare service continuity, regulatory compliance and financial performance.

Balancing the risk of downtime from infrastructure failures, raising cost of maintenance for ageing plant and equipment, resources and budget constraints with an increased demand for performance and efficiency, the healthcare facility management profession is facing also the challenges from service criticality,

TECHNICAL PAPERS considering that asset failure can potentially have direct or indirect impact on patient care outcomes.

This level of complexity, and the number of variables involved in determining the right process and reaction under certain conditions, can no longer be contained without the aid of technology. The meaning of control systems, deployed as tools for managing complexity in Healthcare FM, is extended to become the decision-support mechanism in the areas of operations, maintenance, performance, risk and cost effective optimisation of resource allocation.

It is widely acknowledged that the control systems, implemented to aid the operations of complex building services, have emerged to incorporate technology innovation alongside its applicability in the healthcare dynamic environment. These have become the tools used to collect data on building behaviours and support the course of actions required to retain, sustain or improve the quality of service in building operation. However, considering the complexity and broader operational reach of healthcare FM, there is significant potential to unlock the value from managing the information extracted from these systems.

This can be achieved by providing actionable intelligence and expert guidance with clear prioritised asset optimisation recommendations that are based on statistical analysis, performance trending, and automated diagnostics; with results that improve the performance, compliance, energy, comfort and financial well-being of the healthcare buildings.

Through robust and structured information management, facility managers can understand how to take advantage of the building services data, find hidden cost and inefficiencies, mitigate risk of asset failure or service downtime, hence optimising the operational performance of the facility.

Information management for Healthcare facilities spans beyond the monitoring and control systems and provides the automated fault detection and diagnostics required to identify, prioritise and act on cost savings opportunities while reducing the risk of infrastructure failures.

The transparency into buildings’ behaviour created from analysed data enables fact-based decisions and confidence in capital and sustainment investments allowing a result driven and proactive approach. The business value of information management for healthcare buildings is translated in measurable results in green star rating and energy management, operational efficiency and regulatory compliance, meaningful spending on operational activities and sustained savings from proactive building management.

Managing the information from building systems in healthcare facilities is a process driven activity aiming to translate data into actionable results, while delivering cause and effect scenarios on most costly issues affecting the environment of care. This process is based on robust and structured monitoring, seeking to continuously measure and validate potential infrastructure inefficiencies or failure scenarios.

The most valuable benefit from building services information management arises at the interface with the end-user and

Figure 1: Information Management – a process view

critical processes within the healthcare facility. This is mainly derived from the necessity to support decision making for critical functions at various times, in complex contexts and for varying purposes. Also, having the intent to facilitate productivity, costeffectiveness and standardisation of responses, the management of information exposes the efficiency of standard processes as relevant to healthcare operations, and triggers the risk and opportunity review generating improvement in continuity and quality of operations. Subsequently, the building services control applications could be continuously tuned to facilitate the seamless interaction between services enabling their logical connectivity and response to uniquely complex and critical environment’s inputs. However, this does not exclude the requirement for supervision and control over facility management functions but supports decision making through a coordinated and structured set of principles, processes and methodologies.

Figure 2: Information Management – Improving visibility on buildings data and supporting decision making for healthcare operations.

Another significant benefit from a holistic approach to information management comes from generating automated reports required for assets operating patterns, regulatory compliance and healthcare quality system accreditation. The types and purpose of reporting varies hence need for inbuilt flexibility to extract data from a variety of sources. Reporting on required optimisation of plant operation involves technical parameters which are otherwise insufficient for functional systems THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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TECHNICAL PAPERS performance reports. Similar with all other topics discussed in this article, report generation in healthcare facility is a process driven activity which requires modelling and alignment within the context of core activity requirements. Additionally, the access to information has to be enabled for multiple levels within the healthcare organisation to facilitate management of core or support activities. Also, consolidating healthcare facility information against Australian Council for Healthcare Standards (ACHS) accreditation and reporting criteria allows an auditable path to compliance as well as a tangible proof for quality of service delivery.

In Australia, energy prices have increased 19% over the last 3 years, and in 2012, the government passed a new carbon tax, which is expected to increase hospital electricity bills by %10+ this year. According to media releases from New South Wales Treasury Department and the Victorian Ministries of Ageing and Health,[1], [2] this could cost the hospitals in the state of New South Wales AUD $27 million/year and the hospitals in Victoria AUD $13.7 million/year, if action is not taken to reduce carbon emissions. At the same time, Australia has the potential to make a significant dent in energy waste over the next 20 years, with an estimated AUD $2 billion+ in potential energy savings across the country’s hospitals.

In conclusion, some of the key tangible benefits resulting from a holistic approach to building systems’ information management are: • Consistency of performance and reliability of infrastructure which supports healthcare service continuity; • Retaining and leveraging in operations the value of investment in intelligent building systems; • Continuous visibility and supervision of compliance parameters against specific functional requirements of specialist areas; • Significantly reduced cost from reactive maintenance and breakdowns; also, significantly reduced cost per square meters of operating facility when compared to the traditional maintenance model; • Optimised maintenance regimes and the cost of maintenance, based on predictive operational performance; • Containing and controlling the cost of utilities through active energy management regimes; aiming to retain identify and quantify energy conservation measures, reducing waste in consumption; • Optimising cost of operation over time while delivering improved infrastructure performance and minimising the risk of service disruption.

Hospitals are the number one consumer of energy in buildings and account for more than half of the emissions from Australian government buildings. In fact, 75% of Australia’s electricity comes from coal-burning power plants. An estimate from the Australian Academy of Technology and Engineering estimates that carbon pollution costs Australia $2.6 billion/year in immediate healthcare costs due to related respiratory, cardiac, and nervous system diseases. This means energy waste is now a public health problem [3], [4], [5].

Considering the current and projected cost increase for energy and knowing that healthcare facilities are among the most aggressive consumers, it is time to look into possibilities for energy savings. This can not only help in meeting hospitals’ sustainability targets, including greenhouse gas and peak energy reduction but can also assist in managing an already tight operating budget by optimising consumption while retaining continuity of service. The common denominator for visualising and analysing potential solutions for better informed decision – building services information management. Analysing healthcare energy data can provide tangible benefits and enables transparency of available energy conservation measures.

Figure 4: Managing Information – a holistic approach to building systems’ operation.

References: [1] Premier of Victoria, ‘Julia Gillard’s carbon tax power price increases to hurt Victorian country hospitals’, Media release, 21 July 2011; Steve Lewis, Matt Johnston, ‘Hospitals face $170m hit from sick carbon tax’, Herald Sun, 9 March 2012.

[2] The Hon Mike Baird MP, NSW Treasurer, ‘Cost of Carbon Tax on NSW Schools and Hospitals’, Media release, 29 April 2012.

[3] Kjellstrom, T., et al. Air pollution and its health impacts: the changing panorama, Medical Journal of Australia, 2002, 177, pp. 604-608.

[4] Biegler, T. The hidden costs of electricity: Externalities of power generation in Australia, Report for the Australian Academy of Technological Sciences and Engineering (ATSE), 2009. Available online: http://www.atse.org.au/resource-centre/func-startdown/63

Figure 3: Information Management – Energy performance and benchmarking

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

[5] Lancet: “biggest global Health threat of the 21st century” (2009) Public Library Science of Medicine: Climate change could cause a health crisis at least as big a tobacco.

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TECHNICAL PAPERS

Energy Efficiency Upgrades at SA Pathology Jake Bugden I Managing Director, Sustainable Focus

Background

Sustainable Focus designed a solar PV shading system to the NNW and ENE facades to maximise performance (the WSW façade is shaded by large trees). Some of the benefits of the project included:

S

ustainable Focus has worked with the SA Pathology since 2004 to implement wide-ranging energy and water saving initiatives at their 25,000 m2 site.

Through a whole system perspective Sustainable Focus has been able to identify the most cost effective savings for the buildings located along Frome Road in Adelaide, and has implement opportunities that have not compromised operations.

SA Pathology commissioned Sustainable Focus to identify and manage the implementation of cost effective measures to reduce energy consumption and costs at their facility, whilst simultaneously improving the working environment.

SA Pathology has achieved annual electricity savings of 1.25 million kWh, equating to energy savings of $170,000 per annum. The total investment was $760,000. This represents a simple payback of 4.5 years, equivalent to a 22% return on investment.

Jake Bugden, Managing Director of Sustainable Focus has worked with SA Pathology since these initiatives commenced. The process for implementing the energy efficiency upgrades will be discussed along with other considerations such as funding, accountability, monitoring and verification, capital upgrade and occupant benefits and facility management relationships.

• Solar gain reduction – reduced cooling demand and associated energy consumption of chillers

The main SA Pathology complex has a building area of 25,000 m2 and is the focus of this paper. It is located on Frome Rd in Adelaide, adjacent to the Royal Adelaide Hospital and the University of South Australia. Most of the floor area is dedicated to laboratories and offices.

• Increased occupant comfort levels Roof iron over the plant rooms has also been painted with a highly reflective white paint to reduce radiant heat levels and therefore chiller load.

The Opportunities Building envelope The Hanson Institute Building had been suffering from excessive internal heat gains during the summer period.

In order to improve conditions for the occupant’s and reduce the demand on the air conditioning systems, external shading was identified as the best option to reduce the solar gain through the windows. Furthermore, Sustainable Focus identified the opportunity to use solar panels as the shading elements to provide an additional benefit by generating renewable electricity. This allowed for one feature to provide multiple functions.

About SA Pathology SA Pathology provides a comprehensive range of diagnostic and consultative services in all branches of pathology for the Royal Adelaide Hospital, private and public hospitals, medical practitioners, specialists and research organisations.

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• Solar generation – integration of renewable embedded generation

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

Heating Ventilation and AirConditioning (HVAC) Heating, cooling and ventilation account for 50% of energy use in an average office building. For laboratories energy use is much higher due to specific requirements including 100% fresh air supply.

TECHNICAL PAPERS • Integrating heat reclaim systems and improving control • Preventing concurrent heating and cooling system operation • Adding a new visual interface to assist management teams to better manage energy performance

At this site the heating, cooling and ventilation system used to run 24 hours a day, 7 days a week within a tight temperature band and at full speed.

Completely isolating the system outside of operational hours was not possible as bio-containment is critical.

Sustainable Focus undertook a detailed review of the plant and Building Management System (BMS) and established that tuning up the BMS through the use of more sophisticated control strategies would save considerable energy.

The BMS and HVAC upgrade strategies recommended and implemented by Sustainable Focus included: • Fitting variable speed drives to supply and exhaust air fans and reducing fan speed and water pumps • Allowing the temperature set-point to drift plus or minus 4°C outside of normal operating hours, with after hours push button operation

Lighting The lighting within the facility had been added to over a number of years resulting in a non-standard lighting grid layout, and various types of lighting throughout the premises.

Although the lighting fixtures found in the building varied from location to location, the main type of luminaire was a 2x36W linear fluorescent, 1200x600 mm recessed troffer fitted with a framed prismatic diffuser and low loss magnetic ballast. The existing light fittings had inefficient control gear and older technology lamps, resulting in a lighting power density of 19 W/m2 which is very high compared to current industry standards.

The lighting upgrade strategies recommended and implemented

by Sustainable Focus included: • Retrofit existing luminaires with energy efficient control gear and high performance reflectors, reducing energy consumption from 84W to 35W per luminaire • Replacement of old luminaires with new energy efficient luminaires including warm start electronic ballasts and high performance reflectors • Occupancy control in common areas As a result of the lighting upgrade the power density was reduced to 6 W/m2.

Hot water The central hot water system uses steam to heat the water. Traditionally this process takes place in a calorifier, which is like a very large hot water storage unit.

This is very inefficient as the calorifier radiates large amounts of heat wasting steam. A plate heat exchanger has been installed in place of the calorifier, saving steam and reducing greenhouse emissions. Other benefits include reduced maintenance costs and reduced thermal load in the building.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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TECHNICAL PAPERS Focus managed the procurement process and selected the supplier for this new piece of equipment.

• Installation of the bespoke polyurethane panel.

• This solution costs approximately six times less than installing factory doors.

The other benefit is there is no waste generated in the process.

Boiling water units are similar to an electric kettle that continually reheats to boiling point whenever the water reduces in temperature. Previously, this happened 24 hours a day, 7 days a week. Push button timers have been installed so that the units only switch on when required.

Refrigeration SA Pathology uses significant amounts of electricity through commercial refrigeration units in their laboratories, including display refrigeration units, cold rooms, ultra cold units.

Sustainable Focus has recently reviewed opportunities for savings with the following findings: • Replacing the glass doors with solid insulated doors will reduce electricity consumption by approximately 120,000 kWh per annum for the 500 fridges • Significant savings were achieved by replacing a number of fridges with one large insulated cool room. Sustainable

Monitoring A monitoring and reporting system that utilises data from the BMS to improve management was implemented to provide information of the following building functions: • mechanical ventilation • heating • cooling • water use The monitoring system comprises a number of sensors and meters placed around the building to monitor key parameters such as air temperature, energy and water consumption.

The parameters are monitored at set time intervals of 5-15 minutes and provide data that can then be used to interpret the performance and conditions of a given period. The monitoring system feeds into the reporting system which provides indicators for management of the BMS. Without suitable monitoring equipment and control, systems typically run at inappropriate times. The reporting system includes a number of functions such as the preparation of weekly reports.

Water Sustainable Focus has worked with SA Pathology on various solutions to reduce water consumption including the following projects: • Cooling Tower Water Reduction Sustainable Focus identified the opportunity to improve the efficiency and reduce the running time of the chiller. The reduced chiller demand has a direct impact on the water use in the cooling towers. The estimated water savings through the reduced demand on the chillers is 30,000 litres per week. This should provide a saving of approximately 1,500,000 per year in treated mains water.

• Installation of Holding Tank The upgrade included installing a holding tank plumbed into the toilet block to use waste water for filling toilet cisterns. A new washer disinfector was installed to make use of a simple re-use system that saves 30% of water used in wash cycle. Toilets have been converted from single flush to dual flush • Reverse Osmosis Wastewater Reuse The waste water from the water treatment facility had previously been discharged to the sewer. A holding tank has been installed and plumbed into the toilet block to fill toilet cisterns.

The current reading of the sub meter shows the system is fast approaching total savings of 2,000,000 litres.

• Toilets and hand basins Toilets fed by a flushometer system have been converted from single flush (13 litres) to dual flush (9 litres full flush, 4.5 litres for a half flush). Recycled water is being used for flushing toilets and handbasin tap flow rates have also been reduced.

• Washer disinfector A new washer disinfector has been

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

TECHNICAL PAPERS asked staff to identify any lighting issues and provide an assessment of the quality of the lighting in different work spaces. This survey was repeated after the lighting upgrades were completed.

installed that incorporates a simple and effective reuse system. The final rinse water is stored and reused for the next wash cycle saving 30% of water used in the wash cycle.

• Visual display A visual display of energy and water consumption was installed in the entrance foyer to the Frome Road Complex. The display unit was dynamic with rolling pages containing text and graphics that can be easily updated.

Engagement and communication tools By adopting these engagement and communication tools, the staff at SA Pathology have had ownership and involvement in projects implemented and broader environmental sustainability issues. The engagement and communication tools adopted for this client included:

• Communication tools Sustainable Focus prepared updates for staff about the various projects that were circulated in staff emails and newsletters and also in marketing materials for external stakeholders.

• Staff survey Sustainable Focus prepared a survey for staff to complete before the lighting upgrades commenced. The survey

‘Our partnership with sustainable Focus has seen significant energy and water savings from simple measures. Sustainable Focus has been able to quickly identify the win-win of reduced operating costs and improved environmental outcomes.’

Chris Jeffs, Manager, Director Laboratory Services, SA Pathology

• Signage Sustainable Focus worked with Michael Mullan photography to prepare simple and engaging signage to inform staff about how they could assist with saving energy.

About the author Jake Bugden has developed a unique approach to identifying and managing projects that achieve real environmental benefits within corporate operations. Jake has many years experience in project management including design, delivery, monitoring and reporting. He has specific expertise in energy efficiency and demand management. Jake is also a skilled facilitator and trainer and understands the importance of developing a strong business case for sustainability projects.

Prior to founding Sustainable Focus in 2001, Jake worked for a range of companies, NGOs and the Commonwealth Government as a Senior Project Manager. He holds a Bachelor of Chemical Engineering (honours) from the University of Adelaide.

Refer to www.sustainablefocus.com.au for further information.

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TECHNICAL PAPERS

Campus Infrastructure Models Made Easy Elisa Knowlman I Senior Associate – Health, Peddle Thorp

The design and documentation work flow has substantially changed for design professionals in the last decade. The advent of 3D software and the ability of the software to allow us to embed so much more information into the model generated has meant that there is a rich vein of information that is largely untapped by the owners and managers of the buildings that these models describe.

T

o this end Peddle Thorp has tried to expand the potential points for the client to interact with the model in an effort to get some understanding and buy-in on the client side.

For many smaller existing hospital campuses implementation of a comprehensive Facilities Management system is just not an option.

These facilities typically rely upon the accumulated knowledge of the “old hands” within the organisation, and not everyone is primed to embrace complex new technologies.

Added to this is the reality that these very experienced BEMs managers are such because they have often accumulated many years on a single hospital campus.

We feel that the focus should be on engaging with them and their knowledge base rather than talking of generational change and by that, implying that their replacements are BIM ready.

We have recognised this is the case with the majority of Hospital campuses that we are involved with. We have built up relationships with Facility and capitals works teams and are committed to bringing to bringing these personnel along for the ride.

We have found that we are able to present this information to our clients in a web based viewer that gives them access to a more comprehensible image.

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This image can be used in a number of ways, the principle being way finding but there are many other opportunities that we believe will be revealed once users are given the opportunity to engage with the richness of the information that is available. Including asset identification and maintenance information, staff orientation, certification and approval information and renewal notices, security and circulation paths.

We have called this CIM and it stands for Campus Information Model to describe the scope of the campus wide information that it contains.

It serves as an introductory step to the more widely known BIM – Building Information Modelling.

Building Information Modelling begins with a 3D digital building model. The geometry has intelligent information embedded within it which allows each element to be identified (e.g. a wall or a window), what material it consists of (e.g. brick, steel framing, plasterboard), and additional data (e.g. cost, performance, warranty, etc.). This allows us to construct a virtual model to simulate the building and understand its behaviour before construction begins.

Building Information Modelling (BIM) is accepted industry wide as an efficient tool for communicating design intent, delivering construction information, and helping to manage data through

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

the operational life of a building.

Peddle Thorp were early adopters of this technology, building a thorough understanding of BIMs potential and limitations. This has led to knowledge, experience and maturity that provides us with an advantage when it comes to realising the full benefits BIM. While many architects have been pursuing a BIM workflow for many years, it is frustrating that the information that is developed within the 3D model during design and documentation is not more actively exploited after construction.

With technology evolving so quickly and the potential for Building Information Models (BIM) to become more useful to a wider audience, an ‘easy to use’ interface to access the valuable data is required.

BIM authoring tools and Facility Management (FM) tools are overly complex for all but the most dedicated asset managers. A complete BIM can be of great value to different user groups, including Hospital Management, Clinical staff, FM staff, and asset managers, but they often don’t have the time, skills, or inclination to learn how to operate a new piece of software.

One of the biggest challenges facing clients is how they can adapt to get the most out of BIM. Transitioning from traditional methods to complex digital asset management tools requires a major

TECHNICAL PAPERS commitment and substantial financial investment.

This is where a Campus Infrastructure Model (CIM) such as the one presented here can bridge the gap between existing paper based systems and complete asset management tools. Anyone can make use of the power of BIM, even those with limited computer skills, as the model can be viewed and interrogated in Internet Explorer using a familiar windows interface. The user interacts with a 3D model using basic navigation tools, and can explore down to the finest detail.

Embedded data can be easily viewed and printed within the interface.

In simple terms the CIM application acts as a portal to a Building Information Model.

All of the information usually found within the design model can be accessed,

with the potential to customise data and provide content not usually associated with BIM. At the campus level a view of the overall site is presented and typically any modelled buildings are accessible via a whole building model, then a per floor level model, and can also be broken down into individual room models. Within each model a variety of information can be accessed, this view specific contextual data can also be customised to suit the needs of the client.

As the CIM tool is accessed through Internet Explorer, it can be easily accessed through multiple computers from various sites, the only thing required in Internet Explorer and an internet connection. There is even the potential to use in a mobile environment and a touch screen interface is also available.

The requirement for individual login is implemented by default. The interface can be fully personalised to ensure full corporate branding is maintained.

Various levels of access can be implemented to ensure that the correct employees have access to information relevant to their duties.

In addition, the CIM can be developed in response to a Hospital’s unique needs, requirements and future direction as, each hospital we have encountered has its own set of issues and operating idiosyncrasies.

Once the Hospital management can experience the power and uses of the 3D model through CIM, we feel that the case for implementation of a full BIM and FM program will become more tangible and acceptable.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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TECHNICAL PAPERS

A Surgical Hospital Should Not be Built Like an Ad-Hoc Hotel!

Marshall Hall I Specialist, Engineering Safety in Hospitals

A Surgical Hospital, should not be built like an ad-hoc Hotel! This statement may not be readily understood if one’s point of view is either superficial or technically naive.

My presentation, will uncover wounds currently in the industry, key areas of trauma, the vital signs are not good; the scans reveal an ethical haemorrhage, requiring intervention.

W

hat I’m presenting here, will reveal serious breaches within the Industry, although factual, it would not be appropriate to disclose those Facilities involved. Nearly twenty years of my hospital career has been in New South Wales, but I do get around – only last year in South Australia, I removed a brown snake from a hospital corridor; likewise, can you imagine the legal venom I could receive, if I pointed a finger at any hospital today!

For many years as a Hospital Engineer, I addressed the defects and deficiencies in our old Hospitals, with the saying; well it was built for that period and it met the ordinance 70 standards for that time. We would upgrade these old Buildings where possible to meet the BCA, and especially where the breach involved Safety; affecting our Accreditation.

We have a real conundrum, when working in an Industry that presents as Health Care, when many of our new Hospitals are too compromised in Safety, to meet Duty of Care. Progress can be a fragile word, particularly when we are in an economic slump and this Health Care Industry has possibly suffered the most; notably in Hospital Construction.

Building Hospitals like Hotels appears easier and cost effective, because the strategy in the design process, bears familiarity and commonality with features in Hotel construction. However, this Ad-Hoc Hotel will often not meet all of the 9a Building Codes for many areas and there is often a “trade off” involving both safety and function into the future!

With the financial squeeze, many Organisations have resorted to desperate measures such as with Design and Construct; allowing for long term payments towards ownership. An unfortunate consequence in this process, is that there is too much governance by the various Building Contractors; they often displace or override Health Industry Advisors.

The problem often starts with Architects; could you imagine one designing a car? It may possibly look good, but it would be a

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

drivers curse and a mechanic’s nightmare. This analogy maybe novel, however, it is a reality within our Hospital Designs today.

Far too many of our new Hospitals, are becoming the wrong type of vehicle to drive, maintain and upgrade towards the future – because they don’t share the right priorities.

What if this vehicle was compromised due to cost cutting measures; many of the key Safety features are missing, plus the handling is poor and doors are difficult to exit. You discover, that the quality control was questionable and the project team was naive, not only is this vehicle substandard; in many ways – it would be a Hazard on the road!

I am not one to say that all new Hospitals have this comparative issue, but I can tell you; that the majority of medium to large facilities built in the past decade represent it. Many of these Hospitals should never have been opened with such serious breaches in compliance, often involving the most critical areas; this is unconscionable in my mind.

But there are many grandiose ideas around such as: efficient lighting, heat reclaim, operational solutions and a digital environment that maybe given the thumbs up, however, when our base Architecture is so flawed, it’s like shifting the deck chairs on the Titanic! This last statement, may rock the boat for some but it’s high time we faced the truth out there, fact is, we have an industry improving in many areas; becoming worse in others!

Despite the many defects and deficiencies in new Hospitals, for general interest I’m going to address one involving the BCA, another for DoH plus one Challenging Maintenance.

One of the most defining differences between a Hospital and a Hotel should be found in the Fire Escape Stairs; one should see larger stair landings and more options for escape.

Under the Building Code of Australia; for 9a Class Buildings, the Fire Escape Stairs for Evacuation of Patients; must conform to The BCA, section D under Access and Egress.

Futurebrite™ Technology The most common failing relates to the width of the Landing needing to be 1.6 mtr. That’s the minimum allowed width with stairs of equally minimal size for Compliance. There is a proviso, (not an escape clause); deemed to comply; a feature such as wider stairs: this may provide an acceptable turning radius for stretchers on a 1.5 mtr landing.

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Of all the defects and deficiencies built into Hospitals these days, believe me, this is one of the most common and worst, it’s a major hazard and very complex and costly to fix. Yes, I spent many years upgrading old Hospitals – installing external Fire Escapes Stairs because the internal Stairs failed the Code, but again, that was with some old Hospitals.

To witness this failure in industry today is agonising, because there is such profound contempt or ignorance; relating to the importance of a Hospital’s Evacuation capability. Over the years, I have trained more than twenty thousand persons, in all areas of Safety, including; practical exercise drills: down the stairs involving non-ambulant situations. These design mistakes are made by those with zero experience in Hospital Evacuation.

If there was an Evacuation of a Hotel, or another commercial building such as an office block, it would be unlikely to have high numbers of unconscious or non-ambulant persons to address at the first instance. In a Surgical Hospital, there is usually a high proportion of Patients requiring teamwork to move them to a safe compartment or level.

From my experience, some patients are in such a fragile state, that a stretcher or even an Albac-Mat is unsuitable; a Mattress must be utilised with evac. sheets or straps. It’s almost impossible, for staff to safely negotiate the Stairs, with Hotel size landings of 1.2 M width – with an adult patient on a Stretcher; those that argue have never tried it!

The mandated width of 1.6 M, also allows for congestion with wheel chair patients being carried and of course Bariatric Patients; invariably have to go down on a mattress. From my involvement in Fire Safety management and as a WHS professional; 1.6 mtrs x 2.7 mtrs is just sufficient for the landing, anything less voids Duty of Care in Hospitals.

Today, many Hospital’s harbour an evil secret awaiting discovery; for some, it may follow a disaster; with a category one violation under the Work Health Safety Act.2011, with the latest due diligence requirements in WHS; a prison sentence maybe waiting. Personally, I know major hospitals in the public and private sector taking in thousands of Patients annually,, yet the PCBU fails this most essential area; involving Duty of Care !.

The second item I wish to present relates to Dept of Health Guidelines involving Room Data Sheets and room area; affecting Patients plus overall Work Health & Safety. I do appreciate that the Eastern States of Australia tend to have a more formal structure of administering the industry requirements but there appears to be adherence elsewhere.

This problem, relates to the conflict of attempting to place too many rooms upon a given floor; then end up with a Hospital that fails the guidelines, with undersize rooms. Some Architects treat

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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TECHNICAL PAPERS it like an Ad-hoc Hotel and squeeze to make the most of any given area; ignoring medical work requirements; the rule book is no longer part of their plan.

Very often, the pressure for more rooms may come from within the Health Industry attempting to achieve the prescribed number of Patient rooms but more is sacrificed. The challenge is one of juggling ancillary areas, such as utility rooms that also become undersized, in fact for the sake of adding one extra patient room; all is compromised.

The guideline minimum area is: 15 square metres for a Single Patient Room: then 25 square metres for a Two Bed Patient Room,, again this is very minimal, just passable! There are both Public and Private Hospitals; where the majority of their Patient Rooms are undersize for most building areas plus treatment and utility rooms that are also small.

Another failing in this process; is the lack of Store Rooms on all the Wards due to the requisitioning of available space for patient rooms. This results in excess of trolleys and storage on the corridors, then, this blocks both efficiency and the emergency egress, what started as an over indulgence to gain more Patient Rooms; is now a WHS issue.

Clinicians, especially Nurses incur injuries regularly due to this work environment, not having the space to properly place a patient trolley or crane; this invites an incident. And worse, Patient access both sides of the bed is limited; making medical resources a stretch and emergency equipment awkward to apply; does this look like – Duty of Care?

The third item I wish to cover is not a building Code breach but it certainly defies Maintenance Standards , Infection Control and has total disregard for Future Proofing. To those outside the framework of Hospital Engineering; this issue may not be readily understood because so many in the Design and Construction Industry – don’t get it either!

The subject relates to vertical Service Ducts or Risers taking all manner of Gasses and Liquids up and down from every level.

We should remember in a Hospital this will also involves steam and medical gasses. The Electrical architecture alone would make a Hotel appear primitive, again; this is immense with all forms of power and communications.

But unlike a Hotel, our guests are here every hour of the day with vast numbers of staff working everything like a factory; there is no respite for Hospital support systems. Along with anything goes, the ablutions often don’t manage the pads and miscellaneous; flushed down the Toilet; normally this can be easily cleared through a door in the Riser.

Unfortunately, this Hospital has no access to the Service Duct Risers because this was thought unnecessary; as a cost cutting measure, most of the Risers were bricked-up. To inspect, effect repairs or unblock a waste pipe; requires demolishing brickwork plus destroying aesthetic features; standing an area down; then rebuild Riser to make good.

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All the old Hospitals that I was involved with, either had fire rated doors or panels into every Riser to efficiently carry out maintenance. Now changing construction more like a Hotel or other commercial buildings is a step backwards. We should remember, performing demolishing work regularly on the Wards does challenge our Duty of Care!

Further, contaminated water leaks, seeping from an enclosed Riser is an infection control risk that is patently unacceptable in a hospital environment:: a Design mistake. This is an unfortunate trend in the Industry, not understanding the operational needs of a Hospital; this stems from highly qualified experts that have never worked in a hospital.

Not all new Hospitals have every Riser fully enclosed and even the worst may have a few risers with access, but these are usually for communications and power distribution. What starts out as a cost cutting measure and quick build feature, soon becomes a major problem in the maintenance of the facility and represents a step backwards for Hospitals.

So, who is to blame, the Architects are certainly not alone; we have all the BCA Consultants, together with Builders and Project Managers; where’s that Duty of Care? Often, the BCA Consultants have a world of expertise on everything: except Hospitals and then allow standards more applicable to a Hotel or even worse; an office block!

We have more technology and legislation than ever before; yet we are witnessing a systematic failure involving standards and flexibility for the future, by this industry today. Plant rooms are the heart and lungs of a Hospital, they should have priority of standing to support maintenance and facility upgrades; this underpins our Quality in Health Care.

One of the key problems is that these Hospitals are allowed to open, despite major defects and deficiencies that include breaches of The Building Codes. Yes, there are always, some contractors and officials that have other obligations, this compromises their forms of reporting and official sign off; yes they bend more than the rules in this process.

Very often, Independent BCA Consultants validate our concerns with statements as: This building, definitely fails the Code in several areas, so who the hell signed this off? Corruption exists in many areas of society; honestly, I feel Hospitals should be exempt! When the Authorities go softly, softly, with 9a Compliance of Hospitals in this Country, we are now creating a nightmare for our Health Care Industry; unwell, into the future...

I should add; despite the alarmist side to this report, I again state that Not every new Hospital has all these problems. Also, the criticisms involving contractors has to be proportioned as well; many are a credit to their respective industries. As for all the staff I’ve worked with in the Health Care Industry – including the Nursing Unit Managers; to me, represent some of the best individuals one would find in society. Even all those Architects and Builders, would do well to listen to them!

TECHNICAL PAPERS

*Illustration purposes only E&OE THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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Designing Today for Tomorrows Airborne Diseases Annabel Frazer I Health Facility Planner Bill Drake I Technical Director

T

he future management of airborne diseases in healthcare environments demands a level of environmental control through design which is not limited to the confines of a single room. Historically, the predominant approach to controlling the spread of disease has been to simply separate any potentially infectious persons from the general population.

In the past decade a number of emerging infectious disease epidemics have demonstrated their capability to rapidly transform into pandemics and a new approach to separating the infectious population which responds to the global community is essential. The fact that H1N1 had spread to seven different countries before it was identified by the Centre for Disease Control highlights significant gaps in the current capability to effectively respond to a global pandemic.

Transmission of influenza may be via three modes – airborne or aerosol, large droplet and contact (via contaminated hands) – with airborne transmission creating the greatest risk and demanding the most specialised resources.1 Current and emerging epidemiology trends indicate contagions such as severe acute respiratory syndrome (SARS), avian influenza (H5N1) and influenza A (H1N1) are increasingly pathogenic, and several other animal influenza viruses may also pose pandemic threat. As H5N1 is continuing to circulate in poultry populations, it is considered that this influenza strain has the potential to “dwarf” the Spanish flu of 1918.2 The World Health Organisation (WHO) has identified the Asia-Pacific region as a potential epicentre of emerging diseases and has initiated the Asia Pacific Strategy for Emerging Diseases (APSED) to provide a framework for pandemic preparedness.

APSED’s strategic strengthening has improved health security across the region through a number of measures including event-based surveillance and management systems; increased health facility and laboratory capacity; training of rapid response personnel; and the development of infection management and control protocols.3 At a local level, public health organisations and acute health service providers are developing and implementing pandemic specific clinical tools to support existing infection control practices.

In addition, surge recognition and triage processes have been reviewed to enable health services to effectively manage the flow of patients to appropriate areas or facilities during the containment phase of an outbreak.

This approach to unified and strategic management and control strategies is a core element essential to prevention infectious disease

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transmission in health-care settings. The other two pillars essential for success, are the application of environmental or engineering controls and the utilisation of personal protective equipment (PPE).4 The trend to increase the ratio of standard single rooms, which support contact and droplet precautions, will assist in the management and control of infectious admissions but the allocation of 1 or 2 negative pressure isolation rooms per ward or health planning unit does not provide adequate capacity to meet a surge in demand during an outbreak of airborne disease. The WHO advises that for “patients with acute respiratory diseases, add droplet, contact, airborne and special precautions for aerosol generating procedures as appropriate”.5 It is recommended that suspected cases are managed in negative pressure rooms (if available), as airborne contagions remain infective over time and distance. It is recognised that the use of standard single rooms and droplet precautions rather than full implementation of airborne precautions may represent unreasonable risk during the containment phase.

Therefore rather than continue to deliver minimum requirements in health facility planning, alternatives to single isolation rooms are required to provide for surge isolation requirements.6 As we can anticipate that during a pandemic the demand for containment environments will rapidly exceed the available health resources, a review of the ventilation design of the whole health facility is imperative task to successfully control airborne disease transmission...

While there is a substantial body of work which evaluates the effectiveness of negative pressure rooms; the nature of the ventilation system; supply air and exhaust duct design; air distribution and pressure gradients, there are limited studies of the efficacy of expedient isolation solutions. To achieve a high level of pandemic preparedness, further evidence based research is required to guide the selection or implementation of expedient isolation environments during the containment phase. Clearly the challenge to evaluating the efficacy of makeshift isolation environments is the number of variables including contagion virulency, patient susceptibility, existing external and internal environment including room layout.

Of the approaches employed during the SARS pandemic event, clinical outcomes and CFD modelling indicated that some of the expedient strategies, employed to convert standard ward environments or non-health facilities during the pandemic, were able to offer negative pressure room equivalency in terms of airborne

TECHNICAL PAPERS isolation. The modifications evaluated included the use of windowmounted exhaust fans in 4 or 6 bed wards to achieve a high rate of contaminate removal, a low mean age of air and importantly airflows from clean to dirty which in total offered comparable performance to a negative pressure isolation room as tested using CFD.7 Other potentially viable alternatives to engineered isolation include the use of commercially available portable filtration units such that no building ventilation or structural modifications are required.8 In addition to inpatient care, the management of airborne disease epidemics must also include tiered modifications to health facilities at the points of entry and egress. The built environment and engineered design must support a number of activities along the continuum of care including the triage of patients; fever screening stations for public; donning of personal protective equipment; and degowning procedures with final shower-out for staff. It has been noted that whole of facility design solutions which afford a buffer zone and separation of flow further aid internal separation with dedicated elevators and corridors for patient flow.9 Infrastructure planning should always give consideration to pandemic scenarios and identify locations for expansion such as Intensive Care Units, Post Anaesthesia Care units and Emergency Departments to ensure surge capacity can be achieved.10

3 Securing Regional Health through APSED, Building sustainable capacity for managing emerging diseases and public health events.

WHO Progress Report 2012, Rev Ed. Nov 2012 4 http://www.who.int/csr/resources/publications/cp150_2009_1612_ ipc_interim_guidance_h1n1.pdf 5 Clinical management of adult patients with complications of pandemic influenza A. WHO 2009 6 Containment effectiveness of expedient patient isolation units. Johnson Lynch Mead, 2009 7 Fast-track ventilation strategy to cater for pandemic patient isolation surges. Yuen Yama Yung Choy, Journal of Hospital Infection, 2012 8 An evaluation of portable high-efficiency particulate air filtration for expedient patient isolation in epidemic and emergency response. Mead, Ann Emerg Med 2004 Dec 9 Environmental and Occupational Health Response to SARS. Esswein et al, 2003 10 Surge capacity and infrastructure considerations for mass critical care. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster. Hicks Christian Sprung, Intensive Care Med. 2010 Apr

These types of approaches must be identified to ensure flexibility, adaptability and expandability of facilities such that requisite containment environments are readily available during a pandemic.

Designing for increased physical capacity of health facilities through cost efficient and effective architectural and engineered solutions which require minimal modification and which support established management systems, protocols and patient flows is vital.

Mobilising health resources to treat a large numbers of presentations requires a whole of facility response which starts in the car park, the ambulance deck and continues thought the emergency department, to inpatient wards and back of house support services. This is the paradigm shift in terms of architectural and engineers solutions which the future of health care demands.

Many lessons have been learnt from the SARS, H1N1 and H5N1 pandemic events in the past decade but much is yet to be translated into clinical practice and the built environment of health care. It is recognised that a strategic approach across the region which guides the establishment of standardised evidencedbased interventions is crucial to creating adequate acute facility capacity for surge response and ongoing management of a global pandemic. Engineered protection embedded in the built environment should not be limited to the single room. It is a key component in fortifying our frontline against airborne contagions, and requires solutions which provide a high level of adaptability and flexibility across the entire facility to provide for infectious disease control across the full continuum of care.

References 1 Aerosol transmission of influenza A virus: a review of new studies http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843947/ 2 Beating the Flu: The Natural Prescription for Surviving Pandemic Influenza and Bird Flu. J. E. Williams

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

TOPICS OF INTEREST

What’s in the Pipeline

for Microbial Water Quality in Health Care Facilities Dr Vyt Garnys I Managing Director and Principal Consultant Cetec Pty Ltd and Foray Laboratories Pty Ltd, www.cetec.com.au

J

ust when hospital engineers thought that they had legionella licked, the little beast continues to rear its deadly head in different ways.

Once every four years, experts gather to discuss progress in legionella control, practice and research. The Melbourne conference had a lot to offer Australian facility, medical, policy and research professionals. Central to the 172 presentations was that we are still trying to understand the occurrence, proliferation, control and toxicology of the soil and water borne ubiquitous bacteria.

The 2000 Melbourne Aquarium outbreak, which caused 4 deaths and about 120 diagnosed legionella infections catalysed new cooling tower legislation and standards practices firstly in Victoria and then nationally but it took another eight to twelve years to put potable water systems on the radar in Australia. I can well remember, after my involvement with the Melbourne Aquarium case, that even healthcare regulators were unconcerned with the detection of legionella from warm water systems in a major hospital in 2004. Warm water guidelines for legionella only were progressively introduced by state governments from 2009 to 2013. The latest and most comprehensive potable water Australian guidelines for both microbial and legionella infection in potable water systems were released by Queensland Health (http://www.health.qld.gov.au/legionnaires/) in early November 2013 following an incident at the Brisbane Wesley Hospital.

The learnings from both Wesley and Queensland Health were presented at the conference (Vyt Garnys, Bartley, P and Muguli, R, Advanced Management and Control of a Legionella Outbreak in a Full Service Hospital – Clinical and Technical Collaboration, 8th International Conference on Legionella in Melbourne on 29 October to 1 November 2013).

• Clinical aspects

• Host cell interactions

• Host response to Legionella infection

• Control measures in hospitals

• Diagnostics and detection

• Infection control

• Intracellular Biology • What next

The international participants demonstrated the large amount of ongoing research to understand the nature of the bacteria, responses of infection to drugs, improved detection methods and environments conducive to legionella growth. Australia has small groups doing good and respected work but the implementation is lagging across the board except for these small specialist groups.

Five papers and several posters were presented from Australia.

The key outcomes for hospital facility and health care managers are summarised below.

1. T he legionella detection limits in Australia are 10 colony forming units (cfu) per millilitre using 50-100 ml samples but overseas, greater than 1 litre water samples are taken to achieve 10 cfu per litre and most regulations are based on 1-10 cfu/L, i.e.

1000 times lower than in Australia.

2. B oth microbial and legionella plate counts are not reliable and are likely to be underestimated. The presence of pseudomonas aeruginosa can give false positives on the Legionella plate count whilst the presence of amoebae may give underestimates. The urinary antigen tests for Legionella SG1 do not detect the other legionella serotypes that may also be infectious.

3. T he clinical incidence of legionella in the USA is of the order 1.5 – 8 cases per 1,000 of population ie not uncommon as often perceived in Australia, perhaps due to lack of recognition of the disease from common pneumonia.

4. P CR/DNA/Genomics techniques are increasingly being used and are better for serotyping and the costs are coming down.

5. Water safety plans used in the United Kingdom and are prescribed in the new Queensland guidelines.

6. L egionella strains may develop that are resistant to chlorination.

The key themes of the conference were divided as presentations and posters into the following plenary sessions:

• Genetics and diversity

• Surveillance and outbreaks

Legionella is still bugging health care professionals around the world, as presented at the 8th International Conference on Legionella in Melbourne on 29 October to 1 November 2013 (www.legionella2013.com).

• Global Trends

• Environmental ecology

7. B iofilms in pipes are the key breeding grounds for microbes, including Legionella.

8. P ractical hot water pasteurisation is unreliable for eliminating or controlling Legionella and microbes, especially within biofilms and dead legs.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

55

TECHNICAL PAPERS

LEgIoNELLA RIsk MANAgEMENT FoR ovER 25 yEARs

9. Iron is a confirmed Legionella food source. (Copper may also be implicated). In other words, control or removal of corrosion products and nutrients are important 10. Some plastics and rubbers as in seals and hoses accelerate development of biofilms.

The Wesley Hospital experience has expanded the attention on water systems microbial control from cooling towers to potable water systems, lacking in the water management standard AS3666 and the plumbing standard AS 3500.

For your hospital or aged care facility our team of consultants are experts at providing formal preparation of:

“ Water Quality Risk Management Plans for Healthcare Facilities”

All cold, hot and warm water designs have the potential to house microbially active matter due to their complex design, fittings and intermittent use.

Potable water systems are becoming increasingly complex due to energy saving and contamination measures as shown in Figure 1.

CETEC also provides:

The key bacterial breeding points are:

• Water system expertise

• Dead Legs, Pipe walls, TMV’s,

• Novel and proven disinfection cleaning method for hospital water systems • Rapid onsite microbial screening for mould & bacteria – using Mycometer® / Bactiquant® • Indoor Air Quality (IAQ) testing and investigations • Hospital design & dangerous goods risk assessments • Corrosion and materials assessments

CETEC clients include: • Uniting Care Health • QLD Department of Health • Epworth Private Hospital • Charleville Health Service • VIC Department of Health • Liverpool Hospital • Canberra Hospital • Southern Health (VIC) • Frankston Public Hospital • New Bendigo Hospital • New Royal Children’s Hospital

• Alexandra District Hospital • Children’s Hospital Academic & Research Facility, QLD • Charles Perkins Centre, University of Sydney • Ramsay Healthcare - Beleura Private Hospital, St John of God Hospital, Warringal Private Hospital, Linacre Private Hospital, Donvale Rehabilitation

• Taps, Showers, • Washers, o-rings, ABS plastic, flexible hoses, • Storages, cold and warm water systems Even cold water systems need attention since: • They are often neglected as a repository of biofilm • Can be contaminated by earthworks, repairs and other water supply quality issues and can seed cold and warm water system either directly or through thermal mixing values (TMV).

• Cold water pipes adjacent to warm water pipes, refrigeration, ceilings and/or heating systems, ie. can be warmed • Active Legionella breeding is found in “cold” side of TMVs. Hence there is a need to disinfect both hot and cold water systems and to maintain adequate disinfection. Figure 2 shows a typical thermal mixing valve that allows contamination of the 45 degree C water with “cold” water.

An important aspect of risk management is to set up proper management control. This may include the following: • Daily meeting of all key sector managers • Establish multidisciplinary expert panel

www.cetec.com.au

• Establish physical remediation task group

CETEC Pty Ltd | ABN 44 006 873 687 info@cetec.com.au (03) 9544 9111 | (07) 3857 5531 | (02) 9966 9211

• Regular staff assembly progress briefings

*CETEC are the Australian exclusive distributor for Mycometer®

56

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

Figure 1

• Establish expert communications task group • Ambulance bypass and no new patients • Maintain ICU and dialysis operations on bypass water • Dry washing and bottled drinking water

Figure 2

TOPICS OF INTEREST • Train and use regular staff to assist in control and remediation (tap flushing and testing) The challenges, if infection is encountered but cannot be controlled and hence needs further attention is to:

The risk management section, shown below in Figure 3, of the QueenslandHealth Guidelines 2013, show a graded risk approach that allows for progressive control, based on risk management plans and low and high clinical risk areas.

Figure 3

• Fully understand plumbing networks & condition • Use backflow water prevention to isolate buildings • Not cutting all water to the hospital whilst installing backflow equipment (i.e. maintaining water supplies) • Management of occupants and critical patients within facility during disinfection treatment It is critical to have accurate and timely water quality information.

For remediation projects the following microbial status techniques are required, especially in fully occupied and operational wards: • Baselines established for both Legionella & HCC plate count • Implement rapid same day microbial enzyme analysis techniques such as Mycometer – Bactiquant Water to allow for timely information to guide treatment and disinfection strategies.

• Patient management, diagnosis, treatment & reporting requirements occurring concurrently.

Biofilm removal is essential if reliable ongoing management is to be achieved of systems even less than 5 years. For example, a biofilm removal program, developed by CETEC, shown below has proved to have lasting benefits. However, careful planning, dosing, technical assessment and execution are required for a safe and effective remediation result. This requires involvement of suitably qualified professionals, skilled in disinfection and chemical disciplines.

1. Obtain an appropriate (pH) at each sample location, and maintain that residual continuously for no less than 30 minutes.

2. Ensure that cleaning chemical is in both cold and hot circuits and compatible fittings.

3. Flush until acceptable pH is achieved.

4. Record the degree of contamination (by noting water colour and particulate matter) flushed from each fitting.

5. Superchlorinate and repeat cleaning till there is no visible contamination (discolouration) remaining. This may take 3 cycles or require repeat cycles at convenient times.

6. Flush until achieving acceptable pH and free chlorine levels.

For example, the Table below shows rapid and effective remediation within one day in an operating hospital.

Pre Treatment (cfu/mL)

Post Treatment (cfu/mL)**

Area

*HCC

Legionella (SG1)

HCC

Legionella (TL & SG1)

1

36,000

100

<10

<10

2

13,000

<10

<10

<10

3

1,900

10

<10

<10

4

13,000

>30,000

<10

<10

Improved detection systems such as that offered by Mycometer, Bactiquant®-water offers a rapid method for quantification of total bacteria in water and other liquid samples. It is a USEPA verified and patented technology. (http://mycometer.com/products/ bactiquantr-water/about-bactiquantr-water/). Bactiquant and other specific legionella tests, including PCR techniques will allow for near real time management of maintenance and outbreak management, provided the organisation is equipped with a robust and current water quality risk management plan.

The hope is that the guidelines from all states will be incorporated into AS3666 and AS3500 and there will be developed a uniform national regulatory framework that acknowledges the challenges for controlling all microbial (not just Legionella) infection risks from cooling towers, potable water systems, ground water, fountains, compost and potting mixes, gardening and stagnant water.

To achieve this, a multidisciplinary approach is required, especially for complex facilities and operations such as hospitals, aged care, laboratories and other healthcare facilities. As in the Melbourne Aquarium case for cooling towers, it is hoped for management of potable water systems, that the knowledge gained from the Wesley Hospital and other hospital incidents, the 8th International Conference on Legionella and practical remediation projects allows for flow on of guidelines and standards to offices, public places and even homes.

*HCC = Hetrotrophic Colony Count **CFU = Colony Forming Units

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

57

ADVERTORIAL

Lighting Sensors for Healthcare Facilities

New Technology for Essential Lighting iAutomation has just released a new lighting motion sensor, featuring state-of-the-art technology developed especially for essential lighting applications in small-to-medium healthcare facilities.

M

ost healthcare facilities include areas where reliable lighting must be available at all times, even if primary power supplies are interrupted.

Normally, a standby generator maintains critical lighting in laboratories, hospital administrative zones, public corridors, inpatient therapy rooms, etc, if primary energy supplies are lost.

While sensor-activated lighting is now commonplace in healthcare facilities due to its energy efficiency, ease of use and potential for integration into other building management functions, the task of connecting sensor lighting systems to standby power supplies has always been complex. Traditional solutions have involved the installation of a ‘second set’ of sensors and associated wiring/switching components linked separately to the standby energy supply: a cumbersome and expensive duplication of the primary system.

At last, an alternative technology is available, delivering the same standby functionality, but at a fraction of the cost.

Melbourne-based company iAutomation, a specialist in automated solutions and control systems for buildings, has released the Hospital Sensor (model PD4-M-DS), which permits both primary and back-up energy supplies to be fed directly into a single sensor fitment.

This professional-grade product, designed in Australia and manufactured by German company BEG Bruck Electronic GmbH, was conceived during iAutomation’s fitout of 1,800 sensors at Melbourne’s Royal Children’s Hospital. Craig Gibbs, iAutomation’s Managing Director, says

58

one of the hospital’s requirements was to get away from using BUS systems while still maintaining essential and non-essential lighting activated by motion sensors.

“And that’s where the idea came from,” Craig says. “I was asked to come up with a concept for a single sensor in a room rather than a dual system. In the past, you would have two sensors inside a room – one being on a non-essential circuit and the other on the essential circuit. Our new sensor does away with that second sensor.”

EFFICIENCY & AFFORDABILITY Craig says the Hospital Sensor is a pragmatic and ‘real world’ alternative to traditionally complex systems, making it ideal for smaller healthcare and aged care facilities on tight budgets.

“It’s all about offering true savings to customers,” he says. “Which is why this sensor is a perfect match for either small or large facilities.”

A simplified installation process, he explains, is the key to affordability.

“Traditionally, there are two power supplies and two switches on the wall.

Should you lose power, for example, one of the switches will activate the emergency lights or the standby lighting.

In the last few years people have been putting in lighting control systems, which means you’ve got to accommodate two different supplies inside the distribution board, as well as two lots of switching inside that distribution board. With our new system, you run the two feeds

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

straight to the sensor, which is the distribution point.”

The resulting savings in terms of reduced labour and infrastructure costs are clearly identifiable, enhanced by the removal of wiring duplications and tagging burdens, as well as retention of existing conduits in retrofit applications. It is also important to note that the system in standby mode only activates selected, critically important lights, thereby reducing the load on the generator.

SAFETY IS PARAMOUNT One of the great technological advances with this sensor is that the switch on the wall is actually a low-voltage switch, which is supplied from the sensor and consequently has no reference to any voltage.

As Craig explains, “This means the system is intrinsically safe, has no relevance to any of the voltage that’s controlled from the sensor, and doesn’t require two switches on the wall – you simply require one.”

QUALITY & LONGEVITY The Hospital Sensor has been designed for long-term performance, as confirmed by a design lifespan of at least 10 years.

All casing and clamp fitments are of the highest quality, and units are fully programmable with a range of 24 metres. iAutomation offers full advisory services regarding sensor selection, placement and positioning.

For more information about iAutomation sensors and other automated technologies, including energy metering, call (03) 9572 0944 or visit www.iautomation.com.au

TOPICS OF INTEREST

Optimising Your Kitchen Exhaust System Cleaning REBECCA PHELAN I GENERAL MANAGER, KLEENDUCT AUSTRALIA PTY LTD

A

inspection the most, as they are out of sight, but just because you can’t see them doesn’t mean that nasty volumes of grease aren’t building up in them. You are assessing the frequency of cleaning your filters. Frequencies can vary from weekly to 3 monthly and will depend entirely on your cooking practices.

clean and efficiently running kitchen exhaust system is surprisingly easy to achieve. Take a few simple steps and you will be well on the way to removing fire and health risks and saving yourself hundreds if not thousands of dollars along the way.

Inspection

Step 2 – Filters take a lot of wear and can become damaged. It’s important that they are in good condition and performing well. If a filter has recently been cleaned but seems to be filling up faster than the others or not trapping any grease at all, it’s likely that it needs to be replaced. The most common filters are honeycomb and can usually be “re-cored” for as little as $15 ea.

A reasonable price for a complete replacement filter 395 x 495 x 50 honeycomb type as little as $30. Baffle type filters are a little more expensive at about $40 for a 495 x 495 x 50 and cannot be re-cored. There are many other types of filters in use in hospital kitchens which need to be assessed on an individual basis.

1. C heck the surface of filters for grease accumulation 2. C heck that filters are sound and securely in place 3. T ake a filter out and check the grease accumulation in the gutters 4. C heck the grease accumulation in the plenum/holding chamber 5. C heck the grease accumulation at the initial ductwork Step 1 – For a few weeks look at your filters every few days and record the results on a simple form (example below).

If the surface of a filter looks dirty, take it out, and get a feel of how heavy it is.

If it’s noticeably heavy it’s time to clean (obviously if it drips grease, time to clean urgently!). Drawer type filters need to be inspected. In fact the drawer type need

Right from top: Baffle style filter; Double filter system; Draw type filter; Honeycomb filter

Kitchen Canopy, Filter and Initial Ductwork Inspection Checklist L = Light, M = Moderate, H = Heavy Date

Surface of the filters

Filters sound and secure, free of damage

Grease gutters

Plenum/holding chamber

Initial ductwork

L

Yes

L

L

L

M

No

M

M

M

H

Note below

H

H

H

Notes: A very dirty canopy

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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TOPICS OF INTEREST Step 3-5 – Pretty much if there is excessive grease accumulation in the gutters the system is now compromised.

There are a couple of measuring devices (see example) and of course common sense prevails. Your regular inspections recorded on a simple form in conjunction with a regular filter cleaning/exchange program should reduce your whole system cleaning needs to at most once a year, of course always keeping in mind the volume of meals and type of cooking.

It goes without saying that once grease starts accumulating your fans, horizontal ductwork and riser will need attention too and sadly this can end up being very costly to say nothing of the potential risks.

Filters Once they start filling up with grease they are no longer able to do their intended job. You will start to get a grease build up in the gutters that may well leak back onto your cooking, down the splashbacks and other areas in the immediate vicinity leading to what we call “grease bleeding syndrome”.

Risk – This represents a high risk as the whole system is now basically a fire that’s waiting to happen. The filter’s job is to stop grease from entering the plenum/ holding chamber and consequently the ducts. If the filter is full of grease, the grease will keep accumulating in the gutters and the chamber and will consequently be drawn into the ductwork by the exhaust fan.

Filter cleaning/exchange – In an ideal world the filters will be exchanged/ cleaned on a need to clean basis as dictated by the volume and type of cooking and the results of your inspections. The areas behind the filters the plenum/holding chamber, the ductwork and the fan will remain clean for extended periods of time.

It is recommended that you use the same service provider for both the filter cleaning/exchange as for your canopy, ductwork and fan cleaning. It’s very frustrating for a duct cleaner to have to replace dirty filters into a just cleaned canopy. Obviously if they are really dirty they will start to “bleed” straight away and you might well wonder if the duct cleaner has even done their job. In the

majority of cases filter cleaning cannot be done on site as this opposes by-laws and regulations. Filters can contain large volumes of grease that should not be washed down the drain. A reputable filter cleaning provider will be using a triple-interceptor which filters out the fat and the chemical rendering the waste water safe for storm water drains. The waste will be checked regularly with a kit (similar to a pool water testing kit) and the results recorded. You have every right to ask for evidence of this and it’s highly recommended that you do. We are all affected by unsafe practices at the end of the day.

When you employ a service provider to carry out the cleaning make it very clear from the outset what your requirements are. If you invest in a replacement set of filters your contractor will engrave those filters with your name and if you terminate their services the filters will be returned to you. If you opt for a simple exchange (the filter company provides the swap over filters) they will retrieve any filters that belong to them on termination of service.

Cost effective – Having the filters cleaned on a regular basis is cost-effective.

Filter cleaning/exchange is relatively inexpensive when put into perspective.

The cost will be averagely $8 per filter.

If the system contains 16 filters and they are exchanged fortnightly this represents an annual expenditure of $3,328. If all has gone to plan you will only need a thorough clean of the whole system once a year. If the filters have not been cleaned regularly or at an appropriate frequency you could be looking at a complete clean four times a year. It’s not hard to calculate the cost savings represented by an efficient and regular cleaning programme.

Example of a dirty honeycomb filter

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

Example of a dirty drawer type filter

Canopies Canopies can present some real challenges to a duct cleaner but in the majority of cases can easily be accessed for a good clean. You should be fully informed of what you are getting for your money and if two quotes vary dramatically – there will be a good reason. A “cosmetic” clean only involves cleaning what you can see. If you’ve reached a point with your inspections that tell you a clean is required then the interior areas of the canopy need to be cleaned also. Filters will be removed, boards/protective sheeting will be placed over stove tops and benches and the whole interior of the canopy should be thoroughly cleaned all the way to the initial ductwork and as far as accessible up the ductwork. You have every right to ask for evidence of this cleaning and you should. Reputable duct cleaners are trained to take before and after photos of their work. Be careful of the “other” company that comes in to discredit your current duct cleaner. Many embarrassing situations have arisen as grease can build up surprisingly quickly (particularly if the filters are neglected) and if your current duct cleaner has good evidence that the cleaning was carried out to an acceptable standard you may well have to re-assess your own practices.

A very dirty canopy

TECHNICAL PAPERS

Kleenduct Australia delivers outstanding duct cleaning services to existing and prospective customers throughout Australia.

Our company offers 24 hour, 7 day a week servicing 363 days of the year. This ensures that we are in a position to promptly and efficiently meet the demands of our customers.

ATTRIBUTES 

Accurate tender estimation



Management of complex and extended projects



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



Networked nationally with full IT support



State of the art reporting



Up to date with Industry Standards, regulations and best practices



Fully insured

TYPE OF CUSTOMER 

Hospitals



Naval vessels



Shopping centres



Manufacturers



Fast food chains



Rigs



Stadiums



Cruise ships



Hotels



Banks



Mining



Aged care facilities

Kleenduct Australia has the depth and expertise to fully service all duct cleaning requirements on a national basis, and we hold many national contracts with key organisations in Australia.

In utilising Kleenduct as a maintenance provider our customer has the opportunity to draw from the extensive experience and comprehensive range of services we provide.

DUCT INSPECTION 

Advanced camera system has a articulating eye with a full colour camera head and lets you take a closer look at horizontal and vertical ductwork…



Super bright wide TFT monitor provides brilliant picture quality.



Connection cable 60 to 80 metres.



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



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

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

SERVICES 

Duct cleaning



Air Handling Unit Cleaning



Inspection & reporting



Kitchen Exhaust Cleaning



Filter Exchange



Mould Remediation



Video inspection



Production cleaning

1300 438 287

www.kleenduct.com.au

info@kleenduct.com.au

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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TOPICS OF INTEREST these really high resolution inspection cameras there is a light at the end of the tunnel (so to speak). Most risers will not have a huge build-up and the inspection cameras are really great for determining the need to clean without question. They are also great for spotting leaks and other mechanical problems that may exist.

Grease extracted from just ONE canopy!

Horizontal ductwork Horizontal ductwork exists when a straight run to the exhaust fan can’t be achieved or when the duct has to pick up a couple of kitchens on its way to the exhaust fan. The ductwork will often lead to a riser and then onto the fan. Cleaning horizontal ductwork can be challenging.

Access to the ductwork is the biggest issue faced and to be perfectly honest some systems have been designed with absolutely no thought given to cleaning needs. This can end up being very costly as a seemingly simple job blows out with the need for hire of plant, closure of the site and duct cleaners who are trained in both confined spaces and height safety.

If this is on-going then a better solution is to invest a little money into redesigning the system so it’s suitable for access rather than persevering year after year with costly cleaning.

A cost effective and efficient means of assessing the need to clean is to use an inspection camera. Most duct cleaners offer this alternative now and these cameras are capable of giving excellent high quality imagery – some of them even have Wi-Fi capability and can transmit the imagery to other parties, perhaps sitting in their boardrooms!

In most cases a good clean is possible.

The duct will have to be accessed often from the roof space. Access openings

62

may have to be installed. If the duct is “human friendly” (large) less access openings will be required. If it is small more will be required every 3 – 4 metres.

Where ever a bank of dampers or an inline fan or any other mechanical device exists within the duct access will be cut at either side. Knowing how and where to cut access is the job of a skilled duct cleaner and this is a skill that he/she has learned after a considerable period of time working in this industry.

The duct will be scraped free of grease build-up. Keep in mind that what you are looking for is the removal of “wet” grease. Sometimes it is nearly impossible to return the duct back to bare metal as this stuff has been baked on in some cases over years and years. If you want the bare metal look it will be more costly and you need to make that very clear to your duct cleaner from the outset.

Again you have every right to ask for photographic evidence of the work completed and you should insist upon it.

Risers What were they thinking when they installed risers up the side of a multistory building? Obviously not real practicalities! Anyway if you are “stuck” with a riser like this you are probably already well aware of the problems they represent. Thankfully with the advent of

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

If you do need to clean, get your wallet out right now. Even if the duct is large enough to accommodate a human being, who in this day and age is going to put anyone down there? In our current climate the only person we can put down a riser is a highly trained professional rope worker, a Level One Rope Access Technician, and this comes with a hefty price tag. Not only will you be required to install tie off points you will also have to pay a very high hourly rate for the services of this trained specialist.

If the duct is not “human friendly” it involves swing scaffolding to enable the installation of access points all the way down (or up) the riser allowing for a clean with extension rods and brushes, scrapers and so on. It may also involve isolating the area below at street level ie; traffic control, pedestrian and/or vehicular.

Thankfully most risers are not of the pre-historic monolithic type and can be cleaned relatively easily. The only impediment is lack of access, and access has to be addressed to enable a thorough clean. These concerns should be discussed with your duct cleaner.

Keep in mind that cutting access can be a noisy exercise and therefore some consideration needs to be given as to the time of day it’s performed (this applies to horizontal ductwork also).

TOPICS OF INTEREST

Some commonly encountered access problems

Fans The bane of a duct cleaner’s existence.

Once all the other defences within a cooking exhaust system have been compromised the lowly humble fan ends up in a miserable and often disgusting state. Roof work is impossible in inclement weather and even if weather permits other factors must be taken into consideration, primarily the safety of the duct cleaner. Sloping roofs or fans installed dangerously close to the edge of the roof present a very real danger and every attempt should be made to make safe. Your duct cleaner should provide you with a hazard identification report with their recommendation.

Just the process of cleaning can lead to unbalancing the fan. Duct cleaners can’t fix this and shouldn’t be expected to. You might require the services of a licensed technician to remedy this problem and you should factor this into the cost of cleaning.

The roof area surrounding the fan can often end up covered in grease and the cost of cleaning this is not an inclusion to the fan clean. In fact depending on the severity of the problem consideration should be given to performing a roof clean in daylight hours and should be treated completely

separately to the fan clean. If the roof is badly affected further consideration may be needed to provide access to water enabling a hot water pressure clean.

Conclusion Try to allow the estimator who comes out in normal business hours as much access to the system as is possible. This will enable him/her to accurately assess the whole project and give you a price that reflects this. Giving good access can head off many misunderstandings. For instance if you can’t provide the estimator with access to the ductwork and roof it soon becomes a “guesstimate” not an estimate and this can lead to a job being badly underpriced or perhaps even over-priced.

Good duct cleaners are versatile and adaptable as they encounter many different environments and circumstances.

They need to possess a remarkably wide variety of skills considering that duct cleaning is not even a trade. Duct cleaning is the “non-tradesman” trade.

They need to be well practiced with tools and they need training in quite a few areas; confined spaces, height safety and scissor/boom lift licenses at a minimum.

They need to be able to cut access and importantly where to and they need to

know how to seal an access. Some duct cleaning companies will have the more highly skilled licenses such Level One Rope Access Technician and operating large boom lifts.

You need to ensure that your chosen duct cleaning service provider holds all the necessary insurances such as Public Liability and Workers Compensation.

A good duct cleaning company will automatically provide you with the required SWMS and/or JSA. They will have a sound Quality and Safety Management system in place and you have every right to ask to see it.

Make sure that your duct cleaning service provider meets with all the expectations above and ensure that you discuss your needs fully. Ask questions as to the extent of the clean especially in regard to your requirements. For example returning a duct to bare metal will incur additional costs and roof cleaning; although it can be performed by a duct cleaning company is generally not an inclusion.

Insist on good quality photos of the cleaned system and a certificate of completion as evidence. Continue with your inspection routine and remember at all costs – be vigilant with the filters.

Messy fans and roof areas

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TOPICS OF INTEREST

Hirondelle Hydrotherapy Pool – Part 2 Disinfection By-Products in Indoor Hydrotherapy Pools – The Known and the Unknown Alan Lewis I Pool Consultant

I

n 2007 Christian Zwiener (et al) published an article entitled “Drowning in Disinfection By Products? Assessing Swimming Pool Water”. The outstanding feature of this article was the wake up call, that emphasised the fact that it is time to pay more attention to Disinfection By products of which only a small fraction are actually dealt with under our current practices and concepts.

This was a collective effort between German scientists (Karlruhe Univerity); USA EPA researchers (Georgia and North Carolina) and The German Federal EPA (Bad Elster) This was a rather formidable collection of scientists with a broad brush outlook at what really happens in pools when bathers neglect to shower before entering the pool – or remove cosmetics; sunscreens, and the natural organics which accumulate on our skin.

This led to further studies of Inorganic chloramines (Mono, Di and Tri Chloramines); Trihalomethanes (THMs); Halogenated acetic acids (HAAs) and Haloketones – which irritate the eyes, the skin and the mucous membranes. The most well recognised of these are the smelly Trichloramines, linked to asthma; while yet other by products that are regulated for our drinking water – need further research because of their potential carcinogenicity or genotoxicity, particularly when found excessively present in the blood and/or breath of swimmers.

Since in Australia we have no national research institutes devoted to these topics, we must rely on what researchers in the USA and Europe – and lately in some Asian countries. The latest outcry has been that we have not been focussing enough on the organic by-products due to the presence of urea in our sweat glands and our urine. So much so, that leading competitive swimming trainers in the USA have been encouraging their charges to urinate in the pool – rather than interrupt their training – or when they are in a racing event. So now we need to step back and have yet another look at what happens when chlorine reacts with the organic urea and how to minimise the by-products that develop in addition to the commonly measured inorganic chloramines. These require an in-depth look at the chemical paths that develop from continuing large bather loads and continual chlorine feed that these necessitate.

That is why at the recent World Aquatic Health Conference (2013) in Indianapolis Ernest (Chip) R. Blatchley III (Professor of Environmental and Ecological Engineering at Pursue University)

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

presented a paper entitled “Urine and Pool Water: Water and Air Quality”. In this presentation it turns out that in heavily loaded indoor swimming pools the contribution to DBPs (disinfection by products)

by Urea, is usually similar (quantitavely) to that of the commonly recognised chlorinated amino acids or ammonias which create the inorganic chloramines: the Mono, Di and Tri Chloramines.

The first thing to look at is just how much Urine is actually introduced by swimmers. Blatchley and his collaborators were fortunate to be able, in 2011, to sample water over a period when there were 600 bathers per day in the University pool at a Women’s National Swimming Competition between the dates 17 March 2010 and 21 March 2010. This enabled them over that period to take samples at regular intervals and analyse the chemical paths of the DBPs as they evolved – as opposed to the laboratory analogues that had been prolific in the past. Prior to and during the competition the pool was fed with increasing amounts of Calcium Hypochlorite (Granular chlorine) – the peak being on 19th March when 14 Kgs of Cal. Hypo. was fed.

During that same period there was a clear indication of an increase in two more DBPs which increased with the added Cal. Hypo. significantly – these were: Dichloro-methylamine (CH3NCL2) and Dichloro-acetonotrile (CNCHCL2). So clearly the increase in the dosing of the chlorine – due to the increase in the concentration of swimmers in the pool had brought about the additional unwanted organic DBPs which complicate the analysis because they cannot be tested with the photometer, and in this case, were discovered through the use of Membrane Introduction Mass Spectrometry (MIMS) in the Uni Laboratory.

Now it has been known for at least a decade or two that the DPD tests for inorganic chloramines are inaccurate and in fact are actually measuring both the organic and the inorganic DBPs. This is why Professor Blatchley used MIMS for the testing of the organic DBPs and was able to differentiate accurately between the two types of by – products.

This is also why I regularly advocate that – in sensitive pools such as Hydrotherapy pools and Swim schools – tests should include the DPD2 test rather than the DPD3 test, whereby the monochloramines are a more the important and more accurate by-product that can be identified – rather than the DPD3 test which measures all of the inorganic and the organic chloramines together.

TOPICS OF INTEREST The product which most affects swimmers adversely is Nitrogen Trichloride (NCl3).This is readily created from both the ammonias as well as from the organic Urea. In the case of the inorganic chloramines NCl3 develops slowly over several days, while in the case of Urea the reaction with chlorine can directly produce NCl3 – also slowly. In fact the well known reactions of the development of inorganic chloramines are reversible.

As yet, it is still difficult to ascertain which are the conditions in which the reactions proceed to the right or to the left.

This leaves us with the dilemma of which of the secondary disinfection processes are more effective: UV; Fresh Water Electrolysis; Ozone: – or the new hydro-mechanical solution of the Chloramine Stripper which is used in the Hirondelle solution. Lately Advanced oxidation processes have been tried in olutionsBODY & Pre-Treatment & Desalination from the left side of advert.

Replace with Chemical Water various combinations, and the USA and someTreatment Europeans prefer AMMONIAS: UV while other Europeans prefer Ozone. Since much of the NELLA the main message.

We need this to appear BIG & BOLD. Please make the first sentence Hypochlorous Acid + Ammonia <==> Monochloramine + water research has been solely in the laboratory – we need to look to LA CONTROL? as a main heading. more research of what actually happens in pools. Hopefully our HOCl + NH3 <==> NH2Cl + H20care brox).somewhere in the sed in the twinoxide hospital/aged ad Universities will also see fit to focus on these issues.

HOCl + NH2Cl <==> NHCL2 (Dichloramine) + H2O Typical daily concentrations of Sweat and Urine with 600 egra, one of the largest privately owned etc. bathers in a pool of 487,000 litres (in the Purdue study) were HOCl + NHCl2 <==> NCL3 (Trichloramine) + H2O measured and found to be: DO YOU While HAVEChlorination WARM WATER LOOPSUREA IN YOUR HOSPITALS? of the organic also leads to NCl3: ARE THEY BEING TREATED? Sweat (mg/l)

UREA + Molecular Chlorine <==> Monochloro-urea + Chlorine ion

NH2CONH + Cl2 MINIMISE <==> NH2CONHCl + CLAND TEGRA CAN HELP2 YOU YOUR RISK REDUCE OPERATING COSTS.

HOCl + NH2CONHCl <==> NHClCOCNHCl (Dichloro-urea) A event +atHthe 0 Sheraton.

2

Urine (mg/l)

Tot concentration/ day

Urea

474.86

16512.53

0.7943

Ammonia

54.50

566.17

0.298

Creatinine

4.66

1170.67

0.0544

ps - from 'We also develop entire system solutions for your Endoscope Processing etc ....

611.02 36.80 0.0422 Lactic Acid HOCl + NCL2CONCL2 <==> H+ + CL- + NCL3 + NCl e change to read as follows - "TwinOxide a new age delivery method of chlorine dioxide effective in Legionella control, is

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65

TOPICS OF INTEREST *UREA (NH4 CONH2) ; Ammonia (NH3); Creatinine (C4N3H7O); Lactic Acid (C3H6O3) plus many other more minor by-products.

NOTE: That there is lots of Nitrogen involved here, which readily allows for the development of NCl3. *The bather load equivalent in the Hirondelle Pool would be roughly 1/10th of these results namely 60 – 80 Bathers in one day; and the residuals above would also be 1/10 – assuming that the bathers are exercising while in the pool. It is difficult to compare the two totally different situations.

How much Sweat or urine is actually introduced by swimmers?

Here the assumption is that Urine is introduced voluntarily while Sweat is involuntary. This study was done buy WHO in 2006 using a Mass-Balance model to estimate the input based on 150 swimmers/day; where the samples were taken from the top (500mm) layer of the pool only; and where there is an assumption of negligible Urea decay: #Urea concentration in human body fluids (WHO 2006): Urine: 10.24 grm/l Sweat: 0.68 grm/l #Body fluid inputs: Sweat: 823 – 2769 ml/bather

Urine: 54.7 ml/bather

#Yet another researcher (Erdinger etal. (1997) found the following: Potassium: 60 – 77.5 ml/ Urea: 30 – 35 ml/swimmer swimmer #In 2010 Blatchley and Cheng showed the following formation of Inorganic chloramines from Ureas over a period of 5 hours” (Environmental Science and Technology 44,82529-8534.

the shower – rather than shower immediately before entering the pool to remove the body ammonias and thus reduce by 75 – 85% the initial monochloramines that are rapidly created in the first moments of their immersion in the pools. This type of body hygiene is totally accepted in Europe – but not in Australia or the USA for the most part. This makes it hard to accept that a lot of water (needed for dilution of the chloramines and the TDS in the water) and a lot of chemical can be saved if bathers get used to showering BEFORE they bathe. Then there would be no need to shower after the swim – because the NCll3 would not develop so readily, and less Ozone or UV would be needed to breakdown the unwanted DBPs. We can only hope that this lesson will be learnt over time and with consistent pressure from the pool managers to encourage better, healthier pool water.

The economics of providing showers in public pools in Australia is quite controversial. Most Hospitals today have en-suites – so that patients can shower in their rooms prior to proceeding to the in house Hydrotherapy pool. However should the Hospital see fit to lease out their pool to external therapists; swim schools, or aquarobic groups, then adequate showers are still needed. The absurdity is, that most Australian bathers tend to use the shower to rid themselves of the “Eau De Chlorine” that persists even after

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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TOPICS OF INTEREST

The High Cost of HVAC Corrosion A ‘Forgotten’ Issue Corrie Cook I Blygold Oceania

Corrosion in the HVAC industry is a forgotten issue, says Xavier Castelltort of Blygold Oceania, speaking at the Australasian Corrosion Association’s 2013 Roadshow in Auckland recently.

I

t is estimated that HVAC (heating, ventilation and air-conditioning) costs can represent approximately 50% of a building’s energy consumption, yet maintenance and corrosion of commercial HVAC units is often overlooked when they are mounted on roofs or ‘hidden’ at the side of buildings.

Airborne salt and humidity are major causes of corrosion for New Zealand buildings, as are pollutants like sulphur oxides, hydrocarbons, chlorides and ammonia from vehicles, industrial processes and agriculture. Every part of a HVAC system’s heat exchanger coils is typically exposed to at least some of these every day. Rarely are components cleaned, let alone protected against them.

Maintenance should be ignored at a building owner’s peril, says Untreated coils made of aluminium fins and copper tubes, or similar coils treated with an epoxy coating, exposed to 4000 hours of salt spray will deteriorate as shown here – that’s just Mr Castelltort. When HVAC units six months’ exposure are not maintained and corrosion sets in, it is calculated that operating The weakest link efficiency can soon be reduced by between 50–70%, “Heat exchanger coils are the weakest link,” says Mr Castelltort. and unit life halved.

“In some cases, their aluminium fins are no more than 0.1 mm thick, with a pitch of typically 1.5–2.0 mm. These are then Cooling performance, indoor air quality, energy efficiency, mechanically coupled to copper tubes and manifolds with reliability and a unit’s service life are all affected. This in turn soldered joints. Preventing corrosion setting in where metals causes progressively increasing discomfort and health risks for or alloys touch different metals is notoriously difficult.” occupants, higher running and capital costs for building owners, and the discharge of more CO2 into the atmosphere.

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

Building owners are usually told to expect in excess of 15 years of service life from their heat exchanger coils, but any corrosion cuts this time considerably. Corrosion diminishes the capacity of the coil to transfer heat. As the heat exchanger’s capacity

TOPICS OF INTEREST reduces, the condensate temperature rises to maintain cooling performance.

either, which opens another front for pin leaks and corrosion,” he says.

A higher condensate temperature:

Because epoxy coatings are relatively thick polymers with low thermal conductivity, pre-coating fins and coils with epoxy forms an insulating layer at the critical junction of fins and tubes.

This then acts as insulation that reduces the unit’s efficiency by up to 15%.

• Reduces efficiency, leading to increased power consumption and cost for the same cooling performance • Reduces maximum cooling capacity, which leads to premature coil failure and the need for early replacement • Requires higher system pressure, forcing an increased compressor duty cycle and higher thermal and mechanical loads on the system. This means the unit is less reliable, with more frequent failures and consequently higher maintenance costs to both find and fix failures.

Pre-coatings Protective coatings are the most readily available and most frequently used measures to prevent coil corrosion, Mr Castelltort explains. Pre-coating coil components with epoxy-based inhibitors before assembly is a straightforward solution, and relatively inexpensive.

“The problem with this process is that when fins are cut to shape and holes are punched, raw metal edges are immediately exposed again. This makes the unit’s coil vulnerable to corrosion.

Another disadvantage is that headers and returns aren’t treated

Sometimes, corrosion of units can start within a few weeks when protected in this way, meaning the overall life of the unit is hardly longer than without any form of corrosion protection at all.

“Unfortunately, epoxy coatings are neither flexible nor UV resistant,” claims Mr Castelltort. “Eventually, these coatings disintegrate, which leaves the coils completely exposed to pollution and corrosion.”

Post-coatings In the UK, the BSRIA Institute examined the issue of corrosion in relation to energy saving and sustainability. It is an independent research house that advises the UK government, and it found that energy savings of up to 20% can be delivered, and the lifespan of the units can be doubled, if a high-quality aluminiumpigmented polyurethane is applied after the coils have been assembled.

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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TOPICS OF INTEREST Post-coating the coils using such a coating offers a wide-ranging temperature tolerance. Although it is initially more expensive, experience nevertheless shows the return on investment will be between 12–18 months. Every surface and joint is able to be reached with a spray coating of this corrosion-resistant film that’s only 25–30 microns thick, thus maximising thermal conductivity without dropping pressure. That in turn hardly affects the unit’s performance – studies suggest it would be affected by no more than 3%.

Because the entire surface of the coil is coated, any small gaps between the fins and tubes formed in the manufacturing process, or even corroded areas on units that have been in operation, are effectively filled with conductive material that in turn maximises the unit’s operating efficiency.

Post-coatings can be applied onsite to older units or in-house to new ones, and because this process delivers a smooth surface overall, it resists dirt adhesion while offering high UV resistance and flexibility.

About the ACA The Australasian Corrosion Association is a not-for-profit industry association established in 1955 to service the needs of Australian and New Zealand companies, organisations and individuals involved in the fight against corrosion. www.corrosion.com.au

Author Details Corrie Cook has a strong interest in environmental, sustainability and engineering issues and writes for a wide range of business organisations; she can be contacted at corrie@amcltd.co.nz

Most aluminium heat exchangers (coils) use copper pipes; when two different metals in a conducting liquid (for example, rain) are in direct contact with each other, corrosion of the least noble metal can result – this is called galvanic corrosion

This article was first published in the June/July’13 edition of NZ Construction News magazine, and is reproduced with the permission of its publishers, Aston Publishing Ltd

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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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Plumbing and Fire Services Systems Neil McPherson I Technical, Watermark Services Group Pty Ltd

Just over ten years ago a plumber engaged to install, repair and or maintain a plumbing and fire services system (excluding sprinklers) only needed to know a handful of technical attributes of a small range of materials and products to keep a hospital or nursing home on-line.

Today with the many varieties of metallic and non-metallic piping materials, numerous fittings joining methods, complex operating and controls valves on the market, many plumbers are struggling to keep abreast of the products, associated problems and limitation of those materials. Plumbing services systems and product technology is becoming problematic for hospital engineers and contractors to digest.

N

eil McPherson, of Watermark Services Group, an experience plumber, teacher of plumbing, hydraulic consultant and product development manager is now seeing the impact of some of these materials and installation methods unfolding.

The selection of incorrect material and products is costing hospital much more than first realised. In this article we outline some of the key issues and what you may do to reduce your exposure to incurred systems failures and risk.

Before engaging a plumbing contractor or employing a maintenance staff person our first objective is to understand and appreciate their capabilities in performing their duty or contractual agreement.

Unfortunately most plumbers tend not to appreciate the variety and complexity surrounding plumbing and fire systems.

Further more, many plumbers fail to comprehend the relevant standard and work practices required for a “deemed to satisfy” installation for plumbing services.

When most plumbers are asked about the relevant and current Australian Standard, many would brush aside the need to stay on top of industry and regulatory changes.

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Lets look at the Codes and Regulations.

Plumbing standards

The Plumbing Code of Australia – as an integral part of the National Construction Code (NCC), the Plumbing Code of Australia (PCA) is produced and maintained by the Australian Building Codes Board (ABCB) on behalf of the Australian Government and each state and territory government to bring uniformity and consistency to plumbing, drainage and fire systems.

Those plumbing and fire services standards referenced in the National Construction Code – Volume 3 Plumbing Code of Australia may include a variety of standards published between 2003 up to 2012.

The National Construction Code is published in three volumes, and pertains to classes 1-10 buildings. All three volumes are drafted in a performance format allowing a choice of “Deemedto-Satisfy” provision whilst permitting flexibility to develop Alternative Solutions based on innovated buildings, products and systems or design.

The reliance on an Australian regulated plumbing code for non-domestic plumbing services is becoming more onerous on the hospital engineers, facility and property managers due to the states, territories and local authorities stepping away from day to day responsibility of routine inspections.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

In many cases it is not unusual for a published plumbing standard to be older than 10 years.

For this reason Standards Australia acknowledges their responsibility, they continually strive to update and enhance those technical standards. Plumbers should maintain their library ensuring that the most recently published standards for plumbing installations and products are used.

The most commonly used Australian Standard for Plumbing, Drainage and Sanitary is AS/NZS 3500 Parts 1-5 and for Fire Hydrant Services AS2419 Part 1, these are essential as multi-grips and teflon tape are to any plumber. Not surprising, these installation standards are critical to a plumbing contractor for services installations and maintenance.

What is seldom known or remembered by the plumber is that, those standards contain many “Normative References”, which form

TOPICS OF INTEREST the regulative requirement for installing plumbing and fire services systems.

1. Authorisation, the certifying company and WaterMark logo/standards mark.

An appendix drafted into each AS/NZS 3500 series document and AS2419 list those normative standards to which the services system shall address or include forming the “deemed–to-satisfy provision of the PCA.

2. The product licence number.

Plumbing and fire products Plumbing products certified and used for plumbing or drainage installations are listed in the plumbing Code of Australia – Table A2.1 Material and Products, which requires authorisation. There are two distinct levels of certification for plumbing products; these are based on the level of assessed risk.

For example products that form part of a water supply system (pipes, valves and fittings) are perceived to be a higher risk than say that of drainage pipes and fittings.

Products used for drinking water applications including cold water, recycled water, tank water and alike are listed as Certification Level 1, which is a higher level compared to those of drainage products, which carry a Level 2 Certification.

In addition to Level 1 certified products, materials in contact with drinking water shall be assessed against those requirements outlined in AS4020.

All products are tested against the applicable manufacturing standard to determine the product suitability for use in the plumbing or drainage installation.

A test and certification report issued by an independent and recognised expert demonstrating that the product material, design, construction and installation are authorised and listed by the certification body and now with the Australian Building Codes Board – Watermark Product Database. http://abcb.gov.au/productcertification/watermark/watermarksearch Products are identified as authorised for use in plumbing services systems are mark in manner that describes the;

3. The standard to which has been assessed against.

4. Limitation, such as pressure and or temperature.

5. Manufacturers name.

Certified Product cover items such as fire equipment

Watermark Certified products carry this logo

Selecting the correct product for the application I am often asked how you know if you have selected the correct product for an application. In my opinion designers and plumbers do not fully appreciate the product attributes such as material composition, operations, limitations and the aim and function of the plumbing service system.

3. What are the operating conditions? ie; water pressure, water temperature, pipe sizing and flow requirements.

4. Determine the materials and product limitations. Not all similar products have the same performance characteristics.

5. Select those products on their inservices operating performance and conditions. Ask for the product certifications and installation instructions.

Product selection example A simple tempering or thermostatic mixing valve is to be installed for the purpose of limiting the heated water to 500C. What information is required before selecting the valve?

1. Confirm the supply-heated water; ensuring the temperature is at least 150C above the desired mixed temperature of 500C. (This points to the supply temperature being not less than 650C).

Many installers rely on their plumbing merchant to provide them with the product for a specific application, but in most incidents those suppliers have no qualification or experience to make that recommendation.

2. Determine the supply pressure at the furthest point of discharge, the incoming water pressure of both heated and cold water. (Tempering valves and TMV’s may lose up to 200kPa pressure within the valve mechanism) The outlet pressure ideally should be not less than 120-150kpa.

(This suggests that the supply pressure about 350kpa is necessary).

It is for this reason the responsibility falls directly on the shoulders of the installing plumber. Ultimately the plumber under the Plumbing Codes, States and Territory regulatory framework is held liable.

3. Calculate the length of the blended delivery water and determine the temperature loss in the piping network, choose an appropriate thermal insulation.

My advice to plumbers and designers before specifying or selecting plumbing piping materials and products, follow the essential 5 steps.

4. Is the piping network returning to the heating source or if a dead-leg piping system is used. Calculate how many litres of heated water is lost and the cost of energy to heat that water.

1. Define the services system, its function and intended performance.

2. Conduct a risk assessment of the proposed service type and products.

The plumbing product performance information data is essential for designers and or plumber installing the plumbing system. Product information is not always readily available, you must research the technical data supplied by the manufacturer.

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

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TOPICS OF INTEREST Work practices & statements As mentioned plumbing regulators are stepping away from day to day inspections, seldom venturing into hospital unless an issue arises. The plumber is deemed the competent person who is entirely responsibility to design, install, test and commission all plumbing services work carried out.

This places an enormous responsibility on the shoulder of the plumber, but equally on the hospital engineers who engage them to carry out such plumbing work.

The question remains, does your plumber know enough about services, the products and installation to make the correct decision and what is your role as engineers to ensure he/her does.

Firstly it starts with the engineers engaging the plumber ensuring that they not only hold a plumbers licence, but carries all relevant skills and insurance around the specific task. The best way to avoid systematic failure is to identify those capabilities and qualifications of the plumber by:

1. Assess the plumber’s business structure, capability, insurances and personnel attributes.

2. Determine if the plumber/contractor holds the necessary knowledge and skills and are these skills current. Are they qualified and hold currency to execute the stated work.

3. Check work statements and procedure manual for the services offered. Inspect safety equipment and tools. Electrical tagging.

4. Has induction training been offered?

This is important, in particular, to critical care areas of the building.

5. Witness all completed work, verifying satisfactory completion and sign off.

practice plumbing installations meeting the requirements for “deemed-to-satisfy”.

Watermark Services Group is currently seeking accreditation with NATA; National Accreditation Testing Authority (NATA) In accordance with; ISO/IEC 17020:2012 Inspection Body – Type A. Our accreditation when issued entails a detailed scope for Hydraulic Services –Plumbing, Gas and Fire Systems, including; • Design verification.

• Installation in-service inspection, test and commissioning verification.

In field determination for;

Watermark Services Group Pty Limited recognises the need for conducting plumbing services design verification, in-service inspection, testing and commissioning verification.

• Flow and velocity recording.

We have now developed a comprehension quality manual and offer a service that supports hospital engineers an independent process for ensuring best

• Material analysis – pipe wall and coating thickness.

• Functional performance of plumbing equipment (controls, pressure limiting, backflow and associated devices.

• Water temperatures and pressure.

In-service verification activities including; • Water sampling – water quality and legionella testing.

• Services system tracing, mapping and documenting.

• Fire equipment verification for testing.

• Safety showers and eyewashes.

• Plumbing apparatus for people with disabilities.

• Plumbing products for commercial applications.

In our next issue we will look at the water services systems problems and technical solutions.

Neil McPherson – Technical Watermark Services Group Pty Ltd Suite 8, 198-206 St Johns Road Glebe NSW 2037 Phone: 02 9571 8007 Mobile: 0429 407 277 E: neil@watermarkservicesgroup.com W: http://www.watermarkservicesgroup.com

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TECHNICAL PAPERS

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TOPICS OF INTEREST

Peak Performance

Continuous monitoring helps hospital optimise plant operations Manny Rosendo I co-founder and CEO of Entic

According to the Environmental Protection Agency (EPA), health care organisations spend nearly $8.8 billion annually on energy to meet patient needs. In a typical hospital, the biggest consumer of electrical power is the HVAC system, accounting for as much as 42 percent of total usage. The HVAC system and chiller plant alone can push a hospital’s electric bills close to over a million dollars a year.

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ith the right peak performance strategy and technologies, it is possible to cut HVAC and central plant energy use by as much as 40 percent.

For instance, Broward Health Medical Centre (BHMC), Fort Lauderdale, Fla., registered savings of over $250,000 in one year after implementing advanced analytics and optimisation to provide visibility and transparency into the performance and service of its HVAC system and 6,000-ton chiller plant.

Six steps to savings Because each hospital is unique, understanding HVAC as an integrated eco-system is important for achieving maximum efficiencies. Following are six steps a hospital can take to generate immediate and long-term energy cost savings:

optimisation, regardless of the type of equipment or power source.

Many management teams look at British thermal units (BTUs) per square foot as a key metric. However, if the system is not operating at peak efficiency, this metric fails to provide enough detail to help determine the problems.

When documenting any current issues or pain points with a system, health facilities professionals should take time to extend their thinking beyond the symptoms to what is causing them.

2. Develop realistic goals. Once health facilities professionals have a clear picture of your system’s current The entrance to Broward Health Medical Centre in Fort Lauderdale, Fla.

1. Evaluate the system’s current state.

Everything begins with the documentation of the equipment and correlating specs.

The efficiency of the chiller depends on the amount of energy or electrical current consumed for cooling, measured in kilowatt per ton (kW/ton).

The lower the kW/ton rating, the more efficient the system. While not everyone is using this criteria, it is generally the cleanest metric for measuring

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performance, it’s time to align common objectives with those of other stakeholders to target realistic goals. Facilities professionals will want to ensure that everyone involved in decision making, including operations, finance and administration, is in agreement. Health facilities professionals are looking for immediate and appropriate feedback to help them gain control of their buildings and ensure higher comfort levels. The focus is on controlling and lowering expenses.

It’s easier to prioritise work orders and fixes if a software solution that provides a concise roadmap for energy conservation measures is used. There are some

TOPICS OF INTEREST advanced solutions available, and the right technology tools can enable better articulation of opportunities with payback analysis, along with clear tracking and measurement of results.

Solutions that provide around-the-clock monitoring and interactive dashboards, provide building engineers and facilities managers with greater control and visibility over their sites. This helps improve troubleshooting and leads to better dialogue with your vendors and sub-contractors.

Lowering costs also must be balanced or coupled with maintaining comfort consistently throughout the building.

Reducing energy consumption should be considered across a timeframe, not just one point in time. An investment that keeps the facility professional’s hand on the heartbeat of the plant and the hospital’s energy usage letting the professional know instantly how the system is running is well worth the expense. It can result in up to 40 percent

A portion of Broward Health Medical Centre’s central plant.

energy cost savings with payback in 12 to 18 months.

BHMC reached payback within just 14 months. The hospital was able to identify and correct HVAC performance gaps

almost immediately. With 85 percent of its building under automation, the hospital has attained superior energy efficiency with a 26-percent reduction in energy use and an enhanced kW/ton ratio of 1.5.

FEATURING

HIGH PERFORMANCE BUILDINGS PAVILION ENERGY | WASTE | WATER

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TOPICS OF INTEREST 3. Understand the data and feedback loop. Because a building automation system (BAS) is for static and theoretical sequences, it may not be able to give facilities professionals the advanced analytics needed to holistically optimise an HVAC plant. More advanced analytics can show how a system is operating, and then facilities managers can tweak building automation sequences to better optimise it, thus establishing a smart feedback loop.

For a more precise understanding of data and feedback, facilities professionals should ask “What the most appropriate data for our goals is and why it is important?” “To capture the feedback we want, how often should the data be collected?” and “Are all sensors and meters calibrated and working properly?”

4. Present data as an action plan. Data is only valuable if it can be acted on for results. Because it’s tempting and easy to overload on information, a “Plan – Do – Check – Act” approach works best.

While a traditional BMS presents data, many times it can be too much and overwhelming. This data can be ignored, which often happens due to an overload of alerts, alarms and notifications, or building analytics can be implemented to enable facilities managers to digest the data, analyse it and take intelligent and actionable steps that lead to optimisation.

The captured information will help build a business case for efficiency, supporting all decisions regarding changes to the HVAC system and chiller plant.

5. Stabilise current operations.

Constant monitoring provides complete transparency to ensure that systems are running properly. It immediately notifies operations when something is wrong, rather than waiting until the next commissioning, which could be a year or longer. Over the course of 12 months, equipment ages and degrades and other variables can impact systems.

Additionally, unusual weather conditions can occur along with a multitude of other factors that can strain or change the operational integrity of a plant.

The most important benefit of constant commissioning is the visibility of efficiency

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or inefficiency on specific pieces of equipment. Continuous monitoring ensures that a plant’s true performance is in line with its original design standards.

This type of tracking allows you to conduct cost-saving analysis and to adjust components as needed in order to maintain optimal energy efficiency.

Because the plant is a dynamic environment, issues are constantly occurring. In today’s economy, few hospitals have extra facility workers, so they must focus on the most important faults. A system should be able to prioritise those faults. At Broward Health, 70 percent of all calls to the help desk centre are from individuals complaining that they are too hot or too cold. A proper feedback loop could identify root causes quickly and allow employees to focus on proactive, preventive work rather than on reactive control issues.

Once a constant commissioning program is in place, facilities professionals also can ensure that all repair work improves efficiency. For example, by leveraging constant commissioning, Miami Children’s Hospital was able to uncover serious inefficiencies in its plant that it then brought to vendors to address. The objective is to develop a “fix forever” mentality.

By stabilising first, health facilities professionals can avoid spending money unnecessarily and they can expect to yield long-term savings. Efficiencies and savings are already “latent” with a current HVAC system, waiting to be discovered.

6. Find the peak. Once the system is stabilised, it’s time to find its peak performance. This is easier to accomplish if achieving the peak is viewed not as an expense, but as an investment that delivers energy savings. The organisation has made a substantial investment in the chiller plant and other HVAC components.

Perfecting and protecting that equipment requires an investment mindset as well.

Regardless of the age of the system, health facilities professionals can start conserving energy right away by maximising what they already have in place. They need to identify the key equipment, implement set point adherence and then commit to preventive

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

maintenance. By closely watching usage trends in this key equipment, you will be able to determine problems before they happen. We call this predictive maintenance. This methodology will enable you to analyse data in order to better model improvements and track actual cost savings, supporting your investment.

Now, you are ready to drive your system to further peak performance by applying optimisation science for around-theclock predictive maintenance. New technologies can automatically direct your HVAC system to efficiencies not otherwise possible with conventional sequencing.

Moving into the new era The types of inefficiencies uncovered at BHMC are often found in health facilities and other commercial and industrial buildings, especially as they begin to implement analytics and gain insight into the operations of their plants. By moving a health care facility into the new era of HVAC and central plant peak performance, health facilities professionals can expect to see total energy consumption drop significantly resulting in savings of up to 40 percent.

Manny Rosendo is cofounder and CEO of Entic, a Miami, Fla.-based specialist in HVAC and central plant performance. He can be reached at mrosendo@enticusa.com.

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TOPICS OF INTEREST

The Language of Heat

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rom an article published in the October 16 2013 Electrical Construction and Maintenance http://ecmweb.com/test-ampmeasurement/language-heat, Author Tom Zind presented sound commentary on Infrared thermal imaging.

Zind contends that … “used competently, Infrared imaging (IR) used to pinpoint abnormally high or rising heat from resistance in electrical circuitry sheds bright light on foreknowledge that can save lives, money and remorse”…

Cellular Edition • Monitors temperature, and optional humidity every 15 minutes • Notifies you via phone call, email or text message of changes in room temperature

For only

$439.99

• Completely independent of your existing infrastructure: no phone line or Internet needed

The argument presented primarily centres on Lind’s contention that infrared thermography is only as good as the operator of equipment used in applying the technology.

The article is referenced here to provide Hospital Engineers with points that are worth considering when contemplating contracting out infrared thermography or as an in-house process deploying hospital engineering personnel. The principle argument being that by deploying the technology improperly, interpreting the raw information it produces and failing to develop an action plan that supports the scan findings can present confusing results at best or useless at worst.

In summary the information presented highlights the following: • IR testing procedures should support overall maintenance programs • Capturing images of energised equipment requires IR Technicians to adhere to strict arc flash safety guidelines • Showing a thermal image alongside a standard photograph of the equipment will assist hospital engineers more clearly understand the problem areas detected.

• Capturing thermal images at the appropriate angle and distance are important points when conducting scans.

• Alert escalation notifies multiple recipients

• The importance of scheduling scans.

• Also notifies you of power loss and low battery conditions

• Capturing reality

• All-inclusive monthly monitoring plans start at $29.99 with no annual contract • iPhone & Android apps

1800 300 661 www.thermocontrols.com.au 80

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

• Operator training In conclusion utilising infrared faults can be readily detected for example an overloaded circuit, imbalanced load, or loose connection. However, an understanding of how the equipment is supposed to function to interpret if it is a problem or not.

TECHNICAL PAPERS

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PRODUCT NEWS

Product News Why better service comes from local chiller manufacturers Local manufacturers have more staff, that are better qualified, and are better resourced to support customers than importers and distributors of equipment. This high quality of people and information that a local manufacturer can provide to customers will always ensure the highest possible quality of product, highest quality of installation and lowest risk of project delay.

Manufacturing companies are larger than distributors, and as a result have the overhead to be able to fund and implement a quality process that applies to Sales, Manufacturing, and after sales Service. A company that distributes on behalf of an offshore manufacturer will not have the overhead to implement such a quality process.

Quality at the engineering level means an in depth knowledge of site requirements and legislative requirements for mechanical trades and electrical trades. Summit Matsu Chillers Engineering Manager Scott Rollston is a Mechanical Engineer, Licensed Electrical Contractor and Licensed Refrigeration and Air Conditioning Contractor.

Quality in the sales process means having a thorough process for identifying all relevant information for a chiller project so that risks to the project success can be managed.

Quality in chiller Service means having a single person oversee the factory run testing of a chiller, and then be responsible for installation and commissioning success of the chiller in the field.

Manufacturing in Australia Manufacturing in Australia employs 953,000 people, represents 8 percent of Australia’s economy (GDP) and produces 29 percent of Australia’s exports.

Manufacturing contributes over 25% to Australia’s R&D annual spend. This is more than mining at 21.4%.

Manufacturing employs almost four times as many people as mining, and it does so right across the country.

Manufacturing in the USA and UK An April 2012 report from the Boston Consulting Group shows that 37% of U.S. manufacturing companies with revenues of $1

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billion+ were considering re-shoring operations from China to the United States due to rising wages in China, increased operational supply chain issues, transportation costs and less attractive exchange rates. The result, said the report, could mean the onshoring of up to one million U.S. jobs.

Mining equipment maker Caterpillar has recently moved operations back onto U.S. soil and electric car companies like CODA and Tesla have opened new factories… not in China, but in California.

H I Ning Su, from the University of Western Ontario commented that hot competition among Asian nations, has generated a race to the bottom where wages and business incentives are concerned. Re-shoring is a very real trend, but the bigger question is what kinds of jobs should the U.S. economy want to see re-shored?

The answer: “More high-end manufacturing – manufacturing that’s integrated with service and R&D,” says Mr. Su. “Those are the jobs where the U.S. and Canada have a competitive advantage and those are the jobs that are able to create more value and even more jobs.”

In the United Kingdom Toyota chooses to manufacture its new hybrid engines at its plant in Deeside, and ship them back to Japan. Luxury fashion house Mulberry recently expanded its manufacturing facilities in Somerset and GlaxoSmithKline will invest £500m in its first new UK plant in 40 years.

In the UK manufacturing creates 20 percent of national output, and employs 4 million people, producing 60 percent of exports.

The Government has put in place generous R&D tax incentives for manufacturers and increased availability of funding for SMEs.

Derek Hill of Advanced Technology Services says “Today’s manufacturing jobs are ‘cool’ and appealing. Workers are now required to be experts and operate the most sophisticated equipment in the world. They can cut steel with lasers, water jets and plasma cutters and can program robots to paint, package and palletise products. Computer programming and other high-tech skills are needed, which dovetails precisely with what younger people love these days; these jobs can be more fun and, ultimately, more satisfying than many service-sector jobs.”

A search of the internet reveals case studies of companies that have sourced raw materials from China at what appeared to be very attractive low unit costs. In one case the high minimum order quantity and long lead times meant the company had to lease an additional unit to hold the stock, tying up large amounts of money in both the stock, and the leasing of the unit.

Another case study mentions a high minimum order, delivered in full, with a quality defect.

The Chinese supplier agreed to replace the shipment, but at a 3 month lead time. This had an enormous impact on the company’s delivery schedules.

What is the relevance to chillers? An imported chiller may appear to be cheaper up front, but what is the impact of a quality issue with the chiller? How many hours down-time and lost patient services does it take to offset any “savings” gained by purchasing an inferior product? And if an imported product breaks down is there full back up service for the unit?

And what is the quality of this service? And does the importer have any qualifications?

Is the service endorsed by the manufacturer?

And what is the speed of the service?

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Summit Matsu Chillers has for many years employed fully qualified mechanical engineers, licensed electrical contractors, and licensed air conditioning and refrigeration contractors.

All good reasons why Australian manufacturing matters, and why Australian manufactured chillers are better for customers.

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Further information on chiller service can be found at www.matsu.com.au/service More details on chillers for hospitals including hospital case studies can be found at www.matsu.com.au/hospitals

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So what are these supply chain issues that are causing companies to bring manufacturing back onshore?

THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2013

One of four chillers for LINACS cooling supplied to Wollongong Hospital in 2013

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