VOL 39
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A Great Time Had By All – Full report on page 8 Best Member Paper – Mark Hooper, Echuca
Charlie Shields – 60 yrs IHEA Membership Recognised
Best Non-Member Paper – James DiLiberto, AZZO PP 100010900
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IHEA NATIONAL OFFICE Direct: 1300 929 508 Email: admin@ihea.org.au Address: PO Box 6203, Conder ACT 2900 Website: www.ihea.org.au Conference: http://hfmc2017.org.au
IHEA NATIONAL BOARD National President Brett Petherbridge National Immediate Past President Darren Green
CONTENTS
BRANCH NEWS
4
National President’s Message
7
CEO’s Message
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The IHEA National Conference 2016
National Vice President Peter Easson
12 State Branch Reports
National Treasurer Mal Allen
National Secretary/Communications Darryl Pitcher Membership Registrar/ CHCFM Coordinator Peter Footner
TECHNICAL PAPERS
18 Creating new boundaries 24 Navigating the clean steam requirements of AS/NZS 4187:2014 30 Energy management visualisation
Standards Coordinator Brett Nickels
34 Special requirements in UCV theatres
Asset Mark Coordinator Greg Truscott
40 Cleaning water to CSSD our R.O story
Directors Michael McCambridge, Rod Woodford
42 Condensing boilers 101
IHEA ADMINISTRATION
46 Infection under consideration
Secretariat/Website Administrator Heidi Moon
49 Down the Drain – The air that we breathe
Finance/Membership Jeff Little
52 “The Terrible Twins”: Emergency Management & Business Continuity
Editorial Committee Darryl Pitcher, Brett Petherbridge and Darren Green
Air quality in harmony 54 with infection control
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
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Enhancement of health facilities’ 63 approach to asset management 75 Changes to baseline data AS1851-2012
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PRODUCT NEWS
79 Product news
ADVERTISING Melbourne: Neil Muir T: (03) 9758 1433 F: (03) 9758 1432 E: neil@adbourne.com Adelaide: Robert Spowart T: 0488 390 039 E: robert@adbourne.com PRODUCTION Emily Wallis T: (03) 9758 1436 E: production@adbourne.com ADMINISTRATION Tarnia Hiosan T: (03) 9758 1431 E: admin@adbourne.com
46 Visit the Institute of Hospital Engineering online by visiting www.ihea.org.au or scanning here ➞
The views expressed in this publication are not necessarily those of the Institute of Hospital Engineering Australia or the publisher. The publisher shall not be under any liability whatsoever in respect to the contents of contributed articles. The Editor reserves the right to edit or otherwise alter articles for publication. Adbourne Publishing cannot ensure that the advertisers appearing in The Hospital Engineer comply absolutely with the Trades Practices Act and other consumer legislation. The responsibility is therefore on the person, company or advertising agency submitting the advertisement(s) for publication. Adbourne Publishing reserves the right to refuse any advertisement without stating the reason. No responsibility is accepted for incorrect information contained in advertisements or editorial. The editor reserves the right to edit, abridge or otherwise alter articles for publication. All original material produced in this magazine remains the property of the publisher and cannot be reproduced without authority. The views of the contributors and all submitted editorial are the author’s views and are not necessarily those of the publisher.
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National President’s Message It had also been proposed to the National Board, that the Institute of Hospital Engineering Australia, be renamed as the Institute of Healthcare Engineering Australia. This change in name will enable the Institute to engage with member’s right across the Healthcare sector and will remove the perceived limitation to the “Hospital” sector. Members voted on both resolutions and both items were passed. The notification of change of name has been undertaken by our Auditors through ASIC and this has been completed. A rebranding exercise will be undertaken to cover off our current Webpage, Journal and correspondence over the next few months.
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here’s an old cliché “how time flies” and that is especially true over the past 12 months as we move to the festive season and into 2017. Firstly, I would like to wish all members, families, friends and business partners a Merry Christmas and a safe New Year. For the Board, 2016 has been a year of policy reviews and updating, especially around the Constitution and Regulations, Financial Delegations and Risk, Directors Manual and an updated ANZEX Delegate Guidelines and Handbook agreed between IHEA and NZIHE. These documents underpin the IHEA and provide direction. Your current National Board remains virtually unchanged with the exception of Mr Alex Mair who stepped down at the Annual General Meeting. I would like to extend my sincere thanks to Alex for his work as the Membership Registrar. Alex is replaced by Mr Brett Nickels from our Queensland Branch and we welcome Brett to the National Board.
ANNUAL GENERAL MEETING (AGM) AND NATIONAL BOARD OF DIRECTORS The AGM was held in the William Magarey room of the Adelaide Oval on 20th October 2016. Our email notice to members on 22nd September 2016 provided 2 important items requiring member’s attention at the AGM:1. Adoption of revised Constitution and Rules 2. Proposal to change the name of the Institute The Constitution of the IHEA has not had a significant review undertaken since 2006. The proposed changes to the constitution are to comply with ASIC requirements and to reflect better business practice.
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
The National Board of Directors is as follows:Name
Position
Brett Petherbridge
National President
Peter Easson
Vice President
Darren Green
Immediate Past President
darren.green@gsahs.health.nsw.gov.au
Darryl Pitcher
Secretary
D.pitcher@bethsalemcare.com.au
Mal Allen
Treasurer
Mal.Allen@hnehealth.nsw.gov.au
Karen Taylor
Chief Executive Officer (ex officio)
ceo@ihea.org.au
Peter Footner
Membership Registrar
pesarash@adam.com.au
Brett Nickels
Director – Standards
Brett.Nickels@health.qld.gov.au
Greg Truscott
Director – Asset Mark
Greg.Truscott@health.wa.gov.au
Michael McCambridge
Director (co-opted)
Michael.McCambridge@mh.org.au
Rod Woodford
Director
rwoodford@castlemainehealth.org.au
Executive Committee
brett.petherbridge@act.gov.au Peter.Easson@health.wa.gov.au
Years of service awards were also recognised for 21 members and presented to those present at the AGM. The award recognition of 60 years continual membership was awarded to Mr Charlies Shields from our NSW/ACT Branch. Charlie received this award along with a special presentation at the conference dinner. Congratulation Charlie on this monumental achievement.
2016 NATIONAL CONFERENCE – ADELAIDE The 66th National Conference hosted by the S.A. Branch was very successful and papers presented were of a very high standard. The technical tours were very well attended; I took the tour of the new Royal Adelaide Hospital and with other delegates, was immensely impressed by the facility and set up. The Master class on National Legionella Guidelines held on the conference eve was also very well attended by delegates. The conference dinner was held in the Ian McLachlan Room at the Adelaide oval and this provided a fantastic setting overlooking the oval itself.
The organising committee led by the conference convener – Peter Footner and the event planner Icebergs are to be congratulated on a very good event. Well done to all.
BEST PAPER AWARD The 2016 Best Paper was awarded to Mr Mark Hooper (Vic/Tas Branch). Mark’s presentation “Creating New Boundaries” described a journey of the decision making process behind the innovation that is the new Echuca Hospital. This paper was adjudicated as the best member paper presented by the judging committee. Congratulations Mark.
STRATEGIC PLANNING The next IHEA Board meeting will be held in the first week of February in Royal Melbourne Hospital – Facilities Management and a full day is set aside to undertake and create a new 3 year Strategic Plan. The recently conducted member survey responses will be collated and used as our guide within the portfolios of the strategic plan.
SUMMARY In closing, please ensure you all have some time to relax with family and friend over the festive season and remain safe during this period. Kind regards, Brett Petherbridge IHEA National President
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
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TECHNICAL PAPERS
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With our broad Qi Medical Gas Services portfolio, BOC can help you meet the considerable challenges of compliance and safety in today’s healthcare environment. At the same time, we provide balanced insight and flexible tools to improve control and coordination of medical gases throughout your facility. Ask us how we can help you manage your servicing needs with a tailored servicing and repair plan for best practice preventive maintenance for: – Breathing air testing – Gas manifolds – Air and vacuum plant – Medical gas alarms – Medical gas devices – Zone isolation boxes – Medical gas outlets
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
CEO’s Message
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he 2016 National conference was held in Adelaide at the recently redeveloped Adelaide Oval. And what an outstanding event it was! The theme of ‘Managing Change, Changing Management’ provided the basis for what was an excellent program with much discussion and deliberations at all sessions. The conference provided a great opportunity for professional development and networking for all in attendance. As I spoke with delegates, sponsors and exhibitors, all agreed the IHEA National Conference is an event they highly value and look forward to every year. Thanks to the dedicated team in South Australia for all their hard work. In particular I would like to say a big thankyou to the SA President Peter Footner who really went above and beyond. Thanks too must go to the team from Iceberg who always deliver such high quality events. The Board and executive team have spent 2016 working on a challenging and interesting strategic agenda. Work has been completed on a number of key governance issues including the Constitution, IHEA Governing Rules and the name of our association (more to come on this in 2017). Key strategy including partnerships to benefit the IHEA and members has been significantly progressed and work will continue to strengthen this in 2017. Many operational policies and procedures have also been developed and implemented. This work will be reviewed and a new strategic plan developed for the next three years at the February Board meeting in Melbourne. Strategy for 2017 and beyond will include increasing member benefits, upgrading the website, providing better customer service and administration to members, improved communication including social media to name a few. This will see us well placed to progress a number of important operational plans that you as members will continue to see benefits from in 2017. I look forward to 2017 and the opportunities the new year will bring. In the meantime, I wish you and yours a safe and happy Christmas Kind regards, Karen Taylor CEO
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TECHNICAL PAPERS
“And a great time was had by all....” THE IHEA NATIONAL CONFERENCE: ADELAIDE, 19-21 OCTOBER 2016
S
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et in one of the most ‘livable’ cities in the world, the 2016 conference in Adelaide got off to a showcase start and continued through to the last. A wellattended, informative and interactive master class focussed on Legionella was followed by several site tours; South Australian Health and Medical Research Institute, the new RAH (under construction) and the iconic Adelaide Oval. The visit to the new RAH offered an insight to some of the advanced design features to achieve improved healthcare and building resilience. A leading design in healthcare, this visit to the new RAH created interesting discussions around building form, sustainability and evidenced-based design for patient care. After a warm and informative day, delegates were keen to wet their parched throats and the stunning 2KW bar gave all the opportunity to connect and engage. 2KW is located on the rooftop of no 2 King William St, atop one of Adelaide’s delightful old-charm bank buildings offering incredible views over the technical tour sites, the Adelaide cultural precinct along North Terrace, Parliament and Government Houses, and towards the River Torrens and Adelaide Oval, the conference venue for the next two days.
“Very Good” or “Excellent”. The Welcome Reception at the rooftop bar at 2KW was clearly a hit with delegates, sponsors and exhibitors commenting: “The best ever IHEA cocktail event. Outstanding venue, food and beverages. A great networking event to kick off the conference, getting everyone in the spirit for the next two days”. “What a view, what a night. Great company, great atmosphere....” 90% of the survey respondents (delegates) rated the night as “Excellent” or “Very Good”. Sponsors and exhibitors also enjoyed the night and the networking opportunities presented – 95% of them agreed the event was excellent or very good. If you missed it … you missed out on a winning evening together with your peers and industry supporters.
Recently completed delegates’ surveys confirmed all these pre-conference events were a “winner”. All of the Master Class participants who completed the survey rated the event as either “Good”, “Very Good” or “Excellent”, with positive commentary on the relevance of the subject matter and the high quality facilitation of the event. With a couple of exceptions, most participants rated the technical tours as
Speakers covered a wide range of topics that informed, amused and, at times, made delegates question what they knew or thought they knew. Brendan Hewitt, Executive Director Infrastructure SA Health gave us insight into changes occurring in the SA Health landscape leading into the next decade.
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
The Adelaide Oval provided a great setting for the conference #HFMC16. This year’s theme was ‘Managing Change/Changing Management’ and the conference gave participants information and insight into an environment of change. Stevie Goldsmith from Tandanya National Aboriginal Culture Institute gave a welcome to country which entertained, informed and kicked off a full day.
A wide range of presentations followed and were well received by delegates. Most who responded to the survey rated the conference plenary sessions highly. On measures such as the program content, quality of speakers and diversity of speakers, more than 94% of all delegates rated these as Good to Excellent. 100% of respondents rated the Adelaide Oval venue and the whole conference experience as Good, Very Good or Excellent. We thank all delegates for their feedback through the conference survey. The committee together with Iceberg Events worked hard to ensure the event met the expectations of delegates and we believe it did just that. The other keynotes speakers were really well received. Graeme Cowan spoke to us about where each of us, as individuals, are heading and how it influences our work and vice a versa, while Andrew Horabin had us laughing and second guessing ourselves in cutting through the ‘bullshift’ to get more honesty and straight talk at work. One delegate summed it up thus – “Andrew Horabin – excellent real life experience – glad we got him. Good papers across the two days. Good technical tours.” Between sessions, delegates were treated to a tasty selection of snacks and meals provided to keep us going. The breaks also provided a great chance to mix with exhibitors, sponsors and delegates from around the country. This opportunity to engage with industry suppliers on a one-to-one level was beneficial with open discussions about their products and services occurring. While the speakers brought insights to
the delegates, the suppliers bought opportunity. An opportunity to learn more about what was available, about technological developments in the Healthcare Facility Management field and also how the various products could enhance healthcare facility operations. Topped and tailed by a successful trade night and a fantastic end of conference dinner at the beautiful Adelaide Oval, this successful national event was received well by all. Many people contributed to the success of the 2016 conference and our thanks go out to them – the conference organising committee, the professional conference organisers – Iceberg (Kara, Krysty and Emma) and to our great IHEA supporter, Narelle Turner of Broadspectrum, who kindly handled the MC responsibilities with aplomb. The support and input from delegates who attended was greatly appreciated and we hope and trust that they got plenty from the conference. Finally, our thanks must go to our key sponsors OandMs, Schneider Electric, Amstrong Flooring, ecas4, and Enware for their financial and other contributions to the success of the conference. Peter Footner Conference Convenor President – SA Branch John Jenner Conference Organising Committee Vice President – SA Branch
NRAH streetscape
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
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The IHEA National Conference: Adelaide, 19-21 October 2016
TECHNICAL PAPERS
Conference plenary session
Charlie Shields – 60 years continuous membership
Keynote address Graeme Cowan - An exciting address on human behaviour in the workplace
Delegates appreciating the Conference presenations
L to R: James DiLiberto (winner of Best Non-member Paper), Darryl Pitcher and John Azzolini
Delegates enjoying the opening event at 2KW Rooftop Bar
Gala dinner entertainment in full swing
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
Professional photos of IHEA Conference provided by Andy Stevens Photography
TECHNICAL PAPERS
Stevie Goldsmith providing the Welcome to Country ceremony
nRAH outdoor areas from above
Charlie Shields and Darren Green reminiscing
The iconic SAHMRI Spiral staircase - a place to meet and collaborate on cutting edge research
SAHMRI tour delegates
National President Brett Petherbridge delivering his opening address
ANZEX PRESENTATION –
BEST IHEA MEMBER PAPER –
Mark McCaughan, Mercy Hospital, Dunedin, New Zealand The Australia New Zealand Exchange (ANZEX) delegate from our equivalent organisation in NZ (NZIHE) was Mark McCaughan from Dunedin on the lower South Island.
Mark Hooper, Executive Project Manager, Echuca Regional Health The Best Member Paper at the 2016 IHEA National Conference was awarded to Vic/Tas Branch member, Mark Hooper of Echuca Regional Health, for his paper entitled, “Creating New Boundaries”. Mark’s innovative presentation showed how fresh thinking was employed to bring new dimensions to the recently completed $66M upgrade to the Echuca Regional Health campus. What was needed was a “patient focussed solution” that was both flexible and intuitive, that involved testing new technologies and deploying tried and tested methods in a new setting. The results were outstanding, and those present will remember Mark’s excellent use of video and images to capture on screen the superb results. Well done Mark and congratulations on winning the Best Member Paper Award.
Mark spoke about his experience with water quality issues following an upgrade to the hospital CSSD and in particular the need to install a Reverse Osmosis plant to remediate issues cleaning equipment. The problems were traced to the quality of the water being used to supply the cleaning equipment. Mark’s presentation was a real life experience and tells the story of how the hospital staff had to think outside the square for the cause of their troubles. We congratulate Mark for taking on the ANZEX program and thank him for joining us in Adelaide for the IHEA National Conference and for being involved with the South Australian Healthcare sector during his visit. We appreciated getting to know another of our peers from New Zealand and look forward to the continuing tradition of sharing knowledge and experiences across the Tasman.
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
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STATE BRANCH REPORTS
State Branch Reports WA BRANCH REPORT – GREG TRUSCOTT, BRANCH PRESIDENT Branch Meeting October 2016, King Edward Memorial Hospital ing Edward Memorial Hospital was the venue for a Professional Development session and host Philip Hawkins warmly welcomed the attending 18 members to the facility. Both Phil and Alex Foster proceed to deliver an attention-grabbing presentation on the High Voltage upgrade project for the Hospital, focus was based on the energy safety publications outlining the guidelines for the effective management of the HV infrastructure.
K
The project was initially started with the announcement by the local power provider, Western Power, that the HV power network was being upgraded from 6.6KV to 11KV for the whole surrounding area and suburb of which the Hospital was located. This announcement naturally triggered the necessary upgrade of the facility’s HV infrastructure including several transformers, switchgear, ring mains, electronic metering and site air boxes etc. to accept the new increased voltage. The project was procured via an open tender platform and consideration was especially focused on the temporary supply required during the cut-over period.
The overhauled 1.3 Mega Watt Diesel Generator
High Voltage Western Power Switchgear
Fortunately for the Memorial Hospital, the capital outlay required for the HV upgrade was made available and funded by Western Power.
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
VIC/TAS BRANCH REPORT – RODERICK WOODFORD, BRANCH PRESIDENT
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016 has seen three well attended professional development days with topics on Water Quality Management, Building Construction and Maintenance Regulations and Compliance. These PD events where held in Melbourne at the Institute of Engineering conference rooms. We also had the opportunity to make a site visit to the newly constructed $640 million Bendigo Hospital during its commissioning stage, where the builder and the engineering consultants gave presentations on the construction design and engineering plant to the theme “What worked well and what could we have done better”. Invitations where also extended to non-members through the Victorian Department of Health and Human Services and we were please to welcome between 10 and 15 non-members to each PD seminar. This gave the some potential members exposure to the benefits of IHEA membership as well as experiencing the professional development seminar with members.
and the enthusiastic company. A good time was had by all and thankfully we didn’t lose anyone over board. At one stage when the boat went under a bridge we felt the need to duck and I think Steven Ball did and the good cheer kept flowing. Merry Christmas to all and have a happy new year. Steve Jones receiving his 20yr membership certificate
Congratulations go to Mark Hooper from Echuca who was awarded the Best Member Paper at the National conference 2016 another feather in his cap as Mark was also awarded the Vic/Tas engineer of the Year in 2015. Steven Jones also received his 20 year membership certificate. The Vic/Tas branch has also been busy organising the 2017 national conference with the theme Compliance in Motion; we invite you and your partner to join with us at the Pullman Albert Park Lake in October 2017. The Committee of Management has also started compiling the 2017 professional development topics and locations. Steven Ball has kindly offered to have our country meeting at Epworth Health Geelong in 2017 this is a brand new facility and well worth the effort to join us. This year’s end of year function was a move away from our usual meal at the Sunrise Hotel at South Melbourne. We enjoyed a river cruise and meal along the Yarra seeing the city lights at night appreciating the gentle motion of the boat
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
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STATE BRANCH REPORTS NSW/ACT REPORT – JON GOWDY, BRANCH PRESIDENT
T
he NSW/ACT Branch Professional Development Day was held at Royal Prince Alfred Hospital in Sydney on the 11th November. Whilst there was a specific focus on compliance in medical gas testing it also included an interactive panel discussion on medical gas systems in healthcare facilities. Other technical papers were also provided for delegates covering lighting modernisation at Royal Prince Alfred Hospital, there were also presentations ranging from electronic contractor management systems, contemporary floor coverings to waterproofing of buildings. Included in the day’s program was a walk through and a live demonstration of the recently completed fire safety training simulator at Royal Prince Alfred Hospital. This facility gives clinical staff the opportunity to carry out evacuation training in a realistic ward environment and was recently awarded first prize by the Treasury Managed Fund (TMF) for Safety Innovation in Healthcare.
level of interest and participation in the various group discussions by all attending. The NSW/ACT Branch would like to extend its appreciation to BOC, Danrae Waterproofing, Interface Australia and Time and People for their valuable contribution to the day’s success. Following on from this the CoM is committed to growing the IHEA professional development day program and planning for future events is already underway. NSW/ACT Branch Committee of Management Contact details Name
Position
Phone
Jon Gowdy
President
0411 040 834
Jon.Gowdy@sswahs.nsw.gov.au
Steve Dewar
Vice President
0428 119 421
steve.dewar@gsahs.health.nsw.gov.au
Darren Green
Secretary
0418 238 062
darren.green@gsahs.health.nsw.gov.au
Peter Lloyd
IPP
0428 699 112
peter.lloyd@gsahs.health.nsw.gov.au
Mal Allen
Treasurer
0467 761 867
mal.allen@hnehealth.nsw.gov.au
It is interesting to note that the training facility was fully designed, constructed and commissioned entirely by in house Sydney Local Health District Engineering Services staff.
Peter Allen
COM
0408 869 953
peter.allen@hnehealth.nsw.gov.au
Helmut Blarr
COM
0411 152 898
helmut.blarr@sswahs.nsw.gov.au
Glen Hadfield
COM
0409 780 228
glen.hadfield@swahs.health.nsw.gov.au
Attendance at the day was strong with 40 delegates from across NSW/ACT in addition to suppliers and other presenters; it was pleasing to see the noticeable
Trevor Stonham
COM
0414 899 363
trevor@sah.org.au
Brett Petherbridge
COM
0418 683 559
brett.petherbridge@act.gov.au
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
QLD BRANCH REPORT – BRETT NICKELS
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s we conclude a busy year we are making ready for our final 2016 end of year Professional Development seminar on mechanical services and floor covering technologies. Paul Goodison and John Stilianos from Veolia will be presenting on Central Energy Plants, to the theme “Phase out and Introduction of Refrigerants – new and old” and sharing with us Trane’s latest generation of chillers. Gerflor will also provide a presentation on “Protecting your assets and minimising hospital/facility acquired infection”. We look forward to strong member support of this PD and the opportunity to share in new technologies and guidance on industry changes relevant to professionals working in Healthcare Facility Management. This is a PD not to be missed so keep and eye out for details shortly. We’ll be concluding 2016 with a networking and social night out at a popular Turkish Restaurant on South Bank, Brisbane. Please keep an eye out for the final details and we look forward to catching up. The Branch Committee of Management has been discussing how we can continue to improve engagement with our membership and this will be the main focus of the Queensland team heading into 2017. As a result of 2016 mid-year Conference, we are delighted to welcome a few new members into the Institute. On behalf of the QLD branch I warmly welcome Richard Blatch from the Gold Coast, Adrian Duff from Metro North Hospital and Health Service, Richard MacAvoy & Neil Thomas from Ashburner Francis Pty Ltd as corporate members. We look forward to working together and supporting all the team in Queensland. On behalf of the QLD Branch Committee of Management and its members please have a very Merry Xmas and we look forward to seeing you all in the New Year.
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
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TECHNICAL PAPERS
Creating new boundaries MARK HOOPER B.ENG I EXECUTIVE PROJECT MANAGER, ECHUCA REGIONAL HEALTH. AWARDED “BEST MEMBER PAPER” AT THE 2016 IHEA NATIONAL CONFERENCE
ABSTRACT
I
1. ENERGY LOAD SHIFTING
n late 2015 Echuca Regional Health completed the last stage of a $66M hospital redevelopment. The final product was designed to challenge conventional wisdom and produce a patient focused solution that would announce itself as a flexible intuitive and calming place to support everyone to be healthy and live well. Drawing from the same character traits of the mighty Murray river, the new hospital is a positive statement that as a community we can continue to adapt and overcome challenges as they present. The Old Hospital was delivering emergency department services out of a building that was 129 years old. The newest ward building was built in the 1960’s. The Hospital had a total of 3 private ensuites for 80 inpatient beds. Redevelopment was well and truly overdue. The hospital engineer had worked at the site for over 10 years and understood well the challenges of public hospitals. A 10 year services plan had been put in place to lever opportunity when it was time for the inevitable redevelopment. Strategic asset replacement, energy efficiency improvements and bench testing of new technologies were undertaken to inform a site wide design strategy. This strategy became the keystone of the engineering design that was taken from Master Planning through to schematic design, design development and construction. Post Occupancy Evaluation is currently underway. Creating New Boundaries will take you on the journey of the decision making process behind the innovation that is the new Echuca Hospital. A patient focused, staff friendly, well considered design that through intelligent use of solid engineering principles and stakeholder engagement should deliver a sustainable long term facility that needs no sales pitch. Knowing what you don’t want can be just as powerful as knowing what you do want. Lessons from the past have been used to remove historic inflexibility to future proof the Hospital. Innovations have been incorporated to drive opportunity that can be leveraged towards future cost efficiencies. A dollar spent on energy is a dollar taken from patient care so it was only natural to link the hospital energy profile to the abundant solar energy available at Echuca with two of the largest solar thermal systems in use at a hospital anywhere in the world.
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
It is well known that most hospitals in south eastern Australia use far more annualized energy heating than cooling. Conversely the peak load requirements of cooling are much greater than the peak heating loads. Echuca Regional Health has good historical data and coupled with the load predictions of the new hospital this data was used to design both heating and cooling plant. One obvious issue that arises is where to best spend capital to ensure that plant is not oversized, but is capable of meeting the peaks for current and future demand. The hospital invested in a solar thermal system in 2011 that coupled evacuated tubes with a 500kW single effect absorption chiller and some hot water storage. This system was a demonstration system that allowed the hospital to gather some raw data that would be used to
TECHNICAL PAPERS efficient operating mode and overall system COP so this technology can move towards business as usual for capital redevelopments. Additional advantages of the chilled water strategy were seen in the electrical infrastructure which saw smaller submains and distribution systems as the chilled water capacity was being produced by absorption chillers rather than electrical chillers. The result of the smaller electrical load and demand profile also meant the on site generation was able to be matched to the entire site load eliminating the need to segregate essential and non essential circuits. This had a direct impact on the capacity of generation and cost of electrical infrastructure from submains to distribution boards and load shedding costs. inform the redevelopment commencing in 2014. The heat from this solar field is currently used for cooling in summer and heating in winter. The heating connections supply energy to the domestic hot water system and air conditioning heating hot water system. One of the underpinning principles was that the chiller be available to provide 100% capacity at all times regardless of available solar gain. This is achieved by a steam to hot water heat exchanger from the hospital main steam system.
2. GRID SYNCHRONISATION Most hospitals have some form of back up electrical generation in combination with UPS or DRUPS. Echuca Regional Health is no different in this respect and set some key deliverables from the generation design. These were: • Generators were be tested on real site load. • All testing was to occur without an outage.
With the redevelopment of the hospital came the opportunity to consolidate four separate chilled water loops into one primary/secondary system. This consolidation provided redundancy where there was previously none, and allowed a mix of absorption and electric chillers of varying capacity to provide a flexible production of chilled water. In addition a concentrated tracking solar field was built on top of the new hospital with enough capacity to provide 750kW of chilled water through a double effect absorption chiller. To aid with demand management and energy optimization the hospital required a chilled water storage buffer. Permission was obtained at the design stage from the fire authority to insulate the fire water tanks for chilled water storage. This water was coupled to the chilled water primary loop via a heat exchanger and added another 1200kW of storage. It is believed this is the first time a static fire water supply has been used for this purpose in Australia. The hospital now has the ability to produce 1100kW of chilled water for very low cost via the absorption chiller / solar fields. For a small amount of additional input energy this can be increased to 2000kW. Coupled with both hot water and chilled water storage this energy can be produced and stored for use at peak times in summer and provide base load heating in winter. A 1500kW electric chiller is used to recharge the tanks at night time and cover night time chilled water load. This is advantageous as the peak electrical demand is now decoupled from the air conditioning load. Another advantage is the electrical chiller which operates at night has a much higher COP and lower electrical tariff during this time. Work is now currently underway with CSIRO to undertake a case study to determine the most
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
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TECHNICAL PAPERS • A seamless return to normal supply was required after a supply authority outage. When installing generation at a hospital the electrical wiring standards that are referenced for hospitals relate to the demand side of the electrical installation. The supply side of the installation also has rules that vary by jurisdiction. In Victoria the Victorian Service and Installation Rules (SIR) are the rules applied by the wholesaler. This is important to know if you have a desire to synchronise with the supply authority grid in order to take yourself off or on the grid.
an embedded generator.” The correct terminology in Victoria for the type of installation we require is an “embedded non-exporting backup generator” which is distinctively different to a standby emergency generator. Numerous hospitals have had applications to synchronise refused at design stage simply because the supply authority application form had “standby” ticked instead of “other”.
3. THINGS WE DIDN’T TELL THEM Intuitive design.
The relevant Australian standards are: • AS3000 electrical wiring rules • AS3003 Patient Treatment Areas. • AS3009 Electrical InstallationsEmergency Power Supplies in Hospitals • AS3010 Electrical InstallationsGenerating Sets In Victoria the SIR 6.9.4 states “Standby generators can be installed within an installation as a backup alternative supply that can be used when a distribution network supply interruption occurs. Standby generators can only be installed with a break before make transfer that will not allow the generator to electrically connect to the distribution network…” This clearly means that a hospital generator cannot be called a standby generator if synchronization is required. SIR 6.9.4 also states “In some circumstances it is desirable to be able to transfer load from the distribution network supply to the generator or vice versa without interrupting the supply to the generator. This type of transfer is called make before break (or closed transition transfer) and requires a generator to be able to synchronise with the distribution network supply. Backup generators with make before break transfer allow the generators to be load tested without disrupting the load. Likewise they may allow the load to be transferred from the generator back to the distribution network….” “Any generator that can synchronise with or electrically connect to the distribution network is considered
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One of the hallmarks of successful design is user intuition. This is most evident with children these days who use technology without any instruction. Indeed with good intuitive design the users will participate in the intended way and sometimes a desired change in behavior can be observed. The Echuca hospital provides many intuitive elements that have been designed into the core of the delivery strategy and are used by staff and patients alike with great effect. Sensor taps. One such example is the sensor taps. Sensor taps are not a new thing and have been around for many years now. The 5 moments of hand hygiene are the front line defence against infection. WHO standards indicate that correct hand washing with water should take
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
around 15 seconds. This is actually quite a long time. I have observed at many hospitals staff using sensor taps for less than 5 seconds from pre-rinse to final rinse. The sensor taps installed at Echuca have a 15 second minimum run time from sensor operation to turn off. Some staff were initially embarrassed when walking away while the water was still flowing but have adapted to washing until the water stops. Current observations indicate staff are using the handwashing for the full 15 seconds. This is very pleasing as the majority of hand hygiene is achieved by alcohol foams. As alcohol foams do not work for bacterial spores and tropical parasites it is most important that when water is used it is used correctly. Published results from Hand Hygiene Australia shows an average compliance of 83.9% across Australia. ERH are trending well above this. It is interesting to note that the lowest Australian compliance rate is amongst Medical Practitioners with 72.5% compliance. Reflected Ceiling Plans. All engineers will be familiar with reflected ceiling plans. ERH viewed these as patient ceiling plans. All paths that required patient transport from one department to another were identified. Areas requiring patient transport included strip lighting located to the side of the corridor. This minimised the strobe effect on patients while under transport. Fenestration.
Hospitals typically require deep ceiling voids of up to 2m clearance to conceal building services systems within. The original design incorporated roughly 3m floor to ceiling height within occupied zones and a ceiling void of around 1700mm providing a floor to floor height of roughly 5 meters. A typical south facing ward room would receive dramatically better daylight penetration and uniformity through the simple act of rotating banded landscape format windows to portrait.
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TECHNICAL PAPERS Each bedroom has a sign indicating the room number and a secondary sign for further information that can be tailored to the patients individual needs. This approach allows a consistent professional solution and negates the need for ad-hoc arrangements. Workflow terminal.
Initially to realise the benefit of this arrangement the ceiling void was going to be chamfered back at around 45 degrees to admit diffuse daylight deeper into the room. This also would allow operable windows for natural ventilation. Alternative arrangements were adapted which allowed a 100% fresh air system while still maximising the diffuse daylight penetration. Each bedroom has triple glazing with the outside double glazing providing thermal benefits to the building, while a third glazing on a hinged panel contains a motorized venetian blind between the panels. This motorized blind is controlled via the patient pendant and allows the patient to control the natural light entering the room. Coupled with a 100% fresh air system the patient has fresh air and excellent controllable natural light. Belongings Safe Each room has a motel style safe for personal belongings. The code is able to be set by the patient for safe keeping of valuables while staying at the hospital. This added level of security was determined to best suit the needs of patients who bring expensive valuables with them. It is quite common these days for patients to bring wallets, keys and mobile devices that are worth considerable value. ERH provides peace of mind to patients that their valuables are safe while they are using our facilities.
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Natural Spaces The hospital is filled with indoor and outdoor spaces with seating. The patient and their visitors intuitively use these spaces to help the healing process. Evidence based design worldwide shows that an inviting space that provides natural light and entices visual stimulation is much less draining on patients and encourages movement out of the bedrooms. This aids in mental health by engaging with others in conversation as well as physical benefits of encouraging mobility. Signage
Each bedroom incorporates a patient journey board which is updated daily. It is used a communication tool from staff to patients and family. It incorporates simple things like your direct phone number, what day it is, messages to family members such as “patient is currently having an X-ray� etc.
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
Each bedroom has a workflow terminal that is connected to the over door light in each room and integrated to the site messaging system and BMS. The workflow terminal allows staff to highlight nursing functions such as infection risk, falls risk. It also has cleaning functions, portering functions and room status functions. Each function can be tailored to send reminder messages to the individual work group responsible in the care plan and can only be reset at the work flow terminal in the room of origin. This provides the focus on patient centred care and places the needs of the patient first and foremost. The technology is robust and flexible allowing for any changes in the future. Stairs. The front entrance stairs were deliberately placed front and centre of the pedestrian traffic. Rather than a preference for lifts, the placing of an open stairwell invites usage by staff, visitors and patients. This is consistent
TECHNICAL PAPERS with the corporate message of helping everyone to be healthy and live well.
4. HVAC AND BMS HVAC.
Echuca Regional Health in conjunction with the Department of Health and Human Services and the consulting team adopted a fresh approach for the facility at Echuca. It was identified early on that a fully sealed building with 100% fresh air would be the solution adopted for Echuca. In addition heat recovery would be incorporated to maximise the benefit of energy opportunities. Bench testing had also been completed to allow the incorporation of the Rickards variable geometry diffuser system with the site BMS. Static regain was designed into the duct pressure controls. Wells Reilley formulae were used to assess the mean time to infection for traditional recirculating systems versus the proposed 100% fresh air system. This resulted in a BMS function for a
pandemic mode that can be initiated at times of higher public risk for increased air circulation rates. Additionally a bush fire mode for full recirculation was incorporated for the times when the outside air quality is lower than the indoor air quality due to bushfires in the state of Victoria. Echuca will be clouded in smoke for many days when the state has large bushfires. During these times increased presentations due to asthma have been known to occur. The overall HVAC system adopted includes individual comfort control to each room, individual room supply and return air, 100% fresh air system, heat recovery wheels in all AHU’s (up to 700kW), Bush fire mode, Variable geometry point of use diffusers and a central plant system. Currently the inpatient wards comprise 18.5% of building area but only consume 3.5% of fan, light and power consumption for the whole site. Coupled to the two solar absorption chillers and hot and cold water storage the site has a very low overall energy profile. This profile is currently subject to a study by CSIRO. BMS.
The site Building management system includes a high definition front end that is viewed from the engineer office and trades workshop. Standard functions such as monitoring of site energy and water consumption is logged and able to be reported on. Included in the redevelopment was the installation of temperature monitoring of all bedrooms and the position of all VAV
diffusers. Trending and monitoring is live and can be undertaken without the need to disturb patients. Thermostatic mixing valves are also monitored and automatically report when outside alarm set points. TMV trends have been used to identify building air leakage (ambient tracking) and consumption patterns. They have also been used to indicate hand washing practices which show patterns of usage for individual hand basins. This data can be used to assist with education of staff and helps with auditing. The BMS also controls the automated generator testing program which occurs weekly for one hour. During this time the generators take a portion of site load. The BMS also generates alarms for items of plant that have condition based maintenance programs such as air conditioning filter changes and town water filter changes. Links are also in place for the reporting of DALI light events which can aid re-lamping programs The DALI lighting system automatically dims ward lights at the end of visiting hours. The BMS is also linked to the FIP and isolations and monitoring can be seen from the BMS control screen. The suction tube system is also able to be seen from the BMS control screen to allow remote diagnostics to be undertaken. All exit and emergency lights test and report via software which allows a single point of interrogation. Essential services maintenance reports are automatically generated which assists trades to be streamlined in their maintenance practices. Full data logging and remote access is available to the engineer from anywhere in the world. As a result of the BMS integration the trades staff are moving more to an electronic interrogation and collection of information as part of their daily tasks and have embraced the information available to them at a push of a button.
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
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TECHNICAL PAPERS
Navigating the clean steam requirements of AS/NZS 4187:2014 ANDREW GAY I STERILIZER VALIDATION AUSTRALIA
The use of steam within Hospitals and Health Service Organisations (HSOs) stems back to 1876 when Charles Chamberland, a pupil of Louis Pasteur, developed what is believed to be one of the first pressure steam autoclaves (Harvey, 2011). After that time steam sterilisation became a normal part of procedures for the support of aseptic surgical techniques. Hospitals and HSOs began to utilise steam as a process heating source, and by the mid 1900’s facilities were being built with dedicated steam generation plants using steam reticulation for sterilisation, cooking, laundry facilities, hot water and building heating systems.
W
hilst the trend of using steam for the primary heating source is diminishing, there will always be a need to use steam as the preferred means for the sterilisation of Reusable Medical Devices (RMDs). In fact, the Australian Standard AS/ NZS 4187:2014, in describing the “Reprocessing of Reusable medical devices in health service organisation” states: “Critical RMDs shall be terminally sterilised by a validated moist heat sterilising process between uses on individual patients unless the RMD is heat or moisture liable and is not able to withstand the process.” (Standards Australia, 2014) And whilst steam or moist heat sterilisation remains the core method for terminal sterilisation of reusable medical devices in HSOs, the requirements for the quality of the steam have increased over time.
THE ISSUE High quality steam is required for the sterilisation of reusable medical devices. Specifications for steam quality are given in various European, International and National Standards,
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Normative and Guidelines with varying recommendations and requirements. Which of these requirements should we reference in regards to determining the appropriate specifications for steam quality at our facilities?
STEAM GENERATION AND STEAM QUALITY How do we produce steam for the sterilisation of RMDs in a manner that supports: • Patient safety • Reliability • Redundancy • Efficiency • Compliance In large scale, industrial steam boiler systems, process steam is generated from water which would normally originate from a municipal supply. The feedwater is often softened, preheated and maybe de-gassed before being pumped into the boiler drum as feedwater. Chemicals are added to the feed water and or boiler to assist in the management of suspended and dissolved solids, dissolved gases.
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
Steam quality will be dependent on how the steam system is engineered, configured, controlled and operated. Typically, large well managed steam generation and reticulation systems can produce high quality steam in a reliable manner, however, the trend towards smaller automated systems has resulted in many facilities struggling to produce steam to the required quality for steam sterilisation. The results of poor quality steam can be: • Wet steam due to low dryness fraction and or poor steam distribution design. • Higher than desirable noncondensable gases which may impede moist heat thermal penetration. • Higher than desirable super heat values which may impede moist heat thermal penetration and or damage the load. • High steam contamination levels leading to corrosion of the steam system and or damage to surgical instruments. • Load contamination of steriliser loads which may result in harm to patients.
TECHNICAL PAPERS
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TECHNICAL PAPERS STEAM QUALITY REQUIREMENTS OF AS/ NZS 4187:2014 The release of AS/NZS 4187:2014 seems to bring about new requirements for steam quality, however many of the requirements for steam quality have existed in normative and reference documentation for some time, though with no direct link to any specified limits. In the superseded AS/NZS 4187:2003, reference was made to AS 1410-2003 for steam quality; AS 1410 required: “The steriliser shall be designed to operate with steam that, on condensing, does not contain contaminants in sufficient quantity to impair the sterilisation process or harm the steriliser or sterilised load” (Standards Australia, 2003).
In addition, the reference to additional information on steam quality in AS/NZS 4187, Section A 7.2.3.2 is incorrect as this refers to the Department of Health [UK], (2013) Choice Framework for Local Policy and Procedures 01-01-Management and decontamination of Surgical Instruments (medical devices) used in acute care, Part D: Washer Disinfectors. This reference should be to Department of Health [UK], (2013) Choice Framework for Local Policy and Procedures 01-01 Management and decontamination of surgical instruments
(medical devices) used in acute care. Part C: Steam sterilisation. Diagram A below summarises the navigation between the reference documents and may be helpful in responding to AS/NZS 4187:2014 rationally in view of the changes to the reference document, EN 285. In addressing water quality, Table 1 below illustrates the requirements of each applicable Standard as to the recommended maximum values of
Diagram A – Recommended maximum values for contaminates in feed water for dedicated steam generators and steam supplied to the steriliser chamber.
In AS/NZS 4187:2014 there are updated references to steam quality which give more detailed specifications and limits for steam quality, however, since the publication of AS/NZS 4187:2014, the primary reference document EN 285 has been updated. With the publication of EN 285:2015 some references in the Australian Standard AS/NZS 4187:2014 to EN 285 are now incorrect. Table 1. Steam quality requirements comparison – contaminates in condensate from steam supplied to the steam steriliser chamber Determinant
EN 285:2015, Table 4:
ISO 17665, Table A.1:
ISO 17665, Table A.2:
“Suggested maximum values of contaminates in condensate from steam supply to the steriliser chamber”
“Contaminates in condensate measured at the steam inlet to the steriliser to be considered in relationship to the corrosion of materials”
“Contaminates in condensate from steam used by the steriliser to be considered in relationship to contamination of the load”
Appearance
Colourless, clear without Sediment
Colourless clean without sediment
Clear, Colourless
Degree of acidity (pH)
5 to 7 (@20°C)
5 to 7
Ra
Conductivity at 25ºC (uS/cm)
≤ 4.3 µS/cm (@20°C)
≤3 µS/cm
≤35 µS/cm
Total hardness, CaCO3 - mg/L (Σ ions of alkaline earth)
≤2 or (0.02 mmol/l)
≤2 or (0.02 mmol/l)
Ra (mg/l)
Chloride, Cl (mg/L)
≤ 0.1
≤0,1
≤0,5
Heavy metals, determined as Lead, Pb (µg/L)(mg/l)
≤ 0.1mg/l
≤0,05 mg/l
≤0,1 mg/l
Iron, Fe (mg/L)
≤0.1
≤ 0,1
Phosphate, P2O5 (mg/L)
≤ 0.1
≤0,1
≤0,1
Silicate, SiO2 (mg/L)
≤ 0.1
≤ 0,1
≤0,1
Bacterial endotoxins (EU/mL)
-
-
≤0.25EU/ml
Residual on evaporation
-
-
≤30 mg/l
Cadmium
≤ 0.005mg/l
≤ 0,005 mg/l
-
Rest of heavy metals except iron, cadmium, lead
-
≤0,1 mg/l
-
a
Ammonium (NH4)
-
-
≤0,2 mg/l
Nitrate (NO3)
-
-
≤0,2 mg/l
Sulphate (SO4)
-
-
Ra (mg/l)
Oxidisable substances
-
-
Ra
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
TECHNICAL PAPERS
Contamination within a reusable sterilisation container form chemical carry over of a steam boiler.
contaminates in feed water being supplied to dedicated steam generators and the contaminates of the steam being supplied to steriliser chambers. Table 2 below illustrates the requirements of EN 285:2015 and ISO 17665-2:2009 as to the recommended maximum values of contaminates in feed water being supplied to dedicated steam generators and the maximum contaminates tolerable for the final rinse water.
In addressing steam quality, in particular dryness value, superheat, and non-condensable gases, EN 285:2015 can be used as this Normative now aligns with requirements of AS/NZS 4187:2014 in describing the minimum steam dryness value of 0.95. It should be noted that steam quality testing of dryness value, superheat, and non-condensable gases is only a mandatory requirement at IQ and OQ (Installation Qualification and Operational Qualification). Annual testing for steam dryness value, superheat and non-condensable gases is optional and could be used as an investigative tool to determine root cause of a nonconforming process.
Annual feed water quality testing for sterilisers fed via dedicated nonchemically treated steam generators is required by AS/NZS 4187:2014. Annual steam contaminate testing is also mandatory for sterilisers serviced via centrally generated steam.
Chloride corrosion on a surgical instrument resulting from poor water and steam quality.
Table 2. Comparison of AS/NZS 4187:2014 Final Rinse Water (Standards Australia, 2014), and EN 285:2015, Table B.1 Steam Generator Feed Water (British Standards Institution, 2015). Determinant
AS 4187:2104, Table 7.2:
EN 285:2015, Table B.1:
Final Rinse Water
Contaminates in Feed Water to dedicated Steam Generators
Appearance
Clear, colourless
Colourless, clear without Sediment
Degree of acidity (pH)
5.5 to 8.0
5 to 7.5 (@20°C)
Conductivity at 25ºC (uS/cm)
30
≤ 5µS/cm (@20°C)
Total dissolved solids (mg/100 mL)
4
-
Total hardness, CaCO3 - mg/L (Σ ions of alkaline earth)
50
≤2 or (0.02 mmol/l)
Chloride, Cl (mg/L)
10
≤ 0.5
Heavy metals, determined as Lead, Pb (µg/L)(mg/l)
10
≤ 0.05mg/l
Iron, Fe (mg/L)
2
≤0.2
Phosphate, P2O5 (mg/L)
0.2
≤ 0.5
Silicate, SiO2 (mg/L)
0.2
≤1
Total viable count (TVC) @ 22ºC (cfu/100 mL)
100
-
Total viable count (TVC) @ 37ºC (cfu/100 mL)
100
-
Bacterial endotoxins (EU/mL)
0.25
-
Residual on evaporation
-
≤ 10mg/l
Cadmium
-
≤ 0.005mg/l
a
Steam quality testing does not apply to steam sterilisers (defined by EN 13060:2014) that utilise distilled or reverse osmosis water for steam generation.
CLEAN STEAM “Clean Steam” was a term which was mentioned in Table E.2 of EN 285:2009 (British Standards Institution, 2006) and remains in ISO 17665-2, Table A.2 (International Organisation for Standardisation ISO, 2009). The term has been embraced by industry to describe steam generation and supply systems which are carefully engineered and constructed in such a way that contamination of the steam supply to the steriliser, and or the steriliser load is achieved at levels below those specified in Table A.2 of ISO 176652 (International Organisation for Standardisation ISO, 2009). These systems are often constructed from 316L stainless steel, fed with water from Reverse Osmosis, and are not chemically treated.
WATER SUPPLIED TO WASH AND RINSE PROCESS WITHIN THE RE-PROCESSING ENVIRONMENT The 2014 revision of AS/NZS 4187 also nominates minimum water quality standard for all wash and final rinse water used for the re-processing of reusable medical devices. Of interest is the requirements for final rinse water which could be either demineralised, reverse osmosis, or distilled water (Standards Australia, 2014). This final rinse water requirement is close in specification to the feed water required
Staining and rouging of a steam steriliser chamber.
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
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TECHNICAL PAPERS
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
TECHNICAL PAPERS (Standards Australia, 2014) and EN 285:2015, Table B.1 Steam Generator Feed Water (British Standards Institution, 2015).
CONCLUSION Wet and contaminated sterilised items resulting from poor quality steam.
for dedicated, non-chemically treated stream boiler or generators, therefore, there may be opportunities to combine the specifications of both to derive a single specification for both final rinse activities and steriliser steam generator feed water. Further, monthly testing to the water supplies for washing and final rinse are required under the Standard (Standards Australia, 2014), therefore, the sharing of the demineralised, reverse osmosis, or distilled water supply could introduce some synergies. Note: the higher quality specification of EN 285:2015, Table B.1 (British Standards Institution, 2015) for feed water could be used as the production target values, leaving the maximum recommended contamination values specified in AS/NZS 4187:2014, Table 7.2 (Standards Australia, 2014) as operational limit points. See Table 2 for a comparison of AS/ NZS 4187:2014 Final Rinse Water
It is important for Health Service Organisations to understand and implement the requirements of AS/NZS 4187:2014 and identify the quality of water required for each phase of each process, applicable for the intended product. The establishment of maintenance, testing and monitoring programs for steam steriliser steam systems will be a critical factor in the delivery of patient care.
BIBLIOGRAPHY British Standards Institution, 2006. Sterilisation – Steam Sterilisers – Large Sterilisers, BS EN 285:2006+A2:2009 (Withdrawn, Revised). British Standards Institution, London. British Standards Institution, 2015. Sterilisation – Steam Sterilisers – Large Sterilisers, BS EN 285:2015 (Current). London: British Standards Institution. British Standards Institution, 2014. Small steam sterilisers, BS EN 13060:2014 (Current). British Standards Institution, London. Department of Health (UK), 2013. Choice Framework for local Policy and Procedures 01-01 – Management and decontamination of surgical instruments (medical devices) used
in acute care. Part C: Steam sterilisation. Department of Health (UK), London. Department of Health (UK), 2013. Choice Framework for Local Policy and Procedures 01-01-Management and decontamination of Surgical Instruments (medical devices) used in acute care, Part D: Washer Disinfectors. Department of Health (UK), London. Harvey, Joy (May 2011). Chamberland, Charles Edouard. (Online) (Accessed 30/10/16). Available from: http://www. els.net [doi: 10.1002/9780470015902. a0002750]. International Organisation for Standardisation, ISO 2009, Sterilisation of health care products — Moist heat — Part 1: Requirements for the development, validation and routine control of a sterilisation process for medical devices, ISO 17665-2:2009 (Current). International Organisation for Standardisation, Geneva. International Organisation for Standardisation, ISO 2009, Technical Specification, Sterilisation of health care products — Moist heat — Part 2: Guidance on the application of ISO 17655-1, ISO 17665-2:2009 (Current). International Organisation for Standardisation, Geneva. Standards Australia, 2003. Sterilisers – Steam – Pre-vacuum. AS 1410-2003 (Current). Standards Australia, Sydney. Standards Australia, 2014. Reprocessing of Reusable medical devices in health service organisations, AS/NZS 4187:2014 (Current). Standards Australia, Sydney.
OUR COLUMNLESS FLOOR BED IS FINALLY HERE! Smooth rounded corners for added safety
MAIN FEATURES Shorter overall • NO BULKY END COLUMNS to facilitate external length full view of patient and room environment. • ONLY 130 mm HIGH to the top of platform when lowered • OH&S FRIENDLY 75mm CASTORS tucked under the bed frame for safety. No tripping hazards • German made HIGH QUALITY ‘DEWERT’ ELECTRONICS • Sealed bed head and foot board for infection control • MANUFACTURED IN AUSTRALIA to AS/NZS3200.2.38.2007 & IEC60601-2-52. TGA Registered. Optional side rails, self help pole and IV pole
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(03) 5248 8369 | www.uniquecare.com.au THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
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TECHNICAL PAPERS
Energy management visualisation: Data to Information
JAMES DILIBERTO I DIRECTOR OF ENGINEERING, AZZO AUTOMATION
DATA TO INFORMATION
I
n the last 5 years, breakthroughs in electronics have brought personal healthcare to the masses through wearable devices and intelligent mobile apps. With the introduction of devices like the Fitbit and Apple Watch, weight loss and cardiovascular health have become a social trend – and it’s success has been augmented by the power of social networking and sharing progress. When you stop to think about it – it’s not too long ago that measuring one’s heartrate over time and looking for anomalies could only be done by a doctor with an ECG machine or the amount of steps one took in a day could by a pedometer clipped to one’s belt. And even then, the ability to track it all over time took a lot of paper print outs and clipboard records. For most, even if you had the raw data – there was no simple way to visualize the results, evaluate progress against typical behavior, or receive intelligent alarms on exception. But those days are gone now and this generation is the first to have the ability to cost effectively measure their indicators, visualize the results in a meaningful easy-to-understand way, and make informed decisions about their health. Unfortunately, in most cases, we don’t see the same principles applied to the healthcare facilities being managed today, with respect to power and energy in particular. Healthcare facilities are arguably the most critical assets supporting society – they are 24/7/365 operations whose ability to support ourselves and loved ones in time of need depends on their reliable operation. Not only that, but their ability to keep up with the latest technologies to do that is dependent on their ability to run efficiently and eliminate costly energy waste so that those much needed funds can be channelled to quality patient care. To achieve this, healthcare facilities need to not only measure their energy and infrastructure ‘health’ in key areas and but then also present that data in a meaningful way with business intelligence and analytics already performed to help FMs make informed decisions, fast. We know that many older facilities have very little measurement instrumentation and in the cases where it does exist, many do not have any communications interface. But even in new facilities which have communicating instrumentation, if it is indeed connected to anywhere, the data largely remains logged in raw engineering units in database tables which few can access, and if they did, would be left to analyse the data manually, and out of context of the time it was needed, now stale. For the rest of this article, I will give a
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
case study example of how various platforms can be designed to turn data into meaningful content, smart notifications, engaging interfaces, and high function control systems with the ability make decisions in response to periods of high demand or inefficiency.
BACKGROUND I was prividedged to lead my team on the South Australian Health and Medical Research Institute (SAHMRI) in Adelaide where we designed, commissioned, and continue to maintain the Energy Management and Demand Control System (EMDCS), which itself forms an integral part of the Integrated Building System (IBS) by Schneider Electric. SAHMRI is South Australia’s first independent flagship health and medical research institute, significantly increasing the nation’s capacity for leading scientific research. It is a world-class precinct of medical research and clinical application, with state of the art laboratories and equipment in a purpose-built, iconic, 25,000 square-metre facility, adjacent to the site of the new Royal Adelaide Hospital. The Client Group aimed to construct a medical research institute with a high level of flexibility to accommodate various types of research. The functional areas included: • A Gross Floor Area to accommodate 675 medical researchers • Wet and dry laboratories, Physical Containment Level 2 and Quarantine Containment Level 2 • Preclinical bio-resources centre • Molecular Imaging Therapy and Research Unit including a Cyclotron for radioisotopes manufacture • Cluster of public access/education space including an auditorium • Facility supporting infrastructure and research infrastructure. Operational efficiency and keeping costs down is critical to any health facility to ensure that the maximum amount of funds are going to innovation and research. SAHMRI chose to use a “CAPEX to minimize OPEX in the future” model and energy efficiency measures were implemented from the start as an integrated part of the facility, using innovation instead of the conventional approaches. SAHMRI’s hub of dynamic activities is now fully operational and focused on achieving great medical research outcomes that will strengthen the clinical capability across Australia’s health system.
TECHNICAL PAPERS ENERGY MANAGEMENT AND DEMAND CONTROL SYSTEM
COLLABORATION
• Variable Speed Drives with Integrated Metering for Monitoring and Control of Mechanical Plant Equipment
In today’s environment, anyone who refuses to collaborate is destined for failure. In a connected world, which is much smaller now in professional experience than it used to be, some of the best outcomes are achieved when partners with mastery in different areas work together to innovate. SAHMRI was a pleasure to work on because of the high degree of collaboration involved. In an innovative project delivery model, the client SAHMRI was intensely involved during the whole construction and commissioning process, pushing the limits of design innovation in every aspect. AZZO worked closely with SAHMRI on design and control strategies for the EMDCS, which resulted in great results achieved at commissioning time, with few surprises. Schneider Electric was responsible for delivery of the IBS, of which the EMDCS was a critical part, and they engaged AZZO as a key partner for specialist engineering design and electrical contracting works, bringing the expertise to implement our most advanced monitoring and control system. Nilsen Electrical Contracting was responsible for delivering the electrical infrastructure required for the IBS, and in particular AZZO’s EMDCS. They worked closely with our engineers to ensure the correct product selection, architecture, and reliable control system programming strategy. Cundall was the sustainability consultant for LEED and was supported by AZZO’s engineers during the design and commissioning stages to ensure the datasets were accurately monitored and the reporting results were calculated in accordance with the standards required for LEED certification.
• Intelligent Power Factor Correction with Touch-Screen Controllers
CHALLENGES
Integrated Building System (IBS) innovation includes an Energy Management and Demand Control System (EMDCS), Building Management System (BMS), Security Cameras (CCTV), and Access Control. For the scope of this article, I will be focusing on the EMDCS delivered by my company AZZO (subcontracted under Schneider Electric’s BMS works) which consisted of: • Peak Load Lopping/Shaving and Load Shedding Control System • Energy Management Software for Real-time and Historical Data Visualisation and Reporting • Electrical Network Power Quality Analysis • Emergency Backup Power System Testing • Public Display LEED Dashboards + Live In-Context Energy Footprinting • Intelligent Circuit Breakers with Integrated Metering/ Network Monitoring • Power Quality Analysers and RTUs with Supervisory Programming • Electrical Distribution Power Network Stability Metering • General Lighting, Power, and Mechanical Energy & Demand Metering
• Water and Gas Pulse Metering with Intelligent Virtualisation of Hydraulics • Backup Diesel and Gas Generator Controller Interfacing • Structured Cabling and IP Communications Layer with Diagnostics • Integrated SQL Database with a full redundant Disaster Recovery Given the complexity of the facility and the critical nature of its operations – an advanced system was designed and implemented to ensure power availability and provide contextual usage data for staff engagement to ensure sustainability. AZZO used these components in delivering the EMDCS: • Schneider Electric StruxureWare Power Monitoring Expert: Health Care Edition + Emergency Power Supply System Test Solution • Schneider Electric PowerLogic ION metering and NSX Breakers • Schneider Electric EGX Ethernet Gateways and Altivar VSDs • ABB RVT Colour Touch Screen PFC Controllers • AZZO Custom Modules: Xpert Trending Analysis, Diagnostics, Diagrams, Navigation, and Reports (Sustainability & Cost Management)
The EMDCS is a system that needed to reliably integrate with numerous other systems on site seamlessly. A challenge we faced was to ensure that the supervisory metering systems were all able to communicate over the structured cabling IP network and be completely independent of any PC computer systems – remaining stand-alone for control, and while still reporting to those platforms. During the commissioning phase, there were some challenges in getting mechanical, electrical, and controls systems online and the EMDCS provided the data and root-cause analysis to find many resolutions in a timely manner. Some project elements would have been delayed by months, were the EMDCS not fully operational and delivering the power quality insight needed for resolution. Systems integration addresses the complexity and flexibility required for the purpose-built facility. It optimises the facility by incorporating and monitoring all the required physical components and their exact usage, thereby providing data for accurate and timely maintenance planning. In addition, it rapidly reports on failure, alerting the people who need to know and triggering a chain of events to effectively manage the failure. AZZO’s EMDCS provides real-time monitoring of the electrical network including incoming electrical supply, backup generator supply, and the LV distribution of electricity, as well as water and gas consumption, giving SAHMRI the
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
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TECHNICAL PAPERS data necessary to continuously improve energy efficiency and operational costs throughout the facility’s life cycle.
INNOVATION SAHMRI didn’t settle for an ordinary solution, on all levels, and ensured a completely integrated design with intelligent systems throughout the facility. It is the first of its kind in the world and the goal for the entire project was to think beyond the traditional approach and be extraordinary. We were all required to hand over the project with no defects. There was not any room for errors. The implementation of the EMDCS’s peak load lopping system, using the local on-site emergency power generation, coupled with dual fuel technology, reduces operational costs by decreasing ongoing electricity demand changes, and assists with site peak load management. The EMDCS’s ION Power Quality Analysers are also supervisory controllers with independent oversight of all power and energy sources in the building at <1 second resolution, with low and high level interfaces to all of the major systems on site including the BMS, Generators, Mechanical Plant, and ATS systems. As part of an innovative sustainability program, the project is the first laboratory building in Australia designed to achieve a Leadership in Energy and Environmental Design (LEED) gold rating. The EMDCS and its public display of energy, water, and gas consumption was a requirement for this. To ensure optimal network performance, which is vital to research efficiency, SAHMRI led the implementation of the intelligent patching technology iPatch – a unique solution that gives system managers a real time view of the network physical layer. SAHMRI is the first facility on the planet to implement the imVision System Manager Version 7.0 SP3 system.
ILLUSTRATION Back in Septemeber 2016, South Australia recently experienced the it’s first entire state electrical black out since the night the Beatles arrived to Australia in 1964. It’s not the only time that power has been interrupted or distubrances seen in Adelaide’s CBD, but was the longest and most pronounced. Thankfully, SAHMRI had the EMDCS in place on the night took place as it was able to visually represent the network and provide a visual interface for all of the backup power systems, some of which had issues starting up and changing over. This meant that the building was only running on one of the two make backup generators. Thankfully, staff were able to visualize network at the time and help identify the faulty equipment, and get back online as fast as possible with both generators online. Furthermore, after the restoration of power, our teams were able to log in and run an EPSS report on the whole outage and see every edge change from power loss to restoration and everything in between. This gives management, tenants, staff, and maintenance visual insight into the reliability of the power distribution on site and give everyone confidence that in the worst case scenarios,
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
the systems are functioning as designed, and when there are fault, it is easy to visualize, diagnose, and rectify, to ensure that backup power is delivered reliably.
CONCLUSION SAHMRI is a great example of what can be done when a whole building full of intelligent systems and measurement instrumentation is available on a common network and visualized in a system capable of turning that data into actionable information and insights into the building as a whole. With the Peak Load Lopping / Load Shedding system, thousands of dollars can be saved by mitigating peak-demand augmentation and keeping critical systems up and running in the event of an outage. The Generator Maintenance and Outage Insights provide visual ways of ensuring that the backup hardware assets are functioning reliably. Facilities Management is able to track Water, Gas, and Electricity on their LEED Dashboards and easily identify waste patterns, allocate cost budgets for utilities internally and for tenants, and maintain maximum operational efficiency and asset management. For all of this, having data is not good enough – but having a system which can turn that data into information is something that all modern healthcase facilties should be proactive in investing in for both everyday ops and emergencies.
ABOUT THE AUTHOR • Director of Engineering for the AZZO group of engineering firms, based in the VIC office • He leads a team of engineers who have recently been awarded the top global title of EcoXpert Critical Power Master, by Schneider Electric – and who co-develop their Energy Management software/hardware solutions • As an Electrical Engineer and Certified Energy Manager by the Association of Energy Engineers, he has built energy management and control solutions for almost 10 years • James and his Adelaide firm were the energy management system integrators on all three facilities we have toured at this conference, SAHMRI, nRAH, and right here at the Adelaide Oval as well as others to be presented • His extensive knowledge of power monitoring and control applications in healthcare facilities has placed him in a great position to share the details of these case studies with us all today
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TECHNICAL PAPERS
Special requirements in UCV theatres GRAEME HALL I MANAGING DIRECTOR, BRANDON MEDICAL
Graeme Hall FIHEEM, MIET, managing director of Brandon Medical, considers in detail the particular requirements and criteria for operating lights used in ultraclean ventilation (UCV) theatres, and explains how the recent establishment of a standard for testing of such lighting’s suitability for theatre environments will help designers and manufacturers, as well as those specifying UCV theatre illumination, going forward.
U
ltraclean ventilation (UCV) systems were originally developed in the UK to reduce infection rates during hip replacement surgery. The first artificial hips were developed by Prof. John Charnley, a famous British orthopaedic surgeon who, having spent a period professionally at Manchester Royal Infirmary in the late 1940s (having been appointed a joint honorary assistant orthopaedic surgeon there in 1947) subsequently established a pioneering hip surgery centre at Wrightington Hospital in Lancashire. During this ‘pioneering’ period, having encountered a high incidence of infections during such surgery, Prof. Charnley traced the source of infections to airborne particles falling into the wound, most of which were skin cells from the surgeons and clinical staff in the theatres. Prof. Charnley enlisted the help of a local specialist in clean air systems to develop the first ultraclean ventilation systems for surgery. Sir Hugh Howorth and his company developed the first systems to ‘drop’ clean filtered air down onto the patient, and create a flow from the patient and away past the clinical staff, thus sweeping any contamination away from the surgical site. The air is ‘scrubbed’ clean of bacteria and dust by HEPA filters and chilled below the temperature of the operating theatre, to help it drop down vertically over the patient.
34
Brandon’s Quasar eLite 60 operating theatre lights in situ in a UCV theatre.
INTRODUCING CEILINGMOUNTED LIGHTS There is a very obvious issue created for ultraclean ventilation when a ceilingmounted operating light is introduced. The surgeon has to place the operating light above his head in the clean air, where it forms a major obstruction to the air flow. The lights also get warm, which creates thermal buoyancy,
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
warming the air around the light head, which in turn tries to rise against the flow of chilled air from the UCV system. The combination of these two factors leads to turbulence in the clean air flow, and reduces the effectiveness of the UCV in delivering consistently clean air over the surgical site, with a corresponding increase in surgical site infections.
M
Y
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TECHNICAL PAPERS Professor Charnley and Sir Hugh Howorth looked for an operating light manufacturer which could develop a low turbulence light for UCV theatres. Brandon Medical already worked with Thackrays, which manufactured the Charnley hip joints, and was the only British operating light manufacturer, so was an obvious choice. Brandon Medical designed the first operating lights specifically for UCV applications, and it has been one of our key areas of expertise ever since.
DEVELOPING THE FIRST OPERATING LIGHTS FOR UCV THEATRES The original UCV operating lights were developed by Brandon over 40 years ago, before the advent of computeraided engineering. Empirical testing was used to develop the best shape of light to minimise turbulence Quasar head Advert Getz.pdf 1 28/11/2016 9:53of AM the relatively low speed airflow, with the light head set in different positions
and at different angles, as it would be during surgery. Empirical tests were undertaken to measure and minimise the turbulence of the lights in every position. Finally, a set of design rules were created for the best shapes which can be used to design suitable airflow lights. At the time of the development, all operating lights used incandescent light sources â&#x20AC;&#x201C;generally tungsten halogen â&#x20AC;&#x201C; which creates a considerable amount of heat. In order to achieve the best shape and an effective thermal design, a reticulated design was necessary (pods mounted in a space frame). A reticulated design has a much higher surface area than single cupola design, allowing for a lower surface temperature and fewer heating issues. Lights with a cruciform or torroidal design (â&#x20AC;&#x2DC;doughnutâ&#x20AC;&#x2122; shape) also increase the surface area, but create a larger flow impediment.
Although reticulated lights have been used in UCVs for many years, and can be made to work very well, they are harder to wipe clean after surgery. LED is now the default light source for operating lights, and the considerable increase in such lightingâ&#x20AC;&#x2122;s efficiency has reduced the heating problem considerably, making it possible to design operating lights with low thermal buoyancy, that are also easy to clean.
PROVING SUITABILITY One of the issues in demonstrating the suitability of operating lights for use in UCVs is the lack of available standards. The effectiveness of the original design was proven by measurements of airflow with the lights mounted in a Howorth UCV system. The measurements tested the airflow in the UCV airflow, and smoke tests were carried out to visually check for turbulence. The UK standard governing UCV systems is HTM 03, which sets out an
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TECHNICAL PAPERS initial performance test to demonstrate that the UCV ceiling can achieve the minimum airflow across the whole of the ‘sterile’ zone. This is undertaken by marking out a 1 m grid on the floor under the UCV ceiling, and taking airflow measurements at 1 m intervals. However, the test is undertaken without any obstructions, with the operating table and operating lights removed. The HTM 03 test only tests the UCV as a standalone system, and ignores the turbulence that will be introduced when an operating light is fitted. The only assistance as regards operating lights in HTM 03 is advice that reticulated or cruciform operating lights should be considered for use in UCV theatres. This is of little help to the designer of operating lights, as there is no objective test or standard to test to.
TESTED IN ‘REAL LIFE’ SITUATIONS Brandon Medical’s solution was to test its lights in “real life” situations. A partner was sought to perform scientific testing of the effectiveness of combinations of UCV ceilings and operating lights during live surgery. The University Hospital of Oslo (Rikshospital) had two adjacent, brand new UCV theatres, and was carrying out research into new UCV systems, so was the ideal partners. Rikshospital used four particle counters in each theatre to measure cfus (colony-forming units) at four points under the UCV ceiling during live surgery, with up to 11 clinical staff in the theatre. Brandon Medical’s Galaxy range of reticulated operating lights were tested in one theatre, and conventional lights from another manufacturer in the adjacent theatre. The results, which were widely published in academic journals, clearly demonstrated the suitability of the reticulated lights, and the poor performance of conventional operating lights, to the theatre environment. The Rikshospital results were corroborated in the laboratory in controlled conditions by installing them in the test laboratory at Weiss Klimatechnik in Germany. Here it was possible to make detailed measurements of the airflow conditions with the operating light in
every conceivable position relative to the incident airflow, and to prove the suitability of the design.
EXPENSIVE AND TIME-CONSUMING However, the investment in cost and time to perform this thorough level of ‘real life’ and scientific testing is too expensive and time-consuming for all manufacturers to follow, so attempts were made to develop a quantitative test. The majority of operating light manufacturers are located in Germany, so they led the way in developing a measurement of suitability, resulting in a measurement called the ‘Laminar Flow Index’. Two different theoretical models of Laminar Flow Index were developed, resulting in formulae that can be applied to any operating light, but they were ‘skewed’ towards the German manufacturers’ designs. Neither of the Laminar Flow Index models was adopted by a recognised national or international standards body, as there was a lack of independent evidence that the Laminar Flow Index was a good measure of suitability of lights for UCV.
the tests, as personnel there carried out much of the pioneering work in developing the DIN1946 standard, and the university is accepted as the leading centre of expertise, with fulltime testing facilities. The two-part test is undertaken with a single operating light head in a compliant UCV canopy. The first part is a test for thermal buoyancy from the operating light, to see if it creates an upstream air current in the reverse direction to the UCV supplyair direction. The test is carried out by positioning the operating lights in a carefully specified position as set out in DIN1946 (light head inclination: 45 degrees, light centre: 1.0 m below the UCV diffuser), and warming the lights up to operating temperature.
A PROPER STANDARD AT LAST It has taken a long time, but at last there is a standard for testing the suitability of operating lights for UCV theatres, DIN 1946 Part 4 (12-2008). It was originally proposed in draft format in 2008, and is now published. Although it is a German national standard, it can be treated as advisory in much the same way as our own HTMs. The advantage is that it is a recognised and regulated national standard that gives a clear ‘pass’ or ‘fail’ result for the suitability of operating lights for UCV theatres. It also provides a quantitative measure for the turbulence from the operating lights, enabling alternative models from different manufacturers to be compared. Brandon Medical has submitted its latest Quasar eLite 60 and Quasar eLite 30 operating lights for testing to the new standard. The University of Giessen was selected to perform
Figure 1 and Figure 2: The temperature probe positioning and the thermal camera image, during the testing at the University of Giessen in Germany.
USE OF A THERMAL CAMERA The operating temperature is first established by using a thermal camera to find the hottest part of the light head, placing a thermocouple at the hot spot, and measuring the heating up characteristic of the operating lamp. The operating light has to be set to produce > 70,000 Lux at 1 m from the
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
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TECHNICAL PAPERS light while the thermal test is carried out. The Brandon Medical Quasar eLite was set at a slightly more stringent 90,000 Lux at 1 m, and thermal equilibrium was reached after around 60 minutes. Figures 1 and Figure 2 show the thermal camera image and temperature probe positioning.
Figure 3: Turbulence – Quasar eLite 60. 22
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The test for lift (upstream air current) is performed by introducing an aerosol fog 50 cms above the light head and then 150 cms below the light head. There is a visual check that none of the aerosol rises, which would be a test fail.
Test Report
Tu (%0)
v (m/s)
T-zu (°C)
Average
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0.2
20.6
DEGREE OF TURBULENCE
Standard Deviation
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0.07
0.23
Coefficient of variation
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1
Minimum
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The second and main part of the test measures the degree of turbulence. As with the HTM tests for UCV ceilings, a grid is marked out on the floor under the UCV ceiling, but in 30 cm squares to determine the measuring points. Thermal anemometer probes are set up at the measuring points, 1.0 m above finished floor level, and 0. 8m below the centre point of the light head. Three sets of turbulence measurements are taken – the first without the light head to show the background level of turbulence from the UCV unit itself, the second set with the light in position (the same position as for the thermal buoyancy tests) but cold (turned off and cooled down to at least the temperature of the UCV air flow), and the third set of measurements is taken with the light in position and at working temperature. The results for the Brandon theatre lighting measured at Giessen are shown in Figures 3 and 4 for the Quasar eLite 60 and Figures 5 and 6 for the Quasar eLite 30. The figures for both lights show ‘no lift effect’ in the thermal buoyancy test, and easily meet the turbulence threshold of < 37.5%. Dr Siepp, Professor of Technical Building Equipment in Hospitals at the University of Applied Sciences in Giessen, commented that both models of lights have ‘remarkably low operating temperatures’ of only 21.8 °C and 26.6 °C respectively, and that the Quasar eLite 30 in particular has the lowest turbulence of any light so far measured under the standard, at only
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Coordinates Figure 4: Parameters – Quasar eLite 60.
Boost 50 cms above
No
Boost 150 cms above
No
Figure 5: Turbulence – Quasar eLite 30. 20
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Tu (%)
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T-zu (°C)
Average
22
0.2
20.4
Standard Deviation
19
0.04
0.16
Coefficient of variation
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20
1
Minimum
3
0.11
20.2
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Boost 50 cms above
No
Boost 150 cms above
No
22% (with background UCV turbulence of 7%).The Quasar eLite 60 turbulence score was 31% (with background turbulence of 7%), which equalled the previous best of lights tested.
CONCLUSION There are lots of different models of operating lights, all of which will cause at least some degree of turbulence in a UCV air flow. Some manufacturers, but not all, design their lights to minimise
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
this turbulence to an acceptable level. There is now a practical test to measure the suitability of operating lights for UCV theatres, to quantify the turbulence they create, and to compare the products of different manufacturers. DIN 1946 part 4 (12-2008) is the only test currently available to do this, and should be considered as setting out the key specification criteria when selecting operating lights for installation in ultraclean ventilation theatres. When selecting operating lights for UCVs, air flow turbulence is important, but it is not the only factor to consider. Lights in orthopaedic surgery get splashed with blood and body fluids, which have to been cleaned off between patients. There seems little point investing in ultraclean ventilation to reduce infection rates if lights cannot be cleaned effectively and become an infection risk. The ease of cleaning and disinfecting of the lights should be considered carefully. The shape should be easy to wipe clean, there should be minimal split lines in the light head enclosure, and no exposed fasteners, nooks and crannies, hard-to-clean handles, or soft gaskets which allow contaminants to be pushed under the edges. Some operating lights include antimicrobial agents in the materials of the lightheads, which is an added bonus in disinfecting the lights, but not, however, an alternative to effective cleaning. The latest LED operating lights can be designed as single cupolas that still have excellent air flow suitability and are clean.
ABOUT THE AUTHOR Graeme Hall is a Chartered Engineer, a Fellow of IHEEM, and a member of the IET. He has over 23 years’ experience in research, design, and development of operating theatre equipment, including LED operating lights, operating lights for UCV systems, medical pendants, and high colour rendition lighting. He is managing director of Brandon Medical.
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The FOCUS Laminar and UVC range caters to a range of operating theatre requirements; from day surgeries and surgical rooms with less demanding airflow requirements through to orthopaedic and neuro surgical operating theatres, where deep wound surgery is carried out and there is a high risk of hospital-acquired infection via airborne routes.
• Modular construction • Simple integration with other ceiling mounted equipment • Optional perimeter lighting (including COI compliant LED) • Complies with Australian Council on Healthcare Standards (ACHS)
The integration of the theatre ventilation, lighting and return air provide a controlled sterile, clean field, for the operating theatre team which has a significant cost and quality advantages compared to traditional theatre ceiling solutions. Adopted by many of the major hospitals around Australia, Airepure FOCUS Systems provide the optimum cost effective solution for new and existing operating theatres. Superior Air Quality Through Strict Design Targets Airepure FOCUS Systems are the result of extensive design development through research, CFD modelling and refinement from many years of successful installations; and comply with local ACHS guidelines for air flow at the operating zone, and international standards including the air quality standards nominated in UK HTM-03 and the European standard ISO/DIN 1946-4 (2008-12). Installation Cost and Energy Saving Cost savings are acheived by reducing onsite labour requirements with the provision of a factory built unit and construction that is quick to install on site minimising the complex coordination required with traditional theatre ceiling systems. Available with the option for return air facilities and COI compliant, energy efficient perimeter LED lighting, the unique Airepure FOCUS Systems provide operational cost savings in addition to installation cost benefits. With the extensive experience gained through a great diversity of theatre projects the Airepure team can assist with the theatre ceiling planning and coordination with the theatre surgical lighting and medical gas and services pendants available from a variety of suppliers.
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CFD modelling diagram for Focus 3000 with integrated perimeter lighting and return air grilles.
FOCUS Laminar and UVC Range Models Model *Purpose FOCUS 1000 ST/DP FOCUS 2000 GS/O FOCUS 3000 O/MS
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
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TECHNICAL PAPERS
Cleaning water to CSSD our R.O story MARK MCCAUGHAN I MAINTENANCE ENGINEER, MERCY HOSPITAL DUNEDIN NZ – 2016 ANZEX DELEGATE
We take so much care today. Recording everything, having procedures for the smallest of tasks, every process being documented: covering every possible detail that can affect the running of a modern hospital.
I
s there anything we take for granted? For us, it was water – our domestic water supply to our CSSD Department. Water quality had never been questioned and our washers seemed to work adequately. Then a redevelopment of the CSSD that included the installation of new washers took place. We had gone to much expense to improve our steam quality and our air supply and were testing these regularly. But still we took the water supply to our new washers for granted. It wasn’t until the new washers quite quickly started showing signs of dulling in the chambers, and instruments showed signs of pitting and excessive wear, that we reluctantly started to think about our water supply.
New boiler installation
For a week the lines were flushed, pumps stripped, washer hoses replaced and still we were getting specks in the washers. This was putting a huge work load on the CSSD staff, who were having to hand wash everything. One micron filters were fitted to the main feed line to the three washers. We still had problems. Not until a second set of filters were fitted at each machine did we feel confident to use the washers again.
CSSD upgrade
We also had other cracks starting to show. When replacing the main hot water supply line to the washers, we treated this supply line like any other domestic copper water line with joints brazed and line flushed. So not only were we facing the dulling issue, but now black specks also started to appear on our instruments after being washed as a result of the brazing, thus exacerbating the problems we were already having.
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
Hospital installation of filters
TECHNICAL PAPERS But what was causing the stainless chamber to dull? Calcium was starting to build up in the chambers. Heating the water to 80°C was causing the calcium to precipitate out. Silicates and chlorides could also be causing problems. At this stage, a new set of eyes was needed. We approached water quality experts to look at our washers and produce recommendations. They found our mains water was low in calcium and silicates, with silicates being particularly low as were chloride levels. However, even lower levels were need for good cleaning results. The bottom line: we needed to improve water quality for the last rinse cycle of the machines. A Reverse Osmosis (“RO”) water system producing very pure water was needed. Would it stop the calcium build up and at what cost? RO plant out of Europe would be around $100,000 and have a running cost of 5c per litre, making it an expensive fix and one whose effectiveness would be unknown until post-installation. Our local filter supplier suggested we try a small RO system to our eye washer as a test system. We installed a RO filter and small supply tank for $3,000. RO water was only used in the last rinse cycle. It worked! No calcium build up, and the chamber shone like new.
RO system installed
Because of the good results with the RO system to the eye washer, we installed a 3,000 litre a day system with 4,000 litres of storage feed to all our washers, to be used only in the last rinse cycle. Our same local supplier installed this system, at considerably less cost than the European version. This was back in 2014, and very quickly we found that chamber conditions improved dramatically, our instruments were cleaner and are now being washed to the manufacturers’ specifications. It had taken a major shift in thinking from management and the maintenance department to realise that water quality should not be taken for granted. If it wasn’t for the strong leadership from the CSSD department our RO system may not have been installed. This has led to a total change of practice in how we approach water supply to CSSD areas in new developments. A new two-theatre day stay has just been opened at Mercy Hospital – it was an obvious choice to design and build an RO water system and 1 micron filtered water system into this facility. Also in the future, all pipe work to CSSD departments will be treated with the same care as our medical gas reticulation system.
The result - clean machine interior
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TECHNICAL PAPERS
Condensing boilers 101 DR PAUL BANNISTER
Having been proven in Europe for many years, the benefits of condensing boilers are now being recognised in Australia across a number of sectors including hospitals where energy efficiency is a key driver.
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condensing boiler (or condensing hot water heater) is a much more efficient boiler than traditional boilers because it is able to extract more heat out of the flue gas. When gas burns, it combines with oxygen to produce carbon dioxide and water, as well as some other by-products such as methane gas (natural gas). This process can be illustrated as the following: CH4 + 2O2 > CO2 + 2H2O + ∆E Where ∆E is the energy released in combustion, the size of ∆E depends on the final state of the carbon dioxide and water. The cooler they are, the more spare energy there is. In the case of water, this is particularly important because if the water is vapour, then it carries a lot more energy than if it is liquid. So if, on leaving a boiler, the flue gases are cool and the water is liquid then the amount of energy ∆E that can be used is going to be larger. In a condensing boiler, the water is condensed inside the boiler so more energy can be extracted. This is in contrast to a traditional boiler, where the water escapes as vapour and the energy is lost. To be able to condense the water vapour from the flue gas, the condensing boiler should operate using a lower entering water temperature than a traditional boiler. This is because the condensing process occurs at around 54°C. You can still run a condensing boiler at a conventional 60°C return temperature, but the efficiency benefit won’t be as good as if it runs in condensing mode. A traditional boiler will typically have a minimum entering water temperature of around 60°C, with an exit temperature of 80°C, and will not have the heat exchange elements in place to achieve the extra heat recovery in any case. Indeed, if condensing does occur in a traditional boiler, it is a bad thing – because the condensate will include acidic by-products that will corrode the inside of the boiler and ultimately cause it to fail.
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
Modulex Condensing Boilers combine the efficiency benefits of condensing boiler technology with a high turn down ratio of 39:1. Modulex owes this exceptional modulation capacity to its multiple burner configuration – a feature that also provides built in redundancy.
Condensing boilers have additional heat exchange elements and are manufactured of the right materials to withstand corrosive condensates.
DRIVING EFFICIENCY The efficiency of a boiler is measured by the ratio of energy output to energy input. And in the case of condensing boilers, the Gross calorific value applies. Using Gross calorific values, traditional boilers are typically around 80-83% efficient at full load. By contrast, a condensing boiler is around 95% efficient at full load. If the condensing boiler isn’t running in condensing mode it will still have a 4-5% better
TECHNICAL PAPERS efficiency than a conventional boiler because of its superior heat exchange and burner control. Using Net calorific values, these figures both increase by about 10%, so that the condensing boiler has an apparent efficiency of 103% – because it is extracting more heat from the flue gas that the net calorific value recognises.
It follows that the efficiency of combustion is affected strongly by the temperature of the flue gases, which in turn is affected by the temperature of the return water (because this is what cools the flue gases down) and rate of boiler firing (% gas input), as shown in Figure 1. Figure 1. Combustion efficiency of condensing boilers at part load (% input) as a function of return hot water temperature. Adapted from “Maximising Small Boiler Efficiency” by Peter D’Antonio, PCD Engineering Services.
So the immediate benefit of a condensing boiler is an improvement in efficiency of at least 10-15%. But it’s actually even greater than that.
EFFICIENCY FACTORS There are two factors that drive boiler and hot water system efficiency. They are combustion efficiency and standing losses. Combustion efficiency is the efficiency at which the available heat output from the gas combustion is converted to heat in the hot water system. It is less than 100% because there is energy bound up in the combustion products that is lost via the flue. Furthermore, there is a degree of excess air intake into the boiler (over and above the exact amount needed to burn the gas) that is needed to ensure complete combustion of the gas. This extra air is heated up and lost via the flue.
ENGINEERING EXCELLENCE CERTIFIED PERFORMANCE
In Figure 1, the marked increase in combustion efficiency at around 55°C return water temperature is driven by the commencement of condensation of water from the flue gases. It is also important to note how much more efficient the boiler is at low load (25% input) than at full load (100% input). This is because the reduced flows of gas and air through the boiler mean that the condensation process can happen more efficiently. As a result, the combustion efficiency of condensing boilers improves markedly at low load. By contrast – as is visible in the non-condensing section of the performance – non-condensing boilers have reasonably constant combustion efficiency across all gas input levels.
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TECHNICAL PAPERS The standing losses for a hot water system are proportional to the temperature difference between the hot water and the air surrounding the pipes. For example – a traditional hot water system operating at 80°C flow/ 60°C return in a 20°C environment will have two thirds higher losses than the same system operating at 60°C flow/40°C return. Standing losses become more important as the system load drops because the standing losses are independent of the load on the system. This impact is shown in Figure 2. Figure 2. Effect of standing losses at variable system temperature. Combustion efficiency has been set at a constant 90% in this diagram; standing losses have been modelled as 8% of system capacity.
It shows that while the difference in system efficiency at full load is only a few per cent, the difference across the range of system temperatures opens out to 15% at low load. In reality, Figure 2 – which is based on equilibrium conditions – underestimates the efficiency benefits of lower temperature operation. This is because it is likely that the boiler system will
As a result, several tonnes of hot water and metal gradually cool down until the next boiler start (typically the next morning), when the system will need to reheat all of that thermal mass up to system temperature. Of course, all that heat is lost again when the system turns back off at the end of the day. In mild climates such as Sydney, it is not uncommon for this thermal inertial load to account for 50% of the total system gas use. Of course, if the hot water temperature is lower this effect will be significantly reduced.
TOTAL EFFECT The double effect of combining high combustion efficiency and low standing losses produces large efficiency benefits across the load range as shown in Figure 3. Figure 3. Hot water system efficiency comparison. 6.7% standing losses at 80/60°C for the conventional boiler; 2.7% system losses at 50/30°C for the condensing boiler. Conventional boiler combustion efficiency 85%. Condensing boiler efficiency as per Figure 1. No purge losses included for either boiler type.
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It means that condensing boilers achieve higher efficiency because of two effects:
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
• Higher combustion efficiency, due to the condensation process
At high load these effects can create a net improvement of around 8%, but at low load the condensing boiler system can be as much as 25% more efficient in steady state operation. In practice, thermal inertial effects at low load increase the efficiency benefits even further, making a condensing boiler central to any gas energy efficiency strategy. Written by Dr Paul Bannister, a thought leader and public speaker on energy and energy efficiency issues in Australia, for Automatic Heating Pty Ltd.
TECHNICAL PAPERS
FTC FIRETUBE CONDENSING BOILER
THE DUPLEX 2205 STAINLESS STEEL ADVANTAGE Heavy duty DUPLEX 2205 stainless steel was developed for the chemical and mining industries for superior strength and corrosion resistance compared to standard 304 and 316 stainless steel variants commonly used in most imported condensing boilers. DUPLEX 2205 stainless steel has almost twice the strength and corrosive resistance to 316 stainless steel when used at higher temperatures normally experienced in hot water boilers. Compared to imported condensing boilers, the AIRATHERM FTC TITAN is uniquely AUSTRALIAN MADE utilising DUPLEX 2205 stainless steel throughout the entire condensing section in contact with the corrosive flue condensate produced by a condensing boiler. The long term benefits of DUPLEX 2205 can be easily determined by thegraph shown.
Strength and Relative Corrosion Resistance Duplex 2205 vs 304/316 Stainless Steel
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Infection under consideration ABRAHAM CORONA
2015 AIRAH Future Leader Award finalist Abraham Corona, M.AIRAH, shares his thoughts about HVAC design in medical operating theatres, and why he thinks national Standards need to change. THE AUSTRALIAN SITUATION
D
uring 2013/14, there were more than 2.4 million hospital admissions in Australia involving surgery inside operating theatres (AIHW, 2013–14). There is also a trend of building hybrid operating theatres using the latest technology. In my opinion, operating theatre design Standards regarding HVAC may be lacking the information needed to develop the correct design from an infection-control perspective. The Australian Standard (AS 1668.2 The use of ventilation and air conditioning in buildings – Mechanical ventilation in buildings) sets minimum characteristics.
Indeed, the main risk is the absence of specifications for third-party testing and certification. In order to properly check design, equipment, installation and commissioning of current and new operating theatres, third-party testing and certification must be performed periodically to guarantee performance.
WHAT ARE THE CONSEQUENCES?
Yet comparing this national Standard with some international versions – such as in the UK or Germany – one can see there are deficiencies requiring attention. An example is appropriate protected-zone dimensions and surgical smoke considerations.
When airborne bacteria comes into contact with a patient’s wound, it could be the start of an infection. Common medical practice suggests using antibiotics. But we’ve all read about the global problem of antibiotic resistance and what this might mean for future generations.
Most state health departments have developed design guidelines. Despite this, there is still a lack of common understanding.
The health risks for medical staff working inside operating theatres must also be considered.
The actual design of operating theatres is just one of many issues.
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A recent study developed by urologist centres in Shanghai shows that surgical smoke represents a high risk factor
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
for surgeons’ health due to the high concentration of PM2.5 (air-polluted fine particles) generated within. The concentration can reach very unhealthy levels, which can cause multiple diseases. Commonly used smoke evacuators may be insufficient.
A GUY CALLED MACK Is it possible to prove that less airborne bacteria causes lower infection rates? Or that less airborne bacteria has no effect on lowering infection rates? According to Rupert Mack, a member of the German Standards Committee, this discussion is not objective in any sense, because infections have multiple causes. Even if you develop the best air conditioning design as per the best Standards in the world, if medical practitioners don’t have the correct infection control behaviour – for example, hands and medical equipment disinfection, appropriate
TECHNICAL PAPERS clothing, etc. – the infection risk is still high. Mack also says that in order to achieve a protected zone to safeguard patients and personnel against airborne bacteria and surgical smoke, it is necessary to use unidirectional flow. Any solution therefore has to be a joint effort between designers and medical staff.
LESSON TRANSFER The technology to achieve effective operating theatre HVAC design is available; the pharmaceutical and semiconductors industries have shown us how to build and install inside clean rooms. Of course, not every operating theatre can be treated as a clean room and every design needs to meet a budget. But are semi-conductors more valuable than human beings? Designers can transfer the lessons learned in the field of clean room
design to operating theatres. The correct dimensions of unidirectional flow equipment, air-quality control, and personnel clothing are a few examples of what can be applied.
owners, and builders. However, the main onus must rest with consultants and designers. They can do their job and simply follow the Standards, or they can take on the responsibility of actually improving them.
In 2015 a group of German researchers published a study that analysed the concentration of colonyforming units (CFUs) during 1,286 surgeries inside two different styles of operating theatres (mixing flow and unidirectional flow).
Does Australia need to change the HVAC Standards for Operating Theatres?
It was concluded that an appropriate unidirectional-flow design inside operating theatres reduces airborne bacteria by more than 90 per cent (Fischer, et al., 2015).
A FINAL THOUGHT The responsibility for achieving effective operating theatre design must be shared between all the entities involved – from Standards committees, through to industry organisations, hospital
Please join our open space dedicated to a non-commercial discussion about the Australian current situation regarding the Operating Theatres Design considering the Infection Control Point of View. The aim is to gather the market awareness and opinion in order to achieve better designs Australia wide, protecting all Australians. Please feel free to add your comments and expertise, considering professional ethics and respect to each other. http://www.techin.com.au/ ot-design-blog Abraham Corona M.AIRAH/M.ASME abraham.c@techin.com.au This article originally appeared in May 2016 Ecolibrium, the official journal of AIRAH, and is reprinted with permission.
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
Down the Drain â&#x20AC;&#x201C; The air that we breathe PAUL ANGUS I HYDRAULIC INDUSTRY LEADER
Healthcare facilities are notorious for incorporating complex and unique drainage systems. These intricate sanitation pipework networks will have almost certainly evolved during the lifetime of the facility, following multiple refurbishments and extensions. The Hospital Engineer is faced with a complex challenge to ensure the drainage network remains free from blockage around the clock. If not maintained, not only can be it be catastrophic for the well-being of the patients, it could inadvertently contribute towards major infection outbreaks. Paul Angus, Hydraulic Industry Leader, explores the implications of how an insignificant, minor blockage within a poorly maintained drainage system can potentially quickly escalate to be the source of air-borne pathogen infection related outbreaks.
T
he key drivers to any sewer drainage system is keeping it simple. This ensures the system is reliable for optimum performance for the lifetime of the facility. Add a sprinkle of planning for preventative maintenance regimes to maintain the intricate network of pipework and we can all forget about what we canâ&#x20AC;&#x2122;t see. Easier said than done, especially when the facility you are now responsible is well over 25 years old, appears to have also undergone significant refurbishment or been extended with no accurate drawing records of the pipework routes being kept. In most cases, drainage blockages will occur within lengthy horizontal lengths of pipework or potentially where pipework changes direction abruptly. The blockage will often occur where inspection openings have been located impractically, due to logistical issues involved in having to relocate patients for maintenance work. This presents a complex set of challenges for the Hospital Engineer, who is effectively responsible for keeping drainage networks free from blockages. When sewer drainage pipework systems are installed correctly in accordance with AS 3500-2: 2003, the pipework gradient and pipe diameter designed
for the anticipated flow rate, should, in an ideal world, be self-cleansing, keeping blockages at bay. Unfortunately, patients, as end users of a facility, present the most significant challenges to the maintenance staff by discarding uncontrolled items down the drain, for example patient wet wipes, syringes and dressings causing overflowing toilets and showers within close proximity to clinical areas. When these events occur, they can contribute to pathogens becoming air-borne, leading to infections closely linked to the hospital wastewater that can be quickly transferred via the ventilation system. However, in general these infections most likely go undetected to a poor plumbing installation. Badly maintained drainage systems have previously reportedly been the source of several sanitation related infection outbreaks. It is no surprise that pathogens are evident within wastewater pipework. However, in hospitals, bacteria levels are far more enhanced, due to already ill patients being treated for numerous conditions, creating a higher risk of drainage infection related outbreaks being evident. It is critical that any issues with drainage systems are dealt with immediately to prevent life-threatening
viruses and diseases evolving from the drainage system, ultimately causing a potential outbreak. Where contaminated wastewater enters the air within a building or wing within a healthcare facility in the form of an aerosol, it can have catastrophic consequences. This is exactly what occurred at the infamous severe acute respiratory syndrome (SARS) outbreak in 2003 at the high rise residential building in Amoy Garden, Hong Kong. The World Health Organization (WHO) established that the public health outbreak was mainly due to a combination of incorrect design, installation and maintenance of the drainage system, which resulted in the floor wastes trap seals to become depleted. This consequently allowed virus laden droplets from the drainage system to become airborne via aerosols, entering the ventilation system, which then spread to interconnected rooms and neighbouring apartments throughout the building, causing the major public health infection outbreak. Itâ&#x20AC;&#x2122;s hard to believe that poorly designed and maintained drainage system could become the source of such a devastating and fatal outbreak, which reportedly lead to a
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TECHNICAL PAPERS reported 321 cases of infection and virus, leading to 42 fatalities. Just pause for a moment. Consider the consequences of such an event occurring within a hospital or healthcare facility that you, yes you, are responsible for. The outbreak at Amoy Gardens, which had such a significant impact on relatively healthy occupants would be absolutely devastating in a hospital, where the occupantâ&#x20AC;&#x2122;s health is already significantly susceptible to virus and infection. It is estimated that over 180,000 patients in Australian Hospitals are affected by infections generated within the hospital itself each year. By undertaking a risk assessment, in particular on fixtures and fittings that are unused for a significant period of time can be easily overcome by incorporating a simple maintenance regime. Plantrooms are notorious for floor waste trap seals becoming depleted due to heat generated from various plant. This causes foul odours to be evident locally, which can easily be transferred to nearby rooms or wings in the hospital via the mechanical ventilation system. The number of inspections undertaken recently where fixtures and fittings that were frequently used and no longer used is frightening. On a recent survey undertaken, I discovered a room with four disused toilets and basins connected to a floor waste. When I brought this to the attention of the contractor and Client, I explained that in a very short period of time the traps in each fixture will become depleted, causing foul odours and intensifying the risk of airborne infection, as well as a breeding area from legionella. In any circumstances that this can occur, it is always recommended to review the usage of all facilities, as well as the pipework configuration to avoid any issues with airborne pathogens or foul odours becoming evident within the facility and potentially causing an infection outbreak. Healthcare Establishments will almost certainly contain laboratory systems, which require staff to be educated on the disposal of chemicals and test materials that may be inadvertently discharged uncontrollably down the drain. In wings or zones, where
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refurbished work has occurred can often lead to inappropriate liquids being disposed of down the drain, which may have detrimental effects to the drainage system. The most effective way to overcome this is to install point-of-use or acid-neutralising dilution systems, prior to discharging to the utility sewer drainage. All specialist equipment, in particular wastewater due to the potentially high risk and ability to spread chemicals and disease, requires to be rigorously monitored. This can be either manually, which in itself is time consuming and liable to human error or alternatively connected to the building management system (BMS) to notify the facilities management team immediately should any issues arise. When was the last time you carried out a risk assessment on how the laboratory waste in your facility is being disposed of? It might be time to review that policy. Pathology laboratories differ from general laboratories. Liquids and chemicals that are designed to be discharged down the drain within Pathology laboratories may result in foaming and high temperature liquid discharge. Anti-foaming flow wastes or sealed floor waste can assist in counteracting this from occurring and becoming an issue. To neutralise the chemicals that can potentially be discharged down the drain within pathology laboratories, special antifoaming waste dilution tanks will be necessary, as well as be regularly maintained. Consideration to connect to the BMS should be provided to notify the Hospital Engineer facility team whenever a failure occurs to ensure the dilution pit or tank can be remedied quick and efficiently, without any downtime occurring. Often drainage issues can also can be avoidable. In most instances, drainage issues are either end user related, a product of poor workmanship on installation or occur at the actual design stage, where an uncoordinated design between engineering disciplines can have disastrous and possibly fatal consequences. For example, often large healthcare facilities incorporate central sterile systems. These systems provide
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
high water temperatures and demand to steriliser systems in order to operate at optimum requirements to wash and rinse equipment. What goes in, must come out! In the case of central sterile, extremely high temperature hot water conveys down the drain. The pipework material and diameters requires to be carefully selected for these extreme conditions. Whilst compiling a recent independent expert witness report at a new hospital wing, it was established that due to the mechanical and hydraulic design being undertaken by two separate consultancy practises, resulting in an uncoordinated design. Extremely high temperature hot water in excess of 85°C was being discharged from steam plant located at roof level directly to the rainwater outlets. The rainwater pipework diameter and pipe work material had been designed correctly for the roof area and rainfall intensity, just not to withstand such high temperature. Discharge! It further transpired the horizontal pipework transferring to the main core riser was also located immediately above an intensive ward. Upon discovery, I advised immediately to shut down the ward to avoid any risk or fatalities to the patients located immediately below the affected pipework, as well as provide a solution to rectify the issue. In todayâ&#x20AC;&#x2122;s ever-changing world of healthcare facilities, flexible, reliable and easy-to-maintain drainage networks provide the solution to safeguard for the potential logistical issues to relocate patients and loss of revenue for any period of time a shut-down is required to a wing or unit.
ABOUT THE AUTHOR Paul Angus is a Hydraulic Industry Leader, based in Sydney. He is also the New South Wales Chair for the Chartered Institute of Building Services Engineers, (CIBSE). Paul has extensive experience in the hydraulic design, pre-acquisition and condition surveys, including all forms of specialist client advisory work. He also has extensive experience in expert witness reporting, taking part in adjudications, mediations, negotiations and arbitrations. Paul can be reached at: https://au.linkedin.com/in/paangus
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“The Terrible Twins” Emergency Management & Business Continuity
BRIAN HOLECEK. OAM, CEM I CENTRAL ADELAIDE LOCAL HEALTH NETWORK
The intent of this paper is not to resolve the question is Emergency Management and Business Continuity principles aligning, and how these fundamental principles interact to provide ‘Organisational Resilience’ or ‘Resilience’? The intent is to provide an opportunity to reflect on how these principles are changing or in fact are they changing?
A
fter reading the posts below, it made me reflect more on how I am seeing Emergency Management and Business Continuity terminology and principles change over my career in Emergency Management and Business Continuity.
It was these reflections and discussion with other Business Continuity practitioners that motivated me to present my perspective at the Australasian Business Continuity Institute Summit 2016 held in Sydney and at the IHEA Health Care Facilities Management Conference 2016.
LinkedIn posts 22/10/15 “I give up on “Business Continuity”
Form this presentation and further reflection I provide my thoughts on how these two principles seem to be aligning into one discipline.
“I clung to the term “Business Continuity” for a long time. I’ve finally let it go. It just doesn’t work. For reasons I’ll never fully comprehend, the word ‘business’ seems to act as some kind of natural repellant. Magically, once you drop the ‘business’ part, people are more receptive. I’ve found that the gradual shift from ‘Business Continuity’ to ‘Continuity of Operations’ has had a pronounced and positive impact. The power of words still amazes me. Which words work for you?” (Rian Jones Senior Advisor, Provincial Business Continuity Management Program, Emergency Management BC Linked in Post 22/10/15) ‘I agree. Resilience is just part of BC. You need resilience against an incident (before incident) crisis management (during) and DR (after).’ (Kevin Stevens BC Consultant (Energy and Utilities) at CGI Link In post as a response to Rian Above 22/10/15) Linked in Post 22/10/15) “In my case, it’s because of where I work and who I work with. In a corporate, private sector environment, I would probably stick with “business continuity” but in an emergency management organisation staffed by former military personnel, it strikes the wrong chord. As much as I would explain that “Emergency management is your business and our job is to make sure that you can do yours” it never really resonated with them. They just don’t think of response as a ‘business’. Finally, I realised that winning the name battle might mean losing the war. “ (Rian Jones Senior Advisor, Provincial Business Continuity Management Program, Emergency Management BC
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
When a Business Disruptive Event occurs I often hear the terminology ‘Crisis Management Team’ though having experience in Emergency Response/Management I was used to the terminology ‘Incident Management Team’. I’ve always seen a Crisis Management Team was the same as an Incident Management Team as they essentially do the same function, deals with the event “in a coordinated manner”. I originally described the relationship between Business Continuity and Emergency Management as Cousins, related with similar backgrounds but connected DNA. In Business Continuity terms the initial event is referred to as a disruptive event, in Emergency Response it’s referred to as an Incident. The Glossary of the Business Continuity Institute (BCI) a worldwide organisation to promote Business Continuity defines Disruption as “see Incident” and then defines Incident as ‘Situation that might be, or could lead to a disruption, loss, emergency or crisis.” (BCI Good Practice Guide, 2013 p 109.) In Emergency Management terms the glossary of the Australian Fire and Emergency Services Authorities Council (AFAC) define “incident” as “Any unplanned event requiring emergency intervention” (AFAC Bushfire Glossary January 2012, page 19) different words, same definition. Around three years ago I’ve updated my analogy to they’re not cousins but ‘Terrible Twins’ same DNA (overarching principles). I’ve seen more similar terms and process emerge, the BCI Good practice Guide 2013 p 34 refers to: Incident Management Plans and Incident Response Structure as part of the outcome or review of the Business Continuity Management Program. AFAC
TECHNICAL PAPERS uses the terms Incident Action Plan, “the plan to describe the incident objectives, strategies, resources and other information relevant to the control of an incident” AFAC Bushfire Glossary January 2012, once again different words same intent. As I immerse myself further in Emergency Management and Business Continuity I now see these not only as ’Terrible Twins’ but conjoined, same DNA, same body (overarching principles) but have two similar personalities and react differently to an event (two brains). Therefore my analogy ‘The Terrible Twins”, when a disruptive event or major incident occurs these Terrible Twins emerge to provide the principles of Command, Control, Coordination and Communication”. Utilising these overarching principles, these “terrible twins” react differently to the incident. By differently I mean look at the same incident/event with differing priorities, one looks the immediate impacts of the Emergency initially focusing on immediate response, then at a strategic level of the incident. The other looks at what the impact to the business will be, how long before the business is impacted either though loss of production, financial, reputation etc. are impacted. Emergency Management is defined as the process of “developing policy and plans to respond to, and minimise, the effects of natural disasters or crises.” https://www. ag.gov.au/emergencymanagement/Pages/default.aspx 26/08/2016
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Business Continuity is defines as “The capability of the organisation to continue delivery of products or services to acceptable redefined levels following a disruptive incident.” BCI Good Practice Guide, 2013 p107.) It’s the application of both these Emergency Management and Business Continuity principles that provide an organisation to recovery from an incident/disruptive event in an effective and efficient manner that makes an organisation resilient. Resilience is an outcome not a process. Another consideration is the Risk Management, this underpins both Emergency Management and Business Continuity….. is there a third person in this analogy, making it the “Terrible Triples”?. What’s the future profession for those in Emergency Management or Business Continuity. It is? a) ‘Emergency Management”? b) “Business Continuity”? c) “Organisational Resilience” d) “Resilience” The intent was never to resolve if Emergency Management and Business Continuity are merging in as an overarching philosophy ‘Resilience’ or ‘Organisational Resilience’ but reflect on how these business practices are moving forward in this field and terminology. When a disruptive event or major incident occurs these Terrible Twins or ‘Triplets’ emerge to provide the principles of Command, Control, Coordination and Communication, it really doesn’t really matter as if these principles are used an organisation can recovery effectively from and incident, business disruptive event. Is or has become resilient?
To book your free presentation contact Jason on 1300 579 177 or visit;
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1300 579 177 sales@beckerpumps.com.au THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
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TECHNICAL PAPERS
Air quality in harmony with infection control SARAH BAILEY I QED ENVIRONMENTAL SERVICES
Q
ED has for many years carried out a comprehensive air quality monitoring and management inspection function for commercial buildings, such as high rise multiple occupancy office blocks. QED is the only NATA accredited company carrying out this kind of audit of indoor air quality in Australia. This annual inspection and testing aids compliance with the Australian Standards AS1668.2 (2012) The use of ventilation and airconditioning in buildings, Australian Standards AS 3666 (2012) Air handling and water systems of buildings, and Australian Standard SAA/SNZ HB 32 Control of microbial growth in airhandling and water systems in buildings and other relevant legislation and standards. Similar programmes are also in place in several commercial buildings as tenants require the knowledge that the air in the building is of a high standard, as this can impact upon productivity and profitability. Inspection of the air handling units, along with testing for various air quality parameters in the occupied areas gives a good indication of the overall quality of the system in place, and any rectification works that are required to improve the air quality in the building. Hospitals are however, much more complex that commercial buildings. A commercial building usually has a healthy population, with no extremes of age present, and the presence of very few pre-existing health conditions. The use of space in the building is mostly confined to office use, with usually only the server room having specialist heating and cooling needs. The building usually has fit outs that are all of a similar age, and a few, large air handling units are present. In comparison, hospitals have a much more diverse population of users of
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all states of health and ages, areas of use that vary from offices to laundries, Operating Theatres, commercial sized kitchens, sterile areas, imaging and radiation bunkers. Additional to this, hospitals usually are sites that have developed and evolved over many years, with many stages of construction and development, and reuse of often very old buildings. Air handling units are also of vastly differing ages, manufacturer and type, depending on the needs of the area. Specialist ventilation and heating requirements are also present with HEPA (High Efficiency Particle Arrestance) filtration for isolation rooms, theatres and cleanrooms along with positive and negative pressure isolation rooms. Provision of safe air within a hospital environment is of vital importance. Hospital acquired infection is a major cost burden for hospitals, and also a significant burden on the patients affected. Mortality of the patients is increased, and increased length of stay in hospital of between 7-10 days on average are noted. At a cost in WA of a hospital stay of nearly $2200 average per day per patient in 2013-141, the costs associated with this are significant. Outbreaks have previously been associated with the air handling systems within hospitals – examples include an MRSA outbreaks associated with dirty supply registers and ducting2; an outbreak of fungal infections in cardiac surgery patients3, and an outbreak associated with old air conditioning systems that were poorly maintained which resulted in 6 deaths from 6 infections4. There can also be a problem with ‘pseudooutbreaks’. This is where the laboratory air supply is contaminated, and the air supply introduces contaminants into specimens5. This means that infection can be found in the samples when
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
none is present in the patient – situation which can lead to unnecessary surgery and treatment with antibiotics. NHMRC Australian Guidelines for the Prevention and Control of Infections in Healthcare6 highlight the role of the air handling systems within a hospital of reducing airborne transmission of pathogens, and in contributing to the health of the population within the hospital. The NHMRC guidelines state that many studies indicate that infection rates are lower when there is very good air and water quality. In addition to this, the Australasian Health Facilities Guidelines7 and the WA Health Facilities Guidelines8 state that ventilation should “Provide breathing air free from contamination harmful to building occupants or processes undertaken in and around the building”. With the importance of providing good quality air into the hospital environment being of paramount importance, QED undertook to develop a programme specifically for hospitals, that took into account not only the physical condition of the air handling units, but the quality of the air at the point of supply, and the individual risks present in the areas that the air is supplied to. Taking into account the three critical areas of: • Risk of the population supplied with air • Condition of the Air handling Units • Quality of the air supply in a particular area A risk matrix was developed that, if any rectifications to systems were required, could risk assess each individual problem present and rank this according to the impact it could potentially have on patients and other users within the building.
TECHNICAL PAPERS Examination of both the air handling units and the air quality in unison with each other is vital. Problems beginning in the air handling units may not yet have had an impact upon the air quality within the area supplied, and also, there may be other problems within the hospital, for example moisture ingress or use of chemicals that can impact upon the air quality, without necessarily being related to the air handling unit.
MEASUREMENT OF INDOOR AIR QUALITY A number of parameters are measured to determine the quality of the air inside the hospital. Carbon Dioxide Carbon Dioxide (CO2) is a gas that occurs naturally in the earth’s atmosphere, and is generally accepted as a surrogate indicator of ventilation within buildings and occupied premises. At normal concentration levels carbon dioxide exerts an important regulatory effect in the body; it can however become an asphyxiant at high concentrations. Historically, the most common complaint expressed about indoor air quality is that of “stale air”. Typically, complainants claim symptoms of headache, stuffiness, upper respiratory tract irritation, drowsiness, lethargy and fatigue etc. Research has shown that these symptoms tend to worsen during the course of the day, often peaking in the mid to late afternoon, but abate after vacating the premises in question. Moderately raised levels of carbon dioxide have also been shown to reduce productivity, decision making performance, basic activity levels, information levels and crisis response – all essential for staff within a hospital9, who make life and death decisions every day. Particulate matter The National Environmental Protection Council (NEPC)10 stipulates a standard for ambient particulate matter of ≤10 microns in size (PM10) of 50 μg/ m3 (0.05 mg/m3) measured over a 24 hour period, with five allowable
exceedances per year. QED has adopted the guideline level of 50µg/ m3 for indoor air. Raised levels of particulate matter, especially the PM10, PM2.5 and PM1 fractions have clear associations with increasing respiratory distress and hospital admissions, and also with worsening cardiac function and cardiac events at raised levels. Mortality in cardiac, cancer and respiratory patients is also increased when levels of airborne particulates are high11. Particulates should be controlled to prevent the worsening of these conditions within the hospital Carbon Monoxide In high concentrations, carbon monoxide can be fatal. At lower concentrations, headache, dizziness and other symptoms can be present. It is usually found when combustion products enter the airstream, for example from plant exhausts or vehicle fumes. Carbon monoxide is an odourless gas, and can only be detected using a specialist monitor. Any detection of carbon monoxide must be investigated. Temperature Air temperature is one of the parameters that are known to influence the thermal balance of the human body as a whole, which in turns affects the perceived comfort of the individual. This can often be a contentious area in a hospital, as there are so many different levels of activity, from the busy staff to the bed bound patient. Even within well maintained office spaces, temperature is one of the factors that building managers have the most complaints about. Humidity A level of RH below 35% exacerbates and sensitises an individual’s response to airborne pollutants, and the following problems have been known to occur; • Dryness and irritation of eyes, nose, throat • Increased allergic response by asthmatics • Increased static electricity shocks • Increase rates of ozone generation
High humidity can also provide conditions favourable to the growth of micro-organisms such as Fungi or Mould and Bacteria. Elevated levels of these micro-organisms may then have negative health effects, and also cause damage to property and assets. Volatile organic compounds Volatile organic compounds (VOCs) are measured as a total for the air quality monitoring programme, and act as an indicator that a problem may be present. In an office environment sources of VOCs are usually from furniture, paints, and new building products. Within a hospital, there are many more sources of VOCs, from alcohol hand rub to more toxic chemicals used for disinfection and cleaning. High levels of VOCs usually indicate the need for more targeted investigation, and for measurement of Occupational Exposure12 to the chemicals in use in the area. VOCs are a wide group of compounds, some of which can have quite serious health effects at low concentrations, and some of which are relatively harmless at the concentrations usually found in a hospital day to day12. Microbial Air quality The levels of microbial contamination within the air of the hospital area sampled using an active sampler. No specific guidelines exist for the levels of microbes within the air that are acceptable within a building, except for those within Operating Theatres13. It is however very useful to build up a picture of the usual levels for the different areas of the hospital over time and then deviations from this can be investigated. Comparison of the levels within the building with those in the outside air are also extremely useful. Levels of microorganisms should usually be lower inside a building than outside a building, and be of a similar species mix. Higher levels of microbes inside that outside, or inside air reading that show a predominance of a problem species of fungus for example is a cause for concern and would require investigation. Results should always be interpreted by a person experienced in interpreting microbial air testing results.
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
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TECHNICAL PAPERS
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TECHNICAL PAPERS INSPECTION OF AIR HANDLING UNITS Air handling units are inspected by experienced staff to ensure that they are clean, functional and that no problems are present that may impact upon the air quality supplied. A condition report detailing the condition of the unit, corrosion, condition and cleanliness of the coils, condition, specification and change dates of the filters, along with the condition of the plant rooms and any external factors that may impact upon air quality.
Functional Area Sensitivity Status Group Four Highest risk
All Intensive Care Units and High Dependency Units All Operating Rooms Day Surgery Labour & Delivery Operating Rooms Anaesthesia areas Oncology and Haematology units and outpatient clinics for patients with cancer Transplant units and outpatient clinics for patients who have received bone marrow or solid organ transplants Wards and outpatient clinics for patients with AIDS or other immunodeficiency Infectious Diseases wards. ENT Wards (especially Head and Neck surgery)
Group Three High risk
All patient care areas unless stated in Group 3 or 4 including but not limited to: General medical & surgical wards other than those listed in Group 4 Paediatrics Geriatrics Long-term care Normal newborn nurseries Emergency rooms Radiology/MRI Post anaesthesia care units Mortuary
Transport routes of patients from any of the above categories Transport routes of patients from any of the above categories Labour and Delivery (non-operating room) Nuclear medicine Physiotherapy respiratory function areas Echocardiography Medical laboratories (specimens) Dental clinics Pathology Specimen Collection Kitchens
Group Two Medium risk
Unoccupied wards, Outpatient clinics (except for oncology & surgery), Admission/discharge units, Research laboratories, Psychology Pharmacy
Allied Health areas including but not limited to: Physiotherapy, Occupational therapy, Social work, Dietetic/Nutrition and Prosthetics/Orthotics.
Group One Lowest risk
Office areas Public areas
Workshops and Plantrooms (subject to risk assessment)
Inspection of the maintenance records is also carried out if required to ensure that the monthly inspections required under AS366614 have been carried out. Microbial culture of the heat exchange coils is also possible at inspection, using a method devised by QED in association with a NATA accredited laboratory to give an early indication of if there may be a problem with microbial contamination.
RISK GRADING OF AREAS AND AHUS FOR FUNCTIONAL AREA SENSITIVITY STATUS Each area and the AHU it serves are graded according to a risk assessment tool developed by QED. This is based upon guidelines from Queensland, Western Australia, New South Wales and the Northern Territory15, with additional knowledge from QED consultants. The term â&#x20AC;&#x2DC;Functional Area Sensitivity Statusâ&#x20AC;&#x2122; is used instead of a term that is more focussed on patients, as sometimes, for example in the case of Pathology laboratories, the Cyclotron or pharmaceutical preparation areas, the persons present in the area are of good health, but the use of the area requires a higher grade risk classification. AHUS and areas that are grouped in Groups three and four are examined and air quality testing carried out on a six monthly basis, to ensure that problems are dealt with in a timely manner and do not reach the levels where patients are put at risk. The
Burns Units Respiratory Wards (Chronic) Dialysis Units Tertiary care nurseries Transport routes of patients from any of the above categories All Cardiac Catheterisation & Angiography areas Cardiovascular/cardiology patients All Endoscopy areas Pharmacy admixture rooms Pharmacy Cleanrooms Sterile processing rooms Computer centre Central inventory department Cyclotron
Specific AHU risk groupings, XXX Building AHU risk groupings Asset Number/AHU Identification
Population Served
Functional Area Sensitivity Status
Audit frequency
AHU 1 AHU 2
Oncology
4
Biannual
Respiratory Wards
4
Biannual
AHU 3 AHU 4
Emergency Dept.
3
Biannual
Physiotherapy
2
Annual
AHU 5
Offices
1
Annual
areas grouped into Groups one and two are inspected and tested on an annual basis. This is then used to produce a risk rating for each AHU.
AHU hygiene assessment Low Risk
Manage as part of current maintenance procedures.
RISK ASSESSMENT OF THE AHU OR INDOOR AIR QUALITY PARAMETERS
Moderate Risk
Remedial actions required.
High Risk
Expedite remedial actions.
Very High Risk
Immediate remedial action required.
Each noted exceedance from the expected air quality guidelines, or each rectification that is required for an AHU is graded by our consultants as to the potential impact to the area that is served using the following table.
QED Hygiene Assessment of AHU.
These two pieces of data are then used to calculate a Maintenance priority rating, using the following matrix. The maintenance priority ranking is then used to produce a list of maintenance and other rectifications
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
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Maintenance priority rankings QED Action Priority Ranking Functional Area Sensitivity Status Hygiene risk
Group 1
Group 2
Group 3
Group 4
Low
1
1
1
2
Moderate
2
2
3
4
High
2
3
4
5
Very High
4
4
5
6
1: Routine maintenance issue; 2: Moderate priority; 3: High Priority; 4: Very High Priority; 5: Extremely High Priority; 6: Requires Urgent and Immediate Attention.
and investigations that are required to improve the system and ensure that it is
up to standard and providing safe and clean air to the hospital.
This provides both the Engineering and Infection Control and Prevention Departments with a targeted list of actions, in the order that they need to be done, to ensure maximum patient safety within the hospital with regard to the supply of air. A full report is produced, along with a searchable and sortable excel spreadsheet of recommendations. This ensures that maintenance can then either target a particular air handling
Critical issues and recommendations Location/ Item
Asset #
Hygiene/ Impact Assessment
Area status
Maintenance Priority
Issue/Recommendations
Plant room
AHU 2
Very High
4 Highest Risk
6 Immediate
Microbial growth is present on the heat exchange coils and there is also some corrosion, the coils should be cleaned immediately with an appropriate biocide and the corroded areas sealed. The unit should be shut down for cleaning. As the area served houses particularly sick patients, the Infection Control team should be consulted prior to cleaning taking place.
Plant Room
AHU 1
Very High
4 Highest Risk
6 Immediate
Microbial growth is present on the supply air dampers. This should be removed as a matter of urgency. A suitable biocide should be used, and the unit isolated for cleaning. The unit should be shut down for cleaning. As the area served houses particularly sick patients, the Infection Control team should be consulted prior to cleaning taking place.
High
4 Highest Risk
5 Extremely High
High levels of Volatile Organic compounds have been detected in this area. Alcohol hand gel and isopropyl alcohol wipes were noted to be in use. If these are the only volatile organic substances in use in this area, then exposure levels are likely to be below the Occupational Health and Safety Exposure Standard. If other compounds are in use, further monitoring may be required to ensure that OH&S limits are not exceeded. The MSDS file for the area should be consulted to determine which compounds are in use.
Very High
2 Medium Risk
4 Very High
Bird faeces present on the top of the unit, and these have been washed into the unit by water leaks. The outside and inside of the unit should be cleaned and decontaminated immediately with a suitable biocide. The unit should be turned off and isolated while cleaning takes place.
High
2 Medium Risk
3 High
High levels of fungi and bacteria were detected in the air in the unused physiotherapy department store. This was adjacent to an area of water damage with visible mould present. The source of the water should be investigated and rectified, and the damaged areas removed and made good.
Critical Issues
Oncology Ward
Plant room
AHU 4
Recommendations Physio-therapy
Plant room
AHU 2
Low
4 Highest Risk
2 Moderate
Filters do not have change dates displayed, but appeared clean and new. Change dates and specifications should be displayed at the next filter change date.
Offices
AHU 5
Moderate
1 Lowest Risk
1 Routine
Levels of CO2 higher than the Guideline upper limits were detected. This may affect concentration and alertness. The provision of outside air to this area should be increased to improve occupant comfort.
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
EMPAC Ref#
Date Complete
XXX hospital Sign-off
TECHNICAL PAPERS unit, or sort by the most important rectifications first.
Prevention in Healthcare Settings During Construction and Renovation Clinical Infectious Diseases 2015;61(3):433–44
With only limited budgets for maintenance and repairs, and limited staff to carry out works this ensures that all of the available resources are directed in the most effective, efficient and safest manner.
6. NHMRC Australian Guidelines for the Prevention and Control of Infection in Healthcare 2010 7. Western Australia Health Facility Guidelines for Engineering Services 2006, WA Department of Health
EXAMPLES OF ISSUES UNCOVERED IN AHUS QED carried out this audit scheme for many hospital and commercial buildings, and the following are examples of problems that have been discovered with the air quality testing: • Formaldehyde and VOC exposures • Dampness and mould issues • Fungal growth within critical AHUs • Bird faeces contaminating outside air intakes • Negative pressure room vents adjacent to outside air intakes • Decomposing air handling units
FOLLOW UP PROCEDURES AND REPORTING PROTOCOLS QED produces a comprehensive report of all of the issues, graded as to their importance to patient/staff health and safety. Once these issues have been investigated or rectified, QED can also provide a reinspection service to ensure that rectifications have been carried out and are to standard.
8. Australasian Healthcare Facility Guidelines https://healthfacilityguidelines.com.au/ accessed 10 October 2016
REFERENCES 1. IHPA National Hospital Cost Data Collection Australian Public Hospitals Cost Report 20132014 Round 18. https://www.ihpa.gov.au/ sites/g/files/net636/f/publications/nhcdcround18.pdf accessed 10 October 2016 2. www.esta.org.uk/documents/2013020 5VentilationHospitalsIAQ.pdf Accessed 10 October 2016 3. T. Peláez, P. Muñoz, J. Guinea, M. Valerio, M. Giannella, C. H. W. Klaassen and E. Bouza Outbreak of Invasive Aspergillosis After Major Heart Surgery Caused by Spores in the Air of the Intensive Care Unit Clin Infect Dis. (2012) 54 (3):e24-e31.doi: 10.1093/cid/ cir771 4. Lutz BD, Jin J, Rinaldi MG, Wickes BL, Huycke MM. Outbreak of invasive Aspergillus infection in surgical patients, associated with a contaminated air-handling system. Clin Infect Dis. 2003 Sep 15;37(6):786-93. Epub 2003 Aug 28. 5. Hajime Kanamori, William A. Rutala, Emily E. Sickbert-Bennett, and David J. Weber Review of Fungal Outbreaks and Infection
9. https://thinkprogress.org/exclusiveelevated-co2-levels-directly-affect-humancognition-new-harvard-study-shows2748e7378941#.3hr61la9s accessed 10 October 2016 10. National Environment Protection (Ambient Air Quality) Measure https://www.legislation. gov.au/Details/C2004H03935 accessed 10 october 2016 11. Terzano C1, Di Stefano F, Conti V, Graziani E, Petroianni A. Air pollution ultrafine particles: toxicity beyond the lung. Eur Rev Med Pharmacol Sci. 2010 Oct;14(10):80921. 12. SafeWork Australia Workplace exposure standards for airborne contaminants 2013 13. WA Government Department of Health Microbiological sampling of operating rooms in Western Australian Healthcare Facilities. 2015 14. AS/NZS 3666 (2011) Air Handling and water systems of buildings – microbial control 15. NSW Department of Health Infection prevention and control during construction, renovation or maintenance SESLHDPR/374 September 2015
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Adelaide hospital introduces revolutionary water technology set to radically improve patient safety and recovery An Australian first in healthcare. North Eastern Community Hospital in Adelaide is the first in Australia to introduce ground-breaking technology that will permanently eliminate legionella in their water pipelines, providing patients with the safest water in the country. The Ecas4 system, developed in Italy, and already widely used throughout Europe, successfully eliminates pathogens such as bacteria, fungi, viruses and mono-cell algae from main and drinking water without the use of toxic chemicals. Scott Williams, CEO of the North Eastern Community Hospital, says “We are thrilled to be the first hospital in Australia to introduce this technology which means we offer the safest and cleanest water out of any other hospital in Australia”. Ecas4’s National Business Manager, Simon Crabb, says “Legionella is a real risk for hospitals as it is for any building that has a reticulated water system. There’s nothing on the market that will control Legionella as well as Ecas4 can”. Bacteria are naturally present in water and are able to form a three-dimensional structure on the internal surface of pipes called biofilm. Biofilm is a thin layer of organic material where bacteria like legionella can bind and develop. Williams explains that before using the Ecas4 system their water treatment would flush away the Legionella, but it didn't break down the biofilm. “The difference with this technology is that it actually destroys the biofilm and prevents Legionella from building or forming in the pipes in the first place”. Currently hospitals have to heat their water to more than 70 degrees to eliminate pathogens or bacteria that exist within their water system. Williams says “With this new technology on board we’ll be able to reduce our heating requirements down to domestic levels which has a massive impact on our energy consumption and the ability to reduce our gas bill by a third”. Ecas4 Australia’s CEO, Tony Amorico, says there are significant opportunities within the healthcare and food industries and has invested in the relocation and expansion of the R&D program. Ecas4 have engaged Dr Sergio Ferro - an Italian electrochemist involved in the formation of the technology. NECH have partnered with the University of South Australia to independently research the project. Amorico explains that the Ecas4 Anolyte will destroy pathogens including Escherichia coli, Listeria, Salmonella, Campylobacter and MRSA (' golden staph ') without any form of resistance. He says “The Ecas4 Anolyte solution can be used in nebulisation form to attack pathogens present on surfaces, including equipment, machinery and food. Our long-term goal is to use this technology to sterilise healthcare facilities, waiting areas and hospital rooms". Williams says “Our hospital and aged care facility covers a broad spectrum of patients and residents, from newborn babies to the elderly. We have now improved patient safety, particularly for those vulnerable groups". “Risk is always evident in healthcare and we aim to remove it wherever we can. The Ecas4 project sets us on a clear path to being able to eliminate that risk of Legionella completely”.
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
Visual resources TECHNICAL PAPERS
Media contacts
An Australian first in healthcare (con'td) North Eastern Community Hospital & Aged Care Facility North Eastern Community Hospital, is a not-for-profit, community owned private hospital and nursing home facility focused on providing quality clinical services to the local community. Situated in Campbelltown, 10 km north east of the city of Adelaide, South Australia the modern 60 bed hospital specialises in General Surgery, Medical, Obstetrics, Orthopaedics, Laparoscopic Surgery, Gynaecology, Gastroenterology, Dental and Residential Aged Care. northeasternhospital.com.au
Ecas4 Ecas4 was founded to provide health structures, in patient departments and accommodation of all kinds, with technologies in the field of bacterial disinfection. The Ecas4 system eliminates pathogens such as bacteria, fungi, viruses and mono-cell algae, from main and drinking water without the use of toxic chemicals, and, crucially, also eradicates the biofilm that is commonly found in the piping of any material. A minimal dose of the Ecas4-Anolyte disinfection solution is injected into water pipelines to provide disinfection without altering the potability of the treated water. The Ecas4-Anolyte is safe for humans and the environment, and ensures clean water (elimination of pathogenic bacteria and especially the bacterium responsible for Legionnaireâ&#x20AC;&#x2122;s disease). ecas4.com.au
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
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Enhancement of health facilitiesâ&#x20AC;&#x2122; approach to asset management R A PLATFOOT I COVARIS PTY LTD
This paper utilises the framework incorporated in ISO 55001 to propose the enhancement of asset management across multiple Health facilities, ranging from acute hospitals to community health centres. The methodology is supported by reference to various examples drawn from current practices. The purpose for such an enhancement is to maximise the operational capabilities of existing facilities to deliver Health outcomes to the community as well as to defer the requirement for capital investment to replace existing assets. The key elements of this approach are clear asset management objectives which prioritise investment and resources, the asset management plan to balance new capability investment with funds needed for asset renewal, improvement of the operational delivery of asset management work and implementing continual improvement with lean resources.
1. INTRODUCTION
T
he ISO 55001 Asset Management standard[1] was promulgated in 2014 following a sustained period across the international asset management community of integrated business and technical approaches to asset management suggested by BSI PAS 55[2], the International Infrastructure Management Manual[3] and comparable authoritative specifications. During this period Australian State Governments improved their own individual approaches to asset management such as Total Asset Management in NSW[4], the Investment Management Standard in Victoria[5] and so forth. The essence of ISO 55001 is a fourpart approach to the comprehensive management of capital development and sustainment of physical assets. The four elements commence with a governance framework based on corporate planning, stakeholder requirements and asset management policy summarised in a set of asset
management objectives. Secondly there needs to be balanced planning between capability development of the organisation with renewal of assets culminating in an asset management plan which is risk optimal and in turn drives both capital and maintenance plans.[6] A disciplined and measured approach is then required for asset management operations covering projects, maintenance, utilisation and other support activities, supported by competent teams and appropriate systems.[7] Finally, the enterprise has to be commit to continual improvement based on performance measurement and quality-based auditing precepts which lead to evergreen plans for improvement activities.[8] Because ISO 55001 is a quality management approach to asset management, it requires a combination of well-structured governance documented in appropriate plans and procedures, and demonstrable take-up by teams who understand their role and their accountability for delivery of a service or capability.
ISO 55001 does not mandate a level of investment nor the organisational structure which will deliver effective asset management: it can be applied while accepting the constraints of current systems, level of funding and resources, and the current state of the asset base.[9] What it does require is that information is used effectively to enhance fact-based decision making, resources must be disciplined and competent, the same resources are accountable for their performance and there is an organisational commitment to sustained continual improvement.[10] Effective asset management is about making the best possible use of existing funds and resources, and working to improve the asset condition, safety and capability to an understood future state. This paper will consider the top level governance issues and aspects of asset planning which are the first two elements of the total asset management approach itemised above. These elements need to be supported by good work management practices (for all aspects of asset management
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TECHNICAL PAPERS operational delivery) and a continual improvement process, which are concepts touched on throughout the paper.
2. GOVERNANCE OF ASSET MANAGEMENT There are three parts to the governance of asset management in an ISO 55001 approach. The first is the set of asset management objectives which are measurable targets to be met in order for stakeholder expectations to be achieved and the organisation’s corporate intent to be best supported by the use of the physical assets. The second is the communication to all stakeholders, internal and external, the top level approach to asset management which will be established and implemented. This assists people to understand their role in the context of other teams and processes. The third is specifying the governance documentation which sets out policies, procedures, standards and guidelines for people to use when delivering asset management processes.
2.1. Asset Management Objectives The asset management approach of a Health organisation is based in the corporate goals to deliver excellent health outcomes to the community the organisation serves. An example is drawn from past practice by NSW Health who published in 2009[11] a set of top level goals which may structure an asset management policy whereby the assets are managed to support their delivery. These goals included Healthier People; Fairer Access; Quality Health Care; and Better Value. Each of these goals can be interpreted in terms of top level requirements for the approach to asset management, e.g. managing infection, uptime of assets, capable asset performance and optimal cost in the overall delivery of the asset management support. These goals were in turn interpreted by NSW Health as infrastructure strategies summarised in the table below. This is a credible set of objectives on which to base a Health asset management system: there are not too many objectives which have
to be met all at the same time, they are distinct and clear, they provide guidance for decision making (eg in investment proposals) and they will assist individuals make decisions and set priorities without excessive top level oversight. These elements constitute measurable targets which can be applied by asset managers in the delivery of their service. They reflect a workable set of asset management objectives upon which an asset management system can be developed and importantly address two key requirements: determining how to meet corporate objectives for the Health enterprise and internal as well as how stakeholder requirements will be addressed, covering community, health professionals, workers in asset management services and Government. Expressing the infrastructure strategies in the framework shown above facilitates communication to stakeholders which is an essential requirement of ISO 55001. People need guidance to make decisions as part of their role without explicit instruction from higher corporate
Table 1: NSW Health – Infrastructure Strategies.
Infrastructure Strategy Objectives
NSW HEALTH STRATEGIES Healthier People
Fairer Access
Quality Health Care
Better Value
Results and Services Program – Key Result Area
To keep people healthy
To provide the health care people need
To deliver high quality health services
To manage health services well
The right services in the right location
Improve health status by providing a range and level of services consistent with population needs
Improved access to services for patients and carers
Recurrent and capital resources allocated consistent with population changes and needs
Achieve a level of capital investment based on service need
Up-to-date facilities and equipment lead to more reliable diagnosis and more effective treatment
Match of facilities to catchment population’s health care needs
Newer technology and facilities allow shorter hospital stays and less invasive treatments
Appropriate and proven treatments available across a network of services
Facility supports service model needs for population, e.g. primary health care centres, multipurpose centres targeting priority health needs
Improve throughput and efficiency through more functional facilities which support increased ambulatory and day only care
Assets aligned to meet inpatient, ambulatory and community health service requirements
Improved layout and design which support quality care and improve infection control, safety and security
Reduce unnecessary and excessive costs of maintaining poor infrastructure
Maintain and upgrade assets, where required, to meet demonstrated service needs
Meet recognised standards for facilities and comply with relevant building codes such as the BCA
Improve functional relationships and travel
Meets legislative requirements such as disability access
Assists with attracting and retaining workforce
Facility capable of responding to population
Well maintained facilities provide avoid adverse events
Facilities support efficient and appropriate service provision
Fit for purpose facilities promote better health outcomes Address poor asset condition and functionality
Improved physical environment for staff and patients. Reduced OH&S issues Improved patient management and delivery of better health care
Whole of life cycle approach
Ability to match the asset to the population need
Capacity to respond to future growth and redistribution of the population
Facilities match service needs (particularly rural areas)
More flexible design enables less costly changes
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TECHNICAL PAPERS positions. These statements define what is important and therefore needs to be focused on. 2.2. Asset Management Framework The asset management framework is a diagrammatic expression of how the asset management system is intended to work and is aligned with external oversight and essential systems to which it has to interface. It is an essential piece of communication and a generic example of a framework diagram is shown below. This will need tailoring for the organisation, identifying key processes and methods which have already been put in place.
planning process for selecting, installing, operating and then maintaining different types of assets in a safe and best-value manner. The organisation needs somewhere to store this knowledge so that it continues to learn and the knowledge is available to the people who need access to it. This is an important point: to distinguish between slow changing planning input and that which is relatively fast changing, e.g. condition, risks, improvement needs and so forth. Clear alignment between the asset management objectives and the outcomes of the various processes which make up the asset management system is tested by performance measurement and process auditing as discussed in Section 4 under Continual Improvement. It is the purpose of such assessment to ensure that all elements shown in the framework are working in a balanced manner with none non-performing or conversely, receiving biased attention to the detriment of other elements. 2.3. Corporate Documentation Corporate documentation defining the operational processes which make up the asset management system is an essential part of the overall delivery of the asset management system. Individuals have to know what is expected of their role and they need documentation to assist their training and development. Likewise, they should be held accountable against a standard which is documented and fair. That accountability can be assessed through measurement of compliance against the documented standard or auditors, internal or external, need to be able to access the documentation to determine the basis on which performance can be assessed. Ideally the SAMP should provide the first roadmap into the top level documentation: this drives structure and conciseness, and it immeasurably helps people to understand how to use the governance advisories.
Figure 1: Draft Asset Management Framework
The Strategic Asset Management Plan (SAMP) is an artefact introduced by ISO 55001 and represents a concise overview of the asset management system, literally covering the points set out in this paper and in much the same order. In the authorâ&#x20AC;&#x2122;s experience a detailed SAMP will typically run to around 60-80 pages, covering each of the sections in the Standard. It is an important document to communicate just how the asset management system is intended to work. The Asset Management Plan is a structure which has been interpreted in a multitude of ways by differing asset management specifications and guidelines.[12] In this paper we recommend a very literal interpretation of the Standard specifying work to be undertaken on assets, and this will become clear in Section 3 on Asset Planning. Asset Class Strategies is the corporate know how feeding into the
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Documentation needs to be registered as controlled documentation and held in either a Document Management System or a controlled network directory. Assessors of the asset management system need to be able to locate this documentation and determine if the material is quality controlled, current and utilised. Gaps in the documentation are an indictment on the enterprise and its inability to articulate corporate expectations of peopleâ&#x20AC;&#x2122; roles, whether they be internal, contractors or other. It is highly recommended that the documentation set is concise and when a person is trying to understand an element in the asset management framework, they only need to go to one top level document to at least appreciate expectations, controls and required processes. A multitude of documents simply confuses the control of the asset management system. The foundation of good operational delivery of asset management and a recommended document structure lies with sound processes in the areas of configuration management, risk management, engineering design
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TECHNICAL PAPERS principles, maintenance work delivery, project management, reliability engineering, performance measures and auditing. As these are established, ISO 55001 anticipates people are trained in these processes, expectations are communicated and delivery of work to these standards is continually assessed as part of internal auditing leading to continual improvement projects.
3. ASSET PLANNING
and detailed identification of the assets for which work is required; risk prioritisation of the work, noting it is also helpful to include how the work mitigates the original risk (i.e. what is the residual risk following the completion of the work); and costing, resources required and timing of the work. A top level view of the asset planning process is shown below.
The purpose of asset planning is to recommend future work to be undertaken on the assets within three planning horizons: • Funding period, e.g. 1-2 years. The recommended work which will make up the non-routine component of budgeted work on the assets, where routine work is seen as a mix of preventive maintenance, repairs and fault response. • Medium term, e.g. 2-5 years which is within the required time to investigate, design and implement major projects; and • Long term, e.g. +5 years, which allows options testing for consolidating work, deferring some projects and expediting others, and testing strategies for maximising work for lowest total cost. All of this work is registered in the Asset Management Plan with the following information considered mandatory: clear
Figure 2: Asset Planning Process
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TECHNICAL PAPERS Good asset planning incorporates management of options and linking work packages to address more than one problem in the assets. Hence there is a need to clear distinguish between the fundamental issue being addressed (e.g. condition of the asset, failure history etc) and the proposed work. The planning process balances growth of the enterprise with sustaining its current capability by renewing deteriorated assets. It is an iterative process, particularly at the point of the planning workshops where the competing priorities for investment need to be compared on a like for like basis such as a Risk/Opportunity Cost where the cost of not doing anything is multiplied by the probability of the outcome being realised, e.g. probability of failure or constraint etc. Ideally these costs are also adjusted for any existing value in current assets which may be disposed of as part of the plans. The outcome of this process is that minor works are managed as a single line budget item and major projects have their own budget line and will still require further business case development and gate-based planning approvals before they can progress.
resources within their local budgets. Reasonable candidates for remediation are grouped as a second set shown above, where the maintenance may well have been to a good standard, but fair wear and tear suggests there is now work to be proposed for these facilities. A third grouping, to the left of the figure, is a population of facilities where there is an undeniable need for investment but it needs to be accompanied by a review of the maintenance practices which have potentially led to early deterioration. What compromises the risk assessment process is the qualitative nature of ranking the condition, which is where there is a need for asset health to be based on quantitative measures where possible such as formed from condition monitoring or regulated and independent inspections. [14] 3.2. Asset Management Plan An entry in an Asset Management Plan relevant to a HV asset may look something like the sample below which is mocked up from a true life case.
3.1. Risk Management A key aspect of the asset planning process is the management of risk, and ISO 55001 requires two significant sub-processes: â&#x20AC;˘ Contingency planning if the works do not proceed and the foreseen risk is realised; and â&#x20AC;˘ Consistent risk ranking of all opportunities and proposals for expenditure so that the value of the investment is appreciated in terms of risk control. Leaving aside the need for capability growth based on community requirements forecasting and constraints on the existing Health service, an appreciation of risk across a suite of facilities in the NSW Health system is provided below. [13]
Figure 4: Sample AMP Entry
The referenced AMP has 2299 records or problems which require investment in the assets, and each of these may have one or projects associated with them. This example was extracted from a simple macro-enabled spreadsheet so the process to manage this information is straightforward and does not require an extensive system capability. An interesting and useful aspect of an asset management plan is the intent to group proposed work in project portfolios, indicated in the Portfolio box shown on the figure above. The intent is to group work where possible for the purposes of budget optimisation (typically through compression of costs and sharing of overheads), where the portfolio is led by a project manager who can deliver these cost efficiencies. Hence the proposed work from an asset management plan is not treated project by project but instead as grouping of projects managed per individual portfolio.
Figure 3: Risk Profiling of Existing Facilities
4. CONTINUAL IMPROVEMENT
In this case, risk is interpreted as a combination of condition and age. Three groupings of facilities are identified: the first of which are those in an acceptable level of condition given their age. For these facilities, the maintenance teams are delivering safe and fit-for-purpose assets, utilising their
The asset management objectives introduced in Section 2.1 of this paper must be amenable to measurement and some of these will drive Key Performance Indicators and some will simply be reported on a consistent basis. The purpose of performance reporting is twofold: Key Performance Indicators
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TECHNICAL PAPERS (of which there should only be a few) will assist with holding teams accountable and inform them where they need to consider improvement. Other measures will highlight other issues which may justify an investigation or internal audit being called by the nominated asset manager (i.e. the person accountable that the asset management system is working correctly). Hence in this approach to ISO 55001, auditing is a two-level approach:
It is also appreciated that Health teams are lean with many calls on their time. This is precisely why the asset management system is always at risk and there is a need for ongoing small projects to improve different parts of the process at any one time. This has two benefits, waste is eliminated from the system which will free up time for people and secondly, there will be no major problem in the future which will force people away from other work as they cope with fixing substantial issues.
• A formal audit process, e.g. annual or bi-annual, by impartial experts is needed to cover the entirety of the system and confirm to senior executive that the asset management system is operating correctly; and
A sample register from another industry is shown below, where each item has a registered number and an owner, the action may refer to an asset or group of assets, and the status of each item is tracked.
• Focused smaller audits managed using a small project framework which is both consistent and agile, will explore any specific issues and raise projects in a continual improvement register. The asset management system is a highly integrated process relying on the persistent efforts of multiple stakeholders. As such it will be fragile and in need of continual tuning and improvement. There is a need to nominate the responsible asset manager to maintain watch on the system, to initiate minor audits and to manage a continual improvement register from which projects can be raised, managed and delivered. Without this approach, the asset management system will decay.
Figure 5: Sample Continual Improvement Register (another industry)
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TECHNICAL PAPERS The exhibit which is provided was part of a process which substantially lifted the operational performance of a significant Australian enterprise. Without tracking the myriad of small issues and ensuring the work got done, the overall improvement would never have been achieved. This is the essence of effective continual improvement: many small projects which doggedly progress even though people are busy.
Due to its complexity, it should be appreciated that without continued monitoring, focused audits and investigations and a continual improvement plan, the asset management system will decay. Hence not only is a top level asset manager needed to coordinate the monitoring and continual improvement, but a plan is needed which commits team members to undertake small, focused tasks which will address some aspect of the system at any point in time.
5. CONCLUSION
The author acknowledges the support of Health Infrastructure over many years along with multiple NSW hospital engineers with whom he has worked since 2004. This paper is submitted with the hope that some of these concepts will help busy people deliver the crucial community support they are called on to provide with lean resources and budgets.
ISO 55001 is not an overhead on an organisation but instead a credible change management approach to a better future which manages waste out of the enterprise. Waste is what takes up people’s time and consumes budget on less valuable matters. In an ISO 55001 approach, people understand their role and what is expected of them, they are provided with guidance to make the best possible decisions, and when they are subject to external constraints outside their control, they can measure and report the implications of these issues. The consolidated asset management plan which is risk prioritised and supported by a detailed knowledge of the condition of the assets is essential to managing the short and long term view of investment and balancing between capability growth and asset renewal. It allows a Health team to match requirements from executive level as well as external planning with their local needs to deliver the services expected of them. Importantly the value of that investment can be articulated as both addressing current risk and how proposed work will mitigate that risk in the future. Asset management is complex owing to the need for many stakeholders to work seamlessly together. Hence people need to appreciate the context of their work and how it will affect the work of others, all of whom are combining to deliver the same top level goals expressed in the asset management policy. Understanding the framework of all of the elements which make up the asset management system along with the measurable objectives which mean that teams are working towards policy goals helps the disparate teams work together. Asset management is about a balanced and consistent decision making process. If one aspect of the enterprise’s goals is prioritised over others (e.g. capital development over maintenance), then the asset management system will not deliver on all of the policy goals, which will be shown up by failed objectives. Consistency is delivered by a readable set of standards, procedures and guidelines covering the key operating elements (i.e. work to be done) of the asset management system along with effective communication, training and performance assessment of the people who conduct their work in line with these requirements.
REFERENCES [1] ISO 55001 Asset Management, 2014-01-15 [2] PAS 55-2. (2008). Asset Management, BSI ISBN 978 0 580 50976 6 [3] International Infrastructure Management Manual, ver 4 2011 [4] Asset Strategic Planning, NSW Government, The Treasury, Total Asset Management TAM06-1 2006 [5] State Government of Victoria, Department of Victorian Communities, Asset Management Policy, Strategy and Plan, 2004 [6] T Middleton, M Amarasekera and R Platfoot Implementation of a Tactical Asset Management Plan for Existing Transmission Assets, NZ EEA Conference & Exhibition 2014R Platfoot, Improving the Delivery of Asset Management across the Enterprise, IET IAM 2014 Conference – Asset Management, UK [7] Asset Management – an Anatomy, The Institute of Asset Management, 2012 [8] R A Platfoot, Integrating Asset Management with Work Delivery and Continuous Improvement, WCEAM 2013, Hong Kong [9] R Platfoot, Linking Asset Reliability Improvement with Asset Management Plans, AMPEAK 2015 (Sydney) [10] From Inspiration to Practical Application, Infrastructure Asset Management Report, The Institute of Asset Management, 16th-18th March 2015, London [11] NSW Health, internal document 2009 [12] R A Platfoot, Ageing Plant, Optimal Expenditure and Risk-based Asset Management, TPM: The Next Level of Plant Operation, Melbourne 2014 Marcus Evans [13] R Platfoot, S Safi and P Milankovski, Asset Compliance, Capability and Reliability, IHEA 2015 Health Care Compliance Matters, Newcastle [14] Building Condition & Performance Assessment Guidelines, Practice Note 3, IPWEA-NAMS.AU, 2012
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Changes to baseline data AS1851-2012
DEREK HENDRY I HENDRY GROUP
Aust â&#x20AC;&#x201C; Hospital engineers should study the changes to AS1851-2012 routine service of fire protection systems and equipment, especially relative to baseline data which was published on the 16 November 2016. The changes can save a considerable amount of money.
T
he initial purpose of the amendment to this standard was for editorial reasons, however the industry was in desperate need for clarification of baseline data and how it should be applied. Hospital engineers should be aware of the changes to this standard in particular, Clause 1.8 Baseline data which applies to all routine servicing/testing of active and passive equipment/systems within buildings. Base line data is the set of data required at the time of installation of a system or equipment to establish the performance benchmark of the approved design.
PREVIOUS CLAUSE: AS1851-2012 CLAUSE 1.8 BASELINE DATA Baseline data is necessary to establish the performance benchmark of fire protection system or equipment. The non-availability of baseline data shall be reported as an non-conformance. Notes; 1. E xamples of base line data are detailed in Appendix C. 2. T he complication of base line data is outside the scope of this standard. 3. W here baseline data is not known, it should be established. 4. A t the commencement of the new maintenance arrangements, the fire protection system or equipment
should be compared with the approved design and baseline data. 5. Where the baseline data is not known, it should be re-established at the commencement of routine service or alternatively during the first year of application of this standard (see paragraph C1 Appendix C).
AMENDED CLAUSE: AS1851-2012 CLAUSE 1.8 BASELINE DATA Baseline data may be required to verify the result of routine service activity required by applicable service schedule. Baseline data required by this standard is limited to that â&#x20AC;&#x201C; (a) Necessary to verify a routine service activity result; and (b) Prescribed by the regulations codes or standards that applied to the approved design. Irrespective of the availability of base line data, the routine service activity shall be carried out and the result recorded and reported. Where required baseline data is available the routine service result shall be verified against it. Where required baseline data is unavailable, its unavailability shall be recorded and reported as a non-conformance.
of baseline data was unclear. Some service contractors whilst undertaking maintenance activities required the creation/submission of base line data in order to pass the test/inspection. This is turn raised a non-conformance or worse still no test was conducted due to the fact that no base line data was provided. This therefore had an impact with the buildings compliance status and the signing of the Annual Fire Safety Statement or state equivalent. The new amendment to the standard has clarified the application of base line data, therefore eliminating the failing of routine servicing/testing on the basis that base line data does not exist or it has not been provided to the contractor. Clause 1.8 Baseline data of the amended standard, now clearly indicates that routine servicing/testing of fire protection systems can be carried out and results can recorded and passed without the baseline data. However the absence of base line data itself must be recorded as a nonconformance within the test/inspection. Note: If baseline data does exist for the fire protection systems and is required by an approved design it must be used as a benchmark for the testing of the fire protection systems/equipment.
EXCLUSION OF APPENDIX C
CLARIFICATION BASELINE DATA Prior to the amendment of this standard the implementation and interpretation
Appendix C of the previous standard has been repealed and has removed the requirements for establishing a minimum benchmark for base line
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TECHNICAL PAPERS data. This is due to the fact that the parameters and requirements of the approved design should determine what is required. This has effected multiple clauses throughout the standard with reference to Appendix C.
CONCLUSION In conclusion there are four key amendments to AS1851-2012 in relation to baseline data; • Editorial modifications • Every section now refers to the new clause 1.8 • A Full reword of clause 1.8 • Removal of Appendix C It would be prudent for hospital engineers to be aware of these changes to baseline data and that it does not have to be established to enable contractors to undertake maintenance activities, if you adopt this amended standard under your state building control system.
OFFENCES AND PENALTIES FOR CARRYING OUT BUILDING WORK VIC – The Victorian Building Authority has issued a fact sheet headed offences and penalties for carrying out building work without a permit. The fact sheet explains what’s different about the Building Act 1993 since July 2016. A major concern is the fines as they are up to approx. $75,000 for an individual and $380,000 for a hospital (corporation). Be careful, the situation has changed where you appoint “service contractors” to perform ad hoc building works. Who has to obtain a permit is explained, who a building practitioner is, is defined and nominating all service contractors working on the site to have to ‘sight’ a building permit or obtain a building permit before commencing any building work or fixing defects that require a building permit.
UNFAIR CONTRACT TERMS WA – Hospital engineers should take care when they or management
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contract a small business (builder or contractor) to perform building works. The Treasury Legislation Amendment (Small Business and Unfair Contract Terms) Act 2015 has commenced operation on the 12th November 2016. The Act is intended to address the potential for unfair detriment where unfair contract terms are enforced against small business. (contractors) Maybe contracts have to be altered to suite your intentions. The Building Commission has issued an Industry Bulletin IB 073/2016 and can be viewed at www.commerce.wa.gov.au/ building-commission.
HAZARD CHEMICALS MANIFEST NSW – Fire and Rescue NSW has issued in August 2016 a Fire safety guideline Technical information D15/86318“Hazard chemicals manifest”. This technical information sheet outlines requirements for Hospitals (sites) to provide a manifest of their hazardous chemicals, a Manifest Quantity Workplace, for use by emergency services in an emergency. This document applies to any workplace using, handling or storing hazardous chemicals in quantities that exceed the manifest quantities prescribed in Schedule 11 of the Work Health and Safety Regulation 2011. The document is intended to be used by any person conducting a business or undertaking of a building, facility or site using, storing and handling above manifest quantities of hazardous chemicals. This technical information sheet can viewed at www.fire.nsw.gov.au.
INDOOR AIR QUALITY HANDBOOK AUST – The Australian Building Codes Board has issued an Indoor Air Quality Handbook. This non-mandatory handbook provides details to apply the NCC indoor air quality (IAQ) Verification Methods. The IAQ Verification Methods are
THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
FV4.1 AND FV4.2 in NCC Volume One and V2.4.5 in NCC Volume Two. They may be used when developing a performance solution. The Handbook provides background and guidance to use the Verification Methods. It covers the general principals of building ventilation, air contaminants and IAQ. Guidance on design strategies, modelling principals, and sampling and testing are also included. It is endorsed by the Australian Institute Of Refrigeration, Air-conditioning and Heating, AIRAH and can be downloaded at www.abcb.gov.au.
TERMINATING THE APPOINTMENT OF A PRIVATE BUILDING SURVEYOR VIC – Some Hospital engineers may have the need to change building surveyors before a building project is complete. Most cases require the Victorian Building Authority (VBA) to consent for a termination of a building surveyor to proceed. This legally needs to happen before a new building surveyor is appointed to your project. The VBA has a page on their website listing the reasons why a building surveyor can be terminated from the contract and the process to follow. If the client has appointed the municipal building surveyor to issue the building permit, it must be noted that the VBA is unable to terminate a council building surveyor.
ABOUT THE HENDRY GROUP Derek Hendry is the Founder of the Hendry Group, a property compliance solutions consultancy whose services include building surveying, disability access, essential safety measures, emergency planning and work health and safety. Hendry pioneered the private certification system of building approvals in Australia and operates nationally in all facets of building control. Hendry is aware of the importance of sharing knowledge, and regularly distributes industry news and updates through publications such as ‘Essential Matters’ Hendry’s e-newsletter, blog sites and website. For more information please visit www.hendry.com.au
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TECHNICAL PAPERS
Kleenduct Australia delivers outstanding duct cleaning services to existing and prospective customers throughout Australia. Our company offers 24 hour, 7 day a week servicing 363 days of the year. This ensures that we are in a position to promptly and efficiently meet the demands of our customers.
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We offer a wide range of services and are able to plan and program maintenance across multiple sites on a national level.
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
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Product News Introducing the latest from Japan â&#x20AC;&#x201C; The Hug, a Mobility Support Robot Hug is designed with supporting people who face mobility issues. It allows you to move a person from bed to wheelchair or wheelchair to the toilet. Hug assists when needing to transfer a person to a sitting position or in situations where standing for a period of time is required, such as getting dressed. Hug supports those who have the ability to stand on their own, but for a particular reason, have limited mobility when standing. Hug is ready to use, anytime. Hug does not use a sling or harness, which means no consuming setup time. Hug does not only raise a person, but brings them forward in a sliding motion to stand, effectively distributing their weight to the backs of the heels and allowing the person to feel comfortable while standing up. The Hug allows and gives people their dignity as they are reluctant to move because they do not wish to burden others with heavy lifting. The Hug robot can now take over the lifting work that has been the domain of care workers to ensure less physical stress and the avoidance of back injuries. Contact: Gerald Koh, Kobot Systems Pty Ltd Tel: 04-1996-1978 Email: gkoh@kobot.com.au
BSA BSA is one of Australiaâ&#x20AC;&#x2122;s largest technical services provider to the Health Sector. BSA has completed over $711 million in projects including Fiona Stanley Hospital and New Royal Adelaide Hospital.
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PRODUCT NEWS
Changes to Australian standards demand new kitchen hood filters For full compliance to the flame arrestance clause of AS/NZS 1668.1:2015, a UL 1046 certified kitchen exhaust hood filter is required. Airepure Australia is aware of only one single stage hood filter, now available within Australia, that is UL 1046 rated and would satisfy your compliance to AS/NZS 1668.1:2015 – the Captrate® Solo. Distributed by Airepure Australia, the Captrate® Solo is a highly efficient, single stage hood filter constructed to meet new stringent fire safety criteria. UL 1046 standards test grease filters for their ability to limit the spread of flames in a used state that replicates real world kitchen applications; i.e. “after having being loaded with grease in a manner representative of cooking that produces grease rich exhaust”. Traditional single stage honeycomb filters are not UL 1046 rated and would not comply with AS/NZS 1668.1:2015.
Clause 6.2.9 within AS/NZS 1668.1:2015 relates to cooking processes with exposed flame or embers; such as gas cooktops, oriental cooking tables and open flame charcoal equipment utilising solid fuels, and determines that when exhaust duct length exceeds 10 m “…devices that prevent the spread of flames in accordance with UL1046 shall be incorporated into kitchen exhaust hoods…” With 3 times the grease capture ability of standard baffle filters, Captrate® Solo can significantly reduce the maintenance requirements and fire hazard associated with grease build-up in hood plenums, duct work, fan assemblies, rooftops and adjacent surfaces. These filters will help to reduce operating costs by decreasing the frequency of hood and duct cleaning and extending the life of particle and odour filtration within downstream air purification systems.
Featuring a unique, S-Baffle design in conjunction with a slotted rear baffle design, the Captrate® Solo filters are constructed from robust and lightweight 430 grade stainless steel (typically used for kitchen grade equipment) and is sized to fit into standard 50mm deep hood channels. These filters will also help you achieve AS/NZS 1668.2 compliance, as they are easy to remove by hand from kitchen exhaust canopies. In-house cleaning is achieved simply by soaking these filters in a commercial degreaser overnight and/or washing in a standard dishwasher cycle. For more information on Captrate® Solo, please visit www.airepure.com.au or call 1300 886 353
Save energy and space As well as providing significant energy savings, replacing an aging traditional boiler with a condensing boiler can reduce the boiler plant footprint significantly. Automatic Heating’s Meridian Condensing Hot Water Heaters (Boilers) are available in wall hung and floor standing models to suit various installation requirements, and are cascadable with a BMS Interface option to save plantroom space and provide sequence control of multiple units with BMS feedback. Additionally, installation is made easy with inbuilt pumps and flow and return headers, while the Meridian is an AGA Approved Type A Appliance so no individual approval inspection is necessary. Meridian Condensing Hot Water Heaters work at very high and constant efficiencies reaching up to 108.6% enabling seasonal savings up to 35%. For more information, visit www.automaticheating.com.au
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THE AUSTRALIAN HOSPITAL ENGINEER I DECEMBER 2016
PRODUCT NEWS
Stop chasing builders for your project O&Ms At the recent IHEA conference in Adelaide the opening question of one of our presenters – OandMs Pty Ltd – seemed to highlight a common and frustrating problem for most hospital engineers and facility managers… “How many of you have reached practical completion of a recent project and are still chasing builders for crucial building information… that is, your O&MS?” We were overwhelmed – though not particularly surprised – by the response of the audience – more than 80% of people raised their hands! A clear majority of projects reach PC without critical data being available to those who take over the facility and are assigned the crucial asset management role. Why is it so hard to provide the project information a facility manager needs? When your project starts do you even know what the architect, engineer and construction companies are going to deliver in the way of O&Ms? The short answer is usually “no”. OandMs – the company – was begun to give control back to property owners and their facility managers. As a company, they are obsessive about collecting the information a facility manager really needs – not what an architect, engineer or construction company thinks a facility manager wants.
So why do the AEC groups find it so difficult to deliver project O&Ms?
The main reason has been that until now there has been no process for AEC groups to follow… even though the information required is clearly defined in the building specifications. While there is good intent by AEC groups to provide the operations and maintenance manuals, the diligence around providing them is often poor. What’s more disturbing is that facility managers are rarely consulted regarding the project information they will need, post-PC. OandMs set out to develop a simple process for AEC groups to follow and provide a minimum standard for the delivery of operations and maintenance manuals to facility managers. The OandMs system provides a simple, new methodology for gathering, managing, delivering and using as-built construction data to bridge the gap between O&Ms and facility management, ensuring the long term compliant operation of a facility. The OandMs system helps you regain control of your building information, guaranteeing you will never have to chase a builder for information again. If you are looking for a system to manage your building information, one which links the design and build to the ongoing facility management, visit oandms.com.au or call OandMs on 1300 784 910.
Tente AGV castors for automated guided vehicles Tente’s AGV’s are particularly effective for use in hospitals. These castors feature a Spring Loaded Directional Lock, if a castor loses ground contact, it automatically aligns in the direction of motion again. This is provided by a spring inside the castor. It prevents uncontrolled panning and ensures a smooth passage through doors, elevators and narrow alleys.
The slim design suits all AGV’s and because of the spring loaded directional lock, it avoids damage at the collection site.
Due to stainless steel components and sealed ball bearings, it can easily be cleaned and provides protection against splashing water and detergents which is a crucial advantage in a medical environment. The optional XSX wheel provides additional safety, electrically conductive wheels protect against discharges.
The castors are rated up to 350kg per castor and can easily be relubricated with a grease nipple. Available in a total or modular directional lock as well as with brakes. Contact Tente Australia for further information 1300 836 831 – sales@tente.com.au
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PRODUCT NEWS
Who did your patients shower with this morning? Throughout Australia the biggest single use of fuel in commercial industrial operations is for heating water. LPG is an easy choice as its Efficient, Continuous and Cleaner.
You know that your patients need a nice hot shower and neither of you want to be discussing why that isn’t happening because there isn’t enough gas.
With rising energy costs it can be a balancing act keeping costs down and productivity high. LPG is an extremely cost efficient method of water heating with little energy loss from its production or use. The fast recovery rate of LPG hot water units means the hot water storage tank size can be kept to a minimum too. Because LPG is cleaner burning, lower exhaust emissions make it far healthier for the environment and lowers maintenance costs for your equipment.
Elgas can make sure that your showers ready and your rooms warm 24 hours a day!
In your business you have a enough to do without worrying that there is enough continuous hot water 24 hours a day for your patients not to mention whether your patients rooms are warm enough in the cooler months.
Wherever you are there is a representative near you with local knowledge and expertise of LPG and appliances.
Elgas are Australia’s largest supplier of LPG with a wide distribution network, enormous backup of LPG reserves and can provide an optimised energy solution backed by professional advice and expertise.
For more information contact Ray Squires, Commercial Marketing Manager, Elgas, 1300 362 389.
Improve access control within healthcare buildings Codelocks have been helping estates and facilities managers implement cost-effective access control for many years. We understand that in a complex environment, access control products have to be easy to install and maintain, and above all effective. There are many areas within hospitals and healthcare facilities that can be given instant access protection using push button door locks. As well as the main access routes, there are also consulting rooms, reception areas, cleaning cupboards, staff rooms, washrooms, operating theatres, and areas used to store drugs and medical equipment to consider.
The locks provide all users with an access method convenient to them, whether that’s using a card, smartphone, or simple keypad code. For users that require regular temporary access like cleaners, a time-sensitive code can easily be issued on certain days or at specific times of the day. This function is useful for providing access outside of normal hours, for shift workers, or when contractors need access during certain periods for routine maintenance. The locks come with an audit trail facility which helps to monitor and track visitor and staff movement. Other advanced features, such as codefree entry, enables open access periods.
Codelocks new CL5510 smart lock makes access control easier, offering flexibility and convenience. The locks and technology allow building managers the ability to program locks via a smartphone, generate and send entry codes for easy access and issue smart cards for alternative entry.
For more information on Codelocks smart locks visit www.codelocks.com.au
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