Hospital Engineer Volume 38 Number 2

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Correcting concrete corrosion TR22 Refrigerant phase-out options Safe work at height rules update PP 100010900

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ACCESS DOORS • Can be custom made to any size, thickness or configuration (in-swing, out-swing) • Specified on major Hospitals to reduce leakage and improve energy efficiency • Positive, flat seal created by unique hinge design • High visibility red handles on all internal surfaces • Lockable external handles also available • High quality roller cams reduce friction during the latching process, so doors close smoothly & remain secure ACCESS PANELS • Higher insulation rating of R1.21 • The ONLY 50mm deep access panel available, helps reduce turbulence & inefficient air flow by retaining a smoother internal surface NEW OBSERVATION PANELS • Simple and quick to install on site due to “slide-in” design

VIC/TAS 03 9300 5199

NSW 02 8785 5877

QLD 07 3434 3477

2SA 08 8139 4777

WA 08 9241 7377

NZ 09 277 0040

NT 04 0877 4633

IHEA NATIONAL BOARD OF DIRECTORS National President Darren Green National Immediate Past President Mitch Cadden

CONTENTS

BRANCH NEWS

National Vice President Brett Petherbridge

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National President’s Message

National Treasurer Peter Easson (State Elected – WA)

9

State Branch Reports

National Secretary/ CHCFM Coordinator Scott Wells (State Elected – QLD)

TECHNOLOGY REPORT

19 Save water in your cooling towers

Membership Registrar Alex Mair (Nationally Elected)

21 Correcting concrete corrosion

Standards Coordinator Steve Ball (Nationally Elected)

BEHAVIOURAL HEALTH

Asset Mark Coordinator Mark Stokoe (Nationally Elected)

26 Behavioural health design regulations

Director Rod Woodford (State Elected Vic/Tas)

Communication Darryl Pitcher

31 Design standards for imaging areas are changing

Secretariat/Website Administrator Heidi Moon Finance/Membership Jeff Little Editorial Committee Mitch Cadden, Darryl Pitcher, Scott Wells IHEA MISSION STATEMENT To support members and industry stakeholders to achieve best practice health engineering in sustainable public and private healthcare sectors.

ADBOURNE PUBLISHING 18/69 Acacia Road Ferntree Gully, VIC 3156 PO Box 735, Belgrave, VIC 3160 www.adbourne.com ADVERTISING Melbourne: Neil Muir T: (03) 9758 1433 F: (03) 9758 1432 E: neil@adbourne.com Adelaide: Robert Spowart T: 0488 390 039 E: robert@adbourne.com PRODUCTION Emily Wallis T: (03) 9758 1436 E: production@adbourne.com ADMINISTRATION Robyn Fantin T: (03) 9758 1431 E: admin@adbourne.com

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IMAGING AREA DESIGN

TECHNICAL PAPERS

35 Hospital safety requirements

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45 TR22 Refrigerant phase-out options 48 Security & the hospital environment 50 Electro chemical activated solutions 55 Healthy pools for healthy people 58 Reduce disruption to patients with noninvasive rehabilitation technologies

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63 Safe work at height rules update VOL 38

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67 The importance of flexible health care design

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CASE STUDY

70 Risk reduction through hotspot identification utilising infrared thermal imaging Correcting concrete corrosion TR22 Refrigerant phase-out options Safe work at height rules update

PRODUCT NEWS

The image shows the New South East Regional Hospital in Bega NSW. The hospital will be completed at the end of 2015 at a cost of $190 Million.

PP 100010900

72 Product news Visit the Institute of Hospital Engineering online by visiting www.ihea.org.au or scanning here ➞ The views expressed in this publication are not necessarily those of the Institute of Hospital Engineering Australia or the publisher. The publisher shall not be under any liability whatsoever in respect to the contents of contributed articles. The Editor reserves the right to edit or otherwise alter articles for publication.

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

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

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

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

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TECHNICAL PAPERS

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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

National President’s Message INTRODUCTION

W

elcome all, to the latest edition of the IHEA ‘Hospital Engineer’ one of our most important communiqués providing information and modern industry trends to our members, business partners and the greater healthcare sector.

I am pleased to advise that the Board has been active in several of our nominated key focus areas and I hope this report provides important insight into our progress and direction. Readers will note that we are currently recruiting to our CEO position and this edition will therefore not include our normal CEO Message, more on this below.

Of interest I recently attended the NSW/ACT Conference, AGM and Annual Awards, the event was held in Newcastle early May, noteworthy was the Membership Service Awards where six (6) members amassed over 200 years of membership. It would be remiss of me not to mention our longest continuous member Mr Charles (Charlie) Shields who has been a member since January 1956, a truly remarkable achievement.

More detail on the service awards and the event can be found in the NSW/ACT Branch Report further on in this Journal.

Your IHEA National Board Members

Name

Position

Darren Green

National President

Email

Brett Petherbridge

Vice President (VP)

brett.petherbridge@act.gov.au

Mitch Cadden

Immediate Past President (IPP)

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

Peter Easson

National Treasurer

Peter.Easson@health.wa.gov.au

Scott Wells

National Secretary

scott_wells@health.qld.gov.au

Alex Mair

Membership Registrar

ama58500@bigpond.net.au

Executive Committee

Ex-officio

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

Vacant

Chief Executive Officer

Mark Stokoe

Director

ceo@ihea.org.au Mark.Stokoe@health.wa.gov.au

Darryl Pitcher

Director and IFHE Council Executive

d.pitcher@bethsalemcare.com.au

Steve Ball

Director

STEVE@BarwonHealth.org.au

Rod Woodford

Director

rwoodford@castlemainehealth.org.au

APRIL BOARD PROCEEDINGS AND SUMMARY OF KEY ACTIVITY • As per the image overleaf, the April Board Meeting was kindly hosted in Brisbane at the Brisbane Convention and Entertainment Centre (BCEC).

• The 2018 International Federation of Hospital Engineering (IFHE) Congress, sub-committee met with BCEC representatives and reviewed available rooms/spaces in preparation of more formal bookings late 2015 early 2016.

• CEO recruitment has progressed to advertising and current plans will see interviews in June/July with an anticipated start date as soon as practical. It is hoped that we will have a successful outcome from first round processes and an announcement for members prior to our 2015 Annual Conference and AGM. • The March Finance Report was presented to the Board by our Treasurer (Peter Easson) with a good result reported for the period similar to the previous. It was

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however noted that there is a need to focus on membership growth born from improved Member’s services.

• The draft Risk Register, Delegations Manual, Travel, Social Functions and Reimbursement Policies were reviewed and endorsed by the Board for progress.

• A planning update on the 2015 WA National Conference (September 9 -11) was presented by Mark Stokoe and endorsed by the Board with a commendation on the advanced preparation to date.

• There was a discussion surrounding membership and nonfinancial members, specific debate around the expulsion of long term unfinancial members as per the constitution and rules which was supported to progress.

• The IHEA Constitution review is nearing completion and finalisation of membership grades were debated in detail.

There was an in principal acceptance of proposed changes to be incorporated and presented to the June Board Meeting for further review. Once this is completed IHEA members will be provided a summary of suggested changes which remain subject to membership endorsement before they could be adopted.

• AssetMark was reported by Mark Stokoe including suggestion for some new initiatives including a YouTube Information Video and an applied effort in the NZ market both for further investigation. All IHEA members are encouraged to evaluate

the system’s capabilities and consider advantages it would provide to your organisation/s.

• The Board discussed Professional development opportunities and confirmed this important initiative must be maintained as a focus area and a point of effort for the new CEO. There is currently some work being undertaken promoting Schneider Electric University and the IHEA CHCFM programs.

• The pending ANZEX agreement update was presented

by Mitch Cadden inclusive of the 2015 delegate selection process.

• A report from Steve Ball was presented in relation to slowed activity and representation of the IHEA on current Standards reviews which predominantly revolved around current reviews being undertaken by Standards Australia.

• Through Darryl Pitcher the Board has continued progress for the upgrade of our website; our external consultancy now fully engaged with the required updates and new functions including financial transaction capability which is hoped to be completed in the coming months.

• The next ‘face to face’ Board Meeting will be held in Melbourne on the 26th and 27th June 2015. This meeting will have a strong focus on closing out end of year reporting requirements and preparation for the National Conference and Annual General Meeting.

SUMMARY In closing, I would encourage all members to read through articles, technical papers and Branch Reports as presented in this Journal. It provides important updates and trends in our Healthcare Industry. Our strong links with the International Federation of Hospital Engineering (IFHE) and other like international organisations also provide good information sources and networking opportunities.

I should also note that it is with mixed emotions I can report my two (2) year tenure as National President is drawing to an end.

Through natural rotation at the September Annual Conference in Perth Mr Brett Petherbridge will take over the ‘reins’ of our organisation. Brett and I have commenced a transition of duties and I am confident that the future of the IHEA will be in the good hands of your elected Board, Executive and new CEO. Always remember “none of us are as good as all of us” Ray Kroc.

IHEA NATIONAL BOARD MEETING – Brisbane April 2015 L to R: Darryl Pitcher, Steve Ball, Darren Green, Peter Easson, Brett Petherbridge, Mark Stokoe, Rod Woodford, Mitch Cadden, Alex Mair and Scott Wells.

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

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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

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STATE BRANCH REPORTS

State Branch Reports WA BRANCH REPORT – MARK STOKOE, BRANCH MANAGER Branch Meeting February 2015, Osborne Park Hospital For the first branch meeting of the year, 45 members headed to Osborne Park Hospital to attended February’s gathering hosted by Mr Peter Klymiuk, Engineering Service Manager for the facility.

The evening’s sponsor, Ecosafe International, is an emerging dynamic and independent risk management consultancy which specialises in a range of consulting and auditing services related to water, environment and health. An informative presentation titled ‘Legionella – The Changing Landscape’ was delivered

by Ecosafe’s founder and principle consultant, Mr Ryan Milne, focusing on the challenges and practicality of effective Legionella/Water Hygiene Management within health care facilities.

Country Conference March 2015 – Busselton Health Campus With the builder’s practical completion being approved only days prior to hosting the country conference at the brand new $120m Busselton Health Campus redevelopment project, located in Busselton, 230km’s south of Perth, the new facility is almost twice the size of the old hospital and remains on the existing site.

The new 84 bed facility, with a total active floor space area of over 14,000 m², will boast an expanded emergency department, day ward and surgery facilities, two operating theatres, two birthing suites, expanded dental clinic and medical imaging, outpatient and pathology facilities.

Conference delegates at the new Busselton Health Campus Main Entry

WA Country Health Service Regional Director Grace Ley, opens the conference

The conference was opened by the Regional Director of the WA Country Health Service, Mrs Grace Ley, with an engaging presentation based of the theme ‘From

Old to New’ highlighting the challenges of developing and transitioning to a regional state-of-the-art health facility.

Technology plays a huge part in modern day health care and the new campus offers a number of high-tech systems in line with modern metropolitan hospitals. Patients will be among the first in WA to experience 21st century ward rounds, with the traditional doctor’s visit boosted by state-of-the-art bedside health information screens located at their fingertips via the Patient Entertainment and Medical System within all in-patient rooms.

Hassell, the appointed architects for the South West project, designed the new campus based upon the concept theme of an ‘upturned aluminium dinghy lying on a beach’ as the Indian Ocean laps gently on the shore only meters away, landscaped outdoor therapy courtyards link both the east and west natural light fed corridors, providing direct connections to the key hospital services across the campus.

BHC Emergency Department Bays

It is anticipated the new 15 treatment bay Emergency Department will be presented with over 20,000 individual cases between July 2015 and June 2016.

WA President Mark Stokoe presenting Mr Geoff Smith with his 50 Year Membership badge

Aerial view of the Busselton Health Campus during the construction phase

The conference was also made possible with support from the following sponsors – Foster’s Services, Aurecon, RCR Energy, Schneider Electric, Raulands, BOC & Veeco.

Following a guided tour of the facility, over 60 of the conference participants were whisked off to the local Aravina Estate Winery, nestled amongst the picturesque setting of an expansive 180 acre vineyard, set across rolling hills, natural bushland and manicured gardens. Aravina Estate is one of Margaret River’s finest wine producing estates and a wide selection of wines were sampled on the day by the delegates, surrounded by the Estate’s unique large sports car collection, including Aston Martins, Lamborghinis and a Ferrari or two to name a few.

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STATE BRANCH REPORTS Branch Meeting March 2015, Brightwater Group For the first breakfast meeting of the year, 28 members attended a guided tour of the Brightwater’s Group Linen Facility, hosted

by Mr Peter Holder, property services manager.

Commissioned in 2003, the state-of-the-art facility commercial laundry has been designed and equipped to utilise the latest equipment and technology. The 3,500 m² commercial laundry can cater for a diverse range of linen requirements from standard laundry and client and patient personals, to theatre packs and pre-packs enabling the Brightwater group to operate within an open market space, serving a range of market sectors from Aged Care, Mining, Hotels, Hospital and Medical clients.

A recently commissioned gravity-fed bag rail system has further enhanced the automation of the laundry process and is an impressive operation to witness. Starting from the linin sorting/ weighting machine to loading of their 3 tunnel washers, each laundry batch is individually tracked and monitored using a state-of-the-art computerised system to manage the 155 tons of laundry arriving per week. Transporting all the laundry is a fleet of 8 specialised vehicles which are deployed to pick-up and deliver their clients linin requirements daily, throughout the Perth metropolitan area.

QLD BRANCH REPORT – ALEX MAIR, BRANCH PRESIDENT Activities ur February Country Race Meeting, PD and associated activities had to be cancelled. The weekend had been planned and venues booked when the Turf Club advised that the race track was not ready for racing and there would only be a phantom meeting. We were offered an alternate date, but it was too late to change all the arrangements. Workloads have precluded other activities at present and with only a very small functioning committee our next activity will be the mid-year conference and AGM in early July.

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VIC/TAS BRANCH REPORT – RODERICK WOODFORD, BRANCH PRESIDENT

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he Vic/Tas branch IHEA professional day was a great success we had forty in attendance comprising members, consultants, industry representatives and one work experience student.

Our day started with a light lunch provided by our sponsor Martin Leitch, CEO Strytex after lunch we had a presentation on Compliance Challenges and Solutions by Martin Leitch, one of the interesting statistics was that 38% of compliance is generated by government and the other 62% is generated internally, as hospital engineering and facilities managers we are always dealing with compliance issues Martin provide a list of 38 regulatory compliance requirements, viewed as a whole it looked over whelming it just goes to show how complex Hospital and Aged Care has become and the level of diversified expertise required by the engineering staff to meet the standards.

Leanne Chappell presented an overview of the new Victorian Comprehensive Cancer Centre, being built above the existing Royal Melbourne Hospital and the complexities of building on a site that remains operational while major construction is being under taken; most of us have had this joyful experience; which again comes with a plethora of compliance issues.

The site tour showed the light weight steel building construction materials used, so that extra floors could be added beyond that which the building was original designed for.

Below are photos of the tour group, the mechanical plant and some flue exhaust ducts ready for installation.

Membership Our membership has declined as we have followed up those whose accounts were outstanding. New members are starting to join following the restructure within Queensland Health and this is an indicator that the industry is alive and well and that the members are keen to network and develop as professionals. Unfortunately it also seems that most do not have the time to assist with the planning of that development by joining the Committee of Management.

Additionally many members are outside of the southeast corner of Queensland and that makes it difficult for them to have an active and ongoing involvement.

Management At this point the Committee needs some new energetic members to grow the Branch and provide services to the members. The existing committee members are long serving and tired after staging a very successful Annual Conference last year.

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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

Our next PD day will be up at Echuca including a site tour of the new hospital facility.

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STATE BRANCH REPORTS NSW/ACT REPORT – PETER LLOYD, BRANCH PRESIDENT

O

n behalf of the NSW/ACT Branch I take this opportunity to welcome everyone to the NSW-ACT IHEA 2015 AGM and acknowledge the continued support of the NSW/ACT IHEA Branch Committee of Management (COM), all Branch members, National Board and our many and varied sponsorship partners.

NSW State branch Conference “Health Care Compliance Matters” Extensive planning has culminated in the recent 2015 IHEA NSW-ACT Branch Conference that provided significant PD opportunity for all in attendance. I sincerely thanks members, trade sponsors and all others who have supported this year’s conference that endeavoured to create informative and learning experience to build networks and ideas. A special note to Mal Allen and Steve Dewar who attended the lions share or the work with and on behalf of the COM to bring the conference to reality.

As part of the trade display the Committee took the opportunity to encouraged local hospital trade staff to attend, this was well received by those able to attend.

NSW/ACT Branch – Institute of Hospital Engineering 2015 Annual Achievement Awards NSW/ACT Branch awarded one achievement award for this year’s event, that being The Engineer or the Year Award that has be most deservedly awarded to Deputy Director, Hunter New England Clinical Technology – Mr Rob Arian.

Charlie Shields = Jim Meldrum = Don Little = Keith White = Geoff Johnson = George Storrie = Gary Keenan = Ken Meale = Darren Green = Glen Hadfield = Mal Allen = Paul Morrow = Charles O’Brien = Peter Allen =

50 years (due for 60 next year) 40 years 30 years 30 years 30 years 30 years 20 years 20 years 20 years 10 years 10 years 10 years 10 years 10 years

Site Visit Orica May 2015 Newcastle Conference Orica’s Kooragang Island’s operations play a key role in the New South Wales economy, supplying critical products to the mining and infrastructure, agriculture, water supply, food, dairy and medical sectors. The Kooragang Island facility opened in 1969 as a manufacturer of fertiliser, making ammonium nitrate for use in the agriculture industry. The original operations at the site included the ammonia plant, a nitric acid plant and an ammonium nitrate plant. When the site began operation it produced 150,000 tonnes per annum of ammonium nitrate as fertiliser. A second nitric acid plant and ammonium nitrate plant were constructed in 1989 increasing the ammonium nitrate production to 300,000 tonnes per annum. Orica gained ownership of the Kooragang Island site in 2003. The following year, a third nitric acid plant was added to the site which increased the ammonium nitrate production to its current level of approximately 400,000 tonnes per annum. Fertiliser is no longer produced at Kooragang Island. Ammonium nitrate is now exclusively manufactured to service the mining industry.

Rob was nominated by Mal Allen from Hunter New England.

Rob was able to attend the conference to accept his award.

NSW/ACT Branch Service Awards At Our NSW/ACT Branch Conference in Newcastle, It was with a sense of honour and humility that I had the opportunity to present 14 Members of the NSW/ACT branch with Awards to acknowledge some 270 years of service. The highlight of this being that of a 50 year award to Charlie Shields (bearing in mind that he will soon receive his 60 year service award). Charlie was also presented with a small gift in recognition of his long standing association with the institute.

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AFM Online AFM online (NSW Health, Computer Maintenance Management Program) is progressing state wide with training and familiarisation occurring for each Local Health District occurring leading up to rolling the system out through 2015/16.

STATE BRANCH REPORTS The recent NSW/ACT Branch Conference hosted Gary Jessiman from HSS who has been instrumental in the rollout of AFM online, Gary provided a high level overview AFM in an informative well received presentation.

2018 International Federation of Hospital Engineers Conference 2018 The Australian IHEA has won the opportunity following a bid to host the 2018 IFHE conference in Australia in 2018, this is an excellent result for the National Board and Hospital Engineering throughout Australia. Given this event there will be no NSW-ACT Branch conference in 2018 as focus from the National Board and all State Branches will be on making this event the very best it can be.

NSW/ACT AGM Held 8th May Newcastle The NSW/ACT Branch held the AGM as in integral part of the Newcastle conference, with Elections of new office bearers, and some high level discussion in relation to initiatives to invigorate and move the branch forward, items discussed were as follows:Schneider training – web based training, progression of Certified Health Care Facility Manager (CHCFM), potential for mentoring accessing the wealth of knowledge sitting with our current and retired members, Engagement of more Biomedical engineers into the institute.

Committee of Management Contact details Name

Position

Phone

Email

Peter Lloyd

President

0428 699 112

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

TBA following COM meeting

Vice President

Darren Green

Secretary

0418 238 062

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

Mal Allen

Treasurer

0467 761 867

mal.allen@hnehealth.nsw.gov.au

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

Trevor Stonham

COM

0414 899 363

trevor@sah.org.au

Brett Petherbridge

COM

(0418 683 559

brett.petherbridge@act.gov.au

Jon Gowdy

COM

02 95158041

mailto:Jon.Gowdy@sswahs.nsw.gov.au

Steve Dewar

COM

0428 119 421

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

Summary Finally on behalf of the NSW/ACT branch members I wish to acknowledge the great efforts of last year’s COM and appreciate their efforts and support and look forward to working closely with the new committee to move forward for the IHEA NSW/ACT Branch with various initiatives the COM have taken on board to build the branch.

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STATE BRANCH REPORTS SA STATE BRANCH REPORT – PETER FOOTNER, STATE BRANCH PRESIDENT

A

t the Annual General Meeting in August 2014, the new Branch Committee of Management was elected, with the following appointments made:

State President: Peter Footner Vice President: Mike Frajer Secretary: John Jenner Treasurer: Mike Ellis National Board Nominee: Darryl Pitcher Committee Members: Darryl Pitcher, Tony Edmunds The SA Branch Committee of Management has met regularly throughout the year since and has focussed its attention on two major areas of concern and activity – the development and implementation of a varied, informative and helpful professional development program and the need to sustain and grow our membership locally.

PD Activities Professional development and networking events during the last year have included: • A site visit to a major CBD office block to review a services upgrade to plant at this site which has delivered very significant efficiencies and energy savings to the building owners.

• The annual Christmas networking function which was an excellent opportunity to discuss past activities for the Branch and to highlight planning towards future professional development and other events.

• A major, full-day seminar on Water Quality & Legionella Management in Health and Aged Care Settings, covering Legionella regulations and risk management processes as well information on the application of the Safe Drinking Water Act to hospitals and aged care institutions. These presentations were supplemented by sessions by various corporate members/event sponsors, covering lessons from the field, technologies in the control of Legionella and maintaining cooling water systems. A wide range of attendees, from across a diverse range of organisations participated in this very successful event.

• Providing information to and access by our members to various seminars and briefings organised by other organisations but likely to be of interest to the membership.

Membership Plan With declining membership over the past few years, during the last year the Branch Committee of Management developed a membership strategy which involved: • Reviewing and updating the membership database so that we had a good understanding of the current status of our membership; and • Understanding and addressing the current challenges and factors leading to a declining or stagnant membership.

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The major challenge to the SA Branch membership has arisen over the last few years due to the move towards outsourced FM service provision in the public health sector, ongoing restructuring of FM functions and the resultant decline in our traditional membership base.

The membership strategy focused on new service providers for the provision of health FM services (Spotless and DPTI/ BMFS) and, also, on re-engaging with former and nonfinancial members seeking to understand the reasons for their departure from the ranks of IHEA members and encouraging their return. The strategy also continued to engage further with the service provider/supplier market, seeking to attract more corporate members to the SA Branch.

On all of these fronts, we have had some success with: • The return of some former individual and corporate members, • Several new members from aged care and service provider organisations, • A new corporate membership from one of the major FM service providers to SA Health (Department of Planning Transport & Infrastructure/Building Management Facilities Services group); and • The imminent processing of membership for the facilities managers for the other major service provider to SA Health, Spotless.

I would like to thank these new and returning members and to welcome them to the SA Branch – and reassure them, and the existing members, that we will continue to strive to deliver valued professional development, networking and other benefits through the coming year.

National Board Matters One important outcome of the Branch’s consideration of the changing face of health FM service provision in SA has been the identification of the need to establish corporate membership arrangements that meet the requirements of these new service providers. We found that the existing corporate and individual membership arrangements did not adequately meet the requirements of these new providers as we sought to gain their support (through membership) to allow 15-20 individual facilities managers to participate in local Branch events. We have commenced discussions with the National Board, and have received early, in-principle support for changes to the structure of corporate memberships. However, we acknowledge that formal rearrangements of the membership structure for IHEA will require further constitutional review and endorsement through an Annual General Meeting.

We note and support the plans to enhance the organisation’s education and training programs, as flagged in the Strategic Plan, as this is an area where a small branch like SA requires assistance – any efforts at a national level to support PD activities at a state level (e.g. webinars, central pool of educational resources, improved delivery of material via IHEA website) would be most welcome.

STATE BRANCH REPORTS NATIONAL CONFERENCE Following the changes to the roster of state-organised national conferences (to accommodate the planned IFHE International Congress in 2018 in Brisbane), work has now commenced to plan for the IHEA national conference in South Australia in 2016.

The Future Following the inputs from participants at our recent PD seminar, planning towards other professional development events across the rest of the year is underway. We are hopeful of delivering the following events for members in the next 6-12 months:

• A PD event on commissioning processes in relation to redevelopment projects (prior to, during and after completion of projects) with a particular practical emphasis on infection control during redevelopment.

• A possible seminar on greening the healthcare sector.

• The Branch AGM and Christmas networking functions.

We are also considering the value and viability of a country visits program (in the form of a Q&A session in various sites on topics of interest to our country members).

• Several site visits to the New Royal Adelaide Hospital; • A half-day seminar on risk management principles and processes and emergency management/business continuity management issues.

In closing, I would like to thank the Branch Committee of Management members for their valued support throughout the year. I know many found it difficult to free themselves from the challenges and changes confronting them in their normal working lives but I have been extremely grateful for their past and ongoing efforts to move our branch forward.

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Attend the IHEA 2015 National TECHNICAL PAPERS Conference The Institute of Hospital Engineering, Australia (IHEA) invites engineers, health care facility managers, consultants, suppliers and other health infrastructure professionals from the private and public health care sectors to attend the upcoming IHEA 2015 National Conference in Perth, Western Australia.

Institute of Hospital Engineering Australia Conference 2015 9th September – 11th September 2015

Pan Pacific Hotel, Perth, Western Australia Early Bird Deadline: 30th July 2015 Confirmed Keynote Speaker: Dr Richard Charlesworth AM Richard Charlesworth is one of the best-known hockey players and coaches in Australian hockey history. He has worked with the Australian Institute of Sport as a mentor coach to 5 national team coaches. He was Australian Coach of the Year in 1994, from 1996 to 2000, and again in 2010. Ric has been technical advisor to Indian hockey teams and High Performance Manager of New Zealand cricket.

Ric is also a Doctor of Medicine and the author of 3 books on coaching. Described as one of the world’s best coaches, in 2001 he was appointed Master Coach by the International Hockey Federation.

In 2003 he received an Honorary Doctorate of Science at the University of Western Australia and completed a Bachelor of Arts majoring in Philosophy and History at the University of Western Australia.

Registration Fees for Full Conference (per Delegate in AUD) *IHEA Member Non-Member *Retired IHEA Member *One Day Member Rate One Day Non-Member Rate Additional Dinner Ticket Additional Welcome Reception Ticket

Early Bird $750 $900

Standard $850 $1000 $350 $350 $400 $155 $65

*Appropriate identification must be provided to qualify for a concessional and member rate. **To be entitled to the early registration fee you must have registered and paid by 30th July 2015.

Visit http://www.ihea-wa.com.au/nationalconference2015/registration.php to register for the conference.

Promaco Conventions (Conference Secretariat) PO Box 890, CANNING BRIDGE WA 6153

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Phone: +61 8 9332 2900 Email: promaco@promaco.com.au

THE AUSTRALIAN HOSPITAL ENGINEER www.ihea-wa.com.au/nationalconference2015/ I JUNE 2015 Website:

TECHNICAL PAPERS

Perth, Western Australia Ideal location for the 2015 IHEA National Conference Perth- the sparkling capital of Western Australia- is one of the nation’s fastest growing urban centres. Perth is buzzing with a new energy reinvigorating visitors with its sophisticated style, cleanliness, clear blue skies and pristine coastline, yet the relaxed lifestyle and friendly vibe remain.

IHEA Social

Welcome Reception at Pan Pacific Hotel- Wednesday 9th September The perfect opportunity to enjoy canapés and fine wine, renew old friendships and make new acquaintances, as we welcome you to Perth and the start of the 2015 IHEA Conference.

Conference Dinner at Fraser’s Kings Park- Friday 11th September Join us for a fabulous night with friends and colleagues at Perth’s Fraser’s Restaurant with magnificent views overlooking Perth’s Swan River and city skyline. Enjoy a delicious set menu with a selection of beers and wines before you dance the night away. Fraser’s Restaurant is located in Perth’s highly visited King’s Park.

IHEA Tours

Fiona Stanley Hospital and the New Children’s Hospital Technical Tour- Wednesday 9th September IHEA delegates have an opportunity to visit one of two major hospitals in Perth. Fiona Stanley Hospital, which offers a high standard of patient care to communities across the State or The New Children’s Hospital, which is near to completion and will have the latest in technology/ infrastructure facilities dedicated to children.

Post Conference Tour to Swan Valley- Saturday 12th September Visiting delegates have an opportunity to visit Swan Valley, a must see destination when you visit Perth. Swan Valley is known for their wine, chocolates and beer.

THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

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Australia’s market leading water specialists

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www.hydrochem.com.au 1300 558 788 THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

TECHNOLOGY REPORT

Save water in your cooling towers WATER CORPORATION

Cooling towers are important components of many air conditioning systems and can often be the largest consumer of scheme water for a site.

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recent study by Water Corporation in Perth found many sites had the potential to achieve significant water savings by improving the management of existing cooling towers.

These savings can lead to improved sustainability ratings for your hospital as well as reduced operational costs.

A cooling tower is a heat exchange device that cycles water to operate air conditioning systems in large buildings.

Heat is removed through evaporation and cooled water is pumped back through the air conditioning system. Warm water flowing back from the air conditioner is pumped to the top of the cooling tower where it is evenly dispersed over the tower packing.

The tower’s extractor fan and side louvers allow the hot water vapour to leave the tower. Cool water then flows down and collects in a large basin, where it is sent back through the air conditioning system and used for cooling.

Water is lost during this process through evaporation and wind drift. Some water is also removed from the basin to reduce the build-up of solids that can cause fouling and scaling. This water is replaced and chemicals are added to prevent fouling and limit scaling which in turn decreases the amount of water that needs to be removed. The key to ensure a cooling tower system is not wasting water is to get this balance right.

Water Corporation found that sites with a basic understanding of the operation of a cooling tower were able to identify

Figure 1: How a cooling tower operates

ways to optimise performance, saving water and energy.

It is important to take ownership of the operation and maintenance of your cooling tower and to work closely with the people involved in the process. This may include the building owner, property manager, mechanical services contractor or a water treatment contractor.

Here are three tips to reduce water use in your cooling tower.

1. REVIEW THE CYCLES OF CONCENTRATION Cycles of concentration refers to the relationship between the total dissolved solids and fresh water component in a system. If the cycles are too low you may be wasting water, and if the cycles are

too high, it may have impacts on the system which cause scaling, fouling, corrosion and even health issues such as Legionella. To determine the optimum cycles of concentration balance, speak with a water treatment service provider.

Case study An audit of water use at a commercial office building in Perth confirmed cooling towers accounted for more than half of the building’s total water use. This was much more than would be considered typical for this type of building and further investigation identified an opportunity to reduce water consumption by increasing the cycles of concentration for the system.

By increasing the cycles of concentration from 3.7 to 6, water use was reduced by around 14 million litres per year.

This saved the site more than $33,000*

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TECHNOLOGY REPORT per year in water and wastewater charges, while delivering the same air conditioning service.

To read the full case study visit watercorporation.com.au

While cooling towers present an opportunity to reduce water use at a site, management of towers requires a holistic approach which includes consideration of potential Legionella related health impacts. Water use related decisions should be discussed with your Water Treatment Service Provider prior to making changes.

To read the full case study visit watercorporation.com.au

2. TAKE OWNERSHIP OF YOUR COOLING TOWER SYSTEM Taking ownership of your cooling tower system and conducting regular checks and maintenance is the easiest way to ensure your system is operating efficiently.

and make sure you are informed about the optimal cycles of concentration.

Figure 2: The faulty ball float valve wasted 20 litres of water per minute.

For those in WA, Water Corporation delivers a free training course about efficient water use in cooling towers.

This is available for facility and site managers responsible for cooling tower systems. To find out more about saving water in your hospital, or to register for a free course, visit: watercorporation.com.au or contact: water.efficiency@watercorporation.com.au

Case study – IKEA Perth The IKEA store located in the Perth suburb of Innaloo discovered the importance of regular checks when it experienced a faulty ball float valve in one of its cooling towers. A valve was stuck open, which caused water to continuously flow into the cooling tower at an estimated rate of 20 litres per minute. This water overflowed from the tower directly into the sewer. Not only did this waste water, it diluted the chemicals responsible for maintaining the system’s corrosion control.

3. WORK WITH YOUR WATER TREATMENT SERVICE PROVIDER TO MAINTAIN AN EFFICIENT SYSTEM

This led to damage to the systems’ chilled water pumps, which had to be replaced at a cost of more than $2,800. The full extent of the damage was not discovered until the system was inspected, with management estimating the total cost of repairs running into the tens of thousands of dollars.

Figure 3: The fault also caused significant damage to other parts of the system through loss of corrosion control.

Set clearly defined objectives and responsibilities with your Water Treatment Service Provider to ensure your system is operating efficiently. Set water-use targets, including monthly water treatment reports,

The estimated amount of water lost from the system due to the faulty float valve was 5.55 million litres at a cost of more than $25,000 in water and wastewater charges. Had the problem remained undetected for a year, it would have resulted in more than $48,000 in unnecessary water and wastewater charges. To put that into perspective, the cost to replace the faulty ball valve would have been around $120.

IKEA management now completes daily checks of the system for leaks and overflows. Weekly checks by the Facility Manager are also undertaken to look for any abnormalities and to act on them immediately. Regular readings are also taken from the site’s water meters to identify anomalies which could indicate a leak on site.

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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

*Costs based on Water Corporation 2012/13 water use charges ($2.04/kL) and sewerage volume charges (2.677/kL) respectively

TECHNOLOGY REPORT

Correcting concrete corrosion AUSTRALASIAN CORROSION ASSOCIATION

Corrosion of the reinforcing steel in concrete is a worldwide problem that causes a range of economic, aesthetic and utilisation issues. However, if corrosion effects are considered in the design phase and the right decisions made prior to construction, buildings can be built to last and protected for as long as possible.

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he corrosion of steel in concrete is accelerated in harsh environments, especially coastal or tropical areas where high salt levels or extreme temperatures can accelerate the rate of decay. Usually, the most exposed elements deteriorate first but because the active corrosion may take 5 to 15 years to initiate cracks in the concrete, much of the actual corroded reinforcement is not visible.

It is important that owners and operators of hospitals, not just the engineers, understand the cost implications of ignoring the effects of corrosion on the facilities of which they are in charge.

There are many advantages to planning for corrosion control and mitigation. Two of the main ones are that the life of an asset can be extended and maintenance time and costs reduced. In addition, reduced maintenance requirements increases the asset’s overall utilisation and can improve its environmental sustainability.

It’s not OK just because it can’t be seen...

The alkaline (high pH) conditions in concrete forms a passive film on the surface of the steel reinforcing rods, thus preventing or minimising corrosion. Reduction of the pH caused by “Carbonation” or ingress of chloride (salt) causes the passive film to degrade, allowing the reinforcement to corrode in the presence of oxygen and moisture.

A voltage differential of approximately 0.5 V is set up between the corroding

(anodic) sites and the passive (cathodic) sites resulting in a corrosion cell where electrons move through the steel from anode to cathode. The rate of the reaction is largely controlled by the resistance or resistivity of the concrete.

Acid forms at the anodic (corroding) site which reduces the pH and promotes the corrosion of the steel.

The Australasian Corrosion Association (ACA) works with industry and academia to research all aspects of corrosion in order to provide an extensive knowledge base that supports best practice in corrosion management, thereby ensuring all impacts of corrosion are responsibly managed, the environment is protected, public safety enhanced and economies improved.

The ACA also conducts educational activities such as seminars and training courses to inform and guide organisations and practitioners about topics including the latest protective technologies and processes. Throughout the year, the ACA conducts training courses and hosts seminars across Australia and New Zealand. Corrosion specialists certified by the ACA, and other organisations, have the experience and understanding of corrosion causes and solutions that allow them to recommend mechanisms and procedures to consultants and asset owners.

Corrosion affects all concrete buildings and structures around the world to some extent, with an estimated annual cost of

Spalling concrete on a wall showing corroded reinforcing rods

billions of dollars to national economies.

In addition, the falling concrete from buildings, where spalling is occurring, represents a real safety risk. Hospitals rarely want scaffolding, cabling and exposed metalwork on display for extended periods of time.

There are also constraints on when necessary repair or remediation work can be carried out. Commercial office buildings are usually unoccupied for several hours overnight when disruptive drilling and grinding can be done, but most hospitals operate 24 hours per day making it almost impossible to find convenient times to do the work.

The two commonest causes of concrete corrosion are carbonation and chloride or ‘salt attack’.

THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

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TECHNOLOGY REPORT Managing Director of Infracorr Consulting PL, it might take up to 15 years before any cracking is visible. “It is a hidden problem which means that, when you find it, it is often well advanced, very much like the tip of the iceberg” Godson said.

Carbonation is the result of CO2 dissolving in the concrete pore fluid and this reacts with calcium from calcium hydroxide and calcium silicate hydrate to form calcite (CaCO3).

Dangerously damaged hand rails with exposed rusting metalwork

In broad terms, when carbonation, chlorides and other aggressive agents penetrate concrete, they initiate corrosion that results in cracking, spalling and weakening of concrete infrastructure.

As reinforcing rods rust, the volume of the rust products can increase up to six times that of the original steel, thus increasing pressure on the surrounding material

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which slowly cracks the concrete. Over the course of many years, the cracks eventually appear on the surface and concrete starts to flake off or spall.

As the degradation of the steel and weakening of the concrete occurs from the inside and may not be seen for many years, it is often referred to as ‘concrete cancer’. According to Ian Godson,

THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

Within a relatively short space of time, the surface of fresh concrete will have reacted with CO2 from the air. Gradually, the process penetrates deeper into the concrete and after a year or so it may typically have reached a depth of 1 mm for dense concrete of low permeability, or up to 5 mm for more porous and permeable concrete depending on the water/cement ratio.

Chlorides, usually from seaside splash or windblown locations, migrate into the porous concrete over time, causing

TECHNOLOGY REPORT corrosion when the concentration of chlorides reach critical levels at the reinforcement. In addition, older structures may have utilised calcium chloride as concrete ‘set accelerators’ at the time of construction, again resulting in serious corrosion issues.

CONCRETE CORROSION REPAIR AND PREVENTION According to Justin Rigby, coatings consultant at Remedy Asset Protection, “Concrete is a great material and is generally impervious at the start, but to increase durability, a coating should be applied.”

Elastomeric waterproofing membranes can be either rolled or sprayed on to a concrete surface. Flat rooftops allow membranes to be rolled on, but where there are complex geometries, spraying the coating is the most effective method of application.

The traditional method of concrete repair is to remove the cracked and spalling concrete to a depth of 20-30mm behind the reinforcing bars to fully expose the rusted material and remove the contaminated concrete from the steel.

All the corroded material is then removed and the steel treated or replaced, after which specialist repair concrete mortars are applied and the surface made good. A modern development is for the repair mortars to be polymer modified to improve adhesion and resist further ingress of contaminants. Coatings are commonly used in combination with patch repairs to reduce further entry of carbonation or chlorides.

Elastomeric polymer membrane on a city high-rise mitigates the effects of exposure

One type, Impressed Current Cathodic Protection (ICCP), is a technique whereby a small, permanent current is passed through the concrete to the reinforcement

Hybrid anode installation, typically with Anodes installed in 30mm diameter holes, typically spaced at approximately 400mm, with titanium connector wires. Repair mortar then completely covers the hybrid system components

These “patch repairs” that remove the contaminated concrete from the deteriorating sections often do not address this hidden corrosion and result in accelerated deterioration to the surrounding areas, commonly failing again within 3-5 years. Godson added, “One of the limitations of patch repairs is that you have to remove large quantities of sound concrete to solve the problem, causing significant noise and disruption to the building occupants.”

The main alternative to patch repair is Cathodic Protection.

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TECHNOLOGY REPORT in order to virtually stop the corrosion of the steel.

The main benefit of ICCP is that the extent of removal and repair of concrete is vastly reduced, with only the spalled and delaminated concrete required to be repaired. Once installed, the ongoing corrosion can be controlled for the long term, eliminating future spalling and deterioration even in severely chloride or carbonation contaminated concrete.

The selection of anode systems is the most vital design consideration for a durable and efficient ICCP system. Incorrect selection and placement of the anode system can result in poor performance and vastly reduced life of the installation.

According to Godson, cathodic protection is relatively simple in theory.

“Insert anodes into the concrete at set spacing attached to the positive terminal of a DC power supply and connect the negative terminal to the reinforcing steel.

ICCP systems commonly operate at 2 to 5 Volts DC,” he said. “The drawback

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is that you need lots of cables and permanent power supplies which results in this technology being mainly restricted to civil structures such as wharves and bridges with very rare applications to buildings.”

A relatively recent development has been Hybrid CP which utilises zinc anodes installed in drilled holes with the anodes powered for an initial period of around 10 days. The high initial CP current totally passivates the steel reinforcement, migrating chloride away from the bars and restoring an alkaline (high pH) environment in the concrete.

Following the initial impressed current phase, the temporary power supply and cables are removed, with the anodes then connected to the reinforcement via locally placed junction boxes to provide ongoing galvanic protection. This relatively low galvanic current maintains the ongoing passive condition at the reinforcement and prevents further concrete damage.

Hybrid CP systems are usually designed to give a 30 year or longer design life.

THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

Hybrid CP offers all the advantages of ICCP, including corrosion control and reduced concrete removal, without the high cost and maintenance of power supplies, cables and control systems.

Areas and structures that were previously difficult and uneconomical to treat with ICCP can now be protected using Hybrid CP technology. This includes small scale and remote structures including those situated in non-powered sites such as bridges, marine dolphins and culverts. In the case of building repairs, Hybrid CP offers significant advantages over ICCP by eliminating the need for unsightly and costly cabling and power supplies.

The Australasian Corrosion Association Incorporated (ACA) is a not-for-profit, industry association, established in 1955 to service the needs of Australian and New Zealand companies, organisations and individuals involved in the fight against corrosion. The vision of the ACA is to reduce the cost of corrosion.

TECHNICAL PAPERS

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BEHAVIOURAL HEALTH

Behavioural health design regulations JAMES M HUNT, AIA I WILLIAM N BERNSTEIN LEED AP, AIA

Behavioural health care facilities are intrinsically different from general hospitals in many ways.

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or a start, the basic function of the patient room is different. In general hospitals, the patients spend the majority of their time seeing their doctors, receiving treatment, eating their meals and talking with visitors in their rooms.

In behavioural facilities, all of these functions take place in other locations such as group rooms, day rooms, dining rooms and activity rooms, which do not exist in general hospitals.

Another significant difference is that general hospital patients typically are not considered to be suicidal. While all behavioural health patients are not suicidal, inpatient suicides are a continuing area of concern. Moreover, the rates are not declining despite concerted efforts to reduce them.

Patient-to-staff injuries also are significant issues in behavioural health facilities and not only result in significant workers’ compensation claims, but also impact staff retention and recruitment costs.

These concerns require that furniture and equipment provided for these patients be vastly different from what is typically provided in general hospitals.

Perhaps it is not surprising, then, that regulatory requirements for behavioural health care facilities are much different from those written for general hospitals.

REGULATORY DIFFERENCES Codes, standards and references for behavioural health facilities contain much more emphasis on security and less on patient comfort. For instance, medical gases and nurse call systems

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are required at patient beds in general hospitals, but are specifically not required for behavioural health. Likewise, the requirement for privacy between beds in semiprivate medical patient rooms is also not required for behavioural health.

The emphasis on safety and security often can lead to the creation of an environment that looks and feels more like a prison than a hospital. Consequently, the various codes and regulations also have language that emphasises that a therapeutic environment be provided that is “characterised by a feeling of openness with emphasis on natural light,” as noted in the Facility Guidelines Institute’s (FGI’s) Guidelines for Design and Construction of Health Care Facilities. While these may seem to be conflicting concepts, a welldesigned behavioural health facility can accomplish all of these parameters.

Codes. A number of documents that provide detailed information regarding design and construction of psychiatric facilities are used to regulate design.

Examples are the International Building Code family of documents and the National Fire Protection Association (NFPA) documents including, but not limited to, the NFPA 101 Life Safety Code.

The code documents include not only general requirements that apply to all health care facilities but specific requirements and exceptions that only apply to behavioural health facilities.

These include allowing the locking of exit doors, limiting the opening size of operable windows, locking the fire

THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

PHOTO BY PAUL WARCHOL This dining room is part of a new behavioural health care facility designed by the Behavioural Healthcare Architecture Group and located at Kings brook Jewish Medical Centre in Brooklyn, N.Y.

extinguisher cabinets and fire alarm pull stations, among others.

The ability to lock exits falls into two categories commonly referred to as “failsafe” and “fail-secure.” Fail-safe provides automatic unlocking of exits when the fire alarm system is activated, and fail-secure keeps the exits locked when the fire alarm system is activated until staff members unlock them.

Care should be exercised when interpreting code requirements for any given project. For example, the 2012 edition of NFPA 101 allows doors from patient rooms to corridors to have roller latches in lieu of “positive latching devices.” This was the standard 40 or 50 years ago before the codes began requiring positive latching for all corridor doors. Even though the current edition of the Life Safety Code allows roller latches, the Centres for Medicare & Medicaid Services (CMS), the Joint Commission and other agencies that have a strong say in these matters have not accepted roller latches for these doors. In such

BEHAVIOURAL HEALTH cases and possibly others, it is advisable to make sure that all authorities having jurisdiction (including local agency representatives) are in agreement before proceeding.

Standards. These documents provide detailed information regarding design and construction. Compliance with them is not necessarily legally required, but these standards are referenced in codes, laws and other regulations, and may be relied on by courts to determine the prevailing standard of care. They are developed by a large number of experienced individuals working together to form a consensus of minimum requirements.

One example is the FGI Guidelines.

The 2014 edition has two volumes — the Guidelines for Design and Construction of Hospitals and Outpatient Facilities and the new Guidelines for Design and Construction of Residential Health, Care, and Support Facilities.

The FGI Guidelines is widely accepted as establishing the national standard of care for all types of health care facilities, including freestanding psychiatric hospitals, psychiatric units in general hospitals and a wide range of outpatient

and emergency facilities that treat the mentally ill. It is referenced by the Joint Commission, many state laws and many court systems. In several states, the document is adopted by law and gains a status similar to a code. In other states, it is referenced or used as a template to create their own standards. In any case, following the requirements of this document provides owners and design professionals a more defensible position if an incident leads to legal action.

The central focus of psychiatric hospitalspecific standards in the FGI Guidelines is in Chapter 25, which specifically addresses freestanding psychiatric hospitals. Other chapters refer to this for the basic issues or are referenced from this chapter for other specific exceptions.

This document gets very prescriptive regarding the size of patient rooms, maximum number of patients per room, location and quantity of patient bathrooms, and area of such common spaces as activity rooms, group rooms and dining rooms. For instance, seclusion rooms must be a specific size. Both the length and width can be no less than 7 feet nor more than 11 feet with 9-foot ceilings and provided at a ratio of one

room per 24 beds. They also must be accessed through an anteroom and have a bathroom directly accessible from the anteroom. Other specific requirements regarding finishes, hardware, door sizes and door swing also are provided.

Window systems, light fixtures, air grilles, furnishings, toilet accessories, finishes, door hardware and the therapeutic nature of the environment also are addressed.

The FGI Guidelines is revised on a four-year cycle and the 2014 edition was released last year. There are some significant changes in this edition from the 2010 edition. They include: • Safety risk assessments are now required for all projects. Specific assessments for psychiatric patient injury and suicide prevention are required and discussed in section 1.23.6.

• The term “geriatric” has been removed from the formerly named “geriatric, Alzheimer’s and other dementia” units.

This may be recognition that the lower end of age ranges of patients admitted to dementia units has been going down in recent years — it is important to treat the diagnosis regardless of the chronological age of the patient.

ASSESSING PSYCHIATRIC PATIENT SAFETY The patient population being served and the patients’ level of suicidal ideation both must be evaluated to determine a level of risk that is acceptable for any psychiatric facility.

The level of concern for the safety of patients and staff due to the design of the built environment is not the same in all parts of a behavioural health unit or facility. The level of precautions necessary depends on the staff’s knowledge of the patient (i.e., the patient’s intentions regarding self-harm) and the amount of supervision the patient will have while using that part of the facility. This information will determine the extent to which risk is acceptable in any particular portion of an inpatient unit.

The amount of privacy may be reduced by implementing procedural measures such as assigning a staff member for one-to-one supervision. Determination of the patient’s intent for self-harm may be difficult to quantify. There have been a number of studies in recent years that have concluded that the patient suicide risk-assessment tools currently available are not reliable.

Reducing the opportunities for self-harm by limiting ligature attachment points, breakable glass, curtains of all kinds and other items that patients might use can go only so far. The level of risk that is acceptable to any program must be balanced with the creation of a therapeutic environment that is conducive to patient healing and recovery. Therefore, the acceptable level of risk provided by the physical environment depends on the amount of time a patient may spend alone, unobserved in a space, and the extent to which the patient is contemplating or planning a suicide attempt.

The 2014 edition of the Facility Guidelines Institute’s Guidelines for Design and Construction of Hospitals and Outpatient Facilities requires that a safety risk assessment (SRA) be conducted as part of the planning process for new construction and major renovations. As part of the SRA, the risk of patient injury and suicide must be assessed for “areas that will serve patients at risk of mental health injury and suicide.”

The 2014 Guidelines also refers readers’ seeking more information on SRAs to the National Association of Psychiatric Health Systems’ “Design Guide for the Built Environment of Behavioural Health Facilities.”

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BEHAVIOURAL HEALTH • Acoustic tile ceilings are no longer allowed in seclusion rooms, patient bedrooms, patient toilet rooms or patient bathing facilities.

• Built-in furniture no longer can have doors or drawers, and all open shelves must be fixed in place.

References. These are documents prepared by organisations to assist facilities and designers in understanding the unique differences inherent in behavioural health facilities, and suggestions of specific products that may be more appropriate for use in these facilities. Examples include: • “Design Guide for the Built Environment of Behavioural Health Facilities,” published by the National Association of Psychiatric Health Systems (NAPHS).

• “Patient Safety Standards, Materials and Systems Guidelines,” published by the New York State Office of Mental Health (OMH).

• “Mental Health Facilities Design Guide,” published by the Department of Veterans Affairs (VA), Office of Construction & Facilities Management.

These documents, while similar in many ways, are also different.

One of the differences is the intended audience. The NAPHS design guide is general in nature and attempts to illustrate the range of possible products and design philosophies that may be acceptable in various facilities depending on wide

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variances in patient populations, acuity, staffing patterns, and culture and target market. The New York State OMH document specifically addresses what is allowable in the facilities owned and operated by the state. It includes suggestions of what is appropriate in other facilities in New York and may be applicable to facilities in other states as well. The VA document establishes criteria and specific limitations that are required for use within the VA system and also may be applicable to other behavioural health facilities.

All three documents should be reviewed to determine their applicability.

TAKING CARE The current state of codes, standards and references related to behavioural health care facilities still leaves designers dealing with a series of documents that may be contradictory and confusing.

Care in recognising the differences between general hospitals and behavioural health facilities in all aspects of their space utilisation, patient needs, and code and regulation requirements will result in a completed project that is safe, attractive, functional and compliant with all applicable requirements.

James M. Hunt, AIA, and William N. Bernstein, LEED AP, AIA, are founding partners of the Behavioural Healthcare Architecture Group, with offices in New York City and Topeka, Kan. Hunt also is co-author of the National Association of Psychiatric Health Systems’ “Design Guide for the Built Environment of Behavioural Health Facilities.”

They can be reached at jim@bharchgroup.com and wb@bharchgroup.com, respectively.

REFERENCES CITED IN THIS ARTICLE AND THEIR RESPECTIVE WEB LINKS ARE LISTED BELOW: International Building Code — www.iccsafe.org/Pages/default.aspx National Fire Protection Association’s NPFA 101 Life Safety Code — www.nfpa.org/codes-and-standards/document-informationpages?mode=code&code=101 Facility Guidelines Institute’s Guidelines for the Design and Construction of Health Care Facilities — http://fgiguidelines.org National Association of Psychiatric Health Systems’ Design Guide for the Built Environment of Behavioural Health Facilities — www.naphs.org New York State Office of Mental Health’s Patient Safety Standards, Materials and Systems Guidelines — www.omh.ny.gov/omhweb/ patient_safety_standards Department of Veterans Affairs, Office of Construction and Facilities Management’s Mental Health Facilities Design Guide — www.cfm.va.gov/til/dGuide/dgMH.pdf

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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

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TECHNICAL PAPERS

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TECHNICAL PAPERS

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

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

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

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

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

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

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

BOC: Living healthcare Details given in this document are believed to be correct at the time of printing. While proper care has been taken in the preparation, no liability for injury or damage resulting from its use can be accepted. BOC is a trading name of BOC Limited, a member of The Linde Group.© BOC Limited 2015. Reproduction without permission is strictly prohibited. HCD246 EQUAUS 0515 V2

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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

IMAGING AREA DESIGN

Design standards for imaging areas are changing

FGI Guidelines keep up with technology and safety issues TOBIAS GILK

Imaging services account for a disproportionate amount of capital costs when it comes to new hospital construction. It has been estimated that specialty construction, capital equipment costs and service agreements for imaging services can result in up to 50 percent of total project costs for new hospital construction.

B

ecause of the project costs, the complexity of siting advanced imaging modalities and the delays and changes that can be required, it is essential that more foundational elements such as code requirements do not add unwelcome surprises.

The 2014 edition of the Facility Guidelines Institute’s (FGI’s) Guidelines for Design and Construction of Hospitals and Outpatient Facilities offers some notable changes from the 2010 edition with respect to imaging services, and it is important for designers, engineers, facility and equipment planners to familiarise themselves with them.

BEYOND THE DEPARTMENT For a start, the section title for imaging has been switched from “Diagnostic Imaging Services” to “Imaging Services.”

The removal of “diagnostic” from the section title acknowledges that radiology is no longer strictly a department — a collection of rooms around which can be drawn a defined border. Rather, imaging occurs in locations throughout many enterprises and not strictly for diagnostic purposes.

For instance, imaging increasingly is used to inform and direct interventions: from image-guided biopsies via fluoroscopy, computed tomography (CT)

or magnetic resonance imaging (MRI) to image-guided surgeries. While the 2014 Guidelines preserves a separate section for “Interventional Imaging,” this change shows that the current edition of the Guidelines more closely reflects contemporary practices versus an either/or approach to diagnostic and interventional imaging services.

Shielded alcoves no longer have a prescriptive distance from exposure control to the edge of the shielded partition wall for all ionising radiationemitting modalities, such as X-ray, fluoroscopy and CT. Instead, it is required that the size be suitable to “minimise radiation exposure of technologists and others.” Similarly, the shielded view window now must meet the performance requirement of providing a full view of the exam and procedure table, even when tilted.

As part of recognising that imaging services now frequently support intervention, the finishes used in patient care areas where imaging services are provided must be selected to conform to the maximum level of interventional care used in each room. Image-guided biopsy, for example, may be comparable to a special procedures room and may require finishes that meet an equivalent level of

PHOTO BY LEVENT KONUK/THINKSTOCK Minimum CT clearances have been expanded in the 2014 Guidelines.

performance for cleanability and infection control.

INTERVENTIONAL IMAGING Throughout the 2014 Guidelines imaging sections, there is repeated reference to meeting the minimum siting conditions from the equipment manufacturers.

However, while manufacturer technical minimums are essential, they frequently are not common between vendors or equipment models because of the variability in both equipment and clinical applications.

Because of their often-similar equipment and space configurations, the Guidelines allows for the combination of facilities for interventional imaging and interventional cardiology when it doesn’t conflict with local jurisdictional requirements.

Both in terms of general considerations

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IMAGING AREA DESIGN and specific design requirements and recommendations, the 2014 Guidelines greatly increases guidance for interventional procedure preparation and recovery areas.

has not changed, the planning and design criteria also are fundamentally unchanged from the prior edition, with one notable exception.

Radiation shielding requirements for interventional imaging largely mirror those labelled “Diagnostic Imaging” in the 2010 edition, although with an increased emphasis on provision for personal protective equipment. And while control rooms are required, an exception is provided for dedicated electrophysiology procedure rooms, provided the omission is approved by a radiation physicist and appropriate personal radiation protection is provided.

Mammography is no longer a placeholder as it was in 2010.

The new criteria include visual privacy, a hand-washing station in the procedure room and changing rooms that are immediately accessible, although these changing rooms may be shared with other functions.

While support areas for imaging services are not individually required, the 2014 Guidelines urges planners to consider the needs for each, and to design accordingly. Changes in the requirements for these recommended areas include emphases on staff work and documentation areas, patient consultation areas, point-of-care lab work or contrast preparation areas, image management systems and reading spaces, and medication safety zones, as appropriate to the services being provided.

The 2014 Guidelines also provides for in-unit processing of ultrasound probes with equipment and operational requirements for probe-cleaning facilities. As the last of conventional film imaging equipment is all but retired, the requirement for “film processing” adjacency also has been removed from the 2014 Guidelines.

VARIOUS MODALITIES A closer examination of changes for various imaging modalities reflects the technical and safety considerations brought to bear in the 2014 Guidelines: Computed tomography. Of particular note is the increase in minimum clearances around the CT scanner gantry and table.

Minimums have been bumped up from 3 feet to 4 feet on all sides of the gantry and table in the 2014 edition. This increase is due, at least in part, to the higher patient acuities and greater space needs for emergent and trauma care that contemporary imaging supports.

Another change from the 2010 edition is that the technologist at the operator’s console must be able to see the patient and the part of the anatomy being scanned. Space constraints in retrofit situations sometimes have meant it is easier to have layouts where the operator’s view is perpendicular to the CT scanner patient table. If this arrangement compromises the technologist’s ability to see the part of the patient in the centre of the scanner, it is no longer permitted.

And while it has been seen in practice for many years, the contemporary edition includes language that expressly permits shared control rooms to serve more than one CT scanner room.

X-ray. While the 2014 edition makes strides toward recognising the continuum of use for all imaging, X-ray modalities still are identified as “Diagnostic Radiography Facilities,” suggesting the transition in the text of the Guidelines remains a work in progress. And just as the title of this section

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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

Magnetic resonance imaging. In parallel with CT, minimum clearances of 4 feet have been added around the MRI gantry and patient table. Additionally, the door swing should not encroach on MRI clearances.

While it has always been smart design practice, the Guidelines now requires that MRI equipment siting and site planning take into account potential electromagnetic conflicts between MRI and other equipment. This includes external objects that potentially may interfere with the MRI’s operation, such as elevators, fans, transformers, switchgear and power lines, as well as the MRI’s potential interference with other equipment in the building, such as CT scanners, single-photon emission CT/positron-emission tomography scanners and calibration equipment.

While the FGI Guidelines has referenced the four-zone model of screening, access control and supervision for MRI since the 2010 edition, this has been expanded in 2014 to require design accommodation for containment of non-MRI-safe objects brought to the MRI suite, such as portable oxygen cylinders outside the controlled access zone.

For superconducting MRI systems, cryogen-protection designs should include three elements: venting, emergency exhaust and pressure relief systems. These are to be designed according to the equipment manufacturer’s specifications.

Unlike other areas of patient contact or interventional care for imaging services, the 2014 Guidelines states that hand-washing stations are not required in the MRI scanner room but may be located directly accessible to it. Individual sites’ infection control policies, however, are likely to supersede these FGI requirements.

When a radio-frequency-shielded MRI scanner room door swings outward into a control room or area, the door may not block the view from the console. And, similar to CT, the 2014 Guidelines includes language that explicitly permits shared control rooms that serve more than one MRI scanner room.

MRI suites must have a space identified for code or resuscitation activities located near the control room but beyond the 5-gauss magnetic field extents of the MRI scanner.

If providing interventional services within the MRI suite, sites must provide a pre-procedure preparation and recovery area that complies with the specific provisions in the “Interventional Imaging” section.

IMAGING AREA DESIGN In a move parallel to the design criteria to minimise interference between the MRI scanner and other equipment in the building, the Guidelines now requires the MRI scanner room floor design to take into account the thresholds for ferrous materials for the MRI scanner, or shim tolerances, to help protect image quality.

The 2014 Guidelines also adds a specific reference for sound isolation performance, requiring that designs address acoustic control measures between the MRI scanner room and adjacent areas.

SPECIFIC CHANGES While not intended to serve as a substitute for the 2014 FGI Guidelines, this summary of the more significant changes for sections 2.2-3.4, Imaging Services, and 2.2-3.5, Interventional Imaging, should help to identify many of the specific changes from the prior edition for these two sections.

Changes in imaging technology and clinical practice continue to accelerate and may require special accommodation even before the next iteration of the Guidelines is published. One concrete example of this is the inclusion of a new section title in the 2014 Guidelines for “Interventional and Intraoperative MRI (I-MRI) Facilities,” which provides no specific requirements, but telegraphs the expectation of future standards.

Given the complexities and costs associated with imaging facilities, seemingly modest changes could wind up having tens or even hundreds of thousands of dollars of cost consequences if not discovered early in the process.

The rapidly advancing technical and clinical demands on imaging services will continue to require higher and higher levels of expertise from designers and the design elements from the most recent FGI Guidelines are an essential start.

Tobias Gilk is senior vice president with Radiology-Planning of Kansas City, Mo., and principal of Gilk Radiology Consulting. He also has served as a special imaging consultant to the 2010 and 2014 editions of the Facility Guidelines Institute’s Guidelines for Design and Construction of Hospitals and Outpatient Facilities. He can be reached at tgilk@RAD-Planning.com

FACILITY PLANNING PRINCIPLES FOR IMAGING SERVICES The following encapsulates some of the major planning principles for imaging facilities from the 2014 edition of the Facility Guidelines Institute’s (FGI’s) Guidelines for Design and Construction of Hospitals and Outpatient Facilities.

These may be helpful as part of a standard planning and design review for radiology and nuclear medicine facilities: • To preserve flexibility, facilities professionals should evaluate every new imaging modality siting against the facility’s infection control standards for interventional care. This evaluation should consider finishes, ventilation and hand-washing requirements. Future demands over the projected lifespan of the imaging equipment should be anticipated to minimise risks of future patient care-interrupting modifications to the site.

• Particularly for reuse and upgrades of existing imaging scanning rooms, facilities professionals should verify that the dimensions of the room will accommodate increased clearance requirements. Rooms designed to the minimum requirements of prior editions of the FGI Guidelines or other design standards and codes may not meet the 2014 standards.

• Patient visibility during imaging is receiving greater attention. When planning new imaging equipment installations, facilities professionals should make certain that the technologist can clearly see the patient and the anatomy being imaged from the operator’s console.

• In the absence of specific state, federal or accreditation standards, the 2014 Guidelines is reaffirming itself as the standard-bearer for physical magnetic resonance imaging (MRI) safety protections.

As a general guideline for MRI equipment siting, facilities professionals should make sure to adhere to both the equipment manufacturer’s safety guidance and the most recent MRI safety guidance from the American College of Radiology.

• When planning facilities for new imaging equipment, it is advisable to compare the physical siting requirements of competing systems so that an individual room design can accommodate the minimum requirements of different vendors.

These planning principles represent larger themes found in the FGI Guidelines. Individual facilities likely will have additional design standards imposed by enterprise- or modality-level accreditation providers and may have to meet other requirements from local or state authorities as well.

THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

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TECHNICAL PAPERS

Hospital safety requirements

SOUDI NOORI

DIRECTOR OF SAFETY AND RISK ENGINEERING SOLUTIONS BSC, MENGSCI, GRAD DIP OEH (MONASH) PROFESSIONAL MEMBER OF SAFETY INSTITUTE OF AUSTRALIA, RSP (AUST)

“Statistics show that a hospital is one of the most hazardous places to work.1 Hospitals have serious hazards—lifting and moving, needlesticks, slips, trips, and falls, and the potential for agitated or combative patients or visitors—along with a dynamic, unpredictable environment and a unique culture.”

1. INTRODUCTION

W

ork in hospitals is dynamic and unpredictable. It requires a strong safety culture. A worker must be prepared to respond or react to various situations with split-second decisions. In addition to the special challenges of healthcare workers, hospitals face the diverse safety challenges associated with food services, materials handling, maintenance, cleaning, office work, and various other functions.

Evidence gathered during the 2013 public hospitals audit2 suggests that insufficient priority is currently being given to health and safety in public hospitals.

For example: • there is a culture of accepting WHS risk • resources are not always available for hospital staff to consistently comply with OHS/WHS policy and procedures to work safely • Health and Safety information provided to public hospital staff is not sufficient • training provided to staff and managers across the health system is insufficient • the department does not require assurance from public hospitals that staff safety is adequate

Hospital managers and engineers must recognises its obligation to take all reasonable precautions to provide and maintain so far as is practicable, an environment that is safe and without risks to health of employees, visitors, patients and contractors. This commitment extends to ensuring that the hospital’s operations do not place the local community at risk of injury, illness or property damage.

In order to reach this aim hospital managers/engineers should: • provide safe plant and systems of work • provide written procedures and instructions to ensure safe work method • ensure compliance with legislative requirements and industry standards • provide information, instruction, training and supervision to employees, contractors to ensure their safety • ensure contractors engage in safe work practices based on laws, regulations and standards Managers are responsible for ensuring that contractors, their employees and their subcontractors do not create risks for themselves or others. Contractors must comply with the current Health Safety & Act and Regulations whilst working in hospital including: • Their organisation’s WHS requirements and regulations

• Hospital “Safety, Health and Environmental” instructions • Provisions of relevant Codes of Practice, Australian Standards and Statutory Regulations, etc Contractors are responsible for providing the appropriate safety training to his or her employees and must be able to provide evidence of such training to hospital engineer. The Contractor must provide all his or her employees with a safety induction prior to commencing work on site. The Contractor shall also: • Must identify specific areas of potentially hazardous operations where safety equipment must be used and/or personal protective clothing must be worn • Take reasonable care of themselves and others who may be affected by their actions • Wear personal protective equipment as required • Fill and submit job safety analysis (JSA) form before starting major jobs • Seek information and advice where necessary before carrying out new or unfamiliar work • Be familiar with emergency and evacuation procedures and the location, and use, of emergency equipment

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TECHNICAL PAPERS • Ensure that any hazardous conditions, near misses and injuries are reported immediately to the hospital engineer or site manager

to work being undertaken. The JSA must contain an outline of work practice and procedures that incorporates all necessary safety precautions.

The purpose of this paper is to advise hospital engineers of:

2.3. Hazard Identification, Risk Assessment and Control Contractors must assess risks before commencing work in unfamiliar situations and always learn and respect the limitations of various jobs. Contractors must supply Engineering/Maintenance office with a documented “Hazard Identification, Risk Assessment and Control” which highlights the job hazards, level of risk and the risk control measures they have implemented to control the hazards.

• WHS obligations as per the Workplace Health and Safety Act • Contractors management; and • Importance of the Safe Work Method Statements (SWMS)

2. HOSPITAL SAFETY REQUIREMENT Before contractors undertaking any task manager or hospital engineer must ask himself these vital questions: • Have we checked the contractor’s license and insurance?

• What do contractors need to do to get this task done?

• What are the potential hazards in this task?

• What should contractors do to improve the safety of this task?

• Have they completed a JSA and risk assessment?

• Have contractor informed about the Hospital Safe Work Method Statements (SWMSs)?

2.1. License & Insurance Works on facility or hospital must only to be carried out by persons legally qualified and licensed to do so and in accordance with the relevant Legislation, Regulation, Code of Practice, Australian Standard, Safety Plan, procedure or standing instruction in force at the time.

Prior to the contractors’ commencement of work on site, evidence of the following must be checked: • All relevant licences, permits and risk assessments • Insurance • Professional Indemnity • Public Liability Insurance • Workers compensation 2.2. Job safety Analysis Job Safety Analysis (JSA) must be conducted prior to the commencement of any major works, and forwarded to Engineering/Maintenance office prior

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2.4. Safe Work Method Statements (SWMS) New health and safety laws require a person conducting a business or undertaking (PCBU) to provide documented evidence about how they will control exposure to risk of injury and illness when performing certain tasks.

A safe work method statement (SWMS) is prepared by the manager/hospital engineer for their employees, or by the subcontractor for their workers and themselves. A SWMS must be prepared for any high risk repair, maintenance and construction work and provides step-bystep procedures on how the work can be undertaken safely.

The SWMS should be prepared in consultation with those doing the work.

Anyone involved in undertaking high risk work must also be familiar with all safety procedures outlined in the SWMS. Safe Work Method Statements are most effective when there is participation by both site engineers and contractors, each of whom has a distinct role in ensuring the ongoing preparation, implementation and review of SWMSs. 2.4.1. Plant room Safety All plant rooms shall be kept clean and tidy at all times. When contractors are appointed to undertake work in the plant room; • Works must be undertaken by appropriately qualified personnel • All work shall comply with all statutory Health and Safety Legislation

THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

• Combustible or flammable materials are kept away from switchboards • All types of liquid and solid waste material, such as, grease, lubrication oils, new or used (disposed) filter, etc., shall be removed from plant room • Combustible or flammable liquid or solid material, odour producing liquid or solid material, cleaning equipment or consumable cleaning agents shall not be stored in the plant rooms 2.4.2. Danger Tags and Lockouts The use of Danger Tags & the Lockout system is a very important part of the facility safety rules. Contractors are required to have a system for isolating and tagging out equipment, or locking out of equipment if items are unsafe.

They MUST NOT start repair work on any equipment or machine unless they have filled out a Danger Tag where appropriate and attached it to the correct isolating device after it has been set in the correct position. They should be permitted to do Tag and Lock out activities if they; • have been issued with an Engineering/ Maintenance office work order (Services Isolation Permit) • are familiar with the equipment, its operation, energy sources, isolation points, sequence of isolation, and any other equipment supported or materials transported by the equipment.

• completing JSA form This system ensures that all energy sources including electrical, hydraulic or chemical sources, to equipment are isolated and de-energised before any work is undertaken.

2.4.3. Plant/Mechanical Equipment Safety Contractors and their staff must not operate plant and equipment with safety devices removed. If it is necessary to remove guards from machinery as part of a service or repair process, contractors are responsible for ensuring adequate lockout steps are taken to prevent the untimely start up of plant.

If contractors identify that guards/safety devices are missing from an item of plant or equipment they have been directed to work on or with, they must cease

TECHNICAL PAPERS work, report the matter to Engineering/ Maintenance office.

• Train their staff in the proper use of any tool or machinery prior to operation

Contractors operating plant for which specific training is required are to ensure that all operators are properly trained and hold current certification. Copies of the training certification must be produced on request.

2.4.5. Chemical Safety Contractors must obtain permission from Engineering/Maintenance office before bringing chemicals on site. Contractors bringing chemicals or substances onto hospital must comply with all relevant legal requirements.

2.4.4. Electrical Safety Portable electrical equipment must be Test and Tag in accordance with Australian Standard prior to being brought onto the site/hospital.

Contractors using portable electrical equipment on hospital must do so in conjunction with a portable Residual Current Device (RCD), tested and tagged in accordance with Australian Standard.

Contractors are responsible to: • Maintain, use and store equipment in a safe, correct and tidy manner • Only use equipment for its designed purpose

For instance: • All chemicals must be stored and handled in appropriately marked containers • Chemical containers must be labelled clearly. The label should show at least the following information: 99 Chemical name & concentration 99 Toxicity (described by word such as Hazardous, Poison, etc) 99 Flammability 99 Personal protection requirement • Risk & Safety phrases if appropriate

• Current Safety Data Sheets (SDS) and appropriate documented risk assessment must be held for all chemicals used on site • Contractor must supply any required first aid material and personal protective equipment (PPE) • All chemicals must be transported in accordance with applicable requirements • No chemicals must be left on site without the approval of Engineering/ Maintenance office • Contractors are not to store hazardous substances on site.

Safety Data Sheets (SDS)

Safety Data Sheet, commonly called SDS, has come to be very important document.

This document contains information on hazard information, first aid, precautions for use, safe handing information etc.

Every contractor must supply a SDS for all chemicals and hazardous materials, and manage it accordingly to the SDS.

• Check electrical connections are safe.

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TECHNICAL PAPERS Contractors must become familiar with a material’s SDS before they begin using the chemical. It is very important that the SDS Folders are well maintained so that the information remains relevant and easy to find.

Disposing of Hazardous Substances

The term “Hazardous Substance” means a material which may cause injury to persons or damage property or plant or which may react with other materials to cause injury or damage.

The Environmental Protection Authority (EPA) has strict rules about the correct way to dispose of hazardous substances.

All chemicals and the like used at hospital site should never be poured down the sink or sewer, disposed of in the garbage, burnt or buried. Doing this can risk the health of sewerage workers, garbage collectors and the environment.

Disposal of Hazardous substances is the responsibility of the contractor.

2.4.6. Permit to work Contractors must obtain approval/permit to work from Engineering/Maintenance office before they do the following: • Any electrical installation work • Isolate fire panels • Turn off air-conditioning or ventilation systems • Roof Access • Ceiling Space access • Confined Space Entry and Hot Work 2.4.7. Restricted Areas, Notices, Signs and Barriers Contractors must comply with all signage related to Restricted Areas and confined spaces. Restricted Work Areas are those areas that require special precautions because: • real or potential hazards are known to exist • they are located in a sensitive environment • legal or statutory requirements exist; or • safety incidents have occurred in the area Safety signs and barriers do not replace the need for proper accident prevention measures but must be used to draw

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attention to objects and situations that may affect health and safety.

Contractors shall ensure that the type of sign used is suitable for the intended purpose: • Danger signs – signs warning of a particular hazard or hazardous condition that is likely to be life threatening • Warning/Caution signs – Signs warning of a hazard or hazardous condition that is not likely to be life threatening • Safety Barriers/Cones – Erected to prevent access to the work area by unauthorised persons. Safety Barrier Tags must bear the following information: 99 Name and Company of person who placed the barrier/cone.

99 Date of placement 99 B rief description of protected hazard 2.4.8. Confined Space An enclosed or partially enclosed space which: • is at atmospheric pressure during occupancy; and • is not intended or designed primarily as a place of work; and • may have restricted means for entry and exit; and • may have atmospheric contaminants or an unsafe oxygen level Any person or standby person performing work in confined space must be trained at least the following: • the hazards of confined spaces • assessment procedures, such as how to monitor and test an atmosphere, what to monitor and test for and how to assess the risks associated with confined spaces • control measures to be used, such as how the space is to be ventilated • emergency procedures, such as which respiratory equipment to wear in the event of a rescue, which emergency services to contact and how to administer first aid • the selection, use and maintenance of equipment, such as tripods and

THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

harnesses, monitoring equipment and personal protective equipment • legislative requirements, which include the sections of AS/NZS 2865 as called up in the Regulation; and training for breathing apparatus it is going to be used Examples of Confined spaces in building include Sewerage pit, Ceiling Space, inside mechanical equipment such as cooling tower, tank, etc.

Sewerage pit

You cannot see or smell many toxic or flammable gases and vapours, or sense the level of oxygen or combustible contaminants. Sewage often gives off Hydrogen Sulphide Gas, which is Colourless and Toxic. Hydrogen sulphide (or rotten egg gas) can often be fatal when a person is exposed to it in high concentrations.

• Do not work alone in the Sewerage pit. Use a stand-by person as a safety watch • Visually inspect the pit through a side mounted inspection hole • Use hydrogen sulphide Direct Reading Gas Monitor to find out the level of hazardous gas • Isolate sewage pipes entering the pit by manually closing the valves and locking them closed • Arrange the remaining sewage to be removed by a waste disposal company • Electrically isolate the motor and place a tag on the switch • To ventilate the sewage pit use a “push/pull extraction system” which introduces fresh air into the space and extracts potential pollutants • Calculate the number of air changes required per hour and for how long the system must run with the help of a competent person • Test for oxygen level, carbon monoxide, hydrogen sulphide and the LEL of methane and determine they are all at a safe level • Ensure the atmosphere of the sewer is safe to enter and work in • Wear protective footwear. Wear disposable gloves and overalls

TECHNICAL PAPERS • Wear the multi-gas detector around your neck while in the confined space to warn of atmospheric changes Ceiling Space

(MSD). Hazardous manual handling involves: • repetitive or sustained application of force, awkward postures or movements

Prior to any Ceiling works a qualified electrician is to inspect ceiling space for faulty wiring. Protective Eye Glasses should be used at all times during any ceiling or light fitting works.

• tasks that are difficult due to the degree of force applied (high force)

Hazards associated with ceiling space include, but are not necessarily limited to,

• manual handling of unstable loads that are difficult to grasp or hold.

• confined Space

Hazardous manual handling can lead to injuries or disorders of the muscles, nerves, tendons, joints, cartilage and spinal discs. Some of these injuries are referred to as sprains and strains, back injuries, lower back pain, soft-tissue injuries to the wrists, arms, shoulders, neck or legs or abdominal hernias.

• electrical shock • asbestos • falls from ladders and • other mechanical and physical hazards.

2.4.9. Manual Handling Many jobs involve some form of manual handling, but not all manual handling is hazardous or involves the risk of an injury, such as a Musculoskeletal Disorder

• exposure to sustained vibration • manual handling of live people or animals

• avoid the need for hazardous manual handling, as far as reasonably practicable • assess the risk of injury from any hazardous manual handling that cannot be avoided • check the weight of the load before lifting • get help, if the load seems too heavy

Collectively, these conditions are known as musculoskeletal disorders (MSDs).

2.4.10. Personal Protective Equipment (PPE) Personal Protective Equipment (PPE) means any protective device, belt, harness or garment, safety glasses, earplugs, etc used for personal protection. All PPE shall conform to statutory requirements & Australian Standards.

Contractors are responsible for using appropriate Personal Protective Equipment (Comply with Australian Standards) to their staff and ensuring that it is used correctly. Contractors are responsible for

Contractors shall ensure to;

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TECHNICAL PAPERS ensuring that their subcontractors also wear appropriate safety equipment as well.

2.4.11. Working Alone If any subcontractor or employee of a contractor works alone, the contractor’s supervisor is responsible for ensuring that appropriate precautions are included in the risk assessment or Job Safety Analysis and are implemented. In particular, suitable emergency communication procedures and equipment must be provided.

2.4.12. Working on roofs A permit is required to gain access to the roof. Any work at heights must comply with legal requirements. In particular, contractors must observe the provisions of the WHS (Prevention of Falls) Regulations. Contractors are required to complete a Job Safety Analysis (JAS) which will include Risk Assessment for working on roofs.

• Identify any fall hazard • Assess the risks (Assess the situation including the task, the conditions and the associated risks of a person falling and being injured.)

• All dust accumulation is to be removed before welding/hot work is started • Do not block emergency exits or restrict ventilation • Ensure electrical cord, electrode holder and cables are free from defects • Set Voltage Regulator to Manufactures specifications • Avoid electrical shock, DON’T wrap cables around any body part • When the work is completed, the area shall be returned to normal condition • Fire watch for one hour after welding & until all welds have cooled as most fires associated with Hot Work occur after the work has been completed. A spark that landed in an unnoticed location may smoulder. It takes time for the fire to grow to a point where flame and smoke are visible. By that point the workers may have left the site 2.4.14. Ladder safety People with the following disabilities should not be permitted to use a ladder:

• Control the risk of a fall (Fix the problem.)

Physical Disability, Heart Disease, Epilepsy, Dizziness and Fear of Heights. If you have a fear of heights – don’t climb a ladder.

Working on roof safety tips:

Ladder safety tips:

• Emergency rescue procedures must be in place if there is a risk of a fall and someone needs to be rescued • Make sure that anyone working on the roof is wearing suitable non-slip footwear • Do not work in bad weather, or in conditions of excessive glare • Take additional precautions if the roof work is in close proximity to any electrical sources • Make sure the roof area is kept clear of any debris, materials and equipment 2.4.13. Hot Work (Welding) Hot work includes arc welding, flame cutting, oxy-acetylene welding, grinding, etc.

All hot work requires a permit. Hot Work Permits and information related to them are obtained from Engineering/Maintenance office.

Hot Work Permit should only be valid for a specified period on a specified day. If work extend beyond the time limits recorded on the permit, contractor must contact Engineering/Maintenance office to arrange an extension. Contractor cannot perform a task not listed on the permit, or work on a location other than the one recorded on the permit.

Welding safety tips:

• Ladder condition should be inspected prior to each use • Make sure ground or floor has level, solid flooring. Do not stand ladder on slippery contaminant • Place warning signs in area where work is being performed • Ensure that your shoes are clean and with a well defined heel prior to use • Ensure that ladders are of the correct height to avoid reaching or stretching • Open ladder fully • Never use the top two rungs of a ladder as a step • Always face the ladder when climbing up, climbing down or when working • Secure the top of the ladder when practical; if not practical then a second person must foot the base at all times • Fully lock or open any door near a ladder in use • Fibreglass ladders should be used near electrical installations • Do not place tools or materials on steps • When a ladder is being carried, care should be taken to avoid injuring any person who may be standing nearby • Read carefully the manufacturer’s instructions. They will contain guidelines that help you use ladders safely • Ladder work must not be undertaken when in a physically-tired or hungry condition

• Ensure PPE e.g. welding hood, gloves, rubber boots or soled shoes, apron, fume mask are available and in good condition

• Use the right ladder for the job

• Ensure there is a fire extinguisher adjacent to the work site and it is charged and ready

• The ladder should be placed in a safe working position

• Ensure that adequate ventilation and lighting are in place

• Secure the top of the ladder as needed

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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

• Get help when moving heavy or long ladders • Make sure that your shoes are safe; not wet or muddy

TECHNICAL PAPERS

THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

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TECHNICAL PAPERS • Where there is the danger of traffic, have someone hold the ladder. Post a warning sign, if necessary • Hoist materials or attach them to a belt. Do not carry materials in your hands • Don’t stretch beyond the side rails of the ladder.

• Never stand any higher than the third rung from the top of a ladder 2.4.15. Stress Facility workers or hospital engineers, who work in plant rooms, may be under stress because of an extreme condition.

Work-related stress can cause Heart disease, Ulcers and Emotional problems.

Dangerous incident means an incident in relation to a workplace that exposes a worker or any other person to a serious risk to a person’s health or safety emanating from an immediate or imminent exposure to: a. a n uncontrolled escape, spillage or leakage of a substance; or b. a n uncontrolled implosion, explosion or fire; or c. an uncontrolled escape of gas or steam; or n uncontrolled escape of a pressurised substance; or electric d. a shock; or e. t he fall or release from a height of any plant, substance or thing; or

Heat build up within the Plant room or working area can make you feel uncomfortable, dehydrated and exhausted.

f. t he collapse, overturning, failure or malfunction of, or damage to, any plant that is required to be authorised for use in accordance

Heat stress can be reduced through:

g. with the regulations; or

• keeping the room door open during work

h. t he collapse or partial collapse of a structure; or

• regular rest breaks

i. t he collapse or failure of an excavation or of any shoring supporting an excavation; or

• drinking cool water and using ventilation fans Work stress can be reduced by: • Exercising – take a walk 3-4 times a week • Eating the right foods

3. CONTRACTOR INCIDENT REPORT The WHS Act 2011 section 35 states that; a notifiable incident means the following and must be reported to a regulator immediately: 1. the death of a person; or 2. a serious injury or illness of a person; or 3. a dangerous incident.

In the case of notifiable incident, serious injury and dangerous incident contractors must fill “Contractor incident report”. A serious injury or illness of a person means an injury or illness requiring the person to have immediate treatment as an in-patient in a hospital; or immediate treatment for; a. the amputation of any part of his or her body; or b. a serious head injury; or c. a serious eye injury; or d. a serious burn; or e. the separation of his or her skin from an underlying tissue (such as degloving or scalping); or f. a spinal injury; or g. the loss of a bodily function; or h. serious lacerations; or i. medical treatment within 48 hours of exposure to a substance and includes any other injury or illness prescribed by the regulations but does not include an illness or injury of a prescribed kind.

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j. t he inrush of water, mud or gas in workings, in an underground excavation or tunnel; or k. t he interruption of the main system of ventilation in an underground excavation, or tunnel; or l. any other event prescribed by the regulations

4. CONCLUSION General hospital safety requirements have provided in this paper. It is not just a tired old phrase to say SAFETY FIRST. In fact it’s the only phrase that makes sense when it comes to getting the job done, on time, under budget and, most importantly without incident.

Since 2004, Safety and Risk Engineering Solutions (SRES) has been providing consultancy services to building owners, managers , hotels and hospital engineers throughout Australia with assistant on WHS compliance, due diligence audit, risk assessment, Engineering documentation audit, contractor management and…etc. If you have any questions about managing your WHS obligations, preparing SWMSs, etc. please feel free to contact me on email soudi.noori@sres-australia.com.au

REFERENCES 1. https://www.osha.gov/dsg/hospitals/documents/1.2_ Factbook_508.pdf 2. http://www.audit.vic.gov.au/publications/20131128-OHS-inHospitals/20131128-OHS-in-Hospitals.pdf

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TECHNICAL PAPERS

TR22 Refrigerant phase-out options BRYON PRICE I A.G. COOMBS GROUP

The importation of ozone depleting Hydrochlorofluorocarbons (HCFCs) will effectively cease in 2016. This includes the most common refrigerant, R22, widely used in residential and commercial air conditioning and refrigeration systems. The cost of R22 has increased significantly; it is now more expensive than the refrigerants used in new equipment, and cost and availability issues for gas and parts will continue to escalate.

determination of the best management plan for the equipment. Ultimately, all plant will need to be replaced, or become redundant.

Retain and Manage: For equipment in good condition, that is still suitable for its purpose, a retention plan including improved maintenance to reduce the risk of refrigerant leakage may be a viable short to midterm option. This option is, however, subject to the envisaged R22 gas and parts cost and supply issues, and the criticality of the systems purpose is an important consideration.

T

his poses problems for owners and operators of R22 equipment; maintenance costs are increasing, repair times for critical plant will extend as the gas and parts become harder to source, and ultimately it will not be possible to support the operation of R22 plant because of the unavailability of refrigerant and replacement parts.

Management options include the retention of R22 plant with improved maintenance, retrofitting the plant with a suitable

alternative refrigerant gas, or equipment replacement with modern technology.

An important consideration when looking at options is the application of the system; is it performing a critical function? What are the implications of its failure and a subsequent delay to reinstatement?

It is recommended that a simple audit of R22 equipment be conducted to identify the location, type, age, condition, size of refrigerant change and replacement cost, and what functional area the plant serves and its importance. This will assist in the

Retrofit with an Alternative Refrigerant: Alternative refrigerants can, in suitable circumstances, be considered for R22 retrofits. Options include R438A, R427A, R407C and R407F. There are a number of technical and performance issues with retrofits and care is required in assessing the suitability of plant for retrofit; suitable technical expertise must be applied. • Retrofitting may result in a plant capacity reduction of up to 25%.

This could compromise the ability of the system to fulfil its purpose. It may also have energy usage implications, with plant required to run longer and or harder than previously. • Replacements are blends of various components and behave differently to R22, which is a single component refrigerant. Any leakage will occur at

THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

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TECHNICAL PAPERS

different rates for the components and this may impact the ability to top up refrigerant.

• Retrofit refrigerants may not expand seal materials the way R22 does, and replacement of the various seals could be required to prevent leakage. Changes to lubricating oil, filters, driers, valves and other components may also be required.

• Typically, no warranty will be offered on retrofitted plant, and parts availability for what was R22 plant will become an issue.

• Hydrocarbon-based refrigerants are not recommended for retrofit purposes. The Flammable Refrigerants Safety Guide is available at www.airah.org.au.

• Any activities associated with refrigerant gas must by law be carried out by qualified and licensed organisations and personnel (www.arctick.org).

Replacement: When assessed on a lifecycle basis, the cost of new equipment can be comparable to the total cost of retaining and retrofitting plant with an alternative refrigerant and less than the potential cost and consequences of plant failure and delayed reinstatement problems. New refrigeration technology offers a number of benefits including: • Energy efficiency uplift and reductions in operating energy costs of between 15 - 45%, more in some circumstances.

• Improved equipment design and controllability can result in better system performance.

• Existing plant is sometimes oversized for current requirements; new plant may be able to be smaller than its predecessor.

• Improved reliability and extended warranties of up to five years are available.

• Reduced maintenance and ownership costs, renewed asset value for depreciation.

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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

TECHNICAL PAPERS

There are a number of options for managing the implications of R22 refrigerant phase-out. Increasing cost and availability issues are already here. Management plans should be developed for all R22 equipment addressing capital costs, maintenance and operational costs along with an assessment of risk to operations to determine the priority and timing of actions. *Bryon Price is Strategic Development Director of the A.G. Coombs Group and an experienced building services engineer.

This article first appeared in the December 2014 edition of Facility Perspectives magazine

THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

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TECHNICAL PAPERS

Security & the hospital environment GREG MUIR I MANAGING DIRECTOR OF BEAWARE SOLUTIONS PTY LTD1

Security risk management refers to the systematic application of management policies, procedures and practices to the tasks of establishing the context and identifying, assessing, controlling, monitoring and communicating risk.2

S

ecurity management, in general, relates to the management of possible threats to any building and/or organisation – people, physical assets, information and computer technology, and reputation. All are relevant to healthcare facility management.

MANAGEMENT The foundation for ‘best practice’ security is the existence of full management support of policy and procedures to minimise security risks. From the introduction of a Security Management Plan, the identification and implementation of procedures and practices, to the audit and review process, a management system will only succeed with full participation by everyone within the organisation.

Operational management should be fully aware of that management system and also develop a working relationship with local emergency services and neighbouring facilities.

A Security Management Plan should be documented.

THE PLAN The format for any Security Management Plan should incorporate the following3 – 1. An introduction with a statement from the organisation head detailing the importance of the plan and why it must be supported.

2. A Statement of Purpose links the document with corporate plans and business objectives. If the Plan has been triggered by a specific event, this should be mentioned.

3. Security Environment provides the summary of the threat assessment and the organisation’s current exposure as well as a general assessment of current security management arrangements.

4. Objectives that clearly state what the Plan is designed to achieve and related to the organisation’s corporate objectives.

5. Security Strategies and Actions identifies each action and how it is to be implemented, including the person responsible.

6. Residual Risks should be estimated, described and rated to guide priorities for monitoring risks and evaluating actions.

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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

7. Timetable could be incorporated with item 5 or listed separately, but should provide information about significant steps in the implementation of risk actions.

8. Resources should document the security budget and determine the costs of the recommendations or options.

PERSONNEL SECURITY Any successful management plan will incorporate background checks on both employees and contractors as well as defined responsibilities for security issues, e.g. key management.

Employees should be trained in awareness and crisis/emergency management, as well as ‘stranger challenge’. This can be provided during induction, staff training days and communication with management.

Other areas for management to concentrate on include staff exit procedures, attendance monitoring, secure document control and IT systems password protection.

Fraud by opportunistic staff is related to theft and/or ‘skimming’, the unlawful capture of credit card details from patients and others.

Any such activity if allowed to occur can have a disastrous impact on the organisation’s reputation. Effective supervision, training and the reinforcement of security measures will help to control the risk.

SURVEILLANCE AND MONITORING The presence of CCTV and similar devices has been perceived as detrimental to the comfort of some. The protection of patients who have limited ability to protect themselves has swayed public acceptance of security measures in the healthcare facility.

It is highly recommended that managers promote the existence of security within the building to reinforce the perception of a safe and secure environment. The display of security notices and the positive response to security issues by all staff will have a positive impact on that perception.

The selection and placement of an appropriate surveillance system should be at the recommendation of an accredited consultant and only after a threat assessment has been conducted.

TECHNICAL PAPERS Any system should include a UPS (Uninterrupted Power Supply) or backup unit and be supported by an on--call response unit, documented procedures, communication equipment (checked to identify any building black spots) and the availability of a security hotline for patients and employees.

PROPERTY PROTECTION

CONCLUSION This article has been drafted primarily as a prompt for affirmative action in developing and documenting a security management plan.

It is recommended that advice be sought from an accredited and qualified consultant in the development of that plan or review of any existing plan.

Property protection starts at the perimeter and incorporates all access points, including the car park. Items for consideration include lighting, the use of bollards, means of access, alarmed emergency exit doors and window entry points.

REFERENCES

Internal protection relates to key management, access to building systems control rooms including the HVAC (heating, ventilation and air conditioning) system and other sensitive areas.

3. Talbot & Jakeman, 2008, p.384

The Reception Desk should be located such as to provide clear vision of persons entering the foyer of the building, whether they be patients, visitors, contractors or other employees. Similarly any security, car park attendant or supervisor should have a view, whether physical or through CCTV, of persons and vehicles entering or leaving the building.

BOMB THREAT The emergency procedures should incorporate planning and first response training for staff in the event of a bomb threat. The threat may be written or verbal or following the identification of a suspicious article within the building or surroundings. A Bomb Threat Checklist can be obtained from the Australian Federal Police website4.

Bomb threat stand-off distances have been identified5 for the various mediums in which a bomb can be delivered. When inside a building, for example, the recommended distance for safety from a suspect brief case is 46 metres, for a delivery van 262 metres.

If the latter is parked outside the building the recommended distance is over 1 kilometre. The figures were compiled by the US Counter Terrorism Centre in 2005.

1. Holder of NSW Security Master Licence No 410196472 2. Dunn & Chennell, 2012, p20-040.

4. Dunn Cormack & Chennell Sue, Australian Master Work Health & Safety Guide, 2012.

5. Talbot Julian & Jakeman Dr Miles, Security Risk Management Body of Knowledge, 2008.

ABOUT THE AUTHOR Greg Muir is the Managing Director of Beaware Solutions Pty Ltd1 and has over 40 years experience in risk management relating to buildings and procedures. He has qualifications in Public Safety (Emergency Management), Work Health & Safety, and Security and Risk Management. Beaware Solutions has provided security advice for educational, health, commercial and residential organisations.

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POLICY AND PROCEDURES It is recommended that policy and procedures be documented for the following areas – General security Key control Access control and visitor/contractor management Incident response and reporting Identification card loss and reporting Emergency procedures Security test and audit Mail handling Bomb threat Intruder/trespasser response.

It is important that the policy and procedure for each risk area to be documented, but it is even more important for those procedures to be communicated and implemented.

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TECHNICAL PAPERS

Electro chemical activated solutions DR. SERGIO FERRO I ELECTROCHEMIST, UNIVERSITY OF FERRARA (ITALY)

The presence of microorganisms is often cause of concerns; in water systems, it can lead to disease transmission (e.g., Legionnaires’ disease), in addition to the risk of bacterially induced corrosion, and to inefficient heat transfer due to coating of surfaces with heavy microbial growth (biofilm). The former problem mentioned is of particular concern when the water is intended for human consumption.

W

in contact, also when the latter operation is executed with washing purposes.

ater may also represent an ideal means of microbial diffusion: in fact, the microorganisms can spread to the surfaces with which the water enters

It is currently a standard practice to control microbial growth, in order to avoid the above-cited drawbacks;

different physical methods have been proposed, like UV radiations, thermal shocks and filtering devices, whose efficacy is sometime very high. However, even if the microorganisms are killed or removed from the treated water,

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TECHNICAL PAPERS the treatment does not guarantee any residual effect and the water is then subjected to further infection. Additional problems exist: in the case of the UVbased approach, the water to be treated must be free from suspended particles, which could act as barriers for the microorganisms, protecting them from the radiations; with regard to the filtering devices, their effectiveness depends on the diameter of the pores of the filter, which are in turn subjected to obstruction.

The lack of residual disinfection capabilities limits the utilisation of the above approaches to the point of actual utilisation.

Microbial growth can be easily controlled by applying chemical biocides; again, different approaches exist, which are typically not free from contraindications.

By way of example, the use of chlorine dioxide involves the involuntary introduction of chlorites (which are undesirable in drinking water), while other oxidants require the simultaneous use of catalysts (e.g., heavy metal ions) to activate the process. In both mentioned cases, the process implies the storage of chemical agents, which may be more or less dangerous for the user.

Some disinfectants (chlorine dioxide, ozone) need to be synthesised in the place and time of utilisation; other (e.g., chlorine) may actually be stored in cylinders: their industrial preparation does not differ from that possibly feasible in situ, and that solution can therefore represent a simplification.

As mentioned, the chemical way of disinfection is not free from contraindications: on one hand, the process requires the addition of chemicals to the water; on the other hand, the disinfectant action inevitably produces some byproducts. It is therefore of practical interest to minimise the amount of disinfectant, through the recourse to particularly effective biocides.

The biocidal activity of chlorine-related compounds is known from the early nineteenth century, when the French chemist Antoine-Germain Labarraque began to study the disinfecting and deodorising properties of a sodium hypochlorite solution (which is therefore

ARE YOU AWARE OF THE WAY IN WHICH THE MICROBIOLOGICAL CONTENT OF WATER IS DETERMINED? First of all, it may be of help introducing the concept of “colonyforming unit” (CFU). By definition, a colony of microorganisms refers to a mass of individual cells of a same organism, growing together. Since microorganisms are too small to be counted singularly, and they tend to aggregate, the colony-forming unit represents the most representative way for counting them. To determine the number of colony forming units, a sample is prepared and spread or poured uniformly on a surface of an agar plate and then incubated at some suitable temperature for a number of days. Then, the colonies that form are counted. Since a colony may be formed from a single or a mass of cells or spores, the CFU is not a measure for individual cells or spores. Besides, and contrarily to single-count of cells, a colony may comprise also dead cells, which obviously are no more able to replicate.

Concerning waterborne pathogens, CFUs are typically referred to the unit volume, which may be the litre or his sub-multiple (i.e., a millilitre).

The detection limit for Legionella, as prescribed by the Australian Standard AS 3666 method (Airhandling and water systems of buildings - Microbial control), is 10 colony-forming units per millilitre (CFU/mL). Actually, a significantly lower limit has been established in Europe, where the detection limit is set between 1 and 10 CFU per liter [see e.g. the article written by Dr. Garnys in “The Australian Hospital Engineer”, December 2013, pages 55-57].

The difference between the two above-cited detection limits is very significant: the Australian limit is at least one-thousand times higher (i.e.

less stringent) than the European one. Accordingly, a disinfection procedure that proves to be effective in accordance with European directives is certainly even more reliable under the laws of Australia.

This is actually the case of the Ecas4 electric chemical activated solution disinfection approach.

Ecas4 water disinfection system (WDS) equipment’s have been already installed by a number of healthcare facilities, both in Europe.

Ecas4 produces two slightly different machines, named WDS40 and WDS80 respectively, which basically differ in the hourly productivity of the Ecas4 Anolyte (i.e., 40 and 80 litres per hour).

Based on the number of beds (which in turn is related to the daily consumption of water), we are able to identify facilities optimum needs and suitable equipment. Ecas4 system is extremely flexible: as an example, it allows to produce and use the disinfecting agent at one place, while automatically dosing it also in a different location, within about one hundred meters from the production unit, without any trouble. In this way, even complex structures may be easily and costeffectively managed. In the case that a Facility is too small for justifying the installation even of the small machine, we can provide a specific dosing unit by periodically supplying the disinfecting agent that is required.

Ecas4 technology, avoids further shock-thermal or hyper-chlorination treatment, thus allowing cost savings preserving water networks from undesired corrosion problems.

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TECHNICAL PAPERS sometimes referred to as “Labarraque’s solution”) [A.-G. Labarraque. De l’emploi des chlorures d’oxide de sodium et de chaux. Paris, Imprimerie de Madame Huzard, 1825, 48 pp.]

At a close to neutral pH, the so-called “free active chlorine” (to distinguish it from the “combined active chlorine”, which is the chlorine residual that exists in water in combination with ammonia or organic nitrogen compounds) is constituted by a mixture of hypochlorous acid and hypochlorite. In particular, at a pH value around 7.5, the two species are present in equimolar amounts.

The above discussion is preparatory to consider the electrochemically activated solutions, wherein chlorides are typically present and represent an important ingredient for the synthesis of the so-called anolyte.

As reported in literature, the genesis of what is often referred to as the electrochemical activation of water can be dated back to the early 1800s, when the Russian experimental physicist, selftaught electrical technician, Vladimir V. Petrov discovered that, performing an electrolysis of water, the development of gases at the electrodes is accompanied by a change in the pH of the solution near the electrodes themselves [A.P. Tomilov, Zhizn & Bezopasnost, 3 (2002) 302-307]. By dividing the space between the anode and the cathode with a porous diaphragm, he was the first in obtaining water solutions enriched with

products of the cathodic or anodic electrochemical reactions: catholyte and anolyte, respectively.

In 1972, another Russian scientist, engineer Vitold M. Bakhir, discovered that anolyte and catholyte, generated through the electrolysis of a low-mineral-salt solution in a diaphragm cell, are characterised by physico-chemical parameters and reactivity quite different from those of “model” catholyte and anolyte (the latter solutions were prepared by dissolving suitable chemicals in water, thus reproducing the effects of the classical electrolysis laws) [V.M. Bakhir. Regulating physical and chemical properties of technological aqueous solutions by unipolar electrochemical exposure and experience of its practical application. A Thesis of a Dr. Sci. Tech. - Kazan: Kazan Institute of Chemical Technologies, 1985, 146 pp.].

As discussed by V.M. Bakhir for example in “Theoretical aspects of the electrochemical activation” (Summaries of papers and brief reports – Second International Symposium on Electrochemical Activation in Medicine, Agriculture and Industry, Moscow 1999), the effects of electrochemical activation of water are more marked and persistent, the lower the degree of mineralisation of the treated water. Considering the relaxation phenomena that restore the water conditions as they were before the electrochemical activation, the most significant changes occur when the treated water has a mineral content between 0.1 and 1 g/L. The magnitude of these changes decreases if the degree of mineralisation is either reduced from 0.1 g/L to zero, or increased from 1 to 5 g/L; for a mineralisation content exceeding 5 g/L, changes related to the relaxation phenomena become progressively less evident, disappearing at all if the mineral content increases to approximately 100 g/L. Thus, in order to maximise the effects of the electrochemical activation while minimising the energy expenditure required for the attainment of such activation, it is convenient to consider solutions containing a few grams per litre of dissolved salts, preferably less than 10 g/L and more preferably around 5 g/L. Owing to the electrochemical activation, water enters into a so-called metastable (activated) state, which shows anomalous physico-chemical properties. In particular, water activated at the anode (anolyte) is characterised by low activity of electrons and shows oxidising properties. When the dissolved salt is a chloride salt, free active chlorine forms in addition to other metastable products (nascent oxygen, hydrogen peroxide, ozone, hydroxyl radicals, chlorine radicals, oxygen radicals, etc.). For the sake of simplicity, we can justify the oxidising properties of electrochemically activated water through the presence of the active chlorine but, evidently, this is not the whole reality.

With a patent application deposited in 2006, ECAS s.r.l., an Italian company based nearby Bologna, has claimed a first evolution of the technology developed by V.M. Bakhir.

To inexpert people, the main difference may seem the planar configuration of the electrodes (in the flow-through electrochemical modules of Bakhir, the electrodes are cylindrical and concentric), but the technology also allows the production of a rigorously neutral anolyte, with a number of advantages.

The ECAS technology, which is traded with the name Ecas4

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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

TECHNICAL PAPERS (in order to recall the patented electrochemical reactor with four chambers), produces an anolyte that has proved to be nondangerous and biodegradable, while retaining its effectiveness against bacteria, fungi and viruses.

Different producers exist, and their products differ mainly in the configuration of the electrochemical reactor that allows the synthesis of the anolyte; as a result, anolyte solutions with slightly different properties can be obtained. The concentration of the active ingredient, the concentration of the salt in the brine solution that feeds the reactor, pH and redox potential of the product are the main aspects to be considered. In some cases, a neutral product is achieved by suitably mixing the anolyte and the catholyte produced by the cell, and this operation necessarily implies a dilution. As usual, the customer should compare the performances and verify whether the product is suitable for his purpose.

Thanks to the efficiency of the electrochemical synthesis and the lack of toxicity and bioaccumulation, the electrochemically activated solutions are a viable and environmentally friendly alternative to many of the chemicals commonly used in the

disinfection (for water environments and surfaces). In addition, they have proven to be beneficial also in agriculture, where their use can reduce the recourse to pesticides, leading to significant improvements in quality and to a parallel reduction of environmental impact. Similar findings are being obtained in animal husbandry, where the use of electrochemically activated solutions seems to allow not only to improve the health of the environment (farms), with reduction in the use of drugs (e.g., antibiotics), but also to significantly reduce the mortality, and to increase the conversion yield of the food provided to the animals (this is primarily attributable to the improved sanitation, which involves less problems of diarrhea and stress, with obvious repercussions on the increase in weight of the animal).

Concerning the healthcare facilities, the anolyte is being proposed as an environmentally friendly alternative for the disinfection of hot, warm and cold water-systems, as well as for most surfaces. The Ecas4 technology has been widely adopted for solving problems related to Legionella in Europe (Italy, Germany, Spain and Slovenia), and it is now available in Australia.

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Don’t wait for your pool to have a health emergency!

TECHNICAL PAPERS

Patients should be able to recover in a hospital pool, not feel like they’re risking their health in one. With hospital clients across Australia and New Zealand, Poolwerx understands that a hydrotherapy pool needs to be as clean and sterile as the hospitals themselves.

We ensure that your pools and spas are healthy and comply with legislation to fulfill your duty of care. Our services include: • Professional problem solving and advice • Same day response and breakdown service • Service all year round, with options to suit your requirements • Reductions in pool operating cost with energy saving equipment • System improvements and water chemistry efficiencies Poolwerx can do as much or little of the work you require. We can also provide training for work you wish to be performed in house. Starting with a complementary on-site visual inspection, Poolwerx will then tailor a solution, keeping your current resources and budget in mind.

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TECHNICAL PAPERS

Healthy pools for healthy people POOLWERX

SWIMMING AS REHABILITATION

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wimming is an important process of a patients rehabilitation.

Physiotherapists recommend water activities post operational or trauma because it’s low impact and presents a minimal risk of injury. It has revealed positive impacts on spinal cord injuries, heart disease, arterial health, autism, multiple sclerosis and for athletes it is a great approach to quickly recuperate after injuries.

Benefits include:

1. EASY ON THE JOINTS With swimming, the body weight is supported by the pool water, which means getting a strong, full-body workout without putting painful pressure on injured site and hip, spine, and knees joints.

Source: Centre for Disease Control and Prevention, United States, 2008

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TECHNICAL PAPERS 2. INCREASED FLEXIBILITY Stretching exercises are always the most effective way to maintain good flexibility, but swimming will help to add flexibility – especially in the hips, arms, legs, and neck. Studies show that with improved flexibility comes reduced back pain, better posture, enhanced muscle coordination, less soreness, and a lower rate of injuries.

3. TONED MUSCLES Water is nearly 800 times denser than air, which means putting every muscle to use every time you move around in the water.

Regardless of what type of swimming exercise you are doing, each arm stroke and leg kick functions as a form of resistance training – an excellent way to build muscle strength and tone following trauma.

4. HEART HEALTH Swimming is an aerobic exercise, which means that when you swim, you’re helping your heart to become stronger, larger, and more efficient at pumping blood throughout your body. Not only does regular aerobic exercise reduce the risk of coronary heart disease, it actually lowers inflammation by preventing fatty buildups in the arteries.

‘We specialise in Australian made and tested equipment that is delivered ready for installation into any AS2896 compliant medical gas pipeline system’

PATIENT MAINTENANCE: CHECK. POOL MAINTENANCE? We can all assume that a properly trained pool operator will yield a safer swimming environment for patrons. But, did you know that preventing outbreaks of water illnesses can also result in substantial cost savings? Statistical analysis showed a lack of free chlorine was documented more than twice as often with untrained personnel. A lack of chlorine can result in outbreak scenarios of water illnesses.

Untrained operators can unintentionally drive operating costs up due to improper chemical dosing or systems in place. Ill-advised day-to-day operating procedures can lead to pump failure and other unforeseen budget busting costs.

Prevention of water illness requires pool operators to:1) M aintain appropriate disinfectant and pH levels to maximize disinfectant effectiveness; and 2) Ensure optimal water circulation and filtration.

Hiring a properly trained swimming pool operator can result in substantial cost savings for hospital pool operators – from reducing risk of water illnesses to lengthening the life of mechanical equipment, and everything in between.

SGI Medical Gas Equipment We offer the following AS2896 equipment: • Medical gas isolation valve boxes.

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TECHNICAL PAPERS The most frequently reported type of recreational water illness outbreak is gastroenteritis, the incidence of which is increasing, indicating lapses in proper operation of pools. Improper disinfectant and pH levels can result in transmission of chlorineand bromine-susceptible pathogens.

ARE YOU SURE YOUR HYDROTHERAPY POOL WATER IS HYGIENIC?

STATISTICS IDENTIFY HOSPITAL POOL VIOLATIONS A report released in 2010 by the Center for Disease Control & Prevention found that nearly 1 in eight public pools posed serious violations that threatened the public’s health and resulted in immediate closure due to improper disinfectant or pH levels in the water.

Table 1 reveals that inspections specific to hospital pools resulted in the following statistics: • Of 180 inspections 12 pools were closed immediately because of serious violations; • Of 207 inspections 13 pools identified disinfectant level violations; • Of 161 inspections 32 pools identified other water chemistry violations; • Of 153 inspections 40 pools identified circulation and filtration system violations.

• Therapy pool inspections had the lowest percentage of disinfectant and pH level violations but the highest percentage of other water chemistry violations (43.9%).

The results also demonstrate that pool inspection data can be used as a potential source for surveillance to guide decisionmaking of resource allocation.

LEGAL REQUIREMENTS The Australian State and Territory Public Health Acts and Codes determine the level of maintenance, equipment and testing required for water quality control of hospital pools. Additionally Pool Fencing Regulations to comply with Australian Standards & State Legislation, Work Health and Safety legislation need to be referenced in order to provide a road map to maintain a health and safe pool environment. It is imperative that all Hospitals engage pool maintenance specialist to prevent all water illnesses and comply with legislation.

“in 60 seconds, I can accurately do 9 different tests.”

The only way you really can be sure is to test the water properly. And the best way to do that is with WaterLINK Spin, an innovative new technology that makes water testing faster, easier and much more accurate.

Gone are the days of photometers that require you to crush tablets, wash test tubes and time chemical reactions. Not only were these tasks tedious and slow, but they were also sources of user error. You simply couldn’t be sure if your tests were accurate or not.

Now, with WaterLINK Spin, all users have to do is inject a little water into a disc. From there on the testing process is automatic.

There is almost no chance of user error. And accuracy is assured.

But accuracy and ease-of-use are not the only benefits of WaterLINK Spin. The system is also very fast. It takes just 60 seconds to analyse 9 different parameters of water quality. For people needing to test pool water frequently the saving in labour time and cost can be enormous.

If you would like to know more about WaterLINK Spin please call (02) 9450-0466 or email info@vendart.com.au.

Distributed exclusively by Vendart Pty Ltd Phone: (02) 9450-0466 Fax: (02) 9450-0755 www.vendart.com.au

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TECHNICAL PAPERS

Reduce disruption to patients with non-invasive rehabilitation technologies NUFLOW

A blocked, damaged or leaking pipe can result in significant destruction, disruption and inconvenience. Statistically, excavate and replace has been the preferred method utilised to repair pipes, this is understandable, as historically few other alternatives were available.

The traditional excavation and replace method can have significant impacts, ranging from uninhabitable buildings to patient displacement and expensive restorations costs.

All resulting in an impact on service delivery and reputation.

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s buildings age so does the infrastructure. When buildings are retrofitted, often little thought is given to the ageing infrastructure and many of these services are operating with pipe assets that may fail at any time.

In 2013-14, there were more than 9.7 million hospital visits across Australia. With this number expected to increase by 3.3% on average each year, providing safe, reliable and sustainable services is vital for efficient service delivery. An increase in numbers will result in an increase in pressure on infrastructure; these pressures can be exacerbated by ageing infrastructure.

New approaches to the management of pipe repairs are required to address the increasing inconvenience, damage and danger caused by collapsed or damaged pipes.

Now with non-invasive rehabilitation technologies, pipes can be repaired with minimal disturbance providing Building Managers with the option to completely reline a pipe with absolutely no digging.

To rehabilitate a sewer pipe for example, existing access points would be utilised as entry and exit points.

By utilising this rehabilitation method, there would be no requirement to excavate and replace pipes. This is achieved by infusing a highly specialised epoxy resin into a

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liner; this is then placed over a bladder and pulled into place. The bladder is inflated and left to cure. Once the liner has cured, the bladder is removed leaving behind a structural repair. This results in a rehabilitated section or entire pipe from the inside, providing an increase in protection from deterioration and resulting in increased longevity to the original asset.

There are significant benefits to utilising this repair method, including environmental, the elimination of expensive rehabilitation costs, increased safety and pipe longevity and preventing disruption to patients.

An advantage of utilising non-invasive rehabilitation technologies is that an existing pipe in extremely poor condition can be cleaned out to its original state then relined to reinstate its structural integrity, extending the life of the asset.

Another advantage about this product is that unlike conventional repair and replace options that can often cause a whole site to be shut down whilst work is done, this process can be managed to ensure minimum disruption to operations.

Non-invasive rehabilitation technologies have been used successfully in a variety of applications, both commercially and domestically.

THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

One example of the use of this technology is in a busy hospital in Melbourne, as a result of corrosion, the hospital was experiencing poor pressure in a fire service pipe that was located in a buildings foundation. The hospital had two options, either utilise Redline, a non-invasive pipe rehabilitation process that prevents future problems occurring or excavate and replace the pipe.

Utilising Redline, 35m of a 100mm galvanised (with rolled groove couplings) fire service pipe was repaired. As part of the process, pressure testing of the pipe was also performed.

With the pipe being imbedded in the floor, the alternative of replacing the pipe would have involved closing down the fire system and excavating the concrete foundations.

During this process, patients of the hospital would have been required to be moved, resulting in disruption to services. Utilising Redline, the problem was resolved in just two days and caused no disruption to patients.

While all pipes eventually fail, stormwater pipes are generally found to be in significantly worse condition than sewer and water pipes when it comes to rehabilitation. However, little funding has been put towards these assets in the past, with more focus placed on sewers which can have a much higher environmental

TECHNICAL PAPERS

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TECHNICAL PAPERS impact. But stormwater pipes play a significant role in property damage by causing ground subsidence, structural cracks in properties, and localised flooding.

The problems are generally exacerbated by the fact that stormwater pipes are mostly shallow and in close proximity to above ground structures.

As most pipes have a recognised lifespan of 50 years, the application of non-invasive rehabilitation technologies would be able to rehabilitate the structural integrity of the pipes and result in up to an additional 40 years in pipe performance.

When a pipe fails, it forces those responsible to go into reactionary management. This puts huge pressure on resources, and often results in significant disruption and reduced services offered by a hospital. One of Queensland’s largest private hospitals was experiencing a leak in a copper waste pipe resulting in water seeping into the concrete floor slab.

The managers had two options, either utilise Blueline, a non-invasive pipe rehabilitation process that prevents future problems occurring or excavate and replace the pipe. As the patients at the hospital take priority, the alternative solution of closing down part of the hospital and excavating to replace the pipes was never an option.

Utilising Blueline, the 150mm copper pipe, including a bend and a 150mm to 100mm taper within the waste pipe was repaired.

The line was back in service quickly with minimal noise and damage. The works were completed well within our estimated schedule and by utilising our non-invasive pipe rehabilitation technology there was no disruption to the vital services of the hospital or displacement of vulnerable patients Rehabilitating pipes with non-invasive rehabilitation technologies needs to be seen as an investment; it saves time and saves money in the long run. It also reduces pressure being put on company and council resources, PR disasters and placing other assets at risk.

The health and safety of patients is paramount. An advantage of non-invasive rehabilitation technologies, is that unlike conventional repair and replace options that can often cause a whole car park or building floor to be excavated, this process can be managed to ensure minimum disruption to operations. The use of these technologies assists with safety, as there are no large open holes, reducing chance of land collapses.

In addition, lining is an eco-friendly solution that creates little waste for landfills or for recycling and generates no carbon emissions during manufacturing.

Revolutionary, green technologies such as epoxy lining are replacing temporary, out-dated pipe replacement methods as an eco-friendly trend that efficiently and economically controls pollution.

® UNIQUE Care

The environmental benefits of non-invasive rehabilitation technologies will be attractive to those cities that are ‘going green’.

Current research shows that CO2 emissions are reduced when trenchless methods are used versus open-cut. This translates to a direct-cost benefit for companies that are facing carbon taxation.

Non-invasive rehabilitation technologies are an ideal solution for all maintenance and facility managers in the future. It is a preventative technique that provides peace of mind in terms of the assets function.

We must act now to provide safe, reliable and sustainable services for hospitals. This includes choosing a preventative measure over reactionary remedies. There are significant benefits to relining, including increases in safety, pipe longevity, and water quality. This results in a decrease in emergency spending, patient displacement and bad public relations.

The aim of relining is very simple, to provide the ability to secure an asset and its operation and prevent future problems from occurring.

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The traditional method of excavate and replace has multiple effects on the surrounding environment. The use of heavy construction equipment results in a higher noise level in the vicinity of the work area.

In addition construction work may lead to a higher noise pollution due to changing traffic conditions compared to the ‘normal’ situation.

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HOMECARE™ BED HomeCare™ beds are enclosed in a solid timber frame designed to complement your home decor.

Malmet’s energy saver bedpan washer disinfector reduces NSW health’s energy costs

ADVERTORIAL

Malmet have recently installed its ESD model Bedpan Washer Disinfectors to many NSW Health facilities throughout the Murrumbidgee LHD. Funding for this was obtained by MLHD based on significant energy saving benefits to NSW Health by replacing the old Malmet BP/FS machines with the ESD.

Malmet has been manufacturing hospital and age care equipment since 1969, and supplies hospitals and nursing homes throughout Australia and overseas through a comprehensive network of distributors and agents.

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All Malmet products are manufactured in Leeton, NSW. The site is AS/NZS ISO 9001:2008 certified. All Malmet products also have the appropriate TGA approval, and comply with the relevant Australian and ISO standards.

he Malmet ESD only requires incoming cold water to operate, and only 240V 20A power. There is also an alternative 10A machine for those facilities with limited power.

Compared to the old Malmet BP/FS models still common in many facilities, this results in significant energy savings.

Based on a facility washing 30 bedpans per day, and taking into account savings in power and hot water usage, the estimated payback period is less than 4 years. Malmet would be pleased to provide a detailed Cost Benefit Analysis for a specific facility.

Malmet (Australia) Pty Ltd is a leading manufacturer of Infection Control Solutions and Specialised Hospital and Aged Care Equipment for CSSD, Recovery, Obstetrics, Theatre and Ward Utility Rooms.

Malmet is a company belonging to the Celi Group of Companies, a privately owned and operated family business. Other companies within the Group are Climate Technologies (Bonaire, Pyrox, Celair), Climate House (air conditioning retailers), Curtin Foodservice Equipment, Dadanco (Chilled Beams) and Bradflo (air handling and ventilation).

Utilising its own technicians or authorised service agents, Malmet can also offer comprehensive Preventative Maintenance Agreements to cover most facilities throughout Australia. All supported by local Malmet service support and spare parts readily available.

For more information please contact Malmet on 02 6953 7677.

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• Simple operation: 3 standard cycles • Available in either 240V 20A or 415V 20A • ARTG Class 11b certificate number 232450

• Operates off incoming cold water – reduces load on HWS

• Simple operation: 1 standard cycle • Available in either 240V 20A or 240V 10A • ARTG Class 11b certificate number 232012

For more information please contact Malmet on 02 6953 7677 or visit:

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Visit us at the TECHNICAL PAPERS Institute of Hospital Engineering Australia National Conference 2015 in Perth 9 - 11 September 2015 Derek Jacobs Director Derek.Jacobs@BrookfieldGIS.com +61 423 029 425

Maintaining the continuous availability of your facility is our priority

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TECHNICAL PAPERS

Safe work at height rules update

CARL SACHS I MANAGING DIRECTOR, WORKPLACE ACCESS & SAFETY

Hospitals with roof anchors on single or double-storey buildings face serious risk of falls, explains the newly revised workplace falls model code of practice.

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afe Work Australia published a revision of the model Code of Practice, Managing the Risk of Falls at Workplaces (“Code”) in March.

Chief among the changes to the code are fall distances for harness use along with safe access to the tops of ladders.

FALL DISTANCE FOR HARNESS USE EXPLAINED A worker wearing a harness attaches it to a shock absorber and lanyard system. During a fall, the shock absorber deploys and extends.

This extended distance is added to the person’s height, lanyard length and a safety factor, which allows for harness stretch.

Effectively, that eliminates single-storey buildings and typical warehouses.

Those around 6 to 8 metres high do not provide enough fall clearance if there are obstacles below like trucks or canopies.

Using a technique of restraint, it is possible to use a harness-based system on a roof that is less than 6.5 metres from the ground safely but equally as easy to get it horribly wrong. Simply use the incorrect length lanyard on an anchor close to gutters, for example, and a system design intended to prevent any risk of fall can unravel in an instant – with fatal consequences.

PRACTICAL AND COMMERCIAL CONSIDERATIONS AND SOLUTIONS In fact, the Code points out that harness-based systems should only be used if it is not practicable to provide a barrier such as a guardrail.

In many cases, guardrail is the most practicable and commercial solution for access to hospital rooftops. Consider the lifetime costing of equipment and all of the administrative, inspection, maintenance and training requirements for anchor and static line based systems.

Under the revised code, a person who falls can travel 6.5 metres before their fall is arrested.

Under the revised code, a person who falls can be expected to travel 6.5 metres before their fall is arrested.

The code makes 34 references to rescuing people in harnesses and dedicates an entire section to suspension intolerance, highlighting the importance of having a second person

on site and trained to implement a sitespecific rescue plan, equipped with the right equipment.

Also known as toxic shock and suspension trauma, the risk of death is real, explain Dr Bill Wheems and Dr Phillip Bishop of the University of Alabama in “Will Your Safety Harness Kill You? “Harnesses can become deadly whenever a worker is suspended for durations over five minutes in an upright posture, with the legs relaxed straight beneath,” the paper said.

Using higher-order controls like platforms, catwalks and guardrailing satisfies the legally powerful hierarchy of controls. Importantly, such passive height safety equipment reaps cost savings with lower lifetime costs, reduced administration and ready access for maintenance without the need for specialised height safety skills.

AT THE TOP OF THE LADDER Ladders are also affected by the revised Code, which says they should be installed to meet the requirements of AS1657. The most recent update to AS1657 considers ergonomics and how people use ladders.

The entry gate to an inclined fixed rung ladder fitted with a cage, for example, is now located away from the ladder.

This means workers do not have to stand on the ladder while opening the gate.

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TECHNICAL PAPERS

Buildings around 6 to 8 metres high do not provide enough fall clearance if there are obstacles below like trucks or canopies.

The Code specifies a landing space where workers can orient themselves before releasing their three points of attachment.

Exploratory research by prominent ergonomist Professor David Caple found the transition between rung ladders and a landing deserves special attention.

In the unpublished 2013 study, two types of extended stiles were installed on vertical ladders. One had circular “D” handrails that extended on to the landing and the other simply had vertical extended stiles.

When subjects climbed from the landing back down to the ladder, they felt behind them for the vertical upstands and had to contort their arms to gain a hand-hold. The circular rungs allowed them to achieve a grip before climbing back out to the ladder and to maintain the handhold all the way until they were comfortable and secure.

This was the highest point in the ladder, so a fall from a height of 3 metres from the person’s feet would almost certainly result in a death or permanent disability.

Professor Caple’s report concluded that, “There were evident potential fall risks occurring as they (ladder users) were trying to transition from the top rung of the ladder on and off the landing. “ “In particular, when they were transitioning off the landing on to the top rung, it was difficult for them to position their foot onto the rung whilst maintaining three points of contact with their hands on the styles and their other foot still on the landing.

“Their centre of gravity was behind their hand position and they were looking down through their feet to try to see the top rung of the ladder.”

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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

TECHNICAL PAPERS Professor Caple recommended the stiles extend over the landing so users can stabilise their posture with their hands while they find the top rung with their feet. This is achieved with D-shaped handrails.

A better approach still is to use stairways or step ladder, as recommended in the new AS1657. The standard’s hierarchical approach steers readers to safer options like stairways and step-type ladder arrangements because users can maintain an upright posture while climbing up and down.

This shifts the effort from the upper to the lower body, which results in less fatigue and a lower risk of falling.

HOW THE CODE AND STANDARDS FIT TOGETHER The Code offers practical guidance to reduce or eliminate the risk of falls. Workplaces that adopt the code methodology are deemed to have met their requirements under the regulations.

Australian Standards AS/NZS1891 (anchors and static lines) and AS1657 (Ladders, platforms, walkways, guardrailing) are referenced in the Code. Deviating from them would need to be justified if an incident was examined in court. Document reasons for any deviation in a risk assessment, reviewing the likelihood and consequence of a fall, comparing the cost of safe and compliant control measures versus the cost of injury.

Standards are undated in codes of practice, ensuring that revisions to standards are always referenced. This is particularly relevant to AS1657, which was revised in 2013 and AS/NZS5532 (Anchors), which was published as an addition to AS/NZS1891 dealing with testing of anchorage points.

Gates at the top of an inclined ladder with a cage should be paired with a landing.

CODE IS THE KEY TO PRACTICAL SAFETY AND COMPLIANCE The model Code of Practice, Managing the Risk of Falls at Workplaces, together with the Australian Standards it references, is a neat package.

Together, they spell out sensible height safety rules that make it clear how workplaces can increase the safety of workers at the lowest possible cost while minimising legal liability.

It’s essential reading for any hospital engineer with a roof that needs maintenance, especially if it’s less than 6.5 metres off the ground or is accessed via rung ladders.

ABOUT THE AUTHOR: Carl Sachs is managing director of fall prevention market leader, Workplace Access & Safety. He is the Technical Chair of working at height peak industry body, the Working at Height Association (WAHA).

A member of the Standards Australia committee for AS/NZS1891 (Fall arrests systems and devices), AS/NZS5532 (Anchor points) and, AS1657, Mr Sachs was involved in the drafting of the recently released standards.

Workplace Access & Safety has a NATA-accredited laboratory and four factories around Australia, providing complete service from fabrication through to installation and commissioning of anchors, guardrailing, static lines, platforms other access equipment to government, public and privately-owned companies nationally.

Workplace Access & Safety fabricates a fold-down guardrail system, which meets the based compliance requirements for level 2 systems, yet preserves building aesthetics.

Mr Sachs’ business is independently accredited by NATA for the testing of AS1657 equipment and AS/NZS 5532 safety anchors. Workplace Access & Safety manufactures and distributes the Defender brand of equipment, which includes ladders, staircases, specialised cooling tower platforms, suspended internal walkways, guard-railing and safety anchors. Defender products are the first to achieve AS1657:2013 and AS/ NZS 5532 compliance under SAI Globals StandardsMark and the ABCB’s CodeMark schemes.

Mr Sachs is a registered and licensed commercial builder in all Australian states, providing government and corporate clients with a holistic approach to fall prevention from consultation all the way to construction and installation. Carl can be contacted at carls@workplaceaccess.com.au or 1300 552 984.

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TECHNICAL PAPERS

The importance of flexible health care design ED AVIS

Strategies for keeping hospital physical plants relevant.

W

hen the design professionals at Hammel, Green and Abrahamson (HGA) were contemplating the infrastructure needs of the University of Minnesota Masonic Children’s Hospital during a renovation earlier this decade, they did not just think about the facility’s immediate needs.

They also looked years into the future.

“The existing plant was from the 1890s, and we had to take a large step back to make sure the mechanical and electrical systems would work for today and for future expansion,” says Krista McDonald Biason, PE, associate vice president of HGA. Planning for potential future needs, such as HGA did with Masonic Children’s, is becoming increasingly critical in today’s changing health care environment.

the view of what health care is,” says Arthur Kjos, AIA, NCARB, FASHE, executive director of facilities planning, University of Arkansas for Medical Sciences. “Patient services that have traditionally been the purview of acute care hospitals are rapidly moving down the chain to clinics and to the home.

We cannot predict where this will all end, but certainly it will not be what we are doing now.”

It is that unpredictability that is driving health care organisations to be flexible, because it does not make sense to spend $100 million on a building that may be made obsolete by changing conditions.

And with reimbursement changing in ways that are not yet fully realised, organisations fear that today’s investment may become a liability under a different payment structure.

“Money is scarce today, so the discussion of flexibility is becoming more important,” says Jeff Harris, PE, director of mechanical engineering for HGA. “Hospitals want to get more bang for the dollar.”

LOCATION AND BEYOND

CHANGING LANDSCAPE

For example, many patient services are moving from central hospitals to dispersed neighbourhood locations.

Since neighbourhoods change and populations expand in various directions, a flexible location can serve a health care organisation well. Jason Busby, a senior manager at Kurt Salmon, calls this the Wal-Mart strategy — always being ready to move when the market moves.

The changing nature of health care reimbursement, a growing senior population and general trends in health care all are driving the need for more flexible facilities. Designs that make sense today may not fulfil an organisation’s needs in a decade.

“Health care is in a huge state of change, obviously from pressures created by the Affordable Care Act. But other demographic, sociological and technological trends are also disrupting

The design of a flexible health care facility typically does not begin on the drawing board. Often it begins before a physical location is even determined.

“As populations shift over time, it may make sense to continually move your facility to where the population is going to be,” Busby says.

PHOTO BY HENKE STUDIO/COURTESY OF HGA ARCHITECTS AND ENGINEERS Identical air handling units are manifolded together to provide redundancy, flexibility and future capacity at the University of Minnesota Masonic Children’s Hospital.

An important element in space flexibility is deciding whether it’s smarter to lease or buy. Naturally, that decision often comes down to the use of the facility. It’s easier to find a space to lease if an organisation is opening a clinic, for example, than if it’s opening a new tertiary care centre.

“A primary care clinic is not substantially different from a regular office building,” Busby says. “So why build something new if you can find something less expensive to lease?”

Being flexible regarding location is just one early step. Another is taking on a flexible mindset about the overall project design.

Annie Coull, AIA, ACHA, EDAC, vice president of Stantec, notes that when her firm was developing a new hospital and ambulatory campus for the University of California San Francisco (UCSF), flexibility was identified as a goal at the beginning.

“Flexibility is one of the project’s guiding principles — ‘promote healing, new approaches to care and innovation

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TECHNICAL PAPERS through the adaptive use of space and staff practice,’ ” Coull says.

What exactly flexibility means is up to the client. “The key is to define up front the type of flexibility aspirations held by the client,” she says. “The range may be daily occupancy changes to long-term change of space use. [The designer also should consider] the organisation’s cultural response to change — people’s comfort with change in behaviour to accommodate flexibility inherent in space.”

THE DESIGN PROCESS Knowing early on that flexibility is a key desired characteristic changes how plans are made. The designer no longer can be satisfied with envisioning the project on the day the doors open — he or she must be able to imagine the next use for that structure, and the use after that.

Jack Poindexter, a project executive at DPR Construction in Redwood City, Calif., says that an essential part of flexible design is building a design team with that concept at heart.

“A major challenge is to train the project team to appreciate that health care equipment and practices are constantly changing,” Poindexter says. “It takes seven to eight years to design and build a major hospital in California, thus major aspects of the owner’s initial program and equipment can change. In recognition, the owner, architect and contractor have to build a team responsive to accommodating change.”

When designing for flexibility, several strategies should be considered.

They include: A building block approach. When HGA was designing the Masonic Children’s Hospital, it used a “building block” approach to create a flexible space.

Systems were designed and built in a fashion that easily would accommodate expansion as needed. Designers adopted a “modular” mentality, which meant they incorporated a greater number of smaller, standard-sized units rather than fewer, larger units.

“For example, you’re better off to buy four or five 500,000-Btu boilers than

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one 2 million-Btu boiler and be ready to add more as needed,” explains Harris, of HGA. “You only buy what you need now, but you build in the ability to wheel in more later.”

a storage room between an operating suite and a recovery room.

In the Masonic Children’s Hospital project, for example, the electrical distribution equipment was entirely replaced, and an additional switch was added to accommodate a building that did not yet exist, but which is part of the campus’ long-range master plan.

Another way to arrange spaces to allow for future construction is to make sure the mechanical spaces are located along an exterior wall. “That way the wall can get blasted out and new space added,” Harris says.

“The flexibility is there if that occurs,” McDonald Biason says.

Kjos was involved in the repurposing of two “big box” stores into health care facilities when he was a principal at Clark/Kjos Architects, and those facilities also included some elements that allow for potential future expansion. For example, an 80,000-square-foot building that previously housed a Kmart was repurposed into a wellness centre with space for a gym, physical therapy, urgent care and other services, but the facility was designed so that more services could be added if demand warranted.

“The primary life safety systems were upgraded to a higher standard to allow for various levels of health care to be included,” Kjos explains.

Soft space adjacent to hard space. It is much easier to expand an emergency department or imaging department if the space next door is “soft,” such as a storage room or office. Taking that fact into account during planning makes the eventual expansion much easier.

That’s what designers of the new hospital and ambulatory campus for UCSF did, Poindexter says.

“Designing soft spaces next to areas that will expand enables future growth while maintaining critical adjacencies,” Poindexter says.

The addition of soft space beside hard space is not always easy, however.

Harris notes that one of the principles of Lean thinking is the reduction of steps between work areas, so if Lean principles are deemed more important than flexibility, it’s unlikely a designer will add

THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

“Architects have to take all those criteria into account,” Harris says.

Standardised, multiuse rooms. Many new health care facilities are designed with standardised rooms that can be used for multiple purposes as the need arises.

For example, if the infrastructure is in place, a regular patient room could be upgraded to an intensive care space later or, conversely, downgraded to office or storage space.

The same goes for small exam rooms or procedure spaces. If designed well, their purpose easily can be shifted as needed.

“A facility that wants flexibility needs a room type that is flexible enough to ebb and flow when the need changes,” McDonald Biason says.

Standardised construction also can save money, since building numerous identical spaces is more efficient than building numerous customised, unique spaces.

AT WHAT COST? No discussion of flexibility occurs without a discussion about cost.

Adding future capacity is not free and, in these uncertain times, every dollar is closely watched.

“The idea of universal, modular designs seems really good, but an issue we’re starting to see is facilities that want to build rooms all to an intensive care-level capacity when they can’t predict what will happen three to five years from now,” Kurt Salmon’s Busby says.

“In the future, we may see that as wasting resources because they were overbuilding capacity.”

David Chamberlain, also a senior manager at Kurt Salmon, notes that as reimbursement changes from a volumebased model to a more value-based system focused on population health,

TECHNICAL PAPERS health care facility space no longer can be considered in the same light.

“Conventional thinking has been to build to the highest common denominator, but we really can’t afford to take that approach across the board anymore because space is a fixed cost rather than a revenue generator,” Chamberlain says.

On the other hand, the concept of flexibility is intended to save money in the long run. McDonald Biason says HGA is working on a wing addition to a building that is only 14 years old but does not have the infrastructure to handle additional capacity. Consequently, much more expensive work needs to be done now than would have been the case had a little more money been invested when the building originally was constructed.

“There are a lot of buildings that just wanted to put in the amount of money needed for the moment. If this building we’re working on had just upsized up front, it would have been a better solution,” she says.

Harris says the additional elements being added to the central plant in the Masonic Children’s Hospital project are adding 3-5 percent to the cost of the plant.

Since the central plant represents about a quarter of the total cost of the project, those flexibility additions add up to about 1 percent more in overall costs.

“I think people intellectually understand the need for adding these things, but it does come down to cost,” Harris says. “We try to provide things for an incremental increase in cost now to get more value later on. But there is a finite amount of resources.”

‘THINGS WILL CHANGE’ A flexible, adaptable health care facility is designed to accommodate changing needs. It follows, then, that the process for designing such a facility is not one-sizefits-all. Every project stands on its own, and the process for getting to a flexible final facility varies.

“Each organisation is different, so it’s hard to take a universal solution and apply it to so many places,” Busby says. “Things will change. I guarantee that.”

Ed Avis is a freelance writer based in Oak Park, Ill., who was contracted by the American Society for Healthcare Engineering to write this article.

First Published in Health Facilities Management 02 April 2015

THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

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CASE STUDY

Risk reduction through hotspot identification utilising infrared thermal imaging THERMOSCAN

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hermal imaging is a risk reduction technique offered by Thermoscan, to assist in evaluating the operating status of a building, with electrical services being one area where hazard reduction through thermal imaging is a most successful approach. The technique allows for the identification of hotspots and potential risks of fire or equipment breakdown in electrical and mechanical equipment through the use of thermal imaging cameras operated by trained technicians. Unchecked, unidentified equipment faults can lead to equipment failure, loss of electricity supply or electrical fire. Faults identified during a thermal inspection can be assessed and repaired in a controlled and scheduled manner, instead of waiting for a failure which may occur at an inconvenient time and result in greater equipment damage and downtime.

Thermal imaging allows the identification of abnormalities that would not normally be identifiable by sight, thus allowing a maintenance or preventative action strategy to be put in place. Because it is a non-contact inspection the Health and Safety benefits are many, and the inspection can usually be performed in a much shorter time than old fashioned hands-on inspections of components.

Thermal inspections are performed without the need to disconnect or isolate any equipment, thus ensuring continued operations of the facility are maintained during any inspection. Inspections can be scheduled day or night, depending on facility requirements.

Established in 1980, Thermoscan have approximately 10 licenced electricians specialising in Infrared Thermography.

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All Thermoscan technicians are required to complete Thermographer Certification to Level 1 or Level 2, thus ensuring a level of competence and knowledge.

They conduct business across Australasia, including Fiji, with in excess of 8000 inspections conducted annually. Their technicians are based in SE QLD, as well as VIC and NSW, and travel to destinations all around the region at least twice a year for ongoing inspections.

Thermoscan is an independent operator, not affiliated with any repair provider. You can be assured that all observations and recommendations will be totally unbiased and are not based on trying to drum up possibly unnecessary repair works.

components, and more. The end result of these issues is that the electrical components suffer from heating and premature failure. Regular Thermal Imaging inspection can locate these faults at an early stage, before damage becomes substantial, and when the risk of catastrophic failure is reduced. The longer a fault is allowed to continue, the worse the damage usually becomes, and the rate of deterioration of the fault may increase exponentially as damaged areas become less able to carry the electrical load. The end result in some cases is a rapid deterioration to the point of component failure, flashover, explosion or fire.

Our team of industry qualified experienced electricians and thermographers responds quickly and provides accurate scan reports for most thermal imaging applications. Thermal Image reports are normally supplied to clients within 24 hours of completion of an inspection. Serious thermal anomalies are reported to site personnel immediately so that the necessary risk assessment and repairs may be commenced without delay. Thermoscan operates within systems certified to ISO 9001:2008 & AS/NZS 4801-2001, assuring clients that Quality and Safety are priorities.

The requirements of an effective Thermal Imaging inspection program are as follows:

Over the many years that Thermoscan has been performing Thermal Imaging inspections we have observed that the most common faults encountered are those that are not visible to the eye.

The root causes of these faults may include high resistance connections, circuit overloading, unbalanced loads, incorrectly rated components, broken or cracked conductors, incorrectly fitted

THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2015

• Access to switchboards, distribution boards, and other electrical or mechanical equipment at times of normal load conditions. This ensures the highest probability of faulty components being identified. Thermal Imaging done under low or light load conditions may not indicate a fault that may only become apparent at higher loads. • A good quality Thermal Imaging camera, capable of recording Infrared and digital visible images so that analysis and identification of faults is positive so that repairs can be carried out with minimum delay. All Thermoscan technicians are equipped with Flir cameras that meet these requirements. • An experienced and trained operator who understands the equipment he is using, the equipment being inspected, and the types of potential faults

CASE STUDY that may be encountered. Positive identification of real faults is critical so that false alarms are not given to items that are not faulty. Suspected faults must be imaged and carefully analysed to determine the level of severity and recommended repair options identified.

Thermoscan technicians are all licensed electrical tradesmen with a working knowledge of the various types of equipment encountered in switchboards and machinery in plant rooms. • A suitable inspection frequency. A Risk Assessment which considers the types of equipment, past history of failures, criticality, and site-specific risks, will identify a suitable inspection frequency.

A six monthly interval is common in many industries.

Below are some brief Case Histories that illustrate some common faults.

Case 1: The Thermal image shows a large Isolator which has developed a very serious fault, resulting in excessive heating of the centre busbar.

We can see that it has reached a temperature around 319degC at this stage. The digital visual image (top right), shows the extent of burning of insulation and discolouration of the copper busbars.

The damage within the Isolator is not visible but is likely to be similar, as temperatures within the Isolator will be higher. This particular Isolator had been inspected on three previous occasions, and each time was found to be seriously overheated and in need of maintenance action. These recommendations were ignored until it reached this level of damage, which has now resulted in much more repair work being required to return the Isolator to service. Early intervention would have reduced the level of damage, and the very high risk of failure, explosion, and fire. Given that this

Isolator is rated at several hundred Amps, and was being continuously overloaded, the potential for damage is very high.

Case 2: The Thermal image below illustrates a common Thermal problem that is not visible to the eye.

CONCLUSION In conclusion, Thermal Imaging is a powerful non-invasive method of assisting equipment owners to identify potential problems before they become serious and have the potential to cause severe damage. It has the ability to locate faults early in the deterioration phase, which allows equipment owners to develop a repair strategy that will minimise disruption to services and unwanted downtime. When conducted regularly it will assist in reducing equipment failure.

The central supply fuse opposite has a problem that is resulting in heating, with no apparent damage visible at this stage.

Identification of the Thermal anomaly at this stage has allowed the problem to be addressed in a scheduled and controlled fashion before it progresses to failure. Since this is the building’s incoming mains supply it is important that repairs are carried out in a fashion that limits downtime. Should the fault have progressed to the inevitable failure, downtime would be sudden, and probably longer.

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