Healthcare Facilities Winter 2017

PP 100010900

VOLUME 40 I NUMBER 2 I JUNE 2017

HEALTHCARE INSTITUTE of HEALTHCARE ENGINEERING AUSTRALIA

FACILITIES

WA Country Conference visits Broome Health Campus

Vic/Tas Seminar held at Monash Children’s Hospital

MEMBER EVENTS AROUND AUSTRALIA QLD Branch meeting held at Royal Brisbane Women’s Hospital

NSW/ACT members inspect new Campbelltown Hospital

2017 IHEA NATIONAL CONFERENCE – Details and Program Inside

A CONTEMPORARY CHALLENGE FOR HEALTHCARE – Terrorism & Armed Offenders

BOILERS – Managing Condensate Water

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CONTENTS REGULARS 5

Editor’s message

6

National President’s message

9

CEO’s message

76 News

VALE 10 Geoffrey Brian Johnston

BRANCH REPORTS 12 WA 16 VIC/TAS 18 QLD

31 Preventing infection by monitoring air quality with telemetry

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38 Building contracts The global green and 47 healthy hospitals network 55 The ticking time bomb in health is being ignored 64 Managing condensate for condensing boilers 68 The contemporary challenge of terrorism and active armed offender incidents for hospitals and health providers

55

72 What keeps you up at night?

19 SA 21 NSW/ACT

FEATURE ARTICLES

Visit the Institute of

Water hygiene masterclass 22

Hospital Engineering

The IHEA Healthcare Facilities 28 Management Conference

www.ihea.org.au or

IHEA NATIONAL OFFICE Direct: 1300 929 508 Email: admin@ihea.org.au Address: PO Box 6203, Conder ACT 2900 Website: www.ihea.org.au Conference: http://hfmc2017.org.au IHEA NATIONAL BOARD National President Brett Petherbridge National Immediate Past President Darren Green National Vice President Peter Easson National Treasurer Mal Allen National Secretary/Communications Darryl Pitcher Membership Registrar/ CHCFM Coordinator Peter Footner

online by visiting scanning here ➞

Standards Coordinator Brett Nickels Asset Mark Coordinator Greg Truscott Directors Michael McCambridge, Rod Woodford IHEA ADMINISTRATION Secretariat/Website Administrator Heidi Moon Finance/Membership Jeff Little Editorial Committee Darryl Pitcher, Brett Petherbridge and Darren Green

IHEA MISSION STATEMENT To support members and industry stakeholders to achieve best practice health engineering in sustainable public and private healthcare sectors.

64 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 Tarnia Hiosan T: (03) 9758 1431 E: admin@adbourne.com

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.

3

BRANCH REPORTS

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EDITOR’S MESSAGE

COMPLIANCE ALONE DOES NOT ENSURE SAFETY OR QUALITY Just because you are compliant and ticking the boxes does not automatically mean that all is in order and safe for the staff, patients and public who use your facilities.

I

am sure that every healthcare engineering professional knows this at some level, but recently there has been a lot of bad press emerging associated with the care of our elderly, particularly in a South Australian facility. Significant media attention has been aimed at the Aged Care sector over a report released by the SA chief psychiatrist into management of the facility in Adelaide’s north eastern suburbs. The issues and outcomes being reported are tragic to say the least, and one of the searching questions being asked is, “How could this happen over such a long period of time in an environment that is so tightly regulated by government systems and processes”. Anybody who has been involved in managing residential Aged Care will know that it is a highly regulated and audited environment.

But an audit that is intended to measure compliance against a wide set of quality or industry standards, does not axiomatically ensure the consistent delivery of safety and quality. Audits often take a snapshot, a still image taken of a moment in time, which like any photograph does not necessarily capture the peripheral scenery, the other events occurring outside the field of view, which could be contributing factors to the overall outcome.

Bearing this in mind, even intense regulation and the most rigorous compliance audits are only one set of tools that are intended to assist in delivering an acceptable level of safety or quality. A compliance or audit tool usually dictates a minimum set of acceptable standards, or the minimum base line to be achieved to tick certain boxes. These tools need to be combined with a culture that is willing and prepared to have the bright light of scrutiny shined on it. It helps if that scrutiny is fair and reasonable, and not the blunt instrument of media scrutiny which often seeks to promptly apportion blame.

The reality is that there is nearly always competition for time and resources, and often just exceeding a minimum baseline is seen as having achieved the target, when in fact all that has been achieved is compliance. But compliance does not guarantee safety or quality, and with the rising expectations of consumers and the prevalence of tools like consumer star ratings, meeting a minimum set of compliance standards is no longer going to secure your future or completely mitigate risk of liability.

Changing the cultural mind-set might be what is needed to focus more on customer or stakeholder outcomes, rather than ticking compliance boxes.

What seems to be emerging in the example referred to above is that despite “achieving compliance” to a set of minimum standards, the culture of the organisation guaranteed significant failures at a number of levels.

Achieving compliance is not the goal – meeting the expected outcomes of your stakeholders is.

Maybe as the auditors leave your site, you breathe a sigh of relief, knowing where your gaps are, but thankful that they weren’t exposed, this time around. I am sure we all understand why that happens, and might even accept that time or resources weren’t sufficient to allow you to address everything you would like to.

“Compliance in Motion” is the theme of the IHEA National Conference in Melbourne in October 2017 – keep your eye out in Healthcare Facilities and in your inbox, for information about the Conference.

This second edition of Healthcare Facilities is packed with relevant and useful articles and information to assist you to ensure your Healthcare facility does more than achieve compliance, but helps you to enable world-class healthcare to be delivered across Australia.

Regards Darryl Pitcher

5

REGULARS

NATIONAL PRESIDENT’S MESSAGE

Welcome to the 2nd Edition of the new Healthcare Facilities as the winter chills have well and truly embedded themselves and we enjoy the change in season.

O

ver the past 3 months your National Board has undertaken a number of key focus activities aligning with our strategic plan.

JUNE BOARD PROCEEDINGS AND SUMMARY OF KEY ACTIVITY The National Board meet in Adelaide over 2 days (1-2 June). On the first day the Membership subcommittee met, discussed and outlined a proposed realignment of membership grades.

This is seen as a positive step towards streamlining membership growth and is particularly important in our partnership with Facilities Management Association (FMA) and their management of the membership administration.

The Board also undertook a workshop in the afternoon focussing on:• Establishing an IHEA Baseline, identifying members and addressing key gaps • Building a stakeholder profile of an IHEA member • Completing a 12 month organisational action plan Day 2 consisted of a Board meeting and was held at the Australian Institute of Company Directors (AIDC) rooms in Westpac House Adelaide.

Board Director Reports were submitted and are summarised as follows:-

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Financial and Risk Management Report Mal Allen presented his report which provided a year to date snapshot confirming a good result. The next year budget was also presented and endorsed by the Board.

Standards and Technical Coordinators Portfolio Brett Nickels presented his report outlining the current position with Standards Australia committees that IHEA has representation on. These include:• Medical Gas Systems • Sterilising Equipment – Processing Medical and Surgical Instruments • Digital Hospitals The E-Bulletin to Members June 1st outlined the withdrawal of AS3811 Hard Wired Patient Alarm Systems. The IHEA is advocating a new standard that not only replaces the AS3811 Patient Hard Wired System, but incorporates digital, IP and hybrid Nurse Call systems, Duress systems and TV/ Patient Entertainment. We are looking for a champion or a group of champions to take on the initial stages of the process of developing a new standard so please contact Brett by email (brett.nickels@health.qld.gov.au) if you are interested in being involved with this standards committee.

REGULARS

Membership

Facilities Management Australia (FMA)

It is pleasing that we continue to see a steady increase in new member applications. The Membership Subcommittee’s work on streamlining the “on line” application process will support ongoing future increases, and make the task of admitting new members much simpler.

As previously reported the development of a partnership with FMA is well underway with a particular focus on transitioning our database and setting up our members in a separate portal. Annual membership renewals are due in July 2017 and we are confident that this work will meet the target dates.

ANZEX Delegate

IHEA Website – Revamp

Following the recent expression of interest, the IHEA has endorsed Mr Jon Gowdy (NSW Branch) as our 2017 ANZEX delegate. Jon will represent the IHEA at the New Zealand Institute of Healthcare Engineering (NZIHE) Conference in November 2017 in Dunedin.

Congratulations Jon, and we look forward to hearing and reading your report.

As part of our rebranding exercise the IHEA has undertaken to have the website revamped. The new website should be up and running shortly and we will advise members by E-Bulletin when this has been finalised. The Board viewed some initial design concepts and I can say these are new, vibrant and very progressive in capturing attention of existing and prospective new members.

State Branch Reports Each State presented their reports which outlined activities within their states since our last meeting in February. It was especially pleasing to see the states undertaking successful Professional Development Seminars well attended by members, corporate partners and prospective members.

2017 National Conference The Institute of Healthcare Engineering, Australia is pleased to invite you to the IHEA Healthcare Facilities Management Conference (HFMC 2017) to be held in Melbourne on 11-13 October 2017 at Pullman Melbourne Albert Park.

This year’s theme is Compliance in Motion and will give participants an overview of how Health Services engineering teams manage and support compliance in a very dynamic landscape.

Earlybird registrations are now open and I encourage all to attend.

Whilst meeting at the Australian Institute of Company Directors offices, the National Board was caught up in the activities of the AICD staff who were conducting a Super Heroes fundraising day. Staff and visitors to AICD dressed up as their favourite Super Hero to raise funds for childhood disease research. In the spirit of the day the IHEA Board Members contributed and were allowed a photograph with the assembled “Super Heroes”. Well done AICD!

SUMMARY I urge all members to read through the journal and in particular their own state reports on current and upcoming events. It is now time to register for the 2017 IHEA National Conference as this is the premier event held annually for members and supports your Professional Development.

Brett Petherbridge IHEA National President

The National Board of Directors is as follows:Name

Position

Brett Petherbridge

National President

Email

Peter Easson

Vice President

Darren Green

Immediate Past President

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

Darryl Pitcher

Secretary

D.pitcher@bethsalemcare.com.au

Mal Allen

Treasurer

Mal.Allen@hnehealth.nsw.gov.au

Karen Taylor

Chief Executive Officer (ex officio)

ceo@ihea.org.au

Peter Footner

Membership Registrar

pesarash@adam.com.au

Brett Nickels

Director – Standards

Brett.Nickels@health.qld.gov.au

Greg Truscott

Director – Asset Mark

Greg.Truscott@health.wa.gov.au

Michael McCambridge

Director (co-opted)

Michael.McCambridge@mh.org.au

Executive Committee

brett.petherbridge@act.gov.au Peter.Easson@health.wa.gov.au

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REGULARS

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REGULARS

CEO’S MESSAGE

Why be a member of IHEA?

W

hat drives members to join associations? This question is always front of mind for myself and the board as we constantly strive to discover the best ways to attract new members and ensure a beneficial experience for current members. As part of my thinking on this issue I have researched and summarised the main reasons members join industry associations such as IHEA, according to the 2014 Small Membership Survey Report from Wild Apricot and Webright blog. In our work to ensure a vibrant and relevant association for our members we will continue to deliberate on our reason for being and your reason for joining:

• Networking – IHEA is filled with potential contacts and great sources of support. Members can connect and create relationships, with numerous great networking opportunities for those who want to strengthen ties with clients or colleagues in healthcare engineering or make long-term beneficial connections.

• Events – IHEA hold events on a regular basis, as a way of engaging members and creating value for your membership. These events can be networking functions that give members a chance to form valuable connections, trade shows that help members stay up-to-date on with industry developments, and seminars, workshops and annual National and State conferences to provide continuing industry education.

• Professional Development – Continuing education and professional development is key if you want to succeed in any profession. IHEA not only provides professional development opportunities in the form

of workshops, seminars, and conferences, they also provide the opportunity to learn from other members.

The peer-to-peer learning and potential mentorship opportunities that IHEA provides allow members to combine their knowledge and take advantage of each other’s experiences.

• Learning best practices – If you’re new to Healthcare Engineering and don’t have much experience, ignorance of best practices can pose a serious business and reputational risk. Connections made through IHEA can provide a forum for promulgating industry-wide best practices. IHEA gives you a resource to learn best practices as well as give you a head start on compliance if best practices are amended or changed.

• Information/news – As a member of IHEA you have access to any noteworthy news or developments in Healthcare Engineering. Not only do IHEA members talk to each other, often they provide resources to each other. Staying up-to-the-minute on industry news allows members to take advantage of changes or developments.

• Support Healthcare Engineering – IHEA and our members give a public voice to a vital profession in our community, support the development of industry professionals, and advocate for the well-being of the industry as a whole. As a member your support and belief in the work of IHEA and Healthcare Engineering demonstrates the dedication to your professional lives.

Karen Taylor CEO

9

VALE

VALE: GEOFFREY BRIAN JOHNSTON 27TH MAY 1940 – 14TH MAY 2017

Geoff Joined the NSW Branch on 31st May 1983 as an Associate Member. He became a full member on 26th February 1996. Geoff was always a very active member and specifically gave extra time to the Institute serving many years as Branch Treasurer from 1997 until 2009, National Membership Registrar from 2001 until 2007 and Geoff was awarded his 20 year badge and certificate in 2003.

G

eoff was born on 27 May 1940 at Bankstown, Sydney. Geoff attended North Bankstown Public School and had many friends in that area. Geoff stayed with his grandparents most weekends so that he could play football and continue to socialise with his friends.

At the age of 12, Geoff joined the Naval Cadets and many years later, he shared his interest in the Navy cadets with his son Dale, Geoff being a commanding officer of TS Nepean and Dale a member of the unit.

Geoff attended Punchbowl Boys’ High until the age of 14. The Principal advised his mother to get him a job where he was using his hands. He was indentured to a boilermaker’s apprenticeship at Eveleigh Railway Workshop which was the main railway workshop for the NSW Government Railways. Geoff excelled in his apprenticeship.

Conscription into the armed services or National Service loomed so Geoff joined the Army Reserve, (his mum was not keen to see him going off to war).

He was only with the Army Reserves for a short period of time, where Geoff met Alan who had a sister, Margaret Joss.

Margaret was to become the love of his life, Geoff affectionately called her Margie. Geoff married his Margie on 16th December 1960 and following their wedding the Johnston family lived in Bankstown,

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Villawood, Colyton, St Marys, St Clair, Erskine Park and in retirement moved to Lake Munmorah. An idyllic spot at the head of the Tuggerah Lakes System.

Geoff retired from Nepean Hospital in 2001. He spent his 28 years working in the maintenance department, retiring as the Assistant Engineer.

In their eulogy to Geoff his family remembered that Geoff, after completing his apprenticeship and working on steam locomotives at Eveleigh, took great joy in explaining the workings of a steam engine.

Geoff was a natural when it came to working with his hands and took great satisfaction understanding how complex mechanical systems worked. His passion for engineering was not limited to work. His enthusiasm and intrigue for engineering played a significant role in their own career paths. They fondly remember catching up at family events and their Pop quizzing them on the thermal dynamic properties within closed hydraulic systems.

So many members of the IHEA and the Health Care Engineering community have been helped by Geoff and his great knowledge of Health Care Engineering.

Geoff was a friend and mentor too many and a genuine gentleman who will be missed by all that had the pleasure in knowing him.

Geoff will be missed greatly by many.

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BRANCH REPORTS

WA BRANCH REPORT Branch Meeting March 2017, Osborne Park Hospital

O

sborne Park Hospital was the venue for the March branch meeting and host Fabien Edwards welcomed the attending 35 members and guests. Following the formalities, Ryan Milne from Ecosafe International sponsored the evening, Ecosafe are an independent risk management consultancy service who specialises in a range of consulting and auditing services related to water, environment and health.

Training facilities for maintaining ship propulsion systems, which included a decommissioned MTU V12 cylinder (11.63 litres per cylinder) diesel motor. An Anzac Class Frigate is driven by a combined diesel or gas turbine system of one GE LM 2,500 gas turbine rated at 33,600hp (at 3600rpm) plus two of the MTU diesels as shown which are each rated at 4,828hp (at 1200rpm).

Retired member Len Mumme and decommissioned MTU 12V.1163.TB83 diesel motor

Branch Meeting April 2017, HMAS Stirling (Garden Island) Naval Base.

The Royal Australian Navy (RAN) very kindly allowed us onto the Island which is linked to the mainland via a 4.2 km causeway. It is the largest base in the RAN and home to 2300 service personnel, 600 defence civilians and 500 long term contractors. Anzac Class frigates and Collins Class submarines are stationed there. This opportunity clearly captured the interest of members, with 51 registering (required for security reasons) to attend and 47 members attending on the day.

Aerial view of Island Naval Base

Navy personnel conducted us on a fascinating 3 hour guided tour which included the Central Plant for the whole site, which visitors noted, has power frequency converters used for providing “Shore Power” to the Ships alongside, by converting the 415V 50Hz power supplied from the mainland (and as used throughout the buildings on the Base), to 440V 60Hz which is what’s produced on the ships.

Electrical power converter

The Submarine Escape Training Facility (SETF) which is only one of six in the world.

At depths of 180m or less a submariner can escape from a stricken submarine. Wearing a special escape suit, they can free accent (at 2-3m/sec) to the surface.

The SETF is a dedicated 6 storey building, containing a 22m high water tower with an escape chamber matching that of a Collins Class submarine at the base. Submariners can carry out real life training for such an escape. The submariners are monitored by others in the tank during the accent. There are decompression chambers which are adjacent the base of the tank and another at the top, which are available, should something go wrong.

Submariner who has surfaced from the base of the water tower.

IHEA Corporate member Broad Spectrum is contracted to provide all Facility Management Services on the Island and

12

BRANCH REPORTS

in addition to sponsoring the meeting they were able to present to us the services they provide to the Navy and describe the unique challenges of that contract.

Regional Director Bec Smith and Facility Manager Allan Keenan opening the conference

Decompression Chamber at SETF.

State Country Conference April 2017 – Broome Zoom to Broome for the annual State Country Conference with this years’ theme of ‘Hospitals, Hotels and Hurricanes (the Aussie kind)’. The conference was opened by Bec Smith, the Kimberley WACHS Regional Director and Allan Keenan, the A/Regional Facility Manager for the Broome Health Campus, who also warmly welcomed all the 26 delegates.

The regional Health Campus was officially opened in March 2016, marking the end of an eight year phased $8 million construction & improvements period. Facilities include new operating theatres, consulting rooms for visiting specialists, a public dental surgery, refurbished maternity unit and an expanded emergency department which has more than doubled in size to 15 acute bays.

Following on with the theme, an interactive ‘disaster planning’ workshop, devised by Greg was thrown over to 3 separate groups to brainstorm and prioritise a hospital’s emergency business continuity plan, with the impending impact of a tsunami.

Also, Brad West and Bryan Page from the Pilbara region, presented an interesting talk regarding the effects of cyclones and how to maintain the operation of a health facility, before, during and after such an energetic weather event.

Broome Health Campus Delegates

Broome Hospital now has a modern paediatric facility to provide paediatric and obstetric services in the region.

The Mangrove Hotel vista – the Broome Country Conference Venue

The delegate partners also headed off to the local Willie Creek Pearl Farm for the day, to discover how the rare and beautiful Australian South Sea cultured pearls are produced, with an expertly guided tour of

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BRANCH REPORTS

how the oysters are seeded to harvesting these award winning jewels.

Conference Dinner at the Cable Beach Resort

Broome Health Campus

Fred and Lisa Foley

Best Hawaiian Shirt Competition at the Cable Beach Resort

14

Greg Truscott and Peter Easson enjoying their tropical refreshments

Typical Broome Transport

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The conference would not have been possible without our sponsors and the WA Branch would like to acknowledge and thank Sponsors who delivered presentations at the Conference: Thyssenkrupp, QED Environmental, Centigrade, MPS Mechanical and Comcater.

Greg Truscott

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BRANCH REPORTS

VIC/TAS BRANCH REPORT

Future Activities

Recent Activities

Professional Development Day No 3 – was held on 19th May and was hosted by Sujee Panagoda of the Monash Hospital. We were delighted to have our corporate partner CETEC Pty Ltd supporting this session.

The theme for the day was “Asset Management – The Challenge Ahead/New Requirements and Help”.

The PD seminar also included a site tour of the Monash Children’s Hospital and was supported by 32 attendees.

A special Environmental Sustainability Summit co-ordinated together with the Global Green and Healthy Hospitals network was held on 1st and 2nd June. The day was hosted by Vic/Tas member Kevin Moon and was held at Sunshine Hospital. We were pleased to welcome GreenLand Systems as the corporate partner and the day was supported by 46 attendees. A more detailed report will be provided in the next edition.

The Vic/Tas branch is actively involved in planning for the IHEA National Conference 11–13 October 2017, Pullman Melbourne, Albert Park and is on the theme Compliance in Motion. We look forward to welcoming all members and supporters to the Conference. Look for more details in the later pages in this edition of Healthcare Facilities.

Membership The Committee of Management has commenced discussions on invigorating the link with our Tasmanian members, by seeking new members and considering a biannual Tasmanian Professional Development day.

A special focus on membership will be linked to the National Conference planning.

Steven Jones received his 20 year membership certificate, at the Christmas function Michael McCambridge VIC/TAS Branch President

Committee of Management Branch President

Michael McCambridge

michael.mccambridge@mh.org.au

Branch Secretary

Peter Crammond

peter.crammond@whcg.org.au

Branch Treasurer

Roderick Cusack

rod.cusack@brhs.com.au

Committee of Management

Howard Bulmer

howardjbulmer@gmail.com

Committee of Management

Sujee Panagoda

sujee.panagoda@monashhealth.org

Committee of Management

Steve Ball

steve.ball@epworth.org.au

Committee of Management

Mark Hooper

mhooper@erh.org.au

Committee of Management

Roderick Woodford

rwoodford@castlemainehealth.org.au

Nation Board Reps

Michael McCambridge

michael.mccambridge@mh.org.au

Roderick Woodford

rwoodford@castlemainehealth.org.au

Roderick Woodford

rwoodford@castlemainehealth.org.au

Conference Convenor 2017

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BRANCH REPORTS

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BRANCH REPORTS

QLD BRANCH REPORT

O

n behalf of the QLD Branch, I would like to acknowledge the continued support of the QLD Branch Committee of Management, all Branch members and our many corporate partners all of whom have contributed to another successful quarter.

Activities Professional Development Seminar on Steam Sterilisation and RO Plants – 27th April 2017 1PM to 5PM, Pineapple Hotel.

An afternoon discussion on the concepts of Reverse Osmosis, the pros, cons & pitfalls of installation.

Also included was some useful information relating to AS 4187 regarding compliance / experience for Central Sterilisation Department RO water supplies. It was exciting to see a full house at the Professional Development seminar; and good to see BEMS staff representation from the Gold Coast Hospital. My congratulations and thanks to the Staff and Management of the Pineapple Hotel for the provision of excellent meeting facilities and their continued support.

We thank both Merck & Spirax Sarco for their partnership.

QLD branch trialed “Go To Meeting” as a webinar provider to give our country members live access to the presenters and the opportunity to be part of the PD sessions whilst remaining in their office. The initial feedback was encouraging that identified what we got right and wrong on the day so improvements could be made next time.

The PD seminar consisted of the following speakers: Branka Knezevic (Laboratory Water Sales Specialist for Merck).

Topic: Overview of water types and standards, pure water for CSSD and overview of water purification system design.

David Whiting (After Market Manager for Getinge’s QLD) and Craig Cooper.

Topic: Why RO, when it comes to sterilisation?

Wayne Harvey (National Healthcare and Pharma Sector Manager, QLD State Manager Spirax Sarco Australia).

Topic: AS4187 – clean steam, water treatment and how this impacts the plant steam system..

Membership Membership of the QLD Branch continues to grow through 2016/17, and we especially welcome Kym Collins and Queensland Children’s Health to the IHEA. The Branch Committee of Management meets monthly and has a busy agenda. The focus is to provide members with networking opportunities through professional development seminars, networking events and conferences. I would also like

Committee of Management

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Name

Position

Email

Scott Wells

President

Scott.wells@health.qld.gov.au

Brett Nickels

A/Secretary

Brett.Nickels@health.qld.gov.au

Alex Mair

Vice President

ama58500@bigpond.net.au

Jason Ward

Treasurer

Jward@beckerpump.com.au

Brett Nickels

State National Representative

Brett.Nickels@health.qld.gov.au

Michael Ward

COM

MichaelJ.Ward@health.wa.gov.au

Scott Summerville

COM

scott@opira.com.au

Peter White

COM

palapac444@hotmail.com

Kevin Eaton

COM

kevineaton@sdp.net.au

Stuart Hentschel

COM

Stuart.Hentschel@health.qld.gov.au

BRANCH REPORTS

to express my appreciation, to Brett Nickels for volunteering and stepping in as A/Secretary with the departure of Jeff Turner from the Logan Hospital, who has accepted a position in the United Arab Emirates.

Branch COM Meetings – Royal Brisbane Women’s Hospital The committee continues to focusing on continued improvement with the engagement of our members and the provision of quarterly Professional Development seminars including our Midyear State Conference to be held on the 20th & 21st July at the Victoria

SA BRANCH REPORT Activities

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he SA Branch has informally engaged with likeminded professional/membership organisations in SA to share and jointly plan professional development opportunities. It is hoped that, through these relationships, we will be able to provide more diverse professional development opportunities to IHEA members in SA. These affiliations are also being considered at a national level so that all members can access the benefits.

Coordinated by CIBSE, representatives of these various groups have been meeting on a monthly basis to continue the planning and IHEA has participated in these planning meetings. IHEA’s contribution will be to arrange two seminars/presentations during the remaining part of the year – a presentation on Operating & Maintenance Manuals has been held in May and a seminar on Indoor Air Quality is planned for September. Where appropriate, events arranged by these other organisations have been circulated to/ made available to our members, with a small number taking up the opportunity so far.

An updated Calendar of Events has been prepared and communicated to members via email and on the IHEA website.

Membership Membership is being pursued locally with both government and private Healthcare FM providers to broaden the reach of the IHEA in South Australia.

There have been a number of changes to organisations involved in SA, so it is hoped that this can increase the representation and support for the branch and its activities.

Gold Club. The theme, centering on Wi Fi Challenges and Humidity Management in Healthcare.

We’ll be kicking the conference off with a game of golf; it can only get better from there. This is a conference not to be missed so keep an eye out for details shortly.

Scott Wells QLD State President

Efforts are continually being made to get currently unfinancial/recently resigned members to re-engage with IHEA. This is meeting with mixed results, but we continue to connect with those in the Healthcare FM sector. As most members would be aware there is a lot of movement amongst private providers providing the outsourced services once provided by mostly public health departments and we continue to connect with them as best we can.

Actions Current efforts are also being directed at organising a President’s function to expose potential new members to the benefits of IHEA membership, along with the distribution of associated marketing information built around the recent promotion of the new name for IHEA and the broadened field for membership.

The Committee of Management is monitoring developments within the South Australian healthcare sector that have the potential to impact of IHEA members: • Completion of the nRAH construction period and the move into the transition period • Ongoing developments to give effect to the Government’s “Transforming Health” initiative • Major capital development projects in the private hospital sector • Media attention in relation to a Government-run aged care facility • Release of first international standards for FM (ISO41000) We look forward to continuing to engage and interact with our members and our corporate partners.

Peter Footner SA Branch President

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NSW/ACT REPORT

Committee of Management Contact details

N

SW/ACT branch is holding a professional development day on the 16th June at the Rydges Hotel Campbelltown in south western Sydney. The theme of the day will be “Asset Management – Breathe Easy” and will cover a range of relevant topics including opportunities for interactive group participation.

A tour of the recently completed Campbelltown Hospital redevelopment will be part of the day’s activities. There will also be inclusion of the Branch Special Meeting and Committee of Management Election held as part of the day’s formalities.

The recently released State Audit Office report on maintenance of medical equipment has exposed gaps and inconsistencies in reporting and has subsequently placed an increased focus on asset management across health in NSW/ACT. In line with this the COM is examining strategies on how our members can be informed and supported to ensure

Name

Position

Phone

Email

Jon Gowdy

President

0411 040 834

Jon.Gowdy@sswahs.nsw.gov.au

Steve Dewar

Vice President

0428 119 421

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

Darren Green

Secretary

0418 238 062

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

Mal Allen

Treasurer

0467 761 867

mal.allen@hnehealth.nsw.gov.au

Peter Allen

COM

0408 869 953

peter.allen@hnehealth.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

Peter Lloyd

COM/PP

0428 699112

that our industry is better equipped to rise to this emerging challenge.

Membership interest from both industry groups and health facility management practitioners is increasing and the COM will be discussing strategies on how to ensure that this pattern of growth continues.

Planning for 2017 activities is now well underway with a date and location for end of year state conference to be held in Wollongong on the 24th and 25th

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

November 2017. Strong sponsor interest is already being shown and the COM will be working hard to leverage on this to ensure that an exciting and interesting event is provided for our members and other attendees. The conference will also incorporate the Annual Branch Achievement Awards.

Jon Gowdy Director Engineering Services SLHD MIHEA NSW State President

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WATER HYGIENE MASTERCLASS IN-PREMISE WATER SYSTEMS AS A SOURCE OF HEALTHCARE ASSOCIATED INFECTIONS 27 March 2017, Peter MacCallum Cancer Centre, Melbourne, Australia

The 2017 Water Hygiene Masterclass series was made freely available by Pall Medical and focused on “In-premise Water Systems as a Source of Healthcare Associated Infections”. Water delivered to hospitals and healthcare facilities is treated for general public use; however, within a building the water distribution system still may contain pathogens and can be harmful to vulnerable populations. Advice, guidance and discussion on water hygiene and management was provided by nationally and internationally recognised experts, with information tailored to inform infection preventionists, clinical microbiologists, facilities managers and plumbing engineers of best practice to reduce the risk of waterborne pathogens. This summary was prepared

by Dr. Harriet Whiley and reviewed by the individual speakers prior to publication.

T

he Melbourne Masterclass was held on 27 March 2017 at the Peter MacCallum Cancer Centre and chaired by Dr. Catherine Whapham, Global Portfolio Manager in Healthcare Water, Pall Medical, and Fellow of the Royal Society for Public Health.

Noel Cleaves, Environmental Health Regulation and Compliance Manager, Victoria Department of Health & Human Services, presented an update from the international Legionella workshop in Atlanta, Georgia, USA, titled “Emory University Legionella Workshop 2016: A Snapshot of Legionella Research and Interventions”.

The first key point discussed was identifying lessons learned from the 2015 Legionnaires’ disease outbreak in the South Bronx, USA, that resulted in 138 confirmed cases with a 12% fatality rate. The outbreak resulted in a complete audit of all cooling towers in New York City (NYC) which required 1000 staff to undertake testing and inspection. Over 14 cooling towers returned a positive Legionella result and one was identified as the source of contamination. As a consequence, NYC has now developed a system of annual certification for cooling towers, and a risk communication plan.

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They will also conduct random inspections ongoing to ensure compliance.

The second key point covered lessons learnt from Flint, Michigan, where highly contaminated water from the Flint River was used as a source of drinking water. The contaminants present in the water caused iron and lead to leach from the pipes, resulting in elevated lead levels in the water which were linked to 200 deaths and numerous children affected with elevated blood lead levels. This has also been linked to a range of health issues including behavioural problems, difficulty concentrating, lower IQ, headaches, loss of appetite and fatigue. A significant increase in incidence of Legionnaires’ disease, as a consequence of iron leaching from the pipes encouraging Legionella and biofilm growth, was also seen.

The potential health consequences of water and energy conservation strategies such as “green” buildings utilising low-flow devices and resulting in water stagnation, could promote biofilm formation and potential to exacerbate water quality and hygiene problems was highlighted.

FEATURE ARTICLES

The final points focused on an update on the use of Legionella quantitative microbial risk assessment (qMRA). Research is being conducted to identify the Legionella concentration that will cause an infection in humans. However, this research is not yet suitable for day-to-day management of individual water systems.

The take-home message was that risk management and mitigation remains the best approach for controlling Legionella and a shift in focus from infectious outbreaks to prevention strategies needs to be embraced.

Dr. Harriet Whiley, Lecturer in Environmental Health, Flinders University presented on “Legionella Control in Healthcare Water Distribution Systems: Navigating the Uncertainties of Legionella Risk Assessment”. Dr. Whiley explained the many uncertainties with regard to Legionella control in in-premise water systems and the conditions which may result in Legionnaires’ disease. As such, attempting to precisely quantify risk (or a safe limit) is not a feasible option for risk management of individual systems/premises. A more valuable option is a risk assessment plan that identifies potential sources, exposure routes and vulnerability of the population and then puts in place multiple barriers and strategies to reduce microorganism growth and the likelihood of exposure.

Worldwide, Legionella has been detected in numerous drinking water sources that have not been linked to outbreaks. Currently, the concentration of Legionella that will result in a Legionnaires’ disease outbreak is unknown. Infectious dose calculations determined from previous outbreaks suggest that as few as 2 CFU may cause Legionnaires’ disease.

The size of an aerosol will also affect the likelihood of Legionnaires’ disease, with aerosols smaller than 10 µm travelling past the nose and throat and making their way to the upper and lower respiratory track, and those smaller than 5 µm travelling to the lungs and airways. This is significant as it was identified that 90% of shower aerosols are 1-5 µm, 50% of faucet aerosols are 1-8 µm and as such any Legionella contained within these aerosols could potentially be inhaled directly into the lungs.

The current Australian standard method for Legionella detection is by microbiological culture, which is fraught with limitations. It is time consuming and results are 10 days old when received. The standard [at the time of the masterclass] has a comparatively high detection limit (10 CFU/mL, whereas the UK method has a lower detection limit of 10 CFU/L) and culture methods do not detect Viable-But-Non-Culturable (VBNC) Legionella. This VBNC state is induced by the

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FEATURE ARTICLES

presence of disinfection chemicals, low nutrients, high temperatures and low oxygen, which are all common conditions found in water systems. Studies have shown that between 4.6% and 71.7% of Legionella present in a hospital water distribution system are in VBNC state, which means there is a high likelihood of gaining false negative results using the culture method. Importantly, a negative culture result does not guarantee the system as safe or Legionella-free.

It should be assumed that Legionella is always present in water systems and to therefore ensure all appropriate risk management protocols are in place.

This includes preventing, reducing or removing biofilm, (although complete elimination is not possible without replacing pipework or fittings), maintaining effective disinfection residuals, avoiding warm water (<55oC) temperatures, not having stagnant water sitting in pipes (dead-legs, intermittent use, etc.), identifying and protecting high risk patients.

Dr. Susanne Lee, Director of Legionella Ltd., an independent public health consultancy, and Chair

of the Royal Society for Public Health Water Special Interest Group, presented on the “Water Safety Plan Approach to Controlling Healthcare-Related Water Quality”. Dr. Lee explained the benefit of healthcare facilities developing a specific water safety plan to ensure risk prioritisation to best protect patients from all potential waterborne pathogens (not just legionellae).

The World Health Organisation recommends that all public buildings, including healthcare facilities, develop a Water Safety Plan (WSP), and it is essential that this plan be developed by a competent, multidisciplinary management team. In healthcare this would include representatives from infection prevention, engineering, management, microbiologists and anyone with special requirements with regards to water hygiene (i.e. personnel responsible for hydrotherapy pools, dialysis, endoscopy etc.). The team may also need to include outsourced experts in specific areas. The resulting document should be constantly reviewed and evolve to reflect changes in water throughput, changing user behaviour and populations and the associated

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FEATURE ARTICLES

risks. A review process should be included in the document, and the plan must be suitable for both steady-state and incidence-based events. Supporting programs should be detailed, including a specific risk communication plan to ensure all staff members understand the risks associated with drinking water and the importance of control protocols.

Risk assessment should be conducted to assess the potential hazards and health outcomes from exposure to all water used in healthcare, not just water used for drinking, personal hygiene, food preparation, etc., but also water used in patient treatment and diagnosis.

The quality of the incoming source water must be considered and current control methods need to be assessed to determine if water quality targets are being met for all uses and users. Where the incoming water is not of consistently wholesome quality, is supplied intermittently or greater than 25 ºC at the point of entry, then point of entry treatment should be considered. These water quality targets must then be adjusted depending on patient needs. For

example, it may be determined that only sterile water is appropriate for some high risk patient procedures (i.e. for misting devices in neonate incubators, etc.).

Validated control methods need to be established and documented and it is essential that a multi-barrier approach be adopted for effective control of water quality within the building water distribution system.

Verification of control measures should be carried out ideally by parameters which can be monitored and adjusted in real time such as temperatures, biocide levels and backed up by biological monitoring; however, the plan should not rely only on end-point testing. All components of the water distribution system should be documented and schematic drawings checked to ensure accuracy.

All potential patient and user exposure routes must be considered. This includes direct ingestion (e.g. drinking water or ice), indirect ingestion (e.g. food washed or prepared with water), contact (e.g. hydrotherapy pools), aerosol inhalation (e.g. shower, faucets, misting devices, etc.) and aspiration (risk factors

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include stroke, anaesthesia, taking strong analgesics, recent surgery, sucking ice, drinking whilst prone, chemotherapy etc.). When assessing all exposure routes, it is crucial that an asset register of all potential sources including components subject to colonisation such as thermostatic mixing valves, shower heads and hoses, etc., of installed equipment be created and that a risk assessment is conducted prior to the installation of any additional equipment or alterations to the systems.

Dr. Lee also discussed some of the common problematic areas associated with healthcare water systems. This includes poor plumbing or poor design (e.g. dead legs that support the growth of pathogens in biofilm, or hot and cold pipes located next to each other without sufficient insulation or ventilation); poor cleaning (e.g. cleaning the drain outlet of a hand basin first then wiping the tap outlet could spread Pseudomonas aeruginosa to the tap outlet which could then expose the next person to use that tap); poor quality plumbing components (e.g. flexible plumbing connectors with organic materials that support the growth of bacteria, or poor quality storage tanks that corrode and support biofilm formation); hidden sinks and taps located in cleaning cupboards or areas that never get used (these act like dead legs and encourage growth of biofilm); new plumbing fixtures and fittings that may already be heavily contaminated with biofilm prior to installation (a consequence of pressure testing with water in the factory); and filling a new water distribution system too early during commissioning such that the water sits stagnant prior to operational use.

Dr. Catherine Whapham, Global Portfolio Manager in Healthcare Water, Pall Medical, and Fellow of the Royal Society for Public Health, presented â&#x20AC;&#x153;Water Filtration from Point-Of-Entry to Point-OfUseâ&#x20AC;?. Prevention of illnesses caused by waterborne pathogens is a better alternative to treatment, especially considering the increasing emergence of antibiotic resistance with Gram-negative bacteria.

Chemical and heat based disinfection methods are effective in controlling microorganisms that are suspended in the water phase (planktonic); however, they are much less effective at controlling microorganisms contained within the protective biofilm. Heat and chemical disinfectants will only affect the top layer of biofilm, which can be quickly replaced within a few days through bacterial regrowth and reseeding. Additionally, constant disinfection may select for resistant bacteria strains thus altering the microbiome.

26

Dr. Whapham discussed the findings from a systematic literature review completed by Professor Loveday that investigated hospital interventions aimed at reducing hospital water system acquired Pseudomonas aeruginosa infections. Only two studies demonstrated effective interventions that reduced transmission; both used Point-Of-Use water filters and one additionally used chlorination. Interestingly, sensor taps have been linked to increased risk of Pseudomonas aeruginosa infection and it is suggested that this could be due to their more complex design and use of plastic components. Another study (Trautmann, 2008) was presented on Pseudomonas aeruginosa infections in adult ICU patients. Despite implementing good hygiene practices, including the use of alcoholic hand gels following hand washing and use of sterile water for oral procedures, over a 12-month period 15.5% of patients were staying for more than 3 days in the ICU. Point-Of-Use filters were installed on all tap outlets in the location and the rate of patients staying more than 3 days dropped to 4% over the following 12-month period. In addition, the level of Pseudomonas aeruginosa colonisation and infection fell by 85% and 56% respectively in this population.

This study demonstrated that the reduction in patient stay and complications from infection more than justified the cost of the Point-Of-Use water filters.

When choosing filter types suitable for a water distribution system, the source water quality and patient vulnerability need to be considered. For example, Point-Of-Entry (POE) filters are useful for reducing organic particulate matter, turbidity and potentially microorganisms, and some are fully automated for disinfection and backwash.

POE filtration may reduce installed equipment maintenance needs and potentially improve disinfection efficiency. In-line filtration devices can be used for effective protection in critical areas or for use with speciality equipment such as endoscopy, renal, burns, central sterilising and washer disinfectors. PointOf-Use filters can be used at tap and shower outlets as a final barrier to waterborne bacteria before the water reaches patients. These are typically employed to protect high risk patients or for short term use when critical levels of contamination have been detected in the building water system. Point-Of-Use filters will ensure patients are protected in the short term whilst further sampling and decontamination methods are deployed, or could be adopted as a standard of care for critical applications in high risk patient populations such as burns or neonatal.

FEATURE ARTICLES

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

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FEATURE ARTICLES

THE IHEA HEALTHCARE FACILITIES MANAGEMENT CONFERENCE

THE INSTITUTE OF HEALTHCARE ENGINEERING, AUSTRALIA (IHEA) ARE PLEASED TO INVITE YOU TO THE IHEA HEALTHCARE FACILITIES MANAGEMENT CONFERENCE (HFMC 2017) TO BE HELD ON 11-13 OCTOBER 2017 AT PULLMAN MELBOURNE ALBERT PARK.

At IHEA HFMC-2017, VACUUM SOLUTIONS AUSTRALIA will be showcasing the new generation ECO SUCTION Utilising the latest technology in Plant control, Smart monitoring and High level interface coms

The Institute of Healthcare Engineering, Australia (IHEA), is the relevant professional organisation for engineers and engineering facility managers employed in the private and public health care sectors, from the smallest to the largest facility, as well as consultants engaged in related work. This includes the Hospital Engineer, Health Facility Manager, Architect, Consulting Engineer, Builder, Contractor in the health care field, and all those engaged in Health Care Facilities Management.

M

embers have the opportunity to network with other professionals, share practical experiences and gain access to information on developing technologies. Eligibility for different membership levels depends on the applicant’s qualifications and relevant experience, from apprenticeship through to post-graduate degree.

This year’s theme is Compliance in Motion and aims to give the participants an overview of how Health Services manage compliance. With the role of Healthcare Facility Manager transitioning

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FEATURE ARTICLES

from technical focus to strategic and operational performance driven, there is additional pressure and responsibility to enhance Compliance Management and actively participate in the continual improvement of processes related to infrastructure management.

The mission of facility managers is to embrace a culture of excellence and address Compliance Management with professional pride. Effectively, we become a change agent and a driver for quality in the built environment.

• Various Technical Site Tours • 2 Full Days of Conference Sessions • Trade Night • Conference Dinner • Keynote Addresses from Dr Louise Mahler & Professor David Hood REGISTER NOW via the conference website or for further information: www.HFMC2017.org.au

Conference topics will include: • Health and Human Services building design requirements.

• Building Code of Australia including, occupancy certificate, essential services, statutory and regulatory maintenance.

• Health Service compliance, including OH&S, Infection control, waste and pollution and energy management.

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Medical Suction Systems Dental Suction Systems Anaesthetic Gas Scavenge Australian Medical Suction Systems are offering free presentations on the changes to AS2896 and the implications for the Medical Vacuum Plant.

The presentation offers you knowledge of the relationship between rarefied and free air, the benefits of Variable Speed Drives in a Medical Suction Plant, and ensures you and your team are able to size and specify in accordance with the code; AS2896-2011.

For enquiries, please contact the conference organisers, Iceberg Events on +61 7 3876 4988 or bella@icebergevents.com.au We look forward to seeing you in Melbourne!

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• Encouraging continued personal and professional growth in the practice of healthcare facility management.

• Providing a system to support continuing professional education as a requirement for certification; thereby assisting employers, the public and members of the health professions in the assessment of a healthcare facility manager.

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The IHEA provides a range of professional development opportunities for members. Conferences are offered on a national and state level and are available to both members and interested parties these conferences are designed to keep those attending up to date with relevant issues within our industry. Professional development seminars are available at a branch level in each state and a social function is held at the end of the year, we welcome all those that have a stake in health care engineering and health infrastructure management to participate with us in providing innovative and sustainable solutions for a better health care facility.

FEATURE ARTICLES

PREVENTING INFECTION BY MONITORING AIR QUALITY WITH TELEMETRY – “LET’S NOT BE BEHIND THE 8 BALL”

By Matthew Weir, QED Environmental Services

Indoor Air Quality (IAQ) refers to the air quality within and around buildings and structures, especially as it relates to the health, comfort and performance of building occupants. There are hundreds of pollutants that affect IAQ and thousands of sources.

Worldwide research shows that more than 900 different contaminants are present in the indoor environment, a problem which is exacerbated by the interaction of a complex set of factors that are constantly changing.

I

ndoor air is typically discussed in reference to the health impact of the air to building occupants and is defined by the National Health and Medical Research Centre (NHMRC) as air within a building occupied for at least one hour by people of various states of health.

The likelihood of immediate reactions to indoor air pollutants depends on several factors including age and preexisting medical conditions. In some cases, whether a person reacts to a pollutant depends on individual sensitivity, which varies from person to person.

Indoor air is typically discussed in reference to the health impact of the air to building occupants and is defined by the National Health and Medical Research Centre (NHMRC) as air within a building occupied for at least one hour by people of various states of health.

Other health effects may show up either years after exposure has occurred or only after long or repeated periods of exposure. These effects, which include some respiratory diseases, heart disease and cancer, can be severely debilitating or fatal. It is prudent to try to improve the indoor air quality exposure even if symptoms are not noticeable.

Understanding and controlling pollutants indoors can help reduce the risk of indoor health concerns.

Health effects from poor air quality may be caused from short or long duration exposures to pollutants, and may manifest early or much later after the exposure. Health effects can include irritation of the eyes, nose, and throat, headaches, dizziness, and fatigue. Such immediate effects are usually short-term and treatable, sometimes the treatment is simply eliminating the person’s exposure to the source of the pollution, if it can be identified. Soon after exposure to some indoor air pollutants, symptoms of some diseases such as asthma may show up, be aggravated or worsened.

Clean air is especially important to at-risk population groups within healthcare facilities, in particular those with chronic respiratory conditions.

With the increasing knowledge and guidelines applicable to indoor air quality, pro-active healthcare facility managers are developing strategies to assess sources of poor air quality and robust management procedures to minimise healthcare occupant exposure.

In conjunction with Australian and New Zealand standards, legislative, and regulatory requirements and State healthcare engineering guidelines the following guidelines should also be considered in the

31

FEATURE ARTICLES

provision of indoor air by building owners and facility management teams: • Particulates - Workplace Exposure Standards for Airborne Contaminants (2011), World Health Organisation Air Quality Guidelines (Global Update 2005), National Environmental Protection Measure (NEPM) for ambient airborne PM10 particulates • Carbon Monoxide – Workplace Exposure Standards for Airborne Contaminants (2011) of 30 ppm, the World Health Organisation Air Quality Guidelines (Global Update 2005).

• Ozone - World Health Organisation Air Quality Guidelines (Global Update 2005) • Formaldehyde – Workplace Exposure Standards for Airborne Contaminants (2011), World Health Organisation Air Quality Guidelines (Global Update 2005) • Humidity - (Managing Indoor Environment Quality, Property Council of Australia 2009), ASHRAE 55-2013 guidelines, ISO 7730 (2005) • Temperature – (Managing Indoor Environment Quality, Property Council of Australia 2009). PCA, ASHRAE and ISO standards for recommended values of thermal comfort parameters.

• Carbon Dioxide – Workplace Exposure Standards for Airborne Contaminants (2011), AS1668 (2012), industry accepted limit for comfort (Brown (CSIRO) 1997, Health & Welfare Canada 1989).

The management and monitoring of indoor air quality is one important component of an effective Infection Control Management Plan during construction, renovation, repair, excavation and demolition activities in hospitals and healthcare facilities.

As described in the Australian Guidelines for the Prevention and Control of Infection in Healthcare 2010 (NHMRC) effective control and prevention measures are necessary during construction and renovation within a healthcare facility, because such activities have been frequently implicated in outbreaks of airborne infection.

The key to eliminating infections is to minimise the dust generated during the construction activity and to prevent dust infiltration into patient-care areas near the construction. Suggested approaches to reducing airborne transmission within the Australian guidelines include: • installation of effective air filtration • specifying appropriate ventilation systems and air change rates (e.g. negative airflow pressure)

32

• employing monitoring and control measures during construction or renovation • using single-bed instead of multi-bed rooms.

It is recognised that early risk identification and implementation of controls will minimise the risk of infection but may not completely eradicate the risk of infection for vulnerable patient groups.

As an integral component of the Infection Control Management Plan during construction, renovation, repair, excavation and demolition projects at a number of major hospitals, QED Environmental Services has successfully implemented telemetry air quality monitoring. This led to evaluation of engineering controls, greater contractor accountability, coordinated response by and communication among stakeholders, and ultimately lower risk of patient infection.

Effective infection prevention and control is central to providing high quality health care for patients and a safe working environment for those that work in healthcare settings. There are around 200,000 healthcare-associated infections (HAIs) in Australian acute healthcare facilities each year (Cruickshank M & Ferguson J (eds) (2008)).

A strong body of research shows that the built environment in particular influences the incidence of infection in hospitals and that, by careful consideration of environmental transmission routes of air, surface and water in the design and operation of healthcare facilities, incidence of hospital-acquired infections can be dramatically reduced.

Infection Control is of major concern on all hospital projects because of the potential contaminate exposure to high numbers of immune compromised patients. The level of risk associated with each project is dependent on the project complexity, location of the works, the type of work being undertaken, and the proximity to patients with varying degrees of infection risk.

INFECTION CONTROL DURING CONSTRUCTION In order to minimise the risk of hospital-acquired infections, management plans for construction projects within and adjacent to hospitals should incorporate infection prevention and control strategies.

The 2015 Australasian Health Facilities Guidelines “Part D - Infection Prevention and Control” identifies minimum control measures to be implemented when undertaking construction activities on occupied

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healthcare sites. Based on these recommendations and international best practice, control measures for a specific activity can be identified that will reduce the risk of infection to designated patient groups or zones. There are four key steps in managing the associated risks: • Identify the type of construction activity, • Determine the population or geographical risk group, • Identify the control measures, • Implement and monitor prescribed control measures.

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The Green Star Healthcare Rating Tool (V1 design and as-built) also recommends management of air quality during construction via the requirement of a Construction Indoor Air Quality Management Plan.

Construction, renovation, repair, excavation and demolition activities in hospitals and healthcare facilities present a variety of situations which may release contaminants and pollutants that can impact the indoor air quality (IAQ) of a building. These contaminants may be transported to other areas via the heating, ventilation and air conditioning systems and subsequently affect populations beyond the immediate project area.

Advanced planning and coordination by project and facility managers is required to minimise the risk of infection to at-risk patients. Implementation of effective engineering control strategies, establishing effective communication lines amongst project stakeholders along with the implementation of environmental monitoring for any building or maintenance project are to be considered to successfully control pollutant levels, allay concerns, and maintain occupant comfort during and after construction activities.

The population most at risk from infection is usually immunocompromised either by underlying disease or by contemporaneous treatments e.g., chemotherapy.

Although construction activities at any location may pose a risk to this population group, undertaking these activities within healthcare facilities poses unique risks due to proximity and the numbers of at-risk people in the one location.

ENVIRONMENTAL MONITORING Common environmental contaminates during construction, renovation, repair, excavation and demolition activities: CLEAN AIR SOLUTIONS

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• Particulates (Dusts and Fibres) o Nuisance/hazardous.

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â&#x20AC;˘ Volatile Organic Compounds (VOCs) o From coatings, sealants, adhesives, carpeting, composite wood products, etc. â&#x20AC;˘ Combustion products o Carbon monoxide, o Carbon dioxide, o Nitrogen oxides, o Sulfur dioxide, and o Ozone. â&#x20AC;˘ Biological materials o Bacteria, yeast, mould, o Dust mites, o Insect parts, and o Microorganisms.

Monitoring these contaminants is the key to reducing risk of infection. Infection Control Risk Assessments are essential to identifying the type of monitoring required, parameters monitored and period of monitoring.

Dependent on the environment and scenario being monitored, the implementation can vary from spot measurements to continuous telemetry monitoring.

There are many applications and solutions for air quality monitoring ranging from static standalone instrumentation to solutions embedded within Building Management Systems.

Benefits of continuous telemetry monitoring in healthcare facilities; o Continuous monitoring of occupant exposure (At-risk patient populations), o Real-time alerts allowing for rapid response, o Evaluation of engineering control effectiveness (such as dust barriers or temporary hoarding, exhaust ventilation and management of pollutant paths), o Improved contractor accountability and commitment to infection control, o Improved client/tenant relationships between project groups, facility management, healthcare staff and patients, and o Robust project documentation through recording of results, incidents and outcomes of control investigations.

It may be unrealistic to attempt to completely eliminate airborne contaminants during a construction project, but it is possible to minimise occupant exposure to those contaminants by careful scheduling of the work, implementing effective engineering

controls, active monitoring during the project and effective real-time communication using telemetry.

Telemetry, or wireless communication, is a highly successful monitoring tool for real-time environmental monitoring. The real time monitoring allows an instant response to an event, before complaints are received by the project team from patients, healthcare staff and infection control departments. Conventional data logging of environmental parameters is the reactionary approach, telemetry air quality monitoring provides awareness of the incidents as they occur and provides the opportunity to act upon the notifications to minimise impacts on at-risk populations.

For this method to be effective an Alert and Action Protocol is established as part of the project planning.

This would include an alarm system that is set at an agreed contaminate concentration, a time-frame for investigation, rectification and notification to project lead and key stakeholders. This alarming system enforces contractor accountability and aids effective management by the building or facility manager.

A comprehensive environmental sampling regime includes comparative evaluation of the indoor environment with baseline measurements taken prior to any works, throughout the project period and following the completion of any project.

CASE STUDY QED Environmental Services has successfully implemented real time telemetry air quality monitoring solutions for varied projects within healthcare facilities. One in particular is a large scale HVAC refurbishment project where the internal linings of the air conditioning unit was refurbished whilst the system remained live. It was integral to the project that the HVAC systems maintained high quality conditioned air to the at-risk patient groups throughout the refurbishment programme. Patient-care areas included the Respiratory High Dependency Unit (HDU), Intensive Care Units (ICU), Coronary Care Unit (CCU) and general patient ward areas.

With a design supply air rate of 36,600 l/s the refurbished system mechanically induced up to 284 trillion litres of air into immuno-compromised patient areas during the project period. Considering the high potential of generating pollutants, maintenance and monitoring of engineering controls was essential to the successful completion of the refurbishment project.

The live pollutant monitoring programmes measured airborne particles at the supply air discharge to the Intensive Care Unit (ICU) and Respiratory High

35

FEATURE ARTICLES

Dependency Unit (HDU) as an indicator for contamination caused by the refurbishment activities. When elevated levels were measured instant SMS and email notifications were issued to QED and the project team ensuring the appropriate engineering controls were reviewed and corrective actions were implemented to mitigate any risk to the at-risk patient groups and zones.

“Particulate Matter (PM)” is a term used for a mixture of solid particles and liquid droplets found in the air.

Some particulates are large or dark enough to be seen, while other particulates are so small they can be detected only with analytical instruments.

The size of particles is directly linked to their potential for causing health problems. The smaller sized particles are inhaled more deeply into the lungs, and if ultrafine in size, the particulates may pass directly into the bloodstream.

Exposure to particles can affect the lungs and heart, and in particular for individuals with pre-existing conditions, the young and the elderly. As such PM10 particulates were measured throughout the project to capture Figure 1: PM10 Particulate Monitoring

the respirable proportion of particles in the air.

refurbishment project initiated an immediate response.

The monitoring programme measured low levels of airborne PM10 particulates throughout the refurbishment programme with an average project concentration of 0.004 mg/m3.

1. The primary filtration system was compromised during demolition works.

Following an Infection Control Risk Assessment the alarm system protocols for airborne PM10 particulates was established with the “Alert” and “Alarm” criteria set at 0.03mg/m3 and 0.05mg/m3, respectively. With exceedances of the “Alert” level the head contractor investigated possible sources of airborne particulate matter and reviewed the dust suppression controls. The receipt of an “Alarm” level exceedance by the project team triggered the cessation of site works and the application of additional abatement controls, where necessary, to prevent further occupant exposure. Throughout the HVAC refurbishment project a number of events activated SMS and email notifications to the project team.

As illustrated in the monitoring results in Figure 1 the “Alarm” events experienced during the

o Works ceased immediately, the AC unit was shutdown and the dust suppression controls were reinstated.

2. Unauthorised use of a plasma cutter by a sub-contractor within the AC unit outside a scheduled shutdown period. o Works ceased immediately, investigation into the use of hot work equipment and permits was conducted resulting in the reinforcement/education of appropriate work practices/ procedures with the workforce.

3. Inappropriate removal of dust and debris from within the cold deck plenum prior to the reinstatement of the AC following a shutdown. o Works ceased immediately, the AC unit was shutdown and the appropriate level of surface cleaning was conducted before reinstatement.

4. Welding fumes bypassed the installed engineering controls and were induced into the supply air ducting whilst the air distribution system was under negative pressure. o Works ceased immediately, additional exhaust and ventilation strategies were implemented and where possible welding activities were relocated.

5. Particulates were induced into the outside air intake during a period of prescribed burning by the Department of Environment of Western Australia. o Although these contaminates were not sourced from the refurbishment works, the

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FEATURE ARTICLES

telemetry system alerted stakeholders of the externally induced particulate matter and in turn enabled the site engineers to manage the air quality by manually overriding the operation of the outside air dampers. Simultaneously, additional environmental parameters such as carbon dioxide and temperature were monitored allowing informed decision making by facility management to provide adequate ventilation and air quality to the hospital occupants during this period.

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Following each event mandatory reporting was completed by the head contractor who was responsible for providing a body of evidence to support the contributing factors resulting in the elevation of particulates, this was recorded and documented on an â&#x20AC;&#x153;Environmental Monitoring Incident Formâ&#x20AC;?. This process enforced contractor accountability, transparency and responsiveness to events, review of control effectiveness, and provided evidence for future project evaluation and infection control investigations.

CONCLUSION Effective infection prevention and control is central to providing high quality health care for patients and a safe working environment for those that work in healthcare settings. Infection Control is of major concern on all hospital building projects because of the potential contaminate exposure to high numbers of immune compromised patients.

Construction, renovation, repair, excavation and demolition activities in hospitals and healthcare facilities present a variety of situations which may compromise the health of the building occupants.

Effective control and prevention measures are necessary during such activities within a healthcare facility because they have been frequently implicated in outbreaks of airborne infection. The key to eliminating infections is to minimise the dust generated during the construction activity and to prevent dust infiltration into patient-care areas.

Implementation of effective monitoring programmes such as telemetry air quality monitoring are a key component to evaluate contaminate distribution to at-risk patient populations and zones within health care facilities. This proactive approach informs all relevant stakeholders at the time of incident to allow corrective actions to be implemented and minimise impacts on at-risk populations.

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FEATURE ARTICLES

BUILDING CONTRACTS

By Derek Hendry, The Hendry Group

DEFECTS LIABILITY PERIOD

T

he difficulties hospital managers experience with builders, contractors, consultants and authorities intensifies during the post building works defects liability period (usually 12 months). Discourse can be reduced considerably by analysing the undesirable outcomes from previous projects and putting in place contractual requirements to offset their future occurrence.

Building and maintenance contractors contribute to a hospital managers’ problems during the defects liability period. This causes contract clauses to be examined and tested, creating a situation where the lack of clear guidelines (contractual requirements) for those in the process leads to the hospital manger having to accept unwarranted situations.

A far better option is to make those professionals/ contractors who are involved in delivering a service or product accountable to the hospital manager during the defects liability period, and to be aware of this accountability in the contract negotiations. There are some items that are highly recommended to be included in a contract, and whilst in the main these items will not ‘add’ extra cost to the contract value as they are already performed by most providers, they are not usually offered, as they are not requested. The lack of diligence in the contract liability period may lead to a lack of protection for the hospital manager when issues arise in this period.

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Hospital managers therefore, need to be heavily involved at the commissioning stage with all those involved in the process of building a new building, altering an existing building or when issuing a tenancy agreement.

Hospital managers therefore need to be heavily involved at the commissioning stage with all those involved in the process of building a new building, altering an existing building or when issuing a tenancy agreement.

CHANGE OF OCCUPANCY During our essential safety measures inspections we are noticing a number of clients have enclosed part of a storey (usually a basement or a car park) and are using the area as a store or workshop. The BCA in Part A3.3 (a) (i) allows up to 10 per cent of a floor area of a storey to be used as a different classification, but this is contingent on a building surveyor’s approval (building permit). Not only are these enclosures rendering a number of safety measures inoperative, but the existence of the enclosure is illegal. In the aftermath of an emergency a hospital manager may be called to account by authorities or an insurance company.

Managers need to be diligent in this area and ensure that their building is not compromised.

TOO MANY EXTINGUISHERS On completing an essential safety measures inspection of a new client’s hospital complex we could not believe the excessive amount of fire extinguishers installed throughout their buildings.

The selection of the appropriate fire extinguisher and its location is dictated by regulation. Hospital managers should not allow a fire service company free reign to install fire extinguishers where they think it’s appropriate. It is costly to maintain extinguishers, especially when they are not required.

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TURN KEY CONTRACTS Some hospital managers entering into building contracts called ‘Turn Key’ for alterations to existing buildings are finding problems after completion of the fit out. Problems arise which can be traced back to the specification provided to the builder for quoting because the criteria mainly concentrated on the building fabric and not the interaction with the existing internal tenancy fit out upon completion. A partition, plant or storage layout can cause the building to no longer comply with the regulations (e.g. exit travel, excessive fire loads, inadequate emergency lights, exit signs, hose reels, hydrants and sprinkler systems).

Managers should insist that design and construction contracts (alterations to existing buildings) take into account the current and future use and include in the tender documentation all internal plan details capable of interacting with existing layouts not affected by the building contract.

BUILDING TO BOUNDARIES The construction of a building to the boundary of a property allotment can provide efficient use of a properties allotment. Construction techniques exist that allow for fire rating of boundary walls.

The ongoing maintenance of boundary external walls is sometimes overlooked at the design stage, and it is only in the years following completion that the costly ramifications set in. It is wrong to assume that maintenance can occur from an adjoining property, where unless the adjoining owner grants their permission, no legal right exists to access adjoining property for maintenance purposes on your building. When designing a building constructed to the boundary, it is necessary to consider the legal implications for the ongoing maintenance and the OH&S/WHS requirements of access for maintenance contractors.

ABOUT THE HENDRY GROUP Derek Hendry is the Founder of the Hendry Group, a property compliance solutions consultancy whose services include building surveying, disability access, essential safety measures, emergency planning and work health and safety. Hendry pioneered the private certification system of building approvals in Australia and operates nationally in all facets of building control. Hendry is aware of the importance of sharing knowledge, and regularly distributes industry news and updates through publications such as ‘Essential Matters’ Hendry’s e-newsletter, blog sites and website.

For more information please visit www.hendry.com.au

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The Institute of Healthcare Engineering, Australia (IHEA) are pleased to FEATURE ARTICLES invite you to the IHEA Healthcare Facilities Management Conference (HFMC 2017) to be held on 11-13 October 2017 at Pullman Melbourne Albert Park.

COMPLIANCE IN MOTION

This year’s theme is Compliance in Motion and aims to give the participants an overview of how Health Services manage compliance. With the role of Healthcare Facility Manager transitioning from technical focus to strategic and operational performance driven, there is additional pressure and responsibility to enhance Compliance Management and actively participate in the continual improvement of processes related to infrastructure management.

The mission of facility managers is to embrace a culture of excellence and address Compliance Management with professional pride. Effectively, we become a change agent and a driver for quality in the built environment.

The HFMC 2017 organising committee have put together a diverse, challenging, rewarding and enjoyable plenary program. Under the broader theme of ‘Compliance in Motion’, the program includes presentations across a range of streams such as: • Department of Health and Human Services building design requirements • Building Code of Australia including, occupancy certificate, essential services, statutory and regulatory maintenance • Council and Heritage requirements • Country and Metropolitan Fire brigades.

• Health Service compliance, including OH&S, Infection control, waste and pollution and energy management.

HFMC 2017 are pleased to introduce two keynote speakers: DR. LOUISE MAHLER is a communication specialist and a proven performer in moving individuals and groups to take a positive action through a unique perspective focusing on the unsung wisdom of voice. Louise will help unlock your confidence and have your voice heard!

PROFESSOR DAVID HOOD AM is a civil and environmental engineer with vast experience across major civil and military projects, professional development in emerging economies, senior management in both the public and private sectors and in education.

OPTIONAL MASTER CLASS WORKSHOP

The optional master class, Bridging the Gap to AS4187, will include presentations from key parties involved in the development of “AS4187 – Reprocessing of reusable medical devices in health service organisations”. Experienced industry and practitioner representatives will outline the standard of services required, to meet processing equipment compliance, under this standard. To assist Engineers and Facility Managers to determine their level of compliance with the standard, a gap analysis tool will be introduced, for participants to evaluate their facilities and equipment.

Participants will have the opportunity to ask questions of industry experts and are encouraged to engage in a forum, to explore ways to compliance with the standard.

TECHNICAL SITE TOURS

HFMC 2017 will also feature three technical site tours as part of the conference program: • Victorian Comprehensive Cancer Centre • Royal Children’s Hospital Melbourne • Atherton

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FEATURE ARTICLES

Visit www.HFMC2017.org.au to secure your attendance at this year’s Conference including: • Plenary Sessions • Optional Master Class Workshop • Technical Site Tours • Trade Night • Conference Dinner at Etihad Stadium • Partners Program

COMPLIANCE IN MOTION

The conference aims to bring together all the key contributors to the delivery of healthcare FM services and we look forward to you joining us in October.

REGISTER NOW AT HFMC2017.ORG.AU

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43

IHEA Healthcare Facilities FEATURE ARTICLES Management Conference 2017

COMPLIANCE IN MOTION

11-13 OCTOBER 2017, PULLMAN MELBOURNE ALBERT PARK

Day One: Wednesday 11 October 2017 9.30am - 10.00am

Registration desk open for Masterclass attendees Location: outside Element Room, Ground Floor of Pullman Melbourne Albert Park

10.00am - 1.00pm

Optional Masterclass Workshop: Bridging the Gap to AS4187 Facilitator: Kevin Moon Location: Element Room, Ground Level of Pullman Melbourne Albert Park Optional Masterclass Workshop Presenters: Development of AS4187 Andrew Gay, Steriliser Validation Australia The European Perspective Allard van Beek, Miele Australia.

Steam Requirements for AS4187 Graeme Harley, Spirax Sarco Manufacturers Perspective Sean Boston, Atherton Water Quality Requirements of AS4187 Measure Your Gap to AS4187 Compliance Trish Seagrove, Infection Control & Sterilisation Practitioner Forum - How to meet the implementation challenges for Engineers

1.00pm

Optional Masterclass Lunch

From 2.00pm

Optional Technical Tours

2.30pm - 3.30pm

Technical Tour 1 Victorian Comprehensive Cancer Centre (VCCC)

2.30pm - 4.30pm

Technical Tour 2 Royal Children's Hospital (RCH)

2.00pm - 5.00pm

Technical Tour 3 Atherton

5.30pm - 8.00pm

Registration desk open for all delegates Location: outside Grand Ballroom 1-4, Pullman Melbourne Albert Park

6.00pm - 8.00pm

Trade Night Exhibition Area, Pullman Melbourne Albert Park

Dress: Smart Casual

Day Two: Thursday 12 October 2017 7.00am - 4.45pm

Registration desk open Location: outside Grand Ballroom 1-4, Pullman Melbourne Albert Park

All conference sessions will be held in Grand Ballroom 1-4 8.00am

Official Conference Opening & Housekeeping MC: John Dixon

8.15am

Welcome To Country Elder Ian (Warrend-Badj) Hunter

8.25am

Official Conference Address & Opening

8.45am

KEYNOTE ADDRESS Dr Louise Mahler

9.45am

Morning Tea & Exhibition

10.00am - 2.00pm

Partners Program â&#x20AC;&#x201C; Melbourne By Foot Walking Tour

Stream: Building Code of Australia including occupancy certificate, essential services, statutory & regulatory maintenance 10.15am

Beyond compliance: meeting the indoor environmental needs of the occupants in hospital buildings Prachi Garnawat, RMIT University

10.35am

Epworth Hospital Richmond: making the spectacular safe and easy to maintain Christopher Terranova, Workplace Access & Safety

10.55am

Australian ANZEX DELEGATE PRESENTATION

Stream: Department of Health and Human Services building design requirements 11.25am

AIM for Governance Gary Gilbert, CommScope

11.55am

Regulatory Compliance of Healthcare Facilities Cameron Milne, Amec Foster Wheeler

12.15pm

IHEA AGM

12.30pm

Lunch & Exhibition

Correct at time of printing, this may be subject to change. Visit www.HFMC2017.org.au for the most up to date program.

44 Register now at www.HFMC2017.org.au

#HFMC17

Thursday 12 October 2017 continued

FEATURE ARTICLES

Stream: Health Service Compliance, including OH&S, infection control, waste and pollution and energy management 1.30pm

The implications of the Climate Change Act 2017 on the health and human services sector Tiernan Humphrys, Department of Health and Human Services

1.50pm

Facility Design and Complying with AS/NZS 4187:2014 Andrew Gay, Sterilizer Validation Australia

2.10pm

Infection Prevention and Workplace Safety in Operating Rooms by Airborne Particles and Bacteria Dictate Changes in Existing Standards Rupert Mack, Weiss Klimatechnik GmbHJ

2.40pm

Facilities Management Performance Measurement and Improvement Royce Vermeulen, Turner and Townsend

3.00pm

Group Photo of IHEA delegates Followed by Afternoon Tea & Exhibition

3.45pm

National legislative requirements for the maintenance of essential safety measures Tony Stokes, Stokes Safety

4.15pm

ANZEX DELEGATE PRESENTATION Warren Crawley

4.45pm

Conference Sessions Conclude

5.45pm

Conference Dinner Departure Meet in the Pullman Melbourne Albert Park hotel foyer at 5.45pm for a prompt 6.00pm bus departure

6.30pm - 11.30pm

Conference Dinner Etihad Stadium, Melbourne

Dress: Cocktail

Day Three: Friday 13 October 2017 7.30am - 2.45pm

Registration desk open Location: outside Grand Ballroom 1-4, Pullman Melbourne Albert Park

All conference sessions will be held in Grand Ballroom 1-4 8.00am

Welcome & Housekeeping MC: John Dixon

8.15am

KEYNOTE ADDRESS Professor David Hood AM

Stream: Health Service Compliance, including OH&S, infection control, waste and pollution and energy management 9.15am

Developing a Water Quality Risk Management Plan Sarah Bailey, QED Environmental Services

9.45am

Meeting compliance and minimizing the risk of further waterborne pathogen related outbreaks in Australian hospitals Morten Schnoor, Pall Water

10.15am

Morning Tea & Exhibition

10.30am - 1.30pm

Partners Program - Chocolate Foodi Tour

10.45am

Safety-in Design Responsibilities for Hospital Engineers and Facility Managers - How to avoid being left with difficult and expensive to resolve safety issues David Oakeshott, A.G. Coombs Advisory

11.15am

Compliance with OHS, Legionella and Environmental Legislation and the Role of Management Systems Rafx Hamilton, Engineering Services Manager, Cabrini Health

11.45am

Lunch & Exhibition

12.45pm

Non-Compliance and Hospital Acquired Infection: Using Design Methodologies to Improve Hand Hygiene Practices Kieran John, Monash University

1.05pm

Facility Hygiene - How clean is clean? Or how clean does it need to be?

Brett Cole, Biosafety

1.35pm

Common Approach for Asset Management and Statutory Obligations Seyed Safi, Covaris

2.05pm

2018 Conference Presentation

2.20pm

Conference Close & Prize Draws Rod Woodford, IHEA 2017 Conference Convenor

2.45pm

Conference Concludes

Correct at time of printing, this may be subject to change. Visit www.HFMC2017.org.au for the most up to date program.

Register now at www.HFMC2017.org.au

#HFMC17 45

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FEATURE ARTICLES

THE GLOBAL GREEN AND HEALTHY HOSPITALS NETWORK

WHY ENVIRONMENTAL CHANGES ARE NEEDED IN THE HEALTH SECTOR

By Carol Behne

A healthy natural environment is the foundation for a healthy society, underpinning our social and economic wellbeing. We rely on our environment for food, clean air, security, fresh water, medicines and climate stabilisation1. Climate change, chemical contamination, and unsustainable resource use are exacerbating ill-health the world over. Through the products and technologies it deploys, the resources it consumes, the waste it generates and the buildings it constructs and operates, the health sector is a significant source of greenhouse gas emissions, waste and pollution around the world, and therefore an unintentional contributor to trends that undermine public health2. But as one of the biggest industries in the world, the health sector can play a leading role in responding to climate change and reducing the ecological impact of its operations.

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hile every sector has a role to play to reduce its environmental footprint, the health sector has a particular responsibility to do so to protect and improve public health.

The health sector has a responsibility to mitigate climate change by reducing its own carbon footprint. The health sector also has a responsibility to prepare for the impacts of extreme weather and shifting burdens of disease associated with climate change. Additionally, the health sector can provide leadership by educating staff and the community about climate change, and promoting policies that protect public health from climate change.

Scientific evidence highlights the immediate and long-term risks that climate change poses to population health in Australia3,4. Climate change threatens human health directly through extreme weather such as heat waves, fires, floods, and droughts, as well as indirectly through impacts on air pollution, the spread of disease vectors, food insecurity, displacement, and mental ill health5. This places additional pressure on healthcare services,

as extreme weather aggravates existing illnesses and places more people at risk of illness and injury6.

For example, more frequent, more intense and longer heatwaves can lead to increases in hospital presentations due to heat stroke, dehydration, and exacerbation of cardiac and respiratory conditions.

There are many ways the health sector can reduce its environmental impacts. All around the word hospitals are implementing sustainable initiatives, from reusing water collected from dialysis services, to greener purchasing, to installing solar photovoltaics, to sourcing local produce, and much more. Looking specifically at energy, most large hospitals require significant energy use. Energy is needed for heating water, temperature and humidity controls for indoor air, lighting, ventilation and numerous clinical processes, with associated significant financial cost and greenhouse gas emissions. Yet gains in energy efficiency can be made without sacrificing the quality of care. The most efficient hospitals in Northern Europe consume roughly 35% of the energy that North American

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hospitals average (320 kWh/m2 compared to 820 kWh/m2), while delivering comparable healthcare services8. Examples of opportunities to increase energy efficiency in hospitals include: assessing energy usage patterns and needs; ensuring equipment and systems are operating at peak performance through regular maintenance; minimising lighting energy through the use of daylight, lighting efficiency upgrades and light sensors; minimising energy required to heat, cool and ventilate spaces by insulating heating and cooling systems, maximising natural ventilation in a way that is consistent with demands for infection control, and capturing and re-using waste heat.

St Vincent’s Health Australia plans to implement a range of measures to reduce their energy use by between 35% and 40% by 2018. They are aiming to do this through a variety of building technologies such as upgrading to LED lighting, installing solar PV, voltage optimisation, and power factor correction.

In Canada, the University Health Network’s (UHN) Energy Management Plan 2014 – 2019 demonstrates

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how energy management and use was monitored and tracked. This data was used to inform a vision of where energy management and use should be, and actions to achieve this vision9. For example, UHN installed variable speed drives when they found they were over pumping air and water. UHN also focus on creating a culture of conservation, awareness and engagement among staff9.

CO-BENEFITS OF MAKING ENVIRONMENTAL CHANGES Measures to reduce the ecological impact of healthcare can have economic, social and health co-benefits. For example, the Gundersen Lutheran Health System in the US achieved more than $1 million in annual savings by implementing a number of low- and no-cost measures to improve efficiency and reduce energy demand10. Ensuring equipment and systems are operating efficiently can reduce or postpone the need to replace or add new infrastructure, reducing costs associated with these9.

Reducing healthcare’s reliance on energy from fossil fuels can have health and economic cobenefits, through reductions in hospital admissions and treatments for chronic illnesses that are caused by the pollution created from the extraction, refining and combustion of coal, oil and gas.

This includes chronic illnesses such as asthma, lung and heart disease11.

Improving the sustainability of a health service can also improve its resilience in times of emergency and resource shortages. Implementing environmental initiatives creates opportunities for staff to engage in workplace programs that align with their personal values. Patient and staff comfort can be increased through measures that result in more stable temperatures, improved indoor air quality and appropriate lighting.

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NATA WORLD RECOGNISED ACCREDITATION

The Global Green and Healthy Hospitals (GGHH) network was created to support health institutions, and those leading the environmental agenda in them, to reduce their ecological impacts and foster a healthy future for people and the planet.

GGHH is an initiative of Health Care Without Harm (HCWH), an international coalition of more than 500 members in 53 countries that works to transform the health care sector worldwide, without

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compromising patient safety or care, so that it becomes ecologically sustainable and a leading advocate for environmental health and justice. The Climate and Health Alliance (CAHA), as HCWH’s Australian partner, coordinates the GGHH network in Australia and New Zealand. CAHA is a coalition of 30 organisations in the health sector who work together to advocate for effective policy action on climate change, to highlight the link between climate change and health, and to promote sustainable practices within the healthcare sector.

GGHH is a free, membership based network that brings together hospitals, health systems, and health organisations from around the world under the shared goal of reducing the environmental footprint of the health sector and contributing to improved public and environmental health. In mid-2016 there are over 680 members worldwide, representing 20,500 hospitals and health centres.

The network is based around 10 goal areas: • Leadership – Prioritise environmental health; • Energy – Implement energy efficiency and clean, renewable energy generation; • Waste – Reduce, treat and safely dispose of healthcare waste; • Water – Reduce hospital water consumption and supply potable water; • Buildings – Support green and healthy hospital design and construction; • Chemicals – Substitute harmful chemicals with safer alternatives; • Food – Purchase and serve sustainably grown, healthy food; • Transportation – Improve transportation strategies for patients and staff; • Pharmaceuticals – Safely manage and dispose of pharmaceuticals; • Purchasing – Buy safer and more sustainable products and materials.

An online social platform, GGHH Connect, brings the GGHH member community together and provides access to tools, resources and experts from around the world. These tools and resources include: guidance documents; member case studies; goal communities and discussion forums; webinars series; sustainability experts; and data management tools.

Through GGHH Connect, members can share best practices, find solutions to common challenges, chart their progress, and celebrate successes.

There are goal communities for each of the 10 GGHH goal areas. These online community spaces and discussion forums allow members to access people and information specific to their interests and projects. For example, someone in Australia asking about other people’s experiences with Voltage Power Optimisation in a hospital with complex and large fluctuating demands, received responses from people in Australia and the UK. Experts from around the world are online and available to answer questions, provide advice, and point members to resources to inform their work in each of the goal areas.

Guidance documents provide a comprehensive and global view into the GGHH sustainability goals.

Written and reviewed by leading experts, each document covers various opportunities within the

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topic area for action to reduce their environmental footprint. Guidance documents have been developed for waste, water, energy and buildings.

A chemicals guidance document is currently being drafted. As an example, the energy guidance document helps people make the changes needed to reduce their energy consumption and energy related fossil fuel emissions by identifying specific actions that health care facilities can take. These actions are supported with links to case studies, and lists of specific Action Items that can be used to guide the development of solutions and measure progress towards reducing energy consumption and using cleaner sources of energy.

Data management tools are currently being developed to allow GGHH members to record data, track progress, establish goal benchmarks and visualise successes with graphs and charts.

The GGHH Waste data form is currently available.

GGHHâ&#x20AC;&#x2122;s webinar series includes presentations from experts and members sharing cutting-edge

Less Walking

A library of case studies documents the approaches GGHH members from around the globe have taken when implementing sustainability projects. For example, a case study from the Mater Misericordiae Hospital in Brisbane outlines how they went about upgrading their carpark lighting, a project that resulted in a 30% reduction in lighting energy use, and a two-year return on investment.

A case study from Kooweerup Regional Health Service in Victoria outlines a number of projects that were implemented to reduce energy use. A few examples of these initiatives include: installing solar panels for hot water; installing ozone technology in the laundry to reduce the need for hot water for washing; installing solar tunnels across the organisation; installing light sensors in all clinical storage areas; applying reflective paint on roofs to reduce heat loads; staff awareness and education with induction; and a switch off campaign using stickers to remind staff to shutdown computers and turn off lights. These combined activities, along with a few others not mentioned here, resulted in a saving of 28,500 kWh, 100 gigajoules of energy, and 38 tonnes of carbon emissions (tCO2-e).

In South Korea, a case study from Yonsei University Health System demonstrates a number of measures they put in place to help them reach their target of reducing GHG emissions by 30% by the 2020. Some of these measures include using a Building Energy Management System; installing solar powered street lighting; replacing old HVAC equipment with more efficient equipment; and regulating temperature settings more efficiently. These and other energy saving initiatives resulted in a saving of US$1,730,000 and a reduction of 5,316 tonnes of CO2 emissions in the year 2011.

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strategies for implementing sustainability projects in the health care sector. Webinar topics range from focusing on a specific goal, to focusing on global health issues. Previous webinars topics include: Green Building and Construction, Post Paris: Next Steps for Health Care Leadership in Tackling Climate Change, and Sustainable Healthcare Waste Management: Strategies and Experiences.

In the United states, Promedica Wildwood Orthopaedic and Spine Hospital installed cogeneration systems to augment energy efficiency solutions in their energy management plan (which included variable frequency drives, lighting upgrades, behaviour change programs).

They installed two Capstone C65 micro-turbines that use natural gas to provide electricity and heat to

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the hospital. Benefits include a reduction in annual energy costs, greenhouse gas emissions and source energy use intensity. Other Promedica hospitals have since installed similar systems that have emergency power capabilities to improve resiliency and provide redundancy during power outages.

A case study by the National Health Service in England demonstrates how they showed leadership and created the conditions for change. They did this by engaging staff across the organisation, established a Sustainable Development Unit and developed a Route Map for Sustainable Health in consultation with over 70 of their organisations to align and co-ordinate health system sustainable development.

The process for setting up a theatre recycling program is outlined in a case study from Middlemore Hospital, part of Counties Manukau District Health Board in New Zealand. The program was achieved by setting up green teams, establishing a strategy,

consulting key stakeholders, holding a trial project, educating staff and responding to feedback.

BE A PART OF GLOBAL CHANGE The Lancet states that climate change is the greatest threat to human health of the 21st Century, yet addressing climate change could be the greatest global health opportunity of the 21st Century12,13. The health sector is uniquely placed to be leaders in addressing climate change and help solve the climate crisis. The healthcare sector is a considerable contributor to CO2 emissions, and can set a powerful example by reducing these emissions. Healthcare is on the front line of climate change and will need to improve its resilience and prepare for the shifting burden of disease.

Healthcare can help drive transformational change by making the public aware of how climate change affects health, and leading by example. Healthcare can also influence change by using its moral, political and economic clout to foster a transition from fossil fuels to clean, renewable, healthy energy.

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A mechanism for doing this is through the 2020 Healthcare Climate Challenge, an initiative of GGHH. The 2020 Healthcare Climate Challenge mobilises healthcare institutions from around the world to protect public health from climate change.

It is based on three pillars: 1. M itigation – Reducing health care’s own carbon footprint and/or fostering low carbon health care.

2. R esilience – Preparing for the impacts of extreme weather and the shifting burden of disease.

3. Leadership – Educating staff and the public while promoting policies to protect public health from climate change.

The 2020 Healthcare Climate Challenge provides an opportunity for participants to demonstrate their health institutions commitment to addressing climate change. To enter, participants sign a pledge to reduce their carbon footprint, become more climate resilient and exert leadership for a healthy climate. Participants then establish and record carbon reduction targets for the year 2020, share data on progress over time and automatically become members of the GGHH network.

Participants also have the opportunity to be recognised internationally for their dedication, ingenuity and innovation in reducing their climate footprint and providing leadership, through the Health Care Climate Awards. These awards recognise leaders globally, and by region, for each of the three pillars. The awards highlight and publicise the issues and opportunities around climate change and health, and demonstrate ideas and pathways others can follow.

To participate in the 2020 Healthcare Climate Challenge, join the GGHH network, or share what you are doing to reduce your health institutions environmental footprint visit www.greenhospitals.net for more information.

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3. McMichael, A., Weaver, H., Berry, H., Beggs, P., Currie, B., Higgins, J., Kelly, B., McDonald, J., Tong, S. (2009). National Climate Change Adaptation Research Plan: Human Health.

Gold Coast, Australia: National Climate Change Research Adaptation Facility.

4. Hughes, L. and McMichael, A. (2011). The Critical Decade: Climate change and health. Canberra: Department of Climate Change and Energy Efficiency, Commonwealth of Australia.

5. Smith, K.R., Woodward, A., Campbell-Lendrum, D., Chadee, D.D., Honda, Y., Liu, Q., Olwoch, J.M., Revich, B., Sauerborn, R. (2014) Human health: impacts, adaptation, and cobenefits. In: Climate Change 2014: Impacts, Adaptation, and Vulnerability. Part A: Global and Sectoral Aspects.

Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change [Field, C.B., Barros V.R., Dokken, D.J., Mach K.J., Mastrandrea, M.D., Bilir, T.E., Chatterjee, M., Ebi, K.L., Estrada, Y.O., Genova, R.C., Girma, B., Kissel, E.S., Levy, A.N., MacCracken, S., Mastrandrea, P.R., White, L.L. (eds.)]. Cambridge, United Kingdom and New York, USA; Cambridge University Press, pp.

709-754.

6. Carthy, J., Chandra, V., Loosemore, M. (2009) Adapting Australian health facilities to cope with climate-related extreme events, Journal of Facilities Management, Vol 7, No. 1, pp 36-51.

7. Bi, P., Williams, S., Loughnan, M., Lloyd, G., Hansen, A., Kjellstrom, T., Dear, K., Saniotis, A. (2011) The effects of extreme heat on human mortality and morbidity in Australia: Implications for public health, Asia-Pacific Journal of Public Health, Supplement to 23(2), pp 27S-36S. 8. Guenther, R., and Jarvis, A. (2014) Energy Guidance Document for Members. Health Care Without Harm.

9. University Health Network. (2014) University Health Network Energy Management Plan 2014 - 2019. Retrieved from http://www.uhn.ca/corporate/AboutUHN/Greening_UHN/ Documents/UHN_Energy_Plan.pdf#search=energy%20 management%20plan 10. Gundersen Lutheran, Envision website, http://www. gundluth. org/?id=4651&sid=1

REFERENCES:

11. Biegler, T. (2009) The hidden costs of electricity: Externalities of power generation in Australia, Report for the Australian Academy of Technological Sciences and Engineering (ATSE), Parkville, Victoria.

1. World Health Organisation, 2012. Human health and the Rio Conventions: biological diversity, climate change and desertification. Retrieved from http://www.who.int/ globalchange/publications/reports/health_rioconventions.pdf

12. Costello, A., et al. (2009) Managing the health effects of climate change, The Lancet (Lancet and University College London Institute for Global Health Commission), Vol 373, pp.

1693–1733.

2. World Health Organisation, 2011. Health in the Green Economy. Retrieved from http://www.who.int/hia/hgebrief_ health.pdf

13. Watts et al. (2015). Health and climate change: policy responses to protect public health. The Lancet, Vol 386, no.10006, pp.1861-1914.

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THE TICKING TIME BOMB IN HEALTH IS BEING IGNORED

By Susie Pearn, Client Director, Health & Education, Aurecon

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elcome to 2050 and Alyssa Taylor’s world.

Alyssa is 10 years old. She lives in North America and she has just been diagnosed with dengue fever. Dengue fever used to be rare in North America but it is not anymore.

particularly as there are less of us in the workforce now that our population has aged.

That’s not the only way health looks different in Alyssa’s world.

This may seem far-fetched. Climate change may be questioned. More research is certainly warranted. But this scenario is based on predictions that the World Health Organisation (WHO) is making and if they are right and we don’t act now, we are arguably heading for trouble.

‘Climate disease’ has had a significant impact globally.

Our health systems are struggling to cope. They don’t have the capacity needed and our hospitals and health services haven’t adapted and built the resilience needed. Our individual taxes have increased significantly to afford the health care required,

Back in 2016, we thought our aging population was the biggest health pressure ahead. We were wrong.

It is time for health leaders to become climate leaders.

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THE INDICATORS Likely impacts on health As the earth’s temperature continues to rise, we will fast reach a tipping point where the climate will be the most dominant influence on human health and our health systems, far outstripping current drivers such as the aging population and lifestyle related diseases.

WHO predicts that between 2030 and 2050, climate change will cause approximately 250 000 additional deaths per year, from malnutrition, malaria, diarrhoea and heat stress. Food and waterborne infections show a direct correlation to rising temperatures. According to WHO estimates, the number of people at risk of malaria will increase to 170 million by 2030 and those at risk of dengue fever will increase to 2 billion by 2080.

If temperatures continue to rise, the impact of heat stress conditions and upper respiratory tract ailments, as well as drought and hunger, will be profound. Today an estimated 150 million people live in cities with perennial water shortage, defined as less than 100 litres per person per day. By 2050, climate change will contribute

to doubling the number of people living in waterstressed basins, halving rain-fed agriculture in some African countries by 2020.

On the flip side WHO predicts an increase in exposure to coastal flooding by a factor of 10, along with an increase in other extreme weather events. Aside from the direct health impacts, there is a risk of mental health consequences from climate change, particularly where communities are displaced and their way of life significantly altered.

The cohort of diseases ahead is likely to be significantly different from today. There will be a need for different models of intervention and treatment, with new research and innovation to address climate disease.

Our current hospitals and health systems are not designed to cater for climate disease and hospitals are presently being designed with little regard to how they will adapt.

Our health expenditure today is growing at a greater rate than Gross Domestic Product. A changing climate will magnify the already significant

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Figure 1: Climate disease

negatively intersect and when that point in time may be.

More research into understanding how the healthcare system will be effected by climate change will give direction to policy makers and health leaders to mitigate and prepare for the demands they will inevitably face.

pressure on our health system. The direct damage costs to health from climate change (i.e. excluding costs in health-determining sectors such as agriculture and water and sanitation), is estimated to be between US$ 2-4 billion/year by 2030 (WHO).

Having the right research capacity is critical, as is starting with the right research questions. If researchers collaborated with health leaders, government and non-health sectors we would have a clearer picture of the effects of climate change on our health, which would go a long way to promoting a global adaptive response (figure 2).

Figure 2: Research benefits

In short, our health systems are likely to struggle to cope with climate change if we don’t act now.

Where the weak infrastructure is The places most vulnerable to climate change are the ones with weak infrastructure. Much of the impact is likely to occur in developing countries without assistance to prepare and respond.

We could sit back in places like Australia and think we will be OK. However, while developing countries are the most vulnerable, the developed world will not be exempt. Our densely populated cities, especially those which experience an urban heat island effect, already face extreme heat and degraded air quality. In New York City, each single degree (Celsius) increase in summertime surface temperature has been associated with a 2.7–3.1% increase in same-day hospitalisations due to respiratory diseases, and an increase of 1.4–3.6% in hospitalisations due to cardiovascular diseases.1 In Hong Kong, there is a daily broadcast of the pollutant index and on some days, it’s recommended that parents don’t let their kids play outside.

Besides, we all share a responsibility beyond our own backyard. Reducing emissions of greenhouse gases through better transport, food and energy-use choices can result in improved health for everyone.

Researching the effects Research into the effects of climate change is not new. The collection of statistics by health authorities on disease and medical conditions is not new either.

However there is a lack of research into the point where climate change and the healthcare system

Research is needed to understand the relationship of climate change to health and to consider new strategic funding models for healthcare. Understanding better the potential impacts of climate change on health will also help with guiding the training of healthcare professionals, which will be important in meeting long-term workforce demands.2 Appropriate research can help understand the potential changes ahead to give us the opportunity to plan our healthcare and health infrastructure accordingly. There will be a need for different models of intervention and treatment, with new research and innovation to address climate disease. The shape of our health infrastructure may need to be different to today,

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• • • • • • •

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so just extrapolating infrastructure planning from the past is a risk.

In 2008 the Department of Health in Western Australia produced a document to provide an understanding of the potential health impacts and associated social implications of climate change that may affect the people of Western Australia in the future.3 The information was intended to contribute towards the development of policies and planning by the Government of Western Australia for community adaptations to climate change.

The report identified health impacts and a range of adaptations that could be implemented across Western Australia which can form the basis for future climate change responses by decision makers to protect community health. But it also concluded that the extent of impacts from adverse effects will depend on how well society can estimate the level of the impacts and the planning processes for adaptation strategies, and the fact that more research into this area is required.

Climate change needs to feature in health departments’ evidence collection and policy development, and scientific research needs to point heath leaders in the right direction.

MANAGING PRIORITIES Policy landscape Policy makers in Australia are looking at funding and infrastructure requirements for an aging society.

However, according to the Climate and Health Alliance there are almost no policies at either the national or state level that specifically address the health impacts of climate change in Australia, even though the impacts of future climate change on public health may generate very large healthcare costs if strategies are not developed now. Healthcare frameworks and policies are presently being designed with little regard to how they will adapt to the predicted wave of climate disease.

Levels of government effort that we haven’t seen before are required for health sector adaptation to the effects of climate change on health. If health leaders become climate leaders then the health sector can collaborate as a unified group to lobby government to take action on climate change including and beyond the health sector. Heath leaders must take a strong role in leading the climate debate.

Lack of urgency Health leaders today are constrained by time, operational issues, reporting requirements, funding frameworks, even brand perception, all the while focusing on how all Australians, regardless of their background, culture, geography or socioeconomic status, can have the best health in the world. Where does the effect of climate change fit into the agenda?

One way or another climate change poses a significant risk to our health and health system and it will have to be prioritised. However, there is a lack of urgency within the healthcare sector to address the future implications of climate change.

The health sector has generally been slow to recognise the impacts that global climate change might have on human health. For example, there were no submissions by any health agencies to the 2012 Productivity Commission Inquiry into Barriers to Effective Climate Change Adaptation.4 Health leaders need to do the maths around the impact climate related health diseases will place on the current burden of disease globally, and what this burden may become if the world were to become 2 degrees (Celsius) warmer.

For health leaders the intrinsic inter-relationship between human health and sustainability moves beyond environmental responsibility to actually protecting human health. It is the health sector that can collaborate as a unified group to lobby state and federal governments to take action on policies for climate change.5 Maybe we need to spawn the concept of ‘health credits’ When it comes to health, ‘salutogenics’ has become fashionable i.e. an increasing focus on factors that support human health and well-being, rather than on factors that cause disease. But, in focusing on designing the built environment to support human health, we’ve forgotten that if we do not start to design for wellness of the planet, there is little point in designing for wellness of the body.

Deciding that sustainability measures are unaffordable and treating ‘environmental sustainability’ as if it is an issue that is an adjunct to building design has to cease. Our design of health facilities today, and indeed all facilities, has to be capable of changing drastically. Prevention extends further than healthcare systems, and beyond building and operating hospital infrastructure. It’s about all sectors and all infrastructure

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that is built and operated. It all needs to interconnect and support a common goal and direction.

Figure 3: Health + climate change aspiration

There is a role for health leaders to play across all sectors given the direct connection of climate change to health. For health practitioners and governments, this means moving beyond merely being environmentally responsible to actually protecting human health (figure 3).

Reframing the issue of environmental sustainability to one of human health puts a different spin on it. If environmental sustainability is directly linked to human health, we may need to spawn the concept of ‘health credits’ instead of ‘carbon credits’ and start to value those credits differently, given the potential for positive climate change action to reduce the cost of healthcare in future.

Paradigm shift The healthcare sector requires a new way of thinking to navigate through this uncertain future, as traditional approaches deliver progress on the scale Healthcarecannot Facilities_June_Artwork_PRINT.pdf 1 7/06/2017 9:11:17 AM

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required. We can’t wait another 15 years to start asking what role we can play in changing our course.

Adaptation to climate change is part of a preventive approach to public health – not a distraction.

Prevention includes reducing our impact on climate change but it also includes reducing our burden on the health system by focussing on preventative health,

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particularly for those diseases that are sensitive to climate change.

An example is the Bill & Melinda Gates Foundation with its goal of a world free of malaria. An estimated 207 million people suffered from the disease in 2012, and about 627,000 died. The Foundation along with countless other funding sources has helped to reduce new cases by 25 percent globally, and deaths from malaria by 42 percent in the last 12 years.

Robust, evidence-based preventative policies and action plans need to be shaped now or it will be too late. Public health frameworks and climate change recognition in funding structures will go a long way in addressing the health challenges presented by climate change.

“…while the climatic effects of mitigation measures are long-term and dispersed throughout the world, the health benefits are immediate and local”

World Health Organisation Director-General Margaret Chan, 2009 THE ACTION OF ADAPTATION Adaptation with mitigation The two concepts are not mutually exclusive and when it comes to climate-related effects on the healthcare system both are important. There is time and opportunity now for mitigation of the climate change.

But given the complexity and extent of Australia’s healthcare system and the lack of scientific-based evidence with regards to the effect of climate change, adaptive management will become vital. Adaptive management, a structured process of decision making in the face of imperfect information, is an approach that can help the public health field effectively anticipate, plan for, and respond to the health risks of climate change.6

We will have to start investigating how our health systems would cope with this changing disease cohort and start asking the question: “How will our facilities and health system adapt?”

But what about resilience The factors which encourage resilience need to be better understood because resilience is as important as adaptation and mitigation. The public health sector must communicate concepts of risk, and develop strategies to encourage greater resilience.7 The opposite of vulnerability is resilience – our capacity to respond to challenging or new circumstances. What resilience is required, and who’s going to step up and lead the charge?

We need to consider how our system and infrastructure will withstand the changes ahead. Understanding the risk, for example of the changing frequency, geography and extremity of natural disasters is needed. We should question whether our infrastructure has been built based on past weather patterns rather than predicted future patters. Maybe our emergency power supply and water supply needs to change.

Maybe we need to consider relocation of major infrastructure over time. We have an obligation to the community to prepare and get this right.

We can’t see the future and we can only do so much to curtail the climate change ahead. But we can imagine what the future might be and build resilience and agility to adapt.

CONCLUSION We have to ask ourselves the tough question – are we doing enough?

The risk of not doing enough is Alyssa Taylor’s world in 2050.

The World Health Organisation has outlined how most health risks in the next 20 to 30 years may be averted through: • comprehensive assessments of climate risks to health and health systems

Mitigation has received more attention in academic literature than adaptation. However, adaptability in healthcare design is probably the most forward thinking strategy our health leaders, governments and hospital designers can implement.

• integrated environment and health surveillance

If we want to see lasting and measurable change, health departments will have to heed the climate debate and start synthesising what this will mean to the design of the facilities they are delivering now.

• applied research

• delivery of preventative and curative interventions for identified climate-sensitive public health concerns • preparedness and response to the public health consequences of extreme weather events • strengthening of human and institutional capacities and inter-sectorial coordination.

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Health leaders have a role to play as climate leaders beyond the healthcare sector given the direct relationship of climate change to health.

Prevention, mitigation and adaptation can change the statistics, and change the world in 2050. It requires a united approach from governments, health leaders, non-health sectors and the community – but it can be done.

BIBLIOGRAPHY World Health Organisation 2016, Climate change and health, accessed 26 October 2016, http://www.who.int/mediacentre/ factsheets/fs266/en/ Vajpeyi, D (2013) Climate change, Sustainable Development, and Human Security.

Haylee J. Weaver, Grant A. Blashki, Anthony G. Capon and Anthony J. McMichael (2010) Climate change and Australia’s healthcare system – risks, research and responses. CSIRO, 34(4).

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Blashki G, Armstrong G, Berry H, Weaver HJ, Bi P, Harley D, Spickett J, Hanna L, Preparing Health Services for Climate Change in Australia Spickett, J. Brown, Helen. Katscherian, D (2008) Health impacts of climate change: Adaptation strategies for Western Australia.

Department of Health The Australian Hospital + Healthcare Bulletin (2015), The future health leaders of tomorrow, accessed 25 October 2016, http:// www.hospitalhealth.com.au/news/the-future-health-leaders-oftomorrow/ Ebi, K. Climate Change And Health Risks: Assessing And Responding To Them Through ‘Adaptive Management’.

Health Affairs.

Walter, T. Stevens, P. Verhoeven, A. Boxall, Anne-marie. (2014).

Impacts of climate change on public health in Australia. Deeble Institute.

Ebi, K. & Semenza, J. (2008) Community-Based Adaptation to the Health Impacts of Climate Change. American Journal of Preventive Medicine, 35(5), 501-507.

Costello, A., Abbas, M., Allen, A., Ball, S., Bell, S., Bellamy, R., Friel, S., Groce, N., Johnson, A., Kett, M., Lee, M., Levy, C., Maslin, M., McCoy, D., McGuire, B., Montgomery, H., Napier, D., Pagel, C., Patel, J., Antonio, J., Oliveira, P., Redclift, N., Rees, H., Rogger, D., Scott, J., Stephenson, J., Twigg, J., Wolff, J. & Patterson, C. (2009) Managing the Health Effects of Climate Change. The Lancet, 373(9676), 1693-1733.

REFERENCES 1. Vajpeyi, D (2013) Climate change, Sustainable Development, and Human Security.

2. Haylee J. Weaver, Grant A. Blashki, Anthony G. Capon and Anthony J. McMichael (2010) Climate change and Australia’s healthcare system – risks, research and responses. CSIRO, 34(4).

3. Spickett, J. Brown, Helen. Katscherian, D (2008) Health impacts of climate change: Adaptation strategies for Western Australia.

Department of Health 4. Ebi, K. & Semenza, J. (2008) Community-Based Adaptation to the Health Impacts of Climate Change. American Journal of Preventive Medicine, 35(5), 501-507.

5. Costello, A., Abbas, M., Allen, A., Ball, S., Bell, S., Bellamy, R., Friel, S., Groce, N., Johnson, A., Kett, M., Lee, M., Levy, C., Maslin, M., McCoy, D., McGuire, B., Montgomery, H., Napier, D., Pagel, C., Patel, J., Antonio, J., Oliveira, P., Redclift, N., Rees, H., Rogger, D., Scott, J., Stephenson, J., Twigg, J., Wolff, J. & Patterson, C. (2009) Managing the Health Effects of Climate Change. The Lancet, 373(9676), 1693-1733.

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6. Ebi, K. Climate Change And Health Risks: Assessing And Responding To Them Through ‘Adaptive Management’.

Health Affairs.

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7. Walter, T. Stevens, P. Verhoeven, A. Boxall, Anne-marie. (2014).

Impacts of climate change on public health in Australia.

Deeble Institute.

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MANAGING CONDENSATE FOR CONDENSING BOILERS

CONDENSING BOILER CONDENSATE AND WHY IT NEEDS TO BE MANAGED CORRECTLY

By Anthony Plaisted, General Manager of Automatic Heating Global Pty Ltd

CONDENSING BOILER OVERVIEW

O

ver the last decade, the number of condensing boilers and water heaters being installed has continued to rise every year and all indications are that this trend will continue and eventually become mandatory due to their higher energy efficiency and cleaner emissions, compared to standard boilers.

Condensing boilers discharge a corrosive condensate as a by-product of their operation. Because of the long-term effects of the sustained introduction of this corrosive condensate into drains and sewer lines, there is a growing awareness of the need to educate code enforcement officials, contractors, building owners, facility managers and homeowners of the need to neutralise this corrosive outflow and the means available to do this.

WHAT IS CONDENSING BOILER CONDENSATE? Condensing water heaters achieve higher energy efficiency than standard boilers by condensing the

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water vapour in the flue gasses and using the latent energy recovered through this process to heat the return water going into the water heater.

The condensing process is achieved by passing the piped hot flue gases through the cooler return water flowing back into the boiler. Flue gas starts to condense when it drops below its dew point of 55°C. This is why condensing boilers are designed to accommodate a return water temperature of 54°C or less.

It is this resulting condensate liquid that is acidic and requires treatment to avoid damage to piping systems, sewerage systems and other items it may come in contact with.

HOW MUCH CONDENSATE IS PRODUCED? A general rule of thumb, 3.5 litres of condensate is produced for every 30kw of input providing the boiler is operating in full condensing mode. A boiler having 30kW of input operates for 1200 hours annually will produce approximately 4200 litres of condensate.

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ACIDITY LEVELS

HOW TO TREAT CONDENSATE

The acidic level of the condensate is measured as pH. Most condensate from natural gas appliances will have a pH of between 2.0 and 4 with 7 being neutral. The actual pH will vary according to the actual chemical makeup of the fuel that is being burned.

Treated condensate should be as close to 7 (neutral) as possible with 5 being the minimum. Most national and state codes prohibit anyone from allowing acidic liquid into a drainage system without treating it to raise its pH.

Condensate contains different types of acids that are corrosive to many materials and contain concentrations of nitric, nitrous, sulfuric, and sulfurous and hydrochloric acids. These acids can become more concentrated by repeated condensing and evaporation on heat exchangers and flues.

A pH of 4 can damage drainage pipes, septic tanks, treatment plants and other materials handling waste water. The pH scale is not linear. Each whole number step below 7 is 10 times more acidic than the next higher number.

To increase the pH to acceptable levels, whereby it no longer has the potential to damage the sewer system or environment, a condensate neutraliser should be installed. Condensate neutralisers are designed specifically for this task, and consist of a tank or module containing alkaline limestone aggregate or chips.

Automatic Heating offers several models that accommodate water flow rates from 6.05l/hr to 155l/ hr depending on the size of the condensing water heater system.

The acid is converted to water, carbon dioxide and mineral salts when exposed to the media. The carbon dioxide will generally stay diluted in the water and

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pass out of the neutraliser. The mineral salts generally settle at the bottom of the neutraliser. Over time the media dissolves and must be replenished.

If applied properly and maintained regularly, damage associated with acidic condensate in the drain piping can be avoided.

The above image shows Modulex high efficiency condensing boilers with condensate neutralisers installed in the pipes that connect the boiler drains to the point of discharge.

CONDENSATE DRAINS The condensate expelled from a condensing water heater is acidic with a pH of between 2 and 4, so it is critical that the appropriate materials are used in all piping where this liquid is present.

In high temperature areas, like the flue, stainless steel must be used to prevent corrosion.

The low temperature piping, such as that which drains the condensate from the heat exchanger condensate draining system, should be PVC or ABS to also mitigate corrosion. This system normally consists of a short length of PVC or ABS pipe with a water trap to prevent exhaust gases from being expelled into the drain and building.

MAINTENANCE & SERVICING The best way to check if the condensate neutraliser is working properly is to test the treated condensate with a pH meter. pH meters are available at a reasonable cost and should be added to the technician’s tool arsenal. All manufacturers of condensing boilers recommend annual maintenance and the service

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technician should check and service the condensate neutraliser during this service.

It is the responsibility of the plumbing professional to follow state and local plumbing codes including proper disposal of condensate and equally important for the end user to provide ongoing maintenance ensuring proper function of the unit. Damage can occur underground and in unseen, remote locations.

Imagine digging up your basement floor to replace a rotted out metallic drain line!

IN CONCLUSION • Condensate from condensing boilers is acidic and corrosive to many materials and should be treated to maintain a pH of no less than 5 before disposal.

• There can be a wide variation of the pH of condensate from condensing appliances due to the chemical make-up of the gas being combusted or from the way in which the appliance is operating in a particular application.

• A fully condensing appliance will produce up to 3.5 litres of condensate per hour for every 30kw of input.

• The neutraliser media is reacting with the solution to raise the pH and does need to be replaced. Most manufacturers recommend replacing media and checking operation at least annually.

For more information about Condensing Boilers and Condensate Neutralisers, visit www.automaticheating.com.au The author, Mr Anthony Plaisted, is General Manager of Automatic Heating Global Pty Ltd, a leading provider of waterbased heating and cooling to the commercial HVAC market in Australia.

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THE CONTEMPORARY CHALLENGE OF TERRORISM AND ACTIVE ARMED OFFENDER INCIDENTS FOR HOSPITALS AND HEALTH PROVIDERS – STRATEGIES FOR PROTECTING YOUR KEY ASSETS

By Scott Harris

With ever increasing advances in technology making the world a smaller place, conflict across the globe influencing foreign policy, opinions and radical actions, and violent crime seemingly on the increase, the likelihood that your town, city or community will be impacted by a terrorism or Active Armed Offender Incident appears to be increasing.

W

hilst this contemporary term is often linked to the ever increasing threat of terrorism, it is often more likely that the motivation for an AAOI in your community will be workplace related

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(disgruntled employee, patient or family member); crime related (drugs or robbery); domestic violence related; or mental illness related.

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In January 2017, a significant AAOI criminal incident in the Bourke Street Mall in Melbourne tragically drove home the reality that AAOIs can occur anywhere and at any time but also reinforced that first responders and healthcare professionals need to have incredibly well rehearsed plans and highly developed cross agency partnerships in place for critical incidents resulting in mass casualties.

Bourke Street was a mass casualty AAOI event that has been unparalleled within Australia in recent times and sadly had similar undertones to the terrorist incident that would rock London several months later on a bridge in front of the houses of parliament. Often there is very little difference between the heinous consequences of terror or crime but both can have a significant impact on the hospital and health system responsible for responding to an incident and assisting with treatment and recovery.

Whilst there is a clear message here for health professionals around the enhancement of their planning and response capabilities to deal with the increasing frequency of mass casualty incidents, there is also another important aspect to consider…

What if an active armed offender incident were to occur in your hospital, health facility or precinct tomorrow?

Could your executive leadership team effectively demonstrate that they have put steps in place to prepare for, prevent, respond to and successfully recover from an AAOI? Could your organisation confidently respond to questions from authorities, insurance, media and families of people who may be at risk in a critical incident?

When you consider the substantial impact on your workforce, patients/visitors, reputation, profit and ability to continue to provide essential health services to your community if your key assets were to be adversely impacted by a significant critical incident such as an AAOI, you start to recognise the importance of being proactive around this risk. Your key assets (workforce/physical resources/ information) are literally what makes your business a success so it makes perfect sense for you to be on the front foot when considering their safety and security.

Not certain about how your organisation and workforce would respond in the circumstances that an AAOI were to occur? Here are some tips on where you should start?

1. Ensure that your board and executive leadership team has clear ownership of this risk.

Many organisations often consider the security of their key assets as an afterthought, at the bottom of a long list of priorities and strategies. Consequently, the allocation of funding to ensure the continuing protection of these key assets can be limited and generally difficult to find following a critical incident.

Assign responsibility to a key member of the leadership team and ensure that security around your key assets is a standing item on your board’s agenda. It is ultimately your board who will be responsible.

2. Undertake a Security Vulnerabilities Assessment on your workplace and facilities.

Identifying vulnerabilities in and around your workplace will provide a snapshot of risks and issues, enable budget allocation (including capital expenditure) to be set aside for mitigating critical security concerns and detail areas that require consideration whilst developing your plans.

3. Develop an Active Armed Offender Incident Plan and Bomb Threat/Improvised Explosive Device Plan.

It is no longer sufficient to simply plan only for fire evacuations in your workplace. All potential critical incidents must be considered and your leadership team and workforce need to be equipped with the most contemporary skills and procedures (including the Escape/Hide/Act principles) to assist them in ensuring that your patients, visitors, stakeholders and colleagues remain safe.

Most organisations have a simple bomb threat checklist but what if a device is left at your premises or in a worst case scenario, detonates at your site?

4. Socialise the plans and procedures to your staff and stakeholders through awareness workshops and training.

There is no point developing a plan for your workplace if no one knows about it. Set a training schedule for your workforce, ensuring that all staff

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receive a level of training that is appropriate for their role or position in the organisation.

Consider requirements for face to face or online training methods, being conscious that all members of the organisation need to receive some level of formal training and certain members require detailed sessions.

5. Develop scenarios to facilitate discussion during desktop and site exercises.

Scenarios are a critical element in the overall process of building resilience within your organisation. They should be realistic, consider all possible threats and involve your key team members (including your executive leadership team).

6. Continuous Improvement.

Continuous improvement is an essential part of the process, ensuring that your security strategies remain contemporary and plans and training solutions/activities keep abreast with the changing global environment. Ensure that you have a trusted consultant or key member of your team who can keep delivering to maintain the safety of your key assets.

7. Recovery strategies.

Considering the opportunity for effective recovery is a factor that must be included and is often overlooked. There are many components to a successful recovery and it is often a slow process but at the outset, a well structured Employee Assistance Program or access to relevant support services and professionals should always be available for staff or stakeholders impacted by a critical incident.

The value that you place on maintaining and developing your key assets and how you prioritise their security requirements will ultimately be reflected in your level of commitment in investment and resourcing in this critical area. Early and ongoing investments in mitigation strategies will undoubtedly be more acceptable to your board and stakeholders than the potential loss of life, high costs of litigation and damage to reputation where the threat and risk of AAOIs in your workplace has not been considered.

ABOUT THE AUTHOR Following a successful career in the Queensland Police Service spanning over 26 years, Scott’s passion for protecting the community and creating resilience within organisations ultimately led to him founding Workforce Resilience in 2015 and now sees him consulting to major Australian public and private sector organisations including Optus, Queensland Health, Robina Town Centre, Southbank Corporation, City of Gold Coast and a broad portfolio of facility management and security organisations.

Scott successfully led the Business and Critical Infrastructure engagement portfolio for QPS G20 Group where he developed key partnerships, lasting relationships and delivered organisational resilience sessions to over 25,000 business professionals across Queensland and New South Wales. [Gold Award for Customer Focus – QPS Awards for Excellence; and Winner, Customer Focus – Premiers Awards for Excellence].

In addition to his comprehensive critical incident and emergency management capabilities, Scott developed a good working knowledge of security and emergency management and the associated challenges having performed the role of Facility and Operations Manager for Queensland Police Headquarters. Scott has a good knowledge of the significant security and emergency management challenges facing hospital and health facilities after being engaged by Queensland Health to develop their Active Armed Offender Incident Guidelines in addition to writing updated Disaster, Mass Casualty Incident and Incident Management Guidelines.

Scott’s education qualifications include a BA, Justice Administration (Intelligence and Security) QUT, Advanced Certificate in Policing (Griffith University) in addition to leadership, command and management qualifications from the QPS Management Development Program.

For more information or assistance in developing these key initiatives, contact Scott on 0433 269 388 or email at scott@workforceresilience.com.au

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WHAT KEEPS YOU UP AT NIGHT?

By Mark Cannadine

We’ve all heard colleagues or managers express a professional concern or worry, something that troubles them. Some we register, some we disregard, relative to the individual and the frequency with which they express their woes! There have only been a few times in my career when someone I respected has expressed a genuine concern that’s really resonated with me, usually because it was my job to do something about it. One such occasion was a conversation with a hospital general manager about business continuity and contingency planning. She told me that it wasn’t disasters, or mass casualty incidents or patient surge or demand for clinical services that kept her up at night. It was actually when the lights went out, or the water stopped flowing or the air conditioning failed. This very smart and pragmatic leader knew that during a crisis she could rely on her most valuable and reliable asset, her people, to deal with adversity and cope with extremes. But she also knew that her facility, with ageing infrastructure and systems was a weak link. Consistent with the themes of the IHEA 2016 conference ‘Managing Change/Changing Management’ this paper will consider some of the options when trying to do both of these things from a healthcare risk and emergency management perspective.

I

n 2009 I was the manager responsible for emergency management (EM) in a metropolitan health region consisting of one large tertiary hospital, a general hospital and a smaller local hospital. At that time the health service embarked on an ambitious program to develop and implement an enterprise business continuity management (BCM) program. For any health service that’s a significant undertaking, with such a wide range of services spread across a geographically disparate organisation. So a smart business decision was made to buy in the expertise and engage a professional services consultancy to deliver the program. The driver for initiating the program was an Auditor General’s report mandating BCM for all government agencies and our Chief Executive clearly shared the AGs view, hence the considerable investment. But a failure at that stage to identify drivers for change within the business and not simply from a government directive, only became clear later in the program.

Because however well-intentioned, a directive doesn’t

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necessarily provide our people with the drivers to engage with and adopt a new program.

T

he consultants defined the rationale and vision for the change to the regional and hospital leadership team and a clear and comprehensive project plan was developed detailing timelines, milestones and deliverables. However again it would only become apparent over time that the clearly defined project approach established at the outset, would itself eventually undermine the programs long term future. The project was fully funded, wellresourced and had a clear end date, but the long term program it introduced was lacking a vision for how it would be sustained..

That said, the stakeholders were identified and at the early meetings with the consultants the executive team were present along with a selection of senior clinical and administrative service managers. As the manager responsible for EM I was to be the consultant’s point of contact and responsible for the

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ongoing program, again a perfectly understandable decision, given the links between BCM and EM. But in truth this was the first time I’d ever heard of business continuity and it soon became clear that this wasn’t a project with deliverables that we’re self-sufficient, but a new area of business and none of us really understood what was required to sustain it.

Our consultants spent time working through the risk assessment to provide the basis and direction for the program, identifying the highest priority services to participate in business impact analyses (BIA), the means to identify the critical functions for our hospitals. The team met and worked with representatives from each of those services including emergency departments, intensive care, inpatient services, corporate services, engineering and facilities management (FM), operating theatres and many more. The BIAs were thorough and comprehensive and enabled the team to develop a picture of criticality of services across the hospital. This in turn informed a rating system, with tier 1 and 2 processes being critical and requiring the development of business continuity plans (BCP) and tier 3-5 processes identified for later plan development. So once again, in principle the stakeholders for the program had been identified, consulted and informed. But was informing the right approach, or should there have been a little more listening?

Our hospital engineering/FM department had been identified as a Tier 1 business process and accordingly their BCP was developed. It identified the critical processes and recovery strategies required following a disruption including loss of workforce, loss of power, loss of communications etc. But these addressed the FM department itself and its resources, not contingencies for loss of utilities within the clinical service units, as these were to be addressed within the service unit BCPs. Whole of hospital contingency plans for loss of these services existed, but in part documented and in part in the heads of the unit director and senior staff. This appeared to leave a gap through the lack of the socialisation of these contingencies and awareness amongst the hospital executive and leadership team, the very team who would be leading the hospitals response during any loss of critical services.

As the project progressed each unit director, manager and senior clinician provided the information and data requested, then waited for the promised output in the form of the BIA and subsequent BCP. When those BCPs were duly delivered, I recall one Clinical Director telling a consultant “you haven’t told me

anything I didn’t already know”, unsurprising as she had provided all the information that had informed her BCP. Of course this was one of the programs main objectives, to draw all that knowledge from her and document it in her units BCP and inform responses to a disruption if she weren’t available. So whilst it may not have been new to her, it may have been new to her staff. But it demonstrated a fundamental failing in our engagement by not anticipating the obvious question from our staff “what’s in it for me?” In expecting clinicians to engage with a new corporate program, especially the department’s latest “brain child” we hadn’t properly addressed the only issue they really cared about, what does this mean for patient safety?

So the program rationale was sound in the AG’s directive and the process was appropriate in buying in the expertise, identifying our stakeholders and informing them of the process. But we didn’t ask them if they understood the process, what they expected or wanted in the deliverables, and most importantly explain how those deliverables added value to them and their ability to continue providing safe clinical services during disruption events. We did plenty of telling, but maybe not enough asking.

I discussed this with the lead consultant and as the project moved towards completion and the BCPs were delivered to the business units, we scheduled education sessions for the managers receiving the plans, covering the intent, activation and use of the BCPs. If further proof were needed of the failure to appropriately engage with our key stakeholders the woefully poor attendance at these sessions provided it. So our BCPs were completed, the new folders delivered to the relevant unit heads and whilst some were pleased to receive them as they’d intuitively understood the value to their units, for many the folder found its place amongst the others on their shelves.

As time moved on the risks apparent in the finite project methodology materialised and the health service as a whole struggled to sustain and progress the program. We’d fundamentally failed to embed the capability and knowledge within our organisation, after all none of us had ever written a BCP, our consultants had! My counterparts across the health regions and I struggled to find time and resource to sustain this new business process. Reviewing, exercising and updating the tier 1 plans that’d been produced was challenge enough, without yet considering those tier 1s that had been out of the projects scope and all the tier 2-5s!

It became clear that a greater emphasis on our people and their concerns and issues, was where we

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needed to refocus. A change of BCM governance presented an opportunity to draw a line in the sand, step back from where the program got to and examine what it was our people really needed.

A number of recent failures in utilities/essential services highlighted the need to provide assurance that whole of hospital contingency plans were in place, were reviewed and most importantly were socialised.

A fundamental review of the BCM policy and framework allowed us to establish what became known as Resource Outage Contingency (ROC) plans for critical sites, as the first step in the BCM development process. This enabled the BCM resources in the regions to work closely with their FM departments identifying the time frames for loss of critical functions (electricity, gas, water, medical gasses, catering, cleaning etc) thereby identifying a maximum allowable outage. Then clinical leaders could think about business continuity in a different and more patient focused way for example: • When conducting the BIA for the Intensive Care Unit identifying ventilation and monitoring as critical functions in the provision of intensive and critical care.

• The hospital ROC plan documents contingencies for the uninterrupted supply of power through either mains or generated supply, but should this not occur, a loss of power to ICU would necessitate reliance on battery power for monitors and respirators, with maximum battery operation being 1 hour • Therefore the ICU recovery strategy for loss of power must include either the acquisition of uninterrupted power supplies or activation of the loss of workplace and relocation strategy no later than 45 minutes from power loss, to ensure continuity of power supply for monitors and respirators Fundamentally this changed the focus for clinical leaders and the hospital leadership team. The clinical leaders knew what they would do if they lost power, the hospital leadership team knew that their critical services had contingencies in place during such an event and importantly neither of them were harassing the FM team whilst they were trying desperately to restore power! The loss of power was no longer something they couldn’t influence so didn’t engage with, but could plan for. That doesn’t make planning for relocating ICU patients any easier, but it does at least provide drivers and incentive for clinical leaders to engage with the BCM program, because it was focused on patient care. It also meant that the next

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steps, the BIA and BCP development was more patient focused and resonated with their staff.

So where are we now? All regions have identified their critical sites and developed ROC plans accordingly.

The BCM resources within the regions have been able to refocus their attention to the tier 1 BCPs and real progress has been made reviewing these and developing new plans. Some exercising of plans is ongoing and will add enormous value to the business units involved. Because the value of their plans doesn’t lie in the plastic and paper on their shelves, but in the minds of those who’ve tested, validated and updated those plans and who’ll be better prepared for the real thing.

We still have a long way to go. The best programs around our health service have embedded BCM as part of normal business and assigned responsibility to a unit member, rather than being passive recipients of the service. This best practice model needs to be shared across our health service along with the effective exercise programs, but our real area of focus now is education. We still need to tell our people what BCM is, why we’re doing it and how it works, but we have to then ask them where they see the risks and vulnerabilities to their services and let that knowledge inform the analysis and planning processes.

By clearly defining the reasons for the change, identifying the stakeholders, being clear on the processes that’ll effect change, then enabling our people to inform and manage those processes and making the program part of normal business, we stand a chance of establishing meaningful and sustainable programs through the change process.

But we also shouldn’t beat ourselves with too big a stick! Governments and large organisations don’t move quickly and the introduction of significant change and new business processes to workforces of tens of thousands, dispersed across dozens of sites across entire jurisdictions doesn’t happen overnight.

So for any change process large or small having a feeling for what success looks like from the outset and being realistic about if and when you’ve achieved it, is extremely important.

By asking the right questions of our people, ensuring they understand what we’re doing, why we’re doing it, being clear about how it will add value for them and their patients and reinforcing that we’re doing it together, perhaps we’ll all be able to sleep at night!

FEATURE ARTICLES

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REGULARS

NEWS HEPA FILTER SCAN TEST CONSIDERATIONS FOR CLEANROOMS SUPPLY

10 x Duct Diameter

Positive air pressure (+ve)

Aerosol introduction port, 50 diam

Ceiling

Lin

e

of

sit

e

HEPA

100 % Port Concentration and pressure

Diameter

Aerosol Generator (Laskin nozzles)

Photometer

HEPA filters within the hospital applications are required to be tested annually or whenever moved or disturbed, to confirm effective operation and no breach of integrity.

For cleanroom supply air applications, a photometer is used to scan the entire HEPA filter surface for pinhole leaks that could allow the transmission of contaminant particles that would be unacceptable in a critical application.

The most-common onsite HEPA integrity test method is the Cold DOP test, as described in AS1807.6 and 1807.7.

Important considerations:

• Access is also required to the air output side of the HEPA filter, so that a NATA technician is able to view and scan the HEPA filter surface at 25mm from the installation for traces of the test aerosol.

Airepure are a NATA accredited organisation that complies with the requirements of ISO/IEC 17025:2005 (Airepure Australia Accreditation Number: 19257).

We provide a range of professional on-site testing services as part of your cleanroom certification to the ISO 14644-1 Cleanroom Standards.

• Access is required to the relevant air handling unit related to the HEPA filter to be tested, so the test aerosol can be introduced.

These services include:

• The air system should be operating as normal for the duration of the HEPA test, so the introduced test aerosol will be pulled through the HEPA filter.

• Room pressure differential testing

• HEPA filter integrity testing • Particle counting • Assessment of room air change rates For more information, visit www.airepure.com.au

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REGULARS

THE TIMES, THEY ARE A CHANGING! Sharon Pestonji has been unveiled as the first full time appointment in the 30 – year history of the Chartered Institution of Building Services Engineers (CIBSE) Australia and New Zealand Region.

Engineering Institutions are facing some huge challenges, not least with their aging male dominated membership base.

The Chartered Institution of Building Services Engineers (CIBSE) is the peak professional body worldwide for Building Services Engineers, and the Australia New Zealand Region not only recognises the problem, but has taken action through the appointment of Sharon Pestonji – their first ever Business Development Manager.

I appreciate the scale of the challenge, but CIBSE ANZ Region is made up of a great team of volunteers who are passionate about delivering a better future, and their positive attitude is inspirational.”

Sharon has already hit the ground running, contacting a number of Universities around Australia and New Zealand, and will soon roll out a series of initiatives to encourage the best and brightest to step up.

Sharon will be attending the CIBSE ANZ Seminar Series 2017 – Getting Smart About Metering in Sydney on 23 March, and looks forward to meeting members and delegates at this event.

For more information, email CIBSE ANZ Secretary Paul Angus via pangus@cibse.org.au

Sharon, who has returned to Australia after 12 years in Europe, is charged with shaking up the membership mix, attracting more students and in particular more women to the industry.

“Building services engineering is great profession, and with the environmental challenges that society now faces, I am really excited to be playing a part in encouraging the next generation to step up.

ASCOM MYCO 2 –

THE POWER OF A HEALTHCARE PLATFORM IN A SMARTPHONE A smart handset developed specifically for healthcare, this important update to the Android-based Ascom Myco incorporates significant refinements following its initial launch in 2015. The new Ascom Myco 2 includes key requests from customers, resulting in improved usability, durability and most crucially, an expansion of its role as a critical clinical tool that delivers truly integrated workflow intelligence in the hospital.

The Ascom Myco 2 now features:

Designed to tackle workflow inefficiencies identified by nurses such as the need to multi-task and juggle multiple interruptions, the Ascom Myco 2 is a work horse, mobilising information and connecting the constantly changing caregiver team regardless of where they are within the hospital.

• Google Mobile Services & access to Google Play store

• Android™ 5.1 Lollipop with mission-critical extensions • Higher resolution screen • Improved power management • Headset support (via micro USB) • Near Field Communication (NFC)

For more information visit www.ascom.com

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REGULARS

FLOWTECH NATIONAL Flowtech National is a privatelyowned company operating for over 25 years. We are Australia’s leading HVAC commissioning & critical environment certification firm.

Our Clinical Department is headed

by Mr Graeme Perry Our NATA accredited services extend from Construction projects to Operating Hospitals, pharmaceutical manufactures and anyone who requires NATA accredited testing of their controlled environments.

Flowtech Engineers are both highly trained and experienced, having completed internationally recognised training and accreditation both within Australia and abroad.

This experience combined with our innovative online reporting and ISO 17025 quality management systems, ensures our clients receive a quality product and required support.

Other specialist departments in the company include: 1. Independent Testing and Balancing 2. Clean Room and Clinical Validation (NATA Licence: 19187) 3. Pharmaceutical and Clinical HVAC Preventative Maintenance 4. Building (BET) and Duct Pressure Testing (NEBB Accredited) 5. Pipework Flushing and Cleaning (BSRIA) 6. HVAC Preventative Maintenance We welcome all calls and expressions of interest, so do no hesitate to contact us and experience the difference.

For more information visit www.flowtechac.com.au

STOP DRAIN FLIES AND ODOURS EMANATING FROM HOSPITAL WASTE SYSTEMS The Grate Seal one-way valve and the Grate Seal Bucket Trap offer low-cost, effective solutions to common issues within waste systems, are simple to install and are made here in Australia.

Installation is fast and easy, with no need for a water seal or for any alterations to existing outlets. The existing grate is simply removed, the pipes cleaned and the Grate Seal inserted, before the grate is reinstalled.

The Grate Seal one-way valve prevents drain flies, hazardous sewer gasses, soap suds and vermin from entering habitable areas from waste pipes and drains.

Conversely, the Bucket Trap is designed to prevent any unwanted debris from entering the hospital’s wastewater system.

It is a flexible rubber one-way valve, specially designed to fit straight into an existing waste outlet. The valve doesn’t restrict flow – the Grate Seal can easily cope with the maximum allowable flows from plumbing fixtures.

The Bucket Trap is the most cost effective product of its kind on the market and is the simplest to install, without any disturbance to the existing surface.

The Grate Seal one-way valve can prevent unwelcome breakout from waste pipes in many areas, such as showers, laundries, plant rooms and toilet areas. Three sizes of product are available covering all common waste pipe diameters and the product is suitable for PVC, Copper, Cast Iron, HDPE and Earthenware pipes.

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It’s suitable for a wide range of applications such as kitchens, laundries and plant rooms. The product can be installed within 100mm PVC & HDPE pipes of any drainage outlet style, including trench grating.

For more information call Grate Seal on 1300 393 913 or email sales@grateseal.com.au.

REGULARS

Port Douglas

Mackay

South Pacific Laundry specialises in the provision of quality linen and supplies for the customer service, hospitality and healthcare industries SPL provides:

Adelaide

• A 365 day service to all its clientele with a 24 hour turnaround.

• A leading edge technology in RFID to assist housekeeping and managerial staff in time reduction and efficiency.

South Pacific Laundry (SPL) has been a provider of commercial laundry and linen services to the hospitality and healthcare industries in Melbourne for the last 20 years.

Currently, the South Pacific Group is establishing a strong network of modern laundry across Victoria, New South Wales, Queensland, Western Australia and South Australia with plans for several more facilities up the East Coast of Australia in 2017.

The relocation of our Sydney operations to a new larger facility in Bankstown together with the relocation of our Brunswick plant to Broadmeadows will establish South Pacific Laundry as the single largest privately owned laundry in Australia and in the Southern Hemisphere.

Contact Robert Teoh National PR & Marketing P: (03) 9388 5300 M: 0421 716 888 Coverage Australia wide

Pricing Information Contact supplier direct Delivery Free daily delivery within 25km city metropolitan areas Minimum Order Contact supplier direct

• Dedicated account managers and experienced support staff who are available 7 days a week.

• A dedicated software design package and centralised billing system enables seamless transactions, paperless and customised reports.

• Delivery rationalisation systems, providing and streamlining efficient delivery routes which will reduce the company’s carbon footprint.

• Building of partnerships and sharing benefits with the customers from savings made through its constant laundry process innovations and group purchasing power of linen products.

• Dry cleaning, Uniform cleaning services, Housekeeping services, Dust mat hire and Cleaning services.

• Provision and supplying of Corporate uniforms/work wears and customised hotel room Amenities.

Full Contact Information South Pacific Laundry 9-23 King William St Broadmeadows VIC 3047 P: (03) 9388 5300 F: (03) 9387 2399

*Broadmeadows, Albury only

E: customerservice@southpacificlaundry.com.au robert.teoh@southpacificlaundry.com.au

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The perfect solution for clean steam generation The Spirax AH-CSG Clean Steam Generator is the solution to your sterilization steam generation needs Clean steam to AS/NZS 4187:2014 requirements Compact design - maximum output with minimum footprint Minimal installation and commissioning requirement from a pre-assemble unit Repeatable steam quality delivered under all design conditions

Capabilities

Support

• •

Spirax Sarco can provide installation and turnkey solutions for your clean steam generation needs including clean steam distribution systems, plant steam modifications and steam quality testing.

• • • •

Steam generation capacity up to 300kg/hr Clean steam operational pressures 3 barg to 5 barg Control via local process controllers Foot print 1650 mm (L) x 800 mm (W) x 2050mm (H) On board feed water degassing and heating system Maintenance and service Agreements to suit your requirements

Spirax Sarco clean steam generators are supported nationally with service departments in each state offering service agreements to suit your needs.

Spirax Sarco Pty Ltd Head office 14 Forge Street Blacktown NSW 2148 T +61 2 9852 3100 E info@au.spiraxsarco.com

spiraxsarco.com/global/au