CHF Fall 2015

Canadian

HealthcareFacilities JOURNAL OF CANADIAN HEALTHCARE ENGINEERING SOCIETY

Volume 35 Issue 4

RAISING THE BAR Interior Health receives top nod for Kelowna PM#40063056

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CONTENTS

CANADIAN HEALTHCARE FACILITIES Volume 35

Issue 4

Kevin Brown kevinb@mediaedge.ca PUBLISHER/ÉDITEUR

16

EDITOR/RÉDACTRICE Clare Tattersall claret@mediaedge.ca SENIOR DESIGNER/ CONCEPTEUR GRAPHIQUE SENIOR

Annette Carlucci annettec@mediaedge.ca

NATIONAL SALES/ REPRÉSENTANTE COMMERCIALE CANADA

Stephanie Philbin stephaniep@mediaedge.ca

PRODUCTION MANAGER/ Rachel Selbie DIRECTEUR DE rachels@mediaedge.ca PRODUCTION

DEPARTMENTS

SUSTAINABILITY

6

8

22 Revolutionary Road Interior Health’s journey to a sustainable future

Editor's Note President's Message

10 Chapter Reports 12 Announcements 14 CHES Gallery

CHES AWARDS

26 Technology at Work EMIS helps hospitals with conservation efforts

PRODUCTION COORDINATOR/ COORDINATEUR PRODUCTION

CIRCULATION MANAGER/ Maria Siassini DIRECTEUR DE LA marias@mediaedge.ca DIFFUSION CANADIAN HEALTHCARE FACILITIES IS PUBLISHED BY UNDER THE PATRONAGE OF THE CANADIAN HEALTHCARE ENGINEERING SOCIETY. SCISS JOURNAL TRIMESTRIEL PUBLIE PAR SOUS LE PATRONAGE DE LA SOCIETE CANADIENNE D'INGENIERIE DES SERVICES DE SANTE.

CHES

28 Food for Thought Putting healthcare facilities on a green diet

Canadian Healthcare Engineering Society

SCISS

Société canadienne d'ingénierie des services de santé

PRESIDENT VICE-PRESIDENT PAST PRESIDENT TREASURER

16 Leading by Example Interior Health honoured for excellence in healthcare facilities management 18 Journey of Honour Past president recognized for outstanding contribution to healthcare engineering 20 Healthy Competition Maritime Chapter nudges out rivals to become second President’s Award recipient

32 A Healthy Dose of Green Scarborough Hospital champions sustainability to reduce costs, waste 34 Under the Microscope Healthcare stakeholders can help make hospital labs greener 38 Designed for Disaster

Boston-area hospital addresses impacts of climate change

Committed to service excellence Structural Restoration Structural Engineering Building Science Parking Facility Design

Read Jones Christoffersen Ltd. Engineers 4 CANADIAN HEALTHCARE FACILITIES

SECRETARY EXECUTIVE DIRECTOR

Mitch Weimer Preston Kostura Peter Whiteman Sarah Thorn Craig B. Doerksen Donna Dennison

CHAPTER CHAIRS

Newfoundland & Labrador: Brian Kinden Maritimes: Robert Barss Ontario: Roger Holliss Manitoba: Craig B. Doerksen Saskatchewan: Al F. Krieger Alberta: Tom Howard British Columbia: Steve McEwan FOUNDING MEMBERS

H. Callan, G.S. Corbeil, J. Cyr, S.T. Morawski CHES

MAINTENANCE 40 Hospital Repair 911 New approach to project funding gets the process moving

Karlee Roy karleer@mediaedge.ca

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EDITOR'S NOTE

WINDS OF CHANGE IT SURE DIDN’T FEEL LIKE AUTUMN for much of the country until midOctober. If it hadn’t been for the CHES National Conference, I would’ve sworn it was still summer. Generally held in mid to late September, this year’s event technically took place last season, with the first sitting of the Canadian Certified Healthcare Facility Manager (CCHFM) exam (following the conference on Sept. 23), kicking off fall.

It was fitting that the 2015 National Conference occurred around the change in seasons as there was a changing of the guard at this year’s event. The conference ushered in a new National board, with former vice-president Mitch Weimer elected as the organization’s new president.

As always, the conference included the Society’s annual awards presentation ceremony, which took place during the gala banquet. Two groups, Interior Health and CHES Maritime, and one distinguished individual, John (J.J.) Knott, were honoured by the Society. You can read all about their outstanding achievements beginning on pg. 16.

We then turn our attention to this issue’s main theme: Sustainability. In this section, three hospitals share their inspiring journeys to becoming greener. We also look at: how energy management information systems can improve energy efficiency (pg. 26); advancements in hospital food service that can help healthcare facilities further conserve (pg. 28); and best practices for making one of the worst environmental offenders in hospitals — clinical laboratories — more eco-friendly (pg. 34).

Rounding out this issue is our regular CHES member Q&A. Denis Pellichero with Nova Scotia’s Department of Transportation and Infrastructure Renewal, Healthcare Project Services (TIR), provides insight into a new approach that has been implemented to identify, prioritize and approve a long list of hospital repair projects in the province.

Clare Tattersall claret@mediaedge.ca

Reproduction or adoption of articles appearing in Canadian Healthcare Facilities is authorized subject to acknowledgement of the source. Opinions expressed in articles are those of the authors and are not necessarily those of the Canadian Healthcare Engineering Society. For information or permission to quote, reprint or translate articles contained in this publication, please write or contact the editor.

Canadian Healthcare Facilities Magazine Rate Extra Copies (members only) $25 per issue Canadian Healthcare Facilities (non members) $30 per issue Canadian Healthcare Facilities (non members) $80 for 4 issues A subscription to Canadian Healthcare Facilities is included in yearly CHES membership fees.

6 CANADIAN HEALTHCARE FACILITIES

La reproduction ou l’adaptation d’articles parus dans le Journal trimestriel de la Société canadienne d’ingénierie des services de santé est autorisée à la condition que la source soit indiquée. Les opinions exprimées dans les articles sont celles des auteurs, qui ne sont pas nécessairement celles de la Société canadienne d’ingénierie des services de santé. Pour information ou permission de citer, réimprimer ou traduire des articles contenus dans la présente publication, veuillez vous adresser à la rédactrice.

Prix d’achat du Journal trimestriel Exemplaires additionnels (membres seulement) 25 $ par numéro Journal trimestriel (non-membres) 30 $ par numéro Journal trimestriel (non-membres) 80 $ pour quatre numéros L’abonnement au Journal trimestriel est inclus dans la cotisation annuelle de la SCISS.

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PRESIDENT'S MESSAGE

REFLECTING ON THE PAST, LOOKING TO THE FUTURE AS SUMMER DREW TO A CLOSE, the pace of activity for CHES picked up dramatically. The 2015 National Conference planning committee was busy finalizing plans for the organization’s biggest event of the year. As vice-president of CHES National, I was the executive liaison for the conference. Luckily for me, the Alberta Chapter and National office had things well in hand. This provided some time to reflect on my two-year term as vice-president, which was coming to a close. CHES accomplished so much during this time under the guidance and watchful eyes of past president, J.J. Knott, and president, Peter Whiteman. I count myself fortunate to have had such great mentors. I’d like to thank them and the CHES National board for the past two years of support. I am humbled by the trust placed in me by CHES members to now provide guidance to, and a watchful eye over, our great organization.

Thanks to everyone’s efforts, this year’s National Conference in Edmonton was a great success. The Alberta Chapter truly knocked it out of the park, setting a new national standard. From the opening reception at the Art Gallery of Alberta to the gala banquet, everything went so right. The hypnotist had us rolling in the aisles before we handed out this year’s CHES Awards to three worthy recipients. J.J., who served as National president from 2011 to 2013, received the Hans Burgers Award for his outstanding contributions to healthcare engineering. Interior Health was the recipient of the Wayne McLellan Award of Excellence in Healthcare Facilities Management, and the Maritime Chapter was recognized with the President’s Award for its commitment to education, administration and representation in the activities of the chapter and National board. The educational component of the conference was top-notch, from the keynote speaker to the individual sessions to the trade show floor. I’d like to personally thank Preston Kostura, Tom Howard and everyone else on the conference team for a great time in Edmonton.

It was with great pride that our president was able to personally welcome the new Saskatchewan Chapter into CHES. He and Al Krieger, president of the Health Facilities Resource Council (HFRC) of Saskatchewan, were instrumental in this incredible achievement, which is the culmination of many years of work. As the incoming president of CHES, I would like to personally welcome the HFRC as the Saskatchewan Chapter.

While in Edmonton, the CHES National executive met for its national board meeting and a strategic planning session. Both were fruitful, and we believe we have some challenging yet achievable plans for the next two years.

I would like to personally thank the following individuals for their service and commitment to CHES as they transition out of their executive posts: Robert Barss (treasurer), who remains on the National board as a chapter chair; Randy Cull (secretary), who is the new incoming chair of the communications committee; and J.J. Knott (past president).

I am thankful to be supported on the National board by Preston Kostura (vicepresident), Craig Doerksen (treasurer), Sarah Thorn (secretary), Peter Whiteman (past president), and chapter chairs, Brian Kinden (Newfoundland & Labrador), Robert Barss (Maritime), Roger Holliss (Ontario), Craig Doerksen (Manitoba), Al Krieger (Saskatchewan), Tom Howard (Alberta) and Steve McEwan (British Columbia).

Mitch Weimer President, CHES National

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CHAPTER REPORTS

ONTARIO CHAPTER

NEWFOUNDLAND & LABRADOR CHAPTER

The conference organizing committee has had a significant task finalizing the location/venue for the 2016 Ontario Chapter Conference & Trade Show.

For some reason, many of the candidate venues/cities were already booked. Typically, we’ve had a decent choice of potential sites the summer before an event. The conference organizer is now in the final stages of confirming details that will have KitchenerWaterloo host next year’s spring conference.

The Ontario Chapter continues to develop its relationship with two green third party associations: Healthcare Energy Leaders Ontario (HELO) and the Coalition for Green Health Care. Regular discussions revolve around how the Ontario Chapter can assist in the growth of these two agencies, both financially and from a promotional/endorsement standpoint. Of course, the assistance ultimately has to have a positive impact on chapter members.

The Ontario Chapter is meeting with the Firestop Contractors International Association (FCIA) this fall to discuss whether there is a benefit of working together to improve the knowledge base and physical status of fire-stopping in Ontario hospitals. The goal would be to develop a long-term relationship where FCIA takes a regular active role in chapter conferences and some standalone sessions.

The FCIA recently invited the Ontario Chapter to guest speak at its Ottawa symposium, with the purpose of sharing Canada’s federal/ provincial fire-stopping experience.

On the education front, the chapter awarded a series of bursaries this past quarter. It is looking to expand this offering to further promote facility management career opportunities, in general, and in healthcare, specifically.

Financially, we have received the “all clear” from our third party financial audit. There were no financial issues and it confirmed the Ontario Chapter is in good financial shape.

The new executive team is looking forward to making headway on initiatives that were put in motion by its predecessor. The first formal meeting with the new executives/directors was held at the CHES National Conference in Edmonton. Three other meetings are being scheduled for the remainder of the year.

The Newfoundland & Labrador Chapter had an outstanding Professional Development Day in May. The success of the event has prompted us to expand the day to a full education conference next year.

The chapter has been discussing hosting the CHES National Conference.

The chapter had a marginal increase in membership this year. It is currently fiscally sound.

For some time, we have been operating without a vice-chairman.

Discussion around nominations will take place this fall to fill the vacant position.

The chapter is currently working with the Newfoundland & Labrador Construction Association (NLCA) and the Canadian Standards Association (CSA) to offer an infection prevention course in St. John’s, Nfld., this spring.

—Roger Holliss, Ontario Chapter chair

SASK ATCHEWAN CHAPTER It has been a very busy year. The process of transitioning from the Health Facility Resource Council (HFRC) to the Saskatchewan Chapter of CHES has been a lot of work. We have initiated a Member of the Year Award in celebration of the conversion.

I attended the CHES National Conference in Edmonton, Sept. 20-22, on behalf of HFRC. The annual fall conference and trade show is still scheduled to be held Oct. 25-27, in Regina, at the Hilton DoubleTree.

We are still on solid ground financially and have committed to hosting the CHES National Conference in 2019.

—Alan F. Krieger, Saskatchewan Chapter chair 10 CANADIAN HEALTHCARE FACILITIES

—Brian Kinden, Newfoundland & Labrador Chapter chair

MARITIME CHAPTER The Maritime Chapter has been busy working on several initiatives.

It has been agreed that the chapter will offer a 50 per cent rebate on the Canadian Certified Healthcare Facility Manager (CCHFM) exam cost to any Maritime Chapter member who wishes to write it.

The Maritime Chapter continues to offer free registration for CHES webinars.

Further effort will be given to encourage participation from the New Brunswick Vitalité Health Network.

The conference planning committee is working on developing a conference planning manual.

The Maritime Chapter Education Day is quickly approaching.

To be held Nov. 17, in Truro, N.S., a variety of speakers are scheduled to address front line staff.

Next year’s spring conference has been moved to May 17-19, to coincide with the national MEET (Mechanical Electrical Electronic Technology) show in Moncton, N.B. This will enable members to attend both events. One item that will be expanded on is the opportunity for hospital maintenance staff to attend the exhibit hall. A trial done at the last conference was well-received.

The chapter will also support a Canadian Healthcare Construction Course (CanHCC) session in conjunction with the conference, to be held May 20-21. Members are encouraged to speak to their contractors regarding attendance at this program.

The chapter has been able to balance its books while offering several financial incentives to members in the way of bursaries, webinars and other rebates. At present, assets are approximately $50,000.

Maritime Chapter associate member, Kerry Fraser, is working with the National corporate/associate member advisory council to encourage participation from chapter corporate/associate members.

—Robert Barss, Maritime Chapter chair

CHAPTER REPORTS

BRITISH COLUMBIA CHAPTER Our executive team has had a very busy year. Planning of the 2016 National Conference is well underway. The theme is, “Risky Business: Is Healthcare Sustainable?”

We are pleased and excited to host the next conference in Vancouver, at the Vancouver Convention Centre. The host hotel is the world famous Pan Pacific. It is a great opportunity to showcase the city and push the limits for our national conference.

We are proud to have Mitch Weimar as the newly elected CHES National president, and Sarah Thorn as the CHES National secretary. I am confident they will work hard for the national board.

MANITOBA CHAPTER

The 2015 CHES National Conference was held in Edmonton Sept. 20-22. The trade show was sold-out, delegate registration reached more than 150 and sponsorship goals were met.

The Alberta Chapter held its annual general meeting in conjunction with the national conference.

Following the conference was the first sitting of the Canadian Certified Healthcare Facility Manager (CCHFM) examination.

CHES is very proud of this new designation and hopes it becomes an industry standard. Information on the certification program is available on the CHES website.

2016 is a nomination year, so if you are interested in becoming part of the chapter executive, please contact myself or anyone else on the current executive team.

The Manitoba Chapter has been busy planning two education opportunities: one for fall 2015, in conjunction with the Manitoba Building Expo; the other for spring 2016, which is the chapter’s annual education day.

On Oct. 6, the chapter presented an education session at the Manitoba Building Expo, which is a partnership of the Manitoba chapter of the Building Owners and Managers Association (BOMA), Winnipeg Construction Association and the Mechanical Contractors Association of Manitoba. The chapter supported the event in two ways: CHES Manitoba members were able to attend the province’s largest buildings trade show and CHES education session for free, and their attendance at the keynote luncheon with Gen. Rick Hillier was paid for; and the Manitoba Chapter arranged to have Ian MacDonald from RJ Bartlett Engineering Ltd. present, “Fire Safety During Construction.”

The 2016 Manitoba Chapter Education Day will take place April 28. A committee comprised of the chapter executive, CHES members and industry partners have begun to form ideas around next year’s topic of energy management. We will be electing new officers on the education day so look for nomination information in late 2015.

Recently, we’ve seen several CHES members retire (including the chapter’s secretary, Gary Yuel), promoted and transferred to other healthcare positions, and some move from healthcare into the support/construction industry, and visa versa. The chapter’s goal is to continue to serve these members — regular and corporate/associate, new to the industry and veterans — in order to promote the practice of healthcare engineering as a professional body, career and difference-maker in society.

—Tom Howard, Alberta Chapter chair

—Craig B. Doerksen, Manitoba Chapter chair

—Steve McEwan, B.C. Chapter chair

ALBERTA CHAPTER

CALL FOR NOMINATIONS FOR AWARDS 2016 Hans Burgers Award for Outstanding Contribution to Healthcare Engineering DEADLINE: April 30, 2016

2016 Wayne McLellan Award of Excellence in Healthcare Facilities Management DEADLINE: April 30, 2016

To nominate: Please use the nomination form posted on the CHES website and refer to the Terms of Reference.

To nominate: Please use the nomination form posted on the CHES website and refer to the Terms of Reference.

Purpose The award shall be presented to a resident of Canada as a mark of recognition of outstanding achievement in the field of healthcare engineering.

Purpose To recognize hospitals or long-term care facilities that have demonstrated outstanding success in completion of a major capital project, energy efficiency program, environmental stewardship program, or team building exercise.

Award sponsored by

For nomination forms, Terms of Reference, criteria and past winners: www.ches.org / About CHES / Awards Send nominations to: CHES National Office ches@eventsmgt.com Fax: 613-531-0626 FALL/AUTOMNE 2015 11

ANNOUNCEMENTS

HFRC TO BECOME NEW CHES CHAPTER THE HEALTH FACILITY RESOURCE COUNCIL (HFRC) of Saskatchewan was incorporated Aug. 1, 2000, with the main activities listed as “work to enhance healthcare facilities.” It was established by a group largely made up of architects, engineers and healthcare professionals.

HFRC’s membership has been somewhat unique in that there has always been involvement from healthcare facility professionals, suppliers to healthcare facilities, architects, engineers and government officials, among others. The diversity of the group has benefitted all involved in the organization. Each faction has gained perspective from the others’ experiences and backgrounds.

Like every volunteer organization, HFRC has had its share of ups and downs but has remained relatively stable over the years. Its social events are well-attended, and open communication has always been present and fruitful.

As announced at the CHES National Conference, HFRC is currently in the process of becoming a chapter of CHES, and will soon be known as Canadian Healthcare Engineering Society–Saskatchewan Chapter (CHESSK). HFRC’s board and membership have already voted and approved the transformation. New bylaws have been written and ratified, and approved by CHES’s National board. The board has also accepted HFRC’s offer to become CHES-SK. Only the legal process of changing HFRC’s corporate entity remains, along with determining the effective dates of the transition details.

The transition process has been fairly smooth (once it finally got moving.) HFRC’s bylaws and objectives were already close to typical CHES chapter bylaws. The same for HFRC’s annual general meeting and conference, which were similar in format and content to CHES conferences.

Many HFRC members also held CHES memberships, so they were already on board and helped with the process. That being said, it did take awhile to overcome some internal resistance. But with time, people realized it was more of an evolution than a change — a natural progression to adapt to the current environment — and began to embrace it.

I want to personally thank CHES executive members, Peter Whiteman and Mitch Weimer, for assisting with the education of HFRC’s board and membership, and their unwavering support of HFRC’s executive throughout the process, as well as CHES executive director, Donna Dennison. This has been a long process, spanning approximately four years from first discussions to the probable date of conclusion. HFRC is honoured to formally become part of the CHES family, filling the gap that existed in Saskatchewan. With the end now in sight, I’d like to extend a warm thank you to everyone at CHES. We look forward to the future.

—Al Krieger, president, Health Facility Resource Council, Saskatchewan Inc. 12 CANADIAN HEALTHCARE FACILITIES

s Outgoing CHES National president, Peter Whiteman, with Al Krieger, president of the Health Facility Resource Council and newly created CHES Saskatchewan Chapter.

CORRECTION: The Hospital for Sick Children (SickKids) is the first paediatric hospital in North America to automate the monitoring of staff hand hygiene compliance using the DebMed Group Monitoring System. A sidebar, "Hand Hygiene Monitoring Goes High-Tech," in the Summer 2015 issue mistakenly omitted the DebMed technology.

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CHES GALLERY

CHES RE-ENERGIZES AT ANNUAL CONFERENCE ONCE AGAIN, THE CHES NATIONAL CONFERENCE was a great success. Held in Edmonton at the Shaw Conference Centre Sept. 20-22, this year’s three-day conference surpassed expectations, setting a new national standard. The 35th annual event boasted a sold-out trade show floor and 21 sponsors. Attracting nearly 700 participants and 240 delegates, it was well-attended as in past years. The educational program, based around the conference theme, “Healthcare Facilities and the Technology Highway,” was both engaging and inspiring.

Conference highlights included the Great CHES Golf Game, a facility tour of the Kaye Edmonton Clinic and Mazankowski Alberta Heart Institute, University of Alberta Hospital, the gala banquet and presentation of the annual CHES Awards, and the first exam sitting for the Canadian Certified Healthcare Facility Manager (CCHFM) certification program.

14 CANADIAN HEALTHCARE FACILITIES

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CHES AWARDS

LEADING BY EXAMPLE

Interior Health honoured for excellence in healthcare facilities management

O

ver the past decade, the number of LEED-certified (Leadership in Energy and Environmental Design) healthcare facilities has increased in every region of the country. Despite this, there is a notion that true sustainability isn’t attainable once a hospital becomes operative. One of Canada’s largest health authorities is proving otherwise, though.

In May 2007, Interior Health embarked on a $432.9 million capital construction project. Consisting of approximately 1.3 16 CANADIAN HEALTHCARE FACILITIES

million square feet spread across 50 kilometres, the Kelowna and Vernon hospitals project is essential in meeting both the short- and long-term demand projections, while setting the stage for appropriate healthcare delivery throughout the region and across the wide spectrum of services required by the residents of the southern interior of B.C. The project includes a new patient care tower (Centennial building), clinical academic campus (for the University of British Columbia) and parkade at

CHES AWARDS

s Sam Campese (Interior Health), Lesley Wasyliw (Black & McDonald) and Ken Stewart (Infusion Health), flanked on either side by Honeywell sponsor representatives Lori Hunter (left) and Luis Rodrigues (right).

Kelowna General Hospital (KGH), and a new patient care tower (Polson Tower) at Vernon Jubilee Hospital (VJH) — all of which have achieved a LEED gold rating — as well as major renovations to existing space at both hospitals. Since the project’s inception, an additional clinical support laboratory (Dr. Walter Anderson building) was added at KGH, and the top two floors of the VJH patient care tower fit-out.

“The goal was to achieve the highest level of environmental sustainability that we could strive for,” says Norma Malanowich, chief project officer and corporate director of capital planning for Interior Health. “The fact that we accomplished this across four new buildings in two cities is what sets this project apart as an industry leader across Canada.”

The high level of LEED certification also played a pivotal role in Interior Health’s

recent CHES award win. It joined the ranks of other highly esteemed health authorities and hospitals when it was presented with the Wayne McLellan Award of Excellence in Healthcare Facilities Management at this year’s National Conference in Edmonton.

Green initiatives included removing suspended solids and other contaminants from stormwater during construction to prevent release into the local sewer system; incorporating native plants into landscaping that require no irrigation once established; utilizing recycled and regional construction materials; installing low-flow fixtures to reduce potable water consumption by 40 per cent; instituting facility-wide recycling programs to divert waste from landfills; and using high-performance glazing and insulation, energy-efficient equipment, automatic lighting controls, and occupancy sensors that set back temperatures and ventilation rates to reduce energy consumption.

Savings for both natural gas and electricity consumption in the new buildings have far exceeded expectations. The design and construction base energy target was 2.13 GJ/m2 per month. The energy target has been calculated to an operating efficiency target of 1.14 GJ/m2 per month.

To further improve efficiencies, Interior Health took a new, innovative approach to site facility management, which includes all non-clinical plant maintenance and related services. As part of the public-private partnership (P3) agreement with Infusion Health — a consortium of companies

engaged to deliver the largest single investment in the health system for the interior of B.C. — Black & McDonald was contracted for a 30-year term to preserve the integrity of not just the new structures but all of the existing ones at the two hospital campuses as well.

“No other health authority in Canada has taken this whole-site facility management approach,” says Malanowich. “It provides integration, standardization and consistency of service on these two sites.”

The key to the success of the approach has been the early participation of, and transition with, the facility management service provider. Black & McDonald was involved in the specification and design for the construction and ongoing maintenance of the new buildings. It helped put into place the required expertise and defined accountabilities to ensure the facilities, mechanical systems and infrastructure were built and, subsequently, would be maintained to the highest quality standards for the life of the buildings. Taking over responsibility of the existing facilities early on in the contract, well before the new buildings were commissioned, has also led to a stronger management regime within the new facilities.

“If it wasn’t for the entire team’s commitment to partnership, good communications and willingness to be flexible in decision-making, this first-of-itskind journey wouldn’t have been so smooth,” notes Malanowich.

FALL/AUTOMNE 2015 17

CHES AWARDS

JOURNEY OF HONOUR

Past president recognized for outstanding contribution to healthcare engineering

J

ohn J. Knott, simply known as J.J., has spent much of his professional life working tirelessly to promote, improve and support the field of healthcare engineering. Even after retiring in December 2014, he continues to devote much of his time to advancing this sector and Canada’s healthcare industry as a whole. His relentless dedication and continued enthusiasm to raise the bar for healthcare is what garnered Knott much praise from his peers at this year’s CHES National Conference, where he was presented with the 2015 Hans Burgers Award for Outstanding Contribution to Healthcare Engineering.

“I felt very humbled and at the same time elated that they thought I was worthy of joining the ranks of past award recipients,” says Knott. “My thanks go to all those people who have supported me, worked with me, mentored me and shared my passion.”

Throughout the years, Knott has worked with many exceptional individuals, though they are likely to attest that he’s the extraordinary one. From the day he stepped into his role as director of plant operations at Norfolk General Hospital (NGH) in 1991, Knott has been instrumental in implementing positive change. During his 23-year tenure, he oversaw a major makeover of NGH, which included a new emergency department, intensive care unit, X-ray area, cafeteria and front entrance, and made the hospital more energy-efficient. His accomplishments have been lauded both privately and publicly. In 2008, the hospital won the CHES Wayne McLellan Award of Excellence in Healthcare Facilities Management for its energy and environmental stewardship (of which he played a significant role in), and he was personally awarded the Individual Leadership Award at the Ontario Hospital Association’s 2014 HealthAchieve conference for his contribution to reducing NGH’s environmental impact and inspiring the hospital to “go green.”

The same year that Knott began his storied career at NGH, he embarked on what has 18 CANADIAN HEALTHCARE FACILITIES

s Outgoing CHES National past president, J.J. Knott, with incoming vice-president, Preston Kostura. become a fruitful journey with the Canadian Healthcare Engineering Society. Since joining the membership rank of what was then Region 5 of CHES Ontario, Knott has held most executive positions within the chapter, including president when he led it through a period of growth. During this time, he concurrently sat on the National executive and was elected CHES National president in 2011. In his term, he fostered a strategic partnership with the Canadian College of Health Leaders (CCHL) and strong relationships with affiliated engineering partners, including the American Society for Healthcare Engineering (ASHE) and the International Federation of Hospital Engineering (IFHE). In addition to holding leadership positions, Knott has volunteered his time to sit on various National committees, and has been a staunch supporter and advocate of the organization, particularly on other healthcare-related groups’ boards, such as the Canadian Coalition for Green Health Care (CCGHC). He is currently vice-chair of the CCGHC, where he is the lead on Healthcare Energy Leaders Ontario ( H E LO ) , a p ro g r a m c re at e d i n partnership with CHES Ontario in 2014.

“Originally funded through the Ontario Power Authority (OPA), HELO provided a free service to help healthcare facilities across the province assess and identify opportunities

for energy conservation projects, initiate them and then see them through to completion,” explains Knott.

In the 12 months that Knott led the initiative, the HELO program saved the Ontario healthcare sector $2.4 million in utility costs and obtained $3.8 million in incentive savings (for a total of $6.2 million in savings).

Although no longer supported by the OPA, HELO continues to offer the same services for a nominal fee.

In addition to these professional commitments, Knott continues to teach the nine-module building operators certification course for the IESO (Independent Electricity System Operator), as well as hospital building systems courses at Seneca College, where he has mentored more than 300 students over the past four years. He’s also a member of the Who Did It Club in his hometown of Simcoe, Ont. Servicing Norfolk County, it provides short-term supply of medical equipment, such as wheelchairs, hospital beds, walkers and canes, free of charge to persons recovering from cancer-related procedures, surgeries or illnesses.

“I’ve been very fortunate and have had a great career, so I believe in giving back and doing what I can to support the folks that are working in facilities management, specifically, and healthcare, in general,” he says. “It’s a good feeling. It’s a good thing.”

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CHES AWARDS

HEALTHY COMPETITION

Maritime Chapter nudges out rivals to become second President’s Award recipient

T

s Maritime Chapter team: Helen Comeau

(vice-chair), Gordon Jackson (treasurer), Robert Barss (chair) and Denis Pellichero (past chair).

20 CANADIAN HEALTHCARE FACILITIES

here’s nothing like a bit of friendly competition to bring out the best in people. And CHES’s President’s Award does just that.

“It really drives the chapters to work harder,” says Maritime Chapter chair, Robert Barss, about the award, which he accepted, along with three members of the Maritime executive, on behalf of the chapter at this year’s National Conference in Edmonton.

Created in 2014, the purpose of the President's Award is to foster engagement and encourage chapter participation in executive and committee work. The trophy is presented annually to the CHES chapter that demonstrates its commitment to education, administration and representation in the activities of the chapter and National board. The judging process involves evaluating and scoring each chapter on their accounting practices, conference/education day, membership, chapter executive practices, committee work and additional offerings.

Specifically, points are given for activities that benefit members and the work of the organization, such as number of meetings attended in the course of committee work and special education sessions.

“We were elated to be bestowed this honour,” says Barss, whose chapter also received two national conference registrations and expenses to a maximum of $2,500 for its win. “It shows how much work we’ve put into supporting the organization as well as our membership.”

This past year, the Maritime Chapter pulled off two successful conferences that were held just seven months apart — the 2014 National Conference in Saint John, N.B., and its annual spring conference and trade show in April 2015.

Continuing its commitment to the professional development of members and their staff, the chapter is organizing an education day for Nov. 17, which highlights such topics as legionella, infection control, life safety, energy management and preventive

measurement practices. To be held in Truro, N.S., it is free to all Maritime Chapter members as well as hospital front line workers and long-term care maintenance and operations staff.

“It’s very important that our members have the opportunity to be educated and become more professional,” says Barss, who became chapter chair in September 2014.

“We’re continually giving back to our membership by utilizing some of our finances for different activities.”

These include offering free webinars, a 50 per cent rebate on the Canadian Certified Healthcare Facility Manager (CCHFM) exam cost, and funding a bursary program.

Renamed last year in memory of Per Paasche who helped established the Maritime Chapter, a $1,000 grant is presented annually to a family member of a Maritime Chapter member to assist with their post-secondary education. This year’s recipient was Kyle Bouchie, son of chapter member Joe Bouchie, who is studying mechanical engineering at Dalhousie University in Halifax.

As far as the work of the Maritime Chapter goes, it is actively encouraging increased involvement of the francophone sector of New Brunswick’s Vitalité Health Network and developing a relationship with the CHES National corporate/associate member advisory council. In September 2014, the chapter established the associate chair position (currently held by Kerry Fraser of CBCL Ltd.) on its board for this purpose.

The Maritime Chapter is the only local branch of the Canadian Healthcare Engineering Society that has a corporate/ associate member on its executive team.

“This position is important because the support of our corporate/associate members is essential to CHES,” explains Barss. “They help create the financial backing that we need to move forward as an organization.

Without their commitment, and the commitment of all CHES members, the Society wouldn’t be where it is today.”

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SUSTAINABILITY

REVOLUTIONARY ROAD Interior Health’s journey to a sustainable future

By Tanja Stockmann

D

ecisions made in all aspects of healthcare, including waste creation and disposal, energy use, water consumption, transportation and purchasing, have an impact on the environment and the health of those who live in it. To reduce the risk of harm to its staff, residents and communities, Interior Health has embarked on a journey to minimize the ecological impact of its operations and improve its carbon footprint.

ZERO FOOTPRINT

Interior Health’s large carbon footprint is due in part to the sizeable geographic region it serves. Encompassing more than 216,000 square kilometres, it includes four regional hospitals, two tertiary hospitals, 24 healthcare centres, 16 community hospitals and residential care sites with approximately 6,600 beds.

In addition to occupied beds, more than 1,500 physicians, 19,000 staff and 4,800 volunteers work in facilities across the southern interior of British Columbia.

Keeping the organization running optimally requires a lot of energy, paper,

s Kelowna General Hospital includes the Centennial building, Dr. Walter Anderson building, the University of British Columbia's clinical academic campus and the new Interior Health and Surgical Centre, all of which were designed and built to LEED (Leadership in Energy and Environmental Design) gold standards.

footprint, reducing it wherever possible and offsetting emissions annually so that the remaining emissions are net zero.

MULTIPLE BOILER REPLACEMENTS WERE COMPLETED WITHIN THE LAST 12 MONTHS, WHICH ARE ANTICIPATED TO SAVE MORE THAN $30,000 PER YEAR IN UTILITY COSTS. and fleet vehicles — all of which account for Interior Health’s greenhouse gas (GHG) emissions profile. The majority of the organization’s emissions are derived from fossil fuels to heat its healthcare facilities.

Interior Health has measured its GHG emissions profile since 2010, in an effort to become carbon neutral. Achieving carbon neutrality requires calculating the carbon 22 CANADIAN HEALTHCARE FACILITIES

In the last five years, the organization has invested in more than 200,000 tonnes of carbon offsets, which is equivalent to preventing more than 80,000 litres of gasoline from being consumed or taking approximately 44,000 cars off the road for a year.

BUILDING GREEN

Interior Health has made a commitment to

reduce energy consumption in its buildings, both new and old.

The recently opened Interior Heart and Surgical Centre in Kelowna, B.C., was built to LEED (Leadership in Energy and Environmental Design) gold standards, and showcases the use of B.C. timber products in accordance with the province’s Wood First Act. In Cranbrook, B.C., the upgraded intensive care unit at East Kootenay Regional Hospital provides an enhanced care environment for patients by optimizing mechanical system performance. Multiple boiler replacements were completed within the last 12 months, which are anticipated to save more than $30,000 per year in utility costs while preventing approximately 560 tonnes of emitted carbon dioxide equivalent in the atmosphere.

A major LED lighting upgrade was completed last year at Royal Inland Hospital in Kamloops, B.C. This is

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SUSTAINABILITY anticipated to reduce electrical use by 679,000 kilowatt hours per year — enough to power approximately 42 homes annually.

Planning is underway to determine the feasibility of linking the Enderby Health Centre to a district energy biomass plant in its community, which could reduce energy costs by 25 per cent as well as reduce GHG emissions by 135 tonnes.

SMART CONSERVATION

Interior Health is continually optimizing

recycling opportunities. Working with a consumer battery stewardship organization, staff across multiple facilities has adopted a free battery recycling program. This ensures batteries don’t end up in landfill and, at the same time, avoids any unnecessary costs for battery waste disposal.

To reduce emissions from vehicles, I n t e r i o r H e a l t h h a s i n c re a s e d communications to promote carpooling to and from work. It is currently exploring the feasibility of ride-sharing

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TRUE COMMITMENT

Driving Interior Health’s efforts to reduce energy and GHG emissions is its staff, many of which are involved in conservation projects.

Every person’s actions matter and it is those actions that helped the organization effectively halt emissions growth in 2014.

A n e w l y d e ve l o p e d Wo rk p l a c e Conservation Awareness (WCA) program supported by BC Hydro will further encourage employee action and support for a permanent culture of conservation within the organization. The WCA program will consist of energy roundtables, energy efficiency webinars and regional competitions to build on the awareness and education aspect of energy management.

Plant services employees will take the lead in creating momentum because they have a direct role in turning energy conservation projects into reality.

To engage employees outside plant services, Interior Health has created a comprehensive internal web page, which provides information about, and resources related to, the organization’s energy use and GHG emissions. As well, a new platform, known as “sustainability associates,” has been created to connect informed and environmentally passionate staff who want to promote sustainability goals and raise awareness of ways to reduce Interior Health’s carbon footprint. Concurrently, an organization-wide electronic newsletter is regularly sent to staff to keep “all things green” current and top of mind.

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Interior Health conserves paper resources through various operational paper-saving initiatives. In 2014, the organization reduced the amount of paper it consumed by more than 10,000 packages, due largely to smart printing practices and increasing its use of more post-consumer recycled content paper.

As well, Interior Health participated in a pilot study to determine the feasibility of using alternative sources of paper, such as wheat paper, to reduce GHG emissions associated with paper manufacturing.

Tanja Stockmann is manager of environmental sustainability at Interior Health, which ensures publicly funded health services are provided to the people of British Columbia’s southern interior. She can be reached at tanja.stockmann@interiorhealth.ca.

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FALL/AUTOMNE 2015 25

SUSTAINABILITY

TECHNOLOGY

AT WORK

Energy management information system helps two New Brunswick hospitals with conservation efforts

By Kate Butler

M

any Horizon Health Network facilities have undertaken building system upgrades, which have resulted in energy cost avoidances. To further boost its energy efficiency, the health authority has implemented a low-cost project that measures, monitors and manages energy consumption and demand to uncover low-hanging fruit. The result: Engaged staff and cost avoidances of more than $220,000 in just one year.

MAKING ENERGY VISIBLE

An energy management information system (EMIS) software package was added to the building management systems at two New Brunswick healthcare facilities — Miramichi and Saint John Regional Hospitals. The chosen software tool was a feasible solution that had much potential with its energy dashboards, reports, alerts and alarms, and its live tie-in to the building management systems.

26 CANADIAN HEALTHCARE FACILITIES

EMIS elevates awareness by making energy visible. Building operators, energy coordinators and managers, chief engineers and senior managers can view the energy performance of their hospital in customized dashboards to meet their needs. The energy dashboards assist in determining where energy is being wasted, either by human misjudgement, maintenance issues or technological reasons. The outcome is a continual ability to better manage energy use, which has resulted in a reduction of energy consumption and, subsequently, operational costs.

TAKING MONITORING SKILLS TO THE NEXT LEVEL

Through the use of the tool, Miramichi and Saint John Regional Hospitals have been able to detect performance issues and operational inefficiencies.

Fo r e x a m p l e, i n M i r a m i c h i ’s physiotherapy department, the airhandling unit is scheduled to function in

tandem with its hours of operation — Monday to Friday from 8 a.m. to 4 p.m.

Through monitoring the electrical consumption of the return and supply fans, it became apparent that the airhandling unit was not operating as it should. Building operators were able to quickly and easily make adjustments. As a result, up to $4,000 in annual electrical spend was avoided. Without the dashboards, the malfunctioning airhandling unit may have gone unnoticed for an extended period of time.

In another instan c e, b u i l d i n g operators at Miramichi noticed the steam used for the hospital’s domestic hot water system greatly increased in November 2014, over the baseline ye a r. A f t e r i nve s t i g at i o n , it was determined that hot water was running continuously in the kitchen (almost 12 hours a day) after a timer malfunctioned This was again picked up almost immediately by dashboards in August

SUSTAINABILITY

2015, and rectified. The wasted water and steam approximated 20,000 to 30,000 litres and 9,000 pounds per day, respectively. The annual cost avoidance: $135,000.

Energ y dashboards were also instrumental in managing natural gas demand this past winter at Saint John Regional Hospital. Connecting the natural gas meter to EMIS at the time of setup allowed historical daily demand to be reviewed. It was recognized that contract demand was only being reached on the few coldest days of the year. Effort was made to decrease the maximum natural gas demand by offsetting peak demand days with oil-produced steam. The benefits are twofold: The contract demand will be reduced by the utility company in the following contract year, realizing more than $30,000 net in annual demand cost avoidance; and the back-up oil is being consumed, decreasing the amount of oil remaining in the tanks over an extended

period of time. Demand gauges have now been created, which indicate when demand is nearing the set target; in turn, oil is burned rather than natural gas for the remainder of the 24-hour period.

ACHIEVING IMPROVED ENERGY EFFICIENCY

EMIS is much more than a tool used for comparison and interpretation of data, though. Because it is integrated with the building management system, the software tool can also be used to measure and verify the results of energy upgrades, and to help identify and justify similar energy improvements in other facilities.

Take Saint John Regional Hospital as an example. The 1 million-square-foot hospital boasts more air-handling units than a typical healthcare application — 32 to be exact — as well as four boilers (three 800 HP, and one 600 HP). Variable frequency drives were installed on the feed water

pumps of each of the 800 HP boilers as well as on two air-handling units' supply and return fans. The ability to monitor energy consumption before and after the installation (through the creation of meters and trend logs on the building management system and EMIS), allowed building operators to easily verify savings from this measure. The actual savings were then presented to Horizon’s energy committee — created in 2013, to provide leadership and direction in the reduction of energy consumption at all of the health authority’s facilities — in order to secure funding to roll out EMIS at a number of other hospitals, with even more positive outcomes expected.

Kate Butler is the energy manager for health services at Service New Brunswick (SNB), the province’s new centralized common services organization. SNB supports the Horizon Health Network with a cost-effective strategy for energy management. Kate can be reached at kate.butler@snb.ca.

FALL/AUTOMNE 2015 27

FEATURE SUSTAINABILITY

FOOD FOR

THOUGHT

Putting healthcare facilities on a green diet saves money, the environment

By Hillary Bisnett & Janet Howard

H

ealthcare facility managers are under constant pressure to tighten budgets and be as efficient as possible while meeting the hospital’s overall goal of providing excellent patient care. Despite these constraints, healthcare teams have made great strides in recent years to reduce energy and water consumption, and waste. One often-overlooked opportunity to further conserve, though, is in the hospital food service department. Even small changes in this area can have a positive impact on the environment and a hospital’s bottom line.

HEALING POWER OF FOOD

Hospitals are, first and foremost, places of healing and health promotion. Many 28 CANADIAN HEALTHCARE FACILITIES

healthcare organizations are now expanding this focus to include helping patients adopt healthy habits that keep them well over time. Diet changes are a critical component of promoting lifelong health and it begins during a patient’s hospital stay.

Poor diet is a major risk factor for obesity, high blood pressure, heart failure, stroke and kidney disease, the World Health Organization (WHO) reports. Promoting healthier food options in hospital cafeterias and on patient menus can help lessen the risk of these nutrition-related chronic diseases, which place a significant cost burden on individual healthcare organizations and the healthcare system as a whole. Patients that eat well, stay well longer. They also develop chronic conditions across their lifetimes at a much lower rate.

SUSTAINABILITY

Serving healthy food items — organic, local and/or sustainable — in healthcare organizations remains a challenge, though.

The initial purchase is often cost-prohibitive compared with more processed, conventional foods. However, adopting smart purchasing practices, changing portion sizes and implementing waste reduction measures can lessen and even remove the budgetary impacts of serving fresher fare.

THE INCREDIBLE HEAP

Every year, 35 million tonnes of food waste is thrown away in the U.S. This wastefulness has a huge environmental impact. Not only does all the energy and water that went into food production go down the drain but rotting food waste also produces a tremendous amount of methane — a potent greenhouse gas (GHG) that is more harmful to the environment than carbon dioxide.

According to the Environmental Protection Agency, 20 per cent of the country’s GHG emissions are generated in landfills.

Hospitals contribute significantly to the problem of food waste. Between 10 and 15

per cent of a hospital’s waste stream is comprised of food.

The first step in reducing food waste is to examine the hospital’s purchasing practices and patient menus to make sure that as much of the food coming through the front door is being used. This is an effective way to determine where food waste is occurring and, subsequently, how it can be prevented.

Another cause of food waste generation is overproduction. Reducing portion sizes, cooking to order, providing room service and adjusting meals based on the volume of leftovers can further help trim waste.

The nature of a hospital setting is such that a certain amount of food waste is inevitable. Composting is not only an environmentally responsible but costeffective measure to reduce the amount of scraps sent to landfill (after internal food waste has been curtailed).

Ongoing staff and patient education, both before instituting a composting program and after, is key to ensuring its success. Changes in behaviour require ongoing communications and dialogue in order to make them “stick.”

ON THE CHOPPING BLOCK

The University of California, Los Angeles (UCLA) Health System is just one U.S. hospital that has instituted a successful composting program in recent years. With a food budget of close to $6.7 million, UCLA serves more than 1,000 patient meals and reports approximately 4,000 cafeteria transactions per day at its 535-bed facility. Even with that volume, UCLA diverts between six-and-a-half and seven tonnes of food waste per month from landfills through its composting program. This waste includes not just food scraps but compostable cups, plates and utensils as well.

UCLA has a contract with a waste hauler that collects its food scraps three times a week and then takes the material to a facility where it is turned into fertilizer. Much of the food waste is ground up by a pulper machine in the kitchen beforehand. The machine allows UCLA to compress its food waste down in volume, by squeezing out excess liquid.

To encourage composting in its cafeteria, UCLA has made the process as straightforward as possible for patrons.

FALL/AUTOMNE 2015 29

SUSTAINABILITY

Many food containers are compostable. Signs have been placed above every waste container throughout the facility to inform people about which bins hold compost and recyclables. In addition, UCLA uses the word “landfill” instead of “garbage” to help remind patients, staff and guests that throwing something away actually means just moving it somewhere else.

FULLY EQUIPPED

The food service and healthcare industries are the most energy-intensive sectors in the economy. When combined, energy costs can reach staggering heights if not carefully monitored.

Food preparation makes up a large percentage of a food service’s energy bill — approximately 30 per cent, with refrigeration costs running between 13 and

CHURNING OUT ANTIBIOTIC-FREE MEAT The University of Vermont (UVM) Medical Center in Burlington, Vt., is striving to have the greenest healthcare food service in the U.S. In addition to introducing room service to reduce food waste and growing food on-site in its healing garden, the academic hospital is serving patients, visitors and staff organic, locally sourced ingredients, including antibiotic-free meat.

UVM Medical Center’s decision to alter its food purchasing choices was based on a growing body of evidence that has linked the routine overuse of antibiotics in meat and livestock to the increase in drug-resistant bacteria, which is a threat to the long-term efficacy of antibiotics for human use.

Since introducing its long-term antibiotics reduction plan in 2010, UVM Medical Center’s purchase of antibiotic-free meat has grown from 35 per cent to well over 50 per cent today. It has come at a price, though. Natural meat is more expensive than meat from animals raised on antibiotic-laden feed. But UVM Medical Center considers the cash injection well worth it when the high cost of treating MRSA (methicillin-resistant Staphylococcus aureus) infection in patients is factored in. Still, the hospital is always looking at ways to cut costs, and has since become creative with its beef purchases, using less expensive cuts like flank, top round and ground beef.

30 CANADIAN HEALTHCARE FACILITIES

18 per cent. Then there’s the water heater, exhaust hoods and HVAC systems, which together total the majority of energy used in a food service facility.

However, hospital kitchens, with their basement real estate and outdated equipment, are often the last place where energy efficiency investments are made despite that energy- and waters av i n g e q u i p m e n t p a y s f o r i t s e l f relatively quickly.

Today, there is a growing amount of commercial and institutional food service equipment available that carries the Energy Star label or is deemed highly efficient by research organizations like the Food Service Technology Center (FSTC) and the Consortium for Energy Efficiency (CEE).

Energy Star-rated cooking equipment includes fryers, steam cookers and hot food holding cabinets. FSTC also has a diverse list of commercial cooking equipment that has undergone its efficiency testing. It includes combination ovens, convection ovens, rack ovens, fryers, large vat fryers, griddles, insulated holding cabinets and steam cookers.

Also known as “compartment steamers” or simply “steamers,” steam cookers designed with efficiency in mind can save significant amounts of electricity, gas and water. Convection ovens also offer great energy savings along with big rebates, which sometimes can help cover a good portion of the purchase cost.

On the water front, Energy Star’s sister program, WaterSense, has created standards for pre-rinse spray valves, which can account for nearly one-third of the water used in a typical commercial kitchen. The maximum flow rate for WaterSense-labelled models is 1.28 gallons per minute (gpm) — 0.32 gpm less than the federal standard.

Replacing just one pre-rinse spray valve with an eco-friendly model can save more than 7,000 gallons of water per year, which is equivalent to the amount of water needed to wash approximately 5,000 racks of dishes.

Hillary Bisnett is the national procurement director for the Healthy Food in Health Care (HFHC) program at Health Care Without Harm. Janet Howard is the director of member engagement and the Healthier Hospitals program at Practice Greenhealth.

IRC_CHF_Fall_2015_FINAL.pdf

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2015-10-13

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FALL/AUTOMNE 2015 31

SUSTAINABILITY

A HEALTHY DOSE OF GREEN

Scarborough Hospital champions sustainability to reduce costs, waste

By Julie Dowdie

T

he linens are far from the only thing that’s “green” at The Scarborough Hospital (TSH) these days. Over the last several years, TSH has implemented a series of initiatives to make the hospital more environmentally friendly.

In 2011, TSH introduced reusable textile surgical gowns. Although disposable paper gowns were introduced several years prior to replace cotton and linen, the hospital returned to textile because of its benefits.

Not only does it provide less static than paper, but newer textile weaves and blends are far more efficient barriers to fluids than the previous cotton and linen gowns of decades ago. This improves comfort for the surgical team and helps the hospital reduce what it sends to landfills.

In 2013, TSH took the operating room (OR) textile initiative a step further. Working with its medical supply manufacturer/ distributor and textile supplier, TSH introduced the Complete Delivery Hybrid System for delivering OR supplies. The system begins with the hospital’s manufacturer/distributor shipping “custom packs” of single-use medical supplies required for a specific surgical procedure to its textile supplier. The textile supplier then adds the appropriate reusable linens (gowns, towels and other textiles), and ships the bundles to the hospital based on its procedural needs. This standardization reduces errors, improves patient safety, and saves steps and money in ordering, picking and delivery. Its implementation has resulted in a substantial reduction in packaging waste and multiple handling of products within the 32 CANADIAN HEALTHCARE FACILITIES

SUSTAINABILITY

facility, as well as increased efficiency within and outside of perioperative areas.

The Complete Delivery Hybrid System project received funding from the Ontario Hospital Association (OHA), under its Green Hospital Champion Fund (GHCF) — an initiative that helps Ontario hospitals improve their environmental performance and reduce operating costs through the implementation of green projects.

Since its introduction, TSH has refined the Complete Delivery Hybrid System, removing items that arrived in single packs to purchase them in bulk. The hospital continues to look for opportunities to replace disposable items with textile options.

INHALING CLIMATE CHANGE

In addition to improving its textiles and medical supplies, TSH recently introduced new anesthesia delivery unit machines in its ORs. These machines have a safety engineered medical device component that reduces the flow of anesthetic inhalation gases. This, in turn, lessens the amount of waste anesthetic gases that are vented to the atmosphere through the OR scavenging system.

Modern inhalation anesthetics are known to be aggressive greenhouse gases (GHG) that have 2,000 times the impact on global warming than carbon dioxide.

CAMPUS CONSERVATION

Outside the ORs, TSH has been working with a leading energy efficiency and renewable energy company since 2012, to implement an energy savings project for its General campus. The goal is to

create a more comfortable indoor environment, reduce long-term operating costs and meet stringent environmental standards set by Ontario’s Ministry of the Environment and Climate Change.

Changes to date include: replacement of chillers and cooling towers responsible for air conditioning with two energyefficient models; installation of a heat exchanger that provides cooling in winter at a fraction of previous costs; boiler plant upgrades to capture wasted heat and reuse it to preheat domestic water; i m p rove d a i r- h a n d l i n g c o n t ro l s ; replacement of faulty steam traps; campus-wide installation of nearly 15,000 energy-efficient lamps and light fixtures; and toilet, urinal and faucet upgrades to reduce water consumption.

These efforts have resulted in some impressive improvements that have been well-received by patients, staff and visitors. The hospital now uses 70 per cent less energy in the General campus visitor parking garage, and has reduced GHG emissions in this area by 23 tonnes per year — the equivalent of taking five cars off the road. The bathroom fixture and facility-wide faucet upgrades have saved more than 22,600 cubic metres of water each year. This is equivalent to the annual water usage of 72 single-family homes, nine Olympic-sized swimming pools or two per cent of the City of Toronto’s average daily water use.

All of the upgrades were financed at no charge to the hospital and are funded solely by the energy cost savings generated by the retrofits over the long-term.

MOPPING UP WASTE

This fall, a new lightweight and environmentally sustainable microfibre mop system was introduced at the hospital, which is also helping to achieve significant water savings.

The hospital’s traditional wet loop mop system required seven to eight litres of water and cleaning solution to fill a mopping bucket. The new microfibre mopping system uses only four litres of water and cleaning solution to prepare 15 interchangeable cloth mops. It is estimated this project will conserve more than 1.3 million litres of water each year. Moreover, the new system is easier to manoeuvre, reducing the risk of bodily strain in housekeeping staff.

TSH also recently launched a project to increase environmental responsibility and sustainability across the hospital. Called the “green army,” the team’s goal is to improve the hospital’s waste diversion rate to 30 per cent by April 2016. Strategies include running a recycling awareness campaign targeted to staff, physicians, volunteers, patients and visitors, as well as examining and improving waste disposal practices in each area of the hospital.

Julie Dowdie is a communications officer at The Scarborough Hospital (TSH). Situated in one of the most diverse communities in Canada, TSH delivers a broad spectrum of services from two hospital campuses (Birchmount and General) and five satellite sites.

FALL/AUTOMNE 2015 33

SUSTAINABILITY

UNDER THE MICROSOPE Healthcare stakeholders can help make hospital labs greener

By Allison Paradise

34 CANADIAN HEALTHCARE FACILITIES

SUSTAINABILITY

T

he recent emergence of a green movement focusing exclusively on laboratories has illuminated many opportunities for energy and water savings in these spaces. Championed by a coalition of scientists, facility managers, engineers, designers, sustainability directors and non-profit organizations, the movement seeks to institutionalize sustainability in laboratories through the adoption of green lab programs. These programs, which are built upon four central pillars — energy, water, waste and “green chemistry” — have reached a wide variety of spaces, from university research labs to biotech, manufacturing and hospital (clinical) labs.

Because each space presents its own unique sustainability challenges, green lab programs tend to be custom designed to fit a facility’s needs. Clinical labs in particular require special consideration.

They often operate inside strictly regulated environments, where patient care is of paramount importance.

FULL OF ENERGY

Laboratories consume a substantial amount of energy — often as much as five times more than a typical office space. This is due to 100 per cent outside air requirements, high ventilation rates and energy-intensive equipment.

Ventilation rate optimization is an effective way of reducing laboratory energy consumption by 30 to 50 per cent.

Setback control strategies are often used to reduce hourly air change rates when a lab is unoccupied, usually during nights and weekends. Several studies have demonstrated significant energy savings by reducing air change rates from the typical 12 to 20 air changes per hour (ACH) to between six and eight ACH. Some facilities have even dropped their rates to four ACH in an unoccupied lab.

Ventilation systems are another source of energy savings. A single chemical fume hood can use as much energy as 3.5

households every day due to the large volume of air that must be moved through it. Broadly speaking, ventilation systems and fume hoods can be classified as constant air volume (CAV) and variable air volume (VAV). As these names suggest, a CAV fume hood has constant airflow, whereas the airflow in a VAV fume hood can be adjusted by changing the sash height. Because energy consumption in fume hoods is related to the volume of air flowing through them, reducing the airflow volume in a VAV

in the morning. Even a basic labelling system — ‘always leave on’, ‘ask before turning off ’, or ‘turn off before leaving’ — can be an effective driver of energy conservation.

WATER RUNNETH OVER

In addition to expending large amounts of energy, clinical labs consume a substantial amount of water. Though the extent of opportunities for water reduction tends to depend on the type of work being done in the lab, the near

A SINGLE CHEMICAL FUME HOOD CAN USE AS MUCH ENERGY AS 3.5 HOUSEHOLDS EVERY DAY DUE TO THE LARGE VOLUME OF AIR THAT MUST BE MOVED THROUGH IT. fume hood by closing the sash can result in up to 40 per cent energy savings.

Several large pieces of laboratory e q u i p m e n t , i n c l u d i n g f r e e z e r s, refrigerators, incubators and autoclaves, represent a substantial opportunity for energy savings. Ultra-low temperature freezers (-80 C) have been extensively ex a m i n e d fo r e n e rg y e f f i c i e n c y opportunities, with several studies demonstrating that certain brands use 50 to 70 per cent less energy than their competitors. For this reason, it is important to compare energy c o n s u m p t i o n d at a f ro m va r i o u s suppliers prior to making a large equipment purchase. When doing so, keep in mind that energy-efficient equipment might be costlier but the energy savings are often more than enough to justify the investment.

Energy consumption in labs can also be reduced by simply turning off equipment that is not in use or putting equipment into a standby mode if it cannot be turned off. Outlet timers can easily ensure equipment is turned off at night but ready for use when staff arrives

universal use of autoclaves in hospitals provides a relatively easy target for water savings.

Autoclaves are regularly employed to sterilize equipment, reagents and hazardous waste. They come in an array of shapes and sizes; some fit on a benchtop, while others are large enough to walk in.

Autoclaves consume water in two primary ways: steam generation and cooling the wastewater produced during the sterilization process. The steam generation process accounts for 30 to 50 gallons per day and the effluent cooling can consume up to 150,000 gallons of water per day. Putting autoclaves on a closed chilled water loop and outfitting them with a water-saving device can reduce their water consumption by between 30 and 90 per cent.

BREAKING THE CYCLE

Although the nature of the work performed in clinical labs does not always lend itself to reusing or recycling materials, items should be reused and/or recycled whenever possible.

FALL/AUTOMNE 2015 35

SUSTAINABILITY

GUIDING LIGHT There are many opportunities to decrease the amount of light that is used in a lab and, in some cases, reducing the type of lighting used can have a significant impact.

Turn off overhead lights when daylight is adequate and when leaving the lab. It’s better to turn lights on/off in quick succession than to leave them on all the time.

If more than one light switch is in a panel, mark the switches to indicate their function. Multiple light switches in a panel can be very confusing and lead to people either not using them or using them improperly.

Only use the amount of light that is needed for the task at hand. If working at a desk and not the bench, there is no need for all of the lights in the lab to be turned on; use a talk lamp instead.

Oftentimes, it is possible to remove several overhead fluorescent lamps (or simply not replace ones that burn out) and still have adequate light in the lab. Identify those that may be removed and leave hall lights off if standby lights are adequate.

Switch to LED or other efficient solid-state source light bulbs when a bulb needs replacing. Incandescent, fluorescent, mercury and metal halide bulbs use more energy than LEDs. This applies to overhead lights as well as to equipment lights, such as microscope bulbs.

Replace gas lasers (Argon, HeNe) with longer lasting solid-state lasers when possible. Gas lasers generate a lot of heat, requiring the rooms in which they reside to be kept much cooler than most other spaces, which can put a strain on the air conditioning in the building.

Many waste management companies accept at least some plastics from labs, provided the material is not contaminated or hazardous. Some manufacturers will take back their polystyrene containers. One glove manufacturer in the U.S. has begun a program to downcycle its nitrile gloves.

There are also well-known procedures for recycling xylene, a common chemical used in standard clinical lab protocols.

Since recycling can be difficult in a clinical setting, the best way to reduce waste is to curtail consumption. Purchasing products that use less material or are manufactured in a more sustainable manner is a great way to minimize waste from the outset. It is also advisable to use glassware instead of plasticware, whenever possible. Sharing equipment and reagents is another easy way to reduce waste, and, in the case of equipment, a great measure to maximize valuable real estate in the lab.

A QUESTION OF CHEMISTRY

The term ‘green chemistry’ refers generally to the selection and production of less hazardous chemicals and reagents. Reducing toxic chemical use in the lab is desirable for both the environment and employees.

Because many of the protocols used in hospital labs have been previously approved by a regulatory body, it is not easy to simply exchange one chemical for another, even if the efficacy of the substitution has been proven. One relatively simple way of reducing toxic chemicals in the lab is to eliminate the use of mercury. Hospital labs should avoid using mercury thermometers or mercury-based lighting for microscopy, replacing these highly toxic instruments with alcohol-based thermometers and solid state illumination sources, respectively.

GETTING TO TRUE SUSTAINABILITY

HGH is growing and bringing more healthcare services to better serve the Prescott-Russell community in Eastern Ontario. At the end of 2018, our major redevelopment project of $160 million will provide a new state-of-the-art, purpose-built facility with the latest in equipment and infrastructure. The stellar design will improve patient flow enhancing the patient and family experience.

HGH is proud to bring quality care, closer to home.

HAWKESBURY & DISTRICT GENERAL HOSPITAL 36 CANADIAN HEALTHCARE FACILITIES

Until recently, sustainability efforts in hospitals have focused on the low-hanging fruit, excluding more complex areas such as laboratories. As effective as some of these efforts have been, hospitals will not be able to truly attain goals of carbon neutrality, zero-net energy consumption and zero waste without fully incorporating laboratories into their sustainability programs.

Allison Paradise is the co-founder and executive director of My Green Lab, a U.S.-based non-profit organization that is dedicated to promoting sustainability in laboratories.

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FALL/AUTOMNE 2015 37

SUSTAINABILITY

s Patients at Spaulding benefit from huge triple-glazed windows with a view of Boston Harbour.

Photo courtesy Anton Grassl/Esto.

DESIGNED FOR DISASTER Spaulding Rehabilitation Hospital sets the standard for climate-resilient healthcare facilities

By Kent Waddington

B

uilt on a remediated brownfield adjacent to the former Charleston Navy Yard in Boston’s Inner Harbour, Spaulding Rehabilitation Hospital is one of the largest rehabilitation facilities in the U.S. Measuring 300,000 square feet, it is also one of the most resilient hospitals in the country, designed specifically with climate change in mind.

FLOOD RISK MITIGATION

Learning from hurricane Katrina and 38 CANADIAN HEALTHCARE FACILITIES

informed by scientific reports on climate change, the team responsible for Spaulding’s design focused on making the hospital as resilient to rising sea levels as possible.

The entry lobby and first floor amenities are situated 30 inches above the designated 500-year flood elevation and water-deflecting berms, one of which was constructed to help keep water out of the underground parking garage.

By raising the building above code

SUSTAINABILITY

requirements, the upper levels of the building can remain occupied and operational if the first floor is ever flooded. In the event of an impending flood, many of the first floor fixtures, including those in the lobby, conference centre and cafeteria, can be easily moved to prevent damage.

The green roof atop the in-patient therapy gym helps reduce the stress on stormwater and sewer systems, which can become overwhelmed during big storms.

Its soil and vegetative layers absorb rainwater, reducing runoff that could otherwise exacerbate localized flooding.

A significant and somewhat radical climate-proofing element includes the placement of all major mechanical components on the roof/penthouse level above the eight hospital floors.

This necessitated selling the local power authority on the merit of transferring their high-voltage electricity supply to the primary switchgear vault in the penthouse via a concrete chase from ground level (where the vault would traditionally be located).

is a power outage, daytime electric lighting could be kept to a bare minimum.

This would help conserve energy used by Spaulding’s two emergency generators, which are necessary to keep hospital equipment functioning in order to sustain human life.

ENERGY SHIFT

In addition to Spaulding’s resilience features, the hospital has taken steps to reduce its ecological footprint. Its high-performance building envelope with 40 per cent window-to-wall ratio, daylight harvesting systems, energyefficient lighting, Energy Star certified appliances and equipment, highefficiency chillers and boilers, and 250

kilowatt gas-fired combined heat and power (CHP) co-generation plant all serve to reduce energy consumption year-round. Extensive metering allows for monitoring of the building’s actual performance and adjustments to be made to improve energy efficiency.

This LEED (Leadership in Energy and Environmental Design) gold building was also designed with future renewable energy capabilities in mind. For instance, photovoltaic panels are to be mounted on the roof when the technology becomes more efficient and cost-effective.

Kent Waddington is the communications director at the Canadian Coalition for Green Health Care.

He can be reached at kent@greenhealthcare.ca.

t Opened in April 2013, Spaulding is a 132-bed rehabilitation teaching hospital located on the Boston waterfront. Photo courtesy Steinkamp Photography.

THE COMFORT ZONE

Acknowledging that hospital occupants may be called upon to shelter in place for an extended period of time during disaster, Spaulding was designed to allow a higher degree of occupant comfort while waiting out an incident.

Integral to the resiliency strategy are key-controlled, operable and screened windows in many offices, common areas and patient rooms, which, when opened, can help ameliorate interior temperature by providing fresh outside air.

High insulating values, exterior shade ledges and large high-performance tripleglazed windows also help to maintain a high level of interior comfort. Many offices rely extensively on natural light during daylight hours. As a result, if there

s The fuel gas booster located in the penthouse mechanical room is used to raise the pressure of the fuel gas to the operating level of the combined heat and power (co-generation) plant located on the roof.

Photo courtesy Kent Waddington Photography.

s The roof-mounted 250 kilowatt gas-fired co-generation plant produces both heat and power, adding to Spaulding’s ability to be energy-efficient and remain operational during times of natural calamity.

Photo courtesy Kent Waddington Photography.

FALL/AUTOMNE 2015 39

MAINTENANCE

HOSPITAL REPAIR 911 New approach to project funding gets the process moving

F

or years, Nova Scotia’s nine district health authorities and the IWK Health Centre requested grants from the Department of Health and Wellness (DHW) for hospital infrastructure repairs (both large and small) through the annual business planning process. Due to the large volume of requests and the limited availability of capital funding, though, the district health authorities only received monies for a small percentage of their total capital requirements — a common theme across the country. With little say in which projects were considered province-wide priorities (due to the way the selection system was originally set up), the district health authorities often felt removed from the process and, subsequently, frustrated.

However, much has changed with the introduction of a new approach to identifying, prioritizing and approving the long list of hospital repair projects in an environment of shrinking budgets and increased building requirements. Here, 40 CANADIAN HEALTHCARE FACILITIES

Denis Pellichero, manager of infrastructure for the Department of Transportation and Infrastructure Renewal, Healthcare Project Services (TIR), discusses the current methodology, which has changed the way funds are allocated for hospital repairs.

Why was the original funding allocation system deemed inadequate?

Every year, the DHW’s infrastructure repair and renewal committee — made up of five members from its infrastructure group — would review a multitude of priority hospital repair and renewal requests. The committee would discuss each project and assign a general definition lettering score that determined its province-wide priority ranking.

The problem with the original process was fourfold: the scoring process was subjective; there was too much grey area in the assessment system, making it difficult to justify why one project received priority ranking over another

that was similar in type; there was no mechanism to track decision-making, which hampered transparency; and while the scoring criteria used to assess funding requests was shared with the district health authorities, the districts played no role in developing it, resulting in a missed opportunity to create better buy-in and understanding of the funding allocation process.

How does the new system compare to the old?

The new system, which was first implemented in 2009, as a pilot project and has been used for the past six years, is based off of pairwise comparison — a methodology developed in 1927, and refined in the ‘60s by military institutions.

Basically, it’s a process that identifies and defines common decision-making criteria. It then assigns a weight and scoring scale to each criteria, introducing a more objective methodology to decision-making.

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MAINTENANCE In the case of DHW, pairwise comparison has allowed the infrastructure repair and renewal committee to determine the relative order (ranking) of district health authority submissions by assigning statistical weights to decision criteria. DWH identified and defined six decision criteria: safety; population impact; affect on operation; code, standard violations and liability; probability of failure; and time to implement. Every single decision criteria was then compared against each other, creating a ranked and associated scoring weight of importance. These rankings mean a criterion that is considered more important will contribute more to the final project score. Once the criteria were weighted, definitions were developed to assign scores between 0-10 to remove subjectivity (10 being serious, and zero being not serious). The higher the overall score, the higher the priority of the project.

The new approach offers a number of benefits over its predecessor: it is objective-based; the scoring system

h a s b ro u g h t c o n s i s t e n c y t o t h e evaluation of hospital repair funding requests; and there is actual evidence to support final decisions, which provides transparency and accountability.

T h e re h a v e b e e n a s s o c i a t e d advantages as well. The district health authorities started to work more cooperatively as they understood there was much to gain by doing so. Because each project receives a ranking (or number) in a given year, if there were any unspent funds from one project, it would be allocated to the next on the list. This encouraged the district health authorities to look for ways to come in under budget on their projects so that another could be completed for the greater good of the province’s healthcare system.

Has the process changed since its initial implementation?

In 2012, the Nova Scotia Office of the Auditor General reviewed the process and made a few recommendations,

which were immediately implemented to help strengthen the process. The most critical recommendation was that the district health authorities and the IWK Health Centre be more involved in the entire prioritization process. That occurred in 2014, and for fiscal year 2015/16, they dispersed all the grant money for hospital repair projects.

Since then, the provincial government amalgamated the nine district health authorities into the Nova Scotia Health Authority (NSHA).

Partnering with the IWK Health Centre, the newly developed health authority is responsible for planning and delivering primar y care, community health and acute care for Nova Scotians, effective April 2015.

In the new year, the DWH/TIR will turn the new system over to the NSHA to take the lead and manage, with government oversight. The NSHA is currently leading a new initiative to improve the system with a single source user input that helps complete a preliminary scoring activity.

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