CHF Spring 2015

Canadian

HealthcareFacilities JOURNAL OF CANADIAN HEALTHCARE ENGINEERING SOCIETY

Volume 35 Issue 2

NEW OAKVILLE HOSPITAL

PM#40063056

Ebola Preparedness Legionella Q&A AODA Update

Spring/Printemps 2015

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St. John’s NL – May 26-27, 2015 Whistler BC – June 10-11 2015 Calgary AB – June 16-17, 2015 Toronto ON – October 21-22, 2015 Check website www.ches.org for other dates & locations that may be offered in the future.

Registration is available online.

For further information:

CHES National Office Tel: 613-531-2661 | Fax: 866-303-0626 ches@eventsmgt.com | www.ches.org 4 Cataraqui Street, Suite 310 Kingston ON K7K 1Z7 Canada

www.ches.org

CONTENTS

CANADIAN HEALTHCARE FACILITIES Volume 35

Number 2

Kevin Brown kevinb@mediaedge.ca PUBLISHER/ÉDITEUR

14

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 CIRCULATION MANAGER/ Gill Daniels DIRECTEUR DE LA gilld@mediaedge.ca DIFFUSION

DEPARTMENTS

FEATURE

CANADIAN HEALTHCARE FACILITIES IS PUBLISHED BY UNDER THE PATRONAGE OF THE CANADIAN HEALTHCARE ENGINEERING SOCIETY.

6

8

14 Growing with the Times New Oakville Hospital keeps pace with community's healthcare needs

SCISS JOURNAL TRIMESTRIEL PUBLIE PAR SOUS LE PATRONAGE DE LA SOCIETE CANADIENNE D'INGENIERIE DES SERVICES DE SANTE.

Editor's Note President's Message

10 Chapter Reports

Canadian Healthcare Engineering Society

12 Announcements

INFECTION PREVENTION & CONTROL

REGULATORY UPDATE

20 Combating the Spread of Ebola Inside the University Health Network's preparedness plan

36 A Welcome Delay

Mandatory start-date for LEED version 4 postponed

24 Prepared, Not Scared Health Sciences Centre Winnipeg's response to Ebola outbreak

38 AODA Compliance Update 2015 requirements for Ontario employers

26 A Balancing Act

Designing for infection prevention 30 Reducing the Risk of Legionnaires' Disease

Proactive avoidance is the best practice 34 Clearing the Air

Ventilation strategies to mitigate HAIs

Innovative thinking. Practical results.

Structural Restoration Structural Engineering Building Science Parking Facility Design

4 CANADIAN HEALTHCARE FACILITIES

CHES

SCISS

Société canadienne d'ingénierie des services de santé

PRESIDENT

Peter Whiteman

VICE-PRESIDENT

Mitch Weimer

PAST PRESIDENT

J.J. Knott

TREASURER

Robert Barss

SECRETARY

Randy Cull

EXECUTIVE DIRECTOR

Donna Dennison

CHAPTER CHAIRMEN

Newfoundland & Labrador: Brian Kinden Maritimes: Robert Barss Ontario: Allan Kelly Manitoba: Craig Doerksen Alberta: Tom Howard British Columbia: Steve McEwan FOUNDING MEMBERS

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

4 Cataraqui St., Suite 310, Kingston, Ont. K7K 1Z7 Telephone: (613) 531-2661 Fax: (866) 303-0626 E-mail: ches@eventsmgt.com www.ches.org Canada Post Sales Product Agreement No. 40063056 ISSN # 1486-2530

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EDITOR'S NOTE

COMING FULL CIRCLE GROWING UP, I spent more time in hospitals than most kids. It wasn't because I was sick; my mother is a nurse, so it was inevitable that I'd find myself inside a healthcare facility. Her career spanned four decades and five hospitals, two of which she called home for a total of 34 years. In 2005, she retired as the executive director of operations for the cardiac program at the University Health Network.

Most newly constructed and renovated hospitals, and those being built today, differ greatly from the healthcare facilities my mother worked in. They're often bigger, brighter and "greener." Case in point is the new Oakville Hospital, which is our feature story. Targeting LEED (Leadership in Energy and Environmental Design) silver certification, the approximately 1.6 million-square-foot facility will be more than three times the size of the current hospital upon substantial completion this summer.

One of the reasons hospitals are growing in size is more space is required to control healthcare-acquired infections and the transmission of infectious diseases. However, bigger buildings result in greater travel distances for staff and patients as well as higher operating costs. In A Balancing Act, the authors address the need to reconcile this conflicting objective, among others, when designing hospitals for better infection prevention and control (IP&C).

On the topic of IP&C, we look at what two hospitals have done to prepare to care for known or suspected Ebola patients. Though cases of the potentially fatal disease are diminishing, the outbreak is not over and the virus is still a global threat until it is completely eradicated. As well, in our inaugural CHES member Q&A, Pinchin's Bernard Siedlecki addresses how healthcare facility managers can reduce the risk of legionnaires' disease.

Rounding out this issue is our regulatory update. Here, we look at LEED version 4 and AODA (Accessibility for Ontarians with Disabilities Act) compliance requirements for 2015.

I look forward to covering the topics of interest to the Canadian Healthcare Engineering Society, and gaining a better understanding of the issues facing the healthcare system in which my mom worked.

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

PROFESSIONAL DESIGNATION CLOSE TO BECOMING REALITY THIS WINTER, most of the country wasn't subjected to the environmental extremes of the previous year. However, I'm thankful spring is upon us and I trust this note finds everyone well.

The dictionary defines progress as "an advance towards perfection." CHES continues to advance "educational" opportunities that further healthcare engineering and maintenance for the betterment of the industry we serve. To that end, it is with great pleasure that I take this opportunity to bring everyone up-to-date on the progress the professional development committee has made in the advancement of the Canadian Certified Healthcare Facility Manager (CCHFM) designation. We are excited with the developments thus far and proud to report this very important initiative is preparing to launch. If all goes according to plan, we will hold the first exam sitting at the 2015 CHES National Conference in Edmonton this September.

With the support of the Canadian College of Health Leaders (CCHL), CHES' professional development committee, in conjunction with Seneca College, is working hard to develop the designation/certification process. Our goal is to create an industry-recognized certification program for you, the healthcare professional. This program will replace existing certifications and processes that have been difficult to achieve and provide limited recognition within the healthcare community.

We envision the new CCHFM designation will be nationally recognized by all healthcare professionals, leaders and employers. Certification will provide assurance that holders have met eligibility requirements of education and experience demanded by the industry. We further anticipate this designation will help employers and other healthcare professionals recognize your professional qualifications, opening the door for career advancement opportunities. It will also demonstrate your commitment to personal and professional growth and lifelong learning.

At present, we are working towards the completion of the exam as well as a selfassessment tool and handbook to help prepare eligible candidates for testing. The exam will be web-based, delivered through colleges across Canada. We are currently working out the details of the exam and administration process. Stay tuned for more information and reports as this initiative becomes a reality.

Peter Whiteman President, CHES National

8 CANADIAN HEALTHCARE FACILITIES

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CHAPTER REPORTS

ALBERTA CHAPTER

MANITOBA CHAPTER

Plans for the 2015 CHES National Conference in Edmonton are well underway. Past Alberta Chapter chair Preston Kostura and his team have been working hard.

The venue is booked, the preliminary schedule of speakers is complete and the companion program is being finalized. Vendor booth space and sponsorship spots are filling up quickly. The Great CHES Golf Game is booked, so register soon.

We will be hosting a Canadian Healthcare Construction Course (CanHCC) June 16 - 17, in Calgary. Details and registration information can be found on the CHES website.

This will be a busy year for the Alberta Chapter. I am looking forward to seeing everyone in the fall.

Manitoba Chapter members will have several education opportunities this year to help with the ongoing challenges and changes in our industry.

On April 21, the CHES Manitoba Chapter Education Day — Maintaining Building Envelopes: Keeping the Inside In and the Outside Out — will deliver excellent learning and networking opportunities. Prior to the conference, we encourage members to attend the Canadian Centre for Healthcare Facilities (CCHF) session on April 20, which will focus on the facility design process.

The session will review the integrated design process, implications of CSA Z8000 (Canadian Healthcare Facilities - Planning, Design and Construction) and CSA Z8002 (Operation and Maintenance of Healthcare Facilities), and include a tour of the host facility, Health Sciences Centre Winnipeg. Information will be forwarded to chapter members as it becomes available.

We are working to present a CHES member-focused fall session at the Manitoba Building Expo Oct. 6. This will provide Manitoba Chapter members with an excellent opportunity to explore CHES, the other sessions as well as the largest commercial building trade show in the province.

—Tom Howard, Alberta Chapter chair

BRITISH COLUMBIA CHAPTER Our executive team is currently busy planning the 2015 chapter conference, June 7 - 9, in beautiful Whistler, B.C. The theme: Transforming Healthcare through Technology. We have received 20 education abstracts to date and are looking forward to another quality education program. We have sold out all but one of the sponsorships and 76 per cent of the trade show floor is filled. In conjunction with the conference, we are hosting a Canadian Healthcare Construction Course (CanHCC) June 10 - 11, in Whistler.

We are pleased and excited that the B.C. Chapter will host the 2016 National Conference in downtown Vancouver at the Vancouver Convention Centre. This is a great opportunity to showcase the world-class city and push the limits for our national conference. I hope everyone sets a little extra time aside to visit.

We are now in the process of planning our grassroots program for this year’s conference to ensure our frontline members have an opportunity to attend. Our membership increased by almost 15 per cent in 2014, to an all time high of 255 B.C. Chapter members.

This past year, the B.C. Chapter awarded $15,000 in bursaries at six B.C. colleges and a total of $10,000 in educational grants to chapter members.

We recently reached out to the province's health authorities and are currently providing up to $3,000 per health authority for training in facilities management disciplines.

The B.C. Chapter executive received the President's Award at last year’s national conference in Saint John, N.B. The executive team worked very hard and we are proud to be the first recipients of this prestigious award. It truly is an honour to work with such a dedicated team: Mitch Weimer (past chapter chair), Norbert Fischer (vice-chair/conference chair), Sarah Thorn (public relations/secretary), Ken Van Aalst (treasurer), Mark Swain (communications/website liaison), Arthur Buse (membership) and Steve McTaggart (education).

The new executive is settling into its role. All CHES National committees have representation from the Maritime Chapter. Member representatives can be found on the CHES website.

Planning for the 2015 Maritime Chapter Spring Conference & Trade Show is advancing. A program of great speakers and activities is currently being organized. The conference will be held April 19 - 22 in Halifax, at the Delta Halifax. This year's theme: Supporting Healthcare Facilities. We are looking forward to strong support, and a significant member and exhibitor presence.

A separate education session is being planned for early September.

The present account balance is $12,000. Conference revenue has yet to be determined but is estimated to be $15,000.

The Maritime Chapter has committed to supporting a Canadian Healthcare Construction Course (CanHCC) at its 2016 spring conference in Moncton, N.B. The conference will be May 1 - 3, with the CanHCC to be held May 4 - 5.

The chapter has also agreed to fund the cost of sending its chair to the March 2016 strategic planning session in Vancouver.

The Maritime Chapter is investigating a program that would recognize long-standing members. A token gift would be presented to members based on their years in CHES.

—Steve McEwan, B.C. Chapter chair

—Robert Barss, Maritime Chapter chair

10 CANADIAN HEALTHCARE FACILITIES

—Craig B. Doerksen, Manitoba Chapter chair

MARITIME CHAPTER

CHAPTER REPORTS

NEWFOUNDLAND & LABRADOR CHAPTER It's with great excitement that we announce the chapter is in the planning stage for the 2015 CHES Newfoundland & Labrador Professional Development Day. It will take place May 25 in St. John's, Nfld., at the Capital Hotel. We have a number of speakers lined up, with topics ranging from nurse call systems and building automation to HVAC maintenance and roofing. We encourage all members to attend this very valuable education day.

We are also hosting a Canadian Healthcare Construction Course (CanHCC) May 26 - 27. We have been working with the Newfoundland and Labrador Construction Association, Canadian Construction Association (CCA) and CHES National over the past couple of months and are pleased to announce CanHCC has received accreditation as a gold seal program with the CCA. For those interested in attending the course, registration can be completed online at www.ches.org.

ARE YOU IN COMPLIANCE? THE 2010 NATIONAL BUILDING CODE OF CANADA AND THE 2010 NATIONAL FIRE CODE OF CANADA REQUIRE THE ROUTINE MAINTENANCE AND INSPECTION OF FIRE DAMPERS, FIRE-STOP FLAPS, FIRE DOORS AND FIRE-RATED WALLS. YOUR PROVINCE

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—Brian Kinden, Newfoundland & Labrador Chapter chair

ONTARIO CHAPTER This year, the Ontario Chapter Conference & Trade Show will be held May 24 - 26 in Ottawa, at the Ottawa Conference & Event Centre. As always, the conference will be a memorable event, with an education program that will be informative for all members.

Information will be distributed to members as it becomes available.

You can also keep up-to-date by visiting the website.

Following the conference, I will be stepping down as chair. I had a great time serving a double run. Roger Hollis will lead the executive in Ontario for the next two years.

2015 is an election year. We are looking for a secretary, treasurer and vice-chair. Nominations must be received by April 1.

Our membership and finances remain strong. We are planning an education half-day for March 25. It will be held at the Cambridge Hotel & Conference Centre. We are also looking at another CSA education day closer to summer.

As a reminder, the Ontario Chapter has started a scholarship fund for members whose children attend post-secondary school.

Details are available on the website.

As this will be my last chapter report, I would like to thank the following members of the executive for their ongoing dedication and commitment to the chapter: Ron Durocher, Roger Hollis, Jim MacArthur, Ed Davies, Jim Durocher, Jeff Weir, Richard White and Rick Anderson.

—Allan Kelly, Ontario Chapter chair

CORRECTION: The article, Lighting the Way, One Parkade at a Time, in the Winter 2014/2015 issue of Canadian Healthcare Facilities carried an incomplete byline. The authors of the piece are Chad Berndt and Kent Waddington. We apologize for the inaccuracy.

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SPRING/PRINTEMPS 2015 11

ANNOUNCEMENTS

B.C. CHAPTER HONOURED WITH PRESIDENT'S AWARD LIKE A BUSINESS, raising the profile of an organization's chapter takes time, patience and dedication. Over the past decade, the British Columbia Chapter executive has worked tirelessly, volunteering countless hours to elevate the local branch of CHES and it has paid off. The chapter is now on a stronger footing than it was in the mid-2000s — its membership has grown along with its educational offerings, and it has representation on all CHES National committees — and it was honoured for its efforts this past year with the first-ever President's Award.

"I'm thrilled that CHES National recognized the significant effort that everyone on the executive consistently puts forward to make the chapter successful," says B.C. Chapter chair, Steve McEwan, about the award, which he accepted on behalf of the chapter at last year's national conference in Saint John, N.B. The President's Award was created in 2014 to foster engagement and encourage participation in executive and committee work. It 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. Each chapter is scored on accounting practices, conference/education day, membership, chapter executive practices, committee work and additional offerings (from submitting articles to Canadian Healthcare Facilities to providing extra member benefits). Specifically, points are given for activities that benefit members and the work of the society, such as number of meetings attended in the course of committee work and special education sessions.

"We've really worked hard to strengthen our education component of our annual chapter conference," notes Mitch Weimer, who served as chapter chair for 4 years, from June 2010 to June 2014. "This has allowed us to attract higher quality speakers who are experts in their f ields, which is of more value to conference-goers."

The B.C. Chapter has also created a number of bursary programs to assist with education and training costs. Every year, it offers $1,000 grants to chapter members to help fund special education courses. It also invests in students at six provincial colleges through bursary funds. This past year it awarded a total of $15,000. Most recently, it committed to annually fund up to $3,000 per B.C. health authority for training in facilities management disciplines.

"We get a lot of satisfaction from helping out the healthcare community," says McEwan. "It's important to keep engineering and maintenance staff, as well as students studying in the field, engaged."

12 CANADIAN HEALTHCARE FACILITIES

CALL FOR NOMINATIONS FOR AWARDS 2015 Hans Burgers Award For Outstanding Contribution to Healthcare Engineering DEADLINE: March 31, 2015 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.

2015 Wayne McLellan Award of Excellence In Healthcare Facilities Management DEADLINE: April 30, 2015 To nominate: Please use the nomination form posted on the CHES website and refer to the Terms of Reference.

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

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FEATURE

GROWING WITH

THE TIMES Nestled on the shores of Lake Ontario between Toronto and Niagara Falls, Oakville is known for its picturesque harbours and vibrant arts and culture scene. By year's end, though, the lakefront community will also be coveted for its new hospital.

By Clare Tattersall

14 CANADIAN HEALTHCARE FACILITIES

Just shy of 1.6 million square feet, and with a price tag of $2.7 billion, the new Oakville Hospital is one of the largest healthcare redevelopments in Ontario.

It will provide up to 457 in-patient beds and offer a full range of health services, such as complex continuing care, rehabilitation and acute care, when it opens its doors in December. At that time, the hospital will replace the 450,000-square-foot Oakville-Trafalgar Memorial Hospital (OTMH), which can no longer accommodate the region's high rate of growth.

"The creation of the new Oakville Hospital is critical to ensure we are able to meet the healthcare needs of Oakville residents today and in the f u tu re, " s a i d H a l to n H ea l th c a re Services' (HHS) CEO and president, John Oliver, at the foundation pouring ceremony in June 2012.

OTMH was built more than 60 years ago on nine acres of land to serve a community of less than 20,000. Since then, Oakville's population has grown to more than 180,000. With no room to expand on the existing site and the

FEATURE

t TOP: The New Oakville Hospital is being built on a 50-acre greenfield on the north-west corner of Dundas Street and Third Line in O a k v i l l e , O n t . B OT TO M L E F T: S i m p l e circulation and way-finding systems will allow for accessible and convenient movement throughout the hospital. BOTTOM RIGHT: The hospital will improve the experience of patients and families. Amenities will include family rooms with kitchenettes.

hospital's aging infrastructure, building a new facility was really the only option.

So, HHS set out to make this a reality.

In 2005, it received approval from the Province to proceed with planning for a new replacement hospital in Oakville.

Six years later, it selected Hospital Infrastructure Partners — a consortium that includes Carillion Canada Inc., EllisDon Corp., Parkin Architects Ltd. i n j o i n t ve n t u re w i t h A d a m s o n Associates Architects, Fengate Capital Management Ltd. and Scotia Capital — to design, build, finance and maintain

t h e p ro j e c t . S h o r t l y t h e re a f t e r, construction broke ground and it has moved along smoothly ever since.

Today, less than five months out from substantial completion, slated for July 31, the project is still on time and on budget, which is quite the feat considering the aggressive timeline. In a public-private partnership (P3), public money is leveraged with private investment to fast-track critical projects.

"The schedule is always a challenge on P3s," notes EllisDon senior project manager, Jeff McKay, who adds that

this is the largest hospital project the construction services company has ever undertaken.

Designed as a campus-style hospital (at HHS' request), the new facility is comprised of three main sections: a fivestorey section for complex continuing care and rehabilitation that will also house a number of outpatient programs, such as nephrology, and includes the mechanical penthouse; a 10-storey in-patient tower that will contain patient bedrooms, operating theatres as well as pre- and post-operative support functions; SPRING/PRINTEMPS 2015 15

FEATURE

and a four-storey therapeutic and diagnostic imaging section that houses emergency care, diagnostic imaging, ambulatory clinics, maternal/child services, adult mental health and a penthouse. A fourth section serves as the main hospital entrance and connects the rehabilitation block to the in-patient tower block. A 400,000-square-foot, multi-storey parking garage adjacent to the facility will provide a total of 1,180 parking spaces.

"Other than building a nuclear plant, constructing a hospital is the most complicated thing to do," says McKay. The site conditions have made it easier, though. The hospital is being built on a 50-acre undeveloped site, or greenfield, to allow for future expansion. As a result, the construction team did not have to demolish, or work around, existing buildings; construction work has not been impeded by antiquated infrastructure, such as old sewer systems; and construction has not affected operations at the current hospital. However, the site hasn't been without its challenges.

Since it was essentially a farmer's field, there were no services to the area.

"There was no hydro, water, sewers, telephone or gas, so we had to bring in temporary services," explains McKay. "But I'd take a greenfield or a brownfield any day."

16 CANADIAN HEALTHCARE FACILITIES

A HEALTHY DOSE OF DESIGN

The new Oakville Hospital has been designed and is being built to LEED (Leadership in Energy and Environmental Design) silver certification — the highest standard to be achieved by a hospital in Ontario. The "green" design is expected to reduce the hospital's impact on the environment and provide staff, patients and visitors with the opportunity to experience the outdoor environment, which is considered an important part of the healing process.

Specifically, the facility offers exposure to nature via healing gardens, outdoor scenery and distant views of Toronto (to the east) and the Niagara Escarpment (to the west). Large expanses of doubleglazed windows allow natural light to infiltrate the core of the hospital, providing daylight to staff and patients who otherwise may not see natural light during the day.

"This allows people to understand the passage of time," explains John Christie, a director at Parkin Architects, which is responsible for the interior and clinical design of the new hospital as well as project and construction administration.

"Additionally, the more natural light that's brought into the centre of the

building, the less electricity that's needed to run artificial lighting."

The abundance of natural light is probably nowhere more pronounced than in the three-storey hospital lobby, which features huge floor-to-ceiling windows.

"We've also brought light in from the top of that space," notes Christie.

"People can look from the gardens on the roof down into the (lobby), and those arriving at the hospital can look up and see the gardens, and perhaps their loved ones, above."

A large, linear gas fireplace in the space reinforces the importance of light.

Visible from outside, the unique feature illuminates the hospital entrance in the evening and during the dark days of winter. It also serves as a warm welcome, with the goal of relieving some of the anxiety related to the hospital visit.

PATIENT-CENTRED CARE

Improving the patient experience is a key tenet of the hospital design.

Eighty per cent of the hospital's in-patient rooms are designed for single use. This not only enhances infection control but provides patients with increase quiet and privacy. It also means family can stay overnight.

FEATURE

Bathrooms are located on the corridor side of the patient room so that housekeeping does not have to intrude into the care zone and disturb the patient. They are also on the headside of the patient room. This allows patients to easily make the journey using handrails from bed to bathroom despite limited restrictions in mobility.

Other patient room enhancements include integrated bedside terminals with Internet and television access, lighting and temperature controls, and ceiling mounted patient lifts.

Several options are being explored in order to allow patients to choose their meal menu.

New options for patient registration will be offered, including booths, workstations and kiosks.

Hallways and elevators have been planned for distinct separation of traffic types. This means in-patients, staff and services can be moved between departments without being seen by visitors.

A LOOK TO THE FUTURE

With the construction clock ticking down, HHS is preparing for occupancy of the new facility. It has already begun the meticulous planning required to ensure a smooth transition but much still needs to be done.

After all, relocating to a building three times the size of the current hospital with state-of-the-art technologies brings a lot of changes to the way staff work and provide care.

Carillion is also getting ready to take on a more prominent role in the project. The company will lead general management

services, hard and soft facility management services (operations and maintenance of all plant and building equipment, parking management and landscaping), and the building life cycle for a period of 30 years following substantial completion. Its early involvement in the project's design, construction and financing is vital to the hospital's success over the next three decades.

"There is a real benefit to having the right skill set introduced not only during the design and construction phase but also during the pursuit stage," says Carillion Canada vicepresident, Trevor Gard. "The added value is being able to contribute and collaborate at all stages of the process to influence the finished building. The measure of this influence will be longterm accessibility for maintenance."

LOCATION: OAKVILLE, ONT. | P3 MODEL: DESIGN-BUILD-FINANCE-MAINTAIN | CLIENT: INFRASTRUCTURE ONTARIO | PRIVATE PARTNER: HOSPITAL INFRASTRUCTURE PARTNERS INC. | CONTRACT VALUE: $2.7 BILLION ($1 BILLION CONSTRUCTION; $1.7 BILLION FACILITY MAINTENANCE) | STRUCTURAL CONSULTANTS: STEPHENSON ENGINEERING AND READ JONES CHRISTOFFERSEN LTD. | MECHANICAL CONSULTANTS: H.H. ANGUS & ASSOCIATES LTD. AND CROSSEY ENGINEERING LTD. | ELECTRICAL CONSULTANT: MULVEY & BANANI INTERNATIONAL INC. | CONSTRUCTION WORKERS: 200 ON-SITE DAILY; 1,200 AT PEAK OF CONSTRUCTION | OFFICIAL GROUNDBREAKING: SEPTEMBER 2011 | SUBSTANTIAL COMPLETION: JULY 2015 | MOVE-IN DATE: DECEMBER 2015 | SIZE: APPROXIMATELY 1.6 MILLION SQUARE FEET | CAPACITY: 457 PATIENT BEDS, WITH SHELLED-IN SPACE TO GROW TO 602 BEDS IN THE FUTURE | LEED RATING: TARGETING SILVER CERTIFICATION SPRING/PRINTEMPS 2015 17

2015 Webinar Series Time: 0900 BC/1000 AB & SK/1100 MB/1200 ON & QC/1300 NS & NB/1330 NL One hour in length Wednesday March 25, 2015

Medical Air, What You Need to Know

Speaker: Paul Edwards, BCom, Vice President, Sales, Marketing & Business Development, Air Liquide Healthcare Wednesday April 29, 2015

Energy Efficiency, condensation control and personal protection starts with inspecting mechanical insulation

Speaker: Steve Clayman, B.Comm., Director of Energy Initiatives, Thermal Insulation Association of Canada Wednesday October 28, 2015

Combustible Piping in Health Care Facilities

Speaker: Patrick McQuire, Technical Represenative, IPEX Wednesday November 25, 2015

Proposed requirements for Z317.2-15 (HVAC)

Speaker: Gordon Burrill, President, Teegor Consulting Inc. Speaker: Nick Stark, Vice President Knowledge Management, HH Angus & Associates Limited

Registration CHES Member: Single: $30 + $3.90 HST = $33.90 (per webinar)

Non-Member: Single: $40 + $5.20 HST = $45.20 (per webinar)

Series: $90 + $11.70 HST = $101.70 (per series)

Series: $120 + $15.60 HST = $135.60 (per series)

Register online:

www.ches.org Professional Development

18 CANADIAN HEALTHCARE FACILITIES

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Labour Canada has fully “acknowledged” scopefully of Labour Canadathehas work provided in the semi“acknowledged” the scope of annual inspection program. work provided in the semiIn addition, the written annual inspection program. documentation contributes In addition, the written greatly to thecontributes hospital documentation accreditation greatly to programs. the hospital accreditation programs.

Further we are always pooling the knowledge resources Further we are always poolingof Infection Control and Engineering the knowledge resources of Groups like CHES, the ventilation Infection Control and Engineering inspection is in a constant Groups likeprogram CHES, the ventilation evolution meet future needs for inspectiontoprogram is healthcare in a constant patients and staff. evolution to meet future healthcare needs for patients and staff.

The location and inspection of the hospital ventilation fire doors may be part of The location and inspection the Some hospital your building audit thisofyear. of ventilation fire doors may be part of you have already taken advantage yourofbuilding auditsoftware this year. program Some of our new youwhich have already taken advantage in conjunction with our of patented our newrobotics, softwareallows program us which in conjunction with our to minimize ceiling access patented robotics, allows us requirements. to minimize ceiling access requirements.

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INFECTION PREVENTION & CONTROL

COMBATING THE SPREAD OF EBOLA Inside the University Health Network's preparedness plan

By Kathy Sabo

20 CANADIAN HEALTHCARE FACILITIES

INFECTION PREVENTION & CONTROL

E

bola is not a new virus. It first appeared approximately 40 years ago in two simultaneous outbreaks — one in Sudan, the other i n t h e D e m o c r at i c Re p u bl i c o f Congo. Since then, Africa has dealt with numerous outbreaks, all of which were controlled and confined to relatively small areas; that is, until 2014, when the virus spread beyond the continent's borders.

The most recent outbreak in West Africa is the largest and most complex since the Ebola virus was discovered in 1976. There have been more cases and deaths in this outbreak than all others combined, including 10 reported cases and two deaths in the U.S. TRANSMISSION

Ebola is spread through direct contact (likely through broken skin or mucous membranes) with the blood or body fluids of an infected person. The viral load is heaviest in the fluids of a patient who is very ill, near death or has died.

There is virtually no evidence that Ebola can be transmitted through the air. As well, a person who has been exposed to Ebola cannot transmit the disease until symptoms appear. The most common include fever, chills, abdominal pain, diarrhea, headache, joint aches and vomiting. On average, symptoms develop between eight and 10 days after infection.

Most people are unaware of how quickly infectious diseases can travel the globe until an outbreak makes news headlines. However, healthcare workers — particularly those who worked through the SARS (severe acute respiratory syndrome) outbreak of 2003 — are conscious that global travel can bring a disease to their front door within 24 hours.

SPECIALIZED FACILITIES

Armed with lessons learned from SARS, the Toronto Western Hospital — one of four hospitals that are part of the University Health Network (UHN) — built a new intensive care unit (ICU) in 2008. The six-bed unit within the ICU was designed with negative pressure air flow, separate anterooms and the capacity to add a mobile diagnostics lab within the pod.

This setup means the pod can be completely isolated from the rest of the unit. If called in to use, it can accommodate the need for staff to put on and take off isolation equipment, and ensures that it is disposed of in isolation of the rest of the hospital’s waste.

The negative air pressure rooms prevent airborne infectious diseases from infiltrating the rest of the unit. While there is little to no evidence Ebola can be transmitted through respiratory droplets, the hospital adopted this precautionary principle to ensure every risk is mitigated and staff feel safe working in an environment that dramatically reduces the possibility of airborne transmission.

It was the design of this new ICU, the hospital's experience with SARS and its clinical expertise that allowed Toronto Western to step forward with confidence to serve as one of four Ebola treatment hospitals in Ontario.

Toronto Western also agreed to care for suspected Canadian Ebola cases repatriated from West Africa, in the event this occurs.

THE PLAN

Last July, as the world became more acutely aware of the extent of the outbreak in West Africa, a team was established at UHN to develop a plan to respond to patients arriving at its hospitals' emergency departments with

a history of travel to an Ebola-affected country and symptoms associated with the virus. This team included experts in infectious diseases (including tropical medicine), infection control and occupational health and safety as well as emergency, ICU and laboratory medicine staff — in short, anybody who would play a role in keeping staff, patients and families safe while caring for a potential Ebola case.

The team considered all the elements necessary for safe and effective care.

Preliminary documents and guidelines were drafted, routes through the hospital established in case a suspected Ebola patient arrived and supplies ordered.

The donning and doffing of personal protective equipment (PPE) was tested on frontline workers in the care environments in which it would be needed. UHN then engaged its healthcare human factors group to further enhance the process.

Staff feedback helped UHN determine the various components of its PPE — a hood/shroud and a new type of apron were sourced and ordered to provide additional protection from the initial version of PPE. This input also shaped the training necessary to make sure staff remained safe while caring for an Ebola patient. For instance, it was determined the PPE must be put on and taken off exactly as prescribed in order to afford protection, though removal may vary slightly depending on the configuration of the anterooms.

In August, the federal and provincial governments, the Toronto Central Local Health Integration Network and the city’s academic health centres began to work together to coordinate efforts. This made a great deal of sense since Toronto Pearson International Airport was one of the possible, and most likely, points of entry for a possible Ebola patient from West Africa.

SPRING/PRINTEMPS 2015 21

INFECTION PREVENTION & CONTROL

Throughout the fall, as Ontario’s Ministry of Health and Long-Term Care refined its approach to Ebola, UHN continued to work on its response plan. The team ensured its laboratory medicine could respond to the needs of an Ebola-infected patient and outsourced point-of-care testing; continued to train staff on the use of PPE while enhancing the PPE training program; resolved

THE DIFFICULTY WITH DIAGNOSING EBOLA IS THAT THE DISEASE'S INITIAL SYMPTOMS ARE SIMILAR TO THOSE OF MANY OTHER ILLNESSES, INCLUDING THE FLU AND MALARIA. issues around housekeeping and the safe removal of biological waste; and established that UHN, working with all

Infection Control Sink Designed specifically to minimize splashing and reduce the spread of infectious disease.

TIME FOR ACTION

In October, just three months after planning began in earnest, UHN began to receive patients with a travel history to West Africa and who exhibited Ebola-like symptoms.

The difficulty with diagnosing Ebola is that the disease's initial symptoms are similar to those of many other illnesses, including the flu and malaria. So, Ebola had to be ruled out on a patient-bypatient basis based on the expertise of hospital clinicians and test results. Test results came back negative in one case; in others, the clinical presentation made it clear that Ebola was not causing the symptoms. These cases provided a "dry run" for staff in the emergency department and with each "dry run," the level of confidence grew among staff.

At this time, it appears that Ebola is diminishing in West Africa; however, the outbreak is not over and the virus is still a global threat until it is completely eradicated. Hospitals must therefore not become complacent but remain vigilant with preparedness and training.

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levels of government, could smoothly transfer a confirmed Ebola case from West Africa to Toronto Western Hospital.

Through this entire process, UHN kept all employees up-to-date on what was being done, how staff would be protected and its readiness. Regular communications were sent out via e-mail and staff huddles continued in key clinical areas. As well, all staff could access UHN's internal Ebola preparedness website to obtain documents, policies and procedures relevant to caring for an Ebola patient.

Kathy Sabo is the senior vice-president of the University Health Network (UHN) and executive lead for Toronto Western Hospital. She is responsible for oversight of one of Toronto’s largest acute care facilities, including the day-today operations of patient care and service delivery as well as facility management.

Call for Nominations CHES Board of Directors

CHES members are invited to submit nominations for the following positions:  Vice President  Secretary  Treasurer A member in the Regular Membership Classification is eligible for office.

Nominations can be received either by:  Members identifying and nominating eligible qualified candidates  Members who are interested in standing may submit their own name as a candidate.

Basic function and responsibilities of a board member: Set policy and direction of the Society Serve as a spokesperson for the Society Represent the interests and discipline of the Society Serve as technical resource for Society education programs, publications and advocacy Promote membership and Chapter affiliation Participate in Society committees In fulfilling these duties, the Board member: Serves a two year term, after which he/she is eligible for re-election Attends Board Meetings by conference call and at annual conference (financial assistance provided for conference travel expenses) Carries out projects as assigned by the President Prepares written report of activities for each Board meeting Candidates must be active in and a participating member of the Society for a minimum of two years. Candidate should be in compliance with all provisions of the By-Laws, having the ability to carry out the fundamental duties of the assignments of the Board. Candidates should obtain the approval of their superior for permission to serve on the Board.

Nominations must be received by April 30, 2015 and should be sent by fax or email to: CHES National Office Fax: 613-531-0626 ches@eventsmgt.com Sincerely.

JJ Knott Chairman, Nomination & Elections Committee Past President, CHES

INFECTION PREVENTION & CONTROL

PREPARED, NOT SCARED

Health Sciences Centre Winnipeg's response to Ebola outbreak

By Craig B. Doerksen

T

here are no cases of Ebola in Manitoba and there may never be, but Health Sciences Centre (HSC) Winnipeg is ready to provide care for infected patients should the need arise.

In October 2014, HSC Winnipeg was officially named the designated treatment site for confirmed Ebola cases in the province.

However, the hospital began to prepare to deal with the potentially fatal disease in late summer. It was at this time that operational planning got underway for receiving known or suspected Ebola patients. Clinical treatment protocols were reviewed, personal protective equipment (PPE) evaluated and obtained, patient transportation and movement processes assessed, staff identified and trained, and necessary physical space changes determined.

PATIENT ROOM CONVERSION

Although there is little to no evidence that Ebola can be spread through the air — it is transmitted through direct contact with the blood or body fluids of an infected person — airborne isolation (or negative pressure) rooms are considered the appropriate standard for Ebola treatment. So, HSC Winnipeg 24 CANADIAN HEALTHCARE FACILITIES

converted a group of eight protective environment (or positive pressure) spaces already set up with electrical, medical gas, data and headwall services suitable for intensive care support to airborne isolation rooms equipped with HEPA (high-efficiency particulate arrestance) filtration. The ventilation system in these patient rooms is controlled and monitored by pressure compensating air valves. The valves were easily adjusted from positive to negative pressure and air balance confir med. The fast pressure compensating action of these lab-grade valves have served HSC Winnipeg well since 2006, and are the site standard for critical pressure applications.

ANTEROOM CONSIDERATIONS

The significant cross contamination risks during the donning and doffing of PPE in the anteroom required that it be enlarged. This renovation included removing a closeted flushing rim sink and enclosed millwork, upgrading the hand hygiene sink and installing intercoms for hands-free communications between the hallway nurse monitoring station, anteroom and patient room.

CONTAMINATION CONTROL

Working with its clinical operational staff, HSC Winnipeg thoroughly evaluated and documented its handling of bodily fluids, use of disposable linens and draperies, and cleaning protocols. For operational reasons, the door between the anteroom and patient room was equipped with a special delayed closing function to prevent cross-contaminating it during the removal of biological waste.

Contamination of building systems and equipment was also thoroughly considered.

To ensure the proper and safe management of infectious waste, HSC Winnipeg opted not to use the building sewer systems for toileting of Ebola patients and other patientcontaminated wastewater; instead, it arranged for off-site biohazardous waste disposal. As an added precaution, HSC Winnipeg installed a medical dualcanister vacuum system to collect and retain aerosolized Ebola-contaminated body fluids.

Craig B. Doerksen is divisional director of facility management at Health Sciences Centre Winnipeg. He can be reached at cdoerksen@hsc.mb.ca.

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INFECTION PREVENTION & CONTROL

A BALANCING ACT Designing for infection prevention

By Mark Berest & Carol Ringer

T

he SARS (severe acute respiratory syndrome) epidemic of 2003, and increasingly frequent outbreaks of infectious diseases, such as MRSA (methicillinresistant Staphylococcus aureus), Clostridium difficile and legionellosis, has coincided with a sweeping provincial healthcare infrastructure renewal initiative in Ontario.

This confluence of events propelled a sudden meaningful and practical response to one of the greatest threats to Canada's healthcare system.

Policymakers, the building industry and healthcare professionals have entered into a new conversation about the design 26 CANADIAN HEALTHCARE FACILITIES

of healthcare facilities. The result is a significant re-evaluation of current practices, with the goal of reducing the risk of transmission of infectious diseases amongst the highest concentration of immunocompromised individuals — those in healthcare facilities.

In March 2013, Niagara Health System's (NHS) new St. Catharines Hospital not only opened its doors but opened a window on the future of healthcare in Canada. It is one of the first hospitals to be built in response to growing concerns around the spread of "superbugs." The nearly 1 millionsquare-foot facility contains extensive anti-infection safeguards and is

INFECTION PREVENTION & CONTROL

considered one of the most advanced hospital designs in Canada when it comes to infection prevention and control. With the implementation of these measures, however, other important implications emerged.

MINIMIZING CONTACT

It is critical that hospital patients feel secure in their mobility as they move through the halls of a facility. To this end, wall-mounted handrails are typically specified for all in-patient and treatment areas. These handrails are also often used by hospital visitors who require mobility assistance. As a result, dozens of people use these handrails daily, each transmitting their own organisms, some of which are infectious.

The provision to install handrails is antithetical to infection control; however, they are necessary to reduce the risk of falls. To reconcile these conflicting objectives, it's best to specify handrail materials that are resistant to bacteria and easy to disinfect. Solid, shinier surfaces with fewer assembly joints are recommended. Copper is also a good option since it absorbs microbes but it is expensive and, for many, clinical in feel and sense.

Current evidence suggests that patient recovery time and hospital length of stay is shortened in "nor malized" environments — where facility design allows for longer family visits, patients are allowed to wear their own clothes instead of hospital gowns, and people and their possessions are able to freely roam patient zones, some of which are shared.

But these "home-like" environments and

s Inside Niagara Health System's new St. Catharines Hospital.

rates; however, these measures don't fit easily with "homier" healing environments. And the technology is often expensive and rapidly changing.

Somehow, a balance needs to be struck. For best results, further research is needed to harmonize the variety and weight of these measures with the values and priorities of patients and healthcare providers.

ISOLATING INFECTIOUS DISEASES

The sick often have compromised immune systems. Resultantly, they have the greatest chance of contracting infectious diseases. The obvious response is to separate these patients from possible communicable pathogens by placing them in single-patient rooms with private

THERE IS A NEED FOR BETTER BALANCE BETWEEN THE CURRENT DESIGN OF SINGLE-PATIENT ROOMS AND LARGE CONTAINMENT SPACES, AND CONTROLLING THE TRANSMISSION OF INFECTIOUS DISEASES. increased family involvement in patient care stand in direct opposition to the idea of a “controlled” environment.

Research shows that technology, such as ultraviolet light-emitting, microbekilling robots, with detailed cleaning operations and protocols, can reduce healthcare-acquired infection (HAI)

bathrooms. St. Catharines Hospital has the highest percentage of single-patient rooms in Ontario, with 80 per cent private rooms.

Included in this thinking is the notion that infection containment rooms need to be large to allow for greater access to patients and to accommodate the volume

of medical equipment. With the addition of programmed anterooms, which are an important part of any patient isolation solution, these containment spaces are effectively suites. Accordingly, the hospital floor plate increases substantially.

Reducing travel distances for staff and patients is a primary goal and central tenet of hospital design. There is a great deal of evidence that reduced travel distance correlates with reduced workplace injury and decreased fatigue.

Research also suggests there is a correlation between shorter travel time on a unit and increased rapid response to emergency calls and more face time with patients. The result: Increased patient satisfaction.

As well, shorter travel distances translate into a smaller hospital footprint.

Resultantly, there is less building to heat, cool and ventilate, and to which to supply power and data. It means a more efficient supply of medical, food and laundry services and, consequently, considerably lower capital, energy and operating costs.

Nevertheless, hospitals are bigger than ever, in large part because of the drive to control HAIs and the transmission of infectious diseases. Today, staff and patients have to move through more kilometres per bed than ever before.

Without putting the public at risk, there is a need for better balance between the current design of singleSPRING/PRINTEMPS 2015 27

INFECTION PREVENTION & CONTROL patient rooms and large containment spaces, and controlling the transmission of infectious diseases.

MODIFYING BEHAVIOUR

HEALTHY METAL Copper bed rails have fewer contaminants and remain clean longer than plastic bed rails, according to a report by the Medical University of South Carolina.

The study of occupied patient beds in an intensive care unit found that plastic rails re-contaminate within minutes of being cleaned. Copper rails have considerably lower amounts of bacteria present — likely a consequence of the continuous antimicrobial activity of the alloy.

Researchers assessed the amount of bacteria present before cleaning, 30 minutes after cleaning and at two hour intervals thereafter. While cleaning reduced the bacterial burden on both the plastic and copper bed rails, within six hours the bacterial burden on the plastic was almost at the same as before it was cleaned. The amount of bacteria present on the copper bed rails, however, remained 90 per cent lower than the levels seen on the plastic rails.

Studies have shown that objects in closest proximity to patients have the highest levels of Staphylococcus, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE). These objects act as reservoirs on which pathogens can survive for extended periods of time, posing a risk to patients, healthcare workers and visitors.

—Copper Development Association

Demonstrate

RECONCILING CONFLICTING OBJECTIVES

Due Diligence.

Manage risk of Legionella in building water systems.

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28 CANADIAN HEALTHCARE FACILITIES

Handwashing is probably the single most powerful infection control weapon in a healthcare facility. While there is a cost associated with plumbing and fixtures, space implications are negligible and other clinical operations are not compromised; rather, they're enhanced.

Though policies for handwashing and equipment cleaning were sufficiently stringent at the time, NHS introduced more handwashing sinks than was called for in existing standards — an unprecedented 1,400. It also provided nearly as many antimicrobial handcleaning dispensers.

While handwashing reduces the spread of infectious diseases, it's unknown whether the increased number of handwashing sinks and hand sanitizer dispensers significantly lowers the rate of HAIs. Because of this, the best line of defence is to modify hand hygiene behaviour. If there is a commitment to handwashing, then sinks and hand sanitizers will be more frequently utilized, lowering the risk of transmission.

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St. Catharines Hospital and other new healthcare facilities across the country provide an opportunity to investigate the full impact of new hospital design elements on the incidence of HAIs and the transmission of infectious diseases, in general, and to identify which design elements most greatly affect patient health. With healthcare costs increasing at an unprecedented rate — 7.4 per cent per annum between 1998 and 2008, according to the Canadian Institute for Health Information — the industry can ill afford to avoid deep analysis of completed facilities that have implemented infection prevention and control measures.

Mark Berest is a principal at B+H Architects. He served as the lead on the Niagara Health System's new St. Catharines Hospital bid. Carol Ringer is a clinical design consultant with WR Consulting Group Inc. She has been a consultant on the design-build side for numerous publicprivate partnership projects in Canada.

Healthcare Facilities and the Technology Highway The CHES 2015 National Conference will be held in Edmonton AB at the Shaw Conference Centre, September 20-22, 2015.

The Education Program is shaping up quickly and is comprised of sessions covering topics such as:    

IT, Technology, and Facility Engineering Super Convergence and Healthcare Planning Technology and Clinical Workflow New Trends in Power Systems Maintenance 

  

Integration of Patient Information Systems Prevention, Suppression, and Response to Surgical Fires Healthcare Facility Related Case Studies

And Much More!

This promises to be an exciting and jam-packed program. Please check the website (www.ches.org) in the coming weeks as the full education program will be posted and the online registration will open soon!

The 2015 Program will kick off with Keynote Speaker Don Winn, an MIT Sloan Fellow and organizational coach who has spent 25+ years leading and working with senior leaders to create high-performance cultures and transformational change.

Other Conference Highlights Include:    

The Great CHES Golf Game at one of the Edmonton area’s premiere courses!

The Companion Program will feature stops at Fort Edmonton, The West Edmonton Mall, and more!

A great kick-off event with the Opening Reception taking place at the Art Gallery of Alberta A gala banquet honoring CHES’ award winners, fine dining, and great entertainment!

Join us in Edmonton! We look forward to seeing you!

For additional conference information, please visit: http://www.ches.org/conferences-and-events/2015-national-conference.html Follow CHES on Twitter! https://twitter.com/CHES_SCISS for association updates, conference updates, and more!

Follow CHES on Twitter! https://twitter.com/CHES_SCISS

INFECTION PREVENTION & CONTROL

REDUCING THE RISK OF LEGIONNAIRES'

DISEASE

O

utbreaks of legionnaires' disease are still occurring, with the rate having steadily increased in North America over the past 10 years. While the number of reported cases per annum is still relatively low this is still disconcerting given that the disease, which presents itself as a form of pneumonia, can be fatal. Here, Pinchin's senior associate of indoor air quality and microbial contamination, Bernard Siedlecki, provides insight into the root cause of legionnaires' disease and how facility managers can minimize the hazard that may lead to illness.

What causes legionnaires' disease?

Legionnaires’ disease is caused by inhaling water aerosols (fine water droplets) that contain legionella bacteria.

30 CANADIAN HEALTHCARE FACILITIES

Ty p i c a l s o u r c e s o f l e g i o n e l l a contaminated aerosols include drift (water droplets) from cooling towers and common plumbing systems, such as showerheads, faucets (particularly those with aerator s), decorative fountains, water gardens, therapeutic hot tubs and whirlpools. These fine aerosols can be inhaled deeply in the lungs, particularly when less than five micrometres in size.

Inhalation of legionella bacteria can result in two separate respiratory infections: Legionnaires’ disease and Pontiac fever. Of the two, legionnaires’ disease is more serious, resulting in death in approximately 10 to 15 per cent of cases. Even those who recover may suffer long-ter m respiratory

effects. Persons with compromised immune systems are more likely to be infected and die from this disease; however, healthy individuals can still become infected by legionella.

What are the risk factors for legionella growth in building water systems?

Legionella enters a building's water system as a bacterium found in very low concentrations in lakes and rivers.

It is not completely eliminated by chlorination or other water treatment systems. Therefore, all building water systems should be considered at risk of legionella growth.

That being said, the bacteria prefers warm water (above 20 C) to grow and will not survive in temperatures above

INFECTION PREVENTION & CONTROL

60 C. The ideal growth range is 35 C to 45 C. The disinfection range is 70 C to 80 C. Ideally, water temperatures in hot water storage tanks are maintained at 60 C to minimize legionella growth. However, this temperature can be difficult to maintain without the risk of scalding.

Some regulations, such as Ontario regulation 79/10 made under the LongTerm Care Homes Act, require that hot water that serves resident areas not exceed 49 C. Certain conditions in building water systems can promote legionella growth.

These include sediment, "dead legs" or stagnant water, corrosion or biofilm.

Domestic hot water storage tanks with lower water temperatures (below 50 C)

and sediment buildup can promote legionella growth. Surges in water pressure can release the bacteria from the sediment into the water supply from where it can be aerosolized.

Cooling towers are perhaps the best known source of legionella infections.

If they are improperly maintained, legionella in the re-circulated condenser water can be aerosolized as drift and enter a building via outside air intakes or operable windows, or travel to adjacent buildings and disperse in open public areas.

"Dead legs" or stagnant water can occur in potable water lines that feed fixtures in, for example, a patient room that has not been used for some time.

This “still� water can amplify bacteria

growth, which can be aerosolized into the occupied space via showerheads or faucet aerators. In addition, unused water distribution lines in the construction zone of an occupied area of a building that have not been capped and drained can release contaminated water in the potable water lines serving the occupied area of the building, putting occupants at risk.

Biofilm (slimy deposits of bacteria) can be found on the metal or wood surface of water sumps in cooling towers. It can support and conceal legionella, and withstand standard chemical disinfection.

Consequently, water agitation may release legionella.

Biofilm that is concealing legionella can be trapped within scale or corrosion inside piped services. The legionella can SPRING/PRINTEMPS 2015 31

INFECTION PREVENTION & CONTROL

be released into the water by pressure surges that happen during plumbing renovations or water shutdowns.

What is ASHRAE Standard 188P?

It is a proposed standard by the A m e r i c a n S o c i e t y o f H e a t i n g, Refrigerating and Air-Conditioning Engineers (ASHRAE) that will establish minimum legionellosis risk management requirements for building water systems. The standard is still currently under development.

What are currently the core requirements of ASHRAE 188P?

Every new building design and water system must be surveyed to determine if there are factors that may cause water to aerosolize. As well, all buildings that contain devices that release water aerosols must be surveyed.

If the survey identifies and characterizes factors that relate to legionellosis, a water management prog ram should be developed. While the exact elements of

the program are clearly described in the under development, these requirements standard, it should include: descriptive may change. Public comment on the diagrams of water systems; analysis of fourth version of ASHRAE's proposed w at e r s y s t e m s wh e re h a z a rd o u s standard closed Nov. 10, 2014. conditions may occur; a list of control measures and where they should be What are the benefits of voluntary applied; and guidelines for monitoring compliance with ASHRAE 188P? control measures, and verifying and Voluntary compliance demonstrates that validating the program. documented due diligence is being There is a more stringent section in the followed to prevent legionella growth, standard that applies specifically to which reduces liability in the event of a healthcare facilities. These facilities legionella outbreak. should form a designated team that is responsible for the development and What can healthcare facility managers do implementation of a legionella risk now to prevent legionella bacteria growth management plan, and develop a water in building water systems? system flow diagram, particularly in Healthcare facility managers can conduct locations where patient care and high- a legionella risk assessment of their risk conditions have been identified. facility, including water sampling for This section also includes requirements legionella in high-risk areas and locations for new construction and renovation of suspected growth. It's recommended p ro j e c t s t h a t p e r t a i n t o m a j o r they also develop a legionella water maintenance of water systems and management and risk plan that includes water service disruptions. the water quality and water treatment It's worth noting that since the requirements set out1 in15-02-05 CSA standard Class1_CHF_Spring_2015_FINAL.pdf 12:57 PM legionellosis standard is still currently Z317.13-12.

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INFECTION PREVENTION & CONTROL

CLEARING

THE AIR Ventilation strategies to mitigate HAIs

By Ed Chessor

H

ealthcare-acquired infections (HAI) are a g rowing and costly problem for hospitals across Canada. Resultantly, healthcare facilities are working hard to protect p at i e n t s f ro m t wo o f t h e m o re common HAIs: Clostridium difficile and MRSA (methicillin-resistant Staphylococcus aureus).

C. difficile and MRSA are transmitted through the fecal-oral route and possibly by infected sputum. The bacteria can be deposited on any surface, survive for hours or even days, and then be picked up by a vulnerable person and cause illness. The diseases can also be spread by inhalation of contaminated mist droplets from coughs or sneezes, or through the fecal cloud.

Ventilation can play an important role in preventing the spread of these diseases.

Studies indicate that patients who move into a room previously occupied by an infected person are at increased risk compared to other patients in the hospital. Therefore, patient rooms should be equipped with special air handling and ventilation capacity to limit the spread of the fecal cloud and sputum.

The closer the vent intake is to the emission source, the more effective it will be in controlling contaminants before they reach patients' breathing zones.

THE TOILET

A patient may discharge a mixture of gas, liquid and solids into the space between the toilet water, bowl and their buttocks.

In the absence of exhaust airflow directly from the toilet bowl, the discharge will mix with the air in the bowl and some of it will escape through the opening between the bowl and seat. This 34 CANADIAN HEALTHCARE FACILITIES

INFECTION PREVENTION & CONTROL dispersed mixture is known as the “fecal cloud." It is likely to be infectious and will contaminate most surfaces in a bathroom.

When a patient stands up and flushes the toilet, more fecal cloud will escape.

An exhaust grille in the ceiling will dilute and remove the fecal cloud but not before mist droplets contact a surface. If a room's ventilation system does not provide adequate airflow into the bathroom, the fecal cloud may then waft out or be carried out by persons leaving the room.

Installing an exhaust grille in the wall behind the toilet just above the floor is an option. The bottom edge of the exhaust grille should be at, or 50 to 100 millimetres above, the rim of the toilet bowl for maximum capture. If a patient coughs or sneezes while on the toilet, this higher grille location is more effective in capturing these droplets too. However, while this is a better location than the ceiling, ther mal effects make it less than optimal. Heat given-off by a patient’s body creates an upward air current, which can pull the fecal cloud up.

One of the best ways to prevent the fecal cloud from escaping is to install a vented toilet. The exhaust system creates sufficient inward air velocity through the opening between the seat and bowl that it keeps bacteria from spreading into the bathroom. The downward-facing openings in the air passage around the rim of the toilet bowl can then be used to exhaust the fecal cloud. A duct simply needs to be connected to a suitable fan from the back of the tank. The key is the duct connection must be above the tank's water level.

THE BED

Gaseous emissions happen not only when a patient is on the toilet; they also happen when in bed. Installing an exhaust grille just above floor level at the head of a bed is a potential option. But again, heat given-off by a patient's body and flatulence must be considered. Since passed gas is warmer than room air and body heat creates a rising column of air, the wall grille should be 200 to 400 millimetres above the bed mattress for best effect.

However, closer to the patient is better.

It's therefore recommended that an evacuation tube be placed in-between the sheets, near the patient’s waist. The diameter of the tube should be between 30 and 50 millimetres. The distal 300 millimetres of the tube should have multiple openings so the velocity through the openings is not sufficient to pull in the bed sheets and restrict airflow. A range of flows needs to be evaluated to determine the relationship between airflow and control.

Coughs and sneezes can be controlled by a surgical mask, though a disposable N95 respirator is more effective. If incompatible with the patient’s needs, a system that exhausts from the immediate vicinity of the patient’s face can be used instead. Such systems are used to control waste anesthetic gases that are released or leaked out during medical procedures and pose a risk to healthcare workers.

Ed Chessor is a professional engineer specializing in ventilation for contaminant control. He has helped several British Columbia hospitals over the past 30 years address air pollution issues.

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SPRING/PRINTEMPS 2015 35 Untitled-5 1

15-02-23 5:17 PM

REGULATORY UPDATE

A WELCOME DELAY Mandatory start-date for LEED version 4 postponed

By Barbara Carss

T

he transition to a more rigorous LEED (Leadership in Energy and Environmental Design) certification regime will take longer than the devisors of the building rating system originally envisioned. The U.S. Green Building Council (USGBC) has given program participants an extra 16 months to register projects under the current criteria before LEED version 4 (v4) becomes mandatory on the newly revised launch date of Nov. 1, 2016.

"The market has requested additional time to prepare for LEED v4 so we are responding," said the USGBC's CEO, Rick Fedrizzi, last fall. "Our international LEED users, which account for some 50 per cent of new LEED registrations, have also indicated they would like to have more time to move onto the new rating system."

The announcement followed a survey conducted at the USGBC's 2014 national conference, in which 61 per cent of respondents declared they would not be ready to pursue LEED v4 as initially scheduled for June 16, 2015. Thus far, there have been few voluntary registrants for the program in Canada, where it has been available for an early tryout since the winter of 2014.

"It's an interesting move. The C a G B C (Canada Green Building Council) and USGBC don't usually slow things down. They are for speeding things up and rolling things out," says Jenny McMinn, green planning and 36 CANADIAN HEALTHCARE FACILITIES

bu s i n e s s d e s i g n manager with consulting firm, Halsall Associates. "I suspect they thought they'd have more projects registered for v4 ahead of the official date. We really haven't seen a lot of pioneers stepping up to the plate to take the lead on this."

As the label v4 reflects, regular updates are central to LEED's objective to continuously push the industry to improve perfor mance, foster new skills and market responses.

However, the latest makeover is considered a much steeper step-up than any of the previous iterations.

It includes more stringent requirements for energy and water e f f i c i e n c y, g re at e r e m p h a s i s o n measurement and verification, and a mu ch b ro a d e r s c o p e a p p l i e d t o building materials and the resources expended to extract, manufacture and ultimately dispose of them. The call for transparency and documentation t h ro u g h e nv i ro n m e n t a l p ro d u c t declarations (EPDs) will mean new compliance costs and pressures for both LEED proponents and their suppliers. Indeed, manufacturers are c o u n t e d a l o n g w i t h p ro s p e c t i ve registrants among the beneficiaries of more preparation time.

"Whenever a rating system creates a shift, or attempts to create a shift, in the

marketplace, there is a bit of a learning curve for the design and development community," says Minto Group's manager of sustainable development, Wells Baker, who is overseeing a number of in-progress projects slated to be certified under the currently applicable version of LEED — known as LEED 2009, in reference to the year the USGBC adopted it.

For Canadian proponents, the eligibility period for LEED 2009 has been shorter since the CaGBC didn't actually adopt it until 2010. Once registered, proponents will have until 2021 to complete the project and obtain certification, creating the real possibility that two vintages of LEED projects — those registered just before and just after the compulsory start-date for LEED v4 — will be completed at approximately the same time.

"Due to the nature of construction, it takes a fair amount of time from design to completion and then certification on top of that. So, based on the previous schedule, we would have had to start working on v4 before we had actually delivered any 2009 projects," explains Baker.

USGBC officials speaking at the CaGBC's annual national conference i n Ju n e 2 0 1 4 w e r e a l r e a d y acknowledging the industry's concerns.

Scot Horst, USGBC's senior vice-

REGULATORY UPDATE

president of LEED, noted the general sentiment that LEED 2009 is "too soon to sunset," while LEED v4 is expected to be a challenge for "pretty much everybody."

"The thing about transformation is it's always really challenging," he added.

Horst also asked attendees in one of the conference's educational seminars for their insight, gleaning comments like: "I feel like I need a PhD to read an EPD"; "Too much, too fast, too far and a world of pain, but I think it's important and necessary, philosophically"; and "If it gets harder to get gold, we will probably drop certification."

Green building specialists speculate this has all been factored into the decision to extend the deadline for LEED 2009 registrations.

"There are always the frontrunners who are constantly looking for what the next challenge will be in terms of

“ WHENEVER A RATING SYSTEM CREATES

A SHIFT, OR ATTEMPTS TO CREATE A SHIFT, IN THE MARKETPLACE, THERE IS A BIT OF A LEARNING CURVE FOR THE DESIGN AND DEVELOPMENT COMMUNITY.

”

delivering superior buildings. I think the while they can still voluntarily choose it challenge for the CaGBC and USGBC is — initiative, Halsall's McMinn suggests, providing the opportunity for those that could be a clear market differentiator.

"I actually think it will be the private leaders to excel and demonstrate the ability to be the best without closing the sector that will pick it up first," she door or making the program inaccessible predicts. to the leading pack within the industry," says Minto's Baker. "They risk alienating Barbara Carss is editor-in-chief of Canadian the larger pack if they make it too Property Management. difficult so it's probably a good idea to give a little bit more time for the rest of the industry to catch up."

This article originally appeared in the That also allows more time for Muira_CHF_Spring_2015_FINAL.pdf the still November 2014 issue1of 15-02-06 Canadian Property 11:57 AM elusive vanguard to appear and test v4 Management.

GREEN GARAGE CERTIFICATION Property and facility managers now have access to a new certification program recognizing high standards in sustainable parking facilities.

The Green Parking Council (GPC), a partner of the International Parking Institute, recently introduced Green Garage Certification — the parking industry equivalent to LEED. The program is meant to inspire sustainable parking facility design, technology, operations and management.

“Green Garage Certification applies a holistic approach to garage performance and sustainability, evaluating facilities based on their achievement toward a menu of standards developed by experts from a range of related fields,” says GPC board chair, John Schmid.

The program was developed over several years and honed by external reviewers and a beta phase involving more than 40 facilities in Canada and the U.S. It provides a roadmap and assessment tool to everyone from developers and planners to architects and parking operators.

Parties interested in pursuing certification can obtain information on application procedures, program requirements and certification level criteria at www.greenparkingcouncil.org/certification.

—Green Parking Council

SPRING/PRINTEMPS 2015 37

REGULATORY UPDATE

AODA COMPLIANCE UPDATE 2015 requirements for Ontario employers

By Edie Forsyth

S

ince its inception 10 years ago, the Accessibility for Ontarians with Disabilities Act (AODA) has imposed a series of obligations on public, private and non-profit organizations through the creation of two mandatory accessibility standards: the Accessibility Standard for Customer Service (ASCS) and the Integrated Accessibility Standards Regulation (IASR). The goal is to make Ontario accessible by 2025.

By now, all organizations in the province should be in compliance with the first standard, ASCS. Compliance with certain requirements under IASR — which will remove barriers in transportation, employment, information and communications, and public spaces — came into effect January 2012. On Jan. 1, 2015, a number of additional obligations came into force under such legislation.

LARGE PUBLIC SECTOR ORGANIZATIONS

Large public sector organizations ( s c h o o l s, c o l l e g e s, u n i ve r s i t i e s, municipalities and hospitals) with 50 or more employees must now provide or arrange for the provision of accessible formats and communications, upon request. They must also notify the public about the availability of accessible formats and communications supports.

These organizations must continue to work to make existing websites and web content on those sites accessible, according to the World Wide Web C o n s o r t i u m ’ s We b C o n t e n t Accessibility Guidelines (WCAG).

38 CANADIAN HEALTHCARE FACILITIES

By Jan. 1, 2016, large public sector organizations must incorporate the Design of Public Spaces Standard into any new build or major renovation projects. This standard will help eliminate physical barriers in the outdoor environment, including paths of travel (such as sidewalks, ramps and stairs) and parking.

SMALL PUBLIC SECTOR ORGANIZATIONS

Small public sector organizations with less than 50 employees are now required to develop, implement and maintain policies governing how they achieve or will achieve accessibility through meeting the requirements of t h e I A S R . T h e p o l i c y mu s t b e contained in a written document and include a statement of organizational commitment to meet the accessibility needs of persons with disabilities in a timely manner. The policy must be made publicly available and provided in an accessible format, upon request.

These organizations are also obliged to provide equal opportunity throughout the employment life cycle for paid positions. This requirement addresses recruitment, testing and i n t e r v i e w i n g, h i r i n g, e m p l o ye e accommodation, perfor mance management and career development.

As well, they must now ensure new websites are developed in accordance with WCAG 2.0 Level A. Small public sector organizations must comply with feedback-related obligations and the Design of Public Spaces Standard by year's end.

LARGE PRIVATE SECTOR AND NON-PROFIT ORGANIZATIONS

Large private sector or non-profit organizations with 50 or more employees must now provide training to employees on the requirements of the IASR and Ontario Human Rights Code as it pertains to persons with disabilities. AODA does not provide direction as to the specific content of the IASR training; however, the Ministry of Economic Development, Employment and Infrastructure does offer some guidelines.

These organizations are also required to comply with feedback-related obligations, ensuring the process is accessible. As well, they must ensure all new websites are created in accordance with WCAG 2.0 Level A. As of Jan. 1, 2016, these organizations must abide by the Accessibility Standard for Employment. They must also ensure any business-related information is accessible to persons with disabilities.

SMALL PRIVATE SECTOR AND NON-PROFIT ORGANIZATIONS

Small private sector or non-profit organizations with less than 50 employees don't have any specific requirements this year. By the end of 2016, however, they must provide training to employees and ensure their organizations comply with feedbackrelated obligations.

Edie Forsyth is the founder of Accessibility Experts Ltd. The consulting and training firm is a leading authority on the sweeping changes that the Accessibility for Ontarians with Disabilities Act is imposing on public and private organizations across the province.

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