CHF Summer

Canadian

HealthcareFacilities Journal of Canadian Healthcare Engineering Society

Volume 34 Issue 3

Summer/été 2014

THE PATIENT PERSPECTIVE

PM#40063056

INSIDE

Going for LEED Gold in BC Health Sciences Centre Powers Through the Future Towering Technologies at Royal Victoria Regional Health Centre

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contents

Canadian Healthcare Facilities Volume 34

Number 3

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

14

Steve McLinden e-mail: stevem@mediaedge.ca

PUBLISHER

Matthew Bradford e-mail: matthewb@mediaedge.ca

ADVERTISING SALES

Sean Foley

EDITOR

MediaEdge Communications 416-512-8186

e-mail: info@mediaedge.ca

ARTICLES 12

Going for LEED Gold in BC Four western medical facilities earn top LEED status

Special Section: The Patient Perspective 14 What to do with the Patients?

How Queens General Hospital put patients first during a hospital-wide renovation

26

18

24

Re-Thinking HVAC and HAIs CHAIR's strategies for enhancing patient protection Health Sciences Centre Powers Through the Future Manitoba Hydro helps HSC deliver optimal care

SENIOR DESIGNER

Annette Carlucci

DESIGNER

Jennifer Carter

PRODUCTION MANAGER

Rachel Selbie

SCISS JOURNAL TRIMESTRIEL PUBLIÉ PAR MEDIAEDGE COMMUNICATIONS INC. SOUS LE PATRONAGE DE LA SOCIÉTÉ CANADIENNE D’INGÉNIERIE DES SERVICES DE SANTÉ Steve McLinden e-mail: stevem@mediaedge.ca

ÉDITEUR

RÉDATRIC INTÉRIMAIRE

Matthew Bradford

e-mail: matthewb@mediaedge.ca

PUBLICITAIRE

Sean Foley

MediaEdge Communications 416-512-8186

e-mail: info@mediaedge.ca PUBICITÉ

Annette Carlucci

COORDINATEUR DE PRODUCTION

Rachel Selbie

FEATURES 37

DEPARTMENTS 6

Publisher's Message

8 Message from the President 10 Chapter Reports 11 CHES Announcements

27

2014 CHES Conference Schedule

32

Maintaining the Green Edge at Holland Bloorview Putting conservation first

35

Building the Best Healthcare Facility Leading with a Mission

37 Towering Technologies at Royal Victoria Regional Health Centre

Cooling innovations at Barrie hospital 38

Medical Air Matters Enhancing hospital air quality

CHES Canadian Healthcare Engineering Society

SCISS

Société canadienne d'ingénierie des services de santé

PRESIDENT

Peter Whiteman

VICE-PRESIDENT

Mitch Weimer

PAST PRESIDENT

Michael Hickey

TREASURER

Robert Barss

SECRETARY

Randy Cull

EXECUTIVE DIRECTOR Donna Dennison CHAPTER CHAIRMEN

Maritime: Denis Pellichero Alberta: Preston Kostura B.C.: Steve McEwan Ontario: Allan Kelly Manitoba: Craig Doerksen Newfoundland & Labrador: Brian Kinden

FOUNDING MEMBERS H. Callan, G.S. Corbeil,

J. Cyr, S.T. Morawski

CHES

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

November 3, 4 & 5, 2014 Metro Toronto Convention Centre healthachieve.com

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Confirm your spot at the health care industry’s must-attend event by registering now at healthachieve.com/registration.

2014 Keynote Speakers Register today to be inspired by these revolutionary minds and their innovative ideas at our 90th anniversary! Visit healthachieve.com to see our full roster.

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Tom Rand, Environmental Sustainability Expert Bringing clean technology to life.

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Our Satellite Locations If you can’t make it to the Toronto event, you can still hear from these incredible speakers by attending one of our satellite locations: HealthAchieve North in Thunder Bay and HealthAchieve East in Halifax!

Jennifer Gardy, Scientist and Guest Host on The Nature of Things Uncovering the truth behind medical folklore.

Jessica Green, Director of the Biology and Built Environment and TED Senior Fellow Visualizing the invisible world of microbes.

Nina Tandon, CEO and Co-Founder of EpiBone and TED Senior Fellow Exploring biology’s new industrial revolution.

Vijay (Robert) Gupta, Founder of Street Symphony, Mental Health Advocate and TED Senior Fellow Demonstrating the healing power of music.

Dr. Wendy Sue Swanson, Executive Director of Digital Health at Seattle Children’s Hospital Using new technology to improve care and communication.

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Publisher's Message

Focusing on what matters The patient perspective. It's the theme of this year's CHES conference and the thread connecting every contribution to this special edition of Canadian Healthcare Facilities.

And for good reason. Behind every healthcare initiative, innovation, and idea is a desire to enhance Canada's quality of care and build a better healthcare system for our current and future patients.

In this issue, we've turned out attentions to a number of ways healthcare facilities are prioritizing the needs of their patients. Our special section includes three case studies wherein the patient perspective plays a central role, including within Queens General Hospital's large-scale renovation project, CHAIR's strategies for better HVAC and HAI prevention, and Niagara Health Sciences Centre's energy plant installation.

This central theme can also be found in Bobby Hancock's “Maintaining the Green Edge at Holland Bloorview”, Dr. Chris Bart's “how-to” for team management, “Building the Best Healthcare Facility”, and our look at Royal Victoria Regional Health Centre's cooling innovations in Barrie, Ontario. Please also read with interest BC's own healthcare successes in Ken Stewart's “Going for LEED Gold in BC”, and Paul Edward's refreshing look at hospital air in “Medical Air Matters”.

CHES's 2014 National Conference in Saint John, NB, is a show you will not want to miss. Read all about the events, sessions, and networking opportunities you'll experience in our conference preview, which begins on page 25.

Lastly, while this issue takes a more concerted look at the patient perspective, this journal relies on the perspectives brought forth by healthcare professionals. If you have an idea for a future story, please send it along to myself at stevem@mediaedge.ca, or CHF's editor, Matthew Bradford, at matthewb@mediaedge.ca.

Thanks and enjoy the show!

Sincerely, Steve McLinden Publisher stevem@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.

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. 6 Canadian Healthcare Facilities

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Message from the President

Embracing sustainability, achieving excellence I want to take this opportunity to thank and congratulate the Newfoundland, Ontario, Manitoba, and British Columbia CHES chapters on the overwhelming success in their recent provincial conferences. It is through this leadership that CHES is able to increase the capacity of its members to meet the sustainability challenges in facility management.

Through these educational and credentialing sessions, we deliver important professional development opportunities. In our fast-paced work lives, technology is evolving and changing at an ever-increasing rate. This is challenging everyone’s ability to keep up to date with the latest technologies and processes in the dissemination of knowledge and experiences that contribute to the overall sustainability of our healthcare systems.

The basic principles of sustainability are integrated into facility management processes, and a natural fit for facility management professionals in the planning, implementation, and maintenance of their strategic sustainability programs. Our stakeholders demand and deserve nothing less. However, sustainability is not limited to energy conservation and high performing buildings; it includes our ability to thrive within available resources, including human, financial, and environmental.

Delivering on the promise of a high-quality healthcare experience in an environmentally responsible manner will require tackling these challenges with the right strategies and the right people, as well as the right capital resources to ensure long-term sustainability for our healthcare system for future generations.

On that note, I’m also very pleased to report our Professional Development Committee continues to advance the development of a Canadian Certified Healthcare Facility Manager CCHFM designation that will be accepted nationally within the healthcare industry. It will be one that recognizes and acknowledges that an individual has attained a high degree of skills, abilities, and competencies required of today’s facility managers.

I wish you all a great year. Work hard and play harder.

Kindest regards,

Peter Whiteman CHES National President

8 Canadian Healthcare Facilities

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ALBERTA CHAPTER

Chapter Reports Hello from the Alberta Chapter. We would like to update you on our quest to roll-out e-Facilities for the remaining three zones within Alberta Health Services (AHS). As I author this, our e-Facilities team is working out some operational issues. However, by the time you read this article, the entire province will be operating on the program.

Within AHS and the Capital Management portfolio they have created awards to recognize their staff for performance in specific areas. Recent winners include: • Bill Rutheldge Award for Leadership: Penny Rae, Acting Chief Information Office (former VP of Capital Management) • Energy Management Award: MacKenzie Campus (University of Alberta Hospital) • Humanitarian of the Year Award: Sohan Kuma, Clinical Engineering at the University of Alberta Hospital Campus • Initiative of the Year: Ellen McMahon, Strategic Planner, Calgary/ Central Zone & Centre of Expertise

• LEAN Champion of the Year: Chantha Hem, Maintenance Planner, Facilities Maintenance & Engineering, Calgary Zone • LEAN Site of the Year: Foothills Medical Centre, Calgary • Outstanding Customer Service Award: Amanda Saigeon, Clinical Engineering, Rockyview General Hospital & Satellite Sites • Sheldon Miller Award for Safety Leadership: Fire & Life Safety Team, Protective Services, Centre of Expertise Congratulations to all the winners and the individuals and teams that were nominated by their peers!

Ken Herbert, our past chair of Alberta, had surgery a few weeks ago and is doing very well. We wish him a speedy recovery! When we last spoke, his parting comment was: “Go Stamps Go”. Apparently, they couldn’t remove his flavour for the professional sports team in the southern part of the province.

Have a great summer and travel safe.

MANITOBA CHAPTER

Preston Kostura, Alberta Chapter Chair “Keeping the Air Clean: Elements of Quality HVAC Maintenance” was the theme of the Manitoba Chapter's 7th Annual Education Day. With well over 50 hospital facility staff from all corners and edges of the province, 7 presenters, and 26 exhibitors, this was our largest event ever. The feedback was positive, with particular praise going to the practical and hands-on focus of this year’s presentations. For example, one presenter brought in a full-sized rooftop air handling unit to detail the maintenance requirements of these popular devices.

The Annual General Meeting was held during the education day. Craig Doerksen assumed the role of chapter chair, with Gary Yuel continuing as secretary and Tom Still as treasurer. Reynold Peters, who was thanked for having just completed his twoyear role as chapter chair, accepted the nomination to become vice-chair. While there has been past challenges to gain interest in serving on the chapter executive and the Training Day Organizing Committee, after this year’s event many members have volunteered to be a part for the upcoming years.

The executive team is working on getting an organizing committee going for the 2015 Education Day. As well, we are working on leveraging the chapter's financial strength to provide additional training opportunities in the upcoming year.

MARITIME CHAPTER

CHES Maritime Chapter is pleased to report on a number of initiatives. First, the chapter has developed new by-laws that have been put to the members to vote on online. Secondly, the chapter executives have voted to cover the cost of CHES Maritime member registration at the CHES National Convention in Saint John, NB. We look forward to the event and wish everyone an enjoyable and safe summer.

ONTARIO CHAPTER

Craig Doerksen, Manitoba Chapter Chair

The Ontario Conference was another huge success. Hats off to Ron Durocher and his team for putting on a great show. We hope you enjoyed the education sessions, visited the booths, and made some time for networking. During the OHA in November we will decide where it will be held in 2015. If there are any suggestions, please bring them forward.

The HELO program is moving along at a good pace. With J.J. Knott taking the lead on this project, I know his team will ensure our hospitals are using their resources wisely. CHES Ontario is very enthusiastic about the new partnership and all it brings to our members across the province.

Denis Pellichero, Maritime Chapter Chair

10 Canadian Healthcare Facilities

I would like to thank the Ontario Executive team on the great work they are doing everyday and the time they put in to ensuring our members are receiving good value for their membership.

I look forward to seeing you all in St John for the National Conference.

I look forward to the education program and social gatherings that the committee has put together. On behalf of CHES Ontario, I would like to thank Ralph and his team for making this happen.

Lastly, I would like to personally wish each and every member a very happy and safe summer to spend with your family and friends.

Allan Kelly, Ontario Chapter Chair

CHES Announcements Ralph Mayfield named Energy Efficiency Champion

By Jessica Vihvelin As the director of physical resources for Horizon Health Network, Saint John, and an active member of the CHES Maritime Chapter for a number of years, Ralph Mayfield “walks the walk” when it comes to energy efficiency. His primary role is overseeing maintenance and physical plant operations in facilities from Sussex to St Stephen and looking for ways to reduce energy.

Recently, his efforts were recognized during the Premier's Awards for Efficiency, in which he was named one of 2014's Energy Efficiency Champion.

This year, Ralph oversaw many upgrades at the Saint John Regional Hospital (SJRH), including the installation of a new chiller. Ralph knew that in order to get the best performance out of this new piece of equipment, it needed to be programmed for maximum optimization and efficiency. Ralph went ahead with the investment in this optimization and as a result, the SJRH will avoid approximately $85,000 in electricity costs.

Ralph has implemented a policy: when something breaks, don’t simply fix it -- look for ways to improve it. This approach often results in an improved workplace and patient environment. One example is the replacement of patient room night lights. With 630 night lights at 5W each, approximately $1000 per year was spent on night lights alone. Ralph’s solution was to switch to 2.4W LED light strips. This will save money on electricity costs and the cost of maintenance staff to replace bulbs.

The old 5W bulbs typically only lasted 6 months or less, and the new LED light strips will last 10 years. The light is also brighter and more focused, reducing light disturbance in the middle of the night while patients sleep. It would typically take maintenance staff up to two hours every six months to replace the old lamps, but once this project is complete, staff will be available for other maintenance work.

Comparing 2013’s energy consumption (normalized for weather) to 2011 (when the SJRH expansion opened), the facility has seen an energy reduction of 2.7 million equivalent kWh, totaling an impressive $227,000 cost avoidance in 2013.

CHES Canadian Healthcare Engineering Society

Premier David Alward, Ralph Mayfield, and Minister Danny Soucy

“It’s so important to take advantage of every opportunity possible to reduce our energy costs in health care,” says Mayfield. “And making our operations as efficient as possible is my passion.”

Ralph’s passion for energy efficiency has spread to colleagues and coworkers in facilities throughout the Horizon Health Network. Building staff are excited to showcase their accomplishments, and this is the result of a workplace where the culture of energy efficiency is actively encouraged.

Ralph leads by example. He encourages incorporating energy efficiency into daily activity and has shown the real benefits of energy efficiency projects, no matter how big or small.

Outside of work, Ralph practices what he preaches. In his own home he was an early adopter of ground source heat pump technology in the 1980s, experimenting with a horizontal loop in collaboration with a local geothermal manufacturer. Unfortunately, the geology below his home prevented a successful installation so Ralph installed an energy efficient air source heat pump for heating and cooling. He is also participating in Efficiency NB’s Residential Energy Efficiency Program and increasing insulation levels throughout his home.

Congratulations, Ralph! It is well deserved.

Jessica Vihvelin is website and communications coordinator with Efficiency New Brunswick.

SCISS

Société canadienne d'ingénierie des services de santé

National Healthcare Facilities and Engineering Week October 19 - 25, 2014 Recognize yourself, your department and your staff during Healthcare Engineering Week. Make sure everybody knows the vital role played by CHES members in maintaining a safe, secure, and functioning environment for your institution.

Summer/été 2014 11

GOING FOR LEE Four western medical facilities earn top LEED status

By Ken Stewart

The Dr. Walter Anderson Building

Leadership in Energy and Environmental Design (LEED) is transforming the way we think about how buildings and communities are designed, constructed, maintained, and operated across the globe. Comprehensive and flexible, LEED is a green building tool that addresses the impact buildings place on the environment starting from the first day of construction through to the end of the building service life.

LEED is the Canadian Green Building Council (CaGBC)'s rating system for the design and construction of energyefficient and high-performing buildings. It has awarded the Interior Health Authority of BC’s four new medical-academic buildings LEED Gold status, including: • The Kelowna General Hospital Centennial Building (opened in February 2012).

• The UBC Clinical Academic Campus, (opened in December 2009).

12 Canadian Healthcare Facilities

The Kelowna General Hospital

• The Polson Tower at the Vernon Jubilee Hospital, (opened in May 2011).

• The Dr. Walter Anderson Building – Clinical Support at Kelowna General Hospital (opened in 2012).

Certification of the project was based on green design and construction features that include the following criteria: • During construction, suspended solids and other contaminants were removed from storm water prior to release into the local storm water system; • the project included solar-reflective roofs; • water-efficient landscaping incorporates native plants and requires no irrigation once established; • energy consumption is reduced through use of high-performance glazing and insulation, automatic lighting controls, and occupancy sensors that set back temperatures and ventilation rates;

ED GOLD IN BC

The Polson Tower at Vernon Jubilee Hospital

• the project utilized recycled and regional construction materials; • significant portions of construction waste was diverted from landfills; • low-flow fixtures reduce water use to 40% below standard; and • all sealants, paints, carpeting, and wood products used on the projects emit only low amounts of volatile organic compounds.

"This building project represents a milestone in the development of the hospitals in Kelowna and Vernon," said chief project officer, Norma Malanowich. "[It] visibly demonstrates the Authority’s commitment to sustainable building practices and energy efficiency."

"For the hospitals to achieve Gold in its first attempt at LEED certification testifies to the hard, cooperative work of many at

The UBC Medical Student building and parkade

the hospital sites along with our planners, architects, and construction firms," he added. “Our thanks go to them all.”

Certified Silver, Gold, and Platinum levels of LEED certification are awarded based on the total number of points earned within six categories: sustainable sites, water efficiency, energy and atmosphere, materials and resources, indoor environmental quality, and innovation and design.

LEED can be applied to all building types, including new construction, commercial interiors, core and shell developments, existing buildings, homes, neighbourhood developments, schools and retail facilities.

Ken Stewart is the P3 General Manager for the Kelowna and Vernon Hospital Projects. He brings over 30 years of experience in operations, service and project management, and has worked with nine hospitals and care facilities throughout BC as well as other notable clients.

Summer/été 2014 13

THE PATIENT PERSPECTIVE

Enhancing and maintaining the quality of care is job number one for all healthcare professionals. In this special section, Canadian Healthcare Facilities builds upon the themes of CHES's 2014 Conference with a look at how three different hospitals are putting their patients' health, safety, and overall experiences first.

WHAT TO DO WITH THE PATIENTS?

How Queens General Hospital put patients first during hospital-wide renovation

By Robert Barss

From left to right: Sam Elsworth (project manager), Randall Harnish (carpenter), Elizabeth Watson (infection control practitioner), Steven Mader (plumber), Ryan McCarthy (general maintenance), Tim Chiasson (refrigeration building systems technician), Sheila Lee (infection control practitioner), Danny Dares (carpenter), Tom Hanley (electrician), Kurt Sart (general maintenance), and Robert Barss (manager of facility services).

14 Canadian Healthcare Facilities

When a community hospital undergoes a major renovation and addition to its only medical unit, there are many challenges to face. One of the most difficult questions to answer is: What do you do with the patients?

This was the question posed by staff at Queens General Hospital, an acute care community hospital located in the Town of Liverpool on the beautiful south shore of Nova Scotia. The facility, which has been

providing healthcare services since 1949, and housed a medical unit built in 1965, was due for a much needed upgrade.

Stakeholders from the District Health Authority, the municipal and provincial government, Queens General Hospital Foundation, and the community had a vision of enhancing the health services that were delivered at Queens General Hospital, resulting in an even better care experience

THE PATIENT PERSPECTIVE

for patients and clients. As well, it was imperative to improve the work environment for staff and physicians and create an atmosphere that would support efforts to recruit and retain health professionals in the future.

As such, a $16 million-plus Queens General Health Project was launched to upgrade and modernize the hospital's existing 22-bed medical unit and build a new collaborative healthcare facility. The medical unit construction plans include private washrooms for every patient, technological, and structural improvements to provide for quality patient care, and quiet spaces for patients and families. The on-site collaborative healthcare centre offers a new approach to family practice with doctors, nurses, and other healthcare providers working together under one roof to deliver services to the sick, promote preventative healthcare, and manage chronic illnesses.

Construction on the project, which was largely funded by the community, began in October 2012.

CAREFUL PHASING

Phasing work around patients in an existing patient care area is an extremely difficult and expensive task. Caring for patients in or near a construction zone can also impact the healing process. As a result, the original plan was to move patients off-site during the construction; however, it quickly became clear that staff and community wanted to keep as many patients as possible in the

facility as doing so would reduce the pressure on beds in the district’s other hospitals, which have consistently high occupancy rates.

A transition team was developed to investigate options. The team developed a strategy that would see 14 beds accommodated in the existing facility during the modernization project. The plan included converting several administrative offices, the library, quiet room, and the hospital gift shop into patient rooms and support staff areas. As well, the emergency observation room was to be restructured to house a four-bed ward. As such, the 14 staff occupying these areas readily agreed to be relocated to other areas to assist with the project’s success.

With a plan in place, the next hurdle was deciding how to complete the work to meet the project start date and stay within a $330,000 transition budget. Initial estimates put the cost for the project over $500,000 if done by outside contract.

This is when the district maintenance department stepped up to the task. As the manager of facility services, I approached staff and asked if they could accept the challenge. Their response was unanimous; the maintenance staff wanted to be part of the success of this project and completing the renovations for the transition phase suited the skills and ambitions of the team. By shifting priorities, delaying some regular maintenance projects, adding casual staff to fill in, and receiving senior management's agreement, the group was able to move ahead with the project.

Summer/été 2014 15

Transition crews work on the infection control corridor

Bedroom construction before and after

Carpenter Randall Harnish was the lead on-site for the transition project and was supported by a team consisting of various tradesmen and generalists from across the district, as well as infection control and other hospital staff. The group had a floor plan to work from, but the actual details of the renovation were developed by the group as they worked their way through the project.

The renovations were spread between the first and second floor and directly adjacent to an active medical unit. The areas to be renovated were also in close proximity to various patient services, including a dialysis clinic. Working with infection control practitioners, Sheila Lee and Liz Watson, the construction area was isolated and maintained by closely following the CSA 317.13 standard, ensuring prevention of nosocomial infections due to construction. Sealed drywall barriers were erected and sufficient negative air units were put in place to provide the required amount of negative pressure. Working with the local Department of Environment and Labour (Office of the Fire Marshal), the team created the space so it met the requirements of NFPA, including fire and smoke detection, compartment fire doors, and acceptable means of egress.

The team came up with a plan where the patient rooms were connected by an archway to allow the use of one washroom per three patient rooms. This allowed patients the privacy of a single room other than the shared washroom. Plumber Steve Mader engineered all the plumbing, including a tub room which was created on the first floor, allowing patients on the second level access by a short elevator ride.

Addressing the nurse call was another challenge. Electrician Tom Hanley, who was responsible for all the electrical work, located a simple nurse call which was put in place until he could relocate the existing system from the old medical unit.

In addition, the renovated areas had no air handling unit. HVAC technician Tim Chiasson came up with a combination of HPV and ceiling split air conditioning units to provide fresh and cooled air.

On each floor, rooms were converted to nurse stations and all the equipment required to operate a functional patient care unit were incorporated, including cardiac monitoring, telemetry, bedpan washers, and later an automatic drug dispensing equipment.

Medical gases were permanently installed for the beds located in the observation room of the ER. Portable units were used to support the other beds. Additional patient amenities, such as telephone, data, and television were provided in all the rooms. Randall Harnish was 16 Canadian Healthcare Facilities

responsible for the structural aspects of the construction and depended on assistance from Ryan McCarthy, Kurt Sarty, Danny Dares, and Leonard Rutledge to complete the job.

Outside contractors were utilized in areas where their expertise was required, but the bulk of the work was done in house. As well, the environmental services staff are to be praised for the extra effort they put forth to deal with the regular clean up around the construction area.

Upon completion, staff and patients commented how the upgrades and functionality of the transitional spaces exceeded the existing medical unit.

Another dilemma facing the hospital was in the area of food service.

The kitchen was located below the redeveloped space and, as such, this meant it would lose the air handling unit serving the area. Without ventilation, the kitchen staff could not operate. The team came up with the idea of placing two, large portable negative air units which would provide fresh air and exhaust from the cooking and dish washing spaces. A large portable air conditioner left from a previous project was put in place to provide cooling. Flexible fire rated duct work, secured to the ceiling above, was utilized to move the air.

Both the fire marshall and CFIA (Canadian Food Inspection Agency) approved the plan. The kitchen had to be closed for a period due to the renovations involved with the redevelopment project, but due to the ingenuity of the team, the kitchen was able to function and provide food services for the hospital for the majority of the project.

END RESULTS

The maintenance team took on an enormous task and through their professionalism and commitment to the patients, staff, and people of the community, completed the project on time and under budget by $50,000. This money was redirected to support the larger project.

The transition project demonstrated the abilities of the maintenance team and the contributions by supportive staff from across the district. They rose to the occasion and got the job done.

Thanks to this initiative, most of the patients from the community were able to receive their care close to home and the majority of staff were able to continue working at the hospital.

As with most facility maintenance teams, when faced with a challenge, they didn’t back down, they stepped up.

Robert Barss is manager of facility services with South Shore District Health Authority

THE PATIENT PERSPECTIVE

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THE PATIENT PERSPECTIVE

RE-THINKING

HVAC AND HAIS CHAIR's strategies for enhancing patient protection

By Richard Dixon Healthcare acquired infections (HAI’s) are increasing each year in our Canadian healthcare facilities. Meanwhile, the traditional approaches to HAI reduction are becoming less effective while bacteria is becoming more resistant to our effects to contain its spread.

THE STANDARD APPROACH

The first antibiotic “penicillin” was discovered by Sir Alexander Fleming in 1928. Since then, antibiotics have become widely used (and frequently overused) in the treatment of infections.

Unfortunately, the increased use of antibiotics in healthcare facilities, and in community use, decreases the patient’s immune system and increases their likelihood of contracting a HAI. The traditional defense is for all clinical staff to wash their hands with soap and water to clean the hands of visible dirt, and use a hand sanitizer to kill any remaining organisms. If the skin is visibly soiled, hand sanitizers will not work effectively by themselves. For equipment, it's the same principle: clean before you disinfect. The effectiveness of the hand washing process is measured at reasonably high rates when audits are done, but effectiveness is less when the audit staff is not present (aka the Hawthorne Effect). Thus, when hand washing is not effective, bacteria are easily spread from contaminated touch surfaces though the hands of visitors and care givers to immune-compromised patients.

Also at the front line of defense are the environmental services departments. Herein, staff are required to do extensive disinfections with a wide variety of products that are becoming less effective since the bacteria is becoming more resistant to these disinfection processes. Also, the time associated with the actual clean is not necessarily long enough due to scheduling and budget restrictions. Audits of their cleaning effectiveness with ATP meters (adenosine triphosphate) or glow lights indicate a significant amount of the patient touch surfaces to be contaminated with bacteria. These ATP meters are a verification that provides 18 Canadian Healthcare Facilities

accurate and meaningful results that can help a healthcare facility define and monitor a cleaning standard to make sure it is maintained.

ENTER: CHAIR

Canadian healthcare facilities spend $2 billion on infection prevention and control salaries, hand washing practices, and audits -- plus another $4 billion treating HAIs. More importantly, there are 160,000 to 200,000 annual infections in Canada, with upwards of 12,000 deaths. Just cutting the HAIs by 50% would save $2 billion and thousands of seriously ill patients, many of whom would have died.

In short, patients are getting infections within environments that are supposedly built to keep them safe. It's time to try another approach.

The Coalition for Healthcare Acquired Infection Reduction (CHAIR) is a new organization that was formed to combat HAI’s through the built environment and with engineered solutions.

CHAIR believes that with help from healthcare management and staff, we can all work to reduce HAIs by 80% by 2014. Thus, healthcare heating, ventilation, and air conditioning (HVAC) system people have to re-think their traditional approaches.

ROOM FOR IMPROVEMENT

The Canadian Standards Association Z8000-11 standard requires hospitals build inpatient rooms as “one patient per room”, which is a great advantage in the infection control world. However, there are a few issues to re-think.

Let’s start with the HVAC system in one of these new rooms. The air is supplied within temperature ranges of 22 C to 24 C and 30% to 60% relative humidity. However, the supply air is set at minimum two outdoor air changes per hour (ACH), and minimum six total ACH. Thus, re-circulated air is being used between all the patients in the care unit. As a result, there are single rooms for patients, but some of the air is re-circulated to all the patients. What about raising the

THE PATIENT PERSPECTIVE

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THE PATIENT PERSPECTIVE relative humidity minimum to 40%, providing we could maintain a clean humidification system? The clinical evidence suggests that the optimal conditions to enhance human health by minimizing the growth of biological organisms and the spread of chemical interactions occur in the narrow range of 40% to 60% relative humidity at room temperature.

On the filtration side of the typical HVAC system there are two filters: MERV 8 (#1) and MERV 14 (#2).

In combination, these filters take out 95% of the skin, air, dust, etc., and some bacteria out of the air down to one micron. Some of the bacteria is still recirculated, but these filters effect no virus containment or kill.

Now, imagine if the air was HEPA filtered so that 99.97% of the particles were removed down to 0.3 microns. We should be considering the benefits of HEPA filtering general patient rooms. Even if this system was implemented in high risk areas of a hospital like the intensive care unit or even the operating room, the HAI rate could be reduced. Cost is an issue, and we will get to that soon.

Patient Room HVAC Revised

RETHINKING BATHROOM HVAC

In a patient bathroom, the return air grill is traditionally on the ceiling and most likely directly over the toilet. According to engineers, this placement above the toilet is an efficient way of pulling the “odour” out of the bathroom because the duct work is placed in the ceiling structure. That sounds reasonable, but what is that “odour”?

It is bacteria from the aersolization of toilet water, fecal matter, and/ or urine (aka fecal cloud)?

Think of a patient with C. difficile infection and continual diarrhea. The associated continual flushing of the toilet and the resulting fecal cloud with the exhaust grill in the ceiling pulls the bacteria-laden air from the toilet and up past the patient’s mouth and nose where they can be re-infected over and over. Some of the fecal cloud also escapes into the patient room as the bathroom door may be left open – minimal draft from the return grill and a large open door. This fecal cloud can easily drift into the pressure neutral corridor and beyond.

A simple solution is to place the exhaust grill behind or adjacent to the toilet at approximately 300mm above the floor which is closer to the source of the fecal cloud so the air will flow away from the patient’s hands, mouth, and nose, thereby decreasing the risk of reinfection of airborne diseases. So let’s go back into the patient room and put that exhaust grill behind the bed at that same height to collect the fecal cloud from the patient “off gassing”, or the use of bed pans. That's an easy solution.

CLEANING THE AIR

Here's a harder example. The frequency of supply duct cleaning in healthcare facilities is realistically seldom or never. Why is this situation happening, especially in older facilities? Is it because of budgets? Are staff too busy? It is time to re-think this issue, since old supply ducts (as well as return ducts) need investigation of how much dust, bacteria, insects, etc. they have accumulated; the costs and logistics associated with the cleaning process; as well as the benefits of air that is supplied by sophisticated HVAC systems through clean ducts to patients.

20 Canadian Healthcare Facilities

Airflow

CHAIR Canada

Another way to clean the air is by using ultraviolet light; specifically, UV-C lights which have a wavelength of 100 to 280 nanometers. This technology has actually been around for years, but now studies have shown it to be a very beneficial part of the re-thinking of how the air (and touch surfaces) can be cleaned.

Did you know that UV-C systems are widely used in the meat and fish processing industries to keep the air and surfaces free from bacteria? These state of the art UV-C systems can be installed as in-duct, coil mount, and stand-alone systems to target specific high risk rooms. What's more, controls consultants can link a few UV-C issues to the building management system (BMS). Again, the patient gets the benefit of receiving air that is not only virtually free of unwanted particles from our previously noted filter issues, but the UV-C is killing bacteria and viruses at 99%.

These modern UV-C systems are cost effective to purchase and install, and have long lasting UV-C bulbs that do not emit ozone and systems that can be put in place for safe operational use. Portable UV-C systems are also available that can clean patient rooms post discharge at a disinfection rate typically higher than environmental services in only 15 minutes. That was easy too!

HVAC UNDER PRESSURE

Now that we have safe air, it's time to discuss pressurization issues. A typical hospital is a delicate balance of negative, neutral, and positive pressurized zones – and for very good reasons. The operating room is pressurized as positive to push unwanted air from other zones away from patients who are in a vulnerable state with their insides literally opened up. Meanwhile, the endoscopy department is pressurized as negative to prevent the fecal cloud from migrating into adjacent zones. However, the typical in-patient unit (medical, surgical, paediatric, etc.) is pressurized as neutral.

The patients inside these units, as by the nature of the admission reason and antibiotic use, are reasonably immune suppressed and thus vulnerable to common HAIs like VRE, MRSA, and C. difficile.

Let’s then re-think this issue as to keep air from migrating room to

Case Studies of Hospitals in Ontario Using Energy Performance Contracts (EPC) Hamilton Health Sciences • Family of 5 facilities serving more than 2.3 million residents • Projected to save $55 million over 10 years • No additional funding required from Ontario government • On track to become best practices benchmark

London Health Sciences Centre • Multi-phase project for 3.5 million sq. ft. of property • Completion of 5th Phase expected to reach $3 million in annual savings •

The Ottawa Hospital • $17 million, 15 year performance contract • Guaranteed savings of $2.6 million/year • Savings reinvested in patient care

St. Michael’s Hospital • Founded in 1892, transformed a 90,000 sq. ft. building into a “greenâ€? facility • $258,000 contract • Resulted in reduced energy consumption as well as improved light levels and space conditions for patients and staff

Sunnybrook Hospital • $11 million/year spent on energy • Target is to reduce energy use by 50% from 2006 base year • Process to select ESCO was compliant with Broader Public Sector (BPS) guidelines

Timmins and District Hospital • Following detailed assessment, major energy components replaced and enhanced • Expected to result in savings of more than $4.2 million over the next 8 years •

Hospital Association

Further information on these and other case studies can be found at:

www.energyservicesassociation.ca

THE PATIENT PERSPECTIVE room via the open door to the corridor or through the HVAC system. Why not make the air flow in a more common sense manner: from corridor to patient room to bathroom? Not a lot of effort is needed to make this happen. HVAC engineers can design the system in this manner and balancing contractors can verify its performance.

Truly, we must think ahead to what may be coming next, like Middle Eastern Respiratory Syndrome (MERS) or H5N7 or just control the common HAI’s of VRE, MRSA and C. difficile. This negative balancing of in-patient rooms would be a safer place for all of our patients. It would go a long way towards not having the ‘fecal cloud’ migrate from one patient room to another via the currently neutral corridor. Once again, that was easy.

Another easy engineered solution is to make key humidification components (i.e. coils) out of copper or a copper alloy to reduce the potential for the growth of bacteria. Health Canada has now registered copper as an ‘antimicrobial’ product following the United States' registration with the Environmental Protection Agency. As an alternate, the water for humidification system could be reverse osmosis which would also reduce bacteria growth.

POSITIVE HVAC RESULTS

Naturally, this article is about HVAC in healthcare facilities such as hospitals, nursing homes, long term care centres, and respite homes; as well as specialized facilities like In-Vitro Fertilization (IVF) clinics.

As for the latter, a recent study at an IVF clinic in the United States indicated the success rate of fertilizations went up from 38.9% to 62.3% with just the introduction of UV-C cleaning systems in key rooms. No doubt, this is a dramatic improvement, and it was easy.

Understanding this, it's a good idea to focus on not just hospitals, but all of the healthcare facilities across Canada.

Additionally, many surgeons in Canada have procedure rooms in their office building to perform minor surgical procedures that can be done easily outside of a hospital. Besides building the procedure room to the local building code, they should be following the Canadian Standards Association requirements for HVAC, medical gas piping, etc.

As more and more surgical procedures move from an in-patient to out-patient status, there is also a significant trend to move the outpatient procedures from the traditional hospital building to free standing surgery centres operated by the hospital itself or to physician-based practices. Therefore, another opportunity exists in these physician-based practices for the innovations noted above.

It's important to be realistic about the capital costs for implementing these key findings that came through CHAIR’s process of re-thinking traditional approaches to the built environment and the potential cost savings. Again, cutting the HAI’s by 50% of the estimated $4 billion in costs would save $2 billion annually that could be directed towards a Health Acquired Infection Reduction fund. So there is not a requirement to increase healthcare budgets to combat the problem. The “Return on Investment” (ROI) does this by itself. In fact, we should actually call it “Return on Innovation”.

And for the last time…that was easy!

Richard Dixon is deputy chair of CHAIR and president R&C Dixon Consulting Ltd.(www.ChairCanada.org). He can be contacted at richarddixon@ chaircanada.org.

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22 Canadian Healthcare Facilities

Once he reduced his energy costs by 55% after installing a VFD, savings in other parts of his business went into overdrive.

Once you start seeing the benefits from our incentives for installing premium efficiency motors and VFDs, you’ll want to look into making other areas of your facility like lighting, HVAC and building automation more efficient too. When you do, you’ll be joining institutions like Kingston General Hospital, St. Thomas-Elgin Hospital and Hotel Dieu Hospital who are already enjoying the energy savings that our incentives deliver.

Take a look at their stories and our incentives at

saveonenergy.ca/canadian-healthcare

Subject to additional terms and conditions found at saveonenergy.ca. Subject to change without notice.

OM Official Mark of the Ontario Power Authority.

HEALTH SCIEN POWERS THROUGH THE FUTURE Manitoba Hydro helps HSC deliver optimal care

Contributed by Manitoba Hydro

At Health Sciences Centre (HSC) in Winnipeg, Manitoba, the demand for healthcare services is great. The hospital is the largest of its kind in the province, serving the surrounding community, as well as aboriginal and Inuit communities across Manitoba, northwestern Ontario, and Nunavut.

From left to right: Dirk Hantscher (Manitoba Hydro—Industrial Systems Engineer), Myles Boonstra (Manitoba Hydro—Senior Industrial Systems Engineer), Nicki Caron (Manitoba Hydro—Major Account Advisor), Chantel Charles (Manitoba Hydro—Energy Control Systems Engineer), Craig Doerksen (Health Sciences Centre—Director, Facility Management), Ian Kelly (SMS Engineering—Senior Mechanical Engineer, Principal) and Gerry Hebert (Health Sciences Centre--Manager/Chief Engineer, Central Energy Plant).

24 Canadian Healthcare Facilities

THE PATIENT PERSPECTIVE

NCES CENTRE Myles Boonstra (Manitoba Hydro—Senior Industrial Systems Engineer) reviews the flow meter data from the chilled water system.

With a steady stream of patients coming through its doors, HSC has to continually maintain, upgrade, and expand its systems to be able to provide a high level of service. That’s why it had to take action when its central energy plant (CEP1), which provides chilled water for the hospital’s air conditioning system as well as its emergency power, reached its expansion limit.

“The existing plant opened in 1974 and it had been fully fit out with its last expansion in 1998, fulfilling the original 30-year vision,” said Craig Doerksen, divisional director of facility management at HSC. “The additional plant capacity was required to support the growing campus, with current projects adding an extra 500,000 sq. ft to the existing 3.2 million.”

HSC turned to SMS Engineering Ltd. for help. The Winnipeg-based engineering firm was familiar with HSC’s systems, having worked to expand CEP1 in previous years.

Its team, along with HSC staff, devised a plan that considered the hospital’s current and future energy needs, ways to save energy with new, efficient technology, and how to make the new technology work with the older systems HSC had in place.

The solution involved building a second central energy plant (CEP2) to house three, 1,500-ton chillers, with room to add three more. At $37.9 million, CEP2 was an investment – albeit one that would serve the hospital for

years to come and act up to twice as efficiently as CEP1. It would mean chilled water production and pumping, operating in parallel with the existing plant, both hydraulically and through optimized controls. It would also mean a fully automated, central emergency power system that works with the existing system to provide emergency power for patient safety and for the chilled water system.

Efforts to build the new plant were supported by Manitoba Hydro, the provincial utilities corporation which offers incentives and rebates for building energy efficient designs.

With a sizeable project such as CEP2, HSC decided to work alongside Manitoba Hydro to not only save money and energy while in operation, but to receive an incentive for building with energy efficiency in mind. That incentive, to the tune of $250,000, offered a simple payback over the course of 4.7 years and helped HSC offset the work of optimization.

SUPPORTING IMPROVEMENTS

System performance was enhanced through Manitoba Hydro’s Power Smart Performance Optimization Program, which looks at ways industrial and large commercial buildings can save energy and improve overall performance. HSC’s new energy plant was an ideal candidate for the program, given the size of the project, its potential for significant energy savings, and HSC’s choice of approved equipment.

Summer/été 2014 25

THE PATIENT PERSPECTIVE

Nicki Caron (Manitoba Hydro–Major Account Advisor), Gerry Hebert (Health Sciences Centre– Manager/Chief Engineer, Central Energy Plant) and Myles Boonstra (Manitoba Hydro–Senior Industrial Systems Engineer) stand by the new chillers at the Health Sciences Centre Energy Plant.

“Manitoba Hydro partnered with HSC, providing expertise and supporting HSC to pursue a highly energy efficient design,” said Myles Boonstra, senior industrial systems engineer at Manitoba Hydro. “Manitoba Hydro is also working with HSC throughout the commissioning process, helping them establish an enhanced energy monitoring system that will be used to optimize the (chiller) system.”

Two newly installed control systems help both energy plants work together efficiently. The new Plant Control System (PCS) is an extension of CEP1’s PCS, while the Hartman Loop plant optimization system is a new system that works with the PCS to ensure the plants’ efficiency.

They also keep track of important data such as chilled water production and electrical power consumption, which informs building managers of how well the chillers are performing. With these and other optimization measures in place, CEP2 works as though it’s an expansion of CEP1, despite being a separate entity.

“We also appreciated the ability to work with Tom Hartman, a recognized leading technical expert in the field, to achieve a state-of-the-art chiller plant optimized for energy efficiency.”

Achieving the desired end result, regardless of the relationship between project teams, can be a difficult task— especially when working on a multimillion dollar project with old and new systems that need to operate seamlessly.

“Provision of technology that is both leading edge and cost effective is always a challenge,” said Kelly.

“The project presented the challenge of being able to integrate into an existing central plant, providing energy, operational optimization, and ‘future proofing’ the overall design,” added Doerksen. “These challenges pushed the design team, owner, suppliers, and supporting agencies, such as Manitoba Hydro.”

As planned, the completed initiative has met HSC’s goals. “The project has successfully delivered the central plant services, within budget and schedule,” said Doerksen.

A COLLABORATIVE EFFORT

LOOKING AHEAD TO HSC’S POWER NEEDS

The cooperation between both plants is not unlike that of the teams responsible for building and optimizing them. SMS Engineering, HSC, and Manitoba Hydro’s positive and productive relationships helped the project go smoothly.

“The teams have worked collaboratively to complete the measurement and verification analysis for Manitoba Hydro’s Power Smart Performance Optimization Program, helping HSC realize its energy conservation goals,” said Boonstra.

Ian Kelly, principal of SMS Engineering, echoed the collaborative sentiment: “SMS was directly involved with HSC from the start, including the preparation of a master development plan, research of design options, concept development, and finally, the design, construction, and commissioning of a new plant.”

As for what’s to come, the new central emergency power system is next to commission. With the help of the engineering team and Manitoba Hydro, HSC’s emergency power system will be able to provide more power for longer periods of time.

“Future plans include expanding the emergency power system operation to allow the hospital to potentially ‘island’ itself in long-term power outage situations,” explained Doerksen.

HSC’s technological advances and energy efficient choices create a path for future facility expansion, while also demonstrating the possibilities for other healthcare facilities. It’s a move that will pay off in more than just financial terms for both the facility and its patients.

26 Canadian Healthcare Facilities

www.ches.org

S

P O N S O R S KEYNOTE

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PROGRAM Sunday September 28, 2014 09:00-14:00 The Great CHES Golf Game 08:00-17:30 Companion Program – Day 1 18:30-21:00 Opening Reception | Sponsored by Class 1 Inc.

Track 2B

Shaping Buildings to Improve the Patient Experience

Brock Marshall, Director of Engineering and Facilities, The Ottawa Hospital, Ottawa, ON Joanne Read, Senior Director, AmbCare/Eye Care/Support Services, The Ottawa Hospital, Ottawa, ON Our Canadian healthcare budgets are continuously under strain with limited funds for capital improvements. Deferred maintenance is on the rise and many healthcare organizations find they are only able to address high priority projects.

10:15-16:15 Companion Program – Day 2

There have been a number of studies that link the physical environment of a hospital to patient outcomes. Evaluating this link has become an important factor in prioritizing facility upgrades and greening initiatives at TOH. So, how do you prioritize projects and greening initiatives and demonstrate that they support improving patient outcomes? This presentation will provide an overview of the methodology used at TOH to evaluating and prioritizing facility renewal projects, and how we determine the effect on patients. Examples of projects that have been implemented will be discussed as well as how they link to patient outcomes.

09:00-09:45 KEYNOTE ADDRESS | Sponsored by Honeywell

12:00-12:45 2 CONCURRENT TRACKS – 3A & 3B

Hélène Campbell

Track 3A

Hélène Campbell is the young woman behind what is now known as the Hélène Effect: making things happen through the power of her magnetic personality, her unbridled enthusiasm, her limitless optimism, her passion and iron will. Hélène is a very grateful and feisty double lung transplant recipient and the spokesperson for the Give2Live Foundation.

Chris Brock, Project Manager - Redevelopment, Waypoint Centre for Mental Health Care, Penetanguishene, ON

Monday September 29, 2014 07:00-08:30 Breakfast | Sponsored by Siemens 08:30-09:00 Opening Ceremonies 08:30-16:00 Student Program

Having always loved connecting with people, her journey through disease, surgery and recovery launched her into the spotlight as she harnessed the power of social media and imprinted herself into the hearts and minds of Canadians and people all over the world. Her continued advocacy for the cause of organ and tissue donation triggered an unprecedented rise in registration to donor lists in Canada and the USA. Hélène has caught the attention of leaders and celebrities across Canada and abroad, and she is continuing to be recognized for her courage, strength and incredible spirit. Her passion for the cause dear to her – organ and tissue donation – and the ideals and principles she lives by – be grateful, live passionately and seek out those with tenacity – have made her a sought after speaker. Her recent speaking engagements include: We Day Ottawa 2013, the 2013 Breath! Gala, 2013 Ontario Hospital Association Organ & Tissue Donation Conference, E-Health 2013 Conference, 2013 National Health Leadership Conference, 2013 Canada Day Noon Show, and the 2013 Ontario Hospital Foundation Feature Breakfast .

The general consensus is clear: Hélène’s passion is contagious and no one is immune to her energy and strength. To listen to Hélène makes you feel like taking on the world. The feedback from her recent speaking events is unanimously positive.

09:45:10:45 PLENARY SESSION | Sponsored by Stantec Track 1

Human Factors Engineering in the Facility Design Process: Impact on Human Health

Dr. Elizabeth Bryce, Regional Medical Director - Infection Prevention and Control, Vancouver Coastal Health, Vancouver, BC Ian Clearie, Director - Facilities Maintenance & Operations, Fraser Health, Vancouver Coastal Health, Vancouver, BC Human Factors Engineering is a relatively new discipline that examines the way humans interact with the work environment, technology, tools, and processes with the ultimate goals of optimizing efficiency, effectiveness, and safety. It is an ideal science to interact with Infection Prevention and Control and Facility Maintenance and Planning because it combines the content expertise from all three disciplines to ensure that facilities are designed to not only meet workplace requirements but to enhance quality and safety for both patients and staff. Key principles of Human Factors Engineering will be explained and examples will be provided to specifically illustrate how the science can be applied to the clinical setting.

10:45-11:15 Refreshment Break in Exhibit Hall | Sponsored by Accutech Security 11:15-12:00 2 CONCURRENT TRACKS – 2A & 2B Track 2A

Endearing Healing Garden

Bernard Tong, BA, B Arch, AAA, MAPM, Project Manager, Capital Management, Alberta Health Services, Edmonton, AB

Waypoint Centre for Mental Health Care - Challenges and Outcomes

Saeid Izadpanah, P. Eng M.Sc. LEED, AP BC+C, Senior Associate, Stantec, Toronto, ON Francesco Nardone, LEED AP BD+C, Electrical Consultant, Stantec, Toronto, ON The presentation illustrates the expansion of the existing Waypoint mental health facility located in Penetanguishene, ON, its challenges and the enhanced client experience in the new facility. Waypoint Centre for Mental Health Care is a 350,000 square foot psychiatric hospital built on the hospital’s existing site. Waypoint is the only provider of maximum security forensic hospital services for clients served by both the mental health and justice systems. The new facility consolidated Waypoint into a more efficient, integrated campus.

The building systems have been designed to provide the highest level of flexibility and redundancy and to ensure continuity of service. A critical part of the project was the integration between existing services and systems (i.e. low voltage systems) with new ones. The existing buildings are connected to the new ones so that Waypoint is operated seamlessly.

Track 3B

Lean, Clean, and Green: How Humber River Regional Medical Center is Automating the Age-Old Challenge of Waste, Soiled Linen and Recyclable Collection and Transport

Terry Sim, Director of Planning, Humber River Regional Hospital, Toronto, ON Harry Pliskin, President, TransVac Solutions, Denver, CO This presentation examines Humber River Regional Hospital’s decision to install an automated solution for collecting and transporting soiled linen, waste and recycling. The session examines problems with traditional, more manual methods of collecting, storing and transporting waste and linen. The common approaches can be a major source of expense, inefficiency, worker injury and an infection risk. The advantages of automation relative to cost savings, operational efficiency, space savings and infection control will be reviewed.

This session enables attendees to: • To identify the five major problems associated with traditional, more manual methods of collecting, storing and transporting waste, soiled linen and recyclables in a healthcare setting • Describe how soiled linen is an infection control risk for hospitals using storage or collection rooms as part of its handling processes • Assess the advantages of automation in the collection and transportation of soiled linen, waste and recyclables in a hospital.

• Underway the reasons why Humber River selected an automated solution over traditional waste and linen handling methods.

12:45–13:45 Lunch in the Exhibit Hall | Sponsored by Klenzoid Canada Inc. 13:45–15:30 Exhibit Hall Open

Susan Carr, Chair, 50th Anniversary Committee, Cross Cancer Institute Volunteer Association, Edmonton, AB

14:30-15:15 PLENARY SESSION

Kristin Grimard, BEnvD MLA AALA CSLA, Landscape Architect, EDA Collaborative Inc., Edmonton, AB

Eleanor Rivoire, Executive Vice-President, Clinical Administration, Professional Practice & Chief Nursing Executive, Kingston General Hospital, Kingston, ON

This is a presentation of a Healing Garden conceived by volunteers who have cancer or been affected by cancer, for cancer patients and their families, visitors and staff when they journey through cancer at the Cross Cancer Institute in Edmonton, Alberta. The Healing Garden is a unique legacy project built with donated funds to commemorate the 50th Anniversary of the Cross Cancer Institute Volunteer Association.

15:15-16:00 PLENARY SESSION

Track 4

Track 5

The Patient Perspective

New CSA Standards for Infection Control - HVAC & Plumbing

Richard Dixon, President, R & C Consulting Ltd., Vancouver, BC The Canadian Standards Association (CSA) is going through a process in 2014 and 2015 in

revising its key healthcare standards Facilities – Planning, Design and Construction Z8000, Plumbing Z317.1 and HVAC Z317.2. Plus CSA is pleased to announce a new standard will start development Z317.14 Wayfinding. Our Canadian healthcare facilities are extremely complex to build then maintain. The entire family of CSA healthcare standards thus supports the form and function relationship of this process and most importantly provides a detailed safety element to patients, staff and visitors. Attend this session and be a part of the CSA change process 16:00-17:00 “Happy Hour” in Exhibit Hall | Sponsored by Trane 18:00-19:00 President’s Reception | Sponsored by Tremco 19:00-23:00 Gala Banquet | Sponsored by Johnson Controls Banquet Entertainment - Sponsored by Chem-Aqua

Tuesday September 24, 2013 07:30-08:30 Breakfast | Sponsored by CSA Group 08:30-09:30 PLENARY SESSION Track 6

Legionnaires’ Disease: Past, Present and Future

Janet Stout, PhD, Microbiologist, Director, Special Pathogens Laboratory, Pittburgh, PA Ted Kusz, BSc, VP and Sales Manager, Klenzoid Canada, Mississauga, ON Controlling Legionella in hospital water systems is key to reducing the risk of hospital acquired Legionnaires’ disease. ASHRAE is poised to pass the first national standard in the U.S. Some Canadian jurisdictions have passed new laws requiring compliance with care criteria. Facility directors now face increased responsibility to protect patients and avoid legal risk. A proactive and team approach is recommended that includes conducting a facility-wide risk assessment and developing a water safety plan.

09:30-10:15 CHES National Annual General Meeting 10:15-10:45 Refreshment Break in the Exhibit Hall CHES Maritime Chapter AGM 10:45-11:30 2 CONCURRENT TRACKS – 7A & 7B Track 7A

Blueprint for a Safe and Successful Project

mitigate human errors. When commenting on the future of nosocomial infection control in 1998, Dr Robert Weinstein wrote: “Given the choice of improving technology or improving human behavior, technology is the better choice.

Track 8B

Pressurized Steam Humidification Design Considerations With Focus on Healthcare

Philip Lilja, Product Manager, DriSteem Corporation, Eden Prairie, MN Kendall Brandt, Regional Manager, DriSteem Corporation, Eden Prairie, MN Whether applying humidification for the first time or considering a change to an existing humidification system, this session covers the design considerations needed for a successful implementation. Focus will be on pressurized steam humidification systems in health care facilities. Learn why humidification is important, how much humidification is required, and what types of products are available. In addition, learn common installation and/or operational problems that occur and how to resolve them.

14:15-15:00 2 CONCURRENT SESSIONS – 9A & 9B Track 9A

Maintaining the Environment of Excellence in Healthcare Facilities - An Infection and Control Perspective

David Leblanc, P. Eng., Engineer, Infrastructure Management, Nova Scotia Department of Health and Wellness, Halifax, NS Suzanne Rhodenizer Rose, RN, BScN, MHS, CIC, Director, Quality, Patient Safety and Infection Prevention Control Nova Scotia (IPCNS), Nova Scotia Department of Health and Wellness, Halifax, NS Kim Allain, RN, BScN, MHS, CIC, Provincial Infection Control Consultant, IPCNS, Nova Scotia Department of Health and Wellness, Halifax, NS An environment of excellence includes one that protects patient safety. A core concept in keeping patients safe is the prevention and control of healthcare-associated infections (HAIs). With aging infrastructure, prioritizing maintenance and repair projects with a patient safety lens can be difficult to quantify. Existing organizations need to consider a systematic, proactive approach for the evaluation of their infrastructure condition which may contribute to the risk of HAIs. This presentation will discuss the impact of HAI’s in Canada, the creation and implementation of an evaluation tool which can inform the prioritization of these risks, and the lessons learned.

Anthony Twyman, Infection Control Practitioner, University Health Network, Toronto Western Hospital, Toronto ON

Track 9B

Equally important to the visual environmental experience of the patient are those environmental elements that the patient cannot see: the design features that keep them safe.

This presentation will focus on the importance of knowledgeable infection prevention and control input during the critical pre-planning and design discussions of healthcare facility new construction as well as older building renovation. Specific examples of what can go wrong when the right people are not at the table will be discussed as well as how to avoid these pitfalls.

This presentation will review the ventilation challenges and solutions relative to healthcare facilities design and the impact on infection control.

Track 7B

Effective Climate Control for Hospital Operating Rooms | Sponsored by Shift Energy

Patient Recovery Relative to Ventilation Control & IAQ

Don MacDonald, Canadian General Manager, Phoenix Controls, Acton, MA

15:00-15:30 Refreshment Break 15:30-16:30 PLENARY SESSION Track 10

“Lessons Learned”

Craig Doerksen, Divisional Director, Health Sciences Centre, Winnipeg, MB Roger Holliss, Director of Engineering and Biomedical Services, St. Mary’s General Hospital, Kitchener, ON

Art Doramajian, P. Eng., M.Eng., Senior Engineer, EI Solutions Inc., Laval, QC

JJ Knott, Director, Plant Operations, Norfolk General Hospital, Simcoe, ON

John Gowing, Sales Engineer, EI Solutions Inc., Burlington, ON

Mitch Weimer, Director, Plant Services & Operations, Fraser Health Authority, New Westminster, BC

Controlling humidity in hospitals is obviously important but the fear of mold and bacteria is not what is truly driving the requirement for dehumidification equipment. Surgeons are demanding cooler, drier operating room conditions. Hospital administration has prioritized indoor environmental conditions not just for the safety of the patient, but also to improve the efficiency and quality of work life for the surgeon. The key is to select the most efficient climate control technologies.

11:30-13:30 Lunch in the Exhibit Hall | Sponsored by Thermogenics Inc. Draw Prizes 13:30-14:15 2 CONCURRENT SESSIONS – 8A & 8B Track 8A

C-Diff, MRSA and VRE Disinfection Using Software-Driven Ultraviolet Technology

Normand Brais, P. Eng., Ph. D., President, Sanuvox Technologies, St-Laurent, QC Ultraviolet Germicidal Irradiation (UVGI) has been widely accepted for over 50 years and recognized as a superior alternative to chemicals for the disinfection of drinking water. UVGI is today a well mastered cost effective disinfection technology that unlike antibiotics does not create any new resistant strains and as such creates no undesirable side effect. It has proven capable of deactivating all kinds of microorganisms by dimerization of the thymine pairs of their DNA or RNA. This paper explains and demystifies the fundamentals behind a new generation of software-driven smart automated UVGI devices and how they could be used to complete the sterilization process of operating rooms, patient rooms and hospital bathrooms. Automated systems have been widely adopted in other areas of healthcare to

The closing event will be a dynamic, interactive, informative and fun panel discussion summarizing the key lessons learned from CHES 2014. This is your chance to hear our experts perspective, and to discuss the practical implementation, of key ideas presented at this year’s conference with recognized leaders in our field from across the country. Take in the closing session to take away a “to do” list such that you can start to implement the many ideas you will discover during the conference. This session will ensure that all attendees can make plans to transform your stay in Saint John into positive actions that will enhance the patient experience in your own building.

16:30-17:00 Closing Ceremonies

Companion Program Highlights Sunday, September 28 2014 | A Day By The Sea! Sponsored by Precise Parklink

This exciting tour will begin with an 8:00 departure from the hotel with St. Andrews by the Sea (established in 1783) as the destination. You will be taken for a whale watching cruise along the Bay of Fundy where you will have the opportunity to spot Finback, Minke and Humpback whales, porpoises, dolphins, seals, and more! A memorable morning! (Please dress appropriately for a morning out on the water). Lunch will then be served for you at Kingsbrae Garden. For the afternoon, you will have the choice to take a Highlights Tour of St. Andrews by the Sea (with some shopping time allocated afterwards) or take a tour of beautiful Kingsbrae

Garden. The magnificent 27-acre horticultural garden has much to offer, with over 50,000 perennials in many themed gardens, engaging animals, ponds, and much more. Return to hotel for 17:30.

Opening Reception, Marco Polo Cruise Terminal Monday, September 29 2014 | Exploring Our Host City For the Monday leg of the Companion Program, you will be taken on an in-depth tour of your conference’s host city, Saint John. Established in 1604, Saint John is the largest city in the Canadian province of New Brunswick, and the second largest in the Maritime Provinces. It is known as the Fundy City due to its location on the north shore of the Bay of Fundy at the mouth of the Saint John River, as well as being the only city on the bay. You will visit a number of sites that make this city special. Bring your camera!

The City Tour will end at the City Market, where you will have the choice to procur lunch or return to the hotel as it is just a short walk away.

President’s Reception & Gala Banquet

St. Andrews by the Sea

Tuesday, September 30 2014 | Breakfast with the delegates

Trade Show Abatement Technologies Ltd.

23

Aerocom Systems, Inc.

41

Air Liquide Healthcare

22

Allegion Canada Inc.

10

All-Tech Environmental Services Ltd. Amico Corporation

54 48/49

Asco Power Technologies Canada

60

Atlantic CAT

77

Austco (Canada)

62

Belfor Property Restoration

69

Bender Canada Inc.

25

BG Distribution

46

C/S Construction Specialties

18

Camfil Farr (Canada)

15

Canadian Coalition for Green Health Care

17

CES Group Montreal

42

CHEM-Aqua Canada

83/84

CHES CHES 2015 Chubb Edwards

38 37 50/51

Class 1 Inc.

79

LP Electronics

12

Rauland-Borg Canada

47

ECNG Energy L.P.

64

Marathon Engineering Corp.

35

Reliable Controls Corp.

24

Energy Services Association of Canada

82

MCW Maricor

34

Sanuvox Technologies Inc.

53

ESL Power Systems

44

Medcore Services Inc.

68

Sapling Company Inc.

76

Follett Corporation

74

MediaEdge Communications Inc.

11

Schneider Electric

55/56/57

Forbo Flooring Systems

61

Franke Kindred Canada Inc.

39

Medical Mart

66

SHIFT Energy Inc.

20

Freudenberg Non Wovens

27

Miura Canada Ltd.

43

Siemens

75

GlassCell Isofab Inc.

16

Grundfos Inc.

81

Heat & Frost Insulators Labor Management Cooperative Trust Honeywell Limited IRC Building Sciences Group Johnson Controls Klenzoid Canada Inc.

Mondo America Inc.

9

Specified Technolgies, Inc.

72

Nalco, An Ecolab Company

8

Steam Specialties

78

PG LifeLink

65

Thermogenics Inc.

13

73

Phoenix Controls

45

Thomson Power Systems

40

80

Plan Group

52

Time Trackers

67

59

Precise Parklink Inc.

19

Trane

21

Primex Wireless

26

Tremco Roofing and Building Maintenance

14

RANA - On-site Gas Systems

63

Victaulic Company of Canada Ltd.

58

109 70/71

CHES ANNUAL 2014 TRADE SHOW & EDUCATION FORUM,

EXHIBITOR PREVIEW

BELFOR Property Restoration is a Contractor that specializes in restoration/environmental facility emergencies and rebuilds - 24/7/365.

They are certified in IICRC to handle Fire/Water/Odor/Mould/Wind Storm damages to properties. Belfor also handles Heavy Metal handling/ Abatement (Asbestos, PCB’s, Lead, Mercury) and have a full division handling HVAC/Duct Cleaning. Belfor is trained in Fire Stopping construction as well as handles pre-post construction cleanup.

Come see us at booth #69

Air Liquide Healthcare invites you to learn why facilities in Chatham-Kent, Ontario, and St. Paul, Alberta are validating the medical air they produce to the USP specification. Come see our aerALin™ quality control module, designed to ensure patients are always treated with medical air that complies with your hospital’s formulary.

Come see us at booth #22

Intelligent Steam Boilers Thermogenics is the leading supplier of boilers to the healthcare industry. We are Canadian manufacturers of coiled tube boilers, blowdown tanks, deaerators and economizers and a proud distributor of Fulton products.

Come see us at booth #13

Reliable Controls® specializes in the design and manufacture of Internet-connected, green building automation controls, focusing on providing simple, flexible, and sustainable systems, economically targeted to meet the triple bottom line of people, planet, and profit. All designs utilize the ASHRAE standard BACnet® protocol and ship with a 5-year warranty.

Come see us at booth #24

HELPING YOU REDUCE HAI Hands-on displays: • Copper Silver Ionization • Point of Use Filtration • Pre-treatment Equipment • Auto Chlorine Feed Systems Door Prizes! Special tradeshow pricing on Equipment!

Come see us at booth #83/84

ASCO Power Technologies Canada For more than 40 years ASCO Power Technologies has been the leading Canadian manufacturer of Automatic Transfer switches and Generator Control Switchgear. We are proud of having introduced every major technical innovation in the transfer switch marketplace.

We provide nationwide 24 hour field service and technical support.

Come see us at booth #60

FOR MORE INFORMATION ON ADVERTISING IN CANADIAN HEALTHCARE FACILITIES, COME SEE STEVE MCLINDEN, PUBLISHER AT BOOTH #11

MAINTAINING THE

GREEN EDGE

AT HOLLAND BLOORVIEW Putting conservation first

By Bobby Hancock When Holland Bloorview opened in February 2006, it was recognized by the International Academy for Design and Health. Many green features are present in this state-of-the art facility, among which include the 52kW solar panel installation for green energy production, a 157,000 litre collection system to collect roof rainwater and re-use it for irrigation, low-E windows, variable speed drives for all fans and pumps, and a low voltage lighting control system.

Truly, the facility was designed with conservation as one its primary goals.

The building services team experienced the usual start-up issues for a new building. Moving from two much older facilities, the new equipment and technology required many hours of training in-house and off-site. The commissioning process set up the systems as designed and all equipment was under warranty for at least a year. As occupants adjusted to their areas, schedules were adjusted and normal daily issues were addressed by the team pertaining to lighting, heating, and cooling.

and approval from senior management was received and much appreciated.

A BRIGHT START

The first area of concentration focused on the various lighting systems. The existing fixtures and ballasts were nearing five years of operation. Many advances in lighting technology were made available in that time, as were significant funding incentives.

A re-lamping project in early 2010 enabled the team to install lower wattage T8 lamps, replace MR 16’s with LED lamps, as well as reduce the wattage of other fixtures.

Overall, more than 10,000 lamps were replaced and recycled and a rebate of nearly $23,000 was received.

Additional re-lamping and light fixture replacements took place in 2012 and 2013. The projects focused on the cafeteria, two-storey ceilings in the lobbies and gym, external lig hting in entrance canopies, sidewalk up-lighting, and the receiving area. The incentive granted for these projects was over $9,000.

THE MATURING OF A NEW BUILDING

As the facility headed into its fourth year, the building was no longer “new”. Many warranties had expired and it was becoming more difficult to find certain replacement parts.

The building systems were operating satisfactorily, but with energy costs always a concern, facility management started to look at the hospital with a more critical eye and with the goal of making improvements.

Understandably, a lot of research is required to justify infrastructure improvements and make a good business case for a relatively new facility. Many suppliers, the City of Toronto, Enbridge, and Toronto Hydro were all relied upon to provide expertise and a portion of the funding. Support 32 Canadian Healthcare Facilities

EXPANDING THE SCOPE

While the lighting retrofit project was underway, all aspects of the HVAC systems were being assessed in-house. Using the current Metasys building automation system, the control schedules and operating parameters were in place for the natural gas hot water boilers, supply and return fans, chillers, cooling towers, pumps, and lighting. By analyzing each component based on the time of day use, building services was able to improve the quality of the system’s operation. This led to energy savings, increased satisfaction of building occupants, and reduced maintenance calls.

SPECIFIC IMPROVEMENTS

As a result of the analysis of the various systems, a number of specific projects were undertaken to improve the facility’s infrastructure: • Ultra-violet light systems were installed on the two swimming pools. This provided another level of disinfection that works above and beyond traditional chemical methods, and has reduced the need for routine water shocking and has reduced chemical use • A linkage less fuel/air ratio control system was installed to replace each boiler’s original burner controls. This enabled the boilers to use natural gas more efficiently and burn less fuel. The payback is one year and the estimated savings are approaching a target of 10% ($25,000). Enbridge Gas Distribution’s Commercial Energy Efficiency program supported this project with a rebate of $3,672.

• The facility management teamed with technicians from Johnson Controls to measure and re-calibrate the 16 air handling unit’s supply and exhaust air volumes to achieve maximum energy usage for the heating and cooling seasons. Adjustments were made to improve efficiency by reducing the excess air intake and the volume of conditioned air being exhausted. The overall volume of air required to be heated/cooled was reduced by 11,600 litres/second. This equates to an estimated Summer/été 2014 33

savings of 1,060 GJ or approx. $7,300 per year.

• Water consumption is closely monitored by the building services department. One of the largest uses of water is during the cooling season for the cooling towers. The department monitors the building re q u i re m e n t s o u t s i d e o f t h e daytime business schedule and a d j u s t s t h e ch i l l e r s ch e d u l e s through the building automation system. The changes made to these s ch e du l e s h ave re su l te d w i t h reductions in hydro consumption, treated water discharged to the sanitary sewer system, water lost to evaporation in cooling towers, and water treatment chemicals required for the cooling system.

• Variable frequency drives were installed on the filtration/ circulation systems for the recreational pool and a therapy pool to reduce hydro consumption.

• An additional heat exchanger was added to the 30 ton chiller condenser water. This additional

80

heat is used to pre-heat the domestic hot water system.

• Variable frequency drives were installed for the Pharmacy cytotoxic room and the main electrical vault room exhaust fans.

• 60 Photovoltaic modules were added in a new solar panel array on the west roof. Analysis of the original inverter capacity and roof space identified available

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www.chaircanada.org 34 Canadian Healthcare Facilities

Advertiser: CHAIR Publication: CHES Health Care Facilities Magazine

potential. Facility management took advantage of the oppor tunit y to increase the facility's solar by 33%. The system now annually returns a $40,000 rebate through the OPA Standard Offer Program to the hospital.

MEASURABLE RESULTS

Since the hydro-savings projects started in 2009, our efforts have resulted in an average reduction in consumption at 1.5% per year, through 2013. What's more, Holland Bloorview was recently chosen as one of five finalists for OHA’s 2013 Green Hospital Scorecard Water Conservation and Protection Award for the various systems, fixtures, and staff efforts within the facility.

While the facility is no longer new, the work accomplished by the building services team has kept the original goal of energy conservation as important today as it was during design and construction.

Facility management is proud of the energy savings efforts achieved in 2013 and will continue to seek new opportunities in 2014. Two audits are planned to help identify further energy reductions that will help reduce the facility's environmental footprint and increase overall savings.

Bobby Hancock is senior director,facility management, Holland Bloorview Kids Rehabilitation Hospital, Canada’s largest children’s rehabilitation hospital.

For more than a century, Holland Bloorview has pioneered treatments, technologies, therapies, research and real-world programs that give children with disabilities the tools to participate fully in life.

BUILDING THE BEST HEALTHCARE FACILITY:

LEADING WITH A MISSION

By Dr. Chris Bart, F.C.A. Imagine you just earned your first leadership assignment in operations in a healthcare facility. You get to know your employees, but after a while you realize the employees that report to you aren’t doing what the facility’s new mission statement wants them to do: “Provide exemplary physical, emotional and spiritual care for every person we serve”.

You try to get inventive and encourage them to change, but the results stay the same. Sound familiar?

These challenges face everyone in a leadership role, regardless of whether they are a CEO or the newest team leader.

You may be tempted to dismiss your mission statement as window-dressing with little relevance to your day-to-day business life, but do so at your peril. Decades of research have concluded that there is a tremendous performance advantage to be obtained by those hospitals and health care facilities that sincerely choose to become mission driven.

“Mission driven” means that every decision, action, and behaviour your hospital or healthcare facility organization takes is rooted and linked to the aspirations, goals, and objectives embedded in the mission. However, for this to happen, it means every person in your organization knows, understands, appreciates, and actually remembers the mission. Most importantly, it means that every person commits to carrying out the mission as it applies to their own job. All of this only comes into being through a conscious choice made by inspired and determined leaders like you.

Great leaders carry out the following four essential acts to capture both the hearts and minds of their employees.

Essential Act 1: Give specific direction This is so obvious, yet so overlooked. Employees have a fundamental right to know where their organization is heading so they can play a role in helping to make the achievement of that direction possible.

If employees do not know what exactly it is that they have to do in their particular job to contribute to the mission, they will not see the higher purpose embedded in their jobs. Moreover, when that direction and specification is missing, workers will fill in the blanks with their own interpretations and then let those thoughts drive their own well-intentioned behaviours. Their collective actions, however, usually result in confusion and chaos throughout the ranks as different individuals and groups work at cross purposes.

Without clear direction, mission drift and a malaise will begin to set in. To avoid this, strong leaders will turn to their organization’s mission statement to communicate specific direction. As the most popular management tool in the world, these statements have been much maligned over the years.

Without them, though, it would be nearly impossible for a leader to create a meaningful sense of direction, collective understanding, and unity of purpose. Therefore, good leaders take the words in the mission and then help translate them so that employees can see specifically and unambiguously how their job connects with and contributes to the mission’s realization.

This is the critical first step to truly becoming a mission driven organization.

Essential Act 2: Lead by example According to the ancient warlord Sun Tsu: “One must lead with actions, not just words.” Even the Bible says this as well.

Accordingly, wise leaders constantly look for ways to reinforce the priorities of their organization’s mission through their own behaviour. This is why the legendary founder and CEO of Southwest Airlines would routinely fly his airline while performing the duties of flight attendant. He wanted his crews to see first-hand what the boss meant by the company’s stated mission of providing ‘the highest quality customer service’.

Employees are also looking for leadership acts that inspire them. It is how the organizational culture is developed and shaped. Be sure to send the right messages through your behaviours to reinforce your organization’s stated strategic direction.

Essential Act 3: Practice open, frequent, and focused communications It’s also important that leaders concentrate only on the high priority messages flowing from the mission. Social scientists estimate that the typical person receives 17,000 messages per day.

The messages contained in your company’s mission are fighting against that communication onslaught. It’s therefore important to make sure they don’t get lost -- or worse -- forgotten.

Knowledgeable leaders therefore practice the three R’s of effective communication to maintain their organization’s collective focus: relentlessly repeat and reinforce. Roger Smith, the failed CEO of General Motors, said, “If I had an opportunity Summer/été 2014 35

to do everything over again, I sure wish I’d done a better job of communicating with GM people…. if people understand the ‘why’, they’ll work at it. Unfortunately for me, I never really managed to get that across.”

Also, the most underrated and under-appreciated means of communication is by personal, from the heart, explanations.

When a leader begins to speak about the organization’s mission statement and what it means, employees can begin to judge whether the leader really believes in and even understands it.

In Hamilton, the leaders of St. Joseph’s Hospital developed a unique program called "I make a difference" which involved sessions with every single staff member to ensure that everyone understood their specific role and the behaviours required to support the mission and values statement of the organization.

Such intense and clear communication left no room for confusion. Today, the hospital is renowned for the care it offers patients and the innovative medical research it performs.

Is there some magical frequency for determining the frequency of communication with employees? No. Every situation is different. However, regularly and routinely interspersing key words and phrases from the mission into everyday conversations proves the mission is not just a flavour-of-the-month program.

Essential Act 4: Measure success and give rewards on the basis of the organization’s mission It’s a truism of psychology that “what gets rewarded gets done”.

Still, many organizations that claim to be “mission driven” don’t

measure their progress against the mission and fail to reward employees for helping to make the mission a reality.

Thus, the final step in making a mission statement part of your organization’s internal fabric is to make sure all company systems and processes align with the statement.

This includes hiring, firing, promotions, bonuses, and salary adjustments, just to name a few.

Smart leaders also understand that there is more to rewarding employees than money. This is not to say that money is not important to employees, but when money is the only reward, an organization can quickly run out of the amount it needs to reward its employees’ accomplishments. Rewards that truly make employees feel good about themselves, on the other hand, are in greater supply and are longer lasting. That’s why astute leaders make generous use of non-monetary rewards – especially praise and respect – to motivate their employees.

By following these four essential acts, you can help unlock and unleash the incredible potential that exists in almost every person who works for you and in so doing capture the competitively essential, but often elusive, mission mystique.

Dr. Chris Bart, FCPA., is the author of“The Mission Driven Hospital: Turning Noble Aspirations Into Accountability and Action!” and “A Tale of Two Employees and the Person who wanted to Lead them”, one of the Top Ten Best Selling Business Books in Canada for ten consecutive years. He can be reached at www.corporatemissionsinc.com.

Do you know the quality of medical air being piped to your patients right now?

Quality control for medical air made on‑site is mandatory.

Our unique quality control service provides real‑time, full time traceability and off‑spec prevention.

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36 Canadian Healthcare Facilities

TOWERING TECHNOLOGIES

AT ROYAL VICTORIA REGIONAL HEALTH CENTRE (RVH)

By Matthew Bradford

For innovations in cooling tower technology, look no further than the rooftop of Barrie's Royal Victoria Regional Health Centre (RVH). Situated atop the newly expanded healthcare facility rests a modular tower installed in 2014 to replace failing equipment and meet the requirements of RVH's expansion that doubled the size of the health centre.

“The original building had its own chiller plant, boiler plant, and other standard equipment. One of our challenges during the expansion was to ensure the original building’s equipment and systems were on par with the new building,” says Don Borland, Facility & Building Operations supervisor with RVH. Added to this was the fact the existing cooling tower was on its last legs, despite ongoing repairs and part replacements. Faced with sump leakages, defective motors, mechanical float system failures, and other issues, Borland and his team – headed by Rob Purdy, RVH's director of Facilities and Building Operations – launched a search for a much-needed cooling tower replacement that would meet the hospital's unique requirements.

“One of the biggest considerations was that the two chillers in the original building were not equal in size. One is a 400-tonne unit, while the other is an 800-tonne unit. Our concern with adding a two-tower system was when the smaller chiller was in operation, the tower would be oversized and inefficient,” says Borland, adding, “An even higher priority still was to ensure the system remained sustainable due to the critical areas and systems on the chilled water loop.”

Thankfully, the winter afforded the team some time to seek a replacement. It was during this process that HH Angus & Associates introduced them to a new, modular cooling tower designed by Tower Tech and distributed by Longhill Energy. After a trip to Buffalo to see numerous towers in operation, Borland returned to Barrie with a solution in hand.

“We were very impressed with it,” recalls Rob Purdy. “In our view, the biggest thing was the technology had a lot of built in redundancies, so we should never be shut down.”

Indeed, the TTXL Series modular cooling tower presented many benefits for RVH. Its modular construction, for instance, would make it faster to install into existing systems and adaptable to future capacity expansions. Additionally, a patented Flow-Thru Basin,

which doubles as the base structural component; and technology which sprayed water in a square-shaped pattern, thereby eliminating dry fill to remain efficient and saving water in the process.

“With round spray jets, you either over spray or not spray into the cell corners which both wastes energy and/or allows scale build-up on the fill media. With this new square spray pattern, we're now utilizing 100% of the tower, so there's significant energy conservation.

We are using less condenser water and chemical to treat the condenser water and electrical horsepower via a variable frequency drive system. There are all sorts of savings; one of which enabled us for a saveONenergy incentive,” explains Borland.

Of particular interest was the tower's twelve bottom-mounted fans which, in addition to being either controlled individually or collectively via the VFD system, provided an extra level of comfort to ensure the tower remains in operation. “We have to remember that this tower supports critical equipment. If there's no air conditioning in the dead of summer, the building would get very warm, very fast.

With 12 fans available, if one fan goes we've only lost 8% of what's there,” says Purdy.

All totalled, the tower presented RVH with the solution it was looking for. And, upon learning of its successful operation in Winnipeg, Purdy and Borland were convinced to seal the deal.

“There was really nothing to the installation,” says Borland. “It comes down the highway in one piece and completely ready to go. All you have to do is connect it.”

While the new tower is experiencing its first summer in Barrie, RVH's staff are confident its use will result in significant energy and cost savings. “There's a big operational savings to be had because we're not going to have to change automatic valves and our heat tracing is less so we're going to have some savings that way as well, ” explains Borland.

The success of RVH's modular tower has also attracted attention from across the industry. The health centre has played host to multiple healthcare and assorted industry representatives interested in this new technology, which is new to Ontario.

“All told, this kind of technology is something that other healthcare facilities should entertain if they are looking at tower replacements,” says Purdy, offering, “If anyone is interested in it, we're happy to talk with them.”

Summer/été 2014 37

MEDICAL

AIR MATTERS Enhancing hospital air quality

By Paul Edwards In late 2010, Air Liquide was called to participate in the root-cause investigation of an “off spec” medical gas reported at a western Canadian hospital. At issue was the oxygen concentration in the medical air being dispensed from a hospital’s central pipeline. The United States Pharmacopeia (USP) prescribes a range of 19.5% to 23.5% by volume, and according to the staff, the oxygen level in their medical air was dangerously low; perhaps below 10%.

When commercially produced and delivered in gas cylinders, Health Canada requires lot testing (i.e. parametric batch release) against the USP specification. This involves validation of oxygen content and documented testing for a number of impurities, including carbon dioxide, carbon monoxide, dewpoint, oil vapour, nitric oxide, nitrogen dioxide, and sulphur dioxide. This level of quality control takes place because the drug medical air USP is mission critical to many therapies for patients with compromised respiratory systems. Medical air is inherent to aerosol drug delivery, it’s used daily to resuscitate infants and ventilate patients young and old, and it is a staple in the anaesthesia protocols for most operating rooms.

The volume of medical air dispensed through hospital pipelines rivals, and often exceeds the volume of oxygen. As such, most sites elect to make medical air on-site with specialized compressor systems for economic reasons. These medical air plants take everyday outdoor air and dry it, filter some particulate, and send it down the pipeline to patients.

By rule of Canada’s national building code, “The owner of the health care facility shall ensure that the product delivered by a compressor system used as a source of medical air meets the specifications for Air USP” .

On-site medical air production uses outdoor air as the raw material. Whether from vehicle exhaust, industry, or calamity such as fire, the quality of the source air is unpredictable and ever changing. Today most hospitals employ air exclusion protocols when the outdoor air is not entirely fit for distribution through the HVAC system. But the incident of off-spec air noted above revealed a critical gap; the absence of quality control and traceability to the full USP specification for the air being used to treat patients! Even though the building code mandates 38 Canadian Healthcare Facilities

hospitals to know the quality of the product they make, today most Canadian facilities making medical air monitor dewpoint only and assume the rest of the USP specification is satisfied. As a result, we’re now talking to our customers about Good Manufacturing Practices, and the benefits of quality control for medical air.

To fill the gap, Air Liquide developed a quality control system that monitors all relevant USP parameters and prevents off-spec air from entering the hospital’s pipeline.

Another hospital, St. Therese Hospital in St. Paul, Alberta, was the first site to deploy this level of quality control. The facility became aware of the system and its benefits after working with Air Liquide to address concerns regarding design flaws in a newly commissioned compressor that was causing auto vents to fail due to excessive vibrations.

In addition to fixing the problem, Lester Eldridge, area manager with Alberta Health Services, says the collaboration helped shine a spotlight on a greater air quality control issue.

“This whole matter has opened our eyes to a much broader and longstanding issue,” he says. “Whereas before we had no means of proving all of the Pharmacopia requirements; what we were putting in the pipeline and delivering to people in care. We monitored & controlled some of those requirements but not all of them. We now have that equipment installed, and the ability verify that what we are providing in this facility-wide pipeline meets all the recognized criteria for Medical Air USP. The new equipment enables us to provide certifiable proof of that quality at all times.”

Eldridge adds that since the issue has come to light, it's now discussed in ever-widening circles of discussion within the organization.

Thanks to curiosity sparked by the off-spec medical air at one Canadian hospital, the dialogue is happening around the world. Today, Canada leads the way with the first hospital making and releasing real-time, full-time quality controlled medical air. Why? Because medical air matters.

Paul Edwards is vice president of medical gas at Air Liquide Healthcare.

Putting the “quality” back in “air quality.”

Because if your building’s not healthy, neither are your tenants. truth is, we’ve made our buildings so energy efficient that dust, humidity, volatile organic compounds and hidden gases are trapped indoors. and unless treated properly and regularly, the air in your buildings can become a reservoir for dirt and potentially dangerous contaminants and a source of irritation for your tenants.

Clinicair is here to help with a specially selected suite of the latest state-of-the-art services and products to identify and resolve iaQ problems in multi-unit buildings, businesses, and medical and dental offices. and every member of the Clinicair team attends rigorous training and is certified by Healthy indoors Partnership (HiP), the Canadian professional iaQ association.

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