24 Nitrous Oxide: Friend or Foe Why this medical gas is a growing climate concern 27 Greening the OR Hamilton hospital practices responsible healthcare through single-use medical device reprocessing
28 Infection Control during Construction Release of fifth edition of CSA Z317.13 comes with a slew of changes
EDITOR/RÉDACTRICE Clare Tattersall claret@mediaedge.ca
PUBLISHER/ÉDITEUR Jason Krulicki jasonk@mediaedge.ca
PRESIDENT/PRÉSIDENT Kevin Brown kevinb@mediaedge.ca
SENIOR DESIGNER/ Annette Carlucci CONCEPTEUR annettec@mediaedge.ca GRAPHIQUE SENIOR GRAPHIC DESIGNER/ Thuy Huynh GRAPHISTE roxyh@mediaedge.ca
PRODUCTION Ines Louis COORDINATOR/ inesl@mediaedge.ca COORDINATEUR DE DE PRODUCTION
CIRCULATION MANAGER/ Adrian Hollard DIRECTEUR DE LA circulation@mediaedge.ca DIFFUSION
CANADIAN HEALTHCARE FACILITIES IS PUBLISHED BY UNDER THE PATRONAGE OF THE CANADIAN HEALTHCARE ENGINEERING SOCIETY.
SCISS JOURNAL TRIMESTRIEL PUBLIE PAR SOUS LE PATRONAGE DE LA SOCIETE CANADIENNE D'INGENIERIE DES SERVICES DE SANTE.
PRESIDENT Craig B. Doerksen
VICE-PRESIDENT Jim McArthur
PAST PRESIDENT Roger Holliss
TREASURER Reynold J. Peters SECRETARY Beth Hall EXECUTIVE DIRECTOR Donna Dennison
Newfoundland & Labrador: Colin Marsh
Maritime: Robert Barss
Ontario: John Marshman
Quebec: Mohamed Merheb
Manitoba: Reynold J. Peters
Saskatchewan: Melodie Young Alberta: Mike Linn
British Columbia: Sarah Thorn
FOUNDING MEMBERS
H. Callan, G.S. Corbeil, J. Cyr, S.T. Morawski
CHES
4 Cataraqui St., Suite 310, Kingston, Ont. K7K 1Z7 Telephone: (613) 531-2661 Fax: (866) 303-0626 E-mail: info@ches.org www.ches.org
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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.
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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.
The CHES 2023 National Conference will be held in Winnipeg MB at the RBC Convention Centre, September 17-19, 2023. The RBC Convention Centre is conveniently located in the downtown core and close to local amenities.
The 2023 CHES National Conference will be held in Winnipeg, Manitoba, at the RBC Convention Centre, September 17-19, 2023. The RBC Convention Centre is conveniently located in the downtown core and close to local amenities.
A block of rooms has been reserved at the Delta Hotel, starting at $202 plus applicable taxes standard Queen/King single/double occupancy
A block of rooms has been reserved at the Delta Hotel, starting at $202 plus applicable taxes standard queen/king single/double occupancy.
The theme of the 2023 conference is “Rejuvenating Healthcare Infrastructure”
The theme of the 2023 conference is “Rejuvenating Healthcare Infrastructure”
The CHES 2023 Education Program is well underway and will once again feature dual tracks with talks on relevant industry topics from high-profile experts in the field. Isha Khan, CEO, Canadian Human Rights Museum will be our Keynote Speaker
The 2023 education program is well underway and will once again feature dual tracks with talks on relevant industry topics from high-profile experts in the field. Isha Khan, CEO, Canadian Museum of Human Rights will be our Keynote Speaker
The Call for Abstracts for program submission closes on November 18, 2022. You may submit your completed form at (https://www.xcdsystem.com/ches/abstract/index.cfm?ID=9AqVARj) and/or any inquiries by email to info@ches.org
The Great CHES Golf Tournament will be held at Quarry Oaks Golf Course on Sunday, September 17, 2023.
The Great CHES Golf Tournament will be held at Quarry Oaks Golf Course on Sunday September 17, 2023
Join us for the CHES President’s Reception and Gala Banquet at the RBC Convention Centre. The banquet will celebrate the accomplishments of our peers with the 2023 CHES Awards presentations, while enjoying great food and entertainment with friends.
Join us for the CHES President’s Reception and Gala Banquet again in 2023 at RBC Convention Centre. The banquet will celebrate the accomplishments of our peers with the 2023 Awards presentations, while enjoying great food and entertainment with friends.
See you in 2023 in Winnipeg!
See you in 2023 in Winnipeg!
For more info visit our website at www.ches.org
For more info visit our website at www.ches.org
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Follow us on Twitter!
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Joins us on! @CHES_SCISS
Joins us on! @CHES_SCISS
THE LAST FOUR MONTHS have been a whirlwind. After years of experiencing minimal illness as a result of government mandated public health measures to curb the spread of COVID-19 and ease pressure on hospitals, my kids have been sick a lot since returning to school. Both have fallen ill six times with a variety of viruses, including the common cold, influenza and gastroenteritis. I was panic-stricken when their fevers peaked and children’s liquid acetaminophen and ibuprofen were nowhere to be found on store shelves. Frantic and wanting to avoid a trip to SickKids where admittance wait times were up to 12 hours for some patients, I turned to a local pharmacy to compound both at $40 each and with a shelf-life of just 14 days. Afterwards, my wallet was lighter but so was my heart as the two helped reduce persistent fevers that lasted for days.
The scarcity of children’s pain and fever relievers among other medications that are in short supply, such as amoxicillin, has further shone a light on the vulnerabilities of Canada’s supply chain. Similarly, the recent massive surge of patients to and, subsequently, immense pressures placed on children’s hospitals, resulting in some temporary closures of emergency departments, has amplified the need to fix our ailing healthcare system, which appears to be on the brink of collapse.
But what’s the solution?
While there is no simple answer, investment in infrastructure is part of building a better healthcare system. That involves constructing new hospitals to meet the needs of communities, as was recently done in Grande Prairie, Alta. More than 10 years ago, Alberta Health Services had the foresight to embark on an ambitious project that would support the delivery of care to the city’s residents, keeping northern Alberta patients closer to home whenever possible and providing shorter wait times. Grande Prairie Regional Hospital officially opened its doors this past February, and within months the hospital received international recognition for its design. You can read all about the project, which graces the cover, in Celebrating the Great Outdoors Inside.
We then turn to our two main focuses of this issue — facility management and design and sustainable healthcare. Topics covered include architectural and engineering design considerations to optimize operations in long-term care facilities; sensory strategies to mitigate children’s anxieties in hospitals; nitrous oxide as a climate threat; and the reprocessing of single-use medical devices.
Rounding out this issue, Gordon Burrill of Teegor Consulting Inc. walks us through updates to CSA Z317.13 in our regulatory update.
Clare Tattersall claret@mediaedge.ca
Canadian Healthcare Engineering Society Société canadienne d'ingénierie des services de santé
April 30, 2023
CHES is seeking both sponsors and candidates for the 2023 Young Professionals Grant. The application forms for Sponsors and Candidates are available on the CHES Website.
• The YPG sponsorship application form must be completed by the sponsoring organization/company and submitted to the CHES National Office.
• CHES National Office will invoice sponsoring organization/company for $2,000 once candidate applications have been received and approved.
• Young professionals who are or will become architects, engineers (i.e. mechanical, electrical, power, and civil, etc.), technicians or similar technical disciplines are eligible.
• Eligible candidates are those working within a healthcare organization or a company supplying goods or services to healthcare facilities or organizations.
• Eligible candidates must be working in the healthcare field for less than 5 years.
• The YPG application form must be completed by the eligible candidate and submitted to the CHES National Office. In this form, the eligible candidate will be required to provide information on their recent employment and future career aspirations.
• Confirmed candidates will receive complimentary registration for the 2023 National Conference and complimentary membership for the remainder of the 2023-2024 membership year.
For Nomination Forms, Terms of Reference, criteria, and past winners www.ches.org / About CHES / Awards
Send nominations to; CHES National Office info@ches.org Fax: 866-303-0626
LIKE MOST OF THE eight billion people on earth — the planet reached the milestone this past November, according to the United Nations — I remember those early months of 2020, when there was much talk about a new novel coronavirus, now known as COVID-19, sweeping the globe. The virus has impacted every aspect of life and left an indelible mark or impression on healthcare.
What have we learned? And how have we changed personally, professionally and as a society of healthcare leaders?
It’s about more than just being ready for the next pandemic (which some say we forgot about after the SARS outbreak of 2003, and H1N1 pandemic in 2009); we are being called upon as leaders in healthcare to do just that — lead.
CHES’s mission is to “build member expertise in Canadian healthcare engineering.” Its vision is “excellence in the patient care-focused environment through education, innovation and partnerships.” I am always amazed at how CHES and its members go quietly about pursuing this mission and vision through regular work activities and involvement in the organization.
We celebrated National Healthcare Facilities and Engineering Week (NHFEW) this past October. It was encouraging to see via our social media channels the efforts made to mark the occasion from coast-to coast. Let’s remember we should recognize the role CHES members play in maintaining a safe, secure and functioning healthcare facility throughout the entire year, not just during NHFEW. Partner with your organization’s communications department to acknowledge staff efforts. Employee recognition throughout the year, in big open events and small celebratory gatherings within departments, help us engage and develop staff — a critical step in helping us build our teams.
Also in October, CHES Alberta hosted its conference and trade show and the Saskatchewan chapter held its annual education day. It was great to attend these events in person and see so many healthcare and vendor staff collaborating to lead our organizations through this post-pandemic period of recovery and prepare for what’s next.
Which leads to the question, what’s next for CHES?
The CHES National executive is continuing to build upon the fall 2022 strategic planning session. Expect to hear more as we move those strategic discussions about membership value, education and certification into operational steps. We’ll engage you at your local chapter level via committees and directly, as necessary, to move the association forward. CHES is here to support your personal and professional goals, and provide you and your organization with the skills and knowledge necessary to support our growing, straining and struggling healthcare system that nearly 39 million Canadians depend on.
Craig B. Doerksen CHES National president
Members of the Canadian Healthcare Engineering Society can earn free continuing education units (CEU) by reading the Winter 2022/2023 issue of Canadian Healthcare Facilities and passing a quiz based on articles in the issue. Once you’ve read the issue from cover to cover, simply go online to www.surveymonkey.com/r/K62LS8G to take the quiz. CHES members who pass the quiz will be able to claim one contact hour (0.1 CEU) on their CanHCC or CCHFM certificate renewals.
The Reliable Controls MACH-ProView LCD with EQUIPMENTview is a freely programmable BACnet Building Controller (B-BC) and BACnet Operator Display (B-OD) that resides on Ethernet, PoE, Wi-Fi, or EIA-485 networks.
EQUIPMENTview is an easy-to-use interface that allows you to monitor and interact with HVAC, lighting, and security equipment; hospitality and safety services; energy management and more. Supported by an ever-growing library of graphical assets, the MACH-ProView LCD empowers you to stay in touch with your built environment.
For more information visit reliablecontrols.com/MPV-L
It’s been a historic two and a half years for the Manitoba chapter. We went from no events in 2020, to an online conference in 2021, to a full in-person conference with record attendance in 2022.
The Manitoba chapter is working with CHES National in the planning of the 2023 national conference in Winnipeg, Sept. 17-19, at the RBC Convention Centre. The education program subcommittee has a record number of abstracts to review. There will be facility tours of HSC Winnipeg Women’s Hospital and HSC Energy Centre. The opening night reception will be held at the Canadian Museum for Human Rights. The museum’s CEO Isha Khan will give the keynote address. Social events include golfing at the Quarry Oaks. The companion program is still being worked out. Possibilities include Journey to Churchill exhibit, Winnipeg Art Gallery, Royal Aviation Museum of Western Canada, Winnipeg City Tour, Gardens at the Leaf, The Forks and a Hermetic Code tour of the Manitoba Legislative Building. We hope to have the delegate registration form completed and posted on the CHES website in early 2023.
The Manitoba chapter, together with the Winnipeg Construction Association (WCA), held its second Canadian Healthcare Construction Course (CanHCC) of 2022 at the WCA office, October 4-5. Thanks to WCA’s partnership, their fantastic facilities and our CanHCC faculty, it was another sold-out event. The next session to be held in Winnipeg will be in conjunction with the 2023 CHES National Conference. Proposed CanHCC dates are Sept. 20-21, at the RBC Convention Centre.
—Reynold J. Peters, Manitoba chapter chairThis past October, the Saskatchewan chapter held a successful mini conference for more than 50 delegates that included education sessions around the topic of project delivery in challenging times. We were fortunate to have three presentations, all of which were well-received: KPMG’s global infrastructure advisory division presented on healthcare facilities functions; Johnson Controls Canada talked about price uncertainty, product availability, payment strategies, security/bonding and COVID-19 impacts; and Siemens Healthineers Canada spoke to understanding and overcoming supply chain impacts in healthcare.
CHES Saskatchewan is currently in a transition period with a number of members retiring and new ones keen to take on director positions on the chapter executive. We held an election during our annual general meeting at the mini conference. Many volunteered to remain on the board while new nominees were elected for outgoing directors. The 2022/2023 chapter executive includes myself as chapter chair, Jim Allen as past chapter chair (retired), John Megenbir as vice-chair, Steve Kemp as secretary/treasurer and directors Mitch Empey, Ted Cooke, Carol Cole, Peter Whiteman, Cameron Bantle, Quang Pham, Connie Conrad, Kendall Rathgeber and Brian Runge.
On behalf of the Saskatchewan chapter, I would like to congratulate Jim Allen, Greg Woitas and Derrick Lamb on their retirements, as well as Peter Whiteman and Carol Cole who have also retired but will remain active CHES members. We thank them for their commitment and the hard work they’ve put in over the years.
Our chapter membership has increased over the past few months. I look forward to collaborating with my peers to raise greater awareness of CHES to further grow our organization.
—Melodie Young, Saskatchewan chapter chair
After a successful 2022 Clarence White Conference & Trade Show Oct. 24-25, we are busy planning for the next one in June, which will include an added educational component — the Canadian Healthcare Construction Course. More to come on both events.
Planning for the 2025 CHES National Conference in Calgary, is underway. You can never start too early.
In honour of Ken Herbert, the chapter has created the Ken Herbert Award for Outstanding Contribution to Healthcare Engineering. This award may be presented annually to a resident of Alberta as a mark of recognition of outstanding achievement in the field of healthcare engineering. Candidates must be a member of CHES Alberta. Achievements can either be a series of contributions or one outstanding contribution. Submissions for the award must be made no later than March 15 of the award year. Information on this new award will be posted on the Alberta chapter section of the CHES website.
2023 is an election year for the chapter executive. Any regular, emeritus or lifetime members may run for office. Candidates must be active in and a participating member of CHES for a minimum of two years. A first call for nominations was issued Dec. 19, to our membership for vice-chair, secretary and treasurer positions for the 2023-2025 term. Nominations can be submitted to mike.linn@ahs.ca up to and including Jan. 29, when they will close.
—Mike Linn, Alberta chapterEach time I write my report, I review the one written in the previous year. As I read what I wrote at the close of 2021, I can’t help but reminisce over what we accomplished in 2022.
Going into 2022, the future was a little foggy or mossy, as we say in Newfoundland and Labrador; unclear as to what the new year would bring. While we pushed onward through the worldwide pandemic, we were uncertain as to whether or not we would ever meet in-person again. As luck would have it, we did. In May, the chapter held its largest conference ever. The provincial conference was the most highly attended, and we had the greatest number of vendors and speakers to date. September marked the International Federation of Healthcare Engineering congress/CHES National conference. What a time we had seeing each other again after two years of Zoom meetings.
Financially the chapter is in good shape, as expenditures have been nil over the past year. Looking ahead, we will continue to sponsor and support our members with respect to travel and accommodations to attend the chapter’s professional development day in spring. The chapter executive is discussing what we can offer our membership in terms of sponsorship for the 2023 CHES National Conference in Winnipeg.
chair
—Colin Marsh, Newfoundland & Labrador Chapter chair
CHES hosted its national conference in Toronto this past September. Members of the Quebec chapter executive attended along with others from the healthcare system. The conference was long-awaited after a few years of virtual assemblies. Held in conjunction with the International Federation of Healthcare Engineering congress, the event’s international flavour provided fresh ideas for CHES local chapters.
CHES Quebec is dedicated to its mission and marketing its vision within the healthcare industry. We are presently recruiting members on the executive team to serve on every national committee. On the education front, the chapter is planning a mix of in-person and virtual conferences for 2023.
The Quebec chapter will continue the work started with our province’s health ministry. We are also looking to open communications with our construction partners and present the different courses offered by our association.
—Mohamed Merheb, Quebec chapter chair
The Maritime chapter had a successful education day this past fall. Held in Truro, N.S., on Nov. 15, more than 100 were in attendance, made up of frontline hospital and long-term care staff and administrators. There were seven education sessions on topics related to facility maintenance, as well as ample networking opportunities. Vendor and sponsor support was fantastic. The fall education day is an important event as it has been key to introducing the long-term care sector to the benefits of CHES. The 2022 event resulted in 31 new CHES memberships from the long-term care community in Nova Scotia. It was noted that our New Brunswick members had difficulty obtaining staff approval to make the trip to Nova Scotia, so consideration is being given to alternating the education day between the two provinces.
Planning is underway for the Maritime chapter’s 2023 spring conference. It will be held at the Delta Beausejour hotel in Moncton, N.B., April 30-May 2. The theme is Maximizing the Patient Experience Through the Physical Environment. The education request for abstracts has been sent out. Events & Management Plus Inc. has been contracted to assist with the conference. We are looking forward to working with Sarah Seward, Tanya Hutchison and the rest of the Events & Management Plus team. Stay tuned for further updates.
CHES Maritime will hold the Canadian Healthcare Construction Course May 30-31, in Halifax.
In 2024, the Maritime chapter will host the CHES National conference in Halifax, Sept. 6-10. Much of the planning has already been completed.
On behalf of CHES Maritime, I would like to wish Donna Dennison the very best for a happy and healthy retirement. She has been a cornerstone of CHES. While Donna will be missed, she is so deserving of moving into a new and exciting chapter of her life. Thank you Donna for all you have done.
—Robert Barss, Maritime chapter chairLa SCISS a tenu sa conférence nationale à Toronto en septembre dernier. Les membres de la direction de la section du Québec ont participé à l’activité en compagnie d’autres personnes du système de santé. La conférence était très attendue après quelques années d’assemblées virtuelles. Tenue conjointement avec le congrès de l’International Federation of Healthcare Engineering, la saveur internationale de l’activité a fait toute une impression et a donné de nouvelles idées aux sections locales de la SCISS.
La SCISS Québec s’engage à poursuivre sa mission et à promouvoir sa vision au sein de l’industrie des soins de santé. Nous recrutons actuellement des membres de l’équipe exécutive pour siéger à tous les comités nationaux. Sur le plan didactique, la section prévoit un mélange de conférences en personne et virtuelles pour 2023.
La section du Québec poursuivra le travail entamé avec le ministère de la Santé de sa province et restera disponible pour répondre aux questions sur la SCISS. Nous cherchons également à ouvrir les communications avec nos partenaires de la construction et à présenter les différents cours offerts par notre association.
N’oubliez pas de nous suivre sur les médias sociaux et de consulter régulièrement la page de la section québécoise sur le site web de la SCISS pour les mises à jour. —Mohamed Merheb, chef du conseil d’administration du Québec
Following the excitement leading up to and including the 2022 International Federation of Healthcare Engineering Congress (IFHE)/ CHES National Conference in Toronto this past September, the Ontario chapter has resumed normal business as I assume the role of chair. I am fortunate to be supported by both returning and new members: Jim McArthur (past chair), Beth Hall (vice-chair), Ken Paradise (treasurer), Chris Mackey (secretary), Ron Durocher (conference planning), Derek Lall (education), Jeff Weir (membership), Larry Erwin (communications and public relations) and Alex Sullo (partnerships and advocacy).
This past fall marked the welcomed return of in-person conferences. While the 2022 IFHE Congress/CHES National Conference took the cake, I had the pleasure of also attending and presenting at the Canadian Institute’s forum on Canadian Healthcare Infrastructure and the Canadian Centre for Healthcare Facilities’ conference. CHES Ontario was also represented at the Alberta chapter’s 2022 spring conference by past chair Jim McArthur who was in attendance.
CHES Ontario’s conference planning committee is busy planning our first in-person chapter conference in four years, scheduled for early June, in Windsor. I’m looking forward to reconnecting with members at that time.
—John Marshman, Ontario chapter chairB.C. chapter conference chair Mitch Weimer is leading the planning and preparations for our 2023 spring conference, May 28-30, in Penticton. The theme is Healthcare Facilities: Managing through Crises, which provides the opportunity to discuss many relevant topics like succession planning, lack of qualified personnel, climate change and impacts of past weather events, lessons learned and future-proof planning. The education committee is presently reviewing submitted abstracts. Industry partners are encouraged to continue to submit to present at the conference.
We are discussing potential dates to host the Canadian Healthcare Construction Course (CanHCC) in 2023.
The CHES B.C. executive is trialing an option for centralized document storage. We have set up a cloud-based Google drive shared location that allows all executive and committee members to store files and collaborate. This option was free and satisfies our basic requirements.
The chapter continues to find new ways to encourage CHES membership to those who have not joined. We are also reaching out to those who’ve not renewed.
The chapter executive is drafting the details for the expression of interest process. We plan to issue a call for members to apply for volunteer opportunities to support CHES B.C. These positions will support directors, providing mentorship and pathways to fill future executive positions.
—Sarah Thorn, British Columbia chapter chair2023
Hans Burgers Award
For Outstanding Contribution to Healthcare Engineering
DEADLINE: April 30, 2023
To nominate: Please use the nomination form posted on the CHES website and refer to the Terms of Reference.
Purpose: The award shall be presented to a resident of Canada as a mark of recognition of outstanding achievement in the field of healthcare engineering.
Award sponsored by
2023
Wayne McLellan Award of Excellence In Healthcare Facilities Management
DEADLINE: April 30, 2023
To nominate: Please use the nomination form posted on the CHES website and refer to the Terms of Reference.
Purpose: To recognize hospitals or long-term care facilities that have demonstrated outstanding success in completion of a major capital project, energy efficiency program, environmental stewardship program, or team building exercise.
Award sponsored by
For Nomination Forms, Terms of Reference, criteria, and past winners www.ches.org / About CHES / Awards Send nominations to; CHES National Office info@ches.org Fax:866-303-0626
The impact from the pandemic on the long-term care homes has brought to light the importance of optimal indoor air quality (IAQ) for the health and safety of occupants. But optimizing buildings for better IAQ requires HVAC systems to work harder, use more energy and involves regular monitoring and maintenance — which in turn increases operational costs.
Integrating smarter building management systems such as Schneider Electric’s EcoStruxureTM for Healthcare solution helps you tackle this challenge by boosting the operational and energy
efficiency of your long-term care facility by up to 30%.
The future-ready EcoStruxure for Healthcare solution is tailored to your facility to give visibility and control over the building’s conditions - allowing you to optimize energy efficiency for running the building. In terms of automation, the solution can set up schedules for systems like HVAC and lighting remotely further reducing labour costs. Multi-site portfolio management is also simplified and automated with visualizations for analysis and control of setpoints and schedules.
Integrating the building management system plays a key role in delivering the quality comfort, and health the occupants deserve. With remote monitoring and maintenance of air quality, temperature and lighting, the solution enables the best experience for your occupants while maintaining minimal energy usage. To follow compliance with infection control policies, the solution acts as an integrated control platform to monitor, manage and document patient care in occupant rooms.
With the added visibility, alerts to alarms and security threats are reported real-time for you to respond within seconds using the open, mobile, cloud security system. Pre-canned reports on occupant’s wellbeing and visitors can be generated and sent to the occupants’ loved ones for their peace of mind.
Designed for upgrading or modernization projects of any level, EcoStruxure for Healthcare can achieve higher efficiencies in your facility operations and empower your personnel – anywhere, at any time. To learn more, visit se.com/ca/healthcare
Schneider Electric provides energy and automation digital solutions for efficiency and sustainability. As a global specialist in energy management with operations in more than 100 countries, Schneider Electric offers integrated solutions across energy and infrastructure, industrial processes, building automation, and data centers/ networks, as well as residential applications.Outside Grande Prairie Regional Hospital, a therapeutic walking path links to the Muskoseepi Trail that meanders through the small Alberta city for miles. The structure’s curvy linear form follows the flow of Bear Creek that lies adjacent to the 30-acre site. Through windows of the patients’ rooms, wildlife can be seen wandering along the water’s edge — foxes, deer, coyotes.
As the trail’s northwest anchor point, the hospital, designed by Dialog, and its surrounding green space is the heart of the community, uniting passersby as well as patients inside.
“It becomes a destination,” says Adrian Lao, a partner at Dialog. “Even when you’re sick and unable to go outside, you can be part of the community. You don’t feel as though you’re losing that connection.”
Inside the 681,000-square-foot facility, people are able to experience the landscape and natural light, even throughout the
Àl’extérieur de l’hôpital régional de Grande Prairie, un sentier de marche thérapeutique est relié au Muskoseepi Trail qui serpente sur des kilomètres à travers la petite ville de l’Alberta. La forme linéaire incurvée de la structure suit le cours de Bear Creek, qui se trouve à côté du site de 30 acres. Par les fenêtres des chambres des patients, on peut voir se promener au bord de l’eau des animaux sauvages — renards, cerfs, coyotes.
Points d’ancrage nord-ouest du sentier, l’hôpital, conçu par Dialog, et l’espace vert qui l’entoure constituent le cœur de la communauté, réunissant les passants et les patients.
“C’est devenu une destination,” explique Adrian Lao, associé chez Dialog. “Même lorsque vous êtes malade et incapable de sortir, vous pouvez faire partie de la communauté. Vous n’avez pas l’impression de perdre cette connexion.”
À l’intérieur de l’installation de 681,000 pieds carrés, les gens peuvent profiter du paysage et de la lumière naturelle, même dans
harsh weather extremes in the province, where winters can dip below -50 C and rise higher than 40 C in summer. Wide-shaped, inpatient units create two internal courtyards and surround them on all four sides, creating a cloistered space that is outdoors yet sheltered, explains Lao.
“People can see beautiful views of the courtyards while they are inside the inpatient beds,” he says. “If the weather is warm or sunny, they can also be in the courtyard without having to feel the strong westerlies that blow there all the time.”
Throughout the 240-bed hospital, the outside flows into the interior as one unified aesthetic, with a warm wood-look for doors and panelling, materials that bring a sense of comfort so people feel as if they’re in their own bedrooms. All rooms are single-patient with personal bathrooms. The design of the walls keep everything quiet.
“One of the best things we can do for a patient to heal is to allow them to sleep peacefully with privacy, dignity and security,” says Lao.
The layout allows for deep daylight penetration into all care and treatment rooms, and is just one reason why the hospital was recently honoured with an International Building Award from the International Federation of Healthcare Engineering at its 2022 congress, which was held in conjunction with the CHES National conference in Toronto.
It has been a long journey to that moment. The project began in 2011 and finished in 2020, with 99 patients relocating from Queen Elizabeth II hospital as it no longer provides acute and inpatient care. The hospital officially opened in February 2022 — the
les conditions climatiques extrêmes de la province, où les hivers peuvent descendre en dessous de -50 C et dépasser en été les 40 C. Les unités d’hospitalisation, de forme large, créent deux cours intérieures et les entourent sur les quatre côtés, créant ainsi un espace cloîtré, à la fois extérieur et abrité, explique Lao.
“Les gens peuvent voir de belles vues sur les cours pendant qu’ils sont à l’intérieur des lits des patients hospitalisés,” poursuit Lao. “Si le temps est chaud ou ensoleillé, ils peuvent aussi être dans la cour sans avoir à sentir les forts vents d’ouest qui y soufflent en permanence.”
Dans l’ensemble de l’hôpital de 240 lits, l’extérieur se fond dans l’intérieur comme une esthétique unifiée, avec des boiseries chaleureuses pour les portes et les lambris, des matériaux qui apportent un sentiment de confort pour que les gens aient l’impression d’être dans leur propre chambre. Toutes les chambres sont individuelles et disposent d’une salle de bain personnelle. Le design des murs permet de garder le calme.
“L’une des meilleures choses que nous puissions faire pour qu’un patient guérisse est de lui permettre de dormir paisiblement dans la vie privée, la dignité et la sécurité,” dit Lao.
La disposition permet une pénétration importante de la lumière du jour dans toutes les salles de soins et de traitement, et c’est l’une des raisons pour lesquelles l’hôpital a récemment été récompensé par un prix international du bâtiment décerné par la Fédération internationale d’ingénierie des soins de santé lors de son congrès 2022, qui s’est tenu en même temps que la conférence nationale de la SCISS à Toronto.
process took longer than expected due to a delay in construction and the struggle to find labour. Out-of-town workers travelled from Edmonton and Calgary to Grande Prairie to finish the work.
“This was also the largest project of its type and quite complex so we needed to explain the project to the authorities,” says Lao. “But we had wonderful support from the mayor of Grande Prairie throughout the approvals process.” The design team created a ‘shared vision’ with Alberta Health Services (AHS), the city and community.
“When you have the community excited about what you’re trying to do, it’s wonderful because you have the wind on your back (and it) is filling your sails,” says Lao.
Part of that vision was making the space warm and inviting, open to community events and a celebration of life in Grande Prairie, so it’s more than a place to go when one is sick.
And for those who are unwell, an array of healthcare services can be found: outpatient ambulatory care, emergency, diagnostics, obstetrics, surgery, pediatrics, acute geriatrics, mental health and intensive care. A much-anticipated cancer centre serves patients undergoing chemotherapy who might otherwise have to travel to Edmonton. It’s also the first in AHS’s north zone to offer radiation therapy.
As the hospital came together, the accessibility of mental health care figured prominently into the design, with various components catering to different age groups with particular needs.
The unit is separated into three pods — youths, adults and seniors — to make it easier for staff to care for patients. For instance, a geriatric population may be struggling with mental health alongside chronic diseases and mobility issues.
“Every case is different but, where possible, we have doors that interlink and open for shared social programs and communal dining,” says Lao. “We designed it in such a way that is flexible with care delivery but respects the needs of these three populations, and we allow it to be done safely but together.”
A mental health garden is a therapeutic place for patients to rest,
Le chemin a été long jusqu’à ce moment. Le projet a débuté en 2011 et s’achèvera en 2020. Quatre-vingt-dix-neuf patients seront transférés de l’hôpital Queen Elizabeth II, qui ne fournit plus de soins aigus ni de soins aux patients hospitalisés. L’hôpital a officiellement ouvert ses portes en février 2022 — le processus a pris plus de temps que prévu en raison d’un retard dans la construction et de la difficulté à trouver de la main-d’œuvre. Des travailleurs de l’extérieur de la ville ont voyagé d’Edmonton et de Calgary à Grande Prairie pour terminer les travaux.
“C’était aussi le plus grand projet de ce type et assez complexe, alors nous devions expliquer le projet aux autorités,” explique Lao. “Mais nous avons eu un soutien merveilleux de la part du maire de Grande Prairie tout au long du processus d’approbation.”
L’équipe de conception a créé une “vision commune” avec les Alberta Health Services (AHS), la ville et la collectivité.
“Lorsque la communauté est excitée par ce que vous essayez de faire, c’est merveilleux parce que vous avez le vent dans le dos (et il) gonfle vos voiles,” conclut Lao.
Une partie de cette vision consistait à rendre l’espace chaleureux et accueillant, ouvert aux événements communautaires et à la célébration de la vie à Grande Prairie, afin qu’il soit plus qu’un endroit où aller quand on est malade.
Et pour ceux qui ne vont pas bien, il existe toute une gamme de services de santé: soins ambulatoires, urgences, diagnostics, obstétrique, chirurgie, pédiatrie, gériatrie aiguë, santé mentale et soins intensifs. Un centre de cancérologie très attendu sert les patients sous chimiothérapie qui pourraient autrement devoir se rendre à Edmonton. C’est également le premier de la zone nord de l’AHS à proposer la radiothérapie.
Au fur et à mesure de l’élaboration de l’hôpital, l’accessibilité des soins de santé mentale a occupé une place prépondérante dans la conception, avec divers éléments destinés à différents groupes d’âge ayant des besoins particuliers.
L’unité est divisée en trois groupes — les jeunes, les adultes et les aînés — pour faciliter les soins aux patients. Par exemple, une
and feel the sun and fresh air in a secure yet non-oppressive way. Unlike barbwire penitentiary-style fences, the fencing system was designed to be safe and non-climbable, says Lao, yet look aesthetically pleasing, as though it almost disappears.
“The patients love feeling like they’re in a dignified environment,” he adds. “They feel like they’re being cared for and nurtured without being ostracized.”
For a city with a young and growing population of families, a large obstetrics hospital was designed within Grande Prairie Regional Hospital. The rooms are designed as a “one-stop resting place” for labour, delivery and postpartum recovery.
“Kind of like a hotel suite,” says Lao.
The walls shield outside noise; each room is private with a personal washroom and family space. An operating room is located within 20 feet in case of an emergency C-section. A level two-plus neonatal intensive care unit is also designed immediately adjacent to the mother.
“The whole paradigm has been reversed so the centre of focus is the patient, baby and families,” says Lao. “This is a fundamental change in the way care is delivered. The idea is to make the experience as therapeutic, nurturing, dignified and secure as possible for mother and baby.”
This patient-focused approach, where hospitals are comforting places to heal with minimal noise, more privacy and access to the outside, is where Lao sees the future of healthcare heading — that, along with reducing energy use and achieving net zero, as well as going beyond universal design, where a standardized approach might not be sensitive to the particular needs of every community.
“If you can design an environment that way and respect the community you are doing it for and make it unique — something the whole community can get behind and be proud of, and staff and patients feel comfortable going there — then you will have made the hospital a truly meaningful place for healing,” he says. “The hospital is ultimately for the communities we design for; it’s about them and it’s for their future.”
population gériatrique peut être aux prises avec des problèmes de santé mentale, des maladies chroniques et des problèmes de mobilité.
“Chaque cas est différent, mais dans la mesure du possible, nous avons des portes qui sont reliées entre elles et ouvertes pour des programmes sociaux partagés et des repas communautaires,” explique Lao. “Nous l’avons conçu de manière flexible pour la prestation des soins, mais en respectant les besoins de ces trois populations, et nous permettons que cela se fasse en toute sécurité, mais ensemble.”
Un jardin de santé mentale est un lieu thérapeutique où les patients peuvent se reposer et profiter du soleil et de l’air frais dans un cadre sécuritaire, mais non oppressif. Contrairement aux clôtures de type pénitentiaire en fil de fer barbelé, le système de clôture a été conçu pour être sûr et impossible à escalader, explique Lao, tout en étant esthétiquement agréable, comme s’il disparaissait presque.
“Les patients aiment avoir l’impression d’être dans un environnement digne,” ajoute-t-il. “Ils ont l’impression qu’on s’occupe d’eux et qu’on les soigne sans les ostraciser.”
Pour une ville dont la population de familles est jeune et en pleine croissance, un grand hôpital d’obstétrique a été conçu au sein de l’hôpital régional de Grande Prairie. Les chambres sont conçues comme un “lieu de repos unique” pour le travail, l’accouchement et la récupération post-partum.
“Un peu comme une suite d’hôtel,” lance Lao.
Les murs font écran aux bruits extérieurs; chaque chambre est privée avec une salle de bain personnelle et un espace familial. Une salle d’opération est située à moins de six mètres en cas de césarienne d’urgence. Une unité de soins intensifs néonatals de niveau deux plus est également conçue à proximité immédiate de la mère.
“Tout le paradigme a été inversé, de sorte que le centre d’intérêt est le patient, le bébé et les familles,” explique Lao. “Il s’agit d’un changement fondamental dans la façon dont les soins sont dispensés. L’idée est de rendre l’expérience aussi thérapeutique, nourrissante, digne et sûre que possible pour la mère et le bébé.”
Cette approche centrée sur le patient, où les hôpitaux sont des lieux de guérison réconfortants, avec un minimum de bruit, plus d’intimité et un accès à l’extérieur, est la voie vers laquelle Lao voit l’avenir des soins de santé — cela, en plus de la réduction de la consommation d’énergie et de l’obtention d’un résultat net zéro, ainsi que du dépassement de la conception universelle, où une approche standardisée pourrait ne pas être sensible aux besoins particuliers de chaque communauté.
“Si vous pouvez concevoir un environnement de cette façon et respecter la communauté pour laquelle vous le faites et le rendre unique — quelque chose dont toute la communauté peut être fière et dont le personnel et les patients se sentent à l’aise pour y aller — alors vous aurez fait de l’hôpital un endroit vraiment significatif pour la guérison,” dit-il. “L’hôpital est en fin de compte pour les communautés pour lesquelles nous concevons; ce sont elles qui comptent et c’est pour leur avenir.”
elevators for people with mobility challenges, but having digital information hubs that display information at appropriate heights, languages, and with audio options for the visually impaired.”
These hubs can also make a hospital more accessible by keeping patients and visitors updated on what’s happening within the facility. Here again, notes Martin, they offer an effective and eye-catching way to communicate hospital announcements and initiatives: “Say you have a hospital fundraiser going on, or an upcoming event or initiative you want to get people excited about. You can use that big, bright screen in the lobby to bring attention to those messages and drive engagement.”
Healthcare facilities are always in pursuit of ways to enhance the patient, visitor, and staff experience. After all, anything that contributes to a more inclusive, efficient, and stressfree environment leads to better outcomes for all. Technology has a central part to play in these objectives, and here’s where unlocking the full power of a digital information hub can lead the way.
“The digital directories you find in a hospital have come a long way since the days of static listings and occasional messaging,” says Scot Martin, President and CEO of youRhere. “Today, these signs – or as we now call them, digital information hubs –can do much more to make a healthcare environment more welcoming and accessible.”
That’s not to say digital information hubs aren’t still used to help hospital visitors get to where they’re going. Now, however, digital information hubs within a healthcare facility can be far more interactive and information-rich while offering a suite of services that enrich everyone’s experience.
Hospitals must serve all segments of society, including those with disabilities or people who don’t speak English or French as their first language. And in an environment where accessibility is fundamental to care, having digital information hubs that can be read and understood by all demographics is key.
“In any healthcare setting, accessibility must be emphasized in every sense of the word,” says Martin. “That not only means including ramps and
Initially, digital directories were primarily used to help hospital patients, guests, and visitors get to where they were going quickly and conveniently. That remains true, but modern digital hubs can be much more interactive than before, offering key hospital information, directions to onsite stores and services, and helpful videos and images at the tap of the screen.
“Going to a hospital is often a stressful experience, both for the person who is there for treatment and for their friends or family members coming to visit. So anything you can do to make that environment more welcoming and less of a headache to navigate makes a big impact,” says Martin.
For instance, he adds, one of the most helpful services a modern digital information hub can provide is simply helping people get to and from the building: “A lot of the clients that use our digital information hubs are offering live transit feeds that help their patients and visitors get to where they’re going and then
back home again safely and efficiently. For instance, say you have someone leaving a visit or appointment; they can hit a button on the screen and find out exactly when the next bus to their destination is coming, how close they are to other transportation hubs, or even get information for a ride-share.”
“Not only does that make using transit
“Not only does that make using transit easy and convenient,” Martin continues, “It also means people don’t have to wait outside in the rain or snow for their ride. They know exactly when it’s going to be there.”
Digital information hubs have been invaluable in enforcing health and safety protocols and educating the public on best health and safety practices. This was true during the pandemic and remains so as healthcare facilities strive for clean, hygienic, and comfortable environments.
practices. This was true during the pandemic
It’s also important that real-time information is critical in times of emergency. Here, again, is where digital information hubs can display essential safety information when needed most. “Many healthcare facilities are tying their signage into their building for emergency systems,” says Martin, explaining. “If a disaster occurs and they need to evacuate people quickly, those signs will display critical emergency information like where to go, what to do, and when it’s safe to return again.”
Sustainability is fast becoming a priority for the healthcare community. To that end, many of youRhere’s clients are leveraging their digital information hubs to demonstrate how they’re saving energy, reducing emissions, eliminating waste, or contributing to a healthier indoor environment. Moreover, some healthcare facility managers are even taking their communications further by displaying realtime stats on their environmental initiatives.
“More than ever, hospital staff and visitors are interested in knowing what’s being done to
lower the building’s environmental footprint, and a digital hub can be used to display digital posters that show what the facility team is doing and the successes they’ve had to date,” adds Martin.
Digital information hubs aren’t just for patients and visitors. They are also being used to convey important announcements and updates to staff as they walk through the door.
“Increasingly, we’re seeing people use their hubs to thank their staff for their efforts and promote their accomplishments,” says Martin. “As well, we’re seeing hospitals use their digital displays to share important staff updates in a way that gets noticed.”
Ultimately, he adds, digital information hubs can enhance facility team communications: “People are often looking at their phones and not paying attention to the static hubs around them. That’s where these signs can pique their interest and grab their attention as they’re entering or leaving the facility.”
From connecting patients to supporting visitors, raising awareness or championing sustainability, the healthcare community is tapping into the full potential of their digital displays.
“We’re seeing a range of different and creative uses,” agrees Martin. “All it takes is a bit of imagination, and certainly, we’re more than happy to share best practices with healthcare providers to make sure that they’re getting the full value for their investment.”
Scot Martin is the CEO of youRhere, a leading provider of digital signage solutions for commercial, retail, healthcare, and educational properties across Canada. For more information, visit www.yourhere.ca
The COVID-19 pandemic has had a real and devasting impact on longterm care facilities. By the end of 2021, more than 67,000 residents and 39,000 staff had been infected across Canada, of which nearly 16,000 had died due to the disease.
This stark reality underscores the importance of the purposeful design of long-term care facilities. Thoughtful architectural and engineering design can produce safer environments for one of the most vulnerable populations: seniors.
The conversation is not limited to indoor air quality (IAQ) and infectious aerosol dispersion, which have received much of the recent attention. Creating healthy environments demands a more robust and holistic discussion. Key considerations include the number of residents per household, building height, access to daylight, freedom of movement, community engagement, the ability to isolate when required, and delivery of appropriate levels of ventilation and cooling air to maximize IAQ and the environment, while
also aligning with climate change and carbon emissions considerations. It is critical to identify some of the most impactful architectural and engineering considerations to increase the performance of long-term care facilities, resulting in healthier, safer and more humanized environments.
From an architectural standpoint, the design of long-term care facilities is complex. It requires a deep understanding of the social model for elder care. This model centres around quality of life considerations. In con-
trast, three distinct issues emerge when elder care is delivered through a more traditional medical model. Seniors tend to feel bored, lonely and/or helpless. Through research and time in Europe and Scandinavia visiting best practice elder care facilities, solutions to these challenges have been identified. Social engagement combats boredom, stimulation decreases loneliness and empowering residents removes the feeling of helplessness. Architectural techniques can help deliver these antidotes.
On one end of the spectrum, there’s what is colloquially referred to as the ‘warehousing of seniors.’ On the other is a home setting that includes only one or two seniors. The tradeoffs between area, efficiency, cost and staffing are clear. Absent of recognition of the benefits to seniors provided by smaller households, particularly in terms of social engagement, stimulation and empowerment, it is easy to economically rationalize higher density seniors housing. Nevertheless, what the research and design effort has found is designing long-term care facilities to
accommodate between eight and 12 residents per ‘neighbourhood,’ with a maximum of three neighbourhoods per floor, creates an ideal mix in terms of clinical efficiency, building area and, most importantly, quality of life.
Designing long-term care facilities to provide residents with freedom of movement is critical. The Hogeweyk Dementia Village in Weesp, Netherlands, illustrates this. Through post-occupancy observation of residents’ movements throughout the facility, it was found that residents utilize freedom of movement as a means of both physical and mental therapy.
Making activity visible is another technique that creates interest and engagement. Examples include café seating with views to the kitchen where food is being prepared, views into the maintenance shop, views to the outside and views of the public realm. Like a residential household where activities are naturally in sight, this strategy helps create a home-like setting. The evidence around the health and well-being benefits of providing access to nature and views is well-established.
Considering single-resident room as the gold standard for infection prevention, there are a host of additional engineering considerations that help to improve the performance of a facility. Currently in Canada, nursing homes, long-term care facilities, assisted-living facilities, hospice care facilities, group homes and chronic care facilities are classified as Class B healthcare facilities. As a result, and in accordance with the building code and CSA Z317.2 — Special Requirements for Heating, Ventilation and Air-conditioning Systems in Health Care Facilities — Class B facilities have lower minimum ventilation rates, limited equipment redundancy requirements, lower filtration rates and reduced infection control requirements, as compared to typical acute healthcare facilities.
Based on the growing body of research and evidence tied to the Wells-Riley equation, which provides a simple and quick assessment of the infection risk of airborne transmissible diseases, there is increasing understanding around the inverse relationship between the risk of infection from air-
borne aerosols and the rate of clean air delivery. Essentially, the more clean air delivered, the lower the risk of infection. The most obvious source of clean air is air from outside the building that has not yet been circulated through the facility. But there are broad challenges with simply bringing in more outside air, including the significant increased energy consumption associated with heating and cooling it. Designers and engineers need a solution to the pandemic that also recognizes and respects the climate crisis.
Primary energy modelling research has been conducted on template buildings across all climatic zones. This research sought to determine the energy impacts of higher ventilation rates and how they could be mitigated by using energy recovery systems. In regions with high humidification and dehumidification loads, it was found that heat
recovery enthalpy wheels effectively transfer thermal energy and moisture between departing and incoming air streams to reduce energy demands. The strategic placement of the supply and exhaust fans in this system reduced the risk of cross-contamination. In regions with low humidification and dehumidification loads, exhaust air heat pump recovery proved the most ideal energy recovery strategy, with zero cross-contamination as the air streams are completely separated. In all cases, it was demonstrated that a building running at minimum outside air percentage with no heat recovery, instead of operating at 100 per cent outside air with the appropriate type of heat recovery in place, resulted in lower overall energy consumption.
A further system that demonstrated high performance was displacement ventilation coupled with thermal labyrinths. This sys-
tem configuration has the added benefit of reducing the amount of energy required to provide air conditioning and, in many cases, can run without the use of a chiller or other mechanical cooling system for much of the year.
The final consideration investigated was higher levels of filtration for recirculated air. Research clearly demonstrates upgrading HVAC filters to a MERV 13 from MERV 11 rating improves the infectious droplet nuclei filtration efficiency to 85.9 per cent from 68.2 per cent. In other words, the clean air delivery rate increases by 25 per cent simply by improving the filtration.
These engineering considerations can have a direct impact on reducing the risk of infection and death in long-term care facilities, while helping to reduce the impacts of climate change. Coupled with the noted architectural considerations, this care can be delivered in a humanized setting where seniors flourish and have a high quality of life. The challenge is to distill this knowledge among the larger architecture and engineering community, as Canada embarks on one of the largest long-term care facility construction booms in the country’s history.
Tariq Amlani is a mechanical engineer and healthcare leader who has been with Stantec since 2005. He has extensive knowledge and experience working on the procurement, design and construction of new and existing healthcare facilities, and has the ability to operationalize high-efficiency, patient-centric healthcare facilities. Éléonore Leclerc is the Vancouver healthcare studio lead at Stantec. She has been involved in multiple long-term care projects and visited more than 25 exemplar long-term care facilities in 10 countries to better understand how spaces should be designed to support seniors in the full spectrum of their life.
Accessibility of healthcare facilities has traditionally focused on physical access, as barriers are visible and easy to identify. But there is a concept growing in awareness among facility managers and designers — sensory accessibility. It includes a suite of strategies and provisions to address the varying needs of individuals experiencing elevated levels of anxiety, sensory overload or trauma. While there is no one-size-fits-all approach, the more tools available, the broader the scope of anxiety-reducing options healthcare facilities have at their disposal.
Anxiety due to pediatric hospitalization is well documented. For many children, particularly between the ages of six and 10 years old, hospitalization can be a stressful and traumatic experience, negatively impacting the recovery process. An unfamiliar environment, fear of medical treatment and reduced access to parents and siblings, particularly during the night, are among the major catalysts for heightened anxiety.
Ideally, non-pharmacological interventions are preferred to mitigate symptoms of
anxiety. Many commonly used interventions, such as touring the operating room pre-procedure, visits by clowns or therapy animals, access to toys or unstructured play, have been proven to reduce anxiety levels in pediatric inpatients. The recent use of biophilic design has also shown to mitigate anxiety by offering a more welcoming environment. Biophilic design is an innovative process of harnessing the benefits of nature and the natural environment to create soothing and calming spaces.
Sensory integration strategies are evidence-based practices typically associated with autistic children. However, in acute situations like hospitalization, sensory supportive provisions can provide anxiety-reducing benefits for any pediatric patient in novel ways. Some strategies include social stories and sensory pods.
Social stories are specially written simple stories that visually explain and represent specific social situations. When read by or to children, they know what to anticipate during their stay in hospital, including the sensory experiences they
may encounter. Ideally, actual photos of the hospital and/or pediatric ward, its facilities and staff would be used in the social story.
A sensory pod is a quiet, calming and safe space for a pediatric patient (and their parents). It’s used as a means to reduce anxiety away from areas that are busy, noisy or with too much sensory input.
Other strategies or tools may include adjustable lighting to lower visual impact; noise-cancelling headphones for sound reduction; weighted blankets for comfort; fidget toys; and a sensory room that offers sensory modulation tools, such as massage chairs, rocking chairs, a sensory swing or a mobile sensory cart, which is ideal for nonambulatory patients who can satisfy sensory needs within the limitations of their movement during recovery.
Steve Dering is head of engagement and Jennifer Camulli, PhD, is senior access consultant at Direct Access, a disability accessibility consultancy with healthcare experience from home care to acute frontline services in Europe.
While there are benefits of using nitrous oxide for patients and the healthcare system, the environmental impact is significant.
Nitrous oxide is an analgesic gas used for pain management within maternity, dentistry, emergency, orthopedics, endoscopy, pediatrics, operating rooms and radiology.
The properties of nitrous oxide as a gas make it almost the ideal pharmaceutical. While there are alternative methods of administering pharmaceuticals, such as tablets and intravenous injection, they can take longer to work properly or administer. Nitrous oxide, on the other hand, provides almost immediate pain relief and relaxation
when mixed with oxygen and inhaled though a mask or mouthpiece. What’s more, when a patient stops inhaling the gas mixture, the effect wears off quickly leading to a very fast recovery. This is ideal in a busy hospital setting where staff can reduce necessary observation time and move on to the next patient. The gas mixture is also self-administered, delivering benefits like greater control for the patient over their pain relief.
However, the environmental impact of using nitrous oxide means its use in hospitals needs to evolve.
Healthcare is responsible for 4.6 per cent of Canada’s total greenhouse gas emissions, as reported in the Canadian Medical Association
Journal, in addition to more than 200,000 tonnes of other pollutants, resulting in 23,000 lives lost annually from disability or early death.
Other sources place Canada among the top 10 worst polluters per capita and in the middle of the pack of Organisation for Economic Co-operation and Development nations in terms of the percentage of emissions from healthcare. And while the United Kingdom has cut health sector emissions by nearly one-fifth since 2007, Canada’s healthcare emissions are increasing.
A small number of medicines account for a large portion of these emissions. There is
significant focus on two such groups — anaesthetic gases and inhalers. Nitrous oxide is one of the most harmful gases in the anaesthetic group.
Nitrous oxide is the third most important greenhouse gas. It is emitted into the atmosphere from both natural sources (approximately 57 per cent) and anthropogenic sources (approximately 43 per cent), including oceans, soils, biomass burning, fertilizer use and various industrial processes. The increase in emissions from 2020 to 2021 was slightly higher than that observed from 2019 to 2020, and higher than the average annual growth rate over the past 10 years, according to the World Meteorological Organization.
This environmental impact came to the attention of politicians and healthcare professionals in Sweden 16 years ago. As a result, they began to capture and destroy nitrous oxide used in healthcare. Hospitals in Sweden use a central destruction unit to destroy nitrous oxide from many different rooms at the same time like those on a ward. Meanwhile, mobile destruction units are used to handle single rooms.
If this technology was applied across the U.K.’s entire health system, it could deliver up to a 75 per cent reduction in nitrous emissions, says the National Health Service. Similar results could be achieved across Canada. In Ontario alone, nitrous oxide use as anaesthesia was responsible for approximately 80,000 tonnes of carbon dioxide in 2015, according to the province’s environmental commissioner.
Trapping heat in the atmosphere, known as the greenhouse effect, is a natural and necessary process that enables life on earth. However, in the last century, human activity has rapidly increased the release of greenhouse gases, resulting in an excessive greenhouse effect.
Some gases are extra potent and trap more heat than others; nitrous oxide is one of these. In fact, one kilogram of nitrous oxide is equal to 298 kilograms of carbon dioxide and will remain in the atmosphere for 114 years. Due to this extremely long atmospheric lifetime and high consumption volumes, nitrous oxide has become a major contributor to global warming.
A comparison to the emission of carbon dioxide during a single car trip illustrates the environmental impact of nitrous oxide. The use of nitrous oxide for one hour at one litre per minute has the carbon dioxide equivalency of driving a car for 95 kilometres. Given one litre per minute is almost irrelevant as a clinical dosage — a maternity department, for example, will deliver much higher volumes at normal use — the scale of the issue becomes even more apparent.
The connection between healthcare systems and climate change was reported in The Lancet in 2018. The study concluded climate change is expected to influence the environment, leading to increases in conditions like cardiovascular and pulmonary disease, undernutrition, diarrhea and vector-borne disease. The social consequences from this scenario would be the loss of habitation, mass migration and poverty, which could also result in violent conflicts.
In most countries, nitrous oxide programs have exposure limits for healthcare professionals. Known as threshold limits, they describe how much exhaled gas staff are allowed to be exposed to. These also apply in Canada, meaning that alongside a high room air exchange rate, inhaled and exhaled gas from patients should be controlled in a closed system. To that end, exhaled gas should be captured by an exhalation hose and moved away from where it may affect staff. This process of collection and removal is called scavenging.
Although the effects of exposure to nitrous oxide are still uncertain and the literature is inconclusive, they include headache, dizziness and loss of concentration. These possible effects are not in the best interests of the healthcare professional or patient who expects total focus on the procedure.
The central destruction unit also accommodates multiple treatment room setups, offering caregivers an optimal method of reducing work environment risks and greenhouse gas emissions. The unit also combines minimal energy consumption with ease of use and operates at an efficiency level above 99 per cent.
t
IN ONTARIO ALONE, NITROUS OXIDE USE AS ANAESTHESIA WAS
RESPONSIBLE FOR APPROXIMATELY 80,000 TONNES OF CARBON DIOXIDE IN 2015, ACCORDING TO THE PROVINCE’S ENVIRONMENTAL COMMISSIONER.
In Scandinavia, the use of closed systems for delivering nitrous oxide gas mixes to patients, and capturing and destroying the gas locally, as well as threshold limits for staff exposure are governed by national guidelines. Hospitals have technicians and work environment specialists that make sure guidelines are correct and followed. Medical equipment is used for inhalation and exhalation and captured via pipeline systems, which are designed by hospital gas system contractors. The exhaled gas from patients goes to a medical gas terminal unit in the treatment room. From there, a gas evacuation pipeline transports it to a mechanical services room. Each hospital has a central destruction unit in place, as
there are many rooms that support the nitrous oxide program.
In the same hospital, there may be a pediatric and an emergency department supporting patients with nitrous oxide. In this case, there is no gas evacuating pipeline. The amount of nitrous oxide used is small by both volume and frequency, so this hospital would use the mobile destruction unit.
public and teaching hospital, Rigshospitalet, calculated that nitrous oxide use for its maternity department in 2018 was 4,514 kilograms. Determining the carbon dioxide equivalency by multiplying by 298 means the department alone emitted the equivalent of 1,345,172 tonnes of carbon dioxide.
The environmental case is compelling. By installing a central destruction unit connected to the gas evacuation system, 99 per cent of these carbon dioxide emissions are removed from the hospital’s nitrous oxide program. Compared to other possible carbon dioxide emissions solutions, this technology requires a relatively small investment to deliver a beneficial impact on the hospital’s total carbon footprint.
CSA Z7396.1, Medical Gas Pipeline Systems, recommends that every healthcare facility conduct a review of the use, benefit, cost and environmental impact of piped nitrous oxide to determine whether a pipeline is appropriate and, if deemed necessary, whether measures can be taken to reduce the permeation of nitrous oxide into the atmosphere. For example, pipeline valves could be closed except during periods of use.
As Canada continues its pursuit of a zero-emissions healthcare system, the lessons from Scandinavia will prove invaluable.
Delivers continuous and ongoing antibacterial action.
Helps inhibit the buildup and growth of bacteria within 2 hours of exposure between routine cleaning and sanitizing steps.
Jannik Jensen is global product manager at Medclair, where he works with healthcare systems around the world to reduce their carbon footprint. Medclair is a Swedish green medical technology company that specializes in customized products for environmentally safe handling of nitrous oxide. Alan Pinkerton is president of PMG Systems Ltd., servicing and testing medical gas distribution systems across Canada. A CSA Z7396.1 technical sub-committee member, Alan actively engages with clients in support of financial, health, safety, compliance and sustainability goals. Jannik and Alan can be reached at jannik.jensen@medclair.com and alan@pmgsystems.ca, respectively.
As
As one of Canada’s leading teaching healthcare facilities, McMaster University Medical Centre in Hamilton, Ont., supports a highly engaged team of clinicians who are determined to look for waste reduction solutions in the operating room with a particular focus on single-use medical devices.
In an effort to drive green cost savings throughout the perioperative program, MUMC pursued a robust reprocessing program to move from recycling to reprocessing across all operating rooms, substantially reducing the site’s carbon footprint. Reprocessing of single-use devices is the practice of inspecting, cleaning, function testing, sterilizing and packaging so that they can be clinically and safely used again. Partnering with a reprocessing provider is essential to ensure the process is Health Canada approved.
The process begins with the collection of devices in containers that are placed in convenient usage areas. At MUMC, collection containers were set up in each operating room to maximize collections.
“We went full steam ahead and did all the operating rooms,” says Beverly Barbato, clinical manager of the operating room, procedure rooms and medical device reprocessing department at MUMC. “(Physicians) were very engaged at our site and they made the implementation very successful and turnkey.”
Collection containers are regularly shipped from the hospital to the reprocessing facility, where contents are sorted to isolate reprocessable devices from those that cannot be reprocessed. Devices are individually dissembled, inspected and cleaned by highly trained staff. Each device is subdivided into its core components. Each piece is then independently inspected and approved to be rebuilt. Once rebuilt, each device goes through a robust series of both manual and automated inspection, individ-
ual sterilization and functional testing as part of the validated Health Canada process. Once complete, all devices are packaged, labelled and shipped back to the hospital.
By utilizing a reprocessing program, a facility can divert large amounts of medical waste from being discarded into nearby landfills and significantly reduce their carbon footprint. Collection programs are customized to maximize collections and waste diversion through the collaborative engagement of staff and the hospital’s commitment to drive green cost savings by using reprocessed devices as their primary device of choice.
The team at MUMC formed new habits to include device collection because they understood the cost-effectiveness. Using reprocessed devices at a significant savings offered an opportunity to reallocate funds to other needed equipment and supplies.
“The surgeons were engaged (because) they understand the cost-effectiveness and
what it means to them,” says Barbato.
After implementation in the operating room, MUMC’s senior leadership looked at this as a corporate savings initiative and a benefit to expand across all sites and departments. Originally implemented as a green initiative, the budgetary savings could not be ignored.
“The motivation, I think, initially started more from the green perspective, as well as some financial responsibility, but corporate looked at it from a budgetary savings perspective and grew it organically,” says Trevor Olson, manager of inventory and projects, perioperative services, at MUMC.
Tom Brown is the national account manager for Stryker’s Sustainability Solutions. The Stryker business unit is dedicated to collaborating with facilities to reduce their environmental impact through the collection and reprocessing of singleuse medical devices. Its proprietary reprocessing process is Health Canada and U.S. Food and Drug Administration-approved, providing a positive environmental impact by empowering responsible healthcare practices and measurable cost savings to facilities.
First introduced in 2003, CSA Z317.13, Infection Control during Construction, Renovation and Maintenance of Health Care Facilities, has evolved to keep pace with changes in the industry. The fifth edition, released last March, brings the standard up-to-date with advances in construction and facilities management industry practices.
The premier edition of the standard was the first document in Canada written in normative language to speak to the increasing awareness of the connection between construction dust, stagnant water systems and notable negative patient outcomes among immunocompromised or immune-suppressed building occupants. The second version, released in 2007, built on this model by
introducing requirements for new construction projects to reduce the risk of infections among building occupants over the lifetime of the building.
While these two renditions of the standard revolutionized techniques commonly used in construction in healthcare, the next two (2012 and 2017) removed ambiguities and the potential for misinterpretation, while at the same time keeping pace with the everchanging healthcare construction industry.
The newest edition has once again moved to revolutionize the industry. Its predecessors had reached a level where contaminants raised or elevated during construction were well-controlled and generally kept away from vulnerable building occupants. The latest version continues with this but also aims to reduce the bio load that construction has historically left behind.
While the structure of the standard is unchanged and its foundational preventive measures analysis remains, there have been some adjustments to the detail of that analysis. Users should consult the most recent edition to become familiar with the adjustments to construction activity types and population risk groups. Of note is clarification around construction activities that include working on plumbing systems.
Guidance provided with respect to performance leak testing of construction air handling units has also been significantly updated. With the 2021 release of a performance leak testing guideline from the Environmental Abatement Council of Canada, these critical pieces of equipment have benefited from national industry-wide knowledge in this area.
Time:
0900 BC/1000 AB & SK*/1100 MB/1200 ON & QC/1300 NS & NB/1330 NL
One hour in length
*SK – 1000 during Daylight Savings time; otherwise 1100
Wednesday January 18, 2023
Hospital HVAC - What Now?
Speakers: Nick Stark, P. Eng, CED, LEED AP, ICD.D, Executive Vice President, H.H. Angus & Associates Limited Consulting Engineers
Meagan Webb, H.H. Angus & Associates Limited
Wednesday February 15, 2023
The Art of Building Sustainability
Speaker: Levi Tully, LEED AP BD+C, PMP, Executive Vice President, Sales, Reliable Controls
Wednesday March 22, 2023
Decarbonization for Healthcare Buildings - The Giant Step Forward
Speaker: Ted Loucks, P.Eng.,MBA,PMP,CEM,LEED AP, Partner, MCW Custom Energy Solutions Ltd.
Wednesday April 19, 2023
Barriers and Enablers for New IPAC Technologies - What is the Evidence?
Speaker: Barb Shea, Manager IPAC Hub Central West Region, Central West IPAC Hub
Wednesday May 17, 2023
Leading EDI in Organizations for Non-EDI Experts
Speaker: Jaason Geerts, PhD, Director, Research and Leadership Development, The Canadian College of Health Leaders Wednesday June 21, 2023
Practicalities of [HVAC] Electrification in Healthcare Facilities
Speakers: Gordon Thomson, P.Eng., Senior Electrical Engineer, WSP Canada Inc. Chris Jones, P.Eng., CEng., Eur, Ing, Team Lead, Building Engineering, WSP Canada Inc.
Wednesday October 18, 2023
What's New within the 2022 Medical Gas Standard & the "Qualified Service Technician"
Speakers: Roger Holliss, President, Holliss Consulting Inc. Al Pinkerton, President, PMG Systems Ltd.
Wednesday November 22, 2023
Design of Resilient Bulk Oxygen Supply Systems for Healthcare Facilities
Speakers: Sheldon Ferguson, Technical Sales Consultant, Air Liquide Healthcare (VitalAire)
Faisal Qureshi, Manager Medical Gas System & Sales Ontario, Air Liquide Healthcare (VitalAire & GH Medical)
CHES Member:
Non-Member:
Single: $40 (per webinar) plus 13% HST Series: $150 (per series) plus 13% HST
Single: $30 (per webinar) plus 13% HST
Series: $180 (per series) plus 13% HST Register online: www.ches.org
Professional Development
New techniques and equipment currently available in the market, such as purpose-built modular wall systems, have seen requirements added into the standard so that construction teams will be able to best utilize the tools available today.
One other noteworthy addition is the introduction of a new Annex J. This annex provides users with a checklist to review existing spaces to ensure they have been prepared for safe access to begin the renovation. Checklist items include ensuring any personal identifiable health information or sharps have been removed from the area so construction teams can safely focus on their work.
When it comes to new construction projects — whether brand-new healthcare facilities, additions to existing facilities, new buildings on healthcare campuses or a complete refurbishment of existing spaces — the standard has seen a complete overhaul. All information from previous editions remains; however, the sequence of requirements has been reordered to match construction
sequencing. There is also now a Category 4 for new construction (refurbishment of large areas of an existing building). The old, familiar word ‘phase’ of construction has been replaced with the word ‘stage’ to avoid confusion with financial phases, which occurred under previous renditions of the standard.
This leads to Section 8 that covers four new construction categories, each of which has been broken down into five stages of construction. While many requirements apply across a multitude of categories and stages, there are requirements that are particular to specific combinations. Users will be well-served to thoroughly understand clauses 8.1 and 8.2 that apply to all four new construction categories and then augment those requirements with the category specific requirements that can be found in clauses 8.3 through 8.6 (new construction categories one through four, respectively). A significant change within Clause 8 is the requirement that further advanced stages of construction must have a measured and quantifiable differential air pressure of 2.5
pascals. The introduction of quantifiable pressure differentials ensures the development of structured airflow from further advanced (cleaner) areas of construction toward less advanced (less clean) areas. The goal of such requirements is to reduce the load of microscopic particulate that becomes incorporated into the built environment. This, in turn, curtails the potential for future infections amongst vulnerable occupants.
Gordon D. Burrill, P.Eng., is president of Teegor Consulting Inc., an international consulting firm specializing in healthcare construction, operations and maintenance with a particular focus on codes and standards compliance. Gordon is also president of the Canadian Centre for Healthcare Facilities, chair of CSA Group’s technical committee for healthcare facilities and represents CHES as a committee member of the CSA technical subcommittee for standard Z317.13, Infection Control during Construction, Renovation and Maintenance of Health Care Facilities. Gordon can be reached at info@teegor.com.
