CHF Winter 2024 by MediaEdge

Canadian

HealthcareFacilities JOURNAL OF CANADIAN HEALTHCARE ENGINEERING SOCIETY

Volume 44 Issue 1

Winter/Hiver 2024

COMMUNITY CARE

PM#40063056

New patient care centre at Michael Garron Hospital ties into fabric of East Toronto

Aging in place at Kivalliq long-term care facility Building the world's first organ regeneration lab Steps to creating a water management program

CONTENTS

DEPARTMENTS 4

Editor’s Note

President’s Message

Chapter Reports

HEALTHCARE DEVELOPMENT 12

CANADIAN HEALTHCARE FACILITIES Volume 44

Issue 1

EDITOR/RÉDACTRICE

Clare Tattersall claret@mediaedge.ca

GROUP PUBLISHER/ ÉDITEUR DU GROUPE

Sean Foley seanf@mediaedge.ca

PRESIDENT/PRÉSIDENT

Kevin Brown kevinb@mediaedge.ca

SENIOR DESIGNER/ CONCEPTEUR GRAPHIQUE SENIOR

Annette Carlucci annettec@mediaedge.ca

GRAPHIC DESIGNER/ GRAPHISTE

Thuy Huynh-Guinane roxyh@mediaedge.ca

PRODUCTION COORDINATOR/ COORDINATEUR DE DE PRODUCTION

Ines Louis inesl@mediaedge.ca

EMERGENCY PREPAREDNESS & RESPONSE 24 Troubled Waters Emergency response at Alberta hospital highlights need to be proactive 28 Moving Beyond Crisis Mechanical, electrical post-disaster resilience rejuvenation

The Heart of the Community Le coeur de la communauté

16 Aging in the Arctic New long-term care facility in Canada’s North built on foundation of cultural awareness, dignity and respect 20 Preparing for Transplant Inside construction of the world’s first organ regeneration lab

CIRCULATION MANAGER/ Adrian Holland 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.

CHES Canadian Healthcare Engineering Society

SCISS

Société canadienne d'ingénierie des services de santé

PRESIDENT VICE-PRESIDENT PAST PRESIDENT TREASURER SECRETARY EXECUTIVE DIRECTOR

Craig B. Doerksen Jim McArthur Roger Holliss Reynold J. Peters Beth Hall Tanya Hutchison

CHAPTER CHAIRS

Newfoundland & Labrador: Colin Marsh Maritime: Robert Barss Ontario: John Marshman Quebec: Mohamed Merheb Manitoba: Reynold J. Peters Saskatchewan: Melodie Young Alberta: James Prince 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 Canada Post Sales Product Agreement No. 40063056 ISSN # 1486-2530

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.

EDITOR'S NOTE

GOOD NEWS AMONG THE BAD WITH EACH PASSING WEEK, sometimes even day, there’s another healthcare-related story in the news. Surgery backlogs, overflowing emergency rooms, long wait times, staff shortages and difficulty accessing a family doctor paint a picture of a system in crisis. In Alberta, Premier Danielle Smith is following through on her campaign promise to dismantle the province’s current patient-care model, creating four agencies in Alberta Health Services’ place. On the east coast it’s the opposite; Newfoundland and Labrador is currently transitioning from four health authorities to one. Amidst the bleakness of the headlines is good news — major healthcare infrastructure projects are breaking ground and brand-new state-of-the-art facilities are opening their doors to meet the demands for more efficient and reliable care. This issue focuses on three such projects. Beginning with The Heart of the Community, staff writer and editor Rebecca Melnyk walks through development of the Ken and Marilyn Thomson Patient Care Centre at the largest community teaching hospital in Toronto. Welcoming its first outpatients in January 2023, the addition is the first phase of a larger renovation at Michael Garron Hospital, bringing more private rooms and outdoor spaces to the campus. Then, Aging in the Arctic details the design philosophy and process behind the first-ever modern long-term care facility on Rankin Inlet in Nunavut. The project, to be completed in spring of this year, was born out of a government assessment of long-term care in the territory that dates back 10 years now. Finally, Preparing for Transplant overviews construction of the world’s first organ regeneration laboratory at the number one transplant hospital in North America, Toronto General Hospital. Due to the project’s timing — the site review took place on day one of the first COVID lockdown in Ontario — and its delicate nature, it faced numerous obstacles but none too big to overcome. The lab is now in use, enabling leading edge stem cell work and organ repair regeneration, such as ex vivo lung perfusion whereby a pair of lungs is kept alive outside the body so that a surgeon can evaluate them for transplant, directly within the hospital’s surgical unit. Rounding out this issue, we turn to the topic of emergency preparedness and response. Troubled Waters explores the necessity of a water management plan, backed by a case study of a healthcare facility in Western Canada. To close, Moving Beyond Crisis addresses elements that play a pivotal role in sustaining healthcare operations during crisis, also supported by a case study conducted for an existing hospital in a high-risk seismic zone in Canada. Clare Tattersall claret@mediaedge.ca

4 CANADIAN HEALTHCARE FACILITIES

SAVE THE DATE! The 2024 CHES National Conference will be held in Halifax, Nova Scotia, at the Halifax Convention Centre, September 8-10, 2024. The Halifax Convention Centre is conveniently located in the downtown core and close to local amenities. A block of rooms has been reserved at the following hotels: Cambridge Suites, starting at $205 plus applicable taxes standard queen/king single/double occupancy. Prince George, starting at $245 plus applicable taxes for standard queen/king single/double occupancy.

The theme of the 2024 conference is “Enriching Patient Experiences by Optimizing the Environment” The CHES 2024 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. Alan Mallory will be our Keynote Speaker. The Great CHES Golf Tournament will be held at the Glen Arbour Golf Course on Sunday, September 8, 2024. Join us for the CHES President’s Reception and Gala Banquet at the Halifax Convention Centre. The banquet will celebrate the accomplishments of our peers with the 2024 CHES Awards presentations, while enjoying great food and entertainment with friends.

See you in 2024 in Halifax! For more info visit our website at www.ches.org

Joins us on!

@CHES_SCISS

PRESIDENT'S MESSAGE

PREPARING FOR THE FUTURE,FORWARD TODAY REFLECTIONS AND LOOKING THROUGH RECENT MEETINGS participated on behalf of National CHES, my employer SEPTEMBER WAS A BUSY month that withI’ve three events: thein2023 CHES Conference, and myself, thechapter theme has emergedand thattrade what show, we doand today prepares us for souper-conférence the future. Saskatchewan conference Quebec chapter (dinner This past November, represented CHES asCHES a member of thesee oversight council for the conference). As I wroteI in my last message, members these conferences as International a reunion of Federation Healthcare Engineering. This in council was held during Societylearn, of Health sorts. They of provide an opportunity for those the healthcare industrythe to Mexican come together, share Specialized Architects Mexican Association of Health Engineers’ and investigate how toand make our healthcare system more Specialist efficient and effective,19th withInternational the goal of Congress in Healthand Infrastructure in Mexico City. The meeting looked to the future, improvingTransversality the patient experience healthcare outcomes. in While regardsattothe environmental sustainability, partnering theCHES Worldboard Healthand Organization on incident national conference in Winnipeg, thewith entire four committee chairs response, planning and for preventions. At the congress, on anofartificial gathered over two days strategic planning sessions one and technical meetings. session I’ve hadtouched the honour serving intelligence engine focused on under supporting management decision-making an everon the CHES National board three facility previous presidents. We have built onusing this legacy of expanding library of standards, guidelines and leadership and planning, and again this year wepolicy spent documents. time reflecting on the organization that CHES at the Canadian Centre for Healthcare Facilities conference the Greening Health hasDiscussions become and where it is going. We discussed how to make CHES moreand effective, which included Care annual forum, held this pastpromote December, also emphasized that future and outcomes an assessment of our both leadership model, the value of CHES membership, shape are the irreversibly in the decisions we makeConstruction today, especially with regard to Time climate change and future of ourrooted flagship Canadian Healthcare Course (CanHCC). was also spent prospective healthcare demands. To meet the ever-changing healthcare landscape, CHES must discussing goals and aspirations. In my own employment, we expand. are preparing principles we enter into five-year capital and continue to grow, mature and This requires theasinvolvement andour engagement of CHES operating cycle. and chapter leadership roles and on committees. Look for ongoing dialogue, members plan in national This bringsand meplans to ask: aremoves you preparing fortogether the future byyou, yourits actions today? information asHow CHES forward — with members. IThis hopeyear’s personal development is at the forefront. Whether in need of formal leadership or technical national conference is now ‘in the books’ but there are still plenty of activities taking training, personal discipline for better health and well-being, or developing relationships, delay place. I attended the International Federation of Healthcare Engineering (IFHE) Congressdon’t in Mexico in investigating and making decisions today to guide you to your desired future state. I trust that you City Nov. 4-6, chaired by current IFHE president and former CHES president Steve Rees. Chapters look to CHES for personal development through webinars, the Canadian Healthcare Construction across the country are planning next year’s conferences, and the CHES National conference planning Course, andunder chapter and national conferences. if wanting to assess yourtocapabilities in committee, the leadership of Robert Barss, Further, is preparing the Maritime chapter host the 2024 healthcare facilities to help guide your personal development needs, consider taking the Canadian CHES National Conference in Halifax, Sept. 8-10. CHES’s webinar series, CanHCC sessions, social Certified Healthcare exam. Details all of partner these canorganizations’ be found on media platforms and Facility regular Manager e-blasts ofself-assessment timely news articles, as well on as other the CHES website. events promoted to CHES members, are significant value-added benefits. Finally, CHES as a society is doing the same — weinare the future by taking action And let’s not forget the enormous value found ourpreparing quarterlyforjournal, Canadian Healthcare today andIt’s developing plan.successes, Building on previousand strategic planning with the board and five Facilities. a forum atostrategic share your learnings challenges with design professionals committees councils, a documented strategic plan will create framework for CHES’s future. and vendor and teams, and internally with infection prevention anda control, environmental services, I’m looking forwardsecurity to seeingteams what the futurefacility. has in store for out CHES, Canadian laboratory and/or at your Reach to our the members journal’s and editor, Clare healthcare. Let’s be prepared for thattofuture by making good today. healthcare system. Tattersall, at claret@mediaedge.ca relay your ideas to helpdecisions impact Canada’s

CMY

Craig B. Doerksen CHES National president

EARN CONTINUING EDUCATION CREDITS FROM CHES

Members of the Canadian Healthcare Engineering Society can earn free continuing education units (CEU) by reading the Winter 2024 Fall 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/VZZMXRQ www.surveymonkey.com/r/6QDKXP8 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. 6 CANADIAN HEALTHCARE FACILITIES

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CHAPTER REPORTS

BRITISH COLUMBIA CHAP TER

NEWFOUNDLAND & LABRADOR CHAPTER

The chapter’s next provincial conference is scheduled for June 2-4, in Whistler. Conference planning, spearheaded by Mitch Weimer, is in full swing. The theme is Surviving and Thriving: Stories of Hope Amidst Disaster. The call for abstracts has been announced. We eagerly anticipate the participation and support of all interested parties. The education committee is exploring the possibility of hosting a follow‐up webinar to the conference, building upon the success of the panel discussion. Given the positive reception, we believe it could serve as an excellent opportunity for members to reconnect and share insights. The B.C. chapter remains committed to increasing CHES membership and encouraging renewals for those who have lapsed. I am pleased to report membership executive director Arthur Buse has noted an increase in membership, totalling 365 members. Members of the chapter executive remain actively engaged in various committees, including support for CSA Group, CHES partnership and advocacy, membership, social, standards and the Canadian Healthcare Construction Course (CanHCC). The chapter hosted the CanHCC Nov. 2-3, in Burnaby. The course was sold out with 51 attendees. A big thank you to Steve McEwan for volunteering his time to support the course and faculty. I’d like to remind chapter members of the educational opportunities available to them, such as the bursary program and CHES webinar series. Further, we recently closed an expression of interest for additional chapter executive volunteers, as part of our succession planning efforts. The chapter executive has reviewed these submissions and will be extending invitations to those who expressed interest to participate in the conference planning process.

Another busy year in the books. The phrase, “You get out of it what you put into it,” comes to mind as I write this report. We all have struggles and sometimes balancing family, work and, for some of us, our CHES life proves difficult. Many times, we are restricted by budgets and geography, which places constraints on CHES members’ ability to travel and attend events. Although it may not be easy, the Newfoundland and Labrador chapter executive is committed to promoting CHES provincewide and supporting chapter members. The province is currently transitioning from four health authorities to one, Newfoundland and Labrador Health Services. As we work our way through the challenges of this transition, it’s exciting that we will be able to reunite with our CHES friends across the province with the move to one authority. The chapter is sitting in a solid financial position. We will continue to sponsor and support our members with respect to travel to and accommodations at the chapter’s professional development day in spring. The executive team is in talks about what can be offered to membership in terms of sponsorship for local conferences and the 2024 CHES National Conference in Halifax. We will work harder to promote educational opportunities and partner with local bodies to spread CHES news. —Colin Marsh, Newfoundland & Labrador chapter chair

ONTARIO CHAP TER

CHES Saskatchewan continues to be dedicated to developing our membership. The chapter has experienced a resurgence in new membership from the Saskatchewan Health Authority (SHA). It’s expected this group will be strongly represented on chapter committees this year. Their hard work helped make our fall conference a resounding success. The chapter executive is actively organizing conferences for 2024. We are currently considering topics for a potential spring conference and our annual fall conference. We are committed to providing meaningful conferences with opportunities for learning and relationship building. As the chapter grows, the executive team will continue to look for opportunities to advance the betterment of the province’s health industry through CHES.

The Ontario chapter executive continues to meet quarterly via virtual means, focused on membership development and member benefits, including bursaries, the Young Professionals Grant and education events. With growth in membership over the past year, we are engaging in analytics work to better understand membership complexion and identify opportunities for further development. We are also engaged in long-range financial planning to continue to optimize member benefits with the resilience that served us well through the COVID-19 pandemic. The conference planning committee is currently busy planning the chapter spring conference at Blue Mountain, May 26-28. Our CHES Ontario family will congregate in Collingwood, around the theme Embracing Change and Transformation. The chapter executive continues to engage in networking and advocacy opportunities. I attended and presented at Blackstone’s fall symposium where innovative pathways to decarbonization were put forth, along with a new partnership between Enbridge and the Canadian Infrastructure Bank. I also had the opportunity to tour surgical centres in Houston, and attended the Canadian Centre for Healthcare Facilities conference this past November. In 2024, we look to further partnerships with our long-term care colleagues at Advantage Ontario through participation in their conference in spring.

—Melodie Young, Saskatchewan chapter chair

—John Marshman, Ontario chapter chair

—Sarah Thorn, British Columbia chapter chair

SA SK ATCHEWAN CHAP TER

8 CANADIAN HEALTHCARE FACILITIES

CHAPTER REPORTS

ALBERTA CHAP TER

MARITIME CHAP TER

The Alberta chapter’s in-person executive meeting was instrumental in ensuring a smooth transition of roles on the team. The banking turnover process has been completed and we are actively pursuing new banking opportunities to optimize our financial strategies, including exploring short-term investments. The executive team has held its first conference planning meeting, laying the groundwork for a successful event June 1112. We’ve had the chance to observe the ongoing progress of the new trade show space, which is crucial for enhancing the overall experience of conference attendees and ensuring room for a bigger and better event. We also voted to proceed with a golf game in advance of the conference and support hosting the Canadian Healthcare Construction Course afterwards. Efforts are underway to fill all Alberta representatives for national committee member roles. The success of CHES Alberta relies on a diverse and engaged group of professionals, and we are committed to ensuring all positions are filled with qualified and dedicated individuals who want to be more involved in the future of healthcare engineering. This past November, Alberta Health Services hosted a highly successful online heliport training session. More than 80 heliport managers attended, showcasing a strong commitment to maintaining consistency in heliport management practices across the entire province. This collaboration aligns with CHES’s mission to promote excellence and standardization in healthcare facilities, including heliports. The Alberta chapter is actively seeking input for article submissions to the CHES journal, Canadian Healthcare Facilities. This is an opportunity to contribute valuable insights and expertise to the broader healthcare engineering community. CHES Alberta is exploring the idea of establishing our own award for excellence, specifically tailored for our members. This initiative aims to recognize and celebrate outstanding contributions to our organization. As we continue to advance these initiatives, your support and engagement are crucial. I look forward to your continued involvement and collaboration as we strive to elevate CHES Alberta to new heights.

Planning continues for the 2024 CHES National Conference in Halifax, Sept. 8-10. Much of the preparations have been completed and most events have been confirmed. The opening reception will be at Pier 21, the gateway to Canada for one in five immigrants. Delegates are invited to visit the website to discover those with whom they may have connections. They are also encouraged to sign up for a free tour during the reception. The call for abstracts for educational sessions closed Nov. 30. Submissions are currently under review by Gordon Burrill and the abstract review team. Maritime chapter members were in Winnipeg this past September for the 2023 CHES National Conference to promote the 2024 national conference. There have been 25 early registrations for the event. I encourage all CHES members to join us for some good ol’ homegrown Maritime hospitality and an exceptional conference program. Also at the 2023 CHES National Conference, Kate Butler and Helen Comeau of Women in CHES held a successful meeting. Look for exciting news from this group in the future. Following this year’s national conference, the Maritime chapter will host the Canadian Healthcare Construction Course Sept. 1112, at the Halifax Convention Centre. A successful fall education session was held Nov. 28, in Truro, N.S. The day was open to hospital and long-term care maintenance staff at no cost and included breakfast, lunch and door prizes. Presenting companies and others sponsored to cover the costs. There were seven presentations on a variety of topics, including computerized maintenance management system software, asbestos, infection prevention and control hoarding techniques, power quality, water management, roofs and chiller maintenance. Approximately 100 people took advantage of this CHES offering. A large contingent was long-term care staff, some of which decided to become CHES members. The chapter continues to offer several financial incentives to Maritime chapter members in the way of student bursaries, contribution to Canadian Certified Healthcare Facility Manager exam fees, and covering the cost of webinars and the fall education day, among other benefits.

—James Prince, Alberta chapter chair

—Robert Barss, Maritime chapter chair

The 2024 CHES National Conference will be held in Halifax, N.S., at the Halifax Convention Centre, Sept. 8-10. WINTER/HIVER 2024 9

CHAPTER REPORTS

QUEBEC CHAP TER

CHAPITRE DU QUEBEC

I am pleased to present an overview of the Quebec chapter's accomplishments and future initiatives as we strive to revive our efforts following the challenges posed by the COVID-19 pandemic. In 2023, we successfully hosted three impactful events, each designed to promote the chapter and align with the mission of CHES. Notably, our in-person conference dinner Nov. 8, was strongly attended by more than 60 people. The event, which focused on the crucial subject of decarbonization in the healthcare sector, showcased one of the most significant projects in the Quebec healthcare network, valued at more than $15 million. An additional highlight was the presence of CHES vice-president Jim McArthur, highlighting CHES National’s support for our chapter. In 2024, the chapter executive team will actively explore new offerings, which is unprecedented for CHES Quebec. These actions are proof of our dedication to meeting the evolving needs of the province’s healthcare facilities. In our pursuit of growth, the Quebec chapter is aiming to achieve the ambitious goal of reaching 100 members by 2024/2025. Simultaneously, we are expanding our leadership team to make meaningful contributions to various national committees. As part of CHES’s broader strategy, the Quebec chapter is proactively leveraging social media, including LinkedIn and Instagram, to establish a robust communication network. I encourage you to follow us on these platforms to stay informed on our latest events and initiatives. Your continued support and active engagement are invaluable as we collectively advance healthcare engineering in Canada.

Je suis ravi de présenter un aperçu des réalisations et des futures initiatives du chapitre du Québec alors que nous nous efforçons de relancer nos efforts à la suite des défis posés par la pandémie de COVID-19. Tout au long de cette année, nous avons organisé avec succès trois événements, chacun conçu pour promouvoir le chapitre et s'aligner sur la mission de la SCISS. Notamment, notre dîner de conférence en personne du 8 novembre a attiré une forte participation de plus de 60 personnes. L'événement, axé sur le sujet crucial de la décarbonisation dans le secteur des soins de santé, a présenté l'un des projets les plus importants du réseau de la santé au Québec, d'une valeur dépassant les 15 millions de dollars. Un autre moment fort a été la présence de Jim McArthur, vice-président SCISS, qui s'est joint à nous pour souligner le soutien du bureau national à notre chapitre et notre engagement envers la communauté de la SCISS. En regardant vers 2024, notre équipe explore activement de nouvelles offres, sans précédent pour le Chapitre du Québec. Ces actions témoignent de notre engagement à répondre aux besoins évolutifs du domaine des installations de soins de santé et à favoriser une équipe dynamique et motivée. Dans notre quête de croissance, le chapitre du Québec est résolu à atteindre l'objectif ambitieux d'atteindre 100 membres d'ici 2024/2025. Parallèlement, nous élargissons notre équipe pour apporter des contributions significatives à divers comités nationaux. Dans le cadre de la stratégie plus large de la SCISS, nous exploitons de manière proactive les plateformes de médias sociaux, notamment LinkedIn et Instagram, pour établir un réseau de communication solide. Nous vous encourageons à nous suivre sur ces canaux pour rester informé de nos derniers événements et initiatives. Votre soutien continu et votre engagement actif sont inestimables.

—Mohamed Merheb, Quebec chapter chair

—Mohamed Merheb, chef du conseil d’administration du Québec

MANITOBA CHAP TER The Manitoba chapter is geared up for a successful 2024. Our annual education day will take place April 16, at the Victoria Inn in Winnipeg. The theme is Investing in Healthcare Infrastructure. We will then host, together with the Winnipeg Construction Association (WCA), the Canadian Healthcare Construction Course May 22-23, at the WCA’s office. There have been a few changes to the Manitoba chapter executive, as relayed in my fall report. Until the 2024 CHES National Conference, I will continue to serve as chapter chair. At that time, I will turn over the reins to current vice-chair Stephen Cumpsty and move into the role of past chair. I will be involved in supporting the next chapter executive team and work closely with the education day planning team. A call for nominations for the vice-chair position will be sent out prior to the transition. Both James Kim (treasurer) and Jeremy Kehler (secretary) have agreed to stay on in their respective roles. A call for nominations for the two Manitoba chapter awards in project management and facility management will soon go out. Be sure to get your nominations in as soon as possible. The awards will be presented at the chapter conference in spring.

10 CANADIAN HEALTHCARE FACILITIES

—Reynold J. Peters, Manitoba chapter chair

Held in Winnipeg, the 2023 CHES National Conference was attended by 570 people.

CHES Canadian Healthcare Engineering Society

SCISS

Société canadienne d'ingénierie des services de santé

CALL FOR GRANT SPONSORSHIP & SUBMISSIONS 2024 Young Professionals Grant DEADLINE: April 30, 2024 CHES is seeking both sponsors and candidates for the 2024 Young Professionals Grant. The application forms for Sponsors and Candidates are available on the CHES website. Call for Sponsors: • 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. Call for Candidates: • Young professionals who are or will become architects, engineers (i.e. mechanical, electrical, power, 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 2024 CHES National Conference and complimentary membership for the remainder of the 2024-2025 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

THE HEART OF THE COMMUNITY

Le cœur de la communauté By/Par Rebecca Melnyk

n early 2023, on a chilly mid-January morning, a crowd of people gathered inside Michael Garron Hospital to celebrate a ribbon-cutting ceremony for the new Ken and Marilyn Thomson Patient Care Centre in Toronto’s east end. As part of the largest campus redevelopment project in the hospital’s history, the eight-storey facility was to open the following week and usher in a new era of healthcare. Standing at a podium, former mayor John Tory shared what it meant for more than 400,000 residents of the diverse East York community, many who face increasing health and social care needs, “many who have been newcomers with different 12 CANADIAN HEALTHCARE FACILITIES

n matin glacial de janvier 2023, l’Hôpital Michael Garron s’anime. Les gens se pressent pour une occasion spéciale. Ils célèbrent l’ouverture du Centre de Soins Ken et Marilyn Thomson. Situé à l’est de Toronto, ce bâtiment incarne un progrès significatif. Avec ses huit étages, il représente le cœur du projet de réaménagement le plus ambitieux de l’hôpital. Promesse d’innovation, il ouvrira ses portes la semaine suivante. Un nouvel horizon pour les soins de santé s’annonce. Sur l’estrade, l’ex-maire John Tory prend la parole. Il met en lumière l’impact du centre sur les 400000 âmes d’East York. Cette mosaïque humaine, aux besoins sanitaires et sociaux grandissants,

HEALTHCARE DEVELOPMENT

Art influenced by people throughout East Toronto adorn the walls of the facility.

Photos courtesy B+H Architects

experiences of the healthcare system. Many people (with whom) you have to earn trust and form different kinds of relationships,” he said. The 550,000-square-foot facility broke ground in 2018, on an old parking lot. It was designed by Diamond Schmitt, B+H Architects and CannonDesign. Infrastructure Ontario, the Ministry of Health and EllisDon partnered on its construction. “Having had the chance to be part of the project from the onset, I can say that community engagement has been integral to its development,” says Ilinca Popa, healthcare architect and senior associate with B+H. “From open houses to mock-up engagements to events held in the nearby farmer’s market regarding furniture selection, they have all been instrumental in hearing the diverse range of voices in the community.” Design features of the tower incorporate community-specific elements. The facades are integrated into the scale of the neighbourhood and adjoining houses. New interior spaces reflect the unique characteristics of the population itself. Due to the area’s higher occurrence of chronic disease than the Toronto city average, three of the hospital’s largest chronic illness outpatient programs converge together within an easy-to-access chronic disease unit. Also in the three-storey podium are outpatient clinics and an ambulatory procedures unit for minor care, a food court for

englobe une multitude de nouveaux arrivants. Tory insiste sur la nécessité de gagner leur confiance. Il souligne l’importance de nouer des liens diversifiés, adaptés à leurs expériences hétérogènes du système de santé. Les travaux de la structure de 550000 pieds carrés débutent en 2018 sur un ancien parc de stationnement. Diamond Schmitt, B+H Architects et CannonDesign prennent les rênes de la conception, en partenariat avec Infrastructure Ontario, le ministère de la Santé et EllisDon. Ilinca Popa, architecte chez B+H spécialisée en soins de santé, partage son vécu: “Dès les débuts, j’ai été impliquée. Je souligne combien l’engagement communautaire a été vital dans l’élaboration de ce projet.” “Des activités variées ont jalonné notre parcours. Journées portes ouvertes, simulations, événements au marché fermier voisin pour la sélection des meubles. Ces initiatives ont été cruciales pour capter et intégrer les opinions multiples de la communauté.” La tour se dresse, pensée pour la communauté. Ses façades s’intègrent avec finesse au quartier, dialoguant avec les maisons avoisinantes. À l’intérieur, chaque espace capture l’essence de la population locale. Un miroir de ses caractéristiques uniques. La région, marquée par une prévalence de maladies chroniques au-dessus de la moyenne torontoise, inspire une décision clé. Trois programmes ambulatoires majeurs de l’hôpital fusionnent. Objectif: créer une unité de maladies chroniques aisément accessible. Le podium de trois étages s’élève, abritant des installations essentielles. Cliniques ambulatoires, unité pour soins mineurs, espace restauration pour les familles, services centralisés d’enregistrement des patients. Au cœur, un hall inondé de lumière naturelle. “Le grand hall d’entrée, majestueux avec sa double hauteur, se transforme en lieu de rassemblement,” explique Popa. “Il élargit les espaces de l’hôpital pour accueillir de grands événements. Cette conception a été mûrement réfléchie dès les premières étapes du projet.” Aux étages supérieurs, le Centre de formation en médecine familiale Carswell prend place. Salles de classe, logements pour internes de garde y cohabitent. Un centre de simulation y voisine, destiné à la formation approfondie des soignants. Des soins de courte durée ainsi que deux services dédiés à la santé mentale pour patients hospitalisés constituent des ajouts cruciaux. Cette expansion inclut 215 lits supplémentaires pour les patients hospitalisés, dont 80 pour cent offrent des options WINTER/HIVER 2024 13

HEALTHCARE DEVELOPMENT

LEFT TO RIGHT: Larger single-patient rooms with private bathrooms allow for optimal healing and wellness. Wider corridors filled with natural light boost healthcare delivery.

families to relax together, centralized patient registration services and a lobby brimming with natural light. “The entire entry sequence, with an ample lobby area and double height, acts as a gathering space, extending the spaces available to the hospital for large events,” says Popa. “This was purposefully thought out during the early stages of the project.” Throughout the other storeys are the Carswell Family Medical Education Centre, with classrooms and living quarters for on-call residents, and a simulation centre to further train healthcare providers. Acute care and two inpatient mental health departments are much-needed additions, with 215 new inpatient beds, 80 per cent of which are private. All patients, even those in double rooms, have their own private bathroom and a pull-out couch or sleeper chair for family and friends. The healing journey extends to spacious outdoor areas for both patients and staff. Designed as a cascading set of terraces, the green space acts as an extension of community outdoor amenities, says Popa. “This vision was very well articulated from the beginning of the project,” she explains. “It emphasizes the important role the hospital will play in the community and how the outdoor space will create opportunities for gathering and children’s play.” How nature aids in the recovery of mental healthcare users has long been praised as a primary element of such complex environments. Built between wings of the existing hospital in a phased approach, the outdoor space includes the staff and visitor terrace, as well as a mental health patient terrace. 14 CANADIAN HEALTHCARE FACILITIES

privées. Chaque patient, y compris ceux partageant une chambre, dispose d’une salle de bain attenante et d’un canapélit ou d’une chaise-lit destinés à accueillir leurs proches ou amis. L’aménagement paysager thérapeutique fait partie intégrante du processus de rétablissement, incluant désormais de vastes zones extérieures accessibles tant aux patients qu’au personnel médical. Imaginé sous forme de gradins verdoyants, cet espace naturel complète harmonieusement les installations collectives existantes, dit Popa. “Cette vision a été très bien exprimée dès le début du projet,” explique-t-elle. “Elle souligne le rôle important que l’hôpital jouera dans la communauté et comment l’espace extérieur créera des opportunités de rassemblement et de jeu pour les enfants.” La façon dont la nature aide à la récupération des patients psychiatriques a longtemps été saluée comme un élément principal de ces environnements complexes. Construit entre les ailes de l’hôpital existant dans une approche progressive, l’espace extérieur comprend la terrasse du personnel et des visiteurs, ainsi qu’une terrasse pour les patients en santé mentale. “L’unité de santé mentale est l’une des plus intéressantes de l’hôpital, car elle a dû répondre à plusieurs critères,” poursuit l’architecte Popa. “L’équipe tenait à créer des espaces qui déstigmatisent les troubles mentaux. Deuxièmement, la conception devait accueillir une unité de soins intensifs pédiatriques, une unité de soins actifs pour adultes et une zone dédiée aux patients âgés atteints de démence, le tout dans une seule unité en forme d’hippodrome.”

HEALTHCARE DEVELOPMENT “The mental health unit is one of the most interesting units in the hospital as it had to respond to several factors,” says Popa. “First, the team aimed to create spaces that destigmatize mental illness and disorders. Second, the unit design had to accommodate a pediatric intensive care unit, an adult acute unit and a dedicated zone for elder patients with onset of dementia all in one racetrack unit. The goal of the design team was to create flexibility while respecting the flows and dignity, not only of the patients but also for staff, she adds. “There are many ways to address the needs of patients but it’s also critical that we address the needs of staff in these environments and ensure they have spaces for breaks and rest.” The vision transpired with help from a supercharged donor system. The Heart of the East capital campaign raised more than $100 million over four years, including 28,281 pledges inspired by Peter and Diana Thomson. Overall, the campus project brought in $498 million from donors, the hospital and the Ministry of Health. With updates to the existing hospital underway until 2024, which includes decommissioning outdated wings and new greenery and landscaping, the new tower is already reflecting a future-forward vision. Looking ahead, Popa notes how design will be experiential and focus more on the user experience. “The future of hospital design will also focus on adaptability of the built environment as we progress our thinking toward a more resilient and sustainable future,” she says. Before COVID-19, the project team, including Michael Garron Hospital’s infection prevention and control team, was already mindful of integrating pandemic and disaster management requirements. “They proved invaluable when thinking about the future facility design and future-proofing of healthcare in postpandemic times,” says Popa. “The design includes a lot of flexibility in use. This includes a dedicated inpatient pod that can be isolated during a pandemic, an ambulatory care area that can be operationalized during a pandemic and entrances that clearly separate the flows of patients and staff, limiting unnecessary interactions.” Back in January 2023, before opening day, Shelley Darling, chief of operational readiness at Michael Garron Hospital, stood in a bright new corridor and shared how a very detailed and coordinated process was in place to smoothly transition patients and staff from some of the oldest parts of the hospital to brand-new spaces. Her team led the logistical planning for the move, which involved a proactive and comprehensive training program for staff to ensure teams were comfortable working in the new facility. Workflows were tested and new travel routes inspected to counter potential issues once patients were welcomed. Darling says the new tower is a big improvement. “The windows and natural light are so conducive to healing and that inpatient experience is so much more improved in this facility,” she says. “Our staff benefit from that as well; it has improved and increased space in the rooms to provide care, but also at their team stations where they can collaborate, either through conversations or technology that has been enabled in this building to help improve care.”

L’objectif de l’équipe de conception était de créer de la flexibilité tout en respectant les flux et la dignité, non seulement des patients, mais aussi du personnel, ajoute-t-elle. “Les options ne manquent pas pour satisfaire les patients, mais n’omettons pas non plus de considérer les membres du personnel soignant. Ces travailleurs méritent eux aussi notre attention, notamment en veillant à ce qu’ils bénéficient de moments de pause et de repos bien mérités.” Grâce à un généreux programme de donateurs enthousiasmés, tels le couple Thompson et leur engagement inaltérable, la somme colossale de 100 millions de dollars a été collectée haut la main durant ces quatre années écoulées. Ce montant providentiel constitue une part substantielle du budget global de 498 millions amassé auprès d’ardents philanthropes, du centre hospitalier lui-même et du ministère de la Santé. Alors que l’hôpital existant traverse d’ici 2024 une période de modernisation caractérisée par le démantèlement de sections caduques et la naissance d’espaces naturels resplendissants, la construction de la nouvelle tour symbolise une perspective novatrice et radieuse. En regardant vers l’avenir, Popa note comment le design sera expérientiel et se concentrera davantage sur l’utilisateur. “L’avenir de la conception des hôpitaux se concentrera également sur l’adaptabilité de l’environnement bâti au fur et à mesure que nous progresserons dans notre réflexion vers un avenir plus résilient et durable,” dit-elle. L’équipe du projet, y compris celle de prévention et de contrôle des infections de l’hôpital Michael Garron, avait pris conscience bien avant la COVID-19 de l’importance d’intégrer les exigences de gestion des pandémies et des catastrophes. “Ils se sont révélés inestimables lors de la réflexion sur la conception future des établissements et la pérennisation des soins de santé en période post-pandémique,” explique Popa. “Dans ce plan innovant, la notion de polyvalence occupe une place centrale. On y retrouve des unités pouvant être hermétiquement closes en temps de crise sanitaire; des secteurs cliniques externes aptes à entrer en fonction rapidement; de même qu’une signalétique distincte guidant patiemment les usagers et employés vers des parcours divergents, minimisant ainsi les contacts superflus.” Shelley Darling, chef de la préparation opérationnelle à l’hôpital Michael Garron, a expliqué comment un processus très détaillé et coordonné était en place pour assurer une transition en douceur des patients et du personnel vers les nouveaux espaces. Son équipe a dirigé la planification logistique du déménagement, qui comprenait un programme de formation proactif et complet pour le personnel afin de s’assurer que les équipes étaient à l’aise de travailler dans le nouvel établissement. Les flux de travail ont été testés et de nouvelles voies de déplacement inspectées pour contrer les problèmes potentiels une fois que les patients ont été accueillis. Darling dit que la nouvelle tour est une grande amélioration. “Les fenêtres et la lumière naturelle sont si propices à la guérison et l’expérience des patients hospitalisés est beaucoup plus améliorée dans cet établissement,” dit-elle. “Notre personnel tire aussi des avantages de cette situation. L’espace dans les chambres pour prodiguer des soins s’est accru et s’est amélioré. Il en est de même pour leurs postes de travail où la collaboration est possible. Ils peuvent échanger, soit en conversant, soit en utilisant la technologie mise en place dans le bâtiment. Celle-ci a pour but de renforcer la qualité des soins.” WINTER/HIVER 2024 15

HEALTHCARE DEVELOPMENT

AGING IN THE ARCTIC

New long-term care facility in Canada’s North built on foundation of Inuit cultural awareness, dignity and respect By Jeff Penner

Photos courtesy Verne Reimer Architecture Inc. and Blouin Orzes architectes

n 2014, the Government of Nunavut initiated an assessment of long-term care that described the situation in the territory as beyond capacity and not meeting the needs of the Nunavimmiut (Ungava Inuit) community. The study outlined the need for long-term care facilities in Nunavut, and particularly the Kivalliq region — the selected location of the first modern facility planned for Rankin Inlet on the western shore of Hudson Bay. The project strategized to retain elders in the community and region, closer to family, their culture and home, reducing the current strain and issues related to out-of-territory care. 16 CANADIAN HEALTHCARE FACILITIES

The design and construction of the 24-bed centre, which is expected to be completed in spring 2024, was challenging. When the project commenced design so did pandemic lockdowns, creating a extraordinary task that required a shift and adjustment to the project design process and emerging findings/perspectives on longterm care facility design in Canada. While there were unique complexities, the design team (with contributions from across Canada) remained focused on the paramount need for the new elders’ centre to be reflective of and responsive to Inuit culture, values, history and traditions. The

design team brought experience from Manitoba, Ontario, Alberta, Saskatchewan, Quebec and Nunavut, through an online collaboration not unlike most other remote community project developments during the initial lockdown. The nature of the design process meant all consultants and stakeholders needed to work together in a new way, adapting to remote and digital sharing of complex ideas. This proved to be a challenge with technology limitations related to Internet and power issues often presented in northern communities. An important strategy that was embedded in the project’s design process was the

HEALTHCARE DEVELOPMENT

diverse nature of the team that included expertise in Inuit design, infection control, accessibility and long-term care design, along with various uniquely northern civil, geotechnical and environmental inputs that formed the initial site strategies and analysis. The team was challenged to bring together the greater context while incorporating concepts and details that reflected the site, community, region and requirements of the territorial government. SITE SELECTION

The design process focused on the household model of long-term care, which is a personcentred approach that improves the quality of life of elders at the facility.

The selected site is nestled between Kivalliq Health Centre and Agnico Eagle Centre, neighboured by nearby Nunavut Arctic College and other cultural facilities in the heart of the hamlet of Rankin Inlet. The location, although challenging from a drainage, site services and terrain perspective, is well-suited as a place for generations to connect — where elders can live and Inuit traditions can be shared, maintained and enhanced. The design of the facility focuses on a community space and a welcome centre for family and visitors. The orientation of this public space facing Tupirvik Avenue sets the aerodynamic form that enables persistent northwest winds to scour the site beneath the raised structure and around the building perimeter. As with most buildings in the arctic with ice or ice-rich permafrost conditions, the building required being raised on a platform of steel piles that are drilled into bedrock. This raised architecture sets the stage for mechanical and electrical systems to enter from below through an insulated subfloor system, while protecting the existing

permafrost condition on the site. Access to the facility is created through sloped granular areas that terminate near entrances by gabion stone retaining walls. FAMILY UNITS

The site informed the design, orientation and layout, as well as the program, with two neighbourhoods/houses of 12 resident rooms. This approach enabled the more private home experience to be facing the sloping terrain of the site with views to the immediate landscape and neighbouring community facilities. These houses are set up to provide both Level 2 and Level 3 assisted living residential care, while designed for

Level 4 or Level 5 care for those individuals with more complex needs, such as dementia, when the program and training develops. While modern long-term care design trends are embedded within the program and concept, this facility is designed to embrace local and regional culture with a number of features that include community gathering and a kitchen in each house that accommodates the preparation of country food — the traditional diet of Inuit that can include caribou, musk ox, bear, whale, seal, arctic char, shellfish, berries and other foods that are hunted, fished or gathered locally. The setting encourages family members to be actively involved with elders through

The facility’s location on Kudlulik Peninsula in Nunavut is challenging from a drainage, site services and terrain perspective, but it’s well-suited as a place for generations to connect.

WINTER/HIVER 2024 17

HEALTHCARE DEVELOPMENT programming and design features that are inclusive and community-focused. Each unit is designed to include spaces for activities that promote being with other residents in the home. They include a living room and den, each with exceptional views to the site, and a secure elevated deck to experience the seasonal changes.

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COMMUNITY SPACE

The design of a community spine creates the setting for bringing residents together while providing important amenities and services. The primary multi-purpose room is near the main entry of the facility. It is a large, round room with views to the street, extending toward the community as the most public space in the design. In this area at the entrance zone, the design includes a family lounge, telehealth room and a quiet room — all important in remote northern centres. The spine connects this more public space with a rotunda flanked by resident spaces that mimic a community setting with a coffee shop, workshop, hair care, and exercise and prayer room that connect the two households. These centralized services are offset by the supportservicespacesthatincludeadministration, laundry, food services with additional freezer space for country foods, systems areas and indoor garage for ambulance transfers. ARCHITECTURAL RESPONSE

The resulting form is a direct response to culture and climate, with orientation to manage prevailing northwest winds, summer and winter solstice impacts, and site conditions, all balanced with human factors and community values. The design aims to respond to and connect with these unique features associated with life in Rankin Inlet and Kivalliq in general. It strives to be sustainable and efficient, while ensuring the deeper expression of Inuit culture in a place that elders and the community can both benefit from today and for years to come. Jeff Penner is a senior associate and community architect with Verne Reimer Architecture Inc. (VRA). The medium-sized architectural studio is located on Treaty 1 territory and in the homeland of the Red River Métis in Winnipeg. Practicing across Canada, VRA responds to the ever-evolving global climate and economic dynamics. The firm places a strong emphasis on advocating sustainability, technical and cultural practices, and integration.

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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 Eme; otherwise 1100 Wednesday February 14, 2024 Ductwork Leakage: Effects and Efficiency OpportuniCes Speaker: Josh Lewis, CEM, CMVP, Vice-President of Energy Engineering, Nerva Energy Group Inc. Wednesday March 20, 2024 Using ArCficial Intelligence (AI) to Harness Free Energy to OpCmize HeaCng, VenClaCon and Air CondiConing (HVAC) Efficiency Speaker: Tobias Janes, CEM, Chief Technology Officer, EcoPilot Canada | USA Wednesday April 17, 2024 Beyond DirecCons: Designing EffecCve Wayfinding Systems for User Experience Speaker: Greg Neely, Bachelor of Fine Arts, Visual CommunicaEons/Design Wednesday May 15, 2024 Climate Change and Mould in Your Healthcare Facility Speakers: Dr. Om Malik, Ph.D, P.Eng., CIH, ROH, FAIHA, QP Marianne Levitsky, MES, CIH, ROH, FAIHA Wednesday June 26, 2024 Retrofit for Sustainability Speaker: Chris Pa_erson, CEM, LEED GA, Fitwell Ambassador, Automated Building Systems Technologist and NaEonal Healthcare Segment Lead, Schneider Electric Wednesday October 2, 2024 Major Changes in the 2022 EdiCon of the InfecCon Control during ConstrucCon, RenovaCon and Maintenance in Health Care FaciliCes Standard Speakers: Mike Hickey, MF Hickey ConsulEng Gordon Burrill, P.Eng., CCHFM, FASHE, CHFM, CHC Wednesday October 30, 2024 Applying the Z317.13:22 Standard to RenovaCon Projects Speakers: Jessica Fullerton, B.Sc., M.Sc., CIC Mike Hickey, MF Hickey Consulting Wednesday November 27, 2024 Applying InfecCon PrevenCon and Control PracCces for Hospital Maintenance Workers Speakers: Jessica Fullerton, B.Sc., M.Sc., CIC Gordon Burrill, P.Eng., CCHFM, FASHE, CHFM, CHC

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HEALTHCARE DEVELOPMENT

PREPARING FOR TRANSPLANT

Inside construction of the world’s first organ regeneration lab By John Gregory

Photos courtesy Tom Ridout

he largest health research organization in Canada had one chance to get it right — ‘it’ being building two mini operating rooms (ORs) in a live suite of 20 sterile ORs. “We’re talking about a city of individuals that are having different surgeries in 16 to 18 ORs at any one time,” says Christopher Rizzo, executive director of redevelopment at the University Health Network (UHN). Complicating the endeavour was the pandemic. “The first day we did our site review was the day COVID hit,” says Keith Button, 20 CANADIAN HEALTHCARE FACILITIES

senior architectural designer at Kearns Mancini Architects. “We were on-site when everything locked down. We had to get the director of infection control at UHN to help us exit the hospital.” Not the typical start to a new project, but then again this is among the most unique projects on the planet. Rizzo and Button are specifically speaking about the design and building of the world’s first organ regeneration laboratory at Toronto General Hospital — the the number one transplant hospital in North America.

Toronto General transplant surgeons who developed the regeneration technologies had been honing their techniques in an existing OR. Operating rooms can be up to 700 to 1,200 square feet so it was overkill for their spatial needs and not the best use of precious hospital resources. They brought the concept of a dedicated lab to Rizzo. In the past, if organs were in any sort of trauma, they couldn’t be transplanted. The organ regeneration lab is using technology that was perfected at Toronto General; it’s called perfusion. Perfusion effectively keeps the organ alive for an extended period in a

HEALTHCARE DEVELOPMENT

specialized environment like an incubator, which gives the team time to work on it and get the organ ready for transplant. “These are the projects you do once in your life,” says Rizzo. “Two designated mini ORs that have created the ability to regenerate or repair organs for transplant. There’s a third area, called the islet room, that harvests stem cells from a pancreas and is being used to treat diabetes, reversing the effect of the disease in some patients.” Toronto General completes 1,200 to 1,400 transplants a year, with a success rate hovering around 98 per cent. “We’re in pretty esteemed company on a global scale,” says Rizzo. “We were the first to transplant a lung and double lungs. Right now, if a recipient needs double lungs, they are getting them in one operation. Our track record is probably the best you can get for surviving major transplants.” Groundbreaking work is being done in these facilities but breaking ground to build them was challenging. “It was like playing Tetris in a fully functioning operating ward,” says Button. “We couldn’t do one thing without it affecting something else. We had to free up three rooms that were already in use — one for perfusionists, another for anaesthetists and an equipment storage room. Just to free up these three rooms we had to renovate 12 locations in the hospital, most of them in the operating suite itself.” Due to the tight schedule and a need for experienced team players, the design-

“ONE OF THE BIGGEST ASPECTS WAS TO PUT IN A DEDICATED MEDICAL-GRADE AIR HANDLING UNIT TO PROVIDE THE AIR CHANGES THAT WERE REQUIRED FOR AN ULTRA-STERILE ENVIRONMENT."

build team of Dineen Construction and Kearns Mancini Architects was selected to deliver the project. It was completed in less than 12 months. “COVID shut down elective surgeries,” says Button. “The organ regeneration laboratory project freed up one of the ORs they were using for a jerry-rigged version of the regeneration lab. Time was tight. We had to do the work as fast as we could so the additional OR could be used to deal with the surgical backlog created by COVID.” The greatest concern for surgeons was headroom. A lot of equipment on articulated arms is hung from the ceiling in a typical OR. There needed to be enough clearance so that the equipment did not clash; however, ORs normally have a 10 to 12-foot ceiling height. The rooms being renovated for the regeneration lab did not have more than eight feet of headroom. The design-build team had to work with manufacturers of the lighting and equipment booms to have the least possible depth for equipment overhead.

“Because we are the biggest teaching facility in Canada, and probably ranked highly in North America in teaching, we have about 1,700 to 1,800 fellows that we teach,” says Rizzo. “As we’re doing all this stuff, we’re teaching doctors from all over the world so they can take it back to their place, where they live (and) work.” The organ regeneration laboratory is a lab and a studio at the same time. What you see in the OR is a large light fixture with high-intensity lighting for work over the organ. Everything in the room is done under high-definition video recording, so it can be viewed anywhere as it is happening. A 4K high-resolution camera built in the light fixture is centred perfectly over the surgeon’s table. There are microphones and speakers all over the ceiling. While surgeons are working in the lab, they are also teaching other professionals across the globe how to perform the work. “One of the biggest aspects was to put in a dedicated medical-grade air handling unit to provide the air changes that were required

The organ regeneration laboratory at Toronto General Hospital, as constructed prior to user move-in. WINTER/HIVER 2024 21

HEALTHCARE DEVELOPMENT for an ultra-sterile environment,” says Rizzo. “The islet room is considered on par with a pharmaceutical lab,” adds Button. “It requires 40 air changes an hour. The bio-hood in that room worked in reverse. They are dealing with cell cultures. Normally a hood would be protecting you but here the hood was protecting what was in the hood from you. The room must be HEPA filtered and positively pressurized. So, the mechanical systems were enormous. A completely independent system.” These two labs had to remove pathogens. Most organs are worked on within a glass box so they are not exposed to the room proper. They are within their own environment but the rooms must be ultra-sterile. “This is cutting edge,” says Rizzo. “The intricate layout means you must be quite disciplined. The ergonomics had to be tested and proven in detail. Where is the medical gas? Are services within reaching distance of surgeons in a very tight space? When the surgeon is working around the medical bench — where they work shoulder to shoulder — there must be enough freedom for the surgeons to do their job but

the equipment must be right at their side so it’s within reach. The sightlines, lighting, microphones — it’s all recorded so viewers can see it in real time.” Button spent weeks meeting with their partners, Dineen Construction, about the tight tolerances, putting everything within reach, plotting out the ergonomics and trying to gain five millimetres in ceiling height to hang equipment. There was so little space above the ceiling in the islet room that they couldn’t suspend the ceiling. It had to be supported from underneath. On top of this, how does one build within a sterile environment during a COVID lockdown? “The trades had to go through the OR suites to access the regeneration rooms,” explains Button. “They gowned up like they were surgeons. When they made it through COVID protocols they ditched their street clothes and switched into scrubs. Eventually, the contractors gave them scrubs to put over street clothes, (along with) masks and hairnets. They would come in to do their work, then dispose of their personal protective equipment. There was no coming and

going. The trades on-site had to stay for the entire day.” For Rizzo, Kearns Mancini Architects distinguished themselves from other firms. “They understood the sensitivities (and that) they couldn’t breech a sterile environment, so following the rule to gown-up in the area, removing gowns just like the medical staff and being precise in the way they executed the project was no different than the precision of the surgeons,” he says. The architecture firm’s experience gleaned from being Ontario’s leading passive house architects helped because they understood isolating air and moving air. “We were able to do something that is helping a lot of people,” says Button. “Beyond that, we freed up an OR that is now back to full operation. The hospital gained the extra capacity it needs with so many postponed surgeries.” “These procedures are going to change what is done across the planet.” adds Rizzo. “An amazing journey about something that is cutting edge and that is going to help save many, many people.”

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EMERGENCY PREPAREDNESS & RESPONSE

TROUBLED WATERS

Emergency response at Alberta hospital highlights need to be proactive By Brian Flannigan

n April 20, 2017, facility management leadership received a distressed call from personnel at a brand-new hospital addition. “There’s green water coming out of the taps!” The source of the green water at the healthcare facility in Western Canada was unknown and the situation was quickly exacerbated by reports that it was flowing from taps at multiple locations across the campus. An emergency response team led by facilities management was put together. Phigenics was brought in to assist the team in rapidly developing a water management program to manage this new hazard and recommission the potable water system as safe for occupancy. 24 CANADIAN HEALTHCARE FACILITIES

This case study serves as an example of how to overcome the unique challenges of water management in a crisis and why proactive development and ongoing implementation of a water management plan can better equip a water management team (WMT) to handle unexpected emergencies. WATER MANAGEMENT PLAN

Water requires constant attention as, unlike natural gas or electricity, it is subject to seasonal or even daily shifts that can dramatically impact safety due to biological, chemical and physical hazards. Limited budgets, time and manpower are frequently cited as barriers to oversight. As a result, water management has historically been a reactive activity that waits for a problem to

occur before addressing it. This is fine for a leaky faucet but not for a building or campuswide emergency. A water management plan is proactive, ongoing, operationalized and documented. It’s proactive because it equips a WMT to manage day-to-day operations and emergencies; ongoing because it is continuously implemented, revised and improved; operationalized because members of the team are accountable and responsible for the program’s activities; and documented because the WMT can make data-driven, defensible decisions about what is best for their facility. The seminal publication of the first edition of A NSI/ASHR AE Standard 188, Legionellosis: Risk Management for Building Water Systems, in 2015, established

EMERGENCY PREPAREDNESS & RESPONSE

minimal guidance on what a water management plan is, its scope and how to implement one. Though developed to manage the danger posed by legionella, a biological hazard, the standard cites its presence is not itself sufficient to cause legionellosis. Other necessary factors include building water system design and use conditions that promote legionella growth. As such, managing for legionella is aligned with the goals of water management to ensure water is not a limiting factor to safe occupancy or building operation. ANSI/ASHRAE Standard 188 outlines that water safety and efficiency must be addressed and balanced in potable and non-potable systems. The interconnectedness of safety and efficiency requires facility managers to take a comprehensive approach to their water management plan. The standard is a normative, not prescriptive, document that describes what a plan is, but not necessarily how to build one to provide WMTs with the flexibility to tailor their plan to specific needs. STEP-BY-STEP IMPLEMENTATION

Seven steps were taken at the hospital to create a comprehensive and defensible water management plan, which illustrates the core instructions of the standard. Foremost was the establishment of the WMT, led by facilities management and including personnel from risk management and clinical departments. A multidisciplinary

THE SITUATION WAS QUICKLY EXACERBATED BY REPORTS THAT THE GREEN WATER WAS FLOWING FROM TAPS AT MULTIPLE LOCATIONS ACROSS THE CAMPUS. team brings additional support, expertise, manpower and insight. With this approach, the burden of budget, time, manpower and resources is not shouldered by one department alone. This is more important in emergencies where WMTs must act fast. Next was the development of goals, which naturally focused on getting the potable water system back into the specification and, more importantly, keeping it that way longterm. Step three involved describing the building water system by developing process flow diagrams. This gave the WMT a highlevel view of the journey water took from when it entered each building, where it was processed and how it left via the sewer. The diagrams allowed the WMT to analyze the system, better understand what was happening and where they might begin implementing corrective actions. This was done through environmental water quality testing of noted green water sources at key distribution points, such as recirculation loops in the potable system. The WMT identified stagnant water from dead legs, low use, excessive minerals, lack of oversight of

the many water treatment systems and inadequate supervision of building water system commissioning of the new expansion as contributing factors to the green water. The green water resulted from debris from improperly cleaned copper pipes installed during construction. Section 8.4 of ANSI/ASHRAE Standard 188 addresses water management during construction and includes special considerations for building water system commissioning, as construction is a highly disruptive event, especially the construction of a brand-new building. Historically, water is activated long before significant occupancy occurs, meaning little to no water is moved, resulting in high water age. Building contractors may perform some testing and disinfection according to plumbing and architectural code, but this could be done months or weeks before partial or complete occupancy. In short, once the taps were turned on, the debris from construction began to distribute along the interconnected campus. Data and analysis provided the WMT with a framework to identify control locations — where hazard control should be

WINTER/HIVER 2024 25

EMERGENCY PREPAREDNESS & RESPONSE applied — along with set control limits, monitoring protocols and corrective actions needed to bring the system back into safety compliance. Fixtures across the campus were flushed and backflow preventers tested at critical control points. Verification strategies are the protocols to ensure the water management plan is implemented as intended. This is usually accomplished by reviewing documentation of activities completed by the WMT, such as logs that fixtures were being flushed. If proper procedures were not followed, corrective action would be taken to ensure implementation. In this case, the goal was to flush each fixture for 10 minutes to achieve the desired circulation of water through the system. If this had not been realized, then a repeat flushing for the appropriate time would have been required. Validation strategies are the protocols to ensure the water management plan effectively manages hazards when implemented as designed. This came in the form of follow-up environmental testing and visual inspections of the water to ensure the debris causing green water had been successfully eliminated from the system. In cases where it

had not, a validation response guide gave the WMT prescribed guidance on addressing this hazard. This included but was not limited to supplemental flushing, backflow equipment and fixtures replacement, and subsequent retesting to ensure the additional steps successfully eliminated the green water once and for all. Having set written instructions via a validation response guide allows teams to implement a response quickly and effectively through a level-headed approach that avoids the temptation to give into kneejerk reactions that may exacerbate problems further or prevent the issue from being addressed in a timely (and cost-effective) manner. If these steps seem like a lot of work in a crisis, it’s because they are. The work done by the hospital team was a herculean effort that featured moments of tremendous leadership and cross-departmental unity. Now, many years after this crisis, the hospital has a robust water management plan that has benefitted from the lessons learned from dealing with the green water crisis and the expansion of water management guidance across the healthcare industry, which now includes the

third version of ANSI/ASHRAE Standard 188, published in 2021. The central point of this case study is to show that addressing a water crisis is possible through a water management plan but, more importantly, easier when such a plan is already established. With an ongoing water management plan, a WMT already has the processes needed to address an emergency. Additionally, WMTs should implement water management oversight during construction/renovation activities aligned with Section 8.4 of ANSI/ASHRAE Standard 188 to ensure water is not a limiting factor for occupancy in newly commissioned buildings. Establishing the team and infrastructure of a water management plan now ensures one does not have to while the alarm bells are ringing. Brian Flannigan is senior vice-president of marketing at Phigenics. He has more than 35 years of water management experience and was a voting member of the working group that developed ANSI/AAMI ST108:2023, Water for the Processing of Medical Devices. Brian can be reached at bflannigan@phigenics.com.

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EMERGENCY PREPAREDNESS & RESPONSE

MOVING BEYOND CRISIS Mechanical, electrical post-disaster resilience rejuvenation By Collin Vaness

ecent years have witnessed a dramatic shift in the landscape of natural calamities. The devastating 2017 wildfires in British Columbia, and subsequent atmospheric river events of 2021, are not mere isolated incidents but indicators of a changing climate and its impacts on Canadian communities. These events have underscored the need for healthcare facilities to be more than just structures of care; they need to be bastions of resilience, equipped to operate under the most adverse conditions. Structural integrity, power continuity, and water and sewer management play a pivotal role in sustaining healthcare operations during crisis. These elements form the backbone of a healthcare facility’s capability to not only withstand the initial impact of a disaster but also to continue functioning effectively in its aftermath. The journey toward achieving this resilience is multifaceted, involving innovative engineering solutions, strategic planning and a forward-thinking approach to healthcare facility design and management. 28 CANADIAN HEALTHCARE FACILITIES

STRUCTURAL INTEGRITY

The robustness of a healthcare facility’s structure is its first line of defence against disasters. This involves not only adhering to stringent building codes, but also integrating advanced architectural designs and materials that can withstand extreme events, from earthquakes to floods. Structural integrity ensures the safety of patients and staff, and maintains the facility’s operational capacity during critical times.

On-site generation systems ensure there is no interruption in power supply and, therefore, healthcare operations when external power sources fail and during transitions between different power sources. Additionally, the adoption of renewable energy sources, such as photovoltaic arrays and wind turbines, not only provides a backup power solution but also aligns with sustainable practices, which is crucial in today’s environmentally conscious world.

POWER CONTINUITY

WATER AND WASTE MANAGEMENT

In the event of a disaster, the continuity of power is vital for life-saving equipment and systems within healthcare facilities. Facilities can no longer rely solely on external power sources; instead, they must be equipped with systems that can generate power independently. This requires a multipronged approach to energy management, which encompasses the installation of reliable backup power sources, such as generators, renewable energy sources and the integration of on-site energy storage systems.

Water and sewage management play a pivotal role in maintaining the operational integrity of healthcare facilities during disasters. Ensuring a steady supply of fresh water is essential for medical procedures and sanitation. This can be achieved through dual water lines, large storage tanks and the capability to connect to emergency water trucks. Additionally, incorporating on-site water treatment facilities can ensure the purity and safety of water used. For sewage management, the introduction of on-site storage tanks as a backup

EMERGENCY PREPAREDNESS & RESPONSE

to the main sanitary line is a proactive measure to enhance resilience. In the event of breakdown, waste can be promptly removed using trucks, ensuring the facility maintains its sanitary standards and prevents secondar y health crises. REAL-WORLD APPLICATION

Cross-sectional view of a parking lot with underground emergency sewage storage tanks and no vehicles in this section.

To illustrate a proposed practical application of these strategies, let’s consider a case study that was conducted for an existing hospital in a high-risk seismic zone. Located in White Rock, B.C., Peace Arch Hospital was part of a study that would see the hospital implement several measures to enhance its resilience. These measures include installing dual water lines with large storage tanks, a secondary sanitary system with on-site storage and renewable energy sources for power backup. The proposed update to the hospital’s emergency preparedness plan involves earmarking areas for wastewater storage tanks and emergency dumping zones, using its expansive parking spaces. This would allow straightforward truck access, essential

23_010165_CN_Healthcare_Fac_WNTR_CN Mod: November 30, 2023 3:03 PM Print: 12/05/23 page 1 v2.5

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EMERGENCY PREPAREDNESS & RESPONSE for maintaining sanitary conditions during a crisis. Additionally, the establishment of water storage facilities, coupled with water production wells, would ensure a steady supply of fresh water for the hospital. For power continuity, the hospital would demarcate areas for emergency generator installations and identify suitable spots for mobile generators to be parked and connected directly to the building’s power grid. The proposed integration of renewable energy sources, particularly solar panels linked to energy storage devices, would provide an additional layer of energy security. This proposed case study exemplifies how a comprehensive approach to resilience planning can significantly enhance a healthcare facility’s ability to function effectively during disasters, ensuring the continuity of critical services and the wellbeing of the community it serves. EMBRACING A RESILIENT FUTURE

Reflecting on disaster resilience in healthcare facilities, it’s increasingly clear the journey toward building robust and adaptable institutions is both complex and imperative. The evolving nature of natural disasters,

amplified by climate change, demands a proactive and innovative approach in the design and operation of healthcare facilities. It is not just about constructing buildings that can withstand the brunt of disasters but about creating environments that continue to function effectively in their aftermath, providing essential services to communities in need. The integration of resilient power and energy solutions, coupled with efficient water and sewage management systems, form the crux of a healthcare facility’s ability to respond and adapt to emergency situations. As illustrated through the case study, implementation of these strategies can significantly enhance a facility’s operational continuity, ensuring critical healthcare services are not disrupted even under the most challenging conditions. Moving forward, it is essential that architects, engineers, policy-makers and community leaders work collaboratively to incorporate these resilience strategies into the fabric of healthcare infrastructure. Updating building codes, enhancing government guidelines and adopting forward-thinking approaches to facility design

CHES Canadian Healthcare Engineering Society

are vital steps in this direction. Doing so ensures Canada’s healthcare facilities are not only centres of care and healing, but also beacons of hope and resilience in the face of adversity. The path to achieving this vision is laden with challenges, yet it is one that must be tread with determination and ingenuity. In an ever-changing world, the readiness to face and adapt to disasters is not just a measure of technological and engineering capabilities, but a testament to a commitment to safeguarding the health and well-being of the country’s communities. In navigating these complex challenges, it’s important to strive to create healthcare facilities that stand resilient, ready to face the trials of tomorrow with confidence and preparedness. Collin Vaness, P.Eng., is a partner at MCW Consultants Ltd. Collin has more than 25 years of mechanical engineering experience in healthcare, education and civic projects across Canada and the United States. He holds multiple professional licences and accreditations in both countries, and is an expert in sustainable design, energy management and project management. Collin can be reached at cvaness@mcw.com.

SCISS

Société canadienne d'ingénierie des services de santé

CALL FOR NOMINATIONS FOR AWARDS 2024 Hans Burgers Award for Outstanding Contribution to Healthcare Engineering DEADLINE: April 30, 2024

2024 Wayne McLellan Award of Excellence in Healthcare Facilities Management DEADLINE: April 30, 2024

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

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

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

Award sponsored by

For Nomination Forms, Terms of Reference, criteria and past winners www.ches.org / About CHES / Awards Send nominations to: CHES National Office info@ches.org 30 CANADIAN HEALTHCARE FACILITIES

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