Canadian Healthcare Facilities | Winter 2012

Canadian

HealthcareFacilities Journal of Canadian Healthcare Engineering Society

Volume 32 Issue 2

Winter/hiver 2011/2012

Unauthorized Access: Securing Healthcare Facilities PM#40063056

Inside

Hospital Redevelopment: It Takes More Than Patience Kootenay Lake Hospital Energy Savings Re-Roofing Decisions

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contents

Canadian Healthcare Facilities Volume 32 Number 2

Canadian Healthcare facilities IS published BY under the Patronage of the canadian healthcare engineering society Steve McLinden e-mail: stevem@mediaedge.ca

Publisher

Matthew Bradford e-mail: matthewb@mediaedge.ca

Advertising Sales

Sean Foley

MediaEdge Communications 416-512-8186 e-mail: info@mediaedge.ca

Senior Designer

Annette Carlucci

Designer

Jennifer Carter

production Manager

Rachel Selbie

Editor

departments

SCIss JOURNAL trimestriel publié PAR MEDIAEDGE COMMUNICATIONS INC. sous le patronage de la société canadienne d’ingénierie DES SERVICES DE SANTÉ Steve McLinden e-mail: stevem@mediaedge.ca

Éditeur

6 Message from the Publisher

By Steve McLinden

8 Message from the President

By John J. Knott

e-mail: matthewb@mediaedge.ca

publicitaire

Sean Foley

MediaEdge Communications 416-512-8186 e-mail: info@mediaedge.ca

Pubicité

Annette Carlucci

COORDINATEUR de production

Rachel Selbie

10

Chapter Reports

Articles 13

Call for Nominations

14

Unauthorized Access: Securing Healthcare Facilities

By Drew Robb

18

Hospital Redevelopment: It takes more than patience

By J. Pitman Patterson

22 National Healthcare Facilities and Engineering Week

By Allan Kelly 24

Kootenay Lake Hospital: A case study in energy savings

26 Re-Roofing Decisions: Ready to re-cover or time to replace?

By Richard J. Ruppert

Rédatric intérimaire

Matthew Bradford

CHES Canadian Healthcare Engineering Society

SCISS

Société canadienne d'ingénierie des services de santé

President

John J. Knott

VICE-PRESIDENT

Peter Whiteman

Past President

Michael Hickey

treasurer

Ron Durocher

Secretary

Robert Barrs

EXECUTIVE DIRECTOR Donna Dennison

Maritime: Bill Goobie Alberta: Ken Herbert B.C.: Mitch Weimer Ontario: Allan Kelly

Manitoba: Reynold Peters Newfoundland & Labrador: Randy S. Cull

Chapter Chairmen

Founding Members H. Callan, G.S. Corbeil,

J. Cyr, S.T. Morawski

Ches

4 Cataraqui Street, Suite 310

Kingston, Ontario K7K 1Z7 Telephone (613) 531-2661 Fax (613) 531-0626

e-mail: ches@eventsmgt.com

CHES Home Page: www.ches.org

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Publisher's Message

By the time you read this,

it will be 2012.

It has been a rebound year for the journal. We are well on our way to participation levels experienced prior to the economic downturn, and 2012 promises to build on our momentum with the launch of CHES e-news. Moving forward, there will be more frequent communication with CHES members through the delivery of this exciting new electronic offering. Look for the first issue to arrive mid-February.

Last year, we saw the National Conference take place in Winnipeg. This year, it will be in Montreal. Combined, we are witnessing positive growth in two areas of the country that gives the association more traction in the healthcare sector.

In this issue, you'll find our cover story outlining the importance of security measures within the hospital environment. IP-based access control allows for greater cost efficiencies, and conversions from key based systems are more easily executed.

Also read with interest Guelph General Hospital's report from its annual National Healthcare Facilities and Engineering Week, and J. Pitman Patterson's extensive “how-to” for kicking off successful infrastructure projects in his article, “Hospital Redevelopment: It takes more than patience.”

Roof replacement can be a daunting task and a huge expense. Richard Ruppert provides his perspective on replacement considerations in “Re-roofing Decisions: Ready to re-cover or time to replace?”

Thank you to all our contributors to this issue and all of our issues from 2011.

All the best to our members and our readers. I hope you have enjoyed each issue of Canadian Healthcare Facilities. As always, your suggestions are always welcome.

Happy New Year.

Steve McLinden Publisher stevem@mediaedge.ca

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

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

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

Prix d’achat du Journal trimestriel Exemplaires additionnels (membres seulement) 25 $ par numéro Journal trimestriel (non-membres) 30 $ par numéro Journal trimestriel (non-membres) 80 $ pour quatre numéros L’abonnement au Journal trimestriel est inclus dans la cotisation annuelle de la SCISS. 6 Canadian Healthcare Facilities

The CHES 2012 National Trade Show & Education Forum will be held in Montréal QC at the Palais des congrès, September 23-25, 2012. The Palais is a veritable hub where the city’s main attractions converge. It connects Montréal’s business centre, international district, arts and entertainment district, Chinatown and Old Montréal.

Keynote Speaker: Monday September 23, 2012 Senator Larry Smith Past President & CEO Montreal Alouettes Football Club

city Tour of Montreal:

TourS

The theme of the 2012 conference is “Towards World Class Healthcare”. The CHES 2012 Education Program will feature 2 major tracks, one on Regulatory Compliance and one on Health Care Facility Management Best Practices.

Plenary Sessions: Begin and end each Education Day exploring world-class healthcare facility construction and maintenance from one of four unique perspectives: Québec, Canada, US, and International. These sessions will feature guest speakers from Montreal’s new SuperHospitals, ASHE (American Society of Healthcare Engineers) and IFHE (International Federation of Healthcare Engineers).

Flavors & aromas of little italy:

Sunday September 23, 2012

Monday September 24, 2012

This exciting tour will introduce you to various parts of the city that make Montréal what it is today. You will have the chance to see how culturally diverse Montréal is, as well as visit landmarks and new developments that are so very important in making Montréal such a unique city.

Come discover Little Italy, one of the most captivating neighbourhoods of Montreal with its colourful past, its quaint streets, its well known restaurants and fine epicurean groceries. Come and visit the Jean Talon Market, the biggest outdoor market in North America.

opening reception:

Social

The Great cHES Golf Tournament:

cHES Gala Banquet:

Sunday September 23, 2012

Sunday September 23, 2012

Monday September 24, 2012

Come join us for food, friends and fun!

Quatre Domaines golf club.

Marche Bonsecours

This golf course features 2 courses that can accommodate all levels of play with demanding fairways and lush greens.

Inaugurated in 1847, Marché Bonsecours is acknowledged as one of Canada’s ten finest heritage buildings and has become an essential stop on any visit to Old Montréal.

We look forward to seeing you in Montréal in 2012!

For more info visit our website at www.ches.org

Message from the President

New year brings big opportunity It is hard to believe we are into 2012 already! Here is wishing everyone the very best this new year, and my sincere hopes you all had a chance to spend time with friends and family over the holidays.

2012 promises to be an exciting year for CHES. Our committees are working hard on many fronts to bring forward new programs for the benefit of our membership. We look forward to sharing details on these efforts over the coming year.

As CHES President, I must report that the National Executive regretfully accepted the resignation of our national secretary, Richard Lacoursiere, for personal reasons. Richard spent the last few years on the National Executive as Chair of the Manitoba Chapter, and was also the Chair of the National Conference, held in Winnipeg. I would like to take this time to thank Richard for his hard work on behalf of CHES and, of course, wish him well in the years to come.

It was the decision of the National Executive to approve the appointment of Robert Barss, from Nova Scotia and the Maritime Chapter, into the vacant secretary’s position. Thank you Robert for agreeing to fill this position. We look forward to working with you as national secretary.

I mentioned some of the new initiatives that the National Executive and our committees are working on. One such initiative is the creation of a special Healthcare Facilities journal that will concentrate on the many benefits of being a CHES member and, more specifically, ways in which CHES education and networking opportunities have benefitted the facilities or organizations that our members work for. These benefits include operational or project cost savings, management skills that have led to improvements in service delivery, and useful information and input gained through consultation with a society contact. Each chapter has been asked to come up with a couple of these success stories to be published in our journal. The special journal edition will then be sent out to those who head up our healthcare facilities, and regional authorities, across the country.

It will also be accompanied by a letter from our National Executive that will introduce these folks to CHES and the benefits of membership. In this way, the National Executive hopes to raise awareness of CHES and to plant the idea that funds spent on membership and sending our members to Chapter or National Conferences is money well invested. So please, when you see a copy of this special journal, pass it along to others so that the word gets out.

I attended the 2011 Leadership Institute hosted by the American Society for Healthcare Engineering (ASHE) this past November, and I can tell you the bond between CHES and ASHE continues to grow stronger. I also attended the Alberta Chapter’s Education Session and Trade Show, in Red Deer, and I would like to thank Preston, Ken, and all the others I had the pleasure of meeting for their warm hospitality. I had a great time at your event!

Thanks to one and all who continue to contribute so much to CHES. A special thanks also goes to one of our Alberta colleagues, Steve Rees, who finished his term as CHES National past president at our September AGM and has recently passed the Chair of the Partnership and Advocacy Committee to Allan Kelly. Steve has agreed to stay on the committee, however, and to continue his work with ASHE and IFMA on the setting of benchmark standards for health care facilities. Your hard work and dedication is very much appreciated.

John J. Knott, CET, HMT, CEM 8 Canadian Healthcare Facilities

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started with our BC folks, and was designed to get funding to hire an Energy Efficiency Service Provider for each of the Ontario LHIN’s. The second initiative is to get funding to research and develop energy programs geared toward healthcare facilities, as well as create a model for revolving funds. This is very exciting news, and I wanted to thank Linda Varangu and Kent Waddington from the CCGHC for their hard work on putting this together with such short time lines. Thanks also go to Kady Cowan, Ron Durocher, Paul Soares and J.J. Knott for their input and guidance. We will have more information once the proposals are finalized and accepted.

CHES Ontario conducted an education day this October in Cambridge. The event included two great presentations: the first on fan walls, presented by EFI; and the second on cooling contingencies, presented by Trane.

Members enjoyed the presentations, as well as the following lunch and roundtable discussions on issues within their facilities.

Our next education day is in the planning stages, and will be held either in late February or early March. Most likely we will go back to Cambridge, but we are looking into doing a webcast so our members from parts of

Northern Ontario can join in. Stay tuned to the website and e-blasts for more information.

Ontario remains strong financially and some proceeds from our recent conference in Blue Mountain will help provide funding for another bursary. Rick Anderson is working out the details as to which college will receive the bursary.

Our membership chair is implementing strategies to reduce the number of unpaid memberships. Please check your statements to ensure your dues are paid. This is extremely important to the Ontario Chapter since we receive a portion of these dues.

Please also remember that all minutes from executive meeting are posted on the website.

If you have any questions or concerns, please contact any one of your executive. All contact information is on the website under the Ontario Chapter executive link.

In closing, on behalf of the executive team we hope everyone had a very joyous season and we look forward to seeing you at the CHES Ontario Conference and Trade Show in Kingston.

MANITOBA CHAPTER REPORT

The Manitoba Chapter will be holding its 2012 Education Day, April 25, 2012 at the Victoria Inn in Winnipeg. “Fire and Life Safety Systems” will be the theme for this day and we are anticipating finalizing the agenda for this day shortly. Some of the proposed sessions for this event include Fire Life Safety, a code enforcement overview; Applying Codes in Existing Facilities/Assessments; Testing Fire Suppression Systems; First Stopping: Need & Technology; Role of Fire Marshal/Purpose/ Contents of Fire Plans; and Fire Alarm testing.”

Manitoba members are urged to keep April 25, 2012 open and plan on attending!

With the New Year approaching fast, the Manitoba Chapter Executive has been busy

restructuring the executive positions. The new executive is as follows:

you are interested, feel free to contact me at anytime. You can find my contact info under the member section of the CHES website.

Manitoba Chapter has a number of future items it hopes to address in the next two years.

For one, it will explore future scholarships for engineering students looking to get into the healthcare field. It will also work further with the engineering department of the University of Manitoba and Red River Community College.

I am pleased to report the 2011 Alberta Chapter's Clarence White Conference and Tradeshow, held November 14 to 15, was a great success. We hit an all time high delegate number at over 160, and a vendor booth total of 44! I'd like to express my sincere thanks to the conference planning committee of Randy Badry, Jeff Smith, Preston Kostura, Rod Vesby, and Bernard Tong. Thanks also go to Kent Waddington who, without asking, stepped up became our official photographer of the event. J.J. Knott, CHES National President, also took some time out of his busy schedule to attend the day one monday events, which included our AGM. The educational sessions included topics of great interest, including a presentation

by Alberta Health Services staff members Peter Teskey and Brian Phillips on Facility Recommissioning: A Case Study. It was great to see and hear of the good things staff can accomplish and then present their findings and recommendations to other facilities maintenance and engineering staff.

Planning will soon be underway for our 2012 events, which will hopefully include two site meetings/tours, a spring education day, and the 2012 conference. Alberta will again be hosting an Canadian Healthcare Construction Certificate Course in Edmonton on April 19-20, 2012.

Next year is an election year for the Alberta Chapter and I was pleased with the response of several members who came up to me at

ONTARIO CHAPTER REPORT

Planning is underway for the CHES Ontario 2012 Conference and Trade Show in Kingston, Ontario from June 3 – 5, 2012. Chris Rousseau and his team are doing a fantastic job organizing this event.

The conference will be held at the Ambassador Conference Resort in Kingston.

The Great CHES Golf Game will begin with a 12pm shot gun start, and be held at the Loyalist Country Club--a short distance from the conference center. The conference is being held in June this year so we can all take advantage of the nice weather while cruising on the lake during the Gala. The team will be sending delegate packages once the education tracks are put in place. For more information, please email Chris at rousseauc@ sympatico.ca.

CHES Ontario continues to support the Canadian Coalition for Green Health Care (CCGHC). There are a couple of Ontario-based initiatives that the Coalition and CHES Ontario are trying to launch through the Ontario Power Authority. CHES Ontario is proud to be a partner in these initiatives that will benefit healthcare institutions across Ontario, and hopefully across Canada.

The first is modeled after a program that

Alberta CHAPTER REPORT

Chapter Reports

10 Canadian Healthcare Facilities

Chairman: Reynold J. Peters Vice Chair: Craig Doerksen Treasurer: Tom Sill Secretary: Vacant Thanks to Craig Doerksen for stepping up from the treasurer position to be the new vice chair, and for Tom Sill from the secretary position to become the new treasurer. I am looking forward to working with our executive as we strive to enhance the activities of the MB Chapter over the next two years.

We are currently looking for someone to fill the secretary position as soon as possible. If

Allan Kelly Ontario Chapter Chair

Reynold J. Peters Manitoba Chapter Chair

our conference with the intentions of putting their names forward for a position on the executive.

Ken Herbert Alberta Chapter Chair

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

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MARITIME CHAPTER REPORT

BC CHAPTER REPORT

Chapter Reports The CHES BC Executive has been hard at work planning the next BC Chapter Conference, which will be held in Penticton on June 3-5, 2012. The Conference Planning Committee is comprised of numerous volunteers from the CHES Executive, and they also hard at work preparing for the upcoming release of our request for education sessions for the upcoming conference. We’re also busy ironing out the final kinks in a new online conference registration tool.

Your BC Executive has already met three times this year, most recently in Penticton.

The various members and committees have been working diligently on the upcoming conference and chapter education programs, as well as fleshing out plans to improve our representation on the national committees and subcommittees. CHES BC membership numbers remain strong this year and once again we ask that you as members spread the word and help recruit members for CHES. Mike Keen, Project Director of the Planning Department at St. Michael’s Hospital; and Gordon Burrill, President, Teegor Consulting Inc, recently gave a full day seminar on the CSA Standard Z8000-11 hosted by the Maritime Chapter of CHES in Moncton. The

The CHES BC Education Committee has also been working hard to develop some exciting new member education programs. We have increased both the quantity and types of education programs that will be supported for 2011/12. CHES BC members are open to apply for our personal education sponsorship program, which this year has increased to a maximum of 10 applicants at $1000 per person, and is open to all CHES BC members.

To date, we have received and approved four applications for education sponsorship.

The education committee has also focused on developing a new Health Authority program for upcoming release. As part of this program, CHES BC has set aside $18,000 of targeted funding for BC’s six Health Authorities to secure education related to the operations, maintenance, and construction of healthcare facilities. The committee is also working on developing an approved set of courses for CHES BC member education.

These would provide funding support on preapproved applications based upon successful completion of the course. We’re striving for a fall/winter rollout of this program.

This winter, CHES BC also provided complimentary registration in the recent CHES National Webinar Series. This was a resounding success with many CHES BC members joining this national online event.

Once again, CHES BC is sponsoring educational bursaries at six BC post secondary institutions: BCIT, Camosun College, Okanagan College, College of New Caledonia, Selkirk College, and Thompson Rivers University. The CHES BC public relations team has contacted several of the recipients to seek feedback on how these bursaries have helped them and we hope to publish these in the future on the BC webpage of CHES.org.

Mitch Weimer.

BC Chapter Chair

event attracted 115 participants to what was an excellent introduction to the new standard.

Pictured with Mike and Gordon is Bill Goobie, CHES Maritime's Chapter Chair.

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Award Nominations

Call for Nominations for CHES Annual Awards

2012 Hans Burgers Award For Outstanding Contribution to Healthcare Engineering

2012 Wayne McLellan Award of Excellence In Healthcare Facilities Management DEADLINE: April 30, 2012

DEADLINE: April 30, 2012 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.

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

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

Award sponsored by

For Nomination Forms, Terms of Reference, criteria, and past winners www.ches.org / About CHES / Awards Send nominations to; CHES National Office • ches@eventsmgt.com • Fax: 613-531-0626

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Unauthorized Access:

Securing medical facilities

14 Canadian Healthcare Facilities

There are numerous areas to secure in today’s medical facilities. Outside doors, for instance, must offer protection against unauthorized access by patients, visitors, employees, and outsiders. Similarly, doors to wards, rooms, and offices must also be equally safeguarded. However, that is only the beginning of the story. There is also a growing need to restrict access to medicine storage cabinets, medicine carts, computers, medical records systems, ambulances, and even parking lots.

Failure to monitor these areas can lead to equipment or prescription drug theft, employee assaults, mistakes w ith patient medications, confidential patient information being compromised, or even ambulances being entered without permission.

That said, it is the sheer number of doors and cabinets within a medical facility that makes this a complex issue. What is required, then, is a means of controlling access at any and all of these points despite thousands of employees that have different job duties, restricted areas, and work hours. Fortunately, with today’s access control systems, this can best be achieved

via the establishment of an integrated system, one that can run off a medical facility’s existing IT network.

Access Control Systems – Simplified, Less Expensive Although video surveillance camera systems have been IP-based for many years—meaning they are connected directly into existing IT networks using standard cabling—the access control industry initially lagged behind in transitioning to this technology.

In fact, until recently, video surveillance and access control systems were installed completely independently and custom software often had to be created to allow communication and integration between systems, or even with an IT network.

“Until a few years ago, security cameras and access control systems were completely separate and often proprietary,” states Charles Crenshaw, CEO of ISONAS Security Systems, one of the first companies to develop IP-at-the-door reader-controllers. “ This meant incompatible installations, separate management software and multiple maintenance contracts.”

Winter/hiver 2011/2012 15

Fortunately, today’s access control systems are increasingly IP-based. By piggybacking on the existing network and its cabling, facility managers and security personnel can quickly and easily install door access readers to a common network switch with standard cables.

If the network switch has a built-in Power over Ethernet (PoE) feature (a common feature), it can even supply power to door access readers through the CAT-5 cabling, with no need to tap into building power. Comprehensive access control management software is then used to manage an unlimited number of readers from a single, webenabled interface. “ I P- b a s e d a cce s s co n t ro l s y s te m s re d u ce installation costs. That, combined w ith the continuing reduction in the cost of door access readers means the ‘cost per door’ has dropped significantly over the past 5 years,” says Crenshaw, adding, “It is also much more scalable, so it’s very easy to start in one area and expand into other areas as needs expand or funding becomes available.”

Securing Doors One case study that may be of benefit to Canadian healthcare facilities is the 2010 installment of a new, IP-based access control system at Moundview Memorial Hospital & Clinics in Wisconsin; a facility which provides 24-hour emergency care, clinic, inpatient care, outpatient services, diagnostic testing, surgical procedures and senior services.

According to Jim Franckowiak, Moundview Memorial’s Director of Information Technology, the previous attempt at access control involved a series of keys that were shared by individuals that need to enter important operational locations within the hospital.

“We routinely found ourselves having to track down keys and replace not only keys but locks as well if the keys were lost or if an employee left and forgot to turn their keys in,” explains Franckowiak.

His criteria in selecting an upgraded system included ease of installation, complete access control functionality that includes the ability to remotely lock down a controlled area if necessary, and the ability to manage the system via a web browser using a computer, tablet, or smartphone.

“Having web access to the system I can access remotely, or from my iPad, is very convenient since it allows me to provide access to any door in the system no matter where I am at the moment,” he explains.

The system was initially deployed in a medical supplies storage area and later expanded to additional departments including the pharmacy, IT server room, emergency treatment facilities, and the mail room.

Installation of the hardware was done by in-house maintenance personnel who installed the low voltage CAT-5 cabling, while the IT department configured the management software.

Today, the system provides administrators at Moundview Memorial with accountability that was not previously available, as the system 16 Canadian Healthcare Facilities

automatically logs the identity of each person entering a door or accessing a facility along with the time of entry.

“Superior physical security applied to the security realities of today’s healthcare facilities environment is what we were after,” says Franckowiak, noting, “And that’s what we got.”

Medication Security Every year in North American hospitals, approximately 400,000 patients become ill or injured as a result of a medication error. In as many as 7,000 of these cases the final outcome is death. With liability costs averaging more than $600,000 per incident, many hospitals are addressing shortcomings in its medication dispensing process.

This is issue was recently addressed stateside at Sinai Hospital of Baltimore, where an area of concern was its medication storage. Nurses had to make repeated trips to a medication cart located in the hallway to pick up medications.

With twenty or more cart doors and an unreliable, antiquated manual lock system, personnel struggled to maintain security.

Under the direction of Sinai Hospital patient care director Bonnie Hartley Faust, MS, MBA, RN, Sinai Hospital selected and installed a 400 NetLock Medication Cabinet preintegrated with a security access lock system. Each cabinet can be accessed with an employee badge, thus eliminating the need to remember a code or carry a key.

Using management software, reports are used to track who entered each cabinet and when. Any cabinet can be individually assigned access privileges for that location. For example, nurses and pharmacy staff can be allowed access to a defined list of cabinets and floors limited by specific hours. In addition, pharmacy personnel who stock cabinets can be assigned access at pre-defined time periods.

Securing Other Areas Door access readers can now also be installed inside a fleet of ambulances that are either run by, or partnered with a hospital. In doing so, the access system’s management software can be updated to grant access to the EMTs that operate ambulances. Wireless technology can be used to automatically update the ambulances when they are parked in front of the hospital.

Parking lots is another application that may be of interest to a medical facility. Installing a centralized access control system and long-range readers at parking facilities reduces parking conflicts and makes it easier for the hospital personnel to enter the parking lots.

Not all of these areas, though, would necessarily come under the same person’s direct control, says Crenshaw. For that reason, the access control system’s management software has the ability to give administrators control over different portions of the system, including in-room cabinets might be monitored by a nursing department, the data centre by the IT staff, and building entrances and parking access by the security group.

In summary, Canadian healthcare facilities benefit from IT-based security systems, as their implementation can greatly help reduce human error, theft, and unauthorized access, while enhancing the security and comfort for patients and staff alike.”

Drew Robb is a Los Angeles-based writer specializing in business, engineering and technology. Originally from Scotland, he has a degree in Geology/Geography from the University of Strathclyde in Glasgow.

Winter/hiver 2011/2012 17

Hospital Redevelopment: It Takes More Than Patience Competition for infrastructure dollars for hospital expansions and redevelopment in Ontario is intense.

One of the advantages a hospital can promote when seeking to improve its standing for funding is to demonstrate that it has the required municipal approvals in hand, or well under way.

O b t a i n i n g m u n i c i p a l a p p rov a l s , including various approvals required under the Planning Act, is not a core hospital compentency; and unless the hospital has recently been through the process, the complexit y and dur at ion of the pro cess may b e underestimated. Below are a few observations on municipal matters 18 Canadian Healthcare Facilities

w h i ch m ay a r i s e a n d s h o u l d b e contemplated when planning and executing a redevelopment program.

Layers of Approval Planning in Ontario is a provincial policy led regime, governed by the Planning Act and a variety of policy documents including the Provincial Policy Statement, 2005, the Growth Plan for the Greater Golden Horseshoe, the Greenbelt Plan, the Oak Ridges Moraine Conservation Plan, and the Niagara Escarpment Plan. Municipalities will typically have in place an official plan, which sets the broad vision for managing

grow th in the municipality ; a comprehensive zoning by-law, which regulates use of property; and other approval regimes such as site plan approval, a Committee of Adjustment for minor variances and severances, and subdivision control.

A hospital expansion or redevelopment may trigger the need for several approvals from the m u n i c i p a l i t y, w h i c h m u s t b e consistent with the provincial policy regime. For example, a major redevelopment may require an official plan amendment, a zoning by-law amendment, and site plan approval.

T he complexit y of the approv al

“A master plan engages the institution in an exercise of anticipating broad space requirements over the long-term so that the layout of building blocks and the use of available land is efficient and coherent, and external impacts are minimized.�

regime should not be underestimated, nor should the time required to obtain these approvals. Depending on the complexity of the development, and external factors such as local opposition (and the attendant risk of appeals to the Ontario Municipal B o a rd ) , t h e mu n i c i p a l a p p rov a l process may take from 6 to 24 months.

Consultant Team In my experience, hospitals typically b e g i n t h e p ro ce s s by h i r i n g a n architectural firm with expertise in the health sector. The architects, associated specialists, and hospital staff may undertake a master program rev iew, space analysis, and early design and costing work. The architect may also provide preliminary views

on the various municipal approvals required. However, an architectural firm alone cannot provide all of the supporting documentation required to obtain municipal approvals such as official plan amendments, zoning by-law amendments, and site plan approval—some or all of which may be required before a building permit can be issued.

Depending on the circumstances and the filing requirements of the municipality, additional consultants will need to be engaged, including almost certainly a land use planner and a traffic engineer, and possibly environmental engineers, municipal servicing engineers, heritage consultants, landscape architects, and e c o l o g i s t s . Mo s t m u n i c i p a l i t i e s

require certain reports to be filed in support of the approval applications such as a planning justification report to support the application in the context of applicable prov incial policy, a heritage impact assessment, an environmental site assessment, and a traffic impact study.

Aside from the mandatory nature of these reports, the Planning Act makes it critical that the full suite of e x p e r t o p i n i o n s a n d re p o r t s i n support of the application is available to municipal council when it makes its decision. Finally, legal counsel experienced in the planning process can handle the various legal agreements that municipalities can require, can ensure the supporting reports are complete and litigation Winter/hiver 2011/2012 19

ready (in case of OMB appeal), and can direct the team of consultants to the extent the hospital or architects desire.

Master Plans S o m e m u n i c i p a l i t i e s re q u i re o r e n co u r a g e l a r g e institutional facilities to prepare master plans for the institutional campus. In the land use planning sense, master plans are not to be confused with master program planning that the hospital must conduct as part of its quest to obtain infrastructure funding. A master plan engages the institution in an exercise of anticipating broad space requirements over the long-term so that the layout of building blocks and the use of available land is efficient and coherent, and external impacts are minimized.

Many hospital campuses—in their current form— reflect decades of piecemeal additions as space and funds dictated, and therefore lack an overall vision and associated functional efficiency. The master plan may be documented as a component of a municipal approval, typically either an official plan amendment or a zoning by-law amendment, covering the entire campus. This may be an unanticipated pre-condition to approvals, and can add to the time and expertise needed to advance a redevelopment.

Range of Uses Modern hospitals now seek to provide a wide range of

amenities for patients, staff, and visitors. The uses may include a variety of retail outlets; food sales and service; convenience services, including a post office, courier desk, or mobile phone store; and medically-related convenience services, such as a pharmacy and various forms of laboratories. These amenities may also provide an important source of revenue for the hospital. The scope of uses desired by the hospital may be beyond typical municipal expectations. These issues require careful attention in working with municipal staff and in drafting applicable land use controls.

Heritage What may be a functionally obsolescent building to healthcare providers and administrators may alternatively be viewed as a heritage facility worthy of protection, in whole or in part, by municipal staff and possibly the community. Situations where the desire to provide modern healthcare in a state of the art facility clashes with competing values of heritage preservation need to be handled carefully.

Designation under the Ontario Heritage Act has significant ramifications. Heritage preservation can become a cause célèbre if not addressed appropriately from the outset (and indeed, even with best efforts to do so), leading to a significant delay in the process of obtaining approvals, and potentially an adverse outcome.

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This is one of those situations where having the correct consulting team is critical.

Public Consultation Significant redevelopment projects are more likely to go smoothly where the interested public is engaged early, kept informed, consulted in a meaningful manner, and is ultimately on side w ith the project. A suppor tive community often means supportive municipal councillors.

After all, it is the councillors who will vote on the requested approvals.

Many hospitals have neighbourhood committees and senior staff members assigned to a community liaison role. These resources can be employed in a variety of ways in the context of land use planning, both before an application is made and during the processing of an application by the municipality. The Planning Act mandates various forms of public engagement in the processing of approval applications, which makes early and effective outreach by the hospital essential. The hospital may also have “friends” in the community who can be called upon to play a strategic role in the process.

Nobody Likes Construction As much as any other concern, the issue which always seems to arise from the community is the anticipated disruption during the construction period. It is difficult

during the early land use planning process to address such concerns with specifics about construction staging, schedules and mitigation. Public assemblies dislike hearing general platitudes in response to questions about construction. To the extent possible, consideration should be given to these inevitable questions as early as possible.

In our experience with past hospital redevelopment projects, there have always have been complaints about construction disruption, including breaches of municipal noise by-laws, blocked access and so for th. Such complaints are obviously not unique to this sector, but the general experience of the public makes construction disruption one of the early issues to arise, even if it is not a valid basis for challenging approvals sought.

The municipal approval process, whether apparently simple or complex at first blush, can take on a life of its own if not carefully managed. A tremendous amount of time, and goodwill, can be lost in an approvals process that goes sideways. Even in the best of cases, the process takes time, patience, and experienced direction.

J. Pitman Patterson is a partner in the Toronto office of Borden Ladner Gervais LLP and a member of the Municipal Law Practice Group.

Pitman can be reached at 416-367-6109 or ppatterson@blg.com

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Winter/hiver 2011/2012 21

National Healthcare Facilities and Engineering Week Healthcare workers celebrated at annual Guelph General Hospital event

By Allan Kelly, CHES Ontario Chapter Chair Guelph General Hospital (GGH) c e l e b r a t e d National Healthcare Facilities and Engineering Week this past October 24 to 28. Sponsored by CHES, the week is observed annually to celebrate facility managers, workers, and those in the healthcare facilities field, and the role they all serve in ke e p i n g t h e n a t i o n’s h e a l t h c a re facilities safe and operational. This special event also prov ides an opportunity for facilities management p ro f e s s i o n a l s t o a c q u a i n t t h e i r co-workers, management, and community w ith facility workers through interactive displays, demonstrations, and social events.

The week at GGH began with a b re a k f a s t f o r t h e exe c u t ive a n d facilities team, and was followed with a week of activities, demos, and displays showcasing the work of the facilities staff, which were well received and attended by hospital staff.

For example, the plumbers demonstrated the operation of different fittings such as a water regulator, check valve, and safety valve. Many staff were amazed to learn about the size and weight of the 3-foot pipe wrench that hospital has tucked away somewhere in their plumbing shop.

Elsewhere, the mechanics demonstrated the operation of a Constant Air Volume Box. Demonstrating

22 Canadian Healthcare Facilities

the operation of this unit gave staff a better understanding how the HVAC system works, the complexity in troubleshooting, and why sometimes it’s too hot or too cold in their area.

Another display was set up by the electrician and the electrical apprentice.

Through their presentation board display, the y demonstr ated how electricity arrives at the hospital at 13,800 volts and how it is broken down in to various voltages such as 600 and 120/208.

It also showed staff how they get emergency power and why we colour code red and white plugs to give them a better understanding of what they should do in power failure situation on their units.

The highlight of the week was the facility tours of the physical plant. Our Building Services Lead Hand led the tours that showcased the chillers, generators, boilers, and various pieces of HVAC equipment. This behind-thescenes opportunity was a real eye opener to staff who were amazed at how complex the operation of the hospital is.

T h e e ven t l e f t exe c ut ive te a m members impressed. Reflecting on the success of the week, Eileen Bain, Vice President, Patient Services and Chief Nursing Executive noted, “Engineering We e k p rov i d e d a h o s p i t a l - w i d e opportunity to better understand and respect the complexity of work in facilities management. The tours and

presentations were informative and gave many staff the chance to see a side of the house seldom seen and for facilities staff to share the great work they are doing.”

Rod Carroll Vice President of Human Resources and Support Services added, “This week helped show staff what an important role our facilities team plays in all of us providing quality, patientcentred care."

Union Gas was also on site on the final day of National Healthcare Facilities and Eng ineer ing Week giving away 500 energy efficiency kits to the staff. Included in the kit was pipe insulation, energ y efficient aerators, and showers heads— potentially saving $100 per household.

In addition, a cheque was presented to the hospital for energy savings for replacing steam traps.

The purpose of this week was to not only to show what GGH staff do on a daily basis, but also to educate the staff so they had a better understanding and p ercept ion of the Facilit ies Department. The staff at Guelph General Hospital are already looking for w a rd to n ex t ye a r ’s Na t i on a l Healthcare Facilities and Engineering Week.

Lead Hand Charles Shuurman demonstrates the operation of a 450 kw emergency power generator)

Grand Prize winner Jackie Beaton accepts her Acer Tablet prize

Electrical distribution display

John and Joe Penny answer questions on electrical systems

Facilities accepting a check from Union Gas for a steam trap audit

Staff receiving free energy efficiency kits for their home

Winter/hiver 2011/2012 23

Kootenay Lake Hospital:

A case study in energy savings Boilers are a long-term asset. Those now in operation at Kootenay Lake Hospital will have to last another 30 years to equal their predecessors’ track record. Thus far, however, Chief Engineer Mario Campese seems confident the hospital’s administrators made the right decision more than 10 years ago when they opted to replace aging technology with the current boilers.

“The lifecycle of a boiler is such that when you're starting to push 40 years, you really should be looking at replacement as opposed to constant repair,” he maintains.

Six smaller boilers were chosen in place of two much larger 24 Canadian Healthcare Facilities

existing models. This allowed for three separate sets of boilers, each which exclusively handles a key building function.

“As a result, we had two for domestic hot water use, two for heating the building, and two steam boilers for process steam required in our laundry, operating rooms, sterilizing department, kitchen and laboratories,” Campese explains.

The smaller boilers heat up faster, adjust more rapidly to load changes, are less susceptible to heat and/or chemical loss and are safer to operate. They also have a smaller physical footprint, which frees up space in the hospital’s boiler room.

Maintenance staff at Kootenay Lake Hospital is trained to perform general service adjustments and maintenance on the boilers, excluding tasks that legally must be performed by certified gas fitters.

This is both a cost-saving and somewhat necessary in-house capability given that the distributor for this product line of boiler is located nearly a 10-hour drive away from the hospital’s Nelson, B.C. location.

“We got instructions [from the boiler distributor] concerning the peculiarities of that boiler. After that first time, on the very next service, we took it on and kept going from there,” Campese says.

In the eleven years since then, the hospital has continued to see the benefits of these on-going energy and maintenance cost savings.

The preceding article is provided by Pacific Boiler Ltd., distributor of the Clayton Industries boilers producing Kootenay Lake H o s p i t a l ’s s t e a m s u p p l y. Fo r m o r e information, see the web site at www.pacific-boiler.com.

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Winter/hiver 2011/2012 25

Re-Roofing Decisions Ready to re-cover or time to replace?

A valuable asset to the building envelope, the roofing system is the first line of defense against the elements of nature. And while the decision to re-roof is often made because of problems associated with a failing roof, it can also be the proactive result of careful, documented roof management. This article addresses several important issues and offers a list of items to be considered when approaching a re-roofing project for healthcare facilities.

Existing Roof Condition Be it economics, performance ch a r a c te r i s t i c s , d r a i n a g e i s s u e s , environmental impact, or even aesthetics, there are several factors that help facility managers and roofing specialists gage 26 Canadian Healthcare Facilities

whether a roof re-cover is possible or if it is time for a replacement. For a low-slope roof re-cover, a new membrane or system is installed over an existing roof assembly, leaving most or all of the current system in tact. A replacement— or ‘tear off ’—involves removing the existing roof assembly down to an exposed structural deck.

A critical first step to determining which direction to take involves reviewing field inspection data and locating construction drawings of the existing roof. These materials typically document original specifications, historical repairs, alterations to the roof assembly or rooftop mechanical e q u i p m e n t , a n d o ve r a l l s y s t e m performance. This is particularly useful

for roofing components that cannot be readily determined through a visual inspection, such as insulation type and thickness. The roofing manufacturer can also be a resource for historic leak data.

Armed with a solid understanding of the existing specifications and roof history, an informed visual inspection of the roofing surface will confirm this data or shed light on other concerns.

Mapping a strategy to inspect the roof can be enhanced by first locating the property on one of the many online satellite imaging websites such as Google Earth or MSN Bing Maps. These are updated frequently and give a fair impression of what you will ultimately find in the field.

A thorough visual inspection will allow you to assess: • the deterioration of the field area; • seam failures; • roof edge details and equipment flashings; • positive drainage slope; • fastener holding capacity; • changes in rooftop equipment or level of traffic; and • overall system integrity.

For example, you may find the roofing membrane or surface coating has been damaged by contaminants discharged from vents or mechanical equipment. Depending on the severity, the entire system may need to be replaced. Otherwise, the contaminated areas can be removed prior to any re-covering efforts. Alternately, the source of the mechanical discharge might be reworked to minimize future exposure issues.

Beyond a visual inspection, a nondestructive moisture survey will help identify the presence of moisture within the roof assembly, especially wet insulation.

Infrared thermographic, nuclear, and capacitance moisture surveys are the most common and could be considered vital

before making any re-cover roofing decisions.

Infrared surveys identify locations—or ‘hot spots’—where heat is lost through the roofing system by identifying wet areas which retain heat for several hours, as opposed to dry areas that cool off relatively quickly. Nuclear roof moisture surveys are conducted in a grid pattern, with a moisture gages placed at each location that monitor for heavy concentrations of hydrogen (a component of water) and numerical readings, which are then used to create a map of the wet areas. Lastly, capacitance equipment can be pushed or pulled across a dry surface to detect electricity traveling through the roofing system, however these must be modified for ethylene propylene diene monomer (EPDM) membranes because they are electrically conductive.

While nondestructive surveys can help pinpoint potential moisture trapped in the roofing assembly, gathering and analyzing actual roof system samples–– known as field core cuts–-can reveal valuable information about the condition of the entire roof assembly, including the insulation type and thickness, and status of the roof deck. The data gathered from a test cut analysis can be particularly useful for specification professionals as they seek to determine if there are any deficiencies in the existing roofing system components. These can include poor material choices, advanced deterioration, known environmental contaminates, and even caustic interactions.

If test cuts are to be taken, it is important that all parties involved––including the owner, architect, specifier, roofing contractor, and others––agree up front on the purpose, method, and how the data will be used. Be aware of how any destructive testing may affect system warranties, and be certain appropriate, secure patching is put in place over core cuts before leaving the roof. With all parties working together, analyzing test cuts can inform and benefit everyone.

Another area requiring visual inspection is the roof deck’s underside.

Observing the deck from the building’s interior may help identify leaks, compromised fastener penetrations, and other problem areas. Critical areas to inspect include slope, deterioration, and deck composition. If the insulation was mechanically attached, the insulation fasteners will likely be visible and should be checked for signs of corrosion. Excessive steel deck rust or exfoliation indicates

“Armed with a solid understanding of the existing specifications and roof history, an informed visual inspection of the roofing surface will confirm this data or shed light on other concerns.”

Winter/hiver 2011/2012 27

an internal moisture problem. If left unattended, a fissure in the deck can allow moisture to penetrate the roofing system.

Note that it is nearly impossible to visually determine the grade or gage of a steel roof deck. Again, reliable documentation may be your only resource outside of exotic forensics. Concrete decks often mask potential roofing problems; however, they are less likely to simply rot through.

Additionally, despite best efforts, sometimes roof leaks are misidentified both in source and location. Liquids travel to the lowest point, so it is important to confirm that a persistent drip is not originating at a breach at a higher elevation.

This phenomenon is particularly pronounced in steel frame joist construction.

Also, confirm moisture is not coming from a source other than the roof. Check the proximity of mechanical equipment, plumbing runs, fire suppression systems, and active sources of condensation.

Building Codes and Standards With knowledge of the existing roofing system in hand, it is important to check current local building code compliance requirements as they pertain to re-roofing provisions such as: • slope and positive drainage; • fire resistive classification; and • structural loading/capacity (including snowdrift loads for northern climates and wind loads from major model building codes).

These will always be applied on a regional basis and demand the input of a qualified authority.

For example, if an existing roof has areas of ponding water, it is unlikely that merely adding new insulation board and membrane will provide significant positive drainage. While specific minimum slope requirements on re-roofing projects are not always dictated by current building codes, the slope or drainage problem should first be corrected. The addition of tapered insulation in the form of saddles or crickets may be able to achieve both a positive and directed flow.

Additionally, fire-resistance ratings may be compromised by adding certain types or thicknesses of insulation over an existing system. Likewise, meeting wind-uplift resistance requires that any new roofing system can be adequately secured to the existing one. It is always preferable to secure an overlaid roofing system through the present one to a structural deck. Without complete knowledge of the substrate construction, this may not be achievable.

Buildings already containing multiple layers of roofing systems pose a unique challenge as codes limit the number of layers allowed. A positive outcome in many instances is the removal of existing layers, which is required to achieve the serviceable roof surface anyway. In such cases, at least the top layer of the present 28 Canadian Healthcare Facilities

ClaytonCA_InnovativeAd_Health_v1 4/5/11 11:58

roof construction may have to be removed. The exposed surface may be a candidate for a composite type of elastomeric membrane with a polyester fabric backing commonly referred to as a fleeceback. This material is made up of a single-ply membrane bonded to a spun fabric backing that can absorb irregularities of a less-than-perfect surface. Always be certain when removing only one layer of roofing that the system left in place is dry and able to accept the addition of the new system.

Material Compatibility For re-cover applications, new and existing materials must be compatible, either with each other (direct contact) or with the separator layer. However, even when the layer is incorporated, it is possible for the new and existing materials to contact each other. Therefore, the best option is to ensure the separator layer, such as new insulation or adhesives, is compatible with both systems.

With the rise in green building practices and interest in photovoltaic (PV) solar panels and garden roof systems, it is important to note that both can perform well over a single-ply, fully adhered membrane (EPDM/thermoplastic polyolefin [TPO]/polyvinyl chloride [PVC]) as a separation layer. Where these systems are to be the re-cover solution, a complete analysis of the underlying structural support must be performed. Introduction of the additional weight may exceed the original structural design capacity of the support framing. In most cases, it is advisable to only install such green solutions over a newly installed roofing system. The life expectancy of the primary roofing system should match or exceed the environmental components being incorporated into the overall system Sustainability and Performance Another key aspect of the re-cover versus replacement specification is the building owner’s intentions for the facility. For example, is the building owner seeking to meet certain energy-efficiency performance criteria, such as Energy Star or Leadership in Energy and Environmental Design (LEED) ratings? What are the service life expectations and annualized costs?

In all cases, the desire to achieve new levels of energy efficiency must be weighed against the economics involved. For programs such as Energy Star and LEED, much of the attention has been focused on reflective white roof surfaces, such as thermoplastic and white thermoset membranes, as well as acrylic roof coatings that can be applied over dark membranes. These reflective roofs offer energysaving benefits, such as helping reduce a building’s cooling requirements by lowering rooftop temperatures. In many instances, a white membrane fully adhered over polyiso insulation is the most appropriate roof design for climates where cooling-degree days outnumber heating-degree days. Translating that same solution to a normally colder climate may not yield the same overall energy performance advantages.

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Untitled-3 1

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“In all cases, the desire to achieve new levels of energy efficiency must be weighed against the economics involved.”

Like any critical analysis, the better the input data quality, the better the resulting accuracy as a prediction of performance.

Consideration must be given to the material and installation costs as well as the life cycle costs to fully appreciate the model performance.

Warranty Considerations A sometimes overlooked consideration is the existing roof warranty. It is important to know the specifics with regard to duration, performance criteria, and the scope of coverage and possibility of its extensions. If regular, documented maintenance has been performed, and a manufacturer inspection confirms the roof condition as serviceable, a modest warranty extension may be achievable. This, in turn, can allow an owner some flexibility in their roofing management program. Available options may include material warranties, which only cover the performance of the roofing material; and material and workmanship, which cover both the contractor’s work and the manufacturer’s materials. For the latter, it is important to consider how long the manufacturer has been in business and how it will respond to any future problems.

Less common, but most efficient, is the planned roof replacement dictated by a well-defined roof management program. In this case, the replacement work will have been anticipated in advance, making the allocation of time and resources less impacting on immediate operations. Assisting an owner by helping to establish this type of program may contain future costs and prepare for disruptions and maintain consistently protected buildings Again, with the increased demand for green building practices and energy-efficient roofing materials, warranty considerations may take center stage. In some cases, installing a specific roofing system today will allow an owner to upgrade to green roofing technologies in the future. For some single-ply membrane systems, it may require a sacrificial cover layer in addition to the base line installed system.

Conclusion Re-roofing specification decisions are multi-faceted and complex.

Each roof must be addressed individually based on its particular physical properties as well as a myriad of other factors, including costs, requirements of the tenants, construction scheduling, and long-and short-term facility use.

Richard J. Ruppert, RA, is a strategic account executive for Firestone Building Products, with more than 20 years of experience as a registered architect. His project work ranges from landmark buildings, such as the Wrigley Building and Sears Tower in Chicago, to public schools throughout Indiana. Ruppert may be reached at ruppertrichard@firestonebp.com.

30 Canadian Healthcare Facilities

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Lightweight insu lated concrete roofing Solar guideline s Avoiding LEED-ig ation

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