Chfsummer 2013 lowrez by MediaEdge

Canadian

HealthcareFacilities Journal of Canadian Healthcare Engineering Society

Volume 33 Issue 4

Summer/été 2013

POWERING INTO THE FUTURE

PM#40063056

Inside

Haro Park Centre's Retrofit Success Staying One Step Ahead: Advancements in Facility Flooring Preparing for the Impacts of Climate Change Baycrest Health Sciences' Infrastructure Renewal

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contents

Canadian Healthcare Facilities Volume 33

Number 4

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

Editor

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

Articles 15 Powering Into the Future Successes in heathcare evolution

CHES 2013 Conference Preview

Staying One Step Ahead Advancements in facility flooring

30 Getting in on the Act How Ontario's Green Energy Act can spur long-term energy cost savings 32 Enhancing Outcomes Through Energy Performance Contracts Transferring the risk of hospital retrofits with EPCs 30

departments 6 Message from the Publisher By Steve McLinden 8 Message from the President By John J. Knott 10 Chapter Reports

Preparing for the Impacts of Climate Change How ready is your health organization?

Senior Designer

Annette Carlucci

Designer

Jennifer Carter

production Manager

Rachel Selbie

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

Éditeur

Rédatric intérimaire Matthew Bradford

e-mail: matthewb@mediaedge.ca

publicitaire

Sean Foley

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

Annette Carlucci

COORDINATEUR de production

Rachel Selbie

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 Chapter Chairmen Maritime: Denis Pellichero Alberta: Preston Kostura B.C.: Mitch Weimer Ontario: Allan Kelly Manitoba: Reynold Peters Newfoundland & Labrador: Brian Kinden Founding Members H. Callan, G.S. Corbeil,

J. Cyr, S.T. Morawski

Ches

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

Publisher's Message

Making waves in Niagara Falls The 2013 CHES National Conference is ready to roar in Niagara Falls, gathering healthcare experts from across the country for an unparalleled opportunity to share insights, re-connect with colleagues, and let the ideas flow. See what's in store for the conference's 33rd year in CHES's preview on pages 22-25. This year's conference theme, Powering into the Future, reflects the need to plan for tomorrow's industry by making critical moves today. We've mirrored this theme with a collection of success stories highlighting forward-thinking initiatives from select healthcare organizations. We invite you to read their ideas and seek out the teams behind them at this year's show for a better idea of what's to come. Our look ahead continues with a preview of innovative healthcare flooring solutions in Gail Nash's “Staying One Step Ahead” and Kent Waddington's piece on facility preparedness, “Preparing for the Impacts of Climate Change”. We also take a microscope to the benefits of Energy Performance Contracts and the Ontario Green Energy Act. I hope you find this issue helpful, and that it sparks some ideas of your own. As always, if you have any ideas or suggestions, or would like to submit a story idea to CHF for future editions, please email me at the address below. See you at the show!

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

Message from the President

A fond farewell Welcome to the summer edition of Canadian Healthcare Facilities, the official journal of the Canadian Healthcare Engineering Society (CHES). With September fast approaching, it will soon be time for me to turn over the presidency of CHES to our president elect, Peter Whiteman. Having worked closely with Peter over the past few years, I know he is more than up to the task and will make a good leader and ambassador for our organization. Since this will be my last journal report as president, I would like to take this time to thank everyone I have met from coast to coast in this great country of ours, and internationally. Thanks for your warm hospitality as I travelled to the various conferences, and thank you all for your support. I would also like to personally thank our past president, Mike Hickey, for all of his guidance and encouragement along the way. I couldnâ&#x20AC;&#x2122;t have done it without your words of wisdom and advice, and I know that CHES can count on your support, whenever needed, for many years to come. Many thanks to all the chapter chairs, past and present, who have persevered through the National Board meetings and associated committee meetings. Also, my appreciation goes out to all of the committee chairs and their committee membership. Your hard work and dedication is the stuff that makes CHES the strong organization that it is. I hope the future of CHES continues to include our present and valued partner organizations, including the American Society for Healthcare Engineering (ASHE), the International Federation of Healthcare Engineers (IFHE), the Canadian Coalition for Green Healthcare (CCGHC), Canadian Standards Association (CSA), and the Canadian College for Healthcare Leaders (CCHL). I know there are other partnerships in the works, and hopefully they will come to fruition. I also sincerely hope that the future of CHES includes a Quebec chapter and a Saskatchewan chapter, as this would go a long way toward making us the organization that represents all health care engineers across Canada. Lastly, I would like to offer a word of encouragement and support to those affected by the recent flooding in Alberta. Our thoughts go out to everyone evacuated from their homes and their communities, and we hope that required resources are made readily available to you for a swift recovery. I wish you all a safe and healthy summer season. Hopefully, I will see many of you in September at Niagara Falls. Sincerely, John J. Knott, CET, HMT, CEM CHES National President

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ALBERTA CHAPTER

Chapter Reports Hello from sunny Alberta! If you have ever travelled to our province, you know that the weather has the capability of changing multiple times within an hour, and this year is no different. Our two educational sessions that were held in March were well attended and the feedback was positive for both. We are happy to announce that the Shaw Conference Centre in Edmonton has been selected as our venue for the 2015 National Conference, and we are currently negotiating accommodations. Also, the Annual Clarence White Conference and Tradeshow Committee has had four planning meetings to date, and we are steadily getting things in order. If you know of any vendors interested in exhibiting in our tradeshow in Red Deer on November 18-19, 2013, please have them contact me. And, if you are interested in attending the conference, our doors are always open. See you at Niagara in September!

ONTARIO CHAPTER

Preston Kostura, Alberta Chapter Chair

The Ontario Chapter has been extremely busy since my last report. I have thoroughly enjoyed the position of chapter chair so much that I have decided to stay until May of 2015. Ontario is in election mode and we should have an announcement of the new executive before the CHES National Conference in September. Our education committee consisting of Rick, Ed, and Ron has been doing a fantastic job getting information and education to our members. Eight members attended the first session and, not to be discouraged, our second gathering had 16. Our last session, sponsored by Union Gas, on combined Heat and power hosted a packed room of over 30 members. The presentations will be available for our last session on the website shortly. In addition, we held an education day in April. Mike Keen and Gordon Burrill presented on Z 8000. At this education session, we had over 90 members and signed up 12 new members. Next year, we look forward to our newest standard Z 8002: The Operation and Maintenance of Healthcare Facilities. CHES Ontario continues to market and promote this great organization. We will be having a booth at the Long Term Care Show in Toronto in the fall. We hope to attract some long term care members who face the same operational problems that larger hospitals face. Membership remains steady, and through our education efforts we are seeing new members join CHES because they see value in what we do and what we stand for. The executive is working on the final version of a scholarship for our members' children. CHES Ontario is very supportive of our colleges who will turn out future facility managers and support workers for our hospitals. CHES Ontario wants to give back to our members; and with the high cost of education, this scholarship will help in providing some funds in order to help them through their education. We hope to have the final version soon so we can present the scholarship at our next provincial meeting in 2014. We will send out more information once it has been finalized. In closing, I want to say that I am very proud of the current executive and look forward to working with the new executive. The hard work that takes place behind the scenes to ensure our members receive value for their membership will not be forgotten. Allan Kelly, ON Chapter Chair Scenes from CHES Ontario's Education Day

10 Canadian Healthcare Facilities

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MARITIME CHAPTER

Chapter Reports

The Winner of the Maritime Educational Bursary for 2013 The CHES Maritime Chapter announced Janelle Poushay as the winner of its CHES Maritime Educational Bursary for 2012. Janelle Poushay, a 2012 graduate of Riverview Rural High School in Coxheath, N.S., is currently a first year student in the Bachelor of Engineering program at Dalhousie University in Halifax. She has a keen interest in the sciences and has excelled academically. Janelle has also devoted her time to being involved in school activities as well as actively volunteering in her community. Her pastimes include painting and gardening and various outdoor sports such as snowboarding, swimming, and running. The youngest of six children, Janelle is the fourth of her five siblings to choose engineering as a career choice.

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POWERING INTO THE FUTURE Successes in healthcare evolution

Canada's healthcare industry is a hotbed of innovation. New ideas, exciting technologies, and forward-thinking practices can be found within facilities from coast to coast—each of which are enhancing the quality of care for patients and the working environment for healthcare professionals. With this in mind, Canadian Healthcare Facilities invited industry's leaders to share their ideas and insights for “Powering into the Future”...

Haro Park Centre's Retrofit Success By, Vitaly Lioznyansky, Director of Maintenance, Haro Park Centre Society Energy and money-saving retrofits at Haro Park Centre led the City of Vancouver to recognize the non-profit Campus of Care as a green environmental organization in 2010. In 2008, the city partnered with Prism Engineering to conduct energy audits in seven similar care facilities in the city. The results of that audit revealed that Haro Park Centre is the most energy efficient facility, achieving a 1.05 -1.1GJ combined energy used per square metre. This translates to Haro Park Centre utilizing 45 percent less energy per square metre than similar health care centres. Haro Park Centre spans approximately 150,000 square feet of floor space within one 13-storey build and one 5-storey building. The care facility has 154 beds, 50 bachelor suites, and 14 onebedroom apartments for seniors. Haro Park Centre offers assisted and independent living units, as well as complex, intermediate and extended care for seniors that require advance care. In 2005, Haro Park launched an energy savings program. By 2012, it had reduced electrical consumption by 115,000 kWh, and lowered gas consumption by 1700 GJ, compared with pre-2005 energy consumption figures. With an initial investment of approximately $95,000, Haro Park receives approximately $36,000 in annual cost savings. This translated to a return on investment of 38 percent. As a result, Haro Park was able to recover the initial investment in under three years through energy savings. The first area targeted for energy savings was the facilityâ&#x20AC;&#x2122;s HVAC system. Fine-tuning and extensive re-commissioning of the system and related processes reduced natural gas consumption by 25 percent in nine months and provided over $18,000 worth of savings annually. In addition, the fine-tuning of the ventilation system also helped reduce the air conditioning load by 50 percent, providing a more comfortable environment for both staff and residents. Haro Park Centre collaborated with BC Hydro to replace incandescent signs and lights with energy efficient ones, bringing approximately $300-$400 a month in savings. Additionally, by replacing 190 toilets in 2008-2009 , the centre was able to reduce its annual water consumption by 50 percent, saving 5.5 million litres of fresh water between 2008 and 2012. Financial savings from these improvements were reinvested into upgrading the boiler room and the domestic hot water system. By integrating the hot water system with existing DDC controls and the 16 Canadian Healthcare Facilities

boilers, a lower temperature for the heating loop was set up to provide cost savings in the warm summer months. This had the benefits of reducing heat gains and contributed to Haro Park being heated in a more efficient and responsible manner. We have recently completed the installation of a commercial dishwasher waste heat recovery system, which absorbs heat from wastewater through a double walled water cycle heat exchanger and preheats domestic hot water. Currently, we are working on installing the laundry heat waste recovery units. These two initiatives will likely make Haro Park Centre even more energy efficient in upcoming years.

Drain-water heat exchangers installed in Haro Park Centre recovering heat from the hot water used in commercial kitchen and dishwasher.

CHES Ontario Embarks on EESP Initiative By Kent Waddington, Communications Director with the Canadian Coalition for Green Health Care CHES Ontario and our strategic partner, the Canadian Coalition for Green Health Care, together with our technical partner, ICF Marbek, are excited to share news of a new energy conservation initiative launching July 2013. Funded under the Ontario Power Authority’s (OPA) Energy Efficiency Services Provider (EESPs) initiative, the initiative is part of a province-wide capability-building initiative to provide resources directly to customers through sector-based organizations. Over the next five months, our project team we will be consulting with our health care partners and colleagues to ensure the development of key elements, and four FTE EESPs (similar to energy managers) will be hired in autumn 2013 to provide onsite assistance to Ontario hospitals. In speaking for the Coalition, Executive Director Linda Varangu states, “We feel that our goal is in perfect alignment with the OPA’s: to have our members realize energy savings as soon as possible, and assist in inciting a change in business culture from one of consumption to that of conservation and demand management.” Hospitals are one of the most energy intense of all publicly-funded facilities, spending over $300,000,000 per year on energy. On average, Ontario’s hospitals used 2.51 gigajoules of energy per square metre of conditioned floor space in the 2009/10 operating year. According to Allan Kelly, CHES Ontario Chapter chair, “We are very enthusiastic about the new energy efficiency partnership with the Coalition and all it will bring to our members across the province. We’ve assembled a tremendously talented team that will be out in the field helping to identify energy efficiency opportunities. Together with the technical expertise of ICF Marbek, this is a fabulous opportunity for those of us whose mandate includes energy management to learn from our peers, such as those in BC where a similar program has been running, and exchange ideas on how we can implement energy efficiency initiatives and retain more money for patient services.” JJ Knott, outgoing President of CHES National, and Director, Plant Operations at Norfolk General Hospital in Simcoe, Ontario has been hired to help the Coalition lead the delivery of this initiative. The Norfolk General Hospital has always believed that a healthy environment results in a healthier population and that projects such as this are a good means to achieve that end so with this in mind, hospital CEO Kelly Isfan has agreed to a secondment to permit JJ to lead the energy management team. “As energy lead on this project, I am simply ecstatic about its launch,” says Knott, “and am thankful that Norfolk General Hospital sees the value in such a project and has agreed to allow me to work with the team that is overseeing delivery of this initiative.”

JJ Knott, outgoing president of CHES National, and director of Plant Operations at Norfolk General Hospital in Simcoe, Ontario will lead the energy initiative on behalf of the Coalition and CHES Ontario which is being funded under the Ontario Power Authority’s Energy Efficiency Services Provider (EESPs) initiative.

“For years we have heard health care facility managers coming forward with issues around time constraints and funding opportunities that have negatively impacted their ability to move forward with energy conservation and demand management projects. Now, through partnership between the Ontario Power Authority, the Coalition and CHES, we will be able to help those facility managers with project development and access to available incentive programs and funding sources such as the OPA’s saveONenergy initiative.” “We see this as an exciting opportunity for hospitals in Ontario hospitals currently pledged to support the new initiative include: • Centre for Addiction and Mental Health

• Timmins and District Hospital

• Chatham-Kent Health Alliance

- Health Sciences North

• Children's Hospital of Eastern Ontario

• Hotel Dieu Grace

- Smooth Rock Falls

• Guelph General Hospital

- St Joseph Hospital3 Sites

- Lady Dunn Heath Centre

• London Health Sciences

- Manitoulin Health Centre- 2 sites

• Mt. Sinai Hospital

- Notre –Dame Hospital

• Norfolk General Hospital

- Hornepayne Community Hospital

• Royal Ottawa Health Care Group

- Bingham Memorial Hospital

• St Mary's Hospital

- Anson General Hospital

• University Health Network

- Lady Minto Hospital

• Ross Memorial Hospital

- Sensenbrenner

- South Centennial Manor

Summer/été 2013 17

Ontario to benefit from the expertise of the EESP team and to have opportunities to leverage available funding. Hospitals are also striving to be better stewards of the environment and to be more efficient wherever possible. This program will help hospitals to achieve all of these meaningful objectives.” Kelly Isfan, President & CEO, Norfolk General Hospital What does all this mean for CHES members and others involved in energy and facility management? An initiative developed from the inside out by a team intimate with the challenges and opportunities faced each day in a health care setting. Once fully operational, participants can secure free assistance with consumption audits, identification of energy efficiency opportunities, preparation of business case content to help get senior management’s buy in for project formulation and execution, and guidance in completing saveONenergy program documents for potential funding assistance. The project’s technical support will come from ICF Marbek, which is a member of both CHES and the Coalition. Richard Patterson, a Principal with the company says “ICF Marbek is very excited to be part of this initiative. We have a great deal of experience in designing, implementing, and analyzing energy efficiency programs that reduce energy consumption and are cost effective while meeting increased demand for electricity. We are currently supporting more than two dozen energy efficiency programs and portfolios across North America. ICF International has supported utilities and health care organizations in energy efficiency program design and implementation for more than 15 years and since 1992, has supported the EPA’s ENERGY STAR Commercial and Industrial and Labeling programs.” “We at the Timmins and District Hospital were very pleased to offer our early support for this proposal,” says Tim Prokopetz, Manager Materials/Biomedical Engineering/ Energy, noting “as the energy lead for our facility, I can see clearly this kind of technical assistance will be very welcome and provide an added boost to energy efficiency initiatives in Ontario health care facilities.”

“After many long months of planning, we’ve finally been able to make it happen” beams Coalition Chair, Kady Cowan. “This project dovetails nicely with many other projects the Coalition has brought to the sector such as the new Canadian Green Health Care Revolving Fund to help finance energy efficiency projects - with TRANE as the Chair of the Business Advisory Consortium and providing financial support for the project (www.greenhealthcare.ca/projects/energy/ greenrevolvingfund); our new EcoAction project with Environment Canada to help the sector reduce its GHG emissions and water use, and our climate change project (www.greenhealthcare.ca/climateresilienthealthcare/) with the Nova Scotia Department of the Environment and Health Canada which helps health care facilities to better prepare for the negative effects of climate change including energyrelated initiatives.” Paul Soares, Manager, Plant Operation & Maintenance, Centre for Addiction & Mental Health, Toronto has also lent his support to the project saying, “There is amazing potential within Ontario’s hospitals and long-term care homes to reduce energy consumption and lower the sector’s GHG contributions so I’m very pleased to see the Coalition and CHES have been able to bring the OPA’s Energy Efficiency Service Provider’s program to health care. We will all benefit from the knowledge and best practices that will be gathered and shared and the assistance we will receive from the energy team that will be deployed across the province to help energy managers reveal hidden energy-saving potentials and hopefully effect many energy-saving projects.” CHES members are encouraged to promote the new program among colleagues and business contacts to help ensure the success of the initiative and to better engage the sector in reducing energy consumption. To learn more about participating in this new Ontario health care initiative, visit www.greenhealthcare.ca/Ontario-energy or contact Kent Waddington, Communications Director with the Canadian Coalition for Green Health Care by email at kent@greenhealthcare. ca, or by phone at 613-756-0435.

Doing dishes the safe way at South Shore Regional Hospital By Robert Barss, Manager of Facility Services, South Shore District Health Health care facility dish rooms are an active area. This is the space where all the dirty dishes for the facility are gathered, cleaned, and readied for the next use. Traditional dish washers in feed systems rely on staff to manually place the dishes and food trays into baskets. The baskets are then pushed up onto a roller conveyor by a staff member until they enter the dish washer. This physical movement required by staff has been the source of many injuries and a large amount of loss time, compensated either through organizational sick leave or WCB claims. South Shore Regional Hospital (SSRH), is a primary and secondary care facility and designated District Trauma Centre with 80 medical, surgical, intensive care, obstetrics, pediatric and mental health inpatient beds. It is located in the town of 18 Canadian Healthcare Facilities

Bridgewater, on the beautiful south shore of Nova Scotia, and was one of the hospitals dealing with these issues. The existing dish washer in feed system at SSRH required staff to stretch to fill the baskets with dishes, and then push the loaded basket up a 45-degree incline to a horizontal roller conveyor above. The basket then travelled, often requiring staff assistance, along a 10-metre roller conveyor to the dish washer for cleaning. Staff injuries were a concern for everyone and with the support of funding from the Nova Scotia Department of Health and Wellness, the team at SSH set out to find a solution. It didn’t take long to discover that the method presently used at the hospital was also generally the same used across the country. As well, the dish room equipment

Old manual dishwasher in-feed conveying system

suppliers contacted were not familiar with automated solutions, nor did they have any to offer. As the manager of Facility Services for the district, I would not accept that an automated solution could not be presented. His previous experiences in the food manufacturing industry and trade show exhibitions had presented similar product movement solutions that involved automated machinery with very little physical strain by staff. Working with Steven Skinner, Industrial Engineer for the Health District and a local metal fabrication company, ABCO Industries, (Lunenburg NS), the group set out to develop a solution. And a solution they found. ABCO constructed a six station in-feed system that used pneumatic cylinders, variable speed conveyors, and an Allen Bradley PLC (programmable logic controller) to deliver the baskets safely to the dish washer without any physical exertion by staff, other than the push of a button. The final design resulted in a level platform for the basket that was 10-centimetres closer to the staff member, resulting in less

New automated dishwasher in-feed conveying system

reach required to fill the basket. When the basket was filled, a button beside the station was pushed and the basket entered a queue for safe delivery to the dish washer. Aside from the semi-annual line preventive maintenance, greasing of the pneumatic cylinder shafts twice per week is the only regular maintenance required. Kitchen staff quickly adjusted and are pleased with the results. Everyone is looking forward to no more injuries from pushing dish baskets along conveyors. The project also included the replacement of the dish room’s deteriorated vinyl floor with a seamless polymer floor system by Stoncor. This product provided superior traction to that of vinyl and is highly endorsed the Canadian Food Inspection Agency. The success of this project demonstrates the value of collaboration between healthcare professionals and industry, as well as the utilization of knowledge gained through attending CHES conferences and networking to bring new technologies to health care facilities.

Guelph General Hospital sets energy efficient example By Guelph General Hospital staff With roots dating back to 1875, Guelph General Hospital (GGH) has become a progressive, comprehensive acute care facility providing a full range of services to the 180,000 residents of Guelph and Wellington County. GGH is recognized within the healthcare community as being an excellent place to work, as evidenced by being chosen as one of three Waterloo Area Top Employers for 2013, with an intense focus on patient care and committed to excellence in all areas. As a proud member of the community, Guelph General Hospital is committed to saving energy, complementing the City of Guelph’s Community Energy Plan. Aligned with the objectives of an environmentally conscious community and their own motivations to upgrade their facilities, the hospital sought an energy partner in order to become more energy efficient and environmentally responsible. Given its progressive nature, GGH also initiated a Healthy Hospital program, focused on continually improving the working and healing environment for their patients and staff. In the summer of 2012, GGH selected Honeywell as their energy services provider and entered into the first phase of a

self-funded Energy and Facility Renewal Program. Energy efficient upgrades to the main hospital and Health Service building are included in the $3.5 million program. With $322,850 in guaranteed annual energy and operational savings, the program is expected to pay for itself within 11 years. Guelph General Hospital’s Energy and Facility Renewal Program focuses on identifying opportunities to improve the Summer/été 2013 19

patient healing environment, upgrade the building infrastructure, conserve energy, and lower environmental emissions. Two priorities are to replace the cooling tower that is past its useful life and improve the current condition of the Hospital’s facilities. The upgrades and installations are currently underway and include: • A comprehensive communication and awareness program supporting GGH’s desire to be recognized as an environmental leader in the City of Guelph and the broader healthcare sector, complemented by the hospital’s current Healthy Hospital program • training for building operators to ensure that the upgrades and the enhancements within the facilities continue to function optimally • re-commissioning building controls and some mechanical equipment within the two sites • water conservation measures • replacement of cooling tower plus other required renewal projects (addressing $1M in deferred maintenance funded by guaranteed energy savings); • installing a new state-of-the-art Honeywell Enterprise Buildings IntegratorTM automation platform that will help the facility staff more efficiently manage heating, cooling and other critical building systems • installing programmable thermostats and other measures to improve air quality for patients and staff • extensive lighting upgrades

Having taken the initial step to upgrade and improve the hospital’s facilities in the first phase of this program, patients, staff and the surrounding community will continue to benefit from these positive changes. The upgrades and improvements should reduce GGH's greenhouse gas emissions by more than 1,288 metric tons per year, the equivalent to removing over 430 medium size cars from local roads. Energy consumption and the associated costs will be reduced by $299,477 (17% of GGH’s current utility costs), and this will free up funds for more important priorities, such as continuing to achieve excellence in patient care, and giving back to the community.

BayCrest Health Sciences' Infrastructure Renewal By Matthew Bradford

Energy savings, water conservation, and natural gas reductions are just a handful of benefits Baycrest Health Sciences has reaped from its Energy Retrofit and Infrastructure Renewal Program. Initiated in Spring 2011, the $15.2 million energy management project wrapped one year later bringing ample green benefits to both the Toronto facility's staff and patients. The initiative was led by Nabil Khalil, Manager of Baycrest Facilities Services, alongside Victor Oliveira, Executive Director of Baycrest Redevelopment and Support Services. Improvements were made to virtually all of Baycrest's core systems, including its heating and cooling systems in which Nabil oversaw the replacement of the facility's aging chillers with brand new chillers. The 20 Canadian Healthcare Facilities

BayCrest Health Sciences' Instantaneous domestic hot water system

heating boilers were replaced with water heating condensing boilers, resulting in a natural gas savings of 213,561 m3 a year. “The old heating boilers were starting to fall apart, and we knew the maintenance of them would have been a high cost and that the process also consumed a lot of gas.

each organization like this would go green, we would really make an impact and we'd save money for the medical industry.” More than benefitting the industry, however, Nabil says patients will benefit from Baycrest's building automation system upgrades, adding, “The thermostat will do the work instead of the human being, and it controls all the quality air and circulation of the air, exhaust, which has a great impact on the patient. They won't really feel it, but the operation will.” Evaluating Baycrest's Energy Retrofit and Infrastructure Renewal Program on a whole, Nabil says he is proud of what the facility has accomplished, and eager to see the final touches come to completion. As for what other facility's can take away from his experience, Nabil notes, “Baycrest is not just a contender in the field of energy savings. We are leading the way.”

Welcome to Niagara Falls

Knowing this, we chose to go with condenser boilers for a higher efficiency to make the heating and, at the same time, save energy,” said Nabil. The project also included a conversion of Baycrest's air conditioner chillers with high efficiency units, as well as the conversion of 20 walk-in fridges and freezers to a closed loop cooling system. This closed system was selected to integrate the energ y upgrades w ith minimal affect on Baycrest's existing infrastructure. As a result, the conversion has allowed Baycrest to save 34,000 cubic metres of water a year--enough to supply water to 114 average, two-storey four person households in Ontario each year. For the Energ y Retrofit and Infrastructure Renewal Program, Baycrest installed 10,000 energy efficient light bulbs, upgraded 47 air filtration systems with high efficiency filters, and improved variable frequency drives (VFDs) with circulation pumps for air conditioning. Combined, these efforts have resulted in electricity savings of 2,021,624 kWhr of energy per year, and the diversion of 442,777.28 kgs of CO2 from the environment per year. “The point behind all of this is our impact on the environment is huge because we are a big consumer,” explained Nabil, adding, “If

Come See US At Booth 800 Summer/été 2013 21

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www.ches.org

“Powering Into the Future”

Sponsors KEYNOTE

DIAMOND

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GOLD

SILVER ASCO Power Technologies

IEM Industrial Electric Mfg.

Glasscell Isofab

Precise Parklink

Hemisphere Engineering

Reliable Controls

PROGRAM

digital into one organized system for those in charge of its management and operations. Through internal and web-based management tools, they have generated a robust single repository for their facility’s information. This leading-edge approach creates an efficient realtime knowledge centre for its users that allows St. Mary’s to create partnerships with external stakeholders like vendors, contractors and consultants while maintaining control of the process, the quality of information and information ownership.

Sunday September 22, 2013 09:00-14:00 12:00-16:00 TBD 18:30-21:00

The Great CHES Golf Game Companion Program – Day 1 Facility Tour of the Niagara Health System – St. Catharines Hospital Site Opening Reception

Track 2B

Monday September 23, 2013 07:00-08:30 08:30-09:00 10:15-16:15

Breakfast Opening Ceremonies Companion Program – Day 2

09:00-10:00

KEYNOTE ADDRESS Jay Ingram One of Canada’s best-known science popularizers, Jay Ingram cohosted and produced Daily Planet for over 20 years stepping down from his position in 2011. He has been awarded the 1984 Royal Society of Canada McNeil Medal for the Public Awareness of Science, the 1986 Sandford Fleming Medal from the Royal Canadian Institute for his work popularizing science, and the 2001 Michael Smith Award for Science Promotion by the Natural Science and Engineering Research Council of Canada. He holds four honorary doctorate degrees: from Carleton University, McGill University, McMaster and King’s College in Halifax. Ingram has written eleven books, three of which have won Canadian Science Writers’ Awards. His latest is Daily Planet: The Ultimate Books of Everyday Science. In 2009, Ingram was appointed as a member to the Order of Canada. He is an engaging, provocative speaker who can address complex, scientific issues in non-technical terms, making them interesting, relevant and accessible to a wide range of audiences.

10:00-11:00 Track 1

PLENARY SESSION Niagara Health: New St. Catharines Facility Improving Facility Management Efficiences Through Innovative Technologies - Panel discussion Panel Chair: Robert Copeland, Director, Business Development, Plan Group, North York, ON Panel Members: Dwayne Howden, Director, Intelligent Building Infrastructures, Plan Group, North York, ON Jeff Wilson, Regional Manager, ICT Technical Support, Niagara Health System Niagara Health System (NHS) – New St. Catharines Site is a 375 bed facility with a projected >2 million outpatient, inpatient and day cases per year. The facility is 1 million square feet and came with an overall project cost of $759 million dollars. The site was constructed leveraging the P3 model, and Johnson Controls is and will be the facility managers for the next 30 years. This is the largest hospital in the region and one of the most complex healthcare facilities in Canada. The panel will discuss the utilization of technology in the design/build phase and how decisions made during this time will ultimately lead to environmental and operational excellence in facility management (FM).

We Can Be Heroes – CHES, HAI’s and the Physical Environment Barry Hunt, Bsc., Chairman and Chief Technology Officer, Class 1 Inc., Cambridge ON Hospital acquired infections (HAIs) are the 4th leading cause of death in Canada. Every year, 10,000 Canadian patients will die from an HAI. And despite all the media attention, education and hand hygiene programs, the problem continues to get worse. But now, a solution based on managing the physical environment is appearing, and CHES members, including Facility Managers, Architects, Engineers, and Contractors all have a central role to play in leading the way to solving Canada’s biggest healthcare problem.

14:30 – 15:00 Refreshment Break in the Exhibit Hall 15:00-16:00

2 CONCURRENT TRACKS – 3A & 3B

Track 3A

Trends in Utility Reliability and Current Codes and Standards for Emergency Power Paul Isaac, PEng., General Manager, H.H. Angus & Associates Ltd., North York ON Kim Spencer, PEng, LEED AP BD+C, General Manager, H.H. Angus & Associates Ltd., North York ON Chris Turnbull, PEng, LEED BC+C, General Manager, H.H. Angus & Associates Ltd., North York ON With increasingly failing electrical infrastructure in many parts of Canada and the lessons learned from the Quebec ice storm, the 2003 eastern seaboard blackout, hurricane Sandy as well as the increasing requirements of CSA Z32 over recent iterations, what is and where should we be with on-site emergency back-up electrical generation for hospitals? A mechanical counterpart of the CSA Z32 is CSA Z317.2 where iterations of this standard require increasingly more mechanical systems and healthcare departments be supported when the utility fails. This presentation will focus on examining trends in the utility reliability, natural and electrical system disasters and historic ability to respond to these event, current codes and standards for emergency power and review some recent recommendations such as the Ontario GOS guidelines. In addition, the presentation will examine how co-generation in healthcare facilities can act as back-up power for the mechanical systems to satisfy CSA Z317.2.

Track 3B

Patient Wandering/Staff Duress Integration Robert Hutton, CET, CEM, Coordinator, Facilities Engineering, St. Joseph’s Health Care London, London ON Review of a new implementation of a patient wandering/staff duress system.

16:00-17:00

“Happy Hour” in Exhibit Hall

18:00 – 19:00 President’s Reception 19:00 – 23:00 Banquet

11:00-13:30

Lunch in the Exhibit Hall

Tuesday September 24, 2013

13:30-14:30 Track 2A

2 CONCURRENT TRACKS – 2A & 2B You Can’t Manage What You Can’t See Roger Holliss, M.Eng., P.Eng., Director Engineering, Redevelopment, Parking, Security, St. Mary’s General Hospital, Kitchener ON Nicole Lobb, Manager, MMM Group Limited, Thornhill ON Hospitals deal with increasingly complex aging buildings, redevelopment projects, and knowledge management. To cope with this, St Mary’s Hospital has developed a unique approach that collates and links virtually all of its information; text, drawings, hard copy and

08:30-09:30 Track 4A

2 CONCURRENT TRACKS – 4A & 4B Taking the Risks Out of Energy Efficient Retrofits Peter Love, President, Energy Services Association of Canada, Toronto ON This presentation will start with a summary of recent studies on the major barriers to improving the energy efficiency of existing buildings, the two more important being availability of capital and lack of understanding/confidence in the technologies. It will then describe the evolution over the past 25 years of Energy Performance Contracts as a way to overcome the financial and technical risks associated with energy

efficiency retrofits. It will then discuss how such contracts are now also being used to finance non-energy deferred maintenance priorities such as roof repair, safety upgrades, etc. It will then summarize on a number of recent successful projects in the health care sector. It will conclude with a more in-depth discussion of one health care project, presented by the facility manager responsible for the project. Track 4B

Learning from the “M” in the DBFM (design, build, finance, maintain) Process Karen Langstaff, BN, MHSc, Chief Planning Offier, St. Joseph’s Healthcare Hamilton, Hamilton ON This presentation will highlight some of the key maintenance components and strategies that are realized as a result of the DBFM model of procurement for a new build, which can also be used to enhance the plant and maintenance departments in existing facilities. Included in the session will be an overview of the paradigm shift in providing facility management services within this framework and how to prepare your facility for a service level agreement philosophy. The process that was undertaken, including defining the scope of services, the specific service standards, and the performance indicators will also be highlighted.

09:30 – 10:30 CHES National Annual General Meeting

Track 6B

10:30 – 11:00 Refreshment Break in the Exhibit Hall 11:00 – 12:00 2 CONCURRENT TRACKS – 5A & 5B Track 5A The Brave New World of Medical Gases: New Services, Licensed Gordon Burrill, Vice-Chair, CSA Technical Committee on Medical Gases; President, Teegor Consulting Inc., Fredericton NB After 37 years of evolutionary change, the 2012 CSA Standard on Medical Gases begins a new era targeted toward education and professionalism. Installers need to be trained and licensed. Operators require training. A preventive maintenance program is mandatory and requires 3 year audits. Healthcare facilities are required to designate a “Qualified Person” to manage and authorize medical gas systems, repairs, maintenance and shutdowns. Track 5B

IAQ, Air Cleaning and Energy Jeff Watcke, IAQCP, Canadian District Sales Leader, Dynamic Air Quality Solutions, Princeton NJ Timo Lucas, PEng., Canadian District Sales Leader, Trane Canada, Victoria BC The demand on energy is only increasing, creating a huge opportunity to reduce energy consumption through new technologies in hospital buildings. IAQ technology can lower operating costs and energy consumption. Adopting energy-efficient design and technologies in HVAC and other areas in new and existing healthcare buildings can cut energy costs by as much as 40 percent. An audience of architects, healthcare facility engineers , construction and project managers, will get an in-depth look at air filtration solutions that can significantly reduce energy consumption while dramatically improving IAQ. Jeff Watcke of Dynamic will also discuss why current systems are running inefficiently and provide insight from installations where indoor air quality has significantly improved due to new technology. Detailing real world examples, such as Dynamic’s installation at ASHRAE Headquarters, and performance data to prove the impact that IAQ technology has on energy efficiency, attendees will discover strategies for reducing fan energy and static pressure. With a focus on industry trends and current market forces, this session will change the way people look at a facility’s energy consumption and air quality.

12:00-14:00 Lunch in the Exhibit Hall - Draw Prizes 14:00-15:00 Track 6A

2 CONCURRENT SESSIONS – 6A & 6B Integrated Project Delivery: Lean Leadership in Saskatchewan Healthcare Tom Atkins, PEng., Vice President, Stantec Consulting, Regina SK John Liguori, Executive Director, Five Hills Health Region

The first section of the presentation will describe the current state of the AEC industry in terms of inefficiencies and other project delivery challenges. It will review the current state of healthcare and identify the eight wastes in this and other production systems. The presentation will identify three strategies for removing waste and provide examples of how those strategies could be implemented. The second part of the presentation will get into the specifics of what we can learn from other industries, particularly from manufacturing and how that might be applied to healthcare and the development of healthcare facilities. It will go on to describe the Integrated Form of Agreement and how this contract form allows for the benefits of Lean philosophies to be integrated into facility development projects. It will focus on key project principles, IPD team behaviors and tools. It will close with a section on proof of concept, providing measured results for two projects that were developed for Sutter Health. The panel discussion will allow the individual team members to provide their perspective on the implementation of this process in the FHHR New Regional Hospital project and to more deeply discuss specific impacts of the Integrated Form of Agreement. It will also allow for questions from the attendees and engage is a conversation with all panel members Lighting Design Considerations for the Healing Environment Maarten Mulder, MSc, LC, Solutions Sales Manager, Acuity Brands Lighting, Vancouver BC) This presentation introduces participants to the fundamentals of lighting design and how that pertains to the shift in design to patient centered design. Using the techniques of evidence based design participants are introduced to the effects of aging and other health considerations related to lighting. Participants are shown specific considerations for patient rooms, nursing stations, surgical suites, radiology, labor & delivery, critical care rooms, labs, common areas, and exterior. Considerations include aspects of illumination levels, directionality, layout, and lighting fixture types appropriate for that space. Attention is also given to new technologies and energy saving techniques within the context of healthcare facilities. The optimized healthcare lighting environment considers the patient experience, caregiver and staff performance and environmental sustainability into a cohesive design.

15:00-15:30

Refreshment Break

15:30-16:30 Track 7

PLENARY SESSION Powering into the Future; Increasing Electrical Safety by Leveraging Mobile Technology Mark Jorgensen, Worker Safety Specialist, Electrical Safety Authority Implementing an Electrical Safety Program, in the field, at the face of work, for the front-line employee, can be a challenging endeavor. Most organizations are resource challenged and tasked with an ever-increasing expectation for improved safety results. ESA has developed a CSA-Z462 compliant mobile application, e-WorkSAFE, that will eliminate the administration associated with an Electrical Safety Program. Using available technology, it is now possible to put the safety information required to perform the task in the hands of the worker, in real time, that is up-to-date and accurate. Providing information with respect to safety requirements, specific equipment characteristics, up-to-date drawings, manufacturers’ recommendations (operating procedures, maintenance requirements, equipment drawings etc) can be leveraged using mobile device applications. While CSA-Z462 provides the basis for electrical safety work practices, a managed electrical safety program also includes other components such as continuous improvement and auditing processes, training and competency management, and tool testing to name a few. Learn how technology can assist in increasing

electrical safety and practical applications with technology.

16:30 – 17:00 Closing Ceremonies

Trade Show 718 615 521 520 612 524 706 501 714 601 703 803 1001 514 723 707 1008/1009 1029/1031 901/903 708 613 631 726 722 519 1020 727 503/505 830 702 902 507 815 801 818 614 506 705 721 500 800 924 622 1003 512 528 1019 1025 807 715 610 819/821 1018

Abatement Technologies Ltd. Abbott’s Acklands Grainger Acuity Brands Lighting “Aerocom Systems, Inc.” Alwind Industries Ltd. Amico Corporation Asco Power Technologies Canada Austco (Canada) Bender Canada Inc. BG Distribution C/S Construction Specialties Camfill Farr (Canada) Carmichael Engineering Carrem Controls Limited CEM Engineering CHEM-Aqua Canada “Chubb Edwards, A UTC Fire & Security Company” Class 1 Inc. Clayton Sales & Service Ltd. Clean Air Solutions Inc. D.H. Jutzi Limited Dafco Filtration Group Delta Controls Direct Energy DMS Medical Gas Systems Inc. Dri-Steem Corporation E.H Price E.I. duPont Canada Company ECNG Energy L.P. Ecosystem EI Solutions Energent Incorporated Energy Services Association of Canada Fluke Electronics Canada LP Follett Corporation Franke Kindred Canada Inc. Freudenberg Non Wovens Garland Canada Inc. Genivar GlassCell Isofab Inc. Grundfos Hilti (Canada) Corporation Honeywell Horton Automatics of Ontario HTS Engineering Ltd IEM Industrial Electrical Mfg. (Canada) Inc. Ingersoll Rand Security Technologies Johnson Controls Johnsonite Kathabar Dehumidification Systems Inc. Klenzoid Company Ltd. MacTech Systems Inc.

925 828 713 930 921 623 621 606 919 900 1006 626 928 711 611 824 518 604 511/513 515 602 701 700

Major Air Systems Ltd. MCW Custom Energy Solutions Ltd. Medcore Services Inc. MediaEdge Communications Inc. Mondo America Inc. MTE Consultants Inc. Natural Resources Canada / Building Division Notifier N-Two Cryogenic Inc. Ontario Tire Stewardship Pall Medical Phoenix Controls Pinder’s Security Products Plan Group PMG Systems Ltd. (Pinkerton Medical gas) Precise Parklink Inc. Preston Phipps Inc. Proactive Hazmat & Environmental Ltd. Qualitair RANA - On-site Gas Systems Rauland-Borg Canada Reliable Controls Corporation “Sapling Company, Inc.”

629 Siemens Canada Ltd. 720 SimplexGrinnell 523/525 “Specified Technologies, Inc.” 620 Steam Specialty Sales 619 Stoncor Group 607 Swisslog 510 The Stevens Company Limited 1000/1002/1004 Thermogenics Inc. 616 Thomson Technology 605 Toromont Cat Power Systems 827 Trane 802 Tremco Canada 504 Tri-Phase Environmental Inc. 918 Troy Life & Fire Safety Ltd. 808/909 Union Gas 712 Ventcare Inc. 717 Victaulic Company of Canada Ltd. 502 Web Work by Tero 600 “West-Com Nurse Call Systems, Inc.” 603 Wilshire Works Inc. 725 Wireless RNA Technology Inc.

Ussher’s Creek Golf Course

CHES ANNUAL 2013 TRADE SHOW & EDUCATION FORUM,

EXHIBITOR PREVIEW

Fulton The Fulton Vantage™ hydronic condensing boiler is a traditional firetube boiler designed for ultra-high efficiency hydronic heating applications. Features include a high-mass vessel with superior duplex steel design, high thermal efficiencies, diverse burner configurations, and state-of-the-art controls. The Vantage is the first condensing boiler to offer operation on #2 oil as a backup fuel, taking advantage of existing fuels in retrofit applications. When #2 oil is selected, the Vantage control system automatically loads the correct fuel profile, simplifying backup fuel switchover requirements. The same simplicity exists for natural gas / propane dual fuel applications. Come see us at booth # 1000/1002/1004

Intelligent Steam Boilers Thermogenics is the leading supplier of boilers to the healthcare industry. We are Canadian manufacturers of coiled tube boilers, blowdown tanks, deaerators and economizers and a proud distributor of Fulton products. Come see us at booth # 1000/1002/1004

At Abbott’s, we strive to improve and maintain air quality in all types of buildings. Or services include the refurbishment of broken or damaged air handling units in facilities across Canada. A proper functioning air handling unit reduces indoor air pollution, provides an improved, cleaner working environment, and reduces possible crosscontamination associated with polluted units—all of which lead to healthier, happier employees.

Engineered to exceed the specifications for a wide variety of Variable Air Volume (VAV) applications, the Reliable Controls® MACH-ProAir™ is a fully programmable BACnet Building Controller (B-BC) with numerous downloadable standard codes and flexible I/O options, all priced to meet a modest budget. Please visit us at booth# 701.

Please visit us at Booth# 615

Healthcare facilities choose Follett more often than any other brand. We offer the largest selection of ice and water dispensers for patient care in the industry as well as a full line of high-performance countertop, under counter and upright refrigerators and freezers for pharmacy, labs, blood banks and more. Come see us at booth #614

With more than a century of experience in safety and security, Ingersoll Rand Security Technologies has products and services that help keep your patients safe and your facility’s costs contained. Visit us at our booth and learn more about our Healthcare Solutions. Come see us at booth # 1025

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

Distributor and fabricator of thermal and acoustical insulation systems; solutions provider for all of your mechanical, architectural, industrial, institutional and commercial needs. Exclusive supplier of TEMA (Thermographic Energy Maintenance Audit).

We provide nationwide 24 hour field service and technical support. Come see us at booth #501

See us at booth #800

26 Canadian Healthcare Facilities

Staying One Step Ahead Advancements in facility flooring

By Gail Nash

What’s underfoot in flooring for healthcare? Quite a lot, actually. Flooring is an important focus of those who are responsible for deciding how to design and furnish environments where healing and care giving take place. So how can flooring play a positive role in the highly vulnerable setting of a healthcare facility? What benefits can it bring? An exploration of what’s happening in this category can help answer these questions. Sound decisions

First and foremost, it's best to narrow this discussion down to soft versus hard surface flooring, due to acoustics. That is, when it comes to hospital settings, the issue of acoustics is emerging as one of the most critical issues for designers and facility managers. A quieter, more soothing and home-like environment can affect how quickly a patient’s health improves. It can also enhance staff performance, thereby improving effectiveness. Carpeting—and even more so, carpet tile—can significantly reduce the normal noise level of a bustling hospital environment. From footsteps and beeping monitors to dropped objects and corridor conversations, it is soft surface flooring that has been shown to more effectively control noise by absorbing airborne sound, minimizing surface noise generation, and reducing impact sound transmission from floor to floor in multistory buildings. This is important, as studies show that a quieter setting can reduce a hospital stay by as much as 15

percent and can also result in 25 percent fewer staff errors. For example, data collected by the Carpet and Rug Institute supports that carpet is an outstanding sound absorptive material. Properly specified carpet/cushion combinations have even been shown to handle the vast majority of sound absorption requirements in architectural spaces (CRI Technical Bulletin; “Acoustical Characteristics of Carpet,” 02/00). What’s more, Interface’s own research shows that a floor covered in carpet tile with an underlayment of a cushioning technology like SmartCells can provide a significantly higher acoustical value than rubber flooring—and five times more than VCT. Stepping up safety

The most obvious value of cushioned underlayment is in improved safety, which, of course, ranks right up there with acoustics and creation of an optimum healing environment. In Canada, fall-related injuries in older adults are a major public health issue. According to a 2009 study released by SMARTRISK, these types of injuries represented the number one cause of injury-related hospitalizations and deaths in Canada, with direct costs in excess of $2 billion annually. Serious injuries, such as hip fractures and traumatic brain injuries are caused by falls in up to 90 percent of cases (Grisso et.al., 1991; Pickett et.al., 2001), and the majority of fall-related injuries in the Summer/été 2013 27

senior population occur in high-risk environments such as residential care facilities, seniors' centres, and hospitals (Cameron et. al., 2010). With such injuries adding to skyrocketing healthcare costs, cushioning technology like SmartCells can not only create aesthetically pleasing interiors for healthcare facilities, but

help to minimize the risk of injuries from falls, and therefore reduce hospital costs. While safety of the patient is a primary concern, it’s equally important to focus on the health of the healthcare worker. Indeed, a challenge the flooring industry regularly faces is the perception that carpet inhibits mobility of hospital beds, gurneys, wheelchairs, carts

and equipment. Some broadloom might; however, a dimensionally stable carpet module like carpet tile will not. Typically, transportation or nursing staff must push a 431 kg load when moving the average patient in a hospital bed. This is one of the contributing factors to back injuries among healthcare staff. Plantar fasciitis is another ailment plaguing the profession--something that is no surprise since nursing staff walk an average of eight kilometres a day on duty. Again, both conditions can be kept in check with a more resilient, anti-fatigue and forgiving floor covering solution such as carpet tile. Resistance to moisture is another feature of note. When properly installed, carpet tiles create a significant moisture barrier that can keep spills and moisture on the face where they can be easily w iped away. Moisture won’t seep through the backing to the flooring substrates or concrete slab where it can lead to damage or, potentially, to harmful microbial growth.

“The most obvious value of cushioned underlayment is in improved safety, which, of course, ranks right up there with acoustics and creation of an optimum healing environment.” 28 Canadian Healthcare Facilities

new plank-like sizes, joining the standard square forms and mixing quite intriguingly with them for dynamic visual effects. The path ahead

The future of healthcare flooring is, indeed, friendly. It's also exciting. On our drawing board are tiles incorporating wayfinding guides using RFID technology and other proprietary innovations. And, perhaps, one of the industry's most exciting breakthroughs is the development of new materials other than petroleum for the yarns used in carpet manufacturing. Thus far, some of those alternative materials include salvaged fishing nets and industrial sludge. Of course, this is only the start. Ask any expert what’s new in flooring in another couple years, and you'll certainly find there will be lots more to report. M&E_CHF_Summer_2013_FINAL.pdf

13-07-25

2:22 PM

Gail Nash is Vice President of Healthcare Strategy for Interface Flooring Systems.

The case for carpet tile

Aside from the acoustic properties and safety virtues, an additional differential that gives tile an edge is its ease of installation. In particular, products like Interface's proprietary glueless tile systems are an excellent, affordable option. No glue means virtually no odour or VOCs. It also means less mess not only when installing, but also when it’s time to reinvent a space and remove the flooring. Scraping off old glue from the subfloor is laborious, whereas carpet tile is easily lifted out and just as easily put in place, saving time and money. Moreover, this flexibility and ease eliminate the need to relocate patients or staff during a renovation or flooring replacement. The adhesive connector squares comprising the installation system also represent a “greener” option than a traditional glue instal lat ion, reducing the over al l environmental footprint of a typical installation by more than 90% and helping Canadian healthcare institutions comply with applicable sustainability standards. Carpet tile is, of course, a relative newcomer in the soft surface segment (less than 50 years since being introduced in North America) but is rapidly graduating to a new level of desirability. New manufacturing technologies that we are pioneering are yielding tiles featuring mixed pile heights that raise the aesthetic appeal. Also of late is the development of

MODERN IDEAS P R O F E S SIO NA L S OLU T ION S Mechanical

Electrical

Energy Audits

- Boilers - Chillers

- Fire Alarm - Generators

- ASHRAE

Summer/été 2013 29

Getting in on the Act

How Ontario’s Green Energy Act can spur long-term energy cost savings

By Catherine Thorn

The steps that healthcare institutions in Ontario take to comply with the province’s Green Energy Act can help them make long-term plans that reduce annual energy costs, manage risk, decrease greenhouse gas (GHG) emissions, and demonstrate their commitment to a more sustainable future. Since organizations now have to allocate resources to meet the Act requirements, it is an opportune time to invest a little more and develop an effective energy management system that will generate and sustain meaningful results. This Act, which applies to publiclyfunded infrastructure in the “MUSH” (Municipal, University, School and Hospital) sector, has two main parts. The first had a deadline of July 1st 2013, requiring institutions to report on their energy consumption through the province’s online portal. While the portal tools guide institutions through the process of entering data to compile their energy and GHG report, it is up to each organization to ensure the quality of their data is sufficient for their purposes and that it is accounted for appropriately.

somewhat more demanding (and rewarding) than the first. It involves preparation of an Energy Conservation and Demand Management Plan, with clear steps to be taken, complete with milestones and deadlines. The plan required by the government focuses on the particular energy projects to be undertaken; however; successful energy planning is strategic in nature and is both a technical and organizational process. The technical part focuses on projects and involves gathering and tracking data over time; engineering and implementing solutions; and measuring and verifying project savings. The organizational element is equally important though, because it is the key to continually achieving energy savings in the long term. This type of sustained savings requires change management and begins with engaging a wide range of stakeholders early in the planning process to gain their buy-in. Part of this approach is planning other aspects of the campus’s development with energy management in mind. For example, when a new building or wing for a healthcare facility is planned,

30 Canadian Healthcare Facilities

The regulation requires energy reporting on facilities for which the following is true: • The facility is owned or leased by the public agency; • Utility bills for the facility are paid by the public agency; and • The facility is heated or cooled, or is related to the treatment or pumping of water or sewage. While institutions might want to only report the minimum required by the government, it can be advantageous at this time to develop, for internal use, a more complete energy profile for the institution. This profile could include energy consumption and demand data for all of the institution’s buildings; submetered data for particular, energyintensive equipment and processes; and other major energy uses, such as fuel consumption of institution-owned vehicles. Understanding its energy profile will enable an institution to identify savings opportunities and demonstrate progress as its energy plan is implemented. The second part of the legislation, with a compliance deadline of July 1st 2014, is

there may be an opportunity for more efficient heating and cooling . If additional chiller capacity is required to provide cooling to the wing, then when the plant is upgraded, a heat recovery system can be installed to use rejected heat from the chillers to preheat domestic hot water. Other conservation opportunities may be specific to a particular process. In a healthcare context, there are often laboratory facilities with fume hoods running at a constant volume, exhausting more air than required. Installing variable frequency drives and a control system to vary the flow according to need can decrease the energy used by the fans and the energy required to condition makeup air. Healthcare institutions may also find that significant energy and cost savings can be achieved with combined heat and power. These units are designed to capture the heat created by power generation equipment so that it can be used for space heating, hot water or other

purposes. They can be a particularly good option for healthcare facilities since they provide a source of backup power during extended blackouts. Regardless of whether combined heat and power in particular is appropriate for a specific facility, energy supply should be included in the planning process. As significant users of energy, healthcare facilities can benefit from considering various procurement options and opportunities to install on-site generation of renewable or alternative energy. In this way, meeting the requirements of Ontario’s Green Energy Act can go well beyond satisfying a legal obligation, to building a better future for the organization. Catherine Thorn (catherine_thorn@golder.com) is an energy management specialist in the Mississauga, Ontario, office of Golder Associates. She advises healthcare and other institutions on energy management issues, including compliance with the Ontario Green Energy Act.

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Enhancing Outcomes Through Energy Performance Contracts Transferring the risks of hospital retrofits with EPCs By Peter Love Hospitals and other public sector organizations across North America have been using performance-based solutions such as Energy Performance Contracts (EPCs) to undertake their energy efficiency upgrades for the last twenty-five years. The federal government has used them since 1992 to attract $320 million in private sector financing to upgrade the energy efficiency of their buildings. Today, these buildings are saving about $43 million less per year. Municipalities, schools, universities and schools (the MUSH sector) across Canada have undertaken similar projects. As these projects were done using an Energy Performance Contract, the technical and financial risks associated with them were successfully transferred to the private sector. Figure 1 (shown right) illustrates how such contracts work. Before the contract, the owner is paying more than they should for their energy use. During the contract, the energy savings realized are used to pay the capital cost of the energy efficiency project. At the end of the contract, the owner pays the reduced energy bills.As the contracted savings are guaranteed by the private energy service company, the technical and financial risks are transferred to the private company. In addition to transferring risk, this type of contract has many advantages over the more traditional fee-based model. In addition to reducing pressure on capital funding allocations, it is a turnkey approach with one contract managing many activities. Based on its 20 years of experience with such contracts, the federal government has concluded that using EPCs are not more 32 Canadian Healthcare Facilities

EPC Funding Model   Budget-Neutral approach to funding Energy Efficiency improvements

expensive than using traditional contracting models with multiple sub-contractors. The potential savings for hospitals is very large. Recent studies have found that energy consumption in hospitals with similar facilities can be more than twice as much as that in the best performing hospitals. EPCs can be structured in many ways to suit the specific needs of the client. Interestingly, it is also used to at least partially address the deferred maintenance backlog faced by many facility managers. In this type of arrangement, the energy savings from the EPC can also be used to fund non-energy deferred maintenance priorities such as roofs, parking areas, etc. This is typically achieved by extending the terms of the EPC contract.

In Ontario, many leading hospitals have used EPCs. Highlights include: • Hamilton Health Sciences: This hospital complex includes five facilities serving more than 2.3 million residents. Their EPC is projected to save $55 million over ten years and was completed without additional funding from the Ontario government. This hospital is on track to become a best practices benchmark. • London Health Sciences: This multiphase project covered 3.5 million sq. ft. of property. Completion of the 5th Phase is expected to reach $3 million in annual savings. One of the campuses has the potential to be relatively energy self-sufficient.

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• The Ottawa Hospital: This hospital sig ned a $17 million, 15-year performance contract that guarantees savings of $2.6 million per year with the savings invested in patient care. • St. Michael’s Hospital: Founded in 1892, a $258,000 EPC transformed a 90,000 sq. ft. building into a “green” facility. It has resulted in reduced energ y consumption as well as improved light levels and space conditions for patients and staff. • Sunnybrook Hospital: Their objective is to reduce their $11 million per year spent on energy by half. The process to select the ESCO was found to be compliant with Broader Public Sector (BPS) guidelines. • Timmins and District Hospital: Following a detailed assessment, major energy components were replaced and enhanced. This project is expected to result in savings of more than $4.2 million over the next eight years. This hospital was the 2009

recipient of the Ontario Hospital A s s o c i a t i o n’s A n n u a l E n e r g y Efficiency Award. Take the worry and risk out of your next energy efficiency upgrade project and investigate the many advantages of using an Energ y Performance Contract. You’ll be glad you did. For more information on Energy Performance Contracts including further background on these and other successful case studies, visit www.energyservicesassociation.ca. Furthermore, the upcoming CHES Conference in Niagara Falls Sept 22-24 is a great opportunity to find out more about the many benefits of using an Energy Performance Contract to retrofit your existing hospital. Peter Love is the President of the Energy Services Association of Canada, who will be speaking and exhibiting at the CHES Conference. He is also an Adjunct Professor at York University’s Faculty of Environmental Studies and was Ontario’s Chief Energy Conservation Officer.

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Preparing for the Impacts of Climate Change How ready is your health care organization? By Kent Waddington, Linda Varangu, Peter Berry, and Jaclyn Paterson Canadaâ&#x20AC;&#x2122;s health care facilities are becoming more vulnerable to the impacts of climate change which can disrupt facility services and care delivery. Extreme weather events (e.g. storms, floods, wildfires, heat waves) can create emergencies by damaging infrastructure, compromising access to critical resources (e.g. medical supplies and equipment, transportation, food, water) and threatening the safety of patients, visitors and staff. Climate change also increases risks to Canadians from some vector-, water- and food-borne diseases and it is expected to worsen air quality in many communities. Taken together, impacts on health from these climate-related hazards can have significant implications for demand on health care facility services. 34 Canadian Healthcare Facilities

The World Health Organization has called on decision-makers to prepare for climate change impacts through efforts to increase resiliency in the health sector. This entails mainstreaming climate change into risk assessments, considering climate change when developing plans and programs and engaging in broader community discussions and initiatives around climate-related issues. For example, health care and public health officials can prepare by assessing risks from extreme weather events, increasing readiness to manage climate-related infectious disease outbreaks or atypical cases and increasing understanding of how gradual shifts in weather can affect institutional risk profile. We have only to look to the southern Alberta for tangible evidence of what can

happen when an extreme weather event strikes. Several hospitals and tertiary care facilities were shut down due to the flooding in late June, 2013 in and around Calgary. Alberta Health Services closed the hospital in High River and ordered an evacuation; minor injury nursing services were offered at the fire hall. Surgery schedules had to be scaled back and many elective surgeries were cancelled. Residents from a number of area facilities were transferred to safer, operational sites until the hospital was able to reopen. In all, it appears over 100,000 Albertans were forced from their homes due to the flooding and three residents of High River lost their lives. It was reported by the Canadian Press that the Canmore hospital was entirely surrounded by a moat and the basement

had flooded, putting an end to all food service from the kitchen which was located in the basement. Health care facilities can reduce risks of climate change through proper planning by staff and through careful management of critical resources during extreme weather events and disasters. A resilient health care facility also commits to sustainable practices, such as water and energy conservation, and promotes active transportation, and local food procurement. By investing in such activities, organizations can reduce operating costs and increase resilience in the broader community. To help health organizations evaluate their preparedness and become more resilient to climaterelated risks, the Canadian Coalition for Green Health Care, together with Climate Change Nova Scotia and Health Canada, developed the “Health Care Facility Climate Change Resiliency Toolkit” which includes three components: a resiliency assessment checklist, a facilitator’s guide and an information resource guide. Assessment Checklist (PDF) - The Assessment Checklist includes questions to measure resiliency in many organizational areas including emergency management, facilities management, health care services and supply chain management. Completion of the checklist by officials with information and experience in these areas can identify gaps in preparedness and inform resiliency activities to reduce climate change risks. For more information, click www.greenhealthcare.ca/climateresilienthealthcare/ CCGHC-HealthCareFacility ResiliencyChecklist.pdf Facilitator’s Guide (PowerPoint®) - The Facilitator’s Guide is an electronic presentation for hospital officials leading the assessment which can be tailored to the specific needs of their health care facilities. It provides instructions for conducting the resiliency assessment and can be used to engage facility officials, promote discussion around questions and results, and capture information. For more infor mation, click www.g reenhealthcare.ca/ climateresilienthealthcare/CCGHC- ResiliencyToolkitFacilitatorPresentation.ppt Resource Guide (PDF) - The Resource Guide provides a listing of resources for those seeking more information about climate change impacts on the health services sector and adaptation options to increase resiliency. It provides resource summaries along with references for a wide range of publications and reports on topics such as emergency management, supply chain management, health services, facilities management and infrastructure. For more infor mation, click www.g reenhealthcare.ca/ climateresilienthealthcare/CCGHCResiliencyResourceGuide.pdf

The Assessment Checklist was developed using information obtained from an international literature review and input from an advisory committee of Canadian health care executives, facility managers and engineers, and climate change impacts and adaptation experts. It was designed for use by officials within the health care setting to obtain data on current efforts to prepare for climate change impacts. The checklist questions are based upon key indicators of resilience and respond to the needs of specific health care facilities. To ensure the checklist was formatted and presented so that it could be completed by officials with expert and practical knowledge relating to different aspects of health care facility functioning, a draft version of the checklist was piloted in six Canadian facilities including St. Mar tha's Hospital (Antigonish, NS), Soldiers Memorial Hospital (Kentville, NS), the Queen Elizabeth II Hospital (Halifax, NS), Aberdeen Hospital (New Glasgow, NS), the Ottawa Hospital (Ottawa, ON) and the Stonewall and District Hospital and Health Centre (Stonewall, MB). “Participating as a pilot site has been an invaluable experience for our team,” said David MacKenzie, VP – Operations with the Guysborough Antigonish Strait Health Authority. “The toolkit challenged how we are planning for events and with the recent experience of Sandy in New Jersey and New York, reinforced our conviction in these strategies. Ext reme weather e vents are happening more frequently and can be catastrophic for communities that don’t understand or prepare appropriately.” Support for the initiative was also received from the CHES Maritime Chapter. Representative Robert Barss (Manager, Facility Services, South Shore District Health Authority) speaks on their behalf. “As the managers of health care’s infrastructure, CHES Maritime was excited to help the Coalition and its partners develop the assessment tool and explore opportunities to make our hospitals more resilient and more sustainable in the face of growing climate change and worsening climactic incidents. It is incumbent upon us to be as prepared as possible and to be ready to deliver the best possible patient care from a safe and functional healing facility during times of disaster.” Some health care facilities have already begun to factor climate change into their strategic planning and are making strides in effor ts to increase resiliency. The Ottawa Hospital - A few years ago, the Ottawa Hospital (TOH) had an incident where a sprinkler main line in a service tunnel ruptured and water Summer/été 2013 35

Environmental extremes forced staff at the Regina Qu’Appelle Health Region to rethink how they controlled humidity during periods of high summer temperatures. Upgrading cooling towers helped improve the indoor environment and reduced the incidents of unplanned disruptions to operating room schedules.

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began to fill the tunnel, rapidly encroaching upon the room housing their back-up emergency generator and main electrical distribution system. The City of Ottawa repair crew was able to stop the leak and restore service just short of the water breaching the doors to the emergency generator set, which, if it had, would have resulted in the loss of emergency power to 17 operating suites, curtailed emergency provision of water and sewer services to two million square feet of building space, and the shutdown of HVAC service for 100% of the campus. Patient care would have been seriously impacted by a forced shutdown of all power. This incident got TOH engineering staff thinking about the far-reaching implications of the loss of emergency power and their preparedness for other serious disaster response necessities, and was a catalyst for the rethinking of future generator placement. “About the time we began discussions on replacing emergency generators at our Civic campus,” says TOH Director of Engineering & Operations Brock Marshall, I had attended a conference where one of the speakers presented on the impacts Hurricane Katrina had on his hospital in New Orleans. Their generators were in a bunker twenty-one feet above sea level. When Katrina hit, all he could see were the exhaust stacks poking out above the water. The net effect was complete evacuation of the building. Our new generators are now housed on the third floor of their powerhouse, well above any anticipated flooding threat.” Regina Qu’Appelle Health Region (RQHR) “Here in Saskatchewan, during the summer months we histor ical ly have one or two p er iods of hig h temperatures coupled with high humidity each year,” reports RQHR’s Energy Centres Manager Peter Whiteman. “Howe ver, these o ccur rences were generally short-lived; usually lasting no more than a day or two, and our building could ride through them without developing any significant adverse reactions. Unfortunately, these events now have a tendency to last much longer.” During the summer of 2007, however, RQHR experienced a period of ten consecutive days with the humidity index rating exceeding 45 degrees Celsius. These environmental extremes created uncontrolled humidity conditions throughout RQHR facilities and Whiteman and his team had to shut down all operating rooms except for the most life-critical cases. To safeguard against future unplanned disruptions, RQHR upgraded and added cooling towers, replaced the cooling coils in many HVAC systems and added additional building automation controls to monitor and control humidity in real time to maintain the humidity within acceptable ranges. For the most part, RQHR’s OR HVAC systems were designed for 100% outside air, which was the norm back in the mid-eighties. Medical, environmental and technical advancements since then have significantly

The Nanaimo Regional General Hospital includes extensive use of day lighting and natural light which helps decrease reliance on electricity. Research also shows natural lighting helps improve patient outcomes, and reduces staff stress.

altered how these critical care areas are ventilated and controlled. Mixed air or return air systems can significantly reduce operating costs and improve indoor environmental conditions. “We would have much preferred incorporating these

modifications into our facilities years ago, however, the spatial and resource limitations just didn’t allow for it at the time,” says Whiteman who would l i ke to s e e hu m i d i t y con d i t i on s monitored, recorded and reported in critical care areas by the building

automation system (BAS) with the ability to alarm and modulate control within the desired range. “Subsequently, we designed a BAS to automatically take control of the room temperature setting during p e r i o d s o f e x c e s s h u m i d i t y,

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automatically increasing the spatial temperatures and reducing the relative humidity (RH). Generally speaking, for ever y degree of temperature rise we see a corresponding decrease of 5% RH.” “While we’ve made significant gains with our facilities environmental controls, they are not perfect; we can always do better. Safety over comfort always,” declares Whiteman. Once t h e te a m co m m u n i c a te d throughout the organization that the environmental extremes were beyond the facilities’ original design limitations, everyone came onside to design and develop solutions that enabled building operators to maintain the indoor environment within acceptable standards. In terms of justifying the cost of the changes, Whiteman says “leadership in health care isn’t restricted to doing things right; it’s also about doing the right things. Management was ver y supportive once they understood how climate change was impacting our ability to deliver quality health care.”

Nanaimo Regional General Hospital Emergency Services, Psychiatric Emergency Services and Psychiatric Intensive Care Unit (NRGH ED) Opened in 2012, the Nanaimo Regional General Hospital is a 247-bed facility serving central Vancouver Island’s 160,000 residents and serves also as a referral hospital for an additional 400,000 BC residents. The original hospital building was constructed in the 1960s and has undergone numerous additions and renovations over the years to meet the growing demands of the central island. The NRGH Emergency Depar tment addition provided additional floor area (6,200 m2) and improved functionality for one of the busiest e m e r g e n c y ro o m s o n Va n co uve r Island (53,000 visits per year). Vancouver Island Health Authority (Island Health), and all public sector organizations in British Columbia, were legislated to be carbon neutral by 2010. New buildings must be a minimum of LEED Gold and Island Health wanted to minimize

greenhouse gas emissions with this new building. The designers provided many features that have the co-benefit of mitigating risk in the event of extreme weather. 1. To r e d u c e e n e r g y u s e a n d co n co m i t a n t G H G e m i s s i o n s , building design includes use of displacement ventilation, wood products with lower associated GHG emissions, solar shading, ext r a ro o f i n s u l a t i o n , a h e a t recovery chiller and a subterranean labyrinth for heat storage. During daylight hours, for example, the majority of the building operates with very little artificial light compared to the old Emergency Department which had no natural light. 2. Designers provided day lighting in most areas in the building (even in the t r auma ro om) as we l l as operable windows to allow natural ventilation. 3. The building’s dedicated heat recovery chiller provides preheat for the domestic hot water and

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heating when required by exterior zones. This system is 100% backed up by the main hospital’s existing plant. 4. Design and technology in accordance with LEED Gold and BC Hydro New Construction Standard 5. The building energy performance index (BEPI) is 524 kWh/m2/yr and an annual savings of 939 GJ gas; 1,071,892 kWh electricity and a 39 kW demand reduction for a total annual savings: $59,815. Province of Manitoba - Office of Disaster Management (ODM) - The Prov ince of Manitoba’s Office of Disaster Management’s recently created a Hazard Risk Vulnerability Analysis Tool (HRVA) which embraces the scope of disaster management from a climate change perspective. Developed with f i n a n c i a l a s s i s t a n ce f ro m He a l t h Canada, the tool provides heavier weighting on natural hazards to better prepare the health system and the communities it serves towards climate change and resiliency. During the initial test rollout of the initiative, it was discovered that many in the province were not as comfortable in the knowledge around climate change and its impacts on health care facilities, so the project team took this knowledge and used it to better enhance emergency preparedness for the health sector. This now enabled ODM to advance a greater level of resiliency with respect to natural hazards and how they could be managed or mitigated. According to the project lead, Robert Munro, Disaster Management Specialist with Manitoba Health, “The tool is unique in that it is web-based and contains links to several websites, including Statistics Canada, Environment Canada, and the Inter-Governmental Panel on climate Change (IPCC), thereby permitting users to search for information by specific geographic area. In addition, it contains links to specific disaster information related to key hazards such as flooding, wildfires, drought, and disease outbreaks.” The HRVA tool also includes a lengthy glossary to help clarify terminology for all users. For more information on Manitoba’s HRVA, contact Rober t Munro at robert.munro@gov.mb.ca.

To learn more about how you can help your health care organization prepare for the impacts of climate change, v isit www.greenhealthcare.ca/ climateresilienthealthcare. The Canadian Coalition for Green Health Care is Canada’s premier green health care resource network; a national voice and catalyst for environmental change. www.greenhealthcare.ca Kent Waddington is Communications Director with the, Canadian Coalition for Green Health Care Linda Varangu, Executive Director, Canadian Coalition for Green Health Care Peter Berry, Senior Policy Analyst, Health Canada Jaclyn Paterson, Environmental Health Specialist, Health Canada

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