VOL 36
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JUNE 2013
the australian
engineer HOSPITAL S
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IHEA National Board of Directors National President Mitch Cadden (State Elected – NSW/ACT) National Immediate Past President Daryl Pitcher National Vice President Darren Green (Nationally Elected) National Treasurer Peter Easson (State Elected – WA) National Secretary Scott Wells (State Elected – QLD) 2013 National Conference Coordinator Brett Petherbridge (Nationally Elected) Membership Registrar Alex Mair (Nationally Elected) Standards Coordinator Trevor Sheldon(State Elected SA) Asset Mark Coordinator Mark Stokoe (Nationally Elected) CHCFM Coordinator Mark Turnham (State Elected Vic/Tas) Chief Executive Officer Jim Cozens Secretariat/Website Administrator Heidi Moon Finance/Membership Lynden Smith Editorial Committee Mitch Cadden, Daryl Pitcher, Scott Wells IHEA Mission Statement To support members and industry stakeholders to achieve best practice health engineering in sustainable public and private healthcare sectors. Adbourne Publishing 18/69 Acacia Road Ferntree Gully, VIC 3156 PO Box 735, Belgrave, VIC 3160 www.adbourne.com ADVERTISING Melbourne: Neil Muir T: (03) 9758 1433 F: (03) 9758 1432 E: neil@adbourne.com Adelaide: Robert Spowart T: 0488 390 039 E: robert@adbourne.com PRODUCTION Emily Wallis T: (03) 9758 1436 E: production@adbourne.com Administration Robyn Fantin T: (03) 9758 1431 E: admin@adbourne.com Marketing Tania Lamanna T: (03) 9500 0285 E: tlamanna@bigpond.net.au
CONTENTS
BRANCH NEWS
5
Message from the President
7
Message from the CEO
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South Australia
10 Western Australia 12 NSW/ACT 14 Queensland 16 Victoria/Tasmania
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TECHNICAL PAPERS
18 Central Sterilising Supply Department 25 Airborne Killers 32 From Steam to Nanotechnology 39 Digital Technical Document Control 43 Powering Patient Safety 46 Meaningful Alarms
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56 Planning and Design for Hospitals Belongs to Lean Equation 58 UVC lights the way to improved healthcare and reduced costs
INTERNATIONAL
61 Waste Management in India 62 What does Climate Change have to do with Health Care?
TOPICS OF INTEREST
64 Let’s keep it Simple
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69 Nurturing a Hospital Engineer
PRODUCT NEWS
73 Product news
73 Adbourne Publishing cannot ensure that the advertisers appearing in The Hotel Engineer comply absolutely with the Trades Practices Act and other consumer legislation. The responsibility is therefore on the person, company or advertising agency submitting the advertisement(s) for publication. Adbourne Publishing reserves the right to refuse any advertisement without stating the reason. No responsibility is accepted for incorrect information contained in advertisements or editorial. The editor reserves the right to edit, abridge or otherwise alter articles for publication. All original material produced in this magazine remains the property of the publisher and cannot be reproduced without authority. The views of the contributors and all submitted editorial are the author’s views and are not necessarily those of the publisher.
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TECHNICAL PAPERS
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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
PRESIDENTS REPORT
Message from the President
A
belated welcome to the 2013 year to our members, as you have noticed the journal is a little later than usual for the start of this year. As always many things are happening behind the scenes which are not always obvious and I would like to thank the National Board and especially to our new Chief Executive Officer, Jim Cozens for really committing to making this edition happen despite starting from scratch. As you have previously been made aware in our E-Bulletin publication we have a new CEO on board – Jim Cozens. Jim will be a familiar face to many of you as a work colleague, professional contact or personal friend. It is very satisfying for me and the National Board to have the opportunity to appoint Jim to the position given his years of experience and dedication to the industry. Look out for Jim’s first journal column within this edition of the journal. Everything has been put in place for a great year for the IHEA, here’s a list of what’s currently on the boil; • The National Conference in Sydney is coming together, if you haven’t already put it in your calendar for a “must do”
for this year what are you waiting for – do it now! • Individual State Conferences are in planning, watch out for more on this in future E-Bulletins • Asset Mark our benchmarking tool is currently under significant redevelopment and will be offered as an online system in 2013 • New Professional Development Partnerships are being grown • 2013 State Award nominations will be out in the mail soon • Our ANZEX Delegate has been nominated for 2013 – look out for the 2012 report from Roy Aitken in this edition of the journal • A review of our Constitution and Rules is coming together for circulation to members in the coming months • Planning for a Member Survey to inform our next 3 year Strategic Direction will also be circulated to members in the coming months I look forward to catching up with as many members as I can through 2013. Best Regards, Mitch Cadden IHEA National President
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CEO’s REPORT
Message from the CEO
I
firstly wish to thank the Board for affording me the opportunity to be again associated with the IHEA and on this occasion as the CEO of an organisation that has and continues to meet the needs of its members. Personal association with the IHEA is to the order of 42 years. During this time significant change has been experienced across the health sector relative to the way in which health services are structured. The major change in this regard has witnessed the establishment of area health services, the impact of which on the role and responsibilities of hospital engineers has broadened. The prime focus in this context is an increasing responsibility span necessitating closer attention to management integration across a range of campuses requiring sustainable operating efficiency, statutory compliance, client department satisfaction and budgetary control. Considering the complexities associated with the role of Members in hospitals and other health agencies the IHEA will continue to support engineering personnel through the respective state and national professional development programs conducted by IHEA. Current year inputs are proposed from government regulatory agencies, state health departments, and kindred industry and health associations. The pinnacle event for the current year is the National Conference being held in Sydney between the 9th and 12th of October.
Members are encouraged to participate as time and resources permit in IHEA Professional Development Programs as the benefits are considerable. They are designed to better equip hospital engineers to meet the regulatory and technical challenges of ensuring the clinical safety, efficiency and sustainability of the facilities from which health services are delivered. From my position I look forward to the challenges involved and being committed to ensuring that the Institute is an effective Member support association. In this regard I wish to adopt a closer collaborative working relationship with State Branches to generate positive outcomes of a number of projects that the National Board has in place. The most relevant and important currently of these is to gain acceptance by the health sector of an online Asset Mark scheduled for launching in the last quarter of the year. It is envisaged that Asset Mark will become the prime source of benchmarking data associated with agency facilities management accreditation. A further project is to increase member participation in the Certified Health Care Facilities Management (CHCFM). These initiatives will be well publicised and member supports provided to assist members become more familiar with both facets and for them to enlighten senior management of the benefits that will accrue to participating agencies and to them. Regards Jim Cozens Chief Executive Officer
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BRANCH NEWS
South Australia
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he focus of the activities of the SA Branch committee during the first quarter of 2013 has been on the development of a program of professional development (PD) activities. The first PD session for 2013 will be held on 12 April and will provide presentations on structured cabling and the implementation of the new Work Health & Safety legislation. It promises to be a valuable event for our members in healthcare and aged care, as well as our corporate members. In addition, we have provided members with access to a number of workshops and presentations provided by a range of corporate suppliers, service providers and other membership organisations and these have been appreciated by those members who took the time to attend. These sessions have provided an opportunity for members to hear about the latest developments in such diverse subjects as management of infection control during construction works, medical lighting technologies, chiller technology and corrosion in hot water systems. Planning is continuing for further PD events throughout the rest of the year and has such sessions as a briefing/visit to the New Royal Adelaide Hospital prototype rooms, updates on hydraulic products and equipment, working at heights seminars, FM benchmarking and more general management topics on our radar. We are aiming to establish a dynamic, rolling program, which is continually enhanced and updated as new topics and opportunities present themselves. As part of this refreshed approach to PD, and as a small branch with limited membership and very busy Branch
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Committee members, the SA Branch Committee is following with interest the discussions at the national level about opportunities to access professional event organisation resources to assist us to identify, plan and implement ongoing PD events. It is a critical time for the SA Branch of IHEA. As the Across Government Facilities Management Arrangements are rolled out across the public health sites in SA, there have been impacts on much of our traditional membership base but these changes also create opportunities to involve the new FM service providers in our association. Accordingly, I would like to take this opportunity to encourage all of our SA members to consider what opportunities are out there to attract new members, both corporate and individual, to our Branch. It is understood that the issue of increasing membership is a bit of a “chicken and egg” argument. It is likely to be the case that, if we can provide improved professional development forums and other social opportunities for networking between like-minded individuals, we will attract new members – which, in turn, will generate even more and better PD events. A larger membership base will provide improved networking opportunities, greater access to developmental opportunities and an increased ability to influence the directions of facilities management and healthcare engineering within SA. If you have some ideas about possible new members, or improved ways to attract new members, both the Secretary, John Jenner and I would be very pleased to hear these.
THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
Finally, I would like to take the opportunity to acknowledge the long-standing service of one of the stalwarts of the IHEA in SA. Chris Ford has been a great asset to IHEA in South Australia providing great service and performing a number of roles for us. Both Chris and his wife, Ali, after years of serving the interests of the health care system by providing hospital engineering services to the Flinders Medical Centre, are now clients of the healthcare system as they battle significant medical conditions. The SA Branch wishes them well and looks forward to the most positive outcome from their respective treatments. To borrow an analogy often used by Ali, I am sure they would both welcome the thoughts and support of the wider IHEA community to help them “paddle their canoes” as they chart their way up the treatment “river”. As a reminder, the SA Branch Committee is as follows: President: Peter Footner Vice President: Trevor Sheldon Secretary: John Jenner Treasurer: Chris Ford National Council rep: Trevor Sheldon Committee Members:
Darryl Pitcher Mike Ellis Keith Evans Sam Martin Mick Ziersch Peter Garncarz
Members should feel free to contact any member of the Branch Committee on any matter of interest to them and the rest of the membership group. Regards Peter Footner SA State President
TECHNICAL PAPERS
THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
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BRANCH NEWS
Western Australia Branch Meetings Summer/Autumn 2013
T
he February branch meeting kick started the branch meetings for the 2013 calendar year with members heading East of Perth to Swan Kalamunda Districts Hospital in Midland and hosted by Mr Colin Hartridge Campus Facilities Manager. A presentation was provided by “Soft Logic” on the remote wireless monitoring of fridge alarms and energy metering.
and presentations were provided by “EnerNoc” Electrical Peak who provide financial incentives to hospital campus when called on to peak lop electrical load and, also “hExeis” who presented an overview on electrical metering management.
2013 Annual WA Country Conference – Albany 7-8 June 2013
The March branch meeting the members headed south to the City of Fremantle with the meeting held at Fremantle Hospital and the host being Mr Rob Arnison Manager Engineering Services. A presentation was presented by Schneider Electrical on new product ranges from their Building Management Controls. There were a few new faces as visitors at the meeting – potential members in the making.
The annual state country conference has now been rescheduled to Friday & Saturday 7-8 June 2013 and the Host Andy Smyth is running with the theme “Are we there Yet”. The conference will commence with a welcome function on the Friday evening, conference on the Saturday morning with a tour of the new hospital in the afternoon, finishing of with an evening meal function on the Saturday evening for members and partners. Andy is looking forward to providing a warm welcome to all who make the trip to Albany for the conference.
The April branch meeting was held at Princess Margaret Hospital in Subiaco with a very good turn out of members. The host was Mr Shaun Ensor Campus Facilities Manager
WA State Conference – Friday 13 September 2013
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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
The IHEA WA branch Committee of Management (CoM) is actively organising the Annual WA State Conference to be held at the Pan Pacific Hotel in Perth on Friday 13 September 2013. This is a must attend for all members and non members associated with the Hospital and Healthcare Facilities. The branch is now calling for submissions of papers from prospective presenters with further details to be announced. The theme for the conference is “Technology in Health Today”
Branch Annual Achievement Awards The branch CoM is also calling for nominations for the Annual Achievements Awards with winners announced at the annual state conference. These achievement awards were launched by the CoM last year 2012 and proved successful with the wining recipients receiving complementary attendance at the state conference and a cash prize of $250. Achievement awards are available this in three categories being, Apprentice of the Year, Trades Person of the Year and Hospital Facilities Manager/ Engineer of the Year. All WA members are encouraged to nominate suitable candidates to the branch secretary for consideration. Nominations close end of June 2013. The categories of apprentice and trades person of the year extends to personnel who when working with eligible contractors carry out a significant proportion of their working time on hospital and healthcare campuses. Regards John Doherty IHEA WA State President
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BRANCH NEWS
NSW/ACT It’s hard to believe that we have now moved into the last quarter (4Q) of the 2012/13 cycle and we are all commencing work around end of financial closures and preparation of 2013/14 budgets. Local Health Districts are also labouring away as they compile their Asset Strategic Plans (ASP) due for submission to NSW Health by 30 June. The new NSW Health and Local Health District structures are now all but ‘bedded down’ with our staff managing core Asset Management business. The rollout of the new Electronic NSW Health Asset and Facilities Management System (Tririga) continues and indicative timeframes target Q4 2014 as the likely completion date for implementation.
ACT Government – Health Directorate
Name
Position
Phone
Darren Green
President
0418 238 062
darren.green@gsahs.health.nsw.gov.au
Peter Lloyd
Vice President
0428 699 112
peter.lloyd@gsahs.health.nsw.gov.au
Peter Allen
Secretary
0408 869 953
peter.allen@hnehealth.nsw.gov.au
Mal Allen
Treasurer
0467 761 867
mal.allen@hnehealth.nsw.gov.au
Steve Dewar
Member
0428 119 421
steve.dewar@gsahs.health.nsw.gov.au
Helmut Blarr
Member
0411 152 898
helmut.blarr@sswahs.nsw.gov.au
John Wilson
Member
Brett Petherbridge
Member
0418 683 559
brett.petherbridge@act.gov.au
The HIP provides the basis for building a sustainable and modern health system to ensure the safety, availability and viability of quality health care in the ACT. It addresses some immediate demands and others that will emerge in the future.
Merv Payne
Member
0477 712 883
mervyn.payne@sswahs.nsw.gov.au
Glen Hadfield
Member
0409 780 228
glen.hadfield@swahs.health.nsw.gov.au
Mitchell Cadden
Member
0408 228 419
mcadden@thincprojects.com
Trevor Stonham
Member
0414 899 363
trevor@sah.org.au
To date, new buildings have incorporated many environmentally sustainable design principles such as: energy efficient lighting systems; fresh air ventilation; air-cooled chillers, as opposed to watercooled chillers; in-slab heating; cyclist facilities for sustainable transport; and storm water retention tanks which retain captured water used for irrigating the landscaped areas.
Rob Bampton
Member
(02) 6205 9495
robert.bampton@act.gov.au
The Health Directorate is committed to creating a health system that is able to meet future demand, and has therefore embarked upon the single largest capital works project undertaken in the ACT Government’s history. Currently known as the Health Infrastructure Program – or HIP – the program involves the overhaul and expansion of all aspects of the ACT Government Health Directorate system.
Energy Saving Initiatives As reported in my last report the Audit Office of NSW is currently undertaking a Performance Audit on “Building energy use in public hospitals” and the IHEA
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jfw006@yahoo.com.au
The NSW/ACT Branch – Committee of Management (CoM)
was a participant in the audit process. The outcome from this review will be delivered via a report to be tabled in Parliament this month. The IHEA is looking forward to the results of this work and will keep you as members fully informed of the outcome.
Members Communications I would like to again remind all members that the state CoM and National Board will continue to make every endeavour through various professional development
THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
forums, correspondence and the IHEA Website to maintain current member’s records. Ultimately it is you the member, who can best help in keeping your records accurate, please visit our website and check and amend your records as required. Members should be receiving regular communiqués via emails, E-Bulletins, postal notices, journals and are the NSW/ACT CoM would encourage member to provide feedback for any issues or concerns you might have. http://www.ihea.org.au/
BRANCH NEWS
Bert Anderson receiving his award from Bradley Clyde State Sales Manager of Programmed Property Services Award Sponsor and nominator Peter Lloyd.
The NSW/ACT Branch and National Board encourage all members to provide feedback and information relating to member’s activity, achievements and any important news to share please contact one of the branch CoM if you need any assistance with this or any branch issues.
2013 Annual Conference – Sydney The 2013 IHEA Healthcare Facilities Management conference will be held from the 9-12 October 2013 at Sheraton on the Park, Sydney. The conference theme “Planning the Future” has been selected with the intent of broaching the following topics: • What’s new in your space; • Future Developments; • Strategic Directions; • Strategic Planning; • Health Facility Planning (Design Cycles);
NSW/ACT State Achievement Awards The 2012 Annual NSW/Act Branch Award Ceremony, General Branch Meeting and luncheon was held Friday 30 November 2012, at the Sydney Adventist Hospital (SAN) Wahroonga. It was with Great Pleasure we announced the winners for 2012 were in attendance to receive their prizes. Congratulations to the 2012 winners of the awards and many thanks to our long term partner and Awards Sponsor Programmed Property Services (PPS): Engineer of the Year Ron Fulwood, District Service Engineer – Liverpool Hospital, South Western Sydney Local Health District Asset/Facility Manager of the Year Maurie Pearl, Engineering & Building Services Manager – Mater Hospital Sydney, St Vincent’s and Mater Health Sydney.
• ICT – how this affects infrastructure planning and “future proofing”; • Technology Road mapping; • Looking to the Future; and • Planning for the Future. In 2013, the Conference Dinner will be held on the Starship Sydney, Australia’s largest and most contemporary glass cruise boat, giving all guests panoramic uninterrupted views of the harbour. Set over 3 separate levels with 3m high floor to ceiling glass and an open air top deck, Starship Sydney offers guests a unique entertaining experience. For more information please visit www.HFMC2013.org.au
Importantly the 2013 NSW/ACT Branch Awards have been brought forward this year to both align to the Annual General Meeting (AGM) and align with the new National Award format which is now planned to commence in 2014. The Award Invitations went out this month and we are again hoping for healthy competition in the respective categories. This year the Annual Awards will be held in Goulburn and the days event will include the Branch AGM, General Meeting, Annual Achievement Award presentation ceremony and site inspection and technical tour of the Goulburn base hospital.
Maurie Pearl Receiving his Award from Bradley Clyde State Sales Manager of Programmed Property Services Award Sponsor and nominator Owen Judge.
Maint Supervisor/ Tradesman of the Year Robert ‘Bert’ Anderson, A/Maintenance Supervisor – Corowa Hospital. Murrumbidgee Local Health District.
Darren Green Branch President presenting Sydney Adventist Hospital Chief Executive Officer Dr Leon Clarke a small gift of appreciation for hosting the Awards.
Summary In closing the NSW/ACT Branch is working towards organising the AGM, Annual Achievement Awards and 2013 National Conference and I look forward to working closely with the organising committee and the CoM leading up to these events. I hope that all members have the opportunity to participate in these events and would encourage any new or potential members to come along and embrace Branch activity. On behalf of the CoM I would also like to welcome Jim Cozens to the position of CEO and we look forward to working with Jim into the future. Regards Darren Green M.I.H.E.A., C.H.C.F.M. IHEA NSW/ACT Branch President National Vice President
THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
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BRANCH NEWS
Queensland
T
he last quarter has been fairly quiet after the Race meeting in Toowoomba. There has been one Thursday afternoon session on Fire protection. Arup presented some background information on the current standards and how we might be able to comply and Brooks Fire presented and demonstrated their new Fire Alarm Panel. We have welcomed a few new members, but with State Government pressures life has been a little slow in the Sunshine State. Several of our members have moved and some have retired or are looking at new ventures following redundancy.
Planning for the mid year conference and AGM is now well underway and the event will be held at Victoria Park Golf Course on 25/26th July. This year marks 40 years of the IHEA in Queensland and the theme of the conference is Technology in Hospitals over 40 Years. Topics will include a mix of history and new material with a couple of good technical sessions to finish.
E Regards Alex Mair QLD State Vice President
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BRANCH NEWS
Victoria/Tasmania The past three months have been very hectic within our industry not just for Victoria/ Tasmania but all branches with the funding cuts. This has seen the usual staff reductions and bed closures associated with funding cuts. But our members are resilient and just getting on with the job.
C
hristmas passed some time ago but the social gathering for the branch occurred on the 30th November 2012 and a good night was had by all. The major award ‘Victorian/Tasmanian Engineer of the Year’ went to Bruce Gilpin for a long and productive tenure in the industry and application of his knowledge and skills, a well-deserved award, congratulations.
Terry Lindsey has announced his retirement from West Gippsland Hospital on the 20th March and will move to the retired member status in the IHEA. We wish Terry all the very best in his future life whatever it may bring.
Welcome to our newest members, Roland Pryce, Tony Azevedo, and A.G. & G. Services. We welcome our new members to the branch and they are encouraged to participate in all branch functions especially our professional development program.
Ray Bennett has also announced his retirement from the National Board and we thank him for his representation for our industry.
The next Vic/Tas branch professional development day will take place on Friday 3rd May 2013 at the Department of Health, Room 1.03, 50 Lonsdale Street, Melbourne. All IHEA members,
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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
BRANCH NEWS not just Victorian, are welcome to attend these PDs at no charge, the title for this PD is ‘Programs and Initiatives’. Presentations include: Strategic Asset Management, Energy and Water Programs, Mental Health Program Facilities, Asset Assessment Toolkit and Revaluation, Asset Management Plans and DHSV presentation.
Vic/Tas branch report – PD1 The Vic/Tas branch’s first professional development seminar for the year 2013, Horsham Professional Development day was held at the Victorian Institute for Dryland Agriculture with 20 people attending to enjoy a great day out with an unusual agenda. Guest speakers included: • Peter Jackson, Manager, Wimmera Mallee Pipeline; “Local Water Projects”
• Peter Crammond, Engineer, Wimmera Health Care Group; “Pre-vac Sterilisation”
were staggering when this project was completed in just three years instead of the programmed ten years, with real cost savings and the amount of water used by GWM with planned growth reduced to 30% of existing consumption.
• Brett Benz, National Sales Manager, Atherton; “Current & Future Trends” • Barry Hopper, Director, CHS Group; “Sponsor of the day” • David Fogerty, CAN Operating Theatre, Wimmera Health Care Group; “Proposed Changes to AS 4187”. • Kevin Asplin, Engineer, West Wimmera Health Care Group; “Case Study LED Lighting” The day’s presentations were very interesting and well presented. Peter Jackson’s presentation covered the background of the Wimmera Mallee Water Supply System, the design and construction of the pipeline project itself, and provided an overview of the GWM Water’s asset management information system. The two key outcomes
The afternoon was followed by a tour of the Institute for Dryland Agriculture – Seed Banks, this provided a very comprehensive overview of the importance of seed banks for not only Australia’s, but the world’s, future food production. The gathering, maintenance, reproduction and distribution of seed are an extraordinarily interesting process. We would like to thank our sponsor Barry Hopper for his assistance in the day, without sponsor support these PDs would not be viable. Regards Kim Bruton President Vic/Tas Branch
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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
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TECHNICAL PAPERS
Central Sterilising Supply Department – Air Conditioning
Kim Bruton, Chief Engineer I Northeast Health Wangaratta, Victoria MIHEA, CHCFM
Abstract
T
• Air flow and pressurisation
his paper is a case study that investigates the implication of design and construction or post construction within Central Sterilising Supply Department (CSSD), related to the environmental conditions and infection control. The design requirement for maintaining a sterile environment and product outcome is in many ways a common sense approach. Once there is an understanding of the basic principles required, technical solutions can be achieved.
• Environmental requirements
These include the physical structure that the CSSD will be located in, the HVAC systems that will provide temperature, humidity, cleanliness and air circulation throughout CSSD, and most importantly the management of the final products and how staff will traffic through the CSSD.
Design and structures
Some of the common design problems encountered in existing CSSDs will be discussed, leading into the re-design to rectify the issues of maintaining separation between dirty, clean and sterile functions within a CSSD.
Central Sterilising Supply Department (CSSD) – Air conditioning This case study is the culmination of years of experience in the hospital field and a chance request to teach a class on “Atmospheric Conditions in CSSD for the Certificate IV in Infection Control and Sterilisation” at the Mayfield Education Centre, Melbourne. As hospital engineers, we need to blend our technical skills closely with those of infection control and the CSSD technician disciplines to ensure the sterilised product outcome is of the highest standard. This was highlighted for me when a CSSD manager embarked on compliance with AS 4187, requesting that I shorten the drying cycle on the pre-vac sterilisers to as short as possible, in the realm of several minutes. Clearly the standard includes the drying time inclusive of the overall sterilisation time, but as read was confusing to those not familiar with the standard. I needed to seek confirmation from the Standards Committee to resolve the issue. The case study will touch on: • CSSD design and construction
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• Outcomes of poor management Question: what is so complicated about air conditioning? It consists of fans, filters, ductwork, and supply air registers, return air in some cases, and a controls system. Answer: Nothing – as engineers we deal with heating ventilation and air conditioning (HVAC) on a daily basis.
According to the AS HB50 – Glossary of Building Terms – a CSSD is a centralised service providing sterile materials to a hospital or group of hospitals, located as either a separate entity or department within a hospital. If the CSSD is located adjacent to the operating rooms, it may also double as the sterile supply unit and provide sterile instruments to the operating rooms. To provide the function desired as a sterile production and storage facility, the workflow layout is critical in the design of the HVAC. If we look at figure 1, a relatively simple layout as set out in the Design Guidelines for Hospitals and Day Procedure Centres (DGHDP) functional briefing notes – CSSD, it is clear that workflow and segregation between contaminated, sterilising and storage is crucial to ensuring an adequate outcome. Question – what is complicated about air conditioning that generally consists of an air handling unit (AHU), ductwork, registers and controls? Answer – the design purpose; for a CSSD, it is the means for managing the cross infection between dirty and clean, and sterile stock storage, and has special requirements that exceeds the normal design. For a CSSD, it means controlling the possible contamination of product as well as maintaining comfort conditions. The National Air Filtration Association (NAFA) describes the requirements that make up air conditioning as a process of treating air to control the temperature, humidity, cleanliness and distribution of air. In the design or refurbishment of the HVAC system, consideration needs to be given to the transference of contaminants within the work spaces and the storage requirements of the packaging and final product.
TECHNICAL PAPERS Further consideration of importance is managing infiltration – the controlled or uncontrolled leakage of air into a conditioned space, and exfiltration – the controlled or uncontrolled leakage of air from a conditioned space. Any uncontrolled flow of air in or out of the CSSD or within the spaces can create serious transference issues. Question – generally one would not expect that new facilities would have many design deficiencies. But in any review of a CSSD or refurbishment, we must consider the design in existing facilities’ to understand the problems that may lurk. • When was the building housing the CSSD built? • Or when was the last major structural refurbishment? • Have there been any significant changes to the HVAC systems? Answer – the older the CSSD, the greater the chance that the structure and HVAC cannot achieve the current requirements in sterilisation and infection control standards.
Figure 1 – DGHDP – Functional relationships diagram – CSSD
Airflows and room pressurisation The workflow layout of a CSSD (refer figure 1), the related management of airflows, and room pressurisation are of critical importance. With the exception of the dirty processing area, the basic intention is to increase room pressures through individual spaces to the cleanest areas, the setup and sterile stock rooms hence maintaining a clean to dirty airflow direction. Another important consideration is the necessity for staff, equipment and goods to be able to traverse between spaces within CSSD. As it is sometimes not practical to seal off each space, the cross contamination needs to be controlled by using THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
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TECHNICAL PAPERS pressure gradients between the individual spaces. During the commissioning or re-commissioning of the HVAC, more air is supplied to some spaces than others to create a positive pressure. Other spaces have more air removed to create a negative pressure. If designed and commissioned correctly, the system can compensate for doors or pass-throughs being opened for short periods of time to prevent cross contamination.
NAFA – Guide to Air Filtration
AS 1668.2 states that the pressure in operating rooms shall be greater than those adjacent except for setup and sterile stock rooms, where these rooms are required to have a greater air pressure again, relative to the operating rooms. Also setup and sterile stock rooms shall be mechanically ventilated providing 10L/s per person & 2L/m2 with high efficiency particulate air (HEPA) filters installed as close to or at the supply air register. Air within the system can either be: recirculated air as 50% of room air + 50% makeup; or 100% makeup air from outside (sometimes referred to as fresh air, but better referred to as outside air).
Figure 3 – Common particle sizes
Environmental requirements Environmental conditions within the CSSD will directly affect the final product as well as equipment, linen, woven wraps and plastic packaging stocks. The environmental conditions directly relate to the control of stock contamination or damage by excessive heat or very low or high humidity levels. • To prevent dehydration of packaging product, which can cause subsequent processing problems associated with absorbent materials, humidification can assist. • To prevent any condensation occurring and wetting the packs, a constant temperature range can ensure proper cooling for the packs once released from the sterilisers.
NAFA – Guide to Air Filtration
Figure 2 – Outside air quality
NAFA define external air quality as a mixture of 78% nitrogen, 21% oxygen and 1% generally referred to as argon (but in reality the 1% is made up of all the particulate matter and gases created by man and nature). Although we term this air as fresh or clean, that generally is not the case, dependent on your location. Regardless of the source, contaminants can be either aerosols or gases. Aerosols are measured in microns, one millionth of a metre. The different forms of aerosols are dusts, fumes, fogs, mists and smoke, whilst gases are formed by the evaporation of either liquids or solids. Internal air quality is managed in an air conditioning system by circulation and filtration of air. In a recirculated system, there is always the problem associated with the contaminants given off by modern building products, furniture and furnishings.
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• These environmental controls also manage the microbial growth within the CSSD to prevent contamination of sterile goods. The HVAC system should consist of banks of filters, generally two sets per pre-filter, with an efficiency of G4 to remove large particulate matter, then a final filter with efficiencies of F8 or in some cases F9 to obtain the level of contaminant removal required to all spaces. However, setup and sterile stock rooms require further filtration in the form of a 99.97% efficiency HEPA filter. It should be noted that the UK NHS mandate in HBN 13 that the packaging and sterilising areas must comply with ISO class 8 clean room standards. Australia is lagging behind the rest of the world in this area. Why is filtration so important? It is the means by which particulate matter can be removed. But clean air is of no value if it is not distributed effectively for the outcomes required by the space. The ventilation, temperature and humidity requirements in the key spaces of a CSSD include:
TECHNICAL PAPERS
Figure 4 – Graph of the daily peak results
Filtration Efficiency
Final Filter
N
2
10
G4 - F7
no
Packing/clean workroom
P
2
6
G4 - F8
no
30-60
18–22
• Graph the mean hourly results for each day, including corresponding outside results (refer figure 4).
Sterile storage
P
2 L/m2
10
G4 - F8
99.7% HEPA
30-68
18–24
Microbial Control
Design temperature degrees C
Minimum total air changes per hour
Cleaning/ decontamination room
Relative humidity (%)
Minimum air changes of outdoor air per hour
• Give consideration to:
Air pressure relationship to adjacent area
Area Designation
18–22
Table 1 – Environmental requirements
The measuring and recording of environmental conditions within a CSSD is important for product quality control purposes and the efficient management of the air conditioning. Changes in temperature in particular could signal a problem with the air conditioning whilst changes in the humidity that could have a detrimental effect on sterile stock also indicate a HVAC problem. A simple evaluation could include: • Logging temperature and humidity with a thermo-hygrometer. • A plan of all the rooms/areas that make up the CSSD, showing the related doorways and passages, also the location of the supply and return/exhaust air registers. • Graphing tools.
• Using more than one thermo-hygrometer; from experience three would be the minimum. • Placing one of the logging devices at the air conditioning thermostat of the space being measured. • The other logging devices should be placed elsewhere in the space. • Log at minimum of 15 minute intervals for a minimum of a week longer if possible. • Obtain or log the outside air (OA) temperature and humidity at the same 15 minute intervals for comparison.
Air quality is very important within the CSSD and in particular the packaging and sterile stock stores. Setup and sterile stock rooms not only require very high levels of air filtration and managed environmental conditions but also traffic control to reduce unnecessary human presence within that area. Keep in mind that: • Moisture on a pack will allow bacteria and spores to wick through the wrap. • Lengthy and extreme temperature changes may also cause physical and chemical changes causing plastics, rubber and cellulose materials to deteriorate. • Skin squames (dead skin cells or flakes) can act as a vector for transferring organisms and also can be colonised with all sorts of nasty things like MRSA, methicillin-resistant staphylococcus aureus (golden staph). In 1961 S. aureus was the first bacteria to show resistance to the then new antibiotic methicillin introduced in 1959. It is now a clinically serious THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
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TECHNICAL PAPERS strain, endemic in hospitals around the world and one of many drug resistant bacteria. • Moisture will also promote microbial growth on building surfaces in warm damp conditions. (See figure 5)
Air balancing performed found the general zone of the facility which included CSSD measured a total of 800L/s compared to the design of 1100L/s. Investigation found that the fresh air makeup had been secured shut with a tech screw sometime in the past. For some reason, the staff room on the northern end of the facility was receiving twice the design airflow leaving the CSSD with minimal. Exhaust fans had been installed post construction as creature comforts for the maintenance teams in the steriliser plant room, of which one was a large industrial fan measured at exhausting 180L/s. Even though there were outside air vents, the fan was still extracting 80L/s past the sterilisers from the internal space. Case 2 – Segregation of CSSD spaces during a $1.4M refurbishment
Figure 5 – Microbial growth
As a means of reproduction, mould spores become airborne allowing transmission throughout the space or mechanical systems. Microbial growth can occur anywhere moisture, correct temperature and nutrients exist including AHUs, ductwork and the spaces themselves.
Outcomes of poor management Case 1 – No physical barrier between the dirty decontamination and clean pack and sterilise area.
During this major refurbishment in 2010, the opportunity to provide a segregated clean/decontamination space was realised, ensuring a barrier to the packaging space. If we continue the product flow, no wall was provided between the clean packaging and sterilising workspace and the sterile stock area, at the same time the pass-through separation between the sterile stock and the setup room was removed. Again the outcome was the lack of ability to maintain correct air flows and pressure drops. More importantly, the sterile stock was subjected to direct fluctuations in temperature and humidity being only four metres from the sterilisers. Case 3 – Peracetic acid liquid chemical sterilisation system
In this instance, the CSSD was constructed in 1994 and the glaring omission is a wall between the dirty and clean workspaces. Without the wall, it was impossible to ensure that the air flows and pressurisation within the combined space would not spread contaminants between the workspaces. The initial mechanical installation heralded an ice storage system that, in the original design, shut down the general air conditioning zones every Sunday to build ice for the following week. This in turn provided no cooling for the CSSD unless staff were called in for theatre cases and used the override mechanism. Temperatures in summer were in excess of 28ºC within the CSSD and investigations found the original controls were not fully functional from construction. The three-way valve controlling the operation of the ice burn process was not functioning correctly, resulting in blended return and flow chilled water.
Installation post construction with the unit to be placed on the bench top, filters and pumps in the joinery underneath. In this instance the pump had continual leaks, coupled with water spills from changing the filter and drainage leaks causing the cabinets to become water logged. This in turn caused mould growth through the entire joinery unit. Mould grows prolifically in any manufactured timber such as particleboard or craftwood and as a result the scope wash cabinet and storage space had to be completely rebuilt. THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
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TECHNICAL PAPERS document all changes both structural and HVAC to ensure that the system is meeting the requirements. Then continue to ensure all changes are updated no matter how small. • Have a HVAC maintenance program that includes appropriate filter testing and replacement. • Carry out annual room pressurisation testing and regular air balancing. • Provide prompt maintenance response to HVAC or environmental condition problems. • Maintain a good relationship with the CSSD staff and the infection control team in your facility; they need to know what you do as much as you need to know their requirements. Figure 6 – Common form of microbial growth
Containment barriers in the workplace It is necessary to construct proper barriers when working in any CSSD, theatres or patient immune-compromised spaces. The key requirements are: • Well-sealed barrier walls to prevent the spread of contamination.
Acknowledgements I wish to thank Kevin Moon for his assistance over the years in providing the answers to many of the questions related to infection control issues that I have sought and the Mayfield Education, Melbourne for the opportunity to pass on my experience to CSSD technicians.
References & bibliography Australian Standards:
• Negative pressurisation.
• Air Conditioning and Ventilation Design – AS1668.2
• Airlock depending upon risk survey.
• Air Filters – AS1320 & AS 4260
• Strict worker induction. • Conduct regular barrier inspections. The publication Infection Control Principles for the Management of Construction, Repairs and Maintenance within Health Care Facilities clearly defines the requirements for managing any maintenance or building works to be performed within these areas and should be applied as required. Below are two examples of construction barriers, one is a solid wall type, the other uses a heavy duty plastic.
• Sterilisation – AS/NZs 4187 • Glossary of Building Terms – AS HB50
Victorian Health Governance, Design Guidelines for Hospitals and Day Procedure Centres (DGHDP): • Part B – Health facility briefing and planning • Part D – Health facility infection control • Part E – Building Services and environmental design
Other relevant information • UK National Health Service – Health building notes (HBN 13) and Health technical memorandums (HTM). • National Air Filtration Association – Guide to Air Filtration; ISBN 1-884152-00-7 • Maintenance Engineering Handbook by the McGraw-Hill Book Company; Lof CCN: 656-23560
Conclusion It is most important that if there is any doubt about the product quality in a CSSD, re-commission the HVAC system and
about The Author Kim Bruton has worked in the health industry as a hospital engineer, managing facilities and maintenance and as a maintenance consultant since 1982. His experience covers both Australia and New Zealand with his key appointments being the Chief Engineer of the following facilities; Shoalhaven Area Health Service, Fairfield Infectious Diseases Hospital, Wangaratta District Base Hospital, Wodonga Regional Health Service. Currently he is the Chief Engineer at the Northeast Health Service; providing a broad range of health and aged care services to the
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• Infection Control Principles for the Management of Construction, Repairs and Maintenance within Health Care Facilities – A Manual for Reducing the Risk of Health Care Associated Infection by Dust and Water Borne Micro-organisms. 2nd Edition. (2005). Loddon Mallee Regional Infection Control Resource Centre.
communities of the central Hume region. NHW provides a referral and sub-specialist service for many surrounding communities and it has an important after hours and backup role for the smaller hospitals in the catchment. NHW comprises two principle sites; the 161 bed acute hospital site and the 62 bed Illoura residential aged care facility. Kim has also provided input into several Victorian Department of Health projects including; the Hospital Facility Performance Assessment Tool, the Fire Safety Management Guideline Review and the Maintenance Standards for Critical Areas in Victorian Health Facilities.
TECHNICAL PAPERS
Airborne Killers
Mould Contaminated Hospital Air-conditioning Systems Jeremy Stamkos
The presence of clinically relevant mould contamination in hospital air-conditioning systems can lead to horrendous patient infections and in some cases, deaths.
U
nfortunately, due to poor design, poor maintenance and even sheer negligence, the occurrence of infections and fatalities related to mould contamination within air-conditioning systems in Australian hospitals is far too common.
varying levels are found in most indoor environments. Their presence comes from infiltration during construction (before the structure is weathered in), from moving furniture in and in/on construction materials.
As there are current Australian Standards and Guidelines related to the prevention of microbial contamination in air-conditioning systems, some even legislated in most states and territories; the fact that patients lives are being put at risk is simply inexcusable.
This presence within hospitals is there from day one of the hospital being built; mould spores can be found throughout an entire hospital as well as within the air-conditioning systems.
If the minimum maintenance standards and industry best practice guidelines were complied with, the risk of patient infection and fatalities from mould in air-conditioning systems would largely be avoided. The personnel responsible for maintaining hospital air-conditioning systems in Australia have all the resources available to ensure they meet their legal obligations and duty of care and as such, it is high past time that there was more accountability for ensuring that these tasks are carried out. Individuals as well as organisations need to ensure they understand and meet their obligations to exercise due diligence and meet their duty of care.
Mould in Airconditioning – General Mould spores (like seeds from mould growth) are ubiquitous and are
Certain mould spores on their own can cause infections in patients, but at low concentrations the likelihood of infection is proportionately low. However, levels of mould spores can become extremely high when there is actual mould growth within airconditioning systems. This occurs when there is sufficient moisture within the airconditioning system allowing the mould spores to vegetate and become actual mould growth. Fluctuations of temperature, moisture and air-flow within the air-conditioning system encourage the mould growth lifecycle and mould contamination can become prolific. The key to preventing the occurrence of mould in air-conditioning systems (as well as in buildings) is in controlling indoor moisture and relative humidity levels to within the relevant standards and guidelines. Whilst the maximum recommended indoor relative humidity (RH) levels range
Mould growth coming out of air off side of cooling coil
from 60-65% RH, some moulds start vegetating at relative humidity levels of 65% and therefore often a lower maximum limit of 60% or even 50%RH may be sought. Once relative humidity levels reach 70% RH and higher, the chances of mould growth occurring are far greater. Unfortunately, when in cooling mode, many air-conditioning systems cannot adequately control humidity levels within the internal components and hence mould growth is commonly found. If air-conditioning systems were better designed, manufactured, installed and maintained, moisture through the systems would be properly controlled especially during periods of elevated external temperatures and relative humidity. Buildings located within geographical areas that experience extended periods of elevated relative humidity and temperature levels are more prone mould contamination.
THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
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INDEPENDENT MONITORING CONSULTANTS – AUSTRALIA TECHNICAL PAPERS
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INDEPENDENT MONITORING CONSULTANTS Head Office: 23–25 Daking Street North Parramatta NSW 2151 1300 131 405 (02) 9890 5067 New South Wales: Ian Hartup 0411 109 353 Queensland: David Curry 0408 368 921 South Australia: Roz White 0431 503 195 Victoria: Troy Cairncross 0412 117 114
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TECHNICAL PAPERS General construction dust that enters air-conditioning components prior to commissioning can contain high levels of dormant mould spores. Once the system is commissioned and moisture is introduced, the mould spores within the dust begin vegetating and the mould growth life cycle begins.
Mould growth in flexi-duct
Unfortunately, many air-conditioning systems are not designed appropriately for the climatic regions they operate in and cannot perform to required expectations. Over the past several years, the introduction of energy saving technology and operation has led to increased mould contamination within airconditioning systems. The occurrence of mould growth in hospital air-conditioning systems is more prevalent than most other buildings. This is often due to many hospitals having significantly aged plant and equipment as well as highly restrictive maintenance budgets. Poorly maintained and run down airconditioning systems are at much higher risk of mould contamination. Leaking condensate pans (designed to capture and remove condensation from the cooling coils), rust and corrosion along with years of in-ground dirt all lead to providing the ideal environment for mould growth to flourish. As much as is shouldn’t be so, restrictive hospital budgets is a contributing factor to air-conditioning systems not being properly maintained in spite of current Australian Standards and legislation. When insufficient funding is provided, hospital maintenance staff are simply not able to properly maintain the hospital’s air-conditioning systems to the desirable level. Even newly constructed hospitals can be affected by mould contamination due to high moisture and dust activity during construction.
Mould contamination issues within new buildings are exacerbated by poor maintenance and some energy efficient air-conditioning systems that don’t adequately condition the air allowing excessive moisture levels within the system and the building. To help prevent mould occurrences in air-conditioning systems and buildings, Australian Standards published Australian Standard AS/NZS 3666 in 1985. There are four parts to this standard however parts 2 & 4 are the parts that relate to specific performance-based maintenance of air-handling systems in order to prevent or deal with microbial contamination. AS/NZS 3666.2 requires specific areas within air-conditioning systems to be inspected periodically to identify microbial contamination and internal cleanliness levels. Although compliance with AS/NSZ 3666.2 is a legislated requirement in most Australian states and territories, full compliance with the Standard is very rare. This is largely due to a lack of knowledge on behalf of those responsible to maintain the systems as to what the requirements for compliance are. Most hospital maintenance staff and air-conditioning contractors simply believe that looking within the actual airconditioning unit each month is all it takes to be compliant with the Standard.
every air-conditioning unit should be inspected annually. The problem with this is that very few air-conditioning systems have any access provisions to facilitate the inspection of the internal surfaces. This is because those that design the systems are not fully aware of what the maintenance requirements are and do not design the systems with proper inspection access. To assist maintenance staff and contractors to comply with AS/NZS 3666.2, the Australian Institute of Refrigeration, Air-conditioning and Heating released the AIRAH HVAC Hygiene Best Practice Guidelines in 2009. This Guideline provides detailed information on how to inspect air-conditioning systems for cleanliness and how to determine when cleaning is required.
Ignorance vs. Negligence Due to the higher risk of susceptible patients, one would reasonably expect that hospital maintenance and engineering staff are aware of the heightened requirement to maintain and operate clean, hygienic air-conditioning systems. Unfortunately, numerous hospital maintenance staff and air-conditioning contractors are either unaware of the risks associated with mould in hospital air-conditioning systems or simply being negligent in addressing their duty of care. As stated earlier, many are not aware of the minimum inspection and maintenance requirements set out in Australian Standard AS/NZS 3666.2
Unfortunately, they do not realise that the Standard states that “ductwork in the vicinity of moisture producing equipment” also needs to be inspected annually. This means that the internal surfaces of the supply air ductwork immediately after Mould on hepa 2
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TECHNICAL PAPERS whilst some aren’t aware that the standard even exists. Often, hospital engineers will make reference to the HEPA (High Efficiency Particulate Air) filtration installed in the air-conditioning systems and that any mould contamination in the system isn’t a concern because the HEPA filters will stop the spores entering the critical areas. This is extremely concerning and an ill-informed position for a hospital engineer could possibly have. Firstly, if they know that a system has visible mould contamination, they have already failed to exercise due diligence in their duty of care. When visible mould contamination is present within an air-conditioning system, it is because there has been excessive moisture or relative humidity in the system. If the moisture within the system is high enough, mould spores that have been stopped by the downstream HEPA filters can start vegetating and grow right through the filter. When this occurs, the mould growth that is now downstream of the final defence measure is now able to spread spores into the most critical areas within the hospital. As HEPA filters are made from cellulose (paper) which is highly absorbent, the paper media becomes moist allowing mould to grow on and through them. When this happens, mould spore levels within the occupied critical areas of the hospital become highly elevated placing susceptible patients at a much higher risk of infection. Mould growing on and through HEPA filters in hospital air-conditioning systems servicing critical areas such as Theatres, Recovery Wards, Central Sterile Store Departments is a common occurrence and due to the risk of patient infection, diligent maintenance is required. Even air-conditioning ducts that look visibly clean may be highly contaminated with mould spores and fungal hyphae (fragments from mould growth) that can
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Mould growth on insulation in supply duct
cause serious infections and fatalities. This is common when there has been mould growth in the air-conditioning units and the contamination has spread downstream.
When a patient has a compromised immune system (immuno-compromised/ suppressed), they are highly susceptible to infection from certain mould spores such as Aspergillus.
Clinically Relevant Moulds & Consequences
The risk of infection from mould spores largely depends on individual patient susceptibility, species of mould and level of exposure.
As well as increasing energy consumption and deteriorating internal components, mould growth within any air-conditioning system is unacceptable as it can cause ill health to building occupants.
The two main ways that patients become infected by mould spores are either via inhalation or direct exposure to an open wound.
Many mould species found in airconditioning systems are known to produce mycotoxins (toxins from mould) and in high enough concentrations, can lead to the ill health of generally “healthy” people. Mycotoxins are known to cause mucous membrane irritation, skin rash, nausea, immune system suppression, acute or chronic liver damage, acute or chronic central nervous system damage, endocrine effects, and cancer.
The wards and areas in hospitals that will have the most susceptible patients include but are not limited to,
Many mould species are clinically relevant which means the spores released from the mould can cause serious infections or fatalities for patients that have a compromised immune system.
THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
Examples of highly susceptible immunocompromised/suppressed patients may include cancer patients, transplant patients, burns patients etc.
• Intensive/Critical Care Units • Operating Theatres • Recovery Wards • Oncology Wards • Isolation Rooms • Central Sterile Store Departments • Neonatal Wards
TECHNICAL PAPERS Infections caused by contamination with the hospital are referred to as nosocomial infections which means it was acquired whilst at the hospital. Due to the high nosocomial infection rates in Australian Hospitals and the difficulty in determining direct causes, the source of the infection is rarely investigated properly and the source of the contamination goes undetected. Even when nosocomial infection leads to serious implications to the patients such as amputation of limbs or even fatalities, rarely is the cause of the infection identified and rectified. Advances in technology over recent years including DNA profiling now enables mould contamination leading to infections to be tracked back to its source. This means that the cause of a patient’s fungal infection can be directly linked to the hospital’s air-conditioning system.
Liability & Responsibilities There are legal obligations and duty of care considerations for those who are responsible for maintaining airconditioning systems and are charged with ensuring a building’s plant and equipment do not pose a risk to occupant health. Negligence in allowing people to be exposed to mould contaminated air-conditioning systems may attract significant penalties by relevant authorities which may extend to numerous people that are either directly or indirectly responsible for any resultant health incidents or fatalities.
Maintenance Staff
Engineers Hospital Engineers or Facility Managers are charged with the responsibility to ensure the hospital’s plant and equipment are maintained in accordance with all relevant federal and state legislative requirements and that it does not pose a threat to the health and wellbeing of the patients, staff and visitors of the hospital. Ignorance of these requirements, Australian Standards and industry best practice guidelines is no excuse for placing people’s lives and safety at risk. If adequate funding is not budgeted for to maintain acceptable air-conditioning hygiene, the matter must be dealt with and not brushed aside.
Infection Control Most Infection Control staff are preoccupied with minimising the spread of transmissible diseases, of which, getting staff and patients to simply wash hands is one of their biggest focuses. Whilst many Infection Control staff are aware of the risk of infection associated with airborne mould spores, they do not realise that the single largest contributor to these infection types is the hospital’s air-conditioning systems. As most Infection Control staff don’t have access to the hospital’s air-conditioning systems to inspect for cleanliness, they are reliant on the hospital’s engineering and maintenance department to provide this information. Unfortunately, hospital maintenance staff can be less than cooperative or transparent when it comes to providing Infection Control staff with the information they required to make informed decisions.
Hospital’s maintenance staff or contractors engaged to conduct the maintenance of the air-conditioning systems are the first line of defence against mould contamination in healthcare facilities.
It is crucial that there is a collaborative effort between the engineering/ maintenance and infection control departments to ensure that all the hospital’s air-conditioning hygiene requirements are being met. It is highly recommended that Infection Control staff conduct regular air sampling to monitor airborne mould spore counts and speciation throughout the hospital and in particular, within the critical areas. When high levels of clinically relevant airborne mould spores are present, the infection control staff should work with the engineering/maintenance staff to identify the source of the elevated mould spore counts. This may require engaging the services of specialist mould investigators as the source may not always be easily identifiable.
Hospital Management Hospital Management need assurance from the Maintenance/Engineering department that the air-conditioning systems are being maintained in accordance with Australian Standards and industry best practice. Further to this, Hospital Management need to ensure that adequate funding is allocated to conduct adequate maintenance and remedial works as and when required. . Management need to act urgently on any advice from contractors or hospital maintenance/engineering staff concerning the presence of clinically relevant mould in the hospital.
Preventing Mould in Air-conditioning Ultimately, the best way to prevent mould in air-conditioning systems is through proper design and maintenance.
Design In most cases, ensuring that airconditioning systems are properly designed to adequately condition the areas they service and keep internal moisture levels within acceptable levels should prevent mould growth occurrences.
The individuals charged with this task need to understand what their responsibilities are and what the risks are of not recognising or reporting mould contamination in the systems. Mould growth on aluminium flexi-duct
The use of high quality and efficient air filtration is paramount to preventing THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
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TECHNICAL PAPERS high levels of mould spores entering the systems.
Pre-commissioning Cleanliness Any newly installed hospital airconditioning system should be inspected for cleanliness prior to commissioning. Any components that are determined to no be “clean” in accordance with the AIRAH HVAC Hygiene Best Practice Guidelines should be cleaned to a satisfactory standard and verified as clean prior to commissioning.
Maintenance Every hospital should have a documented Maintenance Plan & Records for the maintenance of their air-conditioning systems including details on the prevention of mould and bacteria within the systems.
to patients and other occupants and need to meet all relevant compliance obligations. Maintaining the systems in accordance with the minimum regular inspection frequencies and hygiene levels detailed in the relevant Australian Standards and Guidelines will help prevent many avoidable nosocomial infections, illnesses and fatalities.
Note on cleaning mould contaminated air-conditioning systems in hospitals When mould contamination has been confirmed present in a hospital air-conditioning system, the importance of engaging a certified, experienced and insured specialist to conduct the remedial works is crucial.
At minimum, every hospital should maintain their air-conditioning systems in compliance with Australian Standard AS/ NZS 3666.2 – “Air-handling and water systems of buildings Microbial control Part 2: Operation and maintenance” as well as the AIRAH HVAC Hygiene Best Practice Guidelines.
The contractor must have adequate experience and equipment to decontaminate mould affected airconditioning systems in critical environments to ensure that mould contamination is not spread and the health of staff and patients not placed at risk.
For an even more proactive approach to address this risk, compliance with the newly published Australian Standard AS/ NZS 3666.4 – Air-handling and water systems of buildings – Microbial control – Part 4: Performance-based maintenance of air-handling systems (ducts and components) will even better help them meet their duty of care.
Conducting mould remediation of air-conditioning systems in critical environments requires specialist knowledge, skills and equipment to ensure all of the mould contamination is properly contained, removed and the system returned to a hygienic condition.
This maintenance standard provides a performance-based approach to the maintenance of hygienic conditions with air-handling systems of buildings.
References: National Air Duct Cleaners Association’s (USA) “ACR 2006 – Assessment, Cleaning & Restoration of HVAC Systems” Australian Standard AS/NZS 3666.2 “Airhandling and water systems of buildings Microbial control Part 2: Operation and maintenance” Australian Standard AS/NZS 3666.4 “Airhandling and water systems of buildings – Microbial control – Part 4: Performance-based maintenance of air-handling systems (ducts and components)” The Australian Institute of Refrigeration, Airconditioning and Heating’s “HVAC Hygiene Best Practice Guidelines” 2009 “Microorganisms in home and indoor work environments. Diversity, health impacts, investigation & control.” Flannigan, B, Samson, R. A & Miller, J. D. 2nd Edn. 2011. CRC Press, Boco Raton, London & New York. “Standard & Reference Guide for Professional Mold Remediation” ANSI/IICRC S520 – Aug. 2008, 2nd Ed. Institute of Inspection, Cleaning & Restoration Certification, Vancouver, Washington 98661 USA “WHO Guidelines for Indoor Air Quality – Dampness and Mould”, 2009 World Health Organisation, Copenhagen, Denmark, ISBN 978 92 890 4168 3. “Worldwide Exposure Standards for Mold & Bacteria – Assessment Guidelines for Air, Water, Dust Ductwork, Carpet & Insulation”, 8th Ed., 2010 – Robert C. & Gail M. Brandys, OEHCS, Inc. IL. ISBN 0-9774785-0-5
Those responsible for engaging such contractors should ask for evidence of appropriate insurances (specifically referencing mould), training & certification for competency as well as previous relevant experience.
Conclusion Whilst extremely common, the occurrence of mould growth in hospital airconditioning systems is inexcusable due to the serious consequences that can result. Hospital Maintenance and Engineering staff need to ensure the operation and maintenance of the air-conditioning systems does not present a health risk
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about The Author Jeremy Stamkos has more than twenty years experience in the inspection, remediation and decontamination of the built environment specialising in microbial contamination. Jeremy is a certified air-conditioning and building mould investigator and remediator and is currently in researching the causes of mould contamination in the built environment due to energy efficient HVAC design and technologies as part of his Masters degree at Queensland University of Technology. Jeremy is also the current President of the Indoor Environmental Quality Association Inc.
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Contact: VIC 0408 054 734, NSW 0427 627 240, QLD 0400 971 753, SA, WA & NT 0419 184 717
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TECHNICAL PAPERS
From Steam to Nanotechnology –
The Anzex Delegate Chronicles Roy Aitken I FIHEA
The 2012 New Zealand Institute of Healthcare Engineering (NZIHE) conference held in Queenstown will long be regarded by many as one of those one-off, unique experiences.
Conference venue outlook
I
was privileged to have been nominated as the ANZEX delegate to this conference and consider myself honoured to represent the IHEA a second time, the first time being 1994. Reviewing my report of 1994 some things never change; the unconditional hospitality of our New Zealand colleagues and the commitment of individuals to the betterment of their Institute and subsequent profile in their health industry. The conference was held at the Rydges Lakeland Resort, Queenstown on the 8th and 9th of November 2012. My wife, Carol-Ann and I flew into Queenstown on Monday 5th. Coincidentally, Kevin Moon and Heidi were at Christchurch Airport for the same Queenstown flight. They generously gave us a lift to our hotel before proceeding to their
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accommodation they were sharing with Kim Bruton and Jana. Business got underway on the Wednesday with the NZIHE Executive meeting with the following NZIHE Executive members present: Doug Moller (President), Nigel Wing (Secretary), Allison Blackler (Treasurer), Bill MacDougall, Max Christensen, Leon Clews, Tony Blackler, Jim Logan, Tony McKee and Greg Taigel. Interestingly, Tony Blackler and Jim Logan attended the 1994 Executive meeting. Mitch Cadden, IHEA President also attended as part of a new collaborative initiative by the IHEA Board. There was a comprehensive agenda for the meeting as the Executive meet only twice a year. It was clear NZIHE has similar challenges to the IHEA; e.g. lack of response for professional development
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funding on offer, and lack of nominations for ANZEX delegates. Clearly there is an issue for both Institutes to address, indeed Mitch Cadden had brought a proposed amendment of the ANZEX Guidelines to the table that generated considerable discussion with agreement that amended guidelines be collaboratively drafted for respective Executive/Board approval. As the NZIHE has a Clinical Engineering and a Facilities Management membership mix (with a membership of 132 across both disciplines), there were reports submitted for each discipline relating to their status and activity within their respective industries. The Executive also endorsed Christchurch as the venue for the 2013 conference. Prior to the close of business, Mitch Cadden gave an overview of the corporate governance initiatives undertaken by IHEA that clearly interested the Executive but were unsure
TECHNICAL PAPERS applied to this procedure. He also gave an enthralling and informative physics perspective of the Fukushima nuclear power plant incident in Japan following the earthquake and tsunami. In a country where such geophysical events are a constant threat, the presentation was keenly absorbed.
Bill MacDougall convincing delegates
that such a model would apply to their Institute. Overall, it was a very productive meeting with the President, Doug Moller keen to advance some of the agreed initiatives. The conference got underway on Thursday based on the theme “From Steam to Nanotechnology” and despite the distractive view it got straight to the theme. Russell Glendinning, MBE, a highly respected NZ steam expert gave an enthralling overview based on his experience over 61 years of the benefits of steam, an energy medium that dates back to Roman times. This aspect of the theme was certainly serendipitous as will be revealed throughout this report.
equally well-attended by delegates and partners. The morning of the second day was a split stream for facilities management and clinical engineering. Kim Bruton from Australia also presented in this session. I changed to the Clinical Engineering stream for the second morning session and was fortunate to hear Dr Jeremy Nicoll give an overview of mammography and the medical physics
One of the delights in attending a stream that is not your core competency is learning of new and innovative technologies. So it was with Michael Anderson’s presentation ‘Nanotechnology and the Modern World’. An introduction to SQUID technology (Superconducting Quantum Interference Device) and scanning hall probe microscopy has you searching the internet for related information and its application in the medical environment. The final afternoon reverted to a combined session and included a very polished report by Gavin Carey-Smith on his ANZEX Exchange visit to Australia. Doug Moller, President closed the conference and encouraged all delegates to attend the 2013 conference to be held at Lincoln University, Christchurch.
Day one provided a range of great presentations including Max Christensen’s overview of the facilities upgrade at the Hutt Valley hospital based on an approved business case for NZ$81m and Kevin Moon from Australia who presented in his own right with his usual engaging style. Entertainment for the day was a conspiracy theorists dream. Bill MacDougall’s “Houston we have a problem” convinced us all there never was a moon landing. His logical argument of the events had delegates all but convinced, but, there again………… A trade exhibition and hot buffet was held on the Thursday evening with an impressive turnout of exhibitors that was
TSS Earnslaw; Kevin Moon, Roy Aitken and Kim Bruton enjoy the lake cruise; Stoking the boiler
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TECHNICAL PAPERS The conference dinner was preceded by an evening cocktail cruise on the TSS Earnslaw, a twin screw steamship propelled by coal-fired, jet condensing vertical marine engines that was launched on Lake Wakatipu in 1912. A marvellous living steam experience complete with stokers that was thoroughly enjoyed by all who made the trip up the stunningly scenic lake. Dinner was a splendid affair with a novel ceremony ‘Addressing the Haggis’ as a surprise event. This ANZEX delegate participated in the ceremony but journalistic coyness precludes further detail! Carol-Ann and I lingered in Queenstown until Monday when we headed for Dunedin to be home-hosted by Doug and Trish Moller. We arrived at Doug’s Dental and Medical Equipment business premises where we met his staff including a few who attended the conference. Greg Taigel was busy reviewing a vet’s portable ultrasound unit that had the misfortune of an encounter with a truck wheel (its condition was terminal). His helpful staff gave me an overview of some of the equipment they service and the sophisticated and expensive test equipment needed. All assets serviced are recorded on a digital document control system. A member of Doug’s staff, Glen McConachie is a steam train enthusiast. He drove me to their workshops of the Otago Railway and Locomotive Society and viewed various steam and diesel locomotives as well as carriages in various stages of refurbishment. Glen offered to take me to another shed of carriages and engines to which I agreed so he promptly started one of the diesel shunting engines and we travelled the few hundred meters in style. What a thrill! On Tuesday, Doug introduced me to Robbie Checketts, Facilities Manager at the Mercy Hospital, a 52-bed private hospital that is currently undergoing an expansion programme.
From top: Glen McConachie with one of his projects; Roy Aitken playing with trains; Robbie Checketts and Doug Moller
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Like any other Health Facility Manager, Robbie has his hands full with interface issues with construction works and operational areas. Interestingly they close the hospital completely for 3-4 weeks
TECHNICAL PAPERS over Christmas and New Year thus the opportunity is taken for maintenance works to be undertaken. Doug then gave me a tour of the Dental Hospital and School where his company provides an on-site maintenance service. The afternoon was another treat as Trish had booked a trip on the Taieri Gorge Scenic Railway departing from the magnificent Dunedin railway station. The three of us enjoyed the impressive scenery through the gorge including the wrought iron Waigatui Viaduct on the 58-kilometre journey to Pukerangi and back again. We continued our journey on Wednesday, heading for Christchurch, stopping in Oamaru for lunch where we discovered the Steam Punk Museum. Continuing the steam theme, this was pure fun. Wikipedia defines ‘Steampunk as a sub-genre of science fiction that typically features steam-powered machinery, especially in a setting inspired by industrialised Western civilization during the 19th century.’ The creations in some cases were quite bizarre. Staff informed me that they are offered old machinery from a range of sources, and then their imagination takes over. Who said steam was boring?! The next site visit was a more sobering experience. Tony Blackler and Nigel Wing welcomed me at Christchurch Hospital. Kevin Moon and Kim Bruton were also in town so we toured the facility together. Following the February 2011 earthquake the facilities management staff has contended with maintaining an operational health facility while carrying out investigative and remedial works to all buildings on the site, a seriously impressive effort. Until you walk through and have issues and faults pointed out all appears fairly normal. This report will not attempt to detail what remedial works have been undertaken to date at a current expenditure of NZ$240m, but, will cite a few of the issues already addressed. The boiler house maintained a steam supply throughout the earthquake. However, the brick boiler stack had developed faults and had to be demolished necessitating an alternative fluing system to be installed. Authorities From top: Steam Punk creations; Shear towers in the boiler house
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TECHNICAL PAPERS
From left: Container-mounted steam boilers; Nigel Wing with Kevin Moon and Kim Bruton
give their buildings an ‘Importance Level’ rating from 1 to 4. The boiler house is rated at IL4 to withstand an earthquake of magnitude 8 and as such work is underway to achieve this rating with construction of shear towers to brace the building. Steam is reticulated through an extensive tunnel system. On investigation it was found that a steam joint at the junction of two building had moved during the earthquake and was under some considerable stress necessitating its redesign with a gimbal connection to this 10 bar steam line. As a contingency six container-mounted steam boilers were placed around the site. We learned of sacrificial crossovers between buildings, use of specialised flexible connections in medical gas pipelines, the performance of building base isolation pads under earthquake conditions, a few were visibly offset . Severely cracked walls were numerous and the specialised chemical injection process for concrete column and wall cracks was extensive. At the end of the morning we were looking at the buildings in a different light; looking for and seeing the telltale signs. The ongoing challenge of master planning for this healthcare facility in an environment of unpredictable earthquake activity makes the work of the facilities management team considerably more complex. The dedicated, professional approach by the FM team to this ongoing challenge is highly commendable. Nigel Wing and his wife Jo welcomed us to their home for a barbecue that evening where we were joined by New Zealand and Australian colleagues, a convivial end to a memorable day.
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We travelled to Napier and were homehosted by Paul and Pauline McCartney (past ANXEX delegates to Perth) over the weekend. We had a general discussion on health FM in the area; I was surprised that their health service is responsible for the Chatham Islands. Situated in the South Pacific Ocean, about 800km east of Christchurch, the Chatham Islands are New Zealand’s most easterly region. An archipelago of 11 islands, only Pitt and Chatham are inhabited, by about 600 people. Our final hospital visit was to the Auckland City Hospital, a 1000 bed facility for adults, women and children. We were again home-hosted by Bill and Lyn MacDougall. Bill introduced me to Ian Harper, Facilities Manager and Jonathon Tham, Building Services Engineer who generously showed me around their facility. They have a staff complement of nine and are responsible for management of the contracted facility manager PAE, building performance, capital improvements and parking. The facilities management contract has been in place for five years and is considered to be operating very satisfactorily. Jonathon provided an overview of their Honeywell BMS that has nine protocols interfaced to the system, an impressive setup. The boiler house provides 21MW of steam to the site at a reticulation pressure of 6.5bar. Bill MacDougall then gave me a tour of some of the clinical areas that the Clinical Engineering Department provides a
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service. They provide a comprehensive ISO-certified service to the hospital and several private facilities with a staff of 38 comprising electronic, mechanical and anaesthetic technicians. Critical areas such as ICU/Theatre, Coronary Care and the Children’s Starship hospital have satellite workshops providing a timely service. Overall, the level of service provided by Health Facility Managers in New Zealand is comparable with Australia. Organisational structural change, emerging technologies and funding issues are a common denominator to all. Such is the intrinsic value of these ANZEX exchange technical tours there is no possibility of not benefiting or learning from the experience. Conferences without a partners’ programme would be a lesser experience. The camaraderie between the partners is something Carol-Ann can articulate: It was a lovely surprise for both Roy and myself to find ourselves representing Australia at the New Zealand conference in Queenstown. I was delighted and looked forward to reacquainting myself with the partners with whom strong relationships had been forged over the years. The Queenstown NZIHE Partners Programme put together by Trish Moller was fantastic. The program included a tour of Arrowtown with a very informative guide (who was passionate about the restoration of this old village) and included a lesson on how to pan for gold
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TECHNICAL PAPERS – most of us came away with a minute piece. The next day was a gondola ride up Ben Lomond that included the luge/ electric go-cart (attempted by a few of the ladies but not me) followed by a magnificent smorgasbord lunch. I have always enjoyed the Trades Night – having a look at the displays and collecting giveaways such as pens, pads, bags etc is always enjoyable; such items are very handy in my handbag. The “business cards raffle” was entertaining, and the contents of the few brown-paper wrapped prizes were original. Visits to Dunedin, Christchurch, Napier and Auckland were great as I was looked after very well whilst Roy visited hospitals. It was very much appreciated. We hope to reciprocate at any future conference. Sunny afternoon at Queen’s Bath House on Lake Wakatipu L-R Lyn MacDougall, Angie McKee, Monica Logan, Allison Blackler, Carol-Ann Aitken
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TECHNICAL PAPERS
Digital Technical Document Control – A Case Study
R A Aitken I Institute of Hospital Engineering, Australia Perth, Western Australia
Migrating from a hard-copy paper-intensive environment to that of digital document management involves a substantial paradigm shift. Such a shift is not an overnight event but evolves over many years to a point when the electronic record becomes the norm. This case study highlights the challenges, setbacks and process requirements to achieve a workable outcome.
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requently challenged in providing adequate space for health professionals to operate effectively as functions change, occupants move out, and space is re-occupied while major redevelopment projects test our objective in creating and maintaining an ‘as constructed/space allocation’ record, Healthcare Facility Managers (HFM) face the imposing task of achieving current, accurate space utilisation and operational documentation in an environmentally sustainable manner. (Bulmer 2011) cited that the ‘use of coordinated, consistent, computable information results in reliable, digital representation of the building’. Accordingly, access to such information in the future will prove invaluable and indispensable.
a digital technical document management system. Such an approach will have almost automatic acceptance with future generations of Health Facility Managers and can be considered as an essential succession-planning tool. However, such implementation of web-based record keeping will compel a change of culture in current HFM incumbents and their ability and indeed their inclination to progress from a ‘silo-based’ fragmented
hard-copy information environment to an all-inclusive ‘information sharing’ webbased environment. Proprietary space management software was introduced in 1997 to manage the space of a campus with buildings having an active floor area in excess of 220,000 square metres occupied by 40 site tenants other than Sir Charles Gairdner Hospital, the principal occupier,
If applied to the site redevelopment (figure 1) currently underway at the Queen Elizabeth 2 Medical Centre (QE2MC) including Sir Charles Gairdner Hospital (SCGH), as the major site occupier, there would be a need for several rooms for hard-copy documentation of the ‘as constructed’ record. The site is undergoing a two-billion dollar redevelopment that has incorporated the use of web-based space allocation software integrating with Building Information Modeling (BIM) tools and Figure 1 Source: www.qeiiredevelopment.health.wa.gov.au
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TECHNICAL PAPERS that itself has a multiplicity of departments. Ultimately, the active floor area will be in the order of 413,000 square metres at the end of the current redevelopment phase in 2016. The main objectives for introducing this software were to: • Introduce a proprietary database system for space management, replacing an in-house system that had not been maintained thus lacked integrity. • Keep pace with the continual change and reconfiguration of space. • Maintain current, accurate facilities information directly linked to existing AutoCAD plans. In these early days the intent was for departments such as Information Technology, Patient Support Services, Security and the like to utilise the system for their specific requirements. These early attempts fell well short of expectations mainly due to the commitment needed to input data e.g. floor coverings or access control data. Ultimately, the system was used predominantly and extensively by the Facilities Management Planning section. Interestingly, the analogy of (Everett Rogers, 1962) Diffusion of Innovation has clearly been demonstrated over the years while implementing web-based space
Figure 3 – Space related information
allocation tools. Although more often applied to marketing new technologies e.g. iPods, the Diffusion of Innovation bell curve (figure 2) has a clear correlation indicating that ‘each adopter’s willingness and ability to adopt an innovation depends on their awareness, interest, evaluation, trial and adoption’. Precisely what has been experienced over the years in promoting the use of the space management tool.
Figure 2 Everett Rogers (1962) diffusion of innovations http://en.wikipedia.org/wiki/Everett_Rogers
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In recent years these systems have developed a web-based capability allowing fast and easy access to spacerelated information (figure 3). The strategic intent for the implementation of web-based capability for the existing system was directed at seizing the opportunity to create an integrated space allocation and technical document management system across the North Metropolitan Health Service (NMHS) permitting Campus Facility Managers and others, appropriate levels of access to utilise the systems to their effective advantage. While evolving the integration of the systems, the NMHS also put the space management system to work assisting in the calculation of the ‘replacement capital value’ (RCV) compliance requirements for the State Auditor General. The cost in resources and time to calculate RCV for the NMHS sites was significantly reduced and completed in hours as opposed to weeks as previously experienced. This web-based tool proved invaluable in the early days of master planning of the Sir Charles Gairdner Hospital departments by providing objective information in space utilisation rather than the subjective ambit claims offered by some client departments. Heading towards practical completion of several
TECHNICAL PAPERS allocations and occupancy in Revit architecture.
Figure 4 Move Manager request sheet
projects the ‘Move Manager’ module (figure 4) is currently being populated in preparation of moves of staff and equipment into the new Cancer Centre and the PathWest buildings in early 2013 having had the base plans ‘polylined’ and posted to the space allocation system. Early preparation work is already being undertaken for the relocation of Princess Margaret Hospital for Children to the New Children’s Hospital in 2015. Several projects are currently being documented using BIM (Building Information Modelling), a quantum step in the design, construction and operation of buildings. (The Built Environment Industry Innovation Council, 2011) has the view that ‘BIM has macroeconomic significance; its accelerated widespread adoption would make a significant difference to national economic performance; and there is a compelling economic case for encouraging greater use of BIM in Australia’. BIM has been developed with differing levels of capability; 2D – two-dimensional plans, 3D – 3 dimensional, 4D – Time Planning (phasing/sequencing), 5D – Cost Planning (cost estimating) and 6D – Life Cycle Management i.e. owner/HFM use. It is the 6D level that now allows health facility professionals to easily
integrate data from such BIM designs into the web-based space allocation software i.e. no polylining of base plans is required saving time and resources, giving these users the benefit of the BIM data without the need to be BIM competent. Thus BIM integration enables space allocation users to connect BIM data from design, construction and renovation to facility management and operations and manage space management inventory,
The future Mental Health Unit at the QE2MC is the first project to be fully documented using BIM. The use of this tool permitted the user client to ‘walk through’ the building in 3D giving them a far greater appreciation of what was being designed from their brief. As the project only recently proceeded to tender in August 2012, an earlier decision to run a pilot project on the project’s BIM solution interfacing into the FM Interact space allocation system demonstrated impressive capability and the level of detail available (figure 5). The new central plant building took the unorthodox step of retrospectively documenting the building services component in BIM, an outcome of strategic expediency to construct the new central plant by October 2012 to permit construction of the New Children’s Hospital that is also being fully documented in BIM. Although BIM is being taken up by an increasing number of design consultants, the impact of the resultant product is not yet apparent in the operational environment. On this basis NMHS facility managers are cognizant of the tendency by some to consider this tool as a panacea for the ‘as constructed’ record and are implementing accordingly i.e. being selective in the level of data being utilised, mindful of the limited accessibility
Figure 5 Revit and FM Interact Integration - (BIM-FM)
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TECHNICAL PAPERS
Figure 6 - WEBFM data illustration
The ‘as constructed’ record including commissioning data is also being compiled by construction contractors using a web-based tool WEBFM (figure 6). In turn, this information is transferred from the supplied CD to the facility technical document management system.
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This document management system is structured typically as illustrated in figure 7, generally matching the structure of the WEBFM tool. Thus the as constructed record is easily retrieved by searching attributes and document type. Relevant information e.g. maintenance procedures are also incorporated into the works management system for ongoing maintenance planning.
to BIM by the lay Health Facility Manager or line manager.
TECHNICAL PAPERS
Powering Patient Safety
Factors to Consider when Configuring an Emergency Electrical System Kevin McKinney
Health care facilities are required to have adequate emergency standby power systems to protect patients and critical systems during utility outages. Industry and regulatory guidelines set minimum standards for emergency standby power systems used in healthcare facilities.
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owever, the way that individual hospitals configure and operate their standby power systems can be quite different. Depending on their size, location and willingness to embrace advanced technologies, hospitals can install a basic standby system, one with multiple redundancies or one that can actually generate savings on utilities bills. Recent examples show the range of possible emergency standby power solutions. Each of the following hospital installations have provided individualised emergency standby power systems that not only meet or exceed health care facility standards, but bring added benefits that improve economics or operational flexibility.
Consolidation and peak shaving Recognised as the region’s leading health care provider, The Medical Center of Columbus (Ga.) Regional Healthcare System is a 400-bed hospital that offers a comprehensive menu of medical services. Rather than add to its mix of existing standby generators – some that were over 30 years old – The Medical Center decided to replace all of them with a central power plant equipped with four new 2,500-kilowatt (kW) generator sets. Not only does the new central plant provide emergency standby power for all of the hospital’s current needs, but it also gives hospital personnel new flexibility in managing the power supply and utility
costs, while ensuring enough backup power to accommodate future growth. The new central plant, located across the street from the main hospital in a freestanding building, houses the new generator sets. With a total capacity of 10 megawatts (MW), the four units could provide the average power consumed by almost 1,000 homes with 200-amp service panels, according to Mark Smith, the hospital’s director of facilities management. Because of its mission-critical role, the hospital has provided for several layers of protection against power outages. For redundancy, the central energy plant is supplied by utility feeds from two separate substations. In the event that power from one utility feed is interrupted, power is automatically switched to the other utility feed. The standby generators get a signal to start if one of the utility feeds fails; however, if the second utility sources remain stable, the generators shut down and return to a standby state. A generator equipment failure won’t cause problems for what Smith describes as a “totally redundant” system. “If any piece of equipment in this plant fails, there’s a backup piece of equipment that will do its job,” he says. “So you’d actually have to have multiple failures before the plant wouldn’t operate.” The generator sets produce power at 12,470 volts, which enables them to connect and distribute at the incoming utility voltage. This allows more
A new central power building was constructed across the street from The Medical Center in Columbus, Ga., to house the four generator sets and paralleling switchgear.
economical power distribution to the rest of the campus, limiting losses from power transformation to that of the local load, thus increasing overall plant efficiency while lowering installation cost. The central energy plant has many advantages over the former collection of standby generators. For one thing, the new plant has the capacity to power all electrical loads in the hospital, not just critical and life-safety branches, says Smith. Among other things, this gives the hospital greater flexibility in managing power use and cost. At any given time, the facility can be totally on the power grid, partially on the grid, or totally off the grid, depending on the situation. Similarly, during the approach of a severe storm that might cause a power outage, the hospital can preemptively run its generators in parallel with the utility until the storm passes. The hospital has already done this once in the brief time the plant has been up and running. “We didn’t lose power in that case, but it was still worthwhile,” Smith says. “All you do is burn a few gallons of fuel, so there’s
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TECHNICAL PAPERS little cost involved. But the payback could be tremendous. If we did it 10 times and lost power just once, it would be well worth it.” The Medical Center’s new central power plant can also be put to use during extremely hot summer days, when power demand soars and utility rates jump. At such times, the hospital can run its backup generators to take some load off the grid and potentially save money on the cost of electricity. If the utility’s price for electricity is higher than the cost of generating power onsite, Smith flips the switch on the new power plant. As a result, during some recent hot periods, the hospital was able to save approximately $5,000 per day in power costs, Smith reports.
Four 2,500-kW generator sets provide standby power and load management functions for The Medical Center.
Capacity and natural disasters Halifax Health is the largest medical centre in east-central Florida, with 944 beds and 500 physicians representing 46 specialties. Founded as a small community hospital in 1928, it has steadily expanded over the decades, and is now consistently ranked in the top five percent of all medical centres in the country in clinical outcomes. When Halifax Health recently added the new, 10-story France Tower to the campus for inpatient and emergency treatment, it selected a 6-MW emergency standby power system. The France Tower contains one of the largest operating rooms on the East Coast in addition to a central energy plant that houses the new standby generators, boilers and chillers. Having a reliable standby power system is not only required by code but necessary as a practical matter, as this area of coastal
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Florida is hit frequently by hurricanes and thunderstorms that cause disruptions in grid power. “Summertime thunderstorms regularly wreak havoc with our local utility due to lightning strikes, but these outages tend to be of short duration,” says James Sawyer, electrical supervisor, Halifax Health. “However, there’s always the threat of bigger storms.” As testimony to the constantly looming danger, the new France Tower has been constructed to withstand a Category 5 storm, Sawyer says. “I’ve been at Halifax for 30 years, and haven’t found anything that Mother Nature can do that I can’t get around, re-feed and get the power going. I have a very high comfort level with the new units. No matter the type of power outage, we are there for the patient.” The power system for the France Tower consists of four 1,500-kW generator sets operating in parallel for a total capacity of 6 MW. The electrical loads are prioritised and segmented by up to eight closed-transition automatic transfer switches per generator set. When an outage occurs, all four generator sets start and assume the load when they are up to speed. If the control system detects that only two generator sets are needed to supply the loads, one generator will shut down for bus optimisation and fuel saving.
specialties as well as minimally invasive surgery and surgical robotics research. With a 120-year history of caring for the communities surrounding Hamilton, SJHH recently expanded its specialties with a new three-story surgical/perioperative tower. The tower’s 100,000-plus square feet of new construction and renovation features new surgical rooms, postanesthesia care beds, a day surgery centre and sterile-processing department. The sensitive electronic equipment in SJHH’s new unit requires sophisticated electrical backup power. The emergency power systems are designed to accept changes in loads with minimal voltage and frequency dips. This transient response, or ability to respond quickly to variations in loads, ensures that surgical procedures and patient safety will not be compromised in the event of a power failure. The power system consists of two 550-kW generator sets that meet the electrical requirements of the Canadian Standard Association’s CSA 282/32. This standard mandates that the units provide power at a steady state within three seconds after 75 percent of the load is applied. Each generator set is powered by a 12-cylinder engine designed specifically for power generation.
Varying institutions and needs
A 6-MW emergency backup system supplies all the power for the France Tower at Halifax Health.
Sophisticated and sensitive backup St. Joseph’s Healthcare Hamilton (SJHH) in Ontario, Canada, a teaching hospital affiliated with McMaster University, is known as a regional “centre of excellence” for a variety of surgical
THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
As health care institutions continue to grow, their emergency standby power needs will also grow and change. Based on evolving hospital design criteria and continuous attention to quality patient care, there will be a need for varying levels of sophistication in backup power systems. While every hospital has a similar mission to protect the safety and well being of its patients, each also has unique missions and core objectives that affect the design of its emergency standby power system. Kevin McKinney is a regional sales manager for MTU Onsite Energy, Mankato, Minn. He can be reached at: kevin.mckinney@mtu-online.com.
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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
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TECHNICAL PAPERS
Meaningful Alarms W. Evans I E. Haywood I C. Frankel I A. Johns Bentrol Pty. Ltd., Bendigo, VIC, Australia
Introduction
T
his paper describes the development and implementation of a building infrastructure alarm program intended for use by non-technical personnel. The program interacts with the Building Management System (BMS) and displays alarms in an ‘easy to glance at’ format. The choice of alarms to display on the alarm panel is configured by the infrastructure engineer and priority is via simple colour coding. The rationale for such development is described along with some of the technical details and examples of use. The alarm panel has been installed at Bendigo Health in three locations: engineering reception, BMS control room and telephone switch room (only activated after hours). Feedback was sought from users of the panel and their experience is described.
Rationale Raising alarms when something goes wrong with the monitored infrastructure of a building is fundamental to a BMS. Usually such alarms are displayed on BMS front-end computer screens and possibly printed out. Some alarms may be sent by SMS or set to dial a number of phone numbers until one is answered and a pre-recorded message is delivered. There are a number of commercially available products that profess to integrate with many BMS systems and convert alarms via a scheduler to ensure that the alarm is sent to the right person. In many major hospitals, there may be 24 hour maintenance staff available, but such staff, are not always in front of the BMS control screen and will be relying on pager or telephone contact for emergency issues. Daytime engineering staff are not always seated at the control screen and will need to be aware of emergencies in some other way. Additionally, the BMS alarms on the control room computer can be numerous and misleading, relying on substantial knowledge and expertise of the infrastructure and BMS system to determine if the fault is critical or can wait. In smaller establishments, the contact person for after-hours infrastructure emergencies (the ‘on call’ engineer) is often via a roster system and changes to the roster are frequent and can be untimely, for example too late to change details within an automated system. There may be a problem relying entirely on an automated system as there are a number of potential holes for such messages to fall though, such as non receipt of SMS or an answering machine receiving the automated message. Facilities large enough to warrant a 24 hour manned telephone switchboard with staff whose main task is to answer the telephone often also undertake to call the relevant person when
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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
an infrastructure emergency arises. They are easily informed of any changes to the on call roster, including last minute ones. Prior to using this software at the Bendigo Hospital, the switchboard had no idea of say a chiller breakdown on a hot summer’s night until numerous phone calls from medical staff raised awareness and only then can maintenance staff be called in. How much better would it be if such issues could be fixed prior to anyone noticing? Engineering reception and the telephone switchboard offices are always manned during the day and it seemed like a good idea to display critical infrastructure alarms in a format that did not require technical knowledge to interpret.
The Alarm Panel – some technical details Written in Delphi, a powerful object-oriented, visual programming environment from Embarcadero (http://www.embarcadero.com/) the program is currently set up for integration with the Sphere Facility System ™, but it is easily adaptable for others if access to the database is possible and information regarding the format of the data tables is available.
Figure 1 Opening screen
The system requires a computer with a network connection to the BMS computer and a display of adequate size to display the required alarm panel. The display needs to be always available so the computer should be either dedicated or have a dual screen system (for the case of a shared computer). Minimal computer power is required to manage the display. The alarm panel displays a matrix of rectangular ‘lights’ on the screen of the dedicated computer and are all the same colour for the ‘no alarm’ situation. Each light has several levels of
TECHNICAL PAPERS display and each level of each light can be linked to a BMS alarm. Lights are prioritised and are updated at a selected period. Alarms from the BMS are linked to a light and light level. Each light level can be programmed for linked alarm, an appropriate colour change when ON, displayed message and contact name.
alarms. Much work has been done to re-evaluate the BMS alarms; removing or re-configuring; to ensure that alarms raised do demand attention either immediately or can wait for a few hours.
The number of lights displayed and the number of levels for each light can be set up in the configuration section. The current version can provide several hundred lights depending on the resolution of the display. Each light can have up to 5 levels, providing support for thousands of alarms. In practice, the number of alarms (and levels) is restricted by the acceptable level of complexity of the display. Figure 2 shows a typical display for a 1920x1080 screen. It contains 102 lights with the first 50 of them programmed and there are 5 alarms active.
Figure 3 Display Contact Details
Configuring the panel Figure 2 Alarm screen displaying alarms
The design of the system was to provide a set of alarm displays with one light per piece of equipment and each level of that light linked (by colour) to a different alarm for that piece of equipment, for example ‘Light 23 might be programmed to represent a particular chiller with level 1 linked to ‘Chiller OFF’ (light goes red on alarm), level 2 linked to ‘Water too hot’ (yellow), etc. The use of colour is completely flexible and the user/ designer can program the light colours to represent any condition required. In each light level the message would describe the alarm in simple local terms as distinct from the message that may be programmed into the alarm by the BMS programmers for use by expert maintenance staff. For increased alert, a sound file is played once when the alarm is triggered, allowing the reception staff to be only within earshot rather than having to constantly check for a new alarm. Clicking on an alarm light, whether active or not will display the appropriate contact details for the staff member to call. Figure 3 shows the information format. The BMS implementation at the Bendigo Hospital contains many legacy alarms, some of which are spurious and could be misleading in terms of their importance and from plant items that are non vital. Anomalies of plant behaviour can usually be picked up during routine system checks instead of via critical
The alarm panel can be configured to suit any size screen being used. The maximum number of lights is indicated once the resolution is selected. Then the desired number of levels and lights to be placed on the screen can be modified. A typical installation with a 1920 X 1080 resolution display can hold a maximum of 102 lights. To add an alarm into the panel, firstly name the light e.g. Hyett Chiller 1 and then select the first level alarm using DP, Minicom and alarm number. Choose the colour of the alarm and whether it needs to be flashing when in alarm. Finally add the contact name and a description of the alarm to be displayed on the screen. The name of the alarm selected from the Facility database is also displayed to aid in selecting the correct alarm and writing a suitable description. All programming of the panel is done by selection of items from automatically loaded drop down displays. The colour-coded convention chosen for Bendigo Health is Red for critical alarms that require an immediate call out to the relevant maintenance staff or on-call engineer. Yellow represents an alarm for less critical plant. The overnight telephone switchboard staff will not respond immediately to a yellow alarm but will inform the on-call engineer if they happen to be calling about a more critical issue. The day engineering reception staff will respond to a yellow alarm by making an immediate call to the relevant maintenance staff. Purple is only used for an alarm indicating a failure of the air conditioning dedicated to the Picture Archiving and Communication System (PACS) server room. An immediate response is a phone call to Emergency
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TECHNICAL PAPERS
Figure 4 Alarm Configuration Screen
Department staff to open the doors to the PACS server and then to call maintenance staff.
How well does it work? The engineering receptionist who was working at the time of the alarm panel introduction thought it was an excellent idea. She “used to get 100s of calls” – a bit of an exaggeration, but many calls would be made by numerous staff reporting the same problem. The receptionist would then have to work out who to ring, or call the chief engineer, whereas the properly configured alarm panel can circumvent the engineer and enable direct calls to the person who can solve the problem. The advantages of this is that often the problem is resolved by timely alarm raising with the appropriate staff member before the medical staff even notice there is a problem. Positive feedback was also supplied by the current engineering receptionist who at times finds that the SMS message just has not reached the phone number programmed in and a call to the same number by her has elicited the response “that didn’t come up on my phone!” Another positive is the non intrusive but amusing “something’s wrong” audible alarm that prompts the receptionist or another member of staff in the office (who cannot see the screen) to look. The panel has improved the feedback from maintenance staff when they are undergoing routine work like changing a filter on an air handling unit or checking the medical air system. The maintenance staff are now aware of the responses by the engineering reception staff to alarms and have become much more disciplined in informing the reception staff BEFORE the
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alarm displays. Otherwise, calls are made to reception from medical staff will elicit an unnecessary response by the reception staff and a timely explanation to the medical staff is worth much in fostering collegiality and support. There was some resistance from the overnight telephone switchboard operators who felt that their workload was to be increased having to respond to the alarms displayed on the panel. However, they have now realised that their workload has indeed decreased since the problem often is fixed before they get hassled by multiple doctors & nurses reporting the problem.
Conclusions The use of this software has added a dimension to the effective management of alarms raised due to equipment failures. It is inexpensive to implement, provides an opportunity to fix problems before their effects cause serious issues and gives simple, immediate and dynamic guidance to monitoring staff. This paper has described the panel developed by Wally Evans in particular, with the help and support of the rest of the authors. We have witnessed first hand how useful this has been at The Bendigo Hospital and improvements to the panel, in particular to the configuration options have been effected as needed. Though the panel has been developed for integration with the Sphere system, as already stated it is a completely separate program and given access and knowledge of the database structure of other BMS systems, re-engineering the product is easily possible.
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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
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TECHNICAL PAPERS
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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
TECHNICAL PAPERS
Platinum Partner
Gold Partners
The Conference Dinner will be held on the Starship Sydney
CONFERENCE PROGRAM
CONFERENCE DINNER
This year’s Conference theme is ‘Planning for the Future’.
The Conference Dinner will be held on Conference Dinner Sponsored by the Starship Sydney, Australia’s largest and most contemporary glass cruise boat, giving all guests panoramic uninterrupted views of the harbour. Set over 3 levels with floor to ceiling glass and an open air top deck, Starship Sydney offers guests a unique experience.
Keynote Speakers include: • Anders Sorman-Nilsson, Futurist and Innovation Strategist •
Kathy Meleady, A/Director, Health System Planning and Investment, NSW Health
•
David Gates, Director, Strategic Procurement and Business Development, NSW Health Department
A Full Program is now available at www.HFMC2013.org.au
CONTACT THE EVENT ORGANISERS
SPONSORSHIP AND EXHIBITION OPPORTUNITIES Sponsoring or Exhibiting will provide an excellent opportunity to promote your organisation and to maintain a high profile within the Health Industry. To download the Sponsorship or Exhibition Brochures, visit www.HFMC2013.org.au
Iceberg Events Phone: 07 3876 4988 Email: admin@icebergevents.com.au THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
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IHEA Healthcare TECHNICAL PAPERS Facilities Management Conference 2013 9-12 October 2013 | Sheraton on the Park, 161 Elizabeth St, Sydney PLA
CONFERENCE PROGRAM
NG NNI
FOR
FUT E H T
URE
Day One: Wednesday, 9 October 2013 Morning
Optional Interactive Workshop
11.00am
Registration
12.00pm - 1.30pm
Welcome Lunch in Trade Area
1.30pm - 1.40pm
Conference Opening: Paul Wade, Conference MC
1.40pm - 1.50pm
IHEA President’s Welcome: Mitch Cadden
1.50pm - 2.00pm
Official Opening Address
2.00pm - 3.00pm
Keynote Address: Anders Sorman-Nilsson
3.00pm - 3.30pm
Afternoon Tea (plus Partner’s Afternoon Tea)
3.30pm - 4.00pm
ANZEX Delegate Presentation
4.00pm - 4.30pm
Conception to Delivery, The Journey of a Health Planner Rob Bampton, Senior Facility Planner, ACT Government Health Directorate
4.30pm - 4.40pm
Gold Sponsor Presentation: Armstrong World Industries
4.40pm - 4.50pm
Conference Session Conclude
4.50pm - 5.00pm
Group Photo Opportunity
5.30pm - 7.30pm
Welcome Reception / Trade Night - Sheraton on the Park
This session is proudly sponsored by
Dress: Smart Casual
Day Two: Thursday, 10 October 2013 8.00am
Registration
8.30am
Welcome and Housekeeping
8.40am - 9.40am
Keynote Address: Kathy Meleady, A/Director, Health System Planning and Investment, NSW Health
9.40am - 10.00am
Platinum Sponsor Presentation: Emerson Network Power
10.00am - 10.30am
Morning Tea
10.30am - 11.00am
Developing a Facility with Maintenance in Mind Narelle Turner, Project Director, Transfield Services
10.45am - 1.30pm
Partners Program - Sydney Opera House
11.00am - 11.20am
Lighting Upgrade Strategies for Health Facilities Jake Bugden, Managing Director, Sustainable Focus
11.20am - 11.40am
A Surgical Hospital, Should not be Built like an Ad-hoc Hotel! Marshall Glen Hall, Consultant – Healthcare Industry, Marshall Consulting
11.40am - 12.10pm
IHEA Annual General Meeting
12.10pm - 1.00pm
Lunch
1.00pm - 1.30pm
Managing Information from Building Systems for Efficiency Irina Lindquist, Solution Architect, Healthcare, Schneider Electric
1.30pm - 2.00pm
Lighting the Way Dean Farnsworth, Group Environmental Engineer, St John of God Health Care
2.00pm - 2.30pm
The Digitisation of the Built Environment - What it Means for Healthcare Facility Management Warwick Stannus, Group Engineering Manager, A.G. Coombs Group
2.30pm - 2.50pm
Unlocking Information In Your Hospital Paul Dearlove, Technical Director, IBMS Pty Ltd
2.50pm - 3.20pm
Afternoon Tea
3.20pm -4.20pm
Keynote Address: David Gates, Director, Strategic Procurement and Business Development, NSW Health Department
4.20pm - 4.30pm
Gold Sponsor Presentation
4.30pm
Conference Sessions Conclude Close
5.30pm
Bus to depart Sheraton on the Park
6.00pm - 11.30pm
Conference Dinner - Starship Sydney, departs from King Street Wharf 4
Dress: Formal
Continued over the page...
For more infoHOSPITAL visitENGINEER www.HFMC2013.org.au 52 THE AUSTRALIAN I JUNE 2013
Event hashtag: #HFMC13
IHEA Healthcare TECHNICAL PAPERS Facilities Management Conference 2013 9-12 October 2013 | Sheraton on the Park, 161 Elizabeth St, Sydney
PROGRAM (CONTINUED) Day Three: Friday, 11 October 2013 8.00am
Registration
8.30am
Welcome and Housekeeping
8.40am - 9.10am
Designing Today for Tomorrows Airborne Diseases Bill Drake, Technical Director, Sinclair Knight Merz & Annabel Frazer, Health Facility Planner, Sinclair Knight Merz
9.10am - 9.40am
Lift Based Evacuation and Hospitals of the Future Darryl Weinert, Associate Director, Fire & Risk, AECOM Australia
9.40am - 9.50am
Gold Sponsor Presentation
9.50am - 10.20am
Morning Tea
10.00am -11.30am
Partners Program - Rocks Walking Tour
10.20am - 10.50am
Campus Infrastructure Models Made Easy Elisa Knowlman, Senior Associate - Health, Peddle Thorp
10.50am - 11.20am
Planning for the Future: Meeting the Mission of Patient Care While Managing Your Energy Risk Jeffrey Staloch, Business Development Manager, EnerNOC
11.20am - 11.30am
Gold Sponsor Presentation
11.30am - 12.30pm
Lunch
12.30pm - 1.00pm
Planning for the Future Needs Robust Data Paul Cannons, Work Group Manager, Asset Management, Opus International Consultants
1.00pm - 1.30pm
Automated Guided Vehicles at Royal North Shore Hospital Oktay Gokce, Manager, Healthcare Systems, Lamson Concepts
1.30pm - 1.45pm
Conference Close and Exhibition Prize Draws
1.45pm - 3.30pm
Optional Technical Tours
6.00pm 6.30pm - 10.30pm
Bus to depart Sheraton on the Park Optional Social Dinner - Hard Rock CafĂŠ, Level 2/2-10 Darling Drive, Sydney
Dress: Smart Casual
Day Four: Saturday, 12 October 2013 9.00am - 3.00pm
Optional Social Day Activity - Fort Denison
Please note: This program is subject to change without notice. Please visit www.HFMC2013.org.au to view the most up to date program.
Platinum Partner
Conference Dinner Sponsored by
Gold Partners
CONFERENCE DINNER - STARSHIP SYDNEY
The Conference Dinner (included in the Full Registration) will be held on Thursday, 10 October on the Starship Sydney, Australia's largest and most contemporary glass cruise boat. Guests will enjoy panoramic uninterrupted views of the harbour. Set over 3 separate levels with 3m high floor to ceiling glass and an open air top deck, Starship Sydney offers guests a unique entertaining experience.
For more info visit www.HFMC2013.org.au
Event hashtag: #HFMC13 53
THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
WESTERN AUSTRALIA BRANCH ANNUAL STATE CONFERENCE
“Technology in Health Today” Friday 13th September 2013 Pan Pacific Hotel 207 AdelaideTerrace Corner Hill Street, Perth
Annual State Conference a Certified Health Care Facility Manager (CHCFM) development opportunity.
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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
www.ihea.org.au
TECHNICAL PAPERS
How to design maximum efficiency into your hospital’s infrastructure Integrating all your systems delivers savings and improves care Draw on the experience of a specialist Whether you are designing a new hospital or expanding an existing one, you are under mounting pressure to do more with less – to create an environment that fosters quality care, patient safety and staff productivity while controlling costs and eliminating waste. It’s a significant challenge – and one that healthcare facilities worldwide are meeting with infrastructure solutions by Schneider Electric. Our EcoStruxure™ architecture integrates all of your hospital’s systems into a single, cohesive network. Now you can see and manage your entire infrastructure from one dashboard, maximising control and saving time. By eliminating energy waste, EcoStruxure solutions free up trapped capital, allowing you to improve margins, advance care and enhance the patient experience.
A better hospital from design to operation As part of your core design team, Schneider Electric ensures that your initial efficiency specifications never get lost in the design/build process. Our Certified Energy Architect for Healthcare keeps everyone on track to meet or exceed your efficiency targets – from the architect and technology providers, to the construction manager, integrators and installers. And because our solutions are open and scalable, they can grow as your hospital grows, maximising your investment.
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©2013 Schneider Electric. All Rights Reserved. All trademarks are owned by Schneider Electric Industries SAS or its affiliated companies. • www.schneider-electric.com • 998-3775_AU CLIPCOM 26534
THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
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TECHNICAL PAPERS
Planning and Design for Hospitals Belongs to Lean Equation Engineering, Architecture, Construction Professional Development and Global Navigation
Mary Maher I University of Wisconsin – Maddison Engineering Department
Hospital Lean Equation “Designers and planners are master integrators. They can be catalysts for thinking clearly about what a healthcare space actually needs to do.”
W. Brent Peterson, HGA, Milwaukee, Workshop Speaker
Planning and Design for Hospitals Belongs to Lean Equation The business of healthcare in the United States today faces the challenge of change on many fronts. Care delivery and reimbursements are evolving. Technology and medical advances are altering patient expectations. And the healthcare marketplace is dynamic with competition. Hospital organisations must take a critical look at every aspect of how they meet or exceed standards of care and stay solvent when they do. Physical environment is a critical component of healthcare delivery. It affects patient satisfaction and worker performance. Increasingly, the thinking behind design of patient rooms and surgical suites and the engineering of spaces that support efficient workflow patterns is that they are integral to the success of a hospital – now and in the future. One approach applies the tools of “Lean thinking” to the equation, creating value by increasing the quality and efficiency of care at a lower cost.
Workshop Explores Effective Solutions A recent workshop, presented by the Healthcare Facility Planning Group of Engineering Professional Development at the University of Wisconsin – Madison, brought together experts who explored the impact of physical environment on patients and healthcare workers. They discussed how facility designers and planners can educate themselves to provide healthcare customers with valid, real-world solutions.
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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
Among the speakers for Planning and Designing Hospitals for Optimal Performance was W. Brent Peterson, Vice President with the Milwaukee-based architecture, engineering, and planning firm Hamel, Green and Abrahamson (HGA). Peterson is a process engineer who uses Lean design principles in his work with healthcare organisations, helping them rethink how people, technology, processes, and space intersect. At the workshop, he plans to examine strategies for designing environments that sustain quality care while helping to reduce waste and maximise efficiency. “For me, the approach starts with asking whether the expectation on a project is to support existing processes by changing the space, to preserve the physical environment by modifying processes, or to dig deeper and evaluate what’s good about both variables,” Peterson says. Supporting questionable current processes limits how Lean a design can be, he points out, so it becomes an issue of the philosophy inside the walls of an organisation. “Does the organisation think every day about how to eliminate waste, manage costs, deliver quality, increase safety, and improve morale? If not, what can they do to get there?” He does see an important role for design to play given that space is one of four key elements – along with people, processes, and technology – that affect how an organisation operates in a Lean way. It takes all these elements, working in concert, to create a high-performing building. Peterson describes his method of negotiating these relationships as a kind of timeline survey of past, present, and future. He starts by drawing benchmarks from past projects. Next he takes a snapshot of what works and what does not work in the present. He then focuses on what the future holds for healthcare, the changing demands of the customer, and market-specific attributes of the organisation.
Challenge Assumptions Research that unearths measurable insights about the needs and wants of the customer aligned with the goals of the organisation is the basis for weighing the value of each process and design solution. In talking about how he gathers information in the pre-design stage, Peterson asks, “Are we here to meet current operational assumptions or, as a team, challenge them?” He engages people at the executive level of an organisation first to hear what they envision. From there, the engagement moves deeper into the organisation. Peterson gives the example of a current project where the customer told him they wanted their organisation to be the epitome of “experientially superlative, operationally efficient, and flexible for the future.” Incorporating those terms into questions for groups of patients, family members, staff members, and other stakeholders, his team listened to the “voice of the customer” and identified where to make significant changes in the organisation’s care model. Those changes include streamlining a pre-examination process, eliminating repeated testing, and reengineering the examination rooms. The result saves everyone’s time, improves communication between patient and provider, and helps the organisation reallocate resources to the most value-added activities. The findings in this case illustrate a close relationship between work processes and physical space. Facility design depends on planners and designers going beyond a building program that outlines adjacency requirements and, in some cases, spatial characteristics, to understand the activities that take place in a hospital and the spaces that can best support those activities.
TECHNICAL PAPERS Do you really know all the costs of running your laundry? ElEctrolux laundry SyStEmS uSES lESS powEr and watEr than othEr waShEr ExtractorS The Danish Energy Association invited 5 leading suppliers Electrolux, Ipso, Meile, Primus and Schutless to participate in the consumption data study. The Association then staged the independent testing of commercial Washer Extractors from the five suppliers in accordance with established industry standards and these are the results: The Electrolux machine uses: • 19% less power consumption than the average • 35% less water consumption that the average The test examined independently verified and uniform consumption and performance data in accordance with EN IEC 60445 – the basis for European energy marking systems for domestic washing machines. The Electrolux machine tested was the W465H Economy Washer Extractor, examined on two program settings Wash (3A03) and Economy (3A01). All other suppliers submitted a like sized machine for testing. Its official – the Electrolux machines consume less water and power than other leading brands. Electrolux environmental considerations don’t stop with water and energy efficient machines... All Electrolux commercial laundry products are manufactured to ISO14001 Environmental Management Standard that incorporates materials composition, environmental impact during manufacturing process, recycling, packaging, distribution and environmental safety.
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It is important that all organisations involved in hospital planning or design allocate time and money for research and planning. By gathering and applying evidence-based data, studying trends in healthcare, and incorporating what they learn into building a better hospital, design firms can add competitive strength. Peterson suggests several approaches besides having a Lean expert in house. He sometimes collaborates with a customer’s internal resources skilled in Lean methods. Another outlet is teaming up with an independent consultant versed in Lean and with experience in the healthcare sector. “One of the major failures in design is the hand-off between one content expert and another,” says Peterson. “However planners and designers educate themselves, they have to be proficient enough to internalise the value proposition of the culture, processes, and technology plan so they can use their talents to create a high-performing hospital environment that achieves the customer’s vision.”
Authors Note: This material is based upon work supported by the University of Wisconsin – Madison. It is for general information and distribution and not intended to provide specific solutions or advice for specific circumstances, which should be sought from appropriate professionals.
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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
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TECHNICAL PAPERS
UVC lights the way to improved healthcare and reduced costs Hillary Spicer I E-CO UK
Last month, the Sunday Express claimed compensation for victims of healthcare associated infections (HCAIs) has topped £10m in the past two years. Arguments surround this data, but what is becoming increasingly clear is that attention on infection rates, and how the NHS is managing infection control, remains significantly high and on the increase. HILLARY SPICER, founder and director of E-CO UK discussed the effect air conditioning systems may be having on these figures.
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Hospital trusts have made great strides in tackling infection control, but while the emphasis has largely remained on cleanliness of internal surfaces for breaking the chain of airborne transmission, there is a lack of acknowledgment of transmission through ventilation and air-conditioning systems, despite mounting evidence indicating a higher risk in spreading airborne infections. Air quality in many buildings, including healthcare facilities, is worryingly poor and typically twice as polluted as it is outdoors. HCAIs are not just transmitted through cross-contamination via hard surfaces and floors, but also by airborne germs, through sneezing, and by round-the-clock movement of visitors, patients and staff as they are drawn into and distributed by heating, ventilation and air-conditioning (HVAC) systems. Hospital patients are typically much more susceptible to contracting infections due to diminished, disabled or compromised immune systems, and the ventilation systems in healthcare facilities are simply helping to further spread bacteria and infections. To effectively tackle HCAIs, it is imperative that NHS trusts decontaminate the whole environment continuously 24/7 and not just periodically, as they do now. This can be easily achieved by harnessing readily available Ultra Violet Germicidal Irradiation (UVGI) technology. Commonly used in hospital and commercial buildings across the USA, this simple technology retrofits into existing heating, ventilation and air conditioning systems. It significantly improves indoor air quality and reduces healthcare associated infections for patients and NHS professionals. It achieves this by destroying thousands of airborne contaminants including fungal pathogens, viruses like Norovirus, that closes so
TECHNICAL PAPERS many wards and results in cancelled operations, and bacteria such as MRSA, C.difficile and Ventilator Associated Pneumonia etc, regardless of type or virulence. Indoor air quality is taken far more seriously across the world. During the SARs outbreak in 2003, the Chinese government standardised UVC technology for all public building and transportation systems because it is proven to intercept and kill viruses and bacteria before they infect people. But the UK has failed to follow suit. It seems to be a case of ‘out of sight, out of mind’ as the NHS has largely failed to tackle the questionable quality of air in hospitals and the spread of infection through ventilation systems. Research into the links is readily available. I have followed closely the work of Dr Ghasson Shabha, senior lecturer at the Birmingham School of the Built Environment. He has published extensively his findings on the link between unclean air conditioning systems and the spread of HCAIs and he believes it comes down to a change of culture. He has said: “MRSA is a frequent component of hospital dust which can easily circulate through the air supply and return via ventilation systems, and this poses a major risk of cross infection. The current short-term vision for tackling HCAIs will always
backfire and this strategy is at the detriment of patient safety. The loss of one life is too many when you consider the hazardous conditions posed by dirty ducting and AHU and grills.” Perhaps, as well as culture, there is a concern over costs. But this technology could, in fact, provide critical cost savings in other areas. Hospitals and healthcare facilities are the second most energy-intensive building sectors in the UK, open 24 hours a day and with an extra commitment on air filtration and circulation and air cooling. Energy savings should be a top priority for the NHS and UVC technology delivers a second major benefit reducing energy consumption of HVAC systems by 15-20%, as well as significantly reducing HVAC maintenance costs. A trial with an NHS trust, where UVC light emitters were fitted into an existing HVAC system, showed a return on investment in just one year on energy savings alone. The results speak for themselves and I believe these systems should be installed in every air conditioning unit in every building in the UK. The technology and products are tried and tested and available to help, not only in the fight against HCAIs, but to reduce operating costs. NHS trusts simply cannot afford to continue ignoring this costly issue. With 2013 being the European Year of Air, there’s never a better time to address it.
ams Laboratories’ scientific standing and expertise make the company a most valuable resource as both an analytical laboratory and as consultants. Using internationally approved methods, standards, equipment and guidelines, ams Laboratories is NATA accredited, TGA licensed and registered with the FDA. ams Laboratories offers microbiological analysis, consultancy and training services which include:
• Air monitoring of Operating Theatre and Clean Room environments • In-house cleaning effectiveness studies (disinfectant & sanitiser qualification) • Microbiological evaluation of water systems (including Legionella testing) • Cytotoxicity studies (medical devices) • Sterility & Endotoxin (dialysis fluids) testing ams Laboratories – Sydney 8 Rachael Close, Silverwater NSW 2128 Ph: 02 9704 2300
www.amslabs.com.au info@amslabs.com.au
ams Laboratories – Brisbane 2/120 Bluestone Circuit, Seventeen Mile Rocks QLD 4073 Ph: 07 3295 0550
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TECHNICAL PAPERS
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Waste Management in India India | Lucknow Hospital Recognised for Cutting-Edge Medical Waste Work
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ndia – The King George’s Medical University (KGMU) received a Special Recognition Award from UNDP/GEF Global Healthcare Waste Management Project, Health Care Without Harm and the World Health Organisation recognising the outstanding work of KGMU medical staff in transforming the hospital over two and a half years from an institution without any effective waste management program into a regional model institution for sound biomedical waste management practices. The award was accepted by Dr. Kirti Srivastava and the Nodal Officers of the Bio-Medical Waste Management Committee of King George’s Medical University. It was presented during the national dissemination work of the UNDP project, funded by the Global Environment Facility, titled ‘Global Healthcare Waste Management.’ The seven country project supports initiatives to create model bio-medical waste management programs in hospitals and healthcare institutions in seven countries including Argentina, India, Latvia, Lebanon, Philippines, Senegal and Vietnam. The Special Recognition Award was presented by Jack Weinberg, Senior Policy Advisor, UNDP Global Healthcare Waste Management Project and Mrs. Payden, World Health Organisation South East Asia Regional Office. The Global project singled out KGMU to receive special recognition. “This project worked with many hospitals and healthcare facilities in seven countries,” said Jack Weinberg, Senior Advisor to the Global Project Team. “KGMU and its medical staff stood out for their deep dedication and the great challenges they overcame to create a state-of-the-art, sustainable model institution for sound biomedical waste management practices.”
The project is implemented by UNDP with funding from the Global Environment Facility. It is supported by the World Health Organisation and the international NGO, Healthcare Without Harm. The Indian component of the project is executed by the Government of India, Ministry of Environment and Forests. According to Dr. Subba Rao, Director, Hazardous Substance Management Division, Ministry of Environment and Forests, Government of India, “The Ministry of Environment and Forests applauds the transformation of KGMU’s hospital into a regional resource centre and model that can support efforts to implement sound bio-medical waste management practices across northern India.” “Good bio-medical waste management practices are necessary to prevent the spread of infectious diseases and to protect patients, hospital staff and the community at large,” said Mrs. Payden, Regional Advisor, World Health Organisation, South East Asia Regional Office. “WHO is proud to support this award to Dr. Kirti and the Nodal Officers.” A national dissemination workshop of the UNDP-GEF implemented health care waste management project titled ‘Demonstrating and Promoting Best Techniques and Practices for Reducing Health Care Waste to Avoid Environmental Releases of Dioxins and Furans and mercury reduction’ is being organised by KGMU on 5 March 2013. This workshop was attended by delegates from UNDP, WHO, MoEF and other organisations. When project activities started at KGMU in 2010, the hospital had no systematic bio-medical waste management program in place. Funds were not available for adequate waste management supplies. Medical professionals and the paramedical staff generally considered the handling of infectious waste to be the responsibility of sweepers and waste handlers who lacked necessary training
and protective equipment. Bags and bins containing infectious wastes were often not well-controlled and were routinely opened so that potentially recyclable materials could be removed and later sold. All waste from the hospital complex was then incinerated or dumped into an open pit, a situation common at most healthcare facilities across India. After two and a half years of intensive effort, the situation in the hospital has been completely transformed and KGMU is now internationally recognised as a model institution for sound healthcare waste management practices. Bio-medical wastes are routinely segregated from other wastes at the point of generation thereby reducing potentially infectious wastes by more than 80 percent. This waste is then sterilised using a steam autoclave, permitting safe recycling which produces a revenue stream for the hospital. Biomedical waste is no longer incinerated, thereby minimising emissions of hazardous air pollutants. Expressing satisfaction at the award, Chief Guest, Shri J.P. Sharma pointed to the importance of implementing this model across the state. The Honourable Vice Chancellor Prof D.K. Gupta “Congratulated the whole team of bio-medical waste management committee for the commendable work they have done to transform the waste management system in the institution.” The Honourable Vice Chancellor, the Dean of Faculty, the Registrar, the Medical Superintendents and the administration of KGMU have all been supportive throughout the implementation of the project,” said Dr. Kirti Srivastava. “They have agreed to devote necessary funds to continue the KGMU’s bio-medical waste program following the end of the project and to retain the staff and training programs needed to sustain it.” Source: UNDP Website
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INTERNATIONAL
What does Climate Change have to do with Health Care? Gary Cohen I Co-Founder and President, Health Care without Harm
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n the last six months, we have witnessed Superstorm Sandy flooding New York City, New Jersey and surrounding areas, a massive Midwest drought impacting 40% of the US corn crop, and unprecedented air pollution from burning fossil fuels that forced Chinese authorities to tell Beijing residents to stay in their homes. When we think about climate change, we are no longer thinking about polar bears stranded on melting ice caps. Climate chaos has come home and its impacts are being felt all around the world. What health scientists are telling us is that climate change will bring increased asthma, more virulent allergens, and medical emergencies from heat stress, the spread of water- and vector-borne diseases and increased severe weather events. The Lancet, Britain’s
premier health journal, calls climate change “the biggest global health threat of the 21st century.” Given these dire warnings, one would expect that the healthcare sector would be prepared for the coming public health storm. Nothing could be further from the truth. When Hurricane Katrina hit New Orleans, the hospitals were completely flooded along with everyone else. But because they all had their electrical equipment as well as their back-up generators in the basement,, they lost all power. And because none of the windows in the hospital were operable, hospital staff had to break all the windows in the hospitals’ upper floors to get air into the facility. Five years later during Hurricane Sandy, a similar story occurred. Both Bellevue Hospital and New York Langone Medical Center had to be evacuated because all their electrical systems were in the basement. At NYU Langone, millions of dollars of medical research specimens were destroyed because of lack of consistent refrigeration. It took Bellevue more than ten weeks to clean up the mess and reopen its doors to patients. We are learning the hard way that the healthcare sector understands and ability to respond to climate change is still in a primitive stage of development. What, then, should the role of healthcare be in dealing with climate change? First, hospitals need to focus on preparedness and resilience in their design and operations so they can be critical players in responding to extreme weather events, rather than being one of the victims. Spaulding Rehabilitation Hospital in Boston is one example of a hospital that has taken the reality of climate change to heart. The hospital, which is scheduled to open in April 2013, employs on-site power generation, operable windows to provide natural ventilation and has put all the mechanical/electrical equipment on the roof of the facility. These innovations are part of the overall business strategy of Partners Healthcare (Spaulding’s owner) which has added climate change to its top “business risks” category. The second critical role for health care should be to model the transition to a post-fossil fuel economy. In the U.S., health care represents 18% of the entire GDP, and is likely to increase to more than 20% when health care reform is in full swing. In other industrialised countries, health care represents 10% of the economy. Given its enormous economic clout and its healing mission, health care is well positioned to “model” the transition away from our
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HEA addiction to fossil fuels, which not only contributes to global climate change but also has local pollution and public health impacts. Reliance on coal, for example, contributes dramatically to increased asthma and respiratory diseases while fracking for natural gas contaminates local groundwater and vents toxic chemicals into the community air. Health care has a mission-related imperative to lower its own extensive carbon footprint and lead the effort to a secure and sustainable energy economy. Reducing hospital dependence on fossil fuel energy through conservation efforts improves resilience – the less energy that hospitals require, the longer they can operate during and after extreme weather events. An alternative source of power independent from the electrical grid also helps in weather emergencies; while all hospitals have diesel generators, much of this infrastructure has proven to be vulnerable and inadequate for prolonged grid outages.
During Sandy, hospitals that had on-site power generation continued to provide critical care to their patients, and offered safe haven for those hospital patients that were evacuated from flooded areas. Known as co-generation (or Combined Heat and Power), this technology not only dramatically improves the hospital’s energy efficiency and saves money, but it also turns out to be a critical climate resiliency strategy. Kiowa County Hospital, destroyed by a massive category 5 tornado in 2007 that damaged 95 percent of the town of Greensburg, Kansas, has been reconstructed with a 100 percent renewable wind energy system. According to FEMA, renewable energy infrastructure has performed well in extreme weather events, demonstrating that sustainable design and increased resilience go hand in hand.
The third central role of the health care sector is in education and advocacy around climate change policy. Health care professionals, especially doctors and nurses, enjoy an unprecedented role as positive messengers for health in society. As we begin to calculate the enormous health care and social costs of climate change, health care professionals are in a position to educate their patients about the public health impacts of climate change and help prepare them for these impacts, and also become potent spokespersons for policies at all levels of government that would rein in climate change. As Margaret Chan, director general of the World Health Organisation, has stated, “the health sector must add its voice – loud and clear – and fight to place health issues at the centre of the climate agenda. We have compelling reasons for doing so. Climate change will affect, in profoundly adverse ways, some of the most fundamental determinants of health: food, air, and water.”
PIT
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Climate change will bring us many more heat waves, hurricanes and droughts in the years to come. We need to engage the health care sector in climate change mitigation so they can help communities be prepared to weather these crises and help lead us to a healthier and more sustainable future. Who else is going to play this role?
HE AL TH
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Let’s keep it Simple Andrew Smyth
When the call came out for abstracts with the theme being Back to Basics my first thought was what a great theme. When the last requests came out I thought “Keep it Simple” would be a good topic, having worked in some of the most remote areas in Australia where it was necessary to keep things simple for many reasons. When I was accepted for the presentation it was a bit of a shock and thinking seriously about the subject, keeping it simple is very difficult to put into words.
H
ow do you explain what you mean, in fact what does simple mean, looking in the dictionary there were more meanings than John Farnham’s comebacks so I settled for the following: • Having or composed of only one thing, element, or part. Not involved or complicated; • Easy: a simple task. • Being without additions or modifications; • Mere: a simple yes or no.” Having gone over this a few times I concluded that simple is difficult. Hard to do, demanding considerable effort or skill to achieve. Really if anyone tells you its simple, it’s not, its challenging and arduous, the trick is to let them think it’s simple. A friend of mine in Scotland started his career as a grave digger and ended up as an undertaker. I asked him how things were going in the business, he said it was challenging and at times traumatic and confronting, however the funny times helped him cope. He was in the local one night talking to the barman, the barman asked why he was looking so glum he said he was an undertaker and supposed to look glum! The barman said surely in your job it must get you down? How hard is the job, he replied in most cases it’s simple and routine, the barman asked for an example:
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He said that one day a few weeks before they collected a lady who had died from a massive heart attack while doing the hokey cokey dance at the local Salvation Army social night. When they got her back to the parlour, they got her ready and were about to place her in the casket, well he said, “we got the left leg in” and that’s when the problems started. It kind of puts it in perspective just when you think a simple process is covered, it proves to be very difficult. I find it difficult to explain the word “simple” myself and so instead will apply it to my experiences in the Kimberley and other regional areas I have been responsible for and the challenges that had to be over come in order to ensure continuity of services to our customers. I arrived in Western Australia in 1978 and was fortunate enough to gain employment in the health services, as a shift engineer at Fremantle Hospital. At that time the hospital was in a state of transition, rapidly expanding, from what one would call a community hospital to one similar to a large metropolitan hospital. Life was simple then, no computers, no mobile phones, no building management systems, no engineering management systems, we did not need them and everything worked fine with a large component of skilled engineering staff. In the early days when we all had dark hair or in some cases “hair” and our own teeth, the role was more practical with
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hands on approach and the emphasis being on continuity of service to the hospital in regard to the maintenance of the assets. This was not always easy, given the financial constraints and lack of suitable resources and in most cases we had to rely on the skills of the Hospital Engineer. In the mid to late 80s cost cutting initiatives were introduced and many health establishments began to out-source non core services. The role of the hospital Engineer began changing at a somewhat rapid rate and to a certain extent still is. This was a difficult time for all concerned as we had to learn new skills, such as computerised systems and most of us, if we are honest with ourselves, at the time did not trust computers to manage our plant and job and this along with things like the integration of planning and management of a wide range of services both hard (e.g. building fabric) and soft (e.g. catering, security, health and safety) with the drive being to achieve better quality and economies of scale, indeed the role of the humble hospital engineer had swung 380 degrees. Life was not so simple now. Having been away from health for a number of years, working in the private sector I came back to work for the Country Health Service which is the biggest Area Health Service in Western Australia, and the largest in country Australia. It services an area of some 2.55 million square kilometres with a combined regional
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TOPICS OF INTEREST population of 454,000 people (almost a third of the State’s population), including 44,900 Aboriginal people (around 10% of the State’s total population). In my 10 years working with WACHS I have been fortunate enough to work in some of the most remote areas of Western Australia, however, the one region that gave me the most challenges and heartache but also a great deal of satisfaction, was the Kimberley. The Kimberley region covers an area of some 424,517 square kilometres, almost twice the size of Victoria and approximately 3 times the size of the UK. This region consists of 5 hospitals, 17 Aboriginal Community clinics and a number of nursing posts. All of the Hospitals had been developed at varied intervals and extended as the demands of the communities dictated. Distance and isolation have held the Kimberley in a vacuum. The Kimberley was truly like the Wild West, no one liked change, they did everything the “Kimberley way” and certainly were not interested in a Southerner coming into their domain and telling them what to do. It was a bit of a shock to the system but at the same time was exciting and challenging.
Resistance It did not take me too long to break down the pack and leaders and started to work with them to take the necessary steps forward as a team and my first thoughts were better keep any changes etc, “SIMPLE” all very well in theory, but in practice this was not quite as “SIMPLE” as first thought. • I had to have a plan, a “SIMPLE” plan, in place to make the changes that were necessary for us to service our hospitals and communities. Simple....... • Check the engineering works management system and go through the schedules, this will give me a picture of what is being done. Wrong.......
• There was no management system in place. OK let’s see the card system, Simple....... Wrong....... • There were no systems in place other than a spread sheet, how do you manage the work? The answer was SIMPLE “we don’t”. Who manages the work? • Answer, we do, and they went on to tell me that they run the engineering and that they spit engineers out and they would give me 3 months, I ended up working 8 years in the Kimberley’s. What about the mandatory maintenance? • Answer, we don’t worry about that unless we have to? This was indeed a challenge and put a different tack on how I had to approach this so I worked on some very “Simple” practices: 1. I had to gain their trust and set some examples to the staff. 2. E stablish rules. 3. S et parameters, guidelines and discipline 4. E ndeavour to get respect back into the department. I achieved this by using some very basic and simple practices, such as: • Separating the leaders and trouble makers. • Introduce team meetings and provide staff with an opportunity to air their grievances and have input into how we manage our business. • Contact the Maintenance officers and Remo’s in the other districts and meet with them and their staff. This was the fist time any of the Maintenance Officers had any contact from the Engineer in years. • That was the first of many phases, then I had to establish a good rapore with the management and staff throughout the Kimberley and probably the simplest of all but something that we don’t use enough of is “COMMUNICATION”. One thing that struck me was that the Remo’s did not get the support they
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deserved and were more or less left to their own devices. I then went on bush trips with Remo’s in the eastern and western Kimberley, during these trips I worked on building up a relationship with the communities, the elders and the community management, this happened over a two year period and involved travelling many thousands of kilometres. During my trips with the Remo’s I worked with them in the course of their duties, not only did this give me an appreciation for their skills and the type of work they did in some of the most isolated communities in Australia, but also allowed me to get a good understanding of the difficulties of working and living in such harsh conditions. I also worked on building up trust with the contractors from all over the Kimberley’s and this proved to be very beneficial during the 8 years I was there. Keeping it “SIMPLE” getting back to basics and teamwork through “SIMPLE” processes made huge progress for our staff and customers. In 2004 plans were afoot to upgrade many of the hospitals and community clinics. New hospitals were built in Broome, Derby, Fitzroy Crossing and Halls Creek and major upgrades occurred in Wyndham and Kununurra Hospitals and new clinics were built in Ommbulgurie, Kalumburu and Balgo, upgrades to Looma, Wankatjunka, and others all within a period of 3 years When the design development was being carried out, a lot of thought and input from the consultants and architects was made in regard to the upgrade of the infrastructure, plant selection etc, and yes keep it “simple” was the brief. The consultants were (and rightly so) looking at good, efficient and sustainable options. It was decided that we stick to what we knew and what the staff were familiar with. Distance and isolation were the main drivers in this and created a very challenging exercise for the architects and consultants.
TOPICS OF INTEREST To digress a little: The role of the country facility manager is to provide effective facilities management, combining both resources and activities, which are as vital in the country areas as they are in the metropolitan area. Both contribute to the delivery of strategic and operational objectives. Much the same as the city, but we have to consider the other important issues, in particular, where we service remote communities. This is an area that our city colleagues don’t need to think about, however we in the bush do, and it is necessary to look at the big picture when serving our indigenous communities. During the many projects that were being carried out the, engineering consultants gave due consideration to installing plant and equipment that the in-house staff and local contractors could be comfortably trained to service. To the credit of all concerned, a great deal of thought was given in this regard by the consultants who by looking at the projects in a practical sense gave due consideration to the brief in respect to standardisation of the plant across the board. We are all aware of the constant change and pressure we are under, in particular to: Asset management • Reducing maintenance costs while endeavouring to continue with continuity of service • Stock control • Maintenance forecasting • Planned Maintenance • Task Frequency i.e. calibration validations etc • JSA’s • OHS • Project forward estimates • Minor Capital works scheduling budgeting • Managing the different cost centres and budgets
• Waste management
• Lack of skilled contractors in the region
• Clinical waste
Why • Would you put a in piece of plant and equipment that cannot be locally serviced?
• Monthly and quarterly reports for our regional directors • Monthly report for clinical and financial managers • MCW reports • If that’s not enough we have to plan for the next ACHS surveys • Why we needed Upgrade emergency procedures • Update the Business continuity plans and test the same • Review ACHS?
Engineers Indeed the role has changed and has more challenges than ever. This is the difference between the metropolitan engineers and country facility managers. In the metro areas they have the benefit of more staff, contractors, fellow engineers and facility managers that they can bounce off, not only to discuss issues, but also the ability to network locally and attend the monthly institute meetings where there is the opportunity to raise any issues with their counterparts. Where as the humble country FM is a one man band, yes we do have other FM’s and yes we do have an FM network that I must admit could be used more effectively, however, to be honest, the problems and issues we have differ greatly from region to region and our work load is such that we do not have the time to chase around. While in the Kimberley and given the adverse extremities of the wet and dry, even the simplest tasks had to be worked through. Maintenance Logistics Cultural considerations For this reason we must endeavour to keep our processes simple and straight forward for the following reasons:
• Why would we select a plant item that requires specialist servicing? • Why use a selection of equipment that for normal servicing would require specialist technicians from Perth or in some cases from the eastern states to carry out the servicing? These were the challenges faced by Health, Architects, and consultants, how do we meet the brief and achieve good sustainable outcomes, easy, keep it simple, how we do this in such a remote region: • We looked at some of the issues and lessons learned from the past, a good example is a sophisticated, electronic, fire alarm and security system that had been installed in a remote clinic. This was at the request of the Commonwealth who were partially funding the project, all very well but when the nearest Fire and Police station was a 5 hour drive away....... • Solution simple all new remote clinics fire alarms and security systems were directed to the nurse quarters and community wardens,or in the case where a Police station was in the community to the Police. • Many of the remote clinics and hospitals had a mix of air conditioning, these were also great targets for prospective spear throwers “solution simple” we caged and standardised the air conditioning systems across the region. • And trained the remote Engineering Maintenance officers in the servicing and installation of the units. • Not to install BMS systems or controls in remote clinics “solution simple” increase the maintenance visits to all remote nursing stations and supply cheat sheets to enable the nurses to self diagnose the problems and advice maintenance. Simple is easy said, can be difficult to achieve so.......
• Tracking budgets and projects
• Work load
• Tracking of budget spend by cost centre & asset type
• Day to day fire fighting • Lack of skilled staff
Ladies and gentlemen to conclude:
Then we have the reporting: • Energy
• Distance
• Water Management
You put your left leg in....... and....... that’s what it’s all about.
• Availability of parts
• Logistics
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Nurturing a Hospital Engineer Kevin Tan, BEng (Hons), M.I.H.E.A
Abstract
A
s the population is growing older with health advancement, and consequentially sicker, there is more reliance on a hospital. As a result, hospitals need to expand to cater for this. Despite this, Hospital Engineering is still quite an unknown Engineering discipline. There is substantial attraction towards working in other industries such as the mines as the pay package is more attractive. In Australia, Hospital Engineers are far and few apart. This creates a niche industry. Consequence of this is people are seeking information because they require it, and people providing assistance is because they understand what circumstances their peers are going through. This is more evident for a professional who is new to the industry. A new Hospital Engineer would often be overwhelmed with information. Support for this person is vital.
1.0 Introduction If Facilities Management were still suffering an identity crisis, Hospital Engineering would be in the same boat. Hospitals not only differ in size, the amount of hospital services also determines the different type of engineering skills required within a facility. e.g. A 1000 bed major metropolitan hospital would have too many specialised plant that they would require multiple specialist engineers looking after specific disciplines, and backed up by a large workforce; may it be external or internal staff. A rural 20-bed facility may only have a part time engineer and/or facility manager managing routine breakdowns and maintenance, with little to no complicated systems to manage.
The Medical-Dictionary.cc (2012) defines Hospital Engineering as a hospital department whose primary function is the upkeep and supervision of buildings and grounds and the maintenance of hospital physical plant and equipment that requires engineering expertise. According to the U.S. Office of Personnel Management (1981), a Hospital Engineering function has been primarily concerned with the technical operation and maintenance of the physical plant within a hospital. Within these departments usually lies a Hospital Engineer whose task is to fulfil the functions of the department as described above. A Hospital Engineer is usually present in a medium to large facility that presents more complex systems. It should be noted that a Hospital Engineer should not be mistaken for either a Clinical Engineer or a Biomedical Engineer. According to the ACCE (2002), a Clinical Engineer is a professional who supports and advances patient care by applying engineering and managerial skills to healthcare technology. On the other hand, a Biological Engineer applies engineering principles to the study of medical and biological problems (Krapp, 2002). Despite this, certain traits of a Clinical Engineer can be adapted for a Hospital Engineer. The core business of a hospital is health related matters. As a result, it is expected that expenditure would be concentrated in the medical field. Hospital Engineering can, in some cases, be classed as a lesser priority. It is thus common for a health facility to only have one or two Engineers who are in charge of a maintenance department. These Hospital Engineers then learn all the different services
that support the facility. A typical list of services normally encountered by a Hospital Engineer shows the need to have knowledge in the various engineering disciplines. This theory is supported in the Grade Evaluation Guide for Hospital Engineer (1981, p.4) where it states that the chief engineer has broad based professional engineering and highly interrelated managerial responsibilities, and that the chief engineer is usually expert in at least one of the required engineering disciplines and competent in most of the others. Most professional engineers graduate from universities and gain qualification in a traditional engineering discipline such as Electrical, Civil, Mechanical, Chemical and etc. The general question arises within the Hospital Engineering circle is; how do you train a professional with a specialist background to learn and understand topics of other engineering disciplines?
1.1 Role of a Hospital Engineer The U.S. Office of Personnel Management (1981) has specified for a Hospital Engineer’s core aim is to: • Responsible for all professional engineering matters within the hospital. • Provide professional engineering consultative service to medical and administrative personnel within the hospital, • Supervises the construction and inspects completed work for professional adequacy, • Manages the design of new projects. • Reviews and maintains utility systems and equipment to ensure compliance.
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TOPICS OF INTEREST • Engineers are curious and enjoy discovering how things work and solving problems.
• Plan maintenance of all equipment and programmed with service and ward areas as to maintain service continuity.
• Engineers use logic to examine ideas and develop theories and explanations.
• Set policies. This work requirement was set in 1981 and most of it still applies to modern day Hospital Engineering. It is a very accurate summary of the role expected of a Hospital Engineer. Despite this, each facility can be very different from another and this creates irregularities.
• Engineers are able to concentrate intently on a subject. • Engineers are perfectionists who are always looking for better ways of doing things. • Engineers want order and structure at work and in their personal life.
2.0 Challenges When compared to a typical list of engineering branches, Hospital Engineering is not a widely known discipline. The closest discipline that a hospital engineer relates to is one from a building services discipline; more specifically, the hotel industry. Another challenge stems from a previously discussed topic where a hospital has only one or two Hospital Engineers. This limits the number of available hospital engineering positions. The above makes Hospital Engineering a very limited and niche field. In Australia, the prime industry for engineers to earn high salaries is in the mining industry. Young graduates are tempted to work for large engineering firms where there is a prospect of advancement within the organisation. The above challenges then results in established Hospital Engineers being a rarity. Age would then play a large factor, as young Hospital Engineers would be harder to come by. The Institute of Hospital Engineering Australia indicates that as of 2011, there are only a total of 35% of its membership base that were born in the 1960s (IHEA 2011, p.10). Members of this age would are most unlikely be retiring within a short period of time. With only 1% of the membership base born in the 1980s, it is quite rare to find a member that is at the start of the career.
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Figure 4.1 Age demographics within the IHEA (Source: IHEA Annual Report 2010-11)
3.0 Methodology of Training a Hospital Engineer It is important that a hospital engineer holds a Bachelors degree. It is recognised in the industry that an engineer’s train of thought is valuable in an environment where the unexpected is expected everyday. An engineer’s ability to thrive in a group is also valuable. A hospital quite often encounters a scenario where a group is required to solve a problem. This group may vary from medical staff to finance staff or a legal team. An engineer is also often regarded as a profession that has the ability to adapt and learn new things easily. That is an important trait as hospitals are such dynamic environment. Alternatively, a professional who holds a diploma or has been in the industry for many years is also important. Such a professional would have had more hands on experience and hence, have the ability to apply a more practical approach to a problem, in contrast to an academic who has had little practical experience. There are very few formal qualifications that can be achieved in order to become a Hospital Engineer. How ever, if an individual has already gained a formal engineering qualification, there are many traits of an Engineer that would be advantageous in achieving skills necessary to be a hospital engineer (Seviour, 2012):
THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
• Engineers enjoy discussion, debate (and arguing), about their topic. • Engineers appreciate and respect intelligence in others. • They often have a good sense of humour. • Engineers can be dogmatic. • Engineers may be unimaginative outside their own field, (so-called tunnel-vision). • Engineers are uncomfortable with vagueness and ambiguity. • Engineers dislike change. • The engineer’s attachment to structure may lead to an authoritarian approach. • Engineers may focus on theories and be reluctant to consider conflicting data. • Engineers can be impersonal and reserved and may take little interest in other people. • Engineers may have poor social skills and be insensitive to the feelings of others. Diplomacy does not come to them naturally. • Engineers may have little commercial awareness and dislike making decisions in business. These traits may not necessarily apply to all Engineers, but being able to understand the way one thinks would assist in training. In order to gain the skills that is expected of one, the following are a few methods of gaining such experience:
TOPICS OF INTEREST 3.1 Training There are many disciplines within Hospital Engineering it is impossible to gain in-depth knowledge of all fields. Engineers should be sent to attend short courses specifically targeted in critical areas where they need a full understanding of the subject matter. Other fields where it is either less critical, or is able to rely on others on their expertise, will then only rely on a general understanding of the subject matter. This can be gained either by self-learning, reading or having hands on experience.
3.2 Learning from Tradespersons Not all graduate engineers would possess a trade background. Hence, an engineer would lack the hands on experience. Although an engineer would not always use tools or become the front line person to fix a fault, practical knowledge would enhance the knowledge base from theories learnt from studies.
3.3 Using the Internet Researching is a fact of life. This is a common exercise that will take place in such a dynamic environment. The Internet is now an unlimited source of knowledge and should be taken advantage of when carrying out research. There still lacks information in hospital specific services but this can be assisted by ingenuity. When carrying out a search for a particular area, research and gain understanding in a general sense, then adapt the basic principles to a hospital.
3.4 Communication A medium to large sized hospital can almost be comparable to a small city. It presents professionals such as the medical team, accountants, legal advisors, scientists, cleaners, kitchen staff, and etc. When an explanation is required for a particular task, an Engineer should appreciate that a person of another profession may not understand Engineering terms. At the
same time, the explanations should not make the listener feel like an idiot!
3.5 Learn the art of Networking Being a Hospital Engineer forces that professional to step out of the perceived stereotype of a typical Engineer. Engineers are seen to have poor social skills and be insensitive to the feelings of others (Sevior, 2010). This is a trait that needs to be overcome as networking plays a big part in personal development. Talking to numerous people about the same topic may yield a multitude of different answers and point of views. The mere discussion with fellow Hospital Engineer can almost be considered as an informal training session as lessons learnt from these conversations may be invaluable.
3.6 Nurturing In a world where one can often feel overwhelmed, it is often quite important to provide continuous support to a Hospital Engineer; especially one that is new to the industry. Nurturing (and supporting) a Hospital Engineer in this instance is quite helpful. As described above, there are many attractions outside Hospital Engineering and it is not difficult for a Hospital Engineer to quit. Seviour (2012) indicated that Engineers are perfectionists. After the completion of a job, may it be big or small, be happy with the end product. The question of “how this could be done better?” can be asked and mistakes can be learnt, but what is important is to remain positive and not concentrate on the negatives of a project.
4.0 Conclusion A Hospital Engineer is a vital position within any health facilities. This article does not aim to lecture all current Hospital Engineering staff on the “stepby-step” method of training a new Engineer, but to create awareness that:
2) W hen an opportunity arises to train a “young” (in age and to the industry) engineer, then steps listed in this article may become a base for training them. 3) A support group plays a vital role in nurturing a Hospital Engineer. Constantly supporting one another is a form of professional development. It is not only important to start a new Engineer on the right foot with appropriate training and guidance, it is also important to continuously support that professional as progression continues. This is important in an environment where one can easily be overwhelmed and discouraged. Each and every professional reading this article now is undoubtedly doing a great job in their respective facilities. There will certainly be new Hospital Engineers introduced to the industry. We must all remember that Rome was not built in one day. Hospital Engineering can’t be learnt in one day, or 10 years, but we can enhance the experience of fellow professionals by assisting and supporting one another.
References and Bibliography Seviour, R, 2012, The Engineer Personality, viewed: 22 May 2012, <http://www. seviourbooks.com/articles/engineerpersonality.htm> Definition of Clinical Engineer, 2002, American College of Clinical Engineering, Plymouth Meeting, viewed: 11 April 2012, <http://www.accenet.org/default.asp?page =about&section=definition> Grade Evaluation Guide for Hospital Engineer, GS-0800 (1981), U.S. Office Personnel Management Medical Specialties, Wiki 2012, ‘Specialty (Medicine)’, wiki article, 17 April, viewed 28 April 2012, < http://en.wikipedia.org/ wiki/Specialty_%28medicine%29 >
1) W hat everyone is currently doing is not wrong. One should ensure motivation is not lost.
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THE AUSTRALIAN HOSPITAL ENGINEER I JUNE 2013
PRODUCT NEWS
Product News Relied upon in our hospitals & health care facilities With a proud design and manufacturing history spanning 80 years, Galvin Engineering vision is to be Australia’s most reliable supplier of specialised commercial taps and valves. Specialising in the health, aged and mental health, we guarantee reliable service, ease of use and expert knowledge. Our highly trained and experienced staff are always on call to assist with innovative design options, evidence based solutions and after-market support to ensure that your facility provides complete patient care. Managing healthcare facilities is a key challenge for engineers, project managers and facility managers today. We are very conscious of this challenge and as part of our product design and review process, we engage with all key stakeholders to ensure we provide a product that goes the extra mile.
Samsung Advanced Care System Samsung Communication Centre/VODA Communications saw a need in the market place for a quality Nurse Call product that would interface successfully to the Samsung telephone systems. The Advance Care System is an Australian designed system that has purposely been tailored to meet the ever increasing demands for quality care in the Aged Care market. The system has been designed to be very easy to use with excellent reporting and administration features. With the requirement of DECT, Paging and Audible Annunciators the system interfaces simply and effectively with the telephone system.
The key challenges where CliniLever® will meet your needs are: Infection Control The contemporary design with smooth lines and curves allows an easier surface to clean and reduces water droplets forming that could harbour bacteria. The horizontal angled spout reduces water becoming trapped and stagnant, helping to minimise bacteria growth and the build up of scale. Reliability CliniLever® is manufactured in Australia to meet the demanding environments present in our hospitals and health care facilities. We strive for total excellence in all our products and perform stringent testing to ensure we have total reliability in the marketplace. Whole of Life We have experienced positive feedback from projects, such as the Queensland Health Rural Enhancement Program and Nambour TAFE College initiative. A key reason that CliniLever® was specified
New CliniLever® designed with ease of use and sustainability in mind
is due to the ease of installation and maintenance, in particular the ability to isolate the tap at the point of use. To learn more please visit www.galvinengineering.com.au or contact our team on 1300 514 074.
Advance Care were one of the first companies to have an IP compatible system using structured cabling and IP networking the system is on the leading edge of technology. Advance Care also has a “Long Range RF” system which enables a system to be installed with minimal cabling, and labour content. The RF system enables an easy transition from an existing Nurse Call system to the new Advance Care product. The flexibility of the Advance Care system means that any of the systems protocols “hardwired”, “IP” or “Wireless” can be implemented either as a complete system or as hybrid were one or more components can be installed to make up the complete solution for a particular site.
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PRODUCT NEWS
Product News Replacement of capital assets An important function of any Facility Management System is to help determine the replacement of assets. This is never an easy decision, except where the life of the asset is mandated by legislation or by a manufacturer’s warranty regime. Many different factors may affect these decisions, including: Financial – acquisition costs, replacement costs, depreciation, maintenance costs (past and projected), opportunity costs etc.
Schneider Electric partners with the Australian Centre for Health Innovation Schneider Electric, a global specialist in energy management and security leader, has reached a partnership agreement with the Australian Centre for Health Innovation (CHI) in Melbourne to showcase live the latest intelligent integrated healthcare technologies starting in July this year. “Through this collaboration, over 6,500 yearly visitors such as clinicians, health administrators and clinical IT professionals will be able to interact first hand with our innovative healthcare infrastructure solution at a direct interface with the clinical environment at the CHI,” says Irina Lindquist, Solution Architect, Healthcare, Schneider Electric. “We have committed to display a holistic technology demonstration package in
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Legislative and Safety – legislative requirements are very often driven by safety or environmental issues. Technology and Obsolescence – rapidly changing technologies and a trend to built-in-obsolescence can often force a replacement decision. Aesthetics and Business-driven factors such as appearance, ‘public relations’ or business needs. Operational and Conditional factors – past and current performances of the assets must be readily measurable and available. This may include the number of breakdowns, the time to repair, unit performance, availability of parts and/or expertise to repair etc.
Another key criterion when projecting replacement needs is the condition of the asset. In manufacturing environments, Predictive Condition Reporting is commonly used. In the built environment, this is rarely applied in a quantitative manner, and all or most of the above factors play a role. BEIMS allows all of the above to be recorded and reported including Condition Ratings to meet standards such as TEFMA, NAMS and DHS.
clinical and clinical-support environment adding value to healthcare operations.” The first stage of deployment this year includes demos related to: staff, visitor and patient safety & security; safe & secure power for critical clinical areas; and lighting control integrated with clinical workflow. Showcasing Schneider Electric’s one healthcare solution at the CHI improves visibility for full capabilities in Healthcare. It also validates the company’s value propositions within the Australian Healthcare context. “We are very excited about this opportunity and what our joint innovation will mean for enabling healthcare innovation across Australia,” says Glen Scott, National Healthcare Manager. Market testing newly introduced solutions at the CHI and proof of concept for growth in retrofit and services within the Healthcare segment are among the benefits of the CHI partnership.
“We welcome Schneider Electric to CHI and look forward to a long-term and meaningful partnership,” says Susan Harrison, General Manager, CHI. CHI facilitates testing and simulation for service improvements adopted in patient care, health administration and safety across Australia & New Zealand Healthcare facilities. Its expertise in simulated education, experiential learning and solution design delivers great outcomes to the toughest health challenges. Schneider Electric’s healthcare solutions are expected to be functional at the CHI by mid July.
*Illustration purposes only E&OE
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