CHF Summer 2015

Canadian

HealthcareFacilities JOURNAL OF CANADIAN HEALTHCARE ENGINEERING SOCIETY

Volume 35 Issue 3

Summer/Été 2015

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CONTENTS

CANADIAN HEALTHCARE FACILITIES Volume 35

Issue 3

Kevin Brown kevinb@mediaedge.ca PUBLISHER/ÉDITEUR

16

EDITOR/RÉDACTRICE Clare Tattersall claret@mediaedge.ca SENIOR DESIGNER/ CONCEPTEUR GRAPHIQUE SENIOR

Annette Carlucci annettec@mediaedge.ca

NATIONAL SALES/ REPRÉSENTANTE COMMERCIALE CANADA

Stephanie Philbin stephaniep@mediaedge.ca

PRODUCTION MANAGER/ Rachel Selbie DIRECTEUR DE rachels@mediaedge.ca PRODUCTION CIRCULATION MANAGER/ Maria Siassini DIRECTEUR DE LA marias@mediaedge.ca DIFFUSION

DEPARTMENTS

TECHNOLOGY

CANADIAN HEALTHCARE FACILITIES IS PUBLISHED BY UNDER THE PATRONAGE OF THE CANADIAN HEALTHCARE ENGINEERING SOCIETY.

6

8

28 Walk this Way Advances in wayfinding technology point hospitals in the right direction

SCISS JOURNAL TRIMESTRIEL PUBLIE PAR SOUS LE PATRONAGE DE LA SOCIETE CANADIENNE D'INGENIERIE DES SERVICES DE SANTE.

Editor's Note President's Message

10 Chapter Reports 12 Announcements

30 A Real Asset Asset tracking targets hospital efficiency

FEATURE SERIES

BUILDING OPERATIONS

16 The Digital Health Revolution Humber River Hospital leverages latest technology to enhance patient care experience

34 Moisture Management CHES member Q&A on how to get operating room humidity under control

18 Robotics at the Glen McGill University Health Centre ushers in new era in healthcare

SUSTAINABILITY

20 Managing Hospital Electrical Shutdowns Customized system provides peace of mind for Lakeridge Health Oshawa

38 Healing Patients, Protecting the Planet A case study of one hospital’s green initiatives

CHES Canadian Healthcare Engineering Society

SCISS

Société canadienne d'ingénierie des services de santé

PRESIDENT

Peter Whiteman

VICE-PRESIDENT

Mitch Weimer

PAST PRESIDENT

J.J. Knott

TREASURER

Robert Barss

SECRETARY

Randy Cull

EXECUTIVE DIRECTOR

Donna Dennison

CHAPTER CHAIRMEN

Newfoundland & Labrador: Brian Kinden Maritimes: Robert Barss Ontario: Roger Holliss Manitoba: Craig B. Doerksen Alberta: Tom Howard British Columbia: Steve McEwan FOUNDING MEMBERS

H. Callan, G.S. Corbeil, J. Cyr, S.T. Morawski CHES

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EDITOR'S NOTE

LEADING THE WAY WITH TECHNOLOGY THIS YEAR’S CHES NATIONAL CONFERENCE is fast approaching and the excitement is palpable. Not only does 2015 mark the 35th anniversary of the conference, but it also sees the first sitting of the Canadian Certified Healthcare Facility Manager (CCHFM) exam. Launched in June, the highly anticipated certification program provides a number of benefits to those who achieve the designation as well as healthcare leaders. You can read more about the designation on pg. 14.

Keeping with the conference, this year’s theme is “Healthcare Facilities and the Technology Highway.” As in years past, the theme has formed the basis of the Summer issue’s feature section. Beginning on pg. 15, we recognize some of the extraordinary technological advancements that hospitals have made — from digital system integration and interoperability at the soon-to-open Humber River Hospital to the installation of cutting-edge robotic equipment at the McGill University Health Centre’s Glen site and the introduction of an electrical shutdown management system at Lakeridge Health Oshawa.

From here we continue the technology theme with articles on advancements in hospital wayfinding (pg. 28), and healthcare asset tracking and management (pg. 30).

Rounding out this issue is a case study of Markham Stouffville Hospital’s green initiatives (pg. 38) and our regular Q&A. This time around, CHES member John Gowing of EI Solutions Inc. tackles the issue of climate control in operating rooms (pg. 34).

I’m always interested in obtaining feedback and article proposals. As well, if you’d like to participate in a Q&A, please e-mail me along with the topic you’d like to discuss.

Clare Tattersall claret@mediaedge.ca

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

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

6 CANADIAN HEALTHCARE FACILITIES

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

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

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PRESIDENT'S MESSAGE

LEARNING IS A JOURNEY THAT NEVER ENDS WHERE HAS THE TIME GONE. It seems like I became CHES National’s president only a short time ago when, in fact, it has been two years since I took office. The focus of my term has been on the sustainability of our healthcare system, from a facilities management perspective. To further advance this cause, I believe healthcare organizations need to invest in two strategic initiatives.

As a service provider, healthcare organizations need to prioritize workplace learning and skills development to avoid falling behind. This will ensure that future generations enjoy the same environment we experience today — positive patient outcomes and experiences, continual innovation and staff engagement.

A significant boost in resources is also required as we are rapidly approaching the tipping point where our crumbling hospital infrastructure will become a barrier to service delivery. Despite the efforts of some talented, skilled, knowledgeable and dedicated individuals, the country’s healthcare facilities are at varying stages of degradation, and deterioration is occurring at an ever-increasing rate. According to a recent study by HealthCareCan, Canadian hospitals have accumulated $15.4 billion in deferred maintenance costs. This, however, is considered a conservative estimate as the same study indicates it could be as high as $28 billion. Resultantly, the healthcare association is calling on the federal government for infrastructure support, citing that these facility assets should be considered “nationally significant” to qualify for funding. From a facilities management perspective, this injection is needed sooner rather than later given that the shelf life of much of our healthcare infrastructure is past its due date.

On a more positive note, CHES is pleased and excited to announce the launch of the Canadian Certified Healthcare Facility Manager (CCHFM) program. The first examination will be held in Edmonton, immediately following the National Conference in September. Following this, eligible applicants can take the exam at an approved testing centre in Canada. This national accreditation program recognizes and acknowledges the successful applicant has attained a high degree of skills, abilities and competencies required of today’s facility managers. It has taken several years to develop and it has only come to fruition because of the hard work and dedication of several people.

It has been an honour and privilege to represent CHES National over the last two years.

This term has been extremely rewarding as it provided the opportunity and pleasure to work with many dedicated individuals from across Canada, creating educational and professional development opportunities for healthcare personnel coast-to-coast.

I’d like to thank the National office, the National executive board, all CHES chapters and their chairs, the conference planning teams, and the countless committee members and volunteers for their overwhelming commitment to healthcare delivery and our organization. It has been truly inspirational.

I wish everyone a great year. Work hard and play harder.

Peter Whiteman President, CHES National

8 CANADIAN HEALTHCARE FACILITIES

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CHAPTER REPORTS

ONTARIO CHAPTER

ALBERTA CHAPTER

It is shaping up to be a significant year for me and the Ontario Chapter as we have just assembled the new executive team. Personally, moving into the role of chapter chair comes with excitement but also a little trepidation. Fortunately, I am following a pair of seasoned past chairs — Ron Durocher and Allan Kelly. Our executive now has the admirable combination of old hand and new blood, with Ken Paradise taking over as treasurer for retiring Ed Davies, and John Marshman stepping in as secretary since Jim McArthur has assumed the role of vice-chair. I’m looking forward to working with this team over the next couple of years, building on many of our predecessors’ initiatives.

The new executive has been busy, updating many of its internal documents and revisiting all job descriptions (created years ago).

There are now completely revised descriptions to reflect the new way CHES conducts business in this world of ever-increasing technological advancement.

The annual Ontario Chapter Conference & Trade Show was held in our nation's capital in May. It was one of the most successful to date, from both an attendance and financial perspective. More than 100 delegates attended the event and there were 67 exhibitors at the trade show. I'd like to thank conference chair, Durocher, and the planning committee for their effort.

We celebrated a couple noteworthy achievements at this year’s spring conference. Rick Anderson was presented with a Life Member Award for his long-time commitment to healthcare in the province. He then shared the results of our 2015 student bursary awards with conference delegates. This year, five Ontario students received cash grants to help them further their education in a technological/engineering program.

—Roger Holliss, Ontario Chapter chair

It’s an exciting time to be in healthcare in Alberta as the province has a new government, which is sure to affect our industry. The health system has experienced a tremendous amount of change in recent years, though, so we should be well-prepared for the coming months.

We hosted the Canadian Healthcare Construction Course (CanHCC) in Calgary, June 16-17. I’d like to thank the Alberta Chapter executive for its last-minute push to ensure spots were filled to exceed our break-even point. Even with the price of oil down, healthcare construction professionals continue to see the value in the course and enroll. A special thank you goes to the instructors for their time and effort in building the course and keeping the material current.

Past Alberta Chapter chair, Preston Kostura, and his team are working hard on the final plans for the CHES National Conference in Edmonton this September. There are still some sponsorship opportunities available. As always, trade show booths are limited, so we encourage vendors to book their spots early.

—Tom Howard, Alberta Chapter chair

NEWFOUNDLAND & LABRADOR CHAPTER The Newfoundland & Labrador Chapter had another successful Professional Development Day. Held May 25, we had approximately 50 attendees, one of which was CHES National president, Peter Whiteman, whom I’d like to thank for his visit. We’ve received feedback on the education session and it has been very positive.

The Canadian Healthcare Construction Course (CanHCC) was held in St. John’s, Nfld., May 26-27. It attracted participants from the Maritime provinces as well as Newfoundland.

The chapter is currently working with the Newfoundland and Labrador Construction Association to offer a course on CSA Z317.13 — Infection Control During Construction, Renovation and Maintenance of Healthcare Facilities — in November. We will send out notifications of the course date when the logistics are confirmed.

The chapter is sending one paid member to the CHES National Conference in Edmonton.

If you have any questions or comments, please e-mail chesnl@outlook.com.

—Brian Kinden, Newfoundland & Labrador Chapter chair 10 CANADIAN HEALTHCARE FACILITIES

MARITIME CHAPTER This year’s Spring Conference & Trade Show was held April 19-21. The conference was well-attended, and received great support from exhibitors and sponsors.

Presentations were educational, with professional speakers covering the topics of today and tomorrow: Super convergence; air quality; healthcare colour and design trends; CSA medical gas standards and preventative maintenance of medical gas systems; energy efficiency in steam plants; building information modelling (BIM); and maintenance in healthcare facilities. There was plenty of opportunity to network with colleagues and vendors.

This year, the exhibit hall was open to hospital maintenance staff, something we plan to promote further in upcoming conferences.

A small profit realized from this year’s spring conference, combined with a substantial contribution from the 2014 CHES National Conference in Saint John, N.B., brings total chapter assets to approximately $50,000.

The 2016 spring conference will be held May 1-3, in Moncton, N.B. This coincides with the national MEET (Mechanical Electrical Electronic Technology) trade show, providing members the opportunity to take advantage of both events.

We will be hosting the Canadian Healthcare Construction Course (CanHCC) in conjunction with the 2016 conference, May 4-5.

Before then, an education day is being planned for early September 2015.

A small committee has been selected to seek out and encourage members to submit articles to CHES’s journal.

The Chapter is reviewing a program to subsidize Canadian Certified Healthcare Facility Manager (CCHFM) applicant fees for Maritime Chapter members. The exact amount and process are still being developed.

—Robert Barss, Maritime Chapter chair

CHAPTER REPORTS

BRITISH COLUMBIA CHAPTER The 2015 Trade Show and Education Forum was the most successful to date. Held June 7-9, Whistler village was bustling with activity. We couldn’t have asked for better weather. This year’s conference, “Transforming Healthcare through Technology,” included nine well-attended education sessions. Our keynote speaker, George Keulen, delivered a moving and engaging speech on his experiences within the healthcare system as a double-lung transplant recipient. Delegate attendance was at an all time high, peaking at more than 150. Hypnotist Randy Charach entertained a sold out crowd at the banquet. He transfixed 360 onlookers into a hypnotic state, ensuring that what goes on at CHES stays at CHES. We sold out all but one of the sponsorships and filled the trade show floor with 99 booths.

In conjunction with the conference, we also hosted the Canadian Healthcare Construction Course (CanHCC), which had 35 attendees.

I’d like to thank CHES National president, Peter Whiteman, for attending the conference, addressing the membership at the annual general meeting on the Canadian Certified Healthcare Facility Manager (CCHFM) program and assisting with the long-term membership awards at the banquet. A special thank you also goes to conference coordinator, Wendy MacNicoll, who raises the bar every year; conference chair, Norbert Fischer; the sponsors and vendors who support the conference; and the B.C. Chapter executive for its hard work in making this an incredible event.

It is an honour to work with such a dedicated team: Mitch Weimer (past chapter chair); Norbert Fischer (vice-chair/ conference chair); Sarah Thorn (public relations/secretary); Ken Van Aalst (treasurer); Mark Swain (communications/ website liaison); Arthur Buse (membership); and Steve McTaggart (education).

Planning for the 2016 National Conference in downtown Vancouver at the Vancouver Convention Centre is well underway.

It will be a great opportunity to showcase this amazing city and push the limits of this annual event. I hope everyone sets a little extra time aside to visit this world-class city.

—Steve McEwan, B.C. Chapter chair

MANITOBA CHAPTER “Maintaining your Building Envelope: Keeping the Inside In and the Outside Out” was the theme of this year’s Education Day, held April 21. With 55 attendees, 60 vendor representatives and 29 exhibitor booths, it ranked as the most successful Education Day for the Manitoba Chapter. The chapter executive, guided by Kelly Hearson, president and principal of Crosier Kilgour & Partners, secured experts to discuss design theory, pass on practical technical tricks and knowledge, and share a significant amount of wisdom. The presentations flowed seamlessly (almost as if choreographed by Hearson) in rapid-fire succession. Exhibitors provided excellent tools, technologies and discussion during breaks between sessions.

Of course, the Education Day would not have been a success without the attendees, who came from as far as the Northern Health Region. We look forward to sharing the presentation material online in the near future.

One day prior to the Education Day, several CHES Manitoba members attended the Canadian Centre for Healthcare Facilities (CCHF) conference — Improving Sustainability of Healthcare Facilities: Planning, Design and Standards — at Health Sciences Centre Winnipeg. Promoted by the chapter executive, the conference was purposely held April 20, to help Manitoba Chapter members from outside Winnipeg save on travel and take in both events.

On Oct. 6, the Manitoba Chapter will present an education session at the Manitoba Building Expo, which is a partnership of the Building Owners and Managers Association (BOMA) Manitoba, Winnipeg Construction Association and the Mechanical Contractors Association of Manitoba (MCAM).

CHES Manitoba members not only get to attend the trade show and CHES education session for free, but their attendance at the keynote luncheon with former chief of defence staff, Rick Hillier, will be paid for by the Manitoba Chapter.

Next year’s Education Day has been set for April 28. Once we receive feedback from the 2015 Education Day, we will begin to work on another fulfilling event. We will be electing new officers to the executive at next year’s Education Day, so look for nomination information in late 2015.

—Craig B. Doerksen, Manitoba Chapter chair

B.C. Chapter conference (left to right): Mitch Weimer and Steve McTaggart; President's banquet; WorkSafeBC education session.

Photos courtesy Sammy Tong.

SUMMER/ÉTÉ 2015 11

s

ANNOUNCEMENTS

NEW COUNCIL REPRESENTS CORPORATE, ASSOCIATE MEMBERS

CHES CORPORATE/ASSOCIATE MEMBERS now have a greater say in matters that directly affect them.

Last fall, the association established the corporate/associate member advisory council in response to growing demand for greater representation. Corporate/associate members comprise more than 40 per cent of CHES’s total membership, up significantly since the association was first established in the early ‘80s.

“This initiative will bring more value to corporate/associate members, which, in turn, will bring more value to CHES as a whole,” says the council’s chair, Luis Rodrigues, who serves as the liaison to CHES’s National executive.

Modelled after the Canadian College of Health Leaders’ (CCHL) corporate advisory council, of which Rodrigues is a member, the newly formed council will provide recommendations and guidance to the national executive on a variety of issues, including (but not limited to) how to improve corporate/ associate membership programs and awareness initiatives to increase the membership base; ways in which CHES member educational programs can be enhanced through the sharing of corporate/associate membership knowledge; and steps CHES can take to offer additional, yet optional, value-added services to corporate/associate members.

“Our objective is to determine new opportunities and initiatives that will benefit this group,” says Rodrigues.

Joining him on the seven-member elected council is Larry Isford, Ron Quarrie, Saeid Izadpanah, Sheldon Ferguson, Steve Clayman and Gordon Burrill. The colleagues met for the first time during the 2014 CHES National Conference in Saint John, N.B. Their first order of business was to survey

corporate/associate members to determine their level of contentment with the status quo.

“If we were going to be the voice of the corporate/associate membership, then we had to make sure we were speaking on its behalf,” explains council member, Burrill.

The results of the survey formed the basis of a “work plan,” which will guide the council’s activities for the foreseeable future.

“We found corporate/ s Luis Rodrigues, chair, corporate/ associate members were most a ssociate member advisor y interested in initiatives that council will improve their level of engagement and potential business activity with professional members,” notes Rodrigues, who adds that seeing a returnon-investment is an important aspect of membership.

Since then, the council has put forth the idea of implementing a new executive engagement program to CHES's National board. Taking inspiration from a successful CCHL program, this initiative would team up a group of healthcare facilities directors from across the country with a corporate/associate member in an informal, relaxed learning setting. The one-day “working session” would enable the corporate CHES member to present and receive feedback on their products and services, as well as obtain inside knowledge on emerging hospital trends.

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ANNOUNCEMENTS

CHES LAUNCHES FIRST-EVER CERTIFICATION PROGRAM A NEW ERA IN HEALTHCARE facilities management is underway with the launch of CHES’s Canadian Certified Healthcare Facility Manager (CCHFM) program in June. The first-of-its-kind certification program is expected to revolutionize the profession, setting a national workplace standard for those responsible for the operations and maintenance of Canada’s healthcare facilities.

“The CCHFM designation will demonstrate the facility manager has obtained the necessary education and experience to qualify as an elite professional in their field,” says Robert Barss, one of four members of the certification advisory panel. “With time, we anticipate certification will become standard practice across the country as it provides a level of comfort to patients, families, friends and hospital staff to know the buildings where they heal, visit and work are overseen by proven, competent individuals.”

Created in 2014 to oversee the development and ongoing evaluation of the CCHFM certification program, the panel also includes Michael McRitchie, George Pankiw and Gordon Burrill.

All were chosen for their experience and expertise, as well as the fact that they are the only members of CHES to achieve the American Society for Healthcare Engineering’s (ASHE) designation — Certified Healthcare Facility Manager (CHFM).

It is therefore natural that the CCHFM program was

CHES Canadian Healthcare Engineering Society

SCISS

Société canadienne d'ingénierie des services de santé

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14 CANADIAN HEALTHCARE FACILITIES

modelled after its U.S. counterpart. Like the CHFM designation, CHES’s new certification program is recognized and supported by its country’s health leaders, specifically the Canadian College of Health Leaders (CCHL). Technical content and areas of competence are also similar, though the CCHFM program contains subject matter that is specifically pertinent to the Canadian context.

The certification exam is designed to test a well-defined body of knowledge representative of professional practice in healthcare facilities management. Administered by a third party, Seneca College, it is composed of 110 multiple-choice questions, to be completed in two hours. A minimum grade of 70 per cent is required to pass.

“The exam is purposely based on a combination of technical knowledge and experience in order to challenge eligible applicants,” says McRitchie. “Studying the topics listed in the certification handbook is important to attaining the CCHFM credential but this must be accompanied by developing fundamental skills in the workplace in order to be successful.”

The first exam sitting will take place Sept. 23, at Edmonton’s Shaw Conference Centre following this year’s CHES National Conference.

Beginning November 2015, applicants will be able to take the exam at one of 13 Seneca College testing centres located across the country.

Only current members of CHES that meet specific eligibility criteria can write the exam, at a cost of $300.

This is a small price to pay for the perks that come with certification.

“The CCHFM designation confirms the facility manager has a certain level of skill and knowledge, which will create opportunities for career advancement,” says Pankiw, adding what sets the CCHFM program apart from others, such as the Building Owners and Managers Association’s Real Property Administrator (RPA) designation, is it is hospital-specific. “The leadership in healthcare organizations will be more inclined to place someone who is CCHFM-certified in a role that requires broad understanding and the ability to perform in a complex field over a facility manager who is not.”

The credentials will also instill a sense of pride and encourage professional growth. The latter is key to recertification every three years, should the facility manager choose that route.

To maintain the CCHFM designation, the facility manager must either successfully pass the certification exam again (up to one year prior to its expiration) or complete 45 contact hours of eligible continuing professional education over the three-year period.

Eligible activities include attending or teaching academic courses, completing online courses and attending professional organization conferences.

“Passing the exam is no easy feat so I’d recommend doing what any good facility manager should be doing anyways — staying current in their field through continued professional development,” says Burrill.

HEALTHCARE FACILITIES AND THE TECHNOLOGY HIGHWAY Inside the walls of three hospitals that have embraced new technology to help staff work smarter and more efficiently, and improve patient care.

FEATURE SERIES

THE DIGITAL HEALTH

REVOLUTION Humber River Hospital leverages latest technology to enhance patient care experience

By Debbie Wadsworth

N

orth America’s first fully digital hospital will open its doors in October, transfor ming the healthcare experience for patients and care providers in the northwest Greater Toronto Area.

Humber River Hospital has incor porated some of the latest technologies to help patients, visitors and staff navigate the approximately 1.8 million-square-foot facility, but its digital vision shines most in the patient care areas.

ENHANCING THE IN-PATIENT EXPERIENCE

Historically, the typical in-patient room has been a fairly low-tech environment; however, Humber River Hospital has leveraged digital technology to enhance 16 CANADIAN HEALTHCARE FACILITIES

patient care and the hospital stay from the bedside-out, while enabling a more personable relationship between patient and clinician.

Mounted to the headwall with a swivel arm is an integrated bedside terminal, which will allow the patient to view their schedule of upcoming tests and imaging appointments, access multilingual healthcare information and check their electronic medical record. It will also serve as the entertainment centre for video chatting, surfing the Internet, and watching television or movies.

Interoperability of the integrated bedside terminal with the hospital’s building automation system will allow the patient to control the room’s lighting and temperature from their bed. When a

FEATURE SERIES

patient is discharged, room settings will automatically reset to default and a notification can be sent to housekeeping to prepare the room for the next patient.

Patients will also be able to control the opacity of the exterior window from their bed. Dynamic glass was used on the windows to fulfill shading requirements and address solar heat gain. It is highly energy-efficient and switches between clear and tinted states, providing glare and heat control without obstructing views. The shading ranges from four to 65 per cent light transmittance and is connected to the building automation system, which detects and responds to the sun position by default. However, patients can override this to set their desired light levels — from fully transparent to fully opaque. This glazing solution will help the hospital meet an aggressive energy savings target, resulting in an estimated 100 kBtu per square foot per year (energy use intensity). With no blinds there are also fewer concerns about infection control and hardware malfunctions.

For future flexibility, a wireless lighting system was installed in non-critical patient care rooms and family zones. The wall switches are actually small remotes that control fixtures digitally via Wi-Fi. All changes to fixture type, placement or switch location can be done without re-wiring or opening drywall. The exception to the Wi-Fi design is the overbed light, which is hardwired and meets emergency lighting criteria.

Just outside each in-patient room is a ro o m s i g n m o n i t o r, w h i ch w i l l communicate information to enhance patient and staff safety. Pictograms and brief notes related to allergies, falls risk, infection control and hand hygiene will indicate the necessary precautions that need to be taken prior to/upon entering the room. Privacy is ensured as no patient name or unique identifier is used on the room sign monitor. However, staff ’s name, photo and position will appear on the patient’s bedside terminal when in the room since their badges are integrated with the hospital’s real-time locating system.

IMPROVING HEALTHCARE SERVICE DELIVERY

During the project specification development, Humber River Hospital engaged GE Healthcare to look at lean process improvements, including the travel distance of nursing staff on in-patient units. With the assistance of architecture fir m, HOK, several technologies were implemented as a result of these studies.

Located on the footwall, a large monitor will allow medical staff to work without interrupting the patient’s activity on the integrated bedside terminal. Any updates made on the terminal will be immediately available to the healthcare team, including the family doctor.

Point-of-care carts, equipped with a laptop and secure medication drawers, will move through the in-patient unit with care team members.

Humber River Hospital staff and physicians will also carry personal digital

assistants (PDA) or handheld tablets to further reduce travel and improve communication. When a patient needs medication, physicians can place an order directly through their device. The order is processed digitally in the on-site pharmacy, equipped with an elaborate automated drug dispensing system. A bar code is adhered to the patient’s dose and the medication is transported to the in-patient unit via password protected pneumatic tube. Medications are then distributed to the point-of-care carts or medication room by authorized staff. At the bedside, nurses use a bar code reader to scan the patient’s bracelet and the medication package. An alarm will let the nurse know if there is a mismatch.

Clean linens and consumables, including meals, will arrive at the patient room with the help of a small, orchestrated fleet of automated guided vehicles. They are programmed to move through Level 0 and via service elevators into staging areas on each floor, where staff is automatically notified of the supplies so that they can distribute them appropriately. A d e d i c a t e d f o o d s e r v i c e e l ev a t o r facilitates meal delivery to pantries on the in-patient tower in a just-in-time model. The mobile robots communicate with building components, like doors and elevators, as well as passersby to alert them of their presence. They politely direct people to clear the way but are confined to controlled paths in service zones to minimize conflict.

Humber River Hospital has raised the benchmark for using technology and innovation in hospital design and construction. Digital system integration and interoperability places the patient firmly at the centre of their care experience — connected to their health information and care team like no other hospital in North America.

Debbie Wadsworth is an architect at HOK, an international design, engineering, architecture and planning firm.

SUMMER/ÉTÉ 2015 17

FEATURE SERIES

ROBOTICS AT THE GLEN

McGill University Health Centre ushers in new era in healthcare

18 CANADIAN HEALTHCARE FACILITIES

FEATURE SERIES

By Elizabeth McPhedran

T

he McGill University Health Centre’s Glen site is the most recent addition to the Montrealarea health network. Consolidating three founding hospitals under one roof, it is also one of the most innovative academic health facilities in North America, featuring more than $255 million worth of cutting-edge equipment and the latest technologies. From cancer care to pharmaceutical distribution, robotics are enabling physicians to perform procedures with unparalleled precision and accuracy, resulting in vast improvements in the delivery of care.

CYBERKNIFE M6

The first of its generation to be installed in Canada, the CyberKnife M6 is an automated radiosurgery system that is revolutionizing how cancerous and benign tumours are being treated throughout the body. Unlike standard machines, which are static, the system moves around the patient — its articulated arms administering a precalculated dose of radiation with submillimetre precision. As a result, the CyberKnife can be used to treat tumours as small as 0.2 centimetres. This level of control, which is not possible with other types of linear accelerators, is expected to improve cancer relapse rates as doctors can be more accurate in targeting tumours during the first round of treatment.

Another important advantage is the impact the machine has on patient well-being. The CyberKnife is a non-

surgical treatment option that can access hard to reach areas of the body and has little effect on nearby healthy organs and cells. It can carry out treatment in just one to five visits (compared to conventional radiology treatment, which can require as many as 30 visits), greatly reducing the time patients need to spend in hospital.

ARTIS ZEEGO ROBOT

At the heart of the Glen’s state-of-theart interventional radiology suite — a first of its kind in Quebec — is the Artis Zeego robot. The machine provides high resolution, 3-D images via its rotating robotic ar m with amazing speed and great flexibility. It can produce a 3-D image of an entire body region in less than 10 seconds and help guide minimally invasive surgical instruments to a very precise anatomic location, reducing the time r e q u i r e d f o r a p r o c e d u r e, a n d increasing patient safety and comfort while avoiding harm to other organs.

For instance, the robot-assisted unit can more accurately target cancerous cells, allowing physicians to administer a much higher dosage of chemotherapy through a minimally invasive procedure instead of intravenously.

This results in a higher impact on t u m o u r c e l l s a n d l e s s c o l l at e r a l damage to normal tissue.

automated medication dispensing system that services the entire hospital.

The robot is responsible for every aspect of the medicine distribution process. It individually packages all medications and labels them with a corresponding bar code for inventory. When a pharmacist enters a prescription into the system, a robotic arm picks and scans the products and brings them to an envelope with the patient’s name. The robot then scans the envelope, places the pills inside and drops it in a bin for a pharmacist who then sends it, through a system of pneumatic tubes, to the patient’s floor. When it reaches its destination, a nurse scans the bar code in the patient’s room before administering the medication. This automatically updates the electronic patient file.

The pharmacy robot goes a long way to improving efficiency, safety and speed when dispensing medication to patients.

It improves drug distribution accuracy to 99.9 per cent, reduces incidents of patients missing doses due to human error by 92 per cent, and cuts turnaround time for drug delivery by an estimated 40 minutes per patient. Moreover, it is expected to reduce the amount of time phar macists spend checking that prescriptions have been delivered correctly, verifying inventory and checking for expired drugs by 90 per cent (which ultimately lowers expired medication costs by 54 per cent).

ROBOT-RX

Spanning the length of the Glen’s pharmacy wall is the Robot-Rx, an

Elizabeth McPhedran is a communications officer at the McGill University Health Centre.

SUMMER/ÉTÉ 2015 19

FEATURE SERIES

MANAGING HOSPITAL

ELECTRICAL SHUTDOWNS Customized system provides peace of mind for Lakeridge Health Oshawa

By Andy Santoro

E

quipment shutdown planning and preparation requires considerable upfront investment and ongoing resources to minimize the potential risk to healthcare facility operations, and staff and patient safety when there is a cessation of electricity.

Accurate, up-to-date single-line diagrams and a list of equipment locations are essential to successfully manage this type of event, whether scheduled (for equipment modification or maintenance) or the result of a power failure.

THE PROJECT

In 2013, Lakeridge Health Oshawa undertook the challenge of generating an overall sing le-line diag ram that incorporated all recent electrical system upgrades and building improvements.

20 CANADIAN HEALTHCARE FACILITIES

Together with project and facilities management application service provider, Sansys Inc., the project evolved into the delivery of a complete electrical shutdown management system. The system enables operations personnel to generate a report with critical information on every piece of equipment and the services each provides.

Key requirements of the system included: cloud-based architecture for access anywhere, anytime; a simple browser interface for staff without third party software; controlled access for staff, limiting their ability to “view only” or “edit” information; the ability for staff to edit equipment information and locations quickly and easily from the hospital’s browser; automatic tracking of what was changed, by whom and when; the ability

to upload notes, images and files for each piece of equipment; the ability to locate single-line equipment on facility floor plans; the ability to locate equipment through dynamic links from a schematic diagram or equipment list; an editable panel schedule form tied into the database; output shutdown reports in Microsoft Excel, indicating equipment affected from the top-down to the circuit level; and mobile capability.

THE PROGRAM

Elect r i c a l e q u i p m e n t , i n c l u d i n g switchboards, transformers, transfer switches, motor control centres and lighting panels, was verified on-site to generate the computer-aided design (CAD)-based single-line diagram.

Attributes such as voltage, type, rating,

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2015

Bunzl Canada

HELPING BUSINESSES PERFORM BETTER

FEATURE SERIES

HAND HYGIENE MONITORING GOES HIGH-TECH The Hospital for Sick Children (SickKids) is the first paediatric hospital in North America to automate the monitoring of staff hand hygiene compliance.

In an effort to reduce the number of hospital-acquired infections and, subsequently, improve patient safety, the Toronto hospital has installed five electronic hand hygiene monitoring systems.

“Experts agree that a multi-faceted, multidisciplinary hand hygiene program must be implemented in all healthcare settings,” says SickKids’ director of quality, safety and infection control, Richard Wray. “Measurement, feedback and staff engagement are among the core elements of a multi-faceted approach.”

The DebMed Group Monitoring System (GMS) tracks if healthcare workers are cleaning their hands as frequently as they should based on the "four moments for hand hygiene" standard, which advocates opportunities for hand cleaning, such as before starting an IV or after risk of exposure to body fluids, instead of just upon entrance and exit of the patient room. It then provides timely web-based reports that encourage staff to work together to help improve hand hygiene compliance.

A wireless signal is sent to a small hub and modem in the hospital’s electrical closets every time a hand hygiene dispenser is used. This signal is then sent off-site to a server where compliance is calculated against a scientifically valid algorithm that takes into account the unique conditions of the hospital unit, such as the nurse-to-patient ratio and frequency of care, to accurately predict the expected hand hygiene opportunities.

According to the Canadian Patient Safety Institute, approximately 220,000 people — or one out of every nine patients admitted to hospital each year in Canada — acquire infections while being treated for something else. Of these patients, 8,000 to 12,000 die. The number one way to reduce these numbers is for healthcare workers to comply with hand-washing guidelines.

22 CANADIAN HEALTHCARE FACILITIES

condition, in-service date, service summary and “fed from” were entered into the system.

Using Java code and a database structure, the system was developed to generate connection diagrams on demand.

Each equipment block is an active tag that provides selection options, including “show location on floor plan” and “generate isolation report.”

The hospital’s floor plans were used as the basis for the equipment tag locations. The CAD floor plans were converted to HTML 5 drawing canvas so they could be used in the browser without special software.

The equipment tag can simply be dragged and dropped from the list onto the location of the floor plan. Staff is able to remove or change the location in the browser.

When upstream equipment is isolated, the management system provides a list of circuits that are affected by an electrical shutdown. Keyword searches (for example, medical gas alarm or nurse call) in the equipment list identify the panel and circuit supply. Panel schedules can be printed by staff and placed at the panel.

THE PROSPECT

Lakeridge Health Oshawa is currently in the process of updating panel schedules (through circuit tracing) as well as the forms in the system.

The hospital has also added other equipment, such as pumps and fans fed from motor control centres, to determine the mechanical services affected by a shutdown.

This electrical shutdown management system is now being implemented at three other facilities in Ontario: William Osler Health System’s Etobicoke General Hospital, London Health Sciences Centre’s University Hospital, and the Ottawa Hospital’s General campus. Because of the simple protocol, the same system can be used for a variety of building services, including air, gas and medical gas distribution. At Etobicoke General Hospital, it is being implemented for medical gases.

Andy Santoro, P.Eng., is president of Sansys Inc. Based in London, Ont., the company provides unique, customized cloud-based solutions for healthcare construction and facility management. Andy can be reached at 1-519-852-4705 or santoro@sansys.com.

35th Annual Conference of the Canadian Healthcare Engineering Society

“Healthcare Facilities and the Technology Highway”

www.ches.org

NATIONAL CONFERENCE CONGRÈS NATIONAL

SEPTEMBER 20 - 22 SEPTEMBRE

Shaw Conference Centre • Edmonton

S

P O N S O R S KEYNOTE

DIAMOND

PLATINUM

GOLD

SILVER HH Angus

IEM Industrial Electrical Mfg.

Primex Wireless

PROGRAM SUNDAY SEPTEMBER 20, 2015 09:00-14:00 The Great CHES Golf Game (Bus time to be determined) 13:00-15:30 Facility Tour - Kaye Edmonton Clinic and Mazankowski Alberta Heart Institute, University of Alberta Hospital The Kaye Edmonton Clinic provides coordinated diagnostic and specialist ambulatory services to patients and their families in a fully integrated facility. Patients benefit from seamless, outpatient clinical care and streamlined access to specialized services and specialists. Ambulatory services are brought together under one roof, including surgical, medical, family and seniors’ clinics, diagnostic imaging, orthopedic and neurosciences clinics and the University of Alberta’s School of Dentistry and the Glen Sather Sports Medicine Clinic. It’s also the future home to the Northern Alberta Urology Centre, the C.J. Woods Prostate Health Clinic, Northern Alberta Renal Program, transplants and adult mental health clinics. When patients come in to see their physician, they can schedule appointments to see a social worker, dietitian or other members of their care team on the same day in the same building. When fully operational, nearly one million patients a year will benefit from the Kaye Edmonton Clinic’s integrated network of care.

The Kaye Edmonton Clinic is an 8 story 118,000 square meter facility, designed and awarded as LEED Silver.

The Mazankowski Alberta Heart Institute is a world-class program within the University of Alberta Hospital. The Mazankowski Alberta Heart Institute has become one of Canada’s leading heart centers in the prevention and treatment of heart disease. It offers comprehensive cardiac surgery, cardiology services and patient education. The Mazankowski is the nucleus for highly skilled cardiac care professionals, researchers and educators. It is also the training ground for the cardiac leaders of tomorrow. Adult and pediatric patients from Alberta as well as western and northern Canada benefit from the highest level of patient-centered care, stateof-the-art diagnostic and treatment technology.

The Mazankowski Alberta Heart Institute also strongly supports cardiovascular research.

It provides a shared environment for patient care and research through The Alberta Cardiovascular and Stroke Research Centre (ABACUS), one of the many research elements in the Mazankowski Alberta Heart Institute. By bringing clinicians and researchers together in a shared environment, they are better able to integrate new knowledge and emerging treatments to advance patient care. The Mazankowski Alberta Heart Institute includes an indoor healing garden, and a state-of-the-art interactive 100-seat digital classroom with two 4K digital projectors offering real-time consultation with the global cardiac community.

The Mazankowski Alberta Heart Institute resides on 5 floors of a 8 story expansion of the Walter C Mackenzie Health Sciences Centre, including Canada’s busiest heliport. The Walter C Mackenzie Health Sciences Centre also includes the remainder of the University of Alberta Hospital, Stollery Children’s Hospital, Provincial Laboratory, and the University of Alberta’s Faculty of Medicine and Dentistry. The Mazankowski Alberta Heart Institute expansion was designed and awarded as LEED Silver.

18:30-21:00 Opening Reception - Sponsored by Class 1 Inc. Art Gallery of Alberta

MONDAY SEPTEMBER 21, 2015 07:00-08:30 Breakfast 08:30-08:45 Opening Ceremonies 08:45-09:30 KEYNOTE ADDRESS - Sponsored by Honeywell Don Winn Don Winn is an MIT Sloan Fellow and organizational coach who works with national and international senior leaders to create high-performance cultures and transformational change.

Over the last 25 years, Don has had direct accountability for organizational transformations valued at in excess of $30B and functioned as an external advisor for other transformations valued at more than $250B. In healthcare, Don has worked with senior leaders across five provinces at clinical, administrative, executive and government levels.

His field experience is complimented with research on high performance teams, senior leadership and creating sustainable results during turbulent times.

09:30-10:30 PLENARY SESSION - Track 1 - Sponsored by MCW Track 1:

The Convergence of Technology and Facilities: Implications for our Health Penny Rae, Chief Infromation Officer, Information Technology, Alberta Health Services, Calgary AB

As technology advances, what we perceive as “health care facilities” will change. From the traditional hospital view to care in the community, the pace of change in health care delivery in the coming years will be staggering. This talk will explore how technology will impact the design of traditional facilities, as well as implications to the healthcare engineering workforce as patients take health care monitoring devices into their homes. Join us to take a look into the future of technology and how it will shape your future and your health!

10:30-11:00 Break in the Exhibit Hall - Sponsored by Thomson Power Systems 11:00-12:00 2 CONCURRENT TRACKS - Tracks 2A & 2B Track 2A:

Using Automatic Guided Vehicles for Hospital Cart Transportation Garry Koff, BSEE, MBA, President, Savant Automation, Inc. [AGVS], Grand Rapids, MI, USA

As hospitals strive to become more efficient, they are turning to Automatic Guided Vehicles (AGVs) to provide major cost savings in labor, energy, and process inefficiencies while dramatically improving safety. These systems move hundreds of hospital carts a day between all major areas of a hospital insuring timely delivery of meals, linens and supplies.

This technology has rapidly evolved to do more, become easier to deploy, to require less maintenance and to become easier to justify for all size customers. It is used in existing and new construction projects. This presentation provides a basic understand of how these systems work, how to properly apply them, and reviews the facility planning needs for an automatic hospital cart delivery system.

Track 2B:

It’s More Than a Call Bell System: It’s a Patient Contact and Communication System Craig B. Doerksen, CEM, CFM, MFM, P. Eng, Divisional Director, Facility Management, Health Sciences Centre, Winnipeg, MB

Today’s nurse call systems have advanced beyond that of the old “call bell” systems which were designed to just summon the nurse. With today’s multi skilled care teams, communication cannot be just between patient and nurse, but must bring in all of the care and support team members. Today’s systems have evolved and elevated to provide call prioritization, workflow management and system integrations. With HL7 integration to ATD, EMR and EPR systems drawing in patient information and SIP and other communication protocol integrations systems put clinical and support staff into a whole new realm.

Understanding, specifying and delivering on these patient contact and communication systems goes beyond specifications, bids and installation. Take a brief walk through the needs assessment, EOI and RFP and selection process to system implementation planning.

12:00-13:00 2 CONCURRENT TRACKS - Tracks 3A & 3B Track 3A:

A Safer & More Reliable Electrical Distribution for Hospitals Ajit Bapat, P. Eng, Senior IEEE Member, Former Central Canada Council Chair Reg. 7, I-Gard Consultant, I-Gard Corporation, Mississauga, ON Sergio Panetta, P. Eng, Senior IEEE Member, Vice-President, Engineering, I-Gard Corporation, Mississauga, ON

According to the authors of Industrial Power Systems Grounding Design Book, over 95% of all electrical outages are caused by ground faults. Whether in their main electrical distribution or for application on their emergency generators, hospitals are choosing highresistance grounding. While high-resistance grounding was initially applied to only process industries as diverse as food processing, mining, and petrochemical, it is being increasingly applied to hospitals to enhance the reliability of uptime of power distribution.

The intent of this session is to illustrate the benefits of HRG and how to create a safer and more reliable distribution system. The benefits identify how to avoid unscheduled power interruption, drastically reducing arc flash incidents, mitigating multiple ground faults by selectively tripping les prioritized feeders, and locating ground faults without de-energizing the power system. The various methods of applying HRG will be explored. Low Resistance Grounding and Hybrid Grounding methods will be assessed as well.

Track 3B:

Superconvergence and the Future of Healthcare Facilities Benjie Nycum, BEDS, M. Arch, NSAA, AANB, PMP, CEO, William Nycum & Associates Ltd., Adjunct Professor, Dalhousie University - Faculty of Architecture and Planning, Halifax, NS

Technology-driven disruption is coming to healthcare. For industries like music, transportation and education, disruption has been good for consumers, but for providers it has created a new landscape. So far, disruption has been slow and incremental for healthcare because there is so much liability and risk, but these will eventually be overcome. The key driver will be the superconvergence of technologies (electronic records; the genome; crowdsourcing; digital and quantum technologies; big data) along with diminished financial and human resources. This presentation explores superconvergence and disruption from a healthcare facility planner’s perspective and aims to position attendees to embrace the disruption caused by superconvergence.

13:00-14:00 Lunch in Exhibit Hall - Sponsored by Klenzoid Canada Inc. 13:00-15:00 Exhibit Hall Open 15:00-16:00 2 CONCURRENT TRACKS - Tracks 4A & 4B Track 4A:

Using Web Based Technology to Monitor, Control & Reduce Utility Costs Harry Vandermeer, P. Eng, CEM, Provincial Director, COE - FME & Energy, Alberta Health Services, Edmonton, AB Frans Diepstraten, Ph.D., LEED AP, Senior Advisor COE FM&E/Energy, Alberta Health Services, Edmonton, AB

This session will share learnings from the utilization of various web based technologies utilized at Alberta Health Services to monitor, control, and reduce utility consumption and costs.

Each web based technology utilized by Alberta Health Services for the sole purpose of controlling, managing and reducing utility consumption and costs will be presented along with implementation costs, savings and paybacks and lessons learned.

Track 4B:

Nanaimo Regional General Hospital Emergency Department and Psychiatric Emergency Services Bruce Raber, Architect AIBC, MRAIC, SAA, MAA, OAA, NSAA, AAA, NWTAA, AIA Associate, LEED AP, EDAC, VP Sector Leader for Health & Wellness, Stantec, Vancouver, BC Ray Pradinuk, Architect AIBC, LEED AP, Principal, Stantec, Vancouver, BC

A case study that demonstrates innovation in the creation of a healthy hospital environment for patients and staff; and a level of daylighting unparalleled in a large Emergency Department in a modern hospital. The design goals, objectives, and sustainability strategies were to achieve a LEED Gold solution around the four values of Timely, Respectful, Quality of Care, and A Place People Would Want to Come to Work.

16:00-17:00 “Happy Hour” in Exhibit Hall - Sponsored by Trane 18:00-19:00 President’s Reception - Sponsored by Tremco 19:00-23:00 Gala Banquet - Sponsored by Johnson Controls Banquet Entertainment - Sponsored by Chem Aqua

TUESDAY SEPTEMBER 22, 2015

flooded many communities including Calgray, High Rver, Canmore and others. The extreme weather events led to the most costly natural disaster to ever occur in Canada. This case study presentation will explain:

• • • • • • • •

Track 6B:

Planning Technology to Compliment Clinical Workflow Michael Brown, Regional Practice Leader, Smith Seckman Reid Inc., Nashville, TN

Technology is integrated into every aspect of our Healthcare delivery model. All too often, newly implemented technology solutions do not coincide with existing clinical processes and creates issues with caregivers.

The appropriate planning, design, implementation, coordination, and training are critical to successfully integrating Technology with Clinical workflow. Strategic planning with new construction or renovation projects will ensure a successful integration to support clinical processes.

Identifying and coordinating workflow processes to existing systems… What works well and what doesn’t? Next, what’s the perfect system look like from a clinical staff perspective?

Finally, blending these requirements with long-term strategic IT planning is critical. Without acknowledging clinical needs and IT system planning, newly implemented systems have a higher rate of failure among clinical staff.

This session will focus on a multi-faceted approach in adopting new Healthcare Technology.

We will look at the steps in preparing new systems coinciding with newly constructed spaces.

14:15-15:15 2 CONCURRENT TRACKS - Tracks 7A & 7B Track 7A:

Power System Maintenance and Electrical Asset Management Dave Emerson, C.E.T., P.S.E., Technical Field Services Manager - Calgary, Magna IV Engineering, Calgary, AB

07:00-08:30 Breakfast 08:30-09:30 PLENARY SESSION - Track 5 Track 5:

Extent of the natural catastrophe Communications during the disaster Command centres - local and provincial The Town of Canmore was completely inaccessible by road Evacuations and how they were accomplished Remediation of damaged facilities Lessons learned Mitigation to reduce the impact in the event of a repeat occurnace

Surgical Fires: Prevention, Suppression, and Response

Roger Grylls, C.E.T., Vice President, Technical Field Services, Magna IV Engineering, Edmonton, AB

Charles Cowles, MD, MBA, Asst. Professor and Chief Perioperative Safety Officer, University of Texas MD Cancer Center, Houston, TX

Virginia Balitski, C.E.T., Project Manager - Training, Magna IV Engineering, Edmonton, AB

David Hood, BS, President, Russell Phillips and Associates, Fairport, NY

Track 7B:

The Right Instruction, to the Right Person at the Right Time

This session will explore successes and failures in implementing effective life and fire safety procedures in the operating room (OR) suite. Discussion will include how to address the unique patient acuity, staffing patterns, and evacuation procedures critical to this environment as well as fire prevention, suppression, and evacuation programs. The session will provide a unique perspective for how to engage physicians and other key team members from the perspective of a staff anesthesiologist.

15:15-15:45 Refreshment Break

09:30-10:15 CHES National Annual General Meeting

15:45-16:45 PLENARY SESSION - Track 8

10:15-10:45 Refreshment Break in the Exhibit Hall

Track 8:

10:15-10:45 CHES Alberta Chapter AGM 10:15-13:15 Exhibit Hall Open 12:15-13:15 Lunch in the Exhibit Hall - Sponsored by Thermogenics Draw Prizes 13:15-14:15 2 CONCURRENT TRACKS - Tracks 6A & 6B Track 6A:

2013 Alberta Floods: Impact on AHS Facilities in the Calgary Zone Allan Roles, P. Eng., Senior Director Capital Management - Calgary Zone, Alberta Health Services, Calgary, AB Craig Schultz, CET, Zone Director, Capital Management Calgary, Alberta Health Services, Calgary, AB Doug McKay, Director Capital Management Rural Sites, Alberta Health Services, Calgary, AB

In June 2013, heavy rainfall over Calgary and in the mountains west of Calgary caused unprecedented flooding from multiple water sheds. The heavy rain over the mountains melted heavy snow pack and melted it virtually overnight. Rivers breached their banks and

Paul Edwards, B. Com., Vice-President - Medical Gases, Air Liquide Healthcare (division of VitalAire Canada Inc.), Mississauga, ON Mark Allen, Bachelors of BioChemistry, Vice-President - Medical Products Marketing, Beacon Medaes - Atlas Copco Group, Rock Hill, SC

Technology Integration - No Longer the Future John Karman, C. Tech, PMP, RSW, Principal, Stantec International Inc., Dubai, UAE

This session will be a case study on the Integrated Communication Technology design of the One Million Square foot King Faisal Hospital and Research Centre Tertiary Care Pediatric Hospital in Riyadh, Saudi Arabia. It will focus on the increasing complexity and the steps that need to be taken to ensure both the design and the construction process pay attention to all the various interfaces. This session will: • Provide the attendees with tools to assess the requirements for integration.

• Allow the attendees to identify the processes involved in System Integration.

• Identify systems affected by and benefiting from integration.

• Assess the benefits from integration • Identify the individuals needed to participate in an integration exercise 16:30-17:00 Closing Ceremonies

TRADE SHOW

Participating companies are listed below.

3D Energy Ltd.

DCM Inc.

NABCO Canada Inc.

Abatement Technologies Ltd.

Door & Hardware Institute Canada

Phoenix Controls

Aerocom Systems, Inc.

DriSteem

Polytek 360

AIC Heat Exchanges

DuPont Canada Company

Precise Parklink Inc.

Air Liquide Healthcare

Eaton

Primex Wireless

A-Line Distributors

ECNG Energy L.P.

Rauland-Borg Canada

Allegion Canada Inc.

Erv Parent Co. Ltd.

Record Automatic Doors

Amico Corporation

ESC Automation Inc.

Reliable Controls Corporation

Aqua Air Systems Ltd.

Excel Systems Inc.

Salto Systems Inc.

Aqueous Solutions

Follett Corporation

Schneider Electric

Asco Power Technologies Canada

Forbo Flooring Systems

Siemens Canada Limited

Austco Communication Systems

Franke Kindred Canada Inc.

Specified Technolgies, Inc.

Axis Communications

Freudenberg Filtration Technologies Inc.

Spirax Sarco Canada Limited

B.G.E. Service & Supply (The Filter Shop)

GE Power & Water

Steam Specialties

Belfor Property Restoration

GroundEffect Aerodrome Consulting Ltd.

Swisslog Healthcare Solutions

Bender Canada Inc.

Hill-Rom Canada

SWS Group

Breathe Easy Duct Cleaning Ltd.

Honeywell

Thermal Insulation Association of Canada

C/S Construction Specialties

IEM Industrial Electrical Mfg. (Canada) Inc.

Thermogenics Inc.

Camfil Farr (Canada)

I-Gard Corporation

Thomson Power Systems

Canadian Coalition for Green Health Care

James Electric Motor Services Ltd.

Time Trackers

Carlisle SynTec Systems

Kapstone Services Inc.

Trane Canada

Cash Acme / Sharkbite

Klenzoid Canada Inc.

Tremco Canada

CGC Inc.

Labor Management Cooperative Trust (LMCT)

Trimco

CHEM-Aqua Canada

Levitt-Safety

Tundra Process Solutions Ltd.

Chubb Edwards

Magna IV Engineering Ltd.

Victaulic Company of Canada Ltd.

Class 1 Inc.

Marathon Institutional Products

Vidir

Computer Environment Solutions (C.E.S.)

Masco Canada Ltd.

Watertiger

Cornerstone Medical

MediaEdge Communications Inc.

Wesco Distribution Canada, LP

Dafco Filtration Group

Medical Mart

The Atrium, Shaw Convention Center, Edmonton, Alberta

DIVERSIFIED CONSTRUCTION ASPHALT PAVING BUILDING RESTORATION CONCRETE INTERLOCKING STONE LANDSCAPE CONSTRUCTION SITE SERVICING

CONTRACTORS

WINTER SNOW SERVICES 24-HOUR EMERGENCY SERVICE

We offer a wide range of services, from pothole lling to reconstruction of parking lots

www.forestcontractors.com

TECHNOLOGY

WALK THIS WAY

Advances in wayfinding technology point hospitals in the right direction

By Chris Wiegand

T

raditionally, hospital wayfinding has relied heavily on colour and symbolism, flooring and ceiling cues, easily identifiable landmarks, and static maps and signs. But today, this is no longer good enough, particularly since most hospitals that undergo renovation and expansion often fail to properly update their wayfinding program. As a result, patients and visitors struggle to traverse the maze of the modern medical complex. For sick patients, navigating a building that has unclear or ambiguous signage leaves them feeling lost, scared and frustrated. Naturally, they turn to hospital staff for assistance; however, staff are already stretched to their limit in an environment where timeliness is critical to delivering quality care.

MOVING WITH PURPOSE

To improve the patient experience, hospitals have installed interactive 28 CANADIAN HEALTHCARE FACILITIES

wayfinding kiosks to supplement traditional signage. Typically positioned at a hospital entrance, kiosks enable patients to check-in for appointments on arrival; chart a route to their treatment destination and obtain an estimated walk time; and print and/or send directions to their mobile device.

However, as people have become more accustomed to the convenience of their mobile devices and apps, they expect the same level of accessibility in other industries to be extended to their treatment experience. This has prompted hospitals to develop mobile wayfinding apps that patients can download to their mobile devices, providing immediate access to appointment notifications and information, driving directions, remote check-in, turn-by-turn indoor navigation and continuous interaction throughout the continuum of care.

Aside from patient convenience, digital

TECHNOLOGY wayfinding has another key advantage over traditional wayfinding signage — data can be updated in real-time through the underlying wayfinding platform.

System administrators have the ability to manage floor maps, wayfinding data and content directly, or to configure business rules that will automatically trigger changes based on events. For instance, if a section of the hospital is quarantined, the wayfinding application will avoid directing patients and visitors to that area.

The advances in interactive hospital wayfinding have been made possible through a combination of location-aware technologies — GPS (global positioning s y s t e m ) , R F I D ( r a d i o - f re q u e n c y identification), Wi-Fi and Bluetooth LE (low energy) beacons — which are able to determine the geographical position of people or objects, and enterprise wayfinding software, which provides powerful mapping and third party integration capabilities.

For patients, this means a visit to the hospital begins with a notification to their mobile device confirming appointment details, providing estimated travel time and turn-by-turn navigation to the entrance nearest their appointment location. Upon entering the hospital, the patient can check-in using an integrated check-in kiosk.

This triggers an event in the patient flow management system, seamlessly adding the patient to the registration queue and delivering estimated wait times directly to their mobile device. Once registered, the app prompts the patient to follow indoor

directions to their appointment location, taking into account accessibility preferences configured by the user. Throughout their visit, the patient is informed of appointment delays. In some cases, a video relevant to the patient’s specific condition can be streamed directly on their mobile device.

IMPROVING HOSPITAL EFFICIENCIES

Advances in wayfinding technologies play an equally important role in helping hospital staff improve patient throughput and optimize clinical workflows. Because patients, staff and medical equipment are in a state of constant movement, healthcare workers waste a lot of time locating people and equipment.

Using wayfinding technologies in combination with positive patient identification and wireless healthcare asset management ensures that once a patient has been positively identified, all subsequent encounters and related workflows are tracked and become more efficient, thus improving patient safety, preventing infant abduction and patient wandering. Meanwhile, healthcare assets tagged with locators or beacons can be quickly found in the event of an emergency. In the case that these assets are confined to a geo-fenced area, staff can be alerted when the machines are removed or disabled outside specific zones.

Because patients and visitors have very distinct needs from hospital staff, wayfinding technologies provide information-based roles. For instance, healthcare workers are able to see patient movement, equipment locations and find

coworkers. Staff also have access to more direct routes through the hospital than those provided for patients. This helps improve staff communication and enables better time management, saving money. Patients and visitors, on the other hand, have a distinct view of the hospital, one that enables them to reduce waiting times and increases the quality of their experience. Patients with disabilities receive essential navigation tips that help them achieve their goals, and reduce the usual stress and anxiety associated with a visit to the hospital.

A NEW PATH TO GROWTH

With more options in healthcare providers, patients are treating this industry just like any other — fully informed and with high expectations of service delivery.

Advances in wayfinding technologies are setting forward-thinking healthcare delivery organizations apart from their competitors. By capturing a patient’s intent to navigate to the clinic and using information from various intelligent systems, an integrated wayfinding system can shape their journey, making it easier to fulfil their goal while, at the same time, saving the clinic significant time.

Although many healthcare units have tapped into the power of data collection through social, mobile, cloud and analytics technologies, they are not maximizing the power of that information because they lack the means to integrate it with their major information systems.

This vital data can be used to its fullest potential by integrating collected patient data with clinician workflows and electronic health records in order to provide a great patient experience.

An efficient wayfinding system can correlate data from mobile, social and cloud technologies and integrate it with a hospital’s information system in order to create a personalized, seamless patient journey.

Chris Wiegand is the CEO of Jibestream, a software development company for digital interactive technologies. Chris co-founded Jibestream in 2009, to pioneer solutions that enhance navigation and deliver real-time information messaging in busy public hubs and private venues, including healthcare facilities, retail malls and corporate campuses.

SUMMER/ÉTÉ 2015 29

TECHNOLOGY

A REAL ASSET

Asset tracking targets efficiency to reduce hospital costs, improve delivery of care

By Kim Osborne

P

atient safety and outcomes have traditionally been key perfor mance indicators for hospitals in Canada, but recently value and ef ficiency have emerged as increasingly important performance metrics. The introduction of new devices and technology that contribute to clinical and financial targets provide an opportunity for hospitals to leverage strategic investments.

REAL-TIME LOCATING SYSTEMS

In 2012, Canada spent $60.6 billion on hospitals alone, up more than $10 billion from 2009. Although total healthcare spending (encompassing hospitals, drugs, physicians, administration and capital) has grown steadily in the last two decades, the percentage share of funding allocated to hospitals has steadily dropped in the last 40 years, from nearly half of total healthcare spending in 1975, to less than one-third in 2012. Hospitals have had to deliver the same services to more patients without significant increases in funding to match demand.

As a result, there is a greater emphasis on efficiency alongside patient safety and satisfaction.

American hospitals are considered by many to be at the forefront of embracing cutting-edge technologies aimed at reducing costs and improving efficiency.

Other countries often follow-suit once there are proven U.S. hospital business cases that substantiate the benefits.

A recent example of this is the widespread adoption of real-time locating systems (RTLS), which are used to track patients, staff and assets. RTLS typically uses Wi-Fi or proprietary technology, or a combination of both, to triangulate the location of radio30 CANADIAN HEALTHCARE FACILITIES

frequency tags within a building and then display the locations on a map. Tags are attached to people or items to be tracked.

Authorized staff are able to easily search for the location of a specific tag or category of tags. RTLS is now being implemented in the majority of new build and redevelopment hospital projects in Canada.

Many of the financial benefits of RTLS come from the ability to track assets and equipment in a hospital. Other benefits include increased staff efficiency and satisfaction, improved maintenance, reduced capital replacement costs and evidence-based decision-making.

INCREASED STAFF EFFICIENCY AND SATISFACTION

Data from the Canadian Institute for Health Information suggests that worker compensation makes up more than 60 per cent of total hospital costs and the majority of this goes to nurses. Other studies have shown that nurses spend between seven and 20 per cent of their shift searching for equipment and supplies, taking time away from patient care and other responsibilities. Asset tracking significantly reduces “wasted� time locating items, which improves nursing efficiency. It also benefits patients since outcomes improve when nurses are able to spend more time at the bedside.

IMPROVED MAINTENANCE

The efficiency gains extend to biomedical and facilities staff as well. Preventive maintenance is not only important for maintaining warranties and extending the useful life of equipment, but also has a critical impact on patient safety by ensuring that medical equipment is functioning properly. Research by the World Health Organization indicates

that globally, up to 60 per cent of hospital medical equipment is not maintained properly, potentially leading to premature failure or adverse patient outcomes.

Given that significant time is often spent locating equipment for maintenance or recalls (with mixed success), asset tracking improves operational efficiency, capital replacement and clinical metrics by ensuring that support staff are able to easily find it.

REDUCED CAPITAL REPLACEMENT COSTS

A study by American national care network, VHA Inc. (for merly Voluntary Hospitals of America), found that, on average, U.S. hospitals s p e n d $ 4 , 0 0 0 p e r b e d p e r ye a r replacing lost or stolen equipment and supplies, leading to a total capital cost of approximately $2 million per year for a typical 500-bed hospital.

F u r t h e r m o r e, r e s e a rc h s u g g e s t s hospitals buy 20 to 50 per cent more equipment than required, and most equipment has only a 40 to 50 per cent utilization rate.

Asset tracking reduces the required fleet size by making equipment more available and increasing its utilization, a benefit that the Ottawa Hospital leveraged to reduce an upcoming i n f u s i o n p u m p d e p l o y m e n t by approximately one-third after implementing a RTLS on its 3 millionsquare-foot campus.

EVIDENCE-BASED DECISION-MAKING

When it comes to making purchasing decisions, there is generally a lack of clear information related to hospital needs, which can lead to an inefficient use of capital funds.

Asset tracking provides the data required to assess equipment usage,

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SUMMER/ÉTÉ 2015 31

TECHNOLOGY maintenance and failure rates in o r d e r t o d r i ve e v i d e n c e - b a s e d purchasing decisions. This eliminates unnecessary equipment purchases and improves the overall usefulness of the hospital’s assets.

BUILDING A BUSINESS CASE

The return on investment (ROI) for RTLS is typically based on three areas of cost savings: improved clinical efficiency (operational/labour savings);

increased utilization/fleet reduction (capital equipment savings); and reduction in loss/theft (capital equipment savings).

There are a number of different methods used to estimate the ROI for a given area of cost savings.

For operational efficiencies, ROI can be estimated using time studies, which track the amount of time spent finding equipment and supplies. These time studies should target assets that are

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MAXIMIZING THE INVESTMENT VALUE

Although asset tracking is an effective tool for improving hospital ef ficiency, maximizing the investment value requires looking beyond immediate cost savings to understand how the solution fits with the overall strategy and goals of the healthcare organization. For example, automatically making the real-time information available (through asset tracking) to other hospital systems helps reduce manual data entry, freeing up additional resources and improving the quality and availability of information. To identify and maximize t h e s e o p p o r t u n i t i e s, d e s i g n a n d implementation of the RTLS should include consultations with clinical, support and facilities staff.

Ultimately, asset tracking provides an opportunity for healthcare organizations to reduce costs and provide better quality care for patients by improving hospital efficiency. The outlook is still optimistic: There may be unprecedented financial pressure on hospitals but there is a parallel unprecedented opportunity in the availability and effectiveness of new technology.

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routinely needed or those that take a long time to find, such as stretchers, wheelchairs, infusion pumps and IV poles.

Savings in capital expenditure can be estimated using industry averages. When considering the savings associated with fleet reduction, equipment fleets can generally be reduced by up to one-third.

Theft can be reduced up to 50 per cent, depending on the current theft rate in the healthcare organization.

ROI calculations should take into account both the operational and capital expenditure savings anticipated through the implementation of asset tracking by calculating a total annual savings and estimated payback period based on i n fo r m at i o n ava i l a bl e w i t h i n t h e organization.

Kim Osborne is an electrical engineer with Angus Connect, a multi-disciplinary team of professionals that brings proven IM/ IT (information management/information technology) strategic planning and implementation expertise to Canadian hospitals. She can be reached at kim.osborne@angusconnect.com.

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BUILDING OPERATIONS

MOISTURE

MANAGEMENT Getting operating room humidity under control

C

ontrolling humidity in operating rooms provides a host of benefits, which contribute to a healthier and more cost-efficient building.

However, it is easier said than done.

Here, John Gowing of EI Solutions Inc. discusses the challenges of curbing humidity and provides climate control strategies.

Why is humidity a challenge in operating rooms?

An operating room requires high volumes of outdoor air. If air entering 34 CANADIAN HEALTHCARE FACILITIES

an operating room is drier (or less humid) than the room itself, it will reduce the amount of humidity in the operating room. Conversely, if air entering an operating room is more humid than the room itself, then the humidity level will rise within the operating room.

Warmer air can hold a higher level of water vapour or humidity. Therefore, a room that is 18 C with 50 per cent relative humidity (RH) has a lower level of absolute humidity than a room that is 20 C with 50 per cent RH. The absolute

BUILDING OPERATIONS

humidity level can be measured in terms of dew point temperature or vapour pressure. Air with a higher absolute level of humidity has a higher dew point and corresponding vapour pressure.

In winter, colder outdoor air limits the dew point temperature to a very low level, which results in very dry air.

As a result, healthcare facility managers are challenged with having enough humidification capacity to compensate for the lower humidity level within the outdoor ventilation airstream and the reduction in humidity in the operating ro o m ( a s h i g h e r i n d o o r va p o u r pressure moves out of the building).

Fortunately, medical professionals

prefer a lower space dry-bulb temperature in the operating room since they must wear heavy gowns that can make surgery uncomfortably hot.

Lowering the operating room t e m p e r at u re h a s t h e b e n e f i t o f increasing the room’s relative humidity.

Spring until fall also poses a challenge to facility operators because outdoor air is very humid. Most traditional cooling coil and reheat systems provide suitable cooling or lower space temperature levels in the operating room during this time.

Regrettably, the same cannot always be said for the absolute humidity levels that are required to be maintained in the operating room. To dehumidify an operating room with a cooling coil, the coil must be designed to operate with very low leaving temperatures in order to supply drier (low dew point) air to the space. It is important to note that the room dew point temperature will always remain higher than the supply air dew point temperature due to internal latent loads (people and infiltration).

The gradient or difference between a cooling coil’s optimum dew point and the operating room is dependent on the humidity load in the operating room; leaks in the ductwork feeding the operating room; and the effectiveness of the vapour barrier between the operating room and surrounding spaces. It is important that adjacent spaces not have high vapour pressure as it will push humidity into the operating room. A good practice for slowing down the rate at which moisture migrates from a surrounding area into the operating

room is to provide a buffer zone of reduced humidity.

The shoulder months of the seasons can also be of concern to facility operators. Some ventilation systems employ an enthalpy control strategy, which allows for free cooling from outside air during cooler periods. However, when the temperature is low and humidity is high, the outdoor dew point will be too high to control the humidity level in the operating room. This free cooling strategy can be corrected by inserting a control loop that takes the outdoor dew point temperature into account.

What is the recommended humidity level and temperature range for operating rooms?

Based upon CSA Z317.20-10, the recommended humidity level in an operating room is within the range of 40 to 60 per cent RH. An acceptable space dry-bulb temperature range is 18 C to 23 C. In terms of absolute humidity levels, a room that has an 18 C space temperature with 40 per cent RH has a corresponding dew point temperature of 4.2 C. Similarly, a room at 18 C with 60 per cent RH has a 10.1 C dew point temperature.

At higher space temperatures, a room at 23 C with 40 per cent RH has a c o r re s p o n d i n g s p a c e d e w p o i n t temperature of 8.7 C. To achieve these humidity levels during the dry months of winter, the dew point in the ventilation air must be higher than the space dew point temperature.

Conversely, to achieve the prescribed humidity levels during the humid months SUMMER/ÉTÉ 2015 35

BUILDING OPERATIONS

of spring through fall, the dew point in the ventilation air must be lower than the space dew point temperature.

What can occur if humidity is too high?

Many bacteria and viruses can thrive in high humidity, putting patients and healthcare workers at risk.

How can humidity be controlled in operating rooms?

A suitable vapour barrier and buffer zone between an operating room and adjacent spaces can help control humidity. The latter will slowdown the rate at which moisture from more humid surrounding spaces migrates into an operating room.

During winter months, the facility should have enough humidification capacity to overcome the net losses of humidity due to ventilation and the migration of moisture out of the operating room.

In the high humidity months, the facility must have enough IEM_CHF_Summer_2015_FINAL.pdf 1 dehumidification capacity (at a low

dew point level) to overcome the humidity in the ventilation air, the humidity loads within the operating room and moisture migration from areas surrounding the operating room.

systems are designed to supply 6.7 C chilled water but lower chilled water supply temperatures can be achieved (3.3 C). However, lower temperature chillers are more expensive, provide less capacity and are far less efficient How does dehumidification equipment than standard chillers. work?

Contemporary system designs use There are two main ways in which desiccant technology to target the new dehumidification systems work. standards for low dew point levels in Most traditional systems employ a operating rooms. T hese systems cooling coil and reheat system. With a employ an active desiccant rotor/ cooling coil dehumidification system, wheel to provide very low supply air air passing over the coil is sub-cooled dew point temperatures. The first to a temperature where moisture s t a g e o f d e h u m i d i f i c a t i o n i s condenses out of the airstream. The accomplished with cooling coils, lower dew point temperature that which lowers the conditioned air dew leaves the coil governs how much the point temperature to 10 C (where the humidity level can be reduced inside chiller remains efficient). The air then the operating room. The very cool air passes through a desiccant rotor where that leaves the cooling coil must be moisture is removed in the vapour reheated so that the operating room is phase, producing very low dew points (typically between -5 C and 0 C). not over-cooled.

A central chiller supplies most These low dew point levels cannot be o n a l c o12:57 o l i n gPM operating rooms’ air-handingClass1_CHF_Spring_2015_FINAL.pdf units a ch i eve d by t r a d1 i t i15-02-05 15-07-22 9:28 AM with chilled water. Common chiller systems.

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SUSTAINABILITY

HEALING PATIENTS, PROTECTING THE PLANET A case study of one hospital’s green initiatives that garnered provincial recognition

By Maria Pavone

T

h i s ye a r m a r k s t h e 2 5 t h anniversary of Markham Stouffville Hospital, a progressive, two-site community hospital focused on the needs of its rapidly growing community of close to 400,000 Ontarians from Markham, Stouffville and Uxbridge.

Since the hospital opened its doors in 1990, patient care has been its top priority; however, its commitment to the planet hasn’t been far behind. This garnered Markham Stouffville Hospital the Green Hospital of the Year award at the Ontario Hospital Association's 2014 HealthAchieve conference and exhibition. The award recognizes a hospital that has demonstrated a significant organization-wide commitment to environmental sustainability and reducing its environmental impact.

ON THE PATH TO SUSTAINABILITY

Over the years, Markham Stouffville Hospital has steadily raised its environmental performance and lowered energy costs while creating an optimal healing environment for patients.

Some of its green initiatives leading up to the award win include: reducing kitchen waste by 33 per cent; instituting a bike to work day; reducing water consumption by 20 per cent; replacing light fixtures with energy-efficient LEDs; 38 CANADIAN HEALTHCARE FACILITIES

implementing and managing an in-house carpooling program; replacing the cardboard packaging on items delivered to the hospital with reusable totes; reducing CFCs (chlorofluorocarbon) in HVAC equipment and eliminating halons; installing rubber flooring that is entirely free of PVC, plasticizers and heavy metals; taking patients’ food orders digitally to help reduce the hospital’s overall paper usage by 10 per cent; and replacing plastic suction canisters in operating rooms and out-patient procedure suites with a reusable liquid waste disposal and canister flushing system, thereby diverting waste from landfill.

What’s more, these initiatives have heightened the level of staff engagement, awareness and action at the hospital.

SIMPLE WAYS TO MAKE A DIFFERENCE

While the 2014 HealthAchieve awards ceremony has long come and gone, Markham Stouffville Hospital continues to demonstrate its commitment to sustainability.

Building on past environmental initiatives, the hospital has expanded its LED lighting retrofit project to all parking areas. It has also extended its recycling program to include the dish room and food services, and added new recycling stations throughout the hospital to make it easier for people to sort and

separate their waste so that it is deposited in the proper bins. To further reduce the amount of waste sent to landfill, t h e h o s p i t a l h a s s w i t ch e d f ro m disposable to reusable sharps containers. Based on preliminary c a l c u l at i o n s, t h i s w i l l d i ve r t a n estimated 4.6 tonnes of plastic waste from landfill annually. Additionally, a high-efficiency dishwasher was recently installed in the dish room to conserve water and energy. And in an effort to encourage staff carpooling, the hospital created a dedicated high occupancy vehicle (HOV) parking lot.

Apart from these internal initiatives, Markham Stouffville Hospital has taken s t e p s t o e m b e d e nv i ro n m e n t a l sustainability in the hospital’s community.

On April 22 — Earth Day — it held a Greening and Sustainability Expo to educate staff, physicians, patients and visitors about how they can be more “green” in their day-to-day activities, and what the hospital has done to become an earth-friendly organization.

Maria Pavone is director of facilities, and support and food services at Markham Stouffville Hospital. She is also chair of the hospital’s greening committee and will be a guest speaker at the Ontario Hospital Association's 2015 HealthAchieve conference and exhibition.

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• Greater EFFICIENCY* means more time to take care of the or • Standardized chemistries, operator training and support mean LoWEr CoSTS* V-PRO Low Temperature Sterilization Systems are part of an unbroken chain of innovative solutions from STErIS that extend throughout the perioperative loop.

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One Integrated Approach to Healthcare. * Reference STERIS Document #M3914EN

V-PRO™ maX Sterilizer

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V-PRO™ 60 Sterilizer