VOLUME 41 I NUMBER 3 I SEPTEMBER 2018 CONFERENCE
HEALTHCARE INSTITUTE of HEALTHCARE ENGINEERING AUSTRALIA
The 2018 IHEA National Conference and IFHE International Congress in association with:
JOIN US AT THE HEALTHCARE ENGINEERING EVENT OF 2018
Gold Coast University Hospital – site of one of the many technical tours for the 2018 IFHE Congress.
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48 Reflecting on the conventions of lighting in hospitals
National President’s message
53 Air filtration and its practical application in the hospital environment
63 Maintenance contracts for 21st century buildings
71 Burning issues affecting the healthcare industry
10 WA 16 VIC/TAS
74 The importance of indoor environmental professionals in investigative and remedial projects
18 NSW/ACT 20 QLD 22 SA
80 Introducing the Cleaning Activity Levels (CAL)
Review of plumbing 24 regulations FEATURE ARTICLES 33 Biomeds’ vital work in Africa’s floating hospital
Recent changes to EP&A 85 Regs in NSW and how it affects your AFSS
89 Life-or-death HVAC&R
37 Water borne pathogens 42 Isolation room mechanical design Visit the Institute of Healthcare Engineering online by visiting www.ihea.org.au or scanning here ➞
IHEA NATIONAL OFFICE Direct: 1300 929 508 Email: firstname.lastname@example.org Address: PO Box 6203, Conder ACT 2900 Website: www.ihea.org.au Conference: http://IFHE2018.com IHEA NATIONAL BOARD National President Peter Easson National Immediate Past President Brett Petherbridge National Vice President Jon Gowdy National Treasurer Mal Allen Communications Darryl Pitcher Membership Registrar Peter Footner
Standards Coordinator Brett Nickels Directors Michael McCambridge, Greg Truscott, Mark Hooper
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IHEA ADMINISTRATION Secretariat/Website Administrator Heidi Moon Finance Jeff Little Membership Wendy Clayton (FMA), email@example.com Editorial Committee Darryl Pitcher, Mark Hooper IHEA MISSION STATEMENT To support members and industry stakeholders to achieve best practice health engineering in sustainable public and private healthcare sectors.
Melbourne: Neil Muir T: (03) 9758 1433 F: (03) 9758 1432 E: firstname.lastname@example.org Adelaide: Robert Spowart T: 0488 390 039 E: email@example.com PRODUCTION Emily Wallis T: (03) 9758 1436 E: firstname.lastname@example.org ADMINISTRATION Tarnia Hiosan T: (03) 9758 1436 E: email@example.com
The views expressed in this publication are not necessarily those of the Institute of Healthcare Engineering Australia or the publisher. The publisher shall not be under any liability whatsoever in respect to the contents of contributed articles. The Editor reserves the right to edit or otherwise alter articles for publication. Adbourne Publishing cannot ensure that the advertisers appearing in The Hospital 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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s the cover of this edition of “Healthcare Facilities” says, it’s now only a couple of weeks until the IHEA hosts the International Federation of Hospital Engineering bi-annual Congress in Brisbane. We look forward to seeing you there and sharing this unique experience. Planning for this event kicked off well before the 2014 Congress in Buenos Aries, at which time a successful bid was made to the IFHE Council to bring the Congress to Australia. Since then it has been full steam ahead. The 2018 IFHE International Building Awards has been incorporated into the Congress program, and I’m looking forward to the announcement of the winner. There were some excellent submissions for the Award and we engaged the UniSA, School of Art, Design and Architecture to assist in running the Awards project. We will be excited to have some of the graduates join us in Brisbane for the awarding of the trophy.
of the organisation. This has been made possible by the commitment of the international Council representatives, the Executive Committee and our current and past Presidents in promoting and advocating for sustainable, safe healthcare facilities management through global associations of IFHE.
The last time the IFHE met in Australia was in Sydney in 2000, soon after the Sydney Olympics – and a great time was had by all (from what I’m told) and prior to that it was held in Melbourne in the early 1980’s. 2018 in Brisbane will be just as memorable. As incoming President of IFHE, I’m looking forward to supporting the ongoing good work
This bumper edition contains a wealth of excellent technical papers once more supported by our partners and sponsors, to whom we once again express our thanks and appreciation. Enjoy – and see you in Brisbane.
Of course from 2018 and onwards the challenges will be just as diverse, presenting new challenges in addressing old problems. The IFHE is increasing its work with the World Health Organisation, and raising the profile of sustainability with members. The line-up of speakers and subjects in Brisbane in October will demonstrate that despite the cultural diversity and distances, issues faced by healthcare architects, engineers and facility managers the world over are amazingly similar. It is therefore an ideal place to learn from global colleagues, network with international peers and share great experiences together.
Regards Darryl Pitcher
NATIONAL PRESIDENTâ&#x20AC;&#x2122;S MESSAGE
It goes without saying that the lifeblood of the IHEA is its membership. Increasing membership numbers is certainly a key aspect of our strategic plan. Continuous Professional Development is one area that the Board is actively pursuing. While CPD is certainly an important aspect to attract, retain and develop our membership, it could be argued that the necessity to cultivate our own networks is just as important.
egular attendance at branch meetings and conferences strengthens relationships between parties, encourages and builds trust which in turn provides support for each other as we all strive towards common goals. Exchanging information and experience underpins the development of new and fresh ideas, providing the individual with new insights and perspectives to support their development. A strong network can support the individual, opening new doors and increasing opportunities for career development, and increase the likelihood of receiving introductions to those who may have the ability to influence or advance your career. Access to advice from experienced individuals is invaluable to the development and furtherment in understanding of industry practices. The opportunity to exchange thoughts, best practice knowledge and lessons learnt from and between peers benefits both parties by providing invaluable insights into current developments within the industry Talking with other likeminded people has the benefit of raising an individualâ&#x20AC;&#x2122;s overall profile within their chosen field. Seeking opinions that provide a different perspective promotes a greater overall understanding
of the business and will often assist in dealing with those day to day problems when they are viewed from a different angle. The IHEA is the specialised organisation for professionals working in the healthcare engineering sector and we provide a wide range of services and resources helping our members develop their knowledge, and extend their connections across the industry and beyond. One of the key benefits of IHEA membership is the opportunity to regularly network with professionals who share a common interest in the healthcare engineering field, which can bring many benefits to the individual. The IHEA offers face to face networking opportunities at the many State Branch Meetings and conferences that occur during the year, and members are encouraged to attend these, not just to enhance their own network, but also to build a reputation as a knowledgeable and supportive individual who is able to assist others in the development of their own careers. Our own Annual National Conference which has grown year on year, is normally our flagship event for
professional development, networking and renewing “auld acquaintances” I say “normally”, because this year we are privileged to host the International Federation of Hospital Engineering (IFHE) Congress. While it is not quite a once in a lifetime event, it is certainly a glorious opportunity for members to expand their network on an international scale. The program includes representatives and delegates from all around the globe including Europe, UK, Latin America, USA, Canada, South Africa, Asia Pacific and New Zealand. The chance to meet, discuss and learn from individuals from large and diverse range of backgrounds all with a common thread, is not to be missed. In an industry that is as demanding as ours, it is not always easy to take the time to attend the various branch meetings and conferences. To countenance this, the Board are committed to utilising, to the best possible advantage, the digital technologies available to us such as Facebook, LinkedIn, Twitter and our rebranded website. While social media may not be the first choice for members to engage and support our networking commitment, it is none the less becoming a fundamental strategic component of any forward-looking organisation.
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There are significant benefits in embracing social media, particularly for those members who are unable to attend organised meetings and miss out on the opportunity to share the knowledge and experiences that fosters and builds relationships. Technology that helps bridge this gap enables individuals to share their own thoughts, learnings and practices with others, is hugely advantageous and should be embraced by all, for the collective benefits of the organisation. Of course, the point of any network is to develop and nurture professional relationships, but some of the strongest and long-standing personal friendships are borne out of fostering collaborative associations with people who share a passion and similar goals. This, I believe was the original intent of the founders of the IHEA, and remains the bond that ultimately holds our Organisation together and forges a strong foundation for the ongoing growth of the Institute. I look forward to catching up with you all at the IFHE congress in Brisbane in October and engaging with you on our social media platforms! Peter Easson IHEA National President
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FROM THE HAGUE TO BRISBANE
wo and a half years ago the International Federation of Hospital Engineering (IFHE) held its international congress in The Hague. IHEA had already been awarded the honour of holding the biannual IFHE Congress in Brisbane in October 2018. An IHEA delegation, including myself, set off to The Hague in April 2016 with much excitement and anticipation, keen to experience an IFHE Congress and start the process of delivering our own successful event. Our Dutch colleagues put on an excellent Congress. The learning opportunities, networking and social events made for an outstanding experience and gave us plenty of food for thought. Since that time the IHEA IFHE Congress organising committee and our event organisers, Iceberg Events, have been working hard to ensure we too deliver an outstanding IFHE Congress. As I write we are less than 6 weeks out and we are well on track. With speakers and presenters from around the world, an extensive array of trade exhibitors, joint plenary session with the 42nd World Hospital Congress 2018, excellent technical tours and social events and delegates from all corners of the globe this is an unrivalled opportunity to truly learn and network around Healthcare Engineering on a global level. IHEA looks forward to welcoming the executive committee and council members of IFHE. IFHE is a nonprofit, non-governmental body established nearly 50 years ago to enable national engineering professional organizations to join in a world-wide federation. The purpose of IFHE is to encourage and facilitate exchange of information and experience in the broad field of hospital and healthcare facility design, construction, engineering, commissioning, maintenance, and estate management. Membership of IFHE has spread to over thirty countries (including Australia) - embracing some ten thousand persons. In addition to national healthcare engineering organisations, IFHE also admits as members:
governmental institutions, corporate consultants, commercial and industrial partners, as well as individuals or small groups of interested persons. IFHE is recognized by the World Health Organization (WHO) in Geneva, as a Non-governmental Organization in Official Relations with the WHO. We also look forward to the energy and input our members traditionally bring to our National Conference. IHEA is the professional organisation for engineers and engineering facility managers employed in the private and public health care sectors, with consultants and suppliers engaged in related work. These members include Hospital Engineers, Health Facility Managers, Architects, Consulting Engineers, Builders, Suppliers and Contractor and anybody involved in Health Care Facilities Management. The expertise you will bring to the room and share with colleagues from around the world is invaluable. The experience in The Hague in 2016 was incredible. Spectacular location, fantastic hosts and an engaging and informing program. From my perspective Brisbane 2018 is not about ‘topping’ that event because we are not in competition. Rather, the IFHE Congress is an opportunity to join together and further the important work healthcare engineering professionals do around the globe. It is about sharing all that you have to offer and the impact you can make when brought to an outstanding location. Australia most definitely provides one of the best locations and our passionate members will undoubtedly lead the way in stimulating discussion, sharing learning and establishing lifelong friendships. See you all in Brisbane! Karen Taylor – CEO
WA BRANCH REPORT Special General Meeting - June 2018, Osborne Park Hospital
he Special General Meeting, attended by 40 members, was called to order by the State President Mr Greg Truscott, who presented his Annual Report and acknowledged the excellent work undertaken by the Committee of Management (CoM) during the past 12 months. The State President also took the opportunity to present to Alex Rodger, of Norman Disney, Young, their ten year IHEA membership certificate.
The CoM wishes to thank the immediate past State President, Mr Greg Truscott and recognise Greg’s contribution to the WA Branch and National Board. Thanks was also extended to the following committee members who are stepping down after many years of valuable service. Mr Craig Aggett Mr Steve Dallas Mr Peter Easson Mr Rob Foley Mr Neil Oliver Alex Foster Delivering the Professional Development Session.
Mr Tom Kelly, and Mr Rohit Jethro, then respectively delivered the Branch Secretary’s and the Branch Treasurer’s report. Alex Rodger of NDY receiving the ten year IHEA Membership Certificate.
At the conclusion of the formal meeting, Mr Alex Foster from Fosters’ Services delivered the Professional Development session on the changes to the electrical licencing and standards, which have occurred over the last 6 months.
After answering questions from members and general discussions, Craig Aggett, was called upon to dissolve the current CoM and conduct the process of members electing a new CoM and Office bearers for 2018/19. The results of the election were:
Alex covered changes to AS/NZS 3003 Medical Electrical Installations; AS/NZS 3000 The Wiring rules, Live work policies in effect in Western Australia including the requirements for all trades to carry out isolations to roof spaces in domestic style offices and dwellings under the new OHS Act changes. He also gave common examples of how they will be applicable in the healthcare work environment.
Branch Office Bearers
Country Conference - July 2018, Karratha
State President: Mr Peter Klymiuk
WA IHEA Members at the new Karratha Health Campus
State Vice President: Mr Fred Foley State Secretary: Mr Thomas Kelly State Treasurer: Rohit Jethro Committee of Management members Mr Philippe Tercier Mr Alex Foster Ms Angela Te Haara Mr James Smith Mr John Bose Mr Greg Truscott (immediate past President)
Red Dog and Red Dirt - Karratha is located in the state’s Pilbara region and is home to some of the world’s most ancient natural landscapes, dating back more than two billion years and stretching over 500,000 square kilometres. This was the setting chosen by the West Australian Branch for the 2018 Country Conference, and to showcase the new Karratha Health Campus. The $207.15 million Karratha Health Campus has been the biggest investment in a public hospital ever undertaken in regional WA. The Health Campus upgrade includes: a new 40 bed facility with a significantly expanded emergency department; a new CT scanner, surgical ward, maternity wing and delivery suites; expanded facilities for outpatients and essential services, such as child health and medical imaging, all brought together in a single healthcare hub. It boasts world class Telehealth services, a helipad, and in addition to outstanding emergency and hospital care, the Karratha Health Campus will provide a comprehensive “one stop shop” for the delivery of integrated health services, including physiotherapy, speech therapy, counselling, community health nursing and community mental health. Karratha Health Campus will also provide valuable support to smaller regional hospitals within the Pilbara region. Decorative Translucent Screens to Public Health Education Rooms
Multiplex delivered the $207 million build, and the Pilbara Industries Community Council donated $650,000 to support construction of the helipad. The five members of this group are BHP Billiton Iron Ore, Chevron Australia Pty Ltd, North West Shelf Venture, Rio Tinto Iron Ore and Woodside Petroleum. “Reinventing Healthcare in Karratha” was this year’s theme. The Conference was opened by Margi Faulkner, Regional Director for the Pilbara West Australian Country Health Service. Margi acknowledged the traditional owners, the Ngarluma People and welcomed 40 delegates. Her address was especially appreciated for illuminating the particular
challenges that face all who work in the remote Pilbara Healthcare Region. Margi’s professional expertise, and the delivery of her presentation, was well received by all and the Institute appreciates the support and commitment to providing our members with continuous professional insight, and in helping to energize and rejuvenate our member community. Margi Faulkner, Regional Director for Pilbara WACHS, with the Opening Address
The Conference continued with a video presentation by Hudson Lun, from Multiplex, that provided the delegates with a comprehensive insight into the construction of the Health Campus, from start to finish. Corporate members presented across a wide range of topics, which included medical gases technology, infection control principles, and practices relevant to healthcare engineering. Brad West, Manager Infrastructure and Support Services, who was kind enough to host the Conference, presented “Hospital Engineering My Way”. Brad informed the group how, in a given week, he could set off and drive in excess of 2,500 kilometres to service healthcare engineering in the Pilbara region - and not all the roads are asphalted, so hundreds of kilometres are travelled on gravel services. Brad also took the opportunity to advise all of the positives of living and working in the Pilbara, showing some great photos of his successful fishing trips! The Multiplex Team
WATER SPECIAL INTEREST GROUP FORUM BRANCH REPORTS
Monday, 08 OCT 2018
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Arbour Level – A2 Room Brisbane Convention & Exhibition Centre (BCEC)
Within Hospital buildings, water can stagnate and its temperature increase. It passes through complex internal distribution systems consisting of narrow pipes, valves, tanks, TMV's, all with possible corroded inner surfaces and dead ends. This environment can provide optimal conditions for the formation of biofilm from which bacteria and other microorganisms may continuously be released into the water, and compromise the safety of vulnerable patients. Pall Corporation is a global leader in high-tech filtration, separation, and purification, offering products and services to Life Sciences and Industrial markets worldwide. Pall Medical Point-of-Use Water Filters are well established and documented as efficient barriers against water pathogens such as Legionella spp. and Pseudomonas aeruginosa deriving from water systems within healthcare facilities. Pall Medical organises and supports educational events relevant to in-premise water hygiene, enabling the audience to access information on current scientific findings, and raising their overall awareness of in-premise water hygiene.
Program: 7:00 pm Cocktails & Canapés 7:30 pm Mary Morrison (Department of Health, Queensland) “Challenges on the Road to Better Water Management in Hospitals and Residential Aged Care.”
8:00 pm Sarah Bailey (QED Environmental Services) “Waterborne Pathogens Pseudomonas aeruginosa”
8:30 pm Anne-Rita Vleugel (Pall Medical ANZ) “Healthcare Water Filtration from POE to POU”
Visit us at the Pall Medical Booth at the IFHE 2018 Conference, 07-09 OCT 2018, Plaza Ballroom, Brisbane Convention & Exhibition Centre (BCEC). RSVP: medical_anz@.pall.com
The Conference concluded with an excellent lunch, which was followed with a technical tour of the new Karratha Health Campus. The tour continued on to the Murujuga (Burrup Peninsula), which is located in the Murujuga National Park. The tour included a visit to “Deep Gorge” where members and partners were able to view engravings (petroglyphs) depicting a record of what is meaningful to the Aboriginal people of the Pilbara and beyond. From human figures and birds, to marine life and extinct creatures, the art provided an insight into the ancient world.
Branch Meeting - August 2018, Optus Stadium Perth
Members and partners were lucky enough to have IHEA member John Bose (who spent a number of years in the Pilbara working with Woodside Petroleum) conduct a very interesting tour of the Northwest Gas Facility. The tour would not have been complete without stopping at the iconic Red Dog statue in Dampier, where photo opportunities were taken.
Jane Spellacy, WA State Director welcomed the 40 members in attendance and provided an overview of the Stadium and the FM contract and BGIS’s deliverables under that contract. The whole project was delivered as is a PPP, with a total construction cost of $800m.
Dampier Port Control Room
BGIS (a Brookfield Company) who joined IHEA WA earlier this year, kindly offered to host a Branch meeting and provide an extensive ‘back of house’ tour of the third largest stadium in Australia - 60,000 seat, for AFL; 65,000 seat, rectangular pitch. BGIS has a 25 year contract with the State Government to provide the hard and soft Facility Management components, right down to the care of the Cricket pitch.
Construction was completed, late last year and it was officially opened in January this year. Optus Stadium Visit Attendees
The 2018 WA IHEA Country Conference closed that evening with an excellent dinner held at the Karratha International Hotel, and sponsored by Multiplex, and which was attended by 60 members and partners. The WA IHEA would like to acknowledge presenters Multiplex, BOC Gases, Flow Tech, Veolia and Eco Jemms, and also sponsors Multiplex, Blueforce, A&M Medical, Foster’s Services and Eco Jemms. Special thanks go to Brad West for hosting, Margi Faulkner for her opening address, and to all members for taking the time to travel to the Pilbara to support our successful Country Conference. Red Dog Memorial
Peter Klymiuk WA Branch President
There are some big numbers BGIS manage; 776 LED Sports lights for the field, 18,000m2 of turf, 1000 Televisions and 1500 bathrooms to name a few. One unique fact re bathrooms, is that due to the whole complex being built on a former rubbish tip, which added cost to the project, there was no opportunity for a basement, so all the toilets on the lowest level are served by a vacuum system to remove waste (i.e. like an aircraft toilet). Fortunately, most public toilets are one level above so gravity discharge. The combination of the vacuum system and the situation on game days of such a large quantity of waste to deal with, in a short period of time, there are 4 massive sewage storage tanks in the building which can store then progressively discharge off site.
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If so, INVISA-BEAM Bed Monitoring systems can help. Invisible beams monitor the sides of the bed. The other component which caught my attention was the ‘beer distribution’ system. A fully insulated, reticulation of beer from central keg cool rooms to taps across the whole site. I note there is a circular situation here, in that, the more efficiently you deliver beer to the punters, the more toilet discharge you need to deal with, so I could see the systems need to align. If they didn’t, that could create a major problem.
When the patient attempts to exit the bed, the invisible beam is broken and transmits the alarm.
One major challenge the Stadium can deal with, is a total power outage. It can function fully and run an event on its diesel generators delivering 8 MVA. The BGIS team were embedded in the design and construction process, which had assisted in the Stadium being easier to maintain and reduced its operational running costs. From what members were shown and the general opinions expressed by the media and users, it is an excellent facility in all regards. Optus Stadium Spectator Seating
The nurse wears either an Entry Pass or Invisalert to respond. This cancels the alarm.
The beam reactivates automatically, when the nurse leaves the bed.
IHEA WA thanks, Jane Spellacy, Bruce Henderson and Adam Grant who conducted the extensive tour, which took us to all parts of the complex. Greg Truscott WA Branch Immediate Past President
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VIC/TAS BRANCH REPORT
IHEA Webinar 1
Victorian Plumbing Regulations Review
he current regulations sunset in November 2018. Department of Environment, Land, Water and Planning (DELWP) sought a hospital engineer to review the proposed changes principally around Thermostatic Mixing Valves. Mark Hooper, Echuca Regional Health undertook a review and submitted a response on behalf of Vic / Tas Branch. Additional areas of concern were around clause 17 ‘routine servicing of fire systems. The full review is found on page 24 in this journal.
On August 28th via Zoom an online webinar was presented for members on the ‘Proposed Victorian Plumbing Regulations changes’ the very successful webinar was viewed by a number of members around the state.
Professional Development: 3 On July 27th the Vic / Tas branch PD event was held at Atherton Sterilisers, and considered ‘The latest innovation in Sterilisers’. Ten members attend and were presented with an overview of the latest Gorilla Steriliser, which has an increased capacity and improved features. The afternoon conclude with a tour of the Atherton’s workshop, and demonstration of the new steriliser function.
2018 Branch Christmas Lunch Early notice is provided for members that this year the branch has opted for a lunchtime function to allow retired members to attend. The function will be Saturday, 1st December from 12.30pm to 3.00pm at Cargo, 55A New Quay Promenade, Docklands. All
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members are invited, so please keep an eye out for invitations when they are circulated. 2018 Branch Strategy Planning Day On August 4th the Committee held a strategy planning day at Castlemaine Hospital. The following actions were agreed: 1. Actively grow the branch membership 2. Strategically align with Department of Health & Human Services / the Victorian Health & Human Services Building Authority 3. Improve branch communications 4. Strengthen the Professional Development program and include Tasmanian members 1. T he branch membership continues to be healthy, there are currently 134 financial members. The COM will undertake a membership drive, and will actively seek potential members across the 250 Public and Private Hospitals, including PPP FM companies. The drive will commence with a letter of introduction from IHEA CEO to each of the hospitals, companies and a follow up invitation to attend a professional development day. 2. S trategic Alignment of Branch and Department of Health & Human Services, the COM are actively engaging with key staff of the Victorian Health & Human Services Building Authority to address the following items: a) VHHSB IHEA Membership b) State directions and annual DHHS PD Day
Branch Committee of Management The Committee of Management meet monthly via teleconference and at the end of PD days. We are always looking for members to assist with the planning so please feel free to join in the conversation, by emailing the Committee your details at: IHEA.VICTAS@ihea.org.au. Branch President
Committee of Management
Committee of Management
Committee of Management Meeting Convenor
Committee of Management
Committee of Management
National Board Reps
Michael McCambridge Mark Hooper
Michael McCambridge â&#x20AC;&#x201C; VIC/TAS Branch President
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c) Role of HPV and Health Facilities / DHHS d) R eview of the (out of date) design guidelines and other relevant legislation and Australian Standards e) Engineers Registration working together to ensure a health category is included 3. T o improve communications, the branch created the role of Communications Officer and Rod Woodford agreed to take on the role for the next 12 months. 4. T he role of professional development convenor will be Simon Roberts. The role will look at ways to engage our membership to participate in the 70th Anniversary celebrations. (1949 to 2019) one of the options will be a branch meeting dedicated to the history of IHEA. We will also assess the viability of a bi-annual Tasmania meeting.
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NSW/ACT REPORT Activities
lanning for the 2019 national conference is in full swing with venue and dates now locked in. The event will be held at the ANZ Stadium at Homebush Bay Sydney (former Olympic Games stadium) on the 9th to the 11th October. The theme for 2019 will be, “Game Plan for the Future of Healthcare Facilities” which aims to give delegates an overview of current and future trends in emerging technologies which are already impacting on operational requirements of Healthcare Services. The future roles of Healthcare Engineering & Facility Managers will be pivotal in ensuring these current and new technologies are implemented effectively from both a technical and strategic perspective. It is essential that Healthcare Engineering & Facility Managers have a strong and informed voice in ensuring that emerging technology is incorporated into all facets of Healthcare Facility design. The call for abstracts is now open and will close in March 2019. For more info & to receive event updates visit www.HFMC2019.org.au The NSW / ACT Branch is holding its final Professional Development Day for 2018 on the 30th November from 10:00 – 16:15. It will be convened in the Kerry Packer Education Centre at the Royal Prince Alfred Hospital, and will be followed by the NSW / ACT Branch End of Year Social Function. The day will be focused around Height Safety and Confined Spaces, comprising; technical presentations, panel discussions and a technical tour of the fire training simulator at RPA including a confined space entry demonstration.
An amendment to the Public Health Regulation 2012 was published on 1 December, with the new requirements to commence on 1 January 2018. Under this amendment the occupier of premises that contain a water-cooling system must ensure that: • All water-cooling systems undergo monthly testing for Legionella count and heterotrophic colony count • Reportable test results of Legionella count ≥1000 cfu/ mL and heterotrophic colony count ≥5,000,000 cfu/ mL are notified to the local government authority for that area. • The first monthly test must be completed by 1 February 2018. Additional amendments are expected to commence in early 2018 and intend to introduce risk management plans, independent auditing, notification to local governments, and unique identification numbers. These proposed amendments are outlined on the NSW Health website: www.health.nsw.gov.au/environment/ legionellacontrol The Committee of Management for the coming year will be: Name
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Membership interest from both industry groups and health facility management practitioners is increasing and it’s been great to see new corporate members joining this month. The CoM will be discussing strategies on an ongoing basis how to ensure that this pattern of growth continues.
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See the IHEA website for further details or contact the Branch for more information.
Technical News NSW Regulatory changes related to monthly legionella testing came into effect earlier in 2018. Some IHEA
members have reported through the CoM that local councils are now starting to send out notifications to sites regarding cooling tower identification and risk assessment plans. It is therefore timely that members take note of the following summary extracted from the amended NSW Ministry of Health regulations;
To make contact with the NSW/ACT Branch please email us at IHEA.NSWACT@ihea.org.au Jon Gowdy – NSW/ACT Branch President
QLD BRANCH REPORT
The themes for the meeting were:
Branch Meeting & Professional Development
Digitisation – Nurse Call and BIM speakers were Christopher Ansley-Hartwell (IHEA), Grant Thomson (Rauland) and Rob Peter & David Oakshott (AG Coombs). All of the presenters are seasoned healthcare engineering professionals and provided excellent insights into the impact of digitisation on the healthcare scene.
n June 21st and 22nd the QLD Branch held a seminar on the Sunshine Coast, one hour north of Brisbane. The opportunity to travel out of the Metropolitan area to meet with members was well supported by both members and corporate partners who attended this very successful activity.
Management of Indoor Air Quality – speakers included Patrick Chambers (Wood and Grieve Engineers), Vance Rowe (Holyoake Air Management Systems), Kristian Kirwin (Airpure Australia) and Scott Summerville (Opira.) Management of Refrigerant Gases – speakers were Michael Hettrick (Honeywell Polymers) and Nathaniel Anderson-Barr (BOC)
RO Water Quality â&#x20AC;&#x201C; speaker, Andy Gay, addressed the topic of water quality impact on sterilisers in hospital CSSD. We express our appreciation and gratitude to all of our sponsors Clevertronics, Higgins, Raulands, Opira, Air Restore, Australian Medical Suction Systems, Becker Pumps, Armstrong Flooring and Almig Compressor Systems. The new Branch Committee of Management meets monthly and had a busy 2018 calendar agenda. The focus is to provide members with networking opportunities through social events, professional Developments and IFHE conference in October 2018. The CoM continues to explore better ways to engage with country members and taking our WA counterparts lead, we are looking at holding a country meet in Townsville next Feb/Mar which we hope will involve a technical tour of the Townsville Hospitals. This will give us the opportunity to consider changes to its water management and chilled water infrastructure that will include a professional development seminar. The QLD branch Committee of Management can be contacted via email at IHEA.QLD@ihea.org.au. President
State National Board
Christopher Ansley Hartwell
Brett Nickels President, QLD Branch
SA BRANCH REPORT Activities
fter the success of our professional development (PD) event in May at the new Remote Retrieval & Aviation Services facility at the Adelaide Airport, we recently hosted another hugely successful PD event. A series of presentations were made available to members on the subject of Emergency Power and Diesel Fuel Management at the British Hotel on August 16th. Presentations included:
Networking at the SA Branch PD event
Diesel Fuel Management (Ron Mattig, Clear Fuel Technologies) • The importance of back-up power generation • Legislated fuel quality requirements • Emergency power generation • Issues and risks associated with storing diesel Samples of diesel fuel on display showing degradation issues
• Impact of degraded diesel fuel on generator operation • Risk assessment relating to the quality of stored fuel
Diesel Power Generation for Emergency Power (Brian Williams, Clarke Energy)
• Mitigating the risk of engine failure due to poor fuel quality or insufficient fuel delivery
Management of Diesel Spills (Dylan Stone, Adviser, Compliance – Environment Protection Authority, SA)
• Brief overview of Company diesel generator set range • Diesel generator set ratings & packaging solutions, plant rooms and enclosures • A presentation on hospital generator set installation
• The requirements of The Environment Protection Authority (EPA) guidelines on bunds or spill containment systems to minimise the risk of environmental harm from spills and leaks
• Recommended bulk fuel system installations for generators
• Practical examples of the application of these guidelines relating to hospitals
• Diesel engine developments – impact on fuel quality requirements
There were 36 attendees, including many IHEA members and affiliates from our joint relationship with CIBSE and their associated organisations. Clarke Energy and Clear Fuel Technologies jointly sponsored the evening, with the post-presentation networking providing a great opportunity for meet new colleagues and continue the discussion about our shared learning and experience. The sponsors and presenters expressed their great satisfaction with the outcomes from the evening. In addition, arising from our joint planning efforts with CIBSE and other partners, a number of other PD
Presenters at the SA Branch PD event August 2018
Membership: With the membership renewal process commencing in July, it has been pleasing to note the generally prompt and thorough take up of memberships from our existing members. With a number of new members joining us throughout the last financial year, and with one new member joining during July, the Branch has managed to sustain and grow slightly our member numbers. Following our most recent PD event, it is anticipated that a number of new members will join over coming months. Actions:
Q_A on clean fuel technologies
opportunities have been offered to our members over the last few months, covering diverse topics such as: • Earthquake Resistance and Design Requirements • New jointing technology for Refrigeration and Air Conditioning pipe work • Hydronic Underfloor Heating/Cooling and Concrete Core Tempering • Changes in fire safety regulations • Forum on current responses to combustible cladding issues
The CoM meets on a monthly basis (when possible) to plan PD activities, follow-up membership and other matters. SA Branch President, Peter Footner attends monthly coordination meetings with CIBSE and affiliated organisations to plan and promote joint PD activities. Events arranged by CIBSE and these other organisations have been made available to the IHEA, with regular involvement of our members. Committee of Management: In June, a State Special Meeting was held and all existing 2017-18 Committee members together with a group of new candidates were elected to run the Branch for the coming year. Details of the new Committee are provided below: Position
• New Royal Adelaide Hospital site visit
National Board Rep
• Latest developments in microbial research in water quality
The Committee of Management regularly reviews opportunities for future PD events and has a number of topics under consideration, including:
• Developments in electrical vehicle infrastructure
• Seminar on EnHealth Legionella Control Guidelines
• Energy upgrade project at a major building in Adelaide
• Latest developments in smart buildings (CIBSE UK visitor) • Cyber security developments • Calvary Hospital redevelopment • Building certification Q&A session Members have become increasingly aware of initiatives undertaken to enhance communications within the IHEA through the new website, electronic versions of the ‘Healthcare Facilities’ journal, e-newsletters and a greater presence on social media - members have welcomed the improved access to information and better opportunities for networking.
I thank the Committee members, past and present, for their contributions and look forward to an exciting period of activity ahead for the SA Branch. The Branch always welcomes the assistance, contributions and suggestions of members by contacting us at IHEA.SA@ihea.org.au with their input at any time. Peter Footner President, SA Branch
REVIEW OF PLUMBING REGULATIONS...
IHEA RESPONDS TO INVITATION FOR PUBLIC COMMENT Comfort . Versatility . Aging in Place • Built in expandable King Single sleep deck 89cm, 99cm and 106cm • Intuitive two-pedal locking system • Warm-to-the-touch half-length assist device (tool less) • Full and reverse trendelenburg • Height travel range: 178mm to 762mm
The Vic/Tas branch responded to a request from Department of Environment, Land, Water and Planning via the relationship we share with the Department of Health and Human Services for the review of the Plumbing Regulations.
3-in-1 bed. Single bed. King single. Bariatric bed. Expandable/retractable deck with quick adjustment.
Aged Care Supplies Australia Pty Ltd
www.soularchagedcare.com.au . email@example.com National: 0418 634 534 John Markarian
Email from DWELP r
Regulatory Impact Statement
he IHEA registered through the Vic/Tas branch for inclusion as an interested party once opportunity for public comment opened.
The intent is “to modernise existing requirements and improve the quality of plumbing work for consumers and the community.” Key changes proposed include: • additional experience requirements for practitioners prior to being eligible for licensing to reduce the rate of defective work; • establishing two new classes of plumbing work, including a new specialised class of work for the maintenance of thermostatic mixing valves and a new class for the installation of basic refrigerated air-conditioning systems; • S17 now requires routine servicing in AS1851 to be undertaken only by registered or licenced plumbers. This is a major deviation away from prior regulations. • reclassifying classes of plumbing work, such as refrigerated air-conditioning and type B gasfitting work, to better reflect training pathways; and
CLEAN AIR FOR HOSPITALS ACCORDING TO ISO16890
• includes several new standards and technical requirements. After reviewing the proposed regulations it was identified that there were significant changes to the regulations that would have direct economic and capability impact on the management of healthcare services. In considering the potential implications for members, the IHEA Vic/Tas branch submitted a response and have also run a branch webinar on the topic. This webinar and response documents will be made available in the members area of the IHEA website. We will continue to keep members informed of progress and response to the submission to DELWP. Thanks to Michael McCambridge and Mark Hooper for the effort and energy put into this submission.
The Institute of Healthcare Engineering, Australia (IHEA) invites you to BRANCH REPORTS register for the 25th Congress of the International Federation of Hospital Engineering (IFHE) to be held on 6-11 October 2018 at the Brisbane Convention and Exhibition Centre.
CONGRESS PROGRAM The IFHE 2018 organising committee have put together a diverse, challenging, rewarding and enjoyable program. Under the broader theme of ‘Healthcare Engineering – Building on Sustainable Foundations’, the program includes presentations across a range of streams such as: • • • • • •
Healthcare Planning, Design and Construction Management and Operation of Healthcare Facilities Safety Sustainability Technology and Case Studies
The congress will be joining with the 42nd World Hospital Congress 2018 for a joint plenary session focused on Disease, Disaster and Destruction: Providing Health Services in Times of Catastrophe, Epidemic and Conflict. IFHE 2018 will feature two engaging keynote speakers: PROFESSOR DAVID HOOD AM is a civil and environmental engineer with vast experience across major civil and military projects, professional development in emerging economies, senior management in both the public and private sectors and in education. TIM LONGHURST works with business leaders to identify opportunities and seize them. He combines the latest data, powerful case studies and entertaining anecdotes to bring possibilities to life.
TECHNICAL SITE TOURS
The congress will feature five technical site tours as part of the program: • The Lady Cilento Children’s Hospital • Gold Coast University Hospital • Royal Brisbane & Women’s Hospital • Hyperbaric Medicine Service • Skills Development Service • Queensland Emergency Operations Centre
SOCIAL PROGRAM The congress will also offer an exciting social program including: • Welcome Reception – chance to get up close and friendly with Australian native animals • Trade Night – opportunity to network with IFHE congress partners and exhibitors • Congress Gala Dinner at Brisbane City Hall • Partners Program • Optional Dinner & Show at the Australian Outback Spectacular • Optional Social Day at Australia Zoo
IFHE 2018 BRANCH REPORTS
6-11 OCTOBER 2018 BRISBANE CONVENTION & EXHIBITION CENTRE
Sunday 7 October 2018 2.00pm - 8.00pm
Registration Desk Open
5.00pm - 8.00pm
Welcome Reception Location: Plaza Terrace Room, Plaza Level, Brisbane Convention & Exhibition Centre Enjoy an Aussie BBQ networking function and get a photo with a wombat!
Location: Plaza Foyer, Plaza Level , BCEC Partnered by YEARS STRONG
Plenary sessions will be held in Plaza Auditorium, Plaza Level, Brisbane Convention & Exhibition Centre
Monday 8 October 2018 7.00am - 5.30pm
Registration Desk Open
Location: Plaza Level, BCEC
Official Congress Opening & Housekeeping Emcee: Madonna King
Welcome To Country Songwoman Maroochy
IHEA & IFHE Welcome Address Peter Easson, IHEA President & IFHE President
9.40am – 10.40am KEYNOTE ADDRESS Professor David Hood AM Partners Program: Mt Cootha Lookout, Lunch & Lone Pine Koala Sanctuary Meeting Location: Meet at the congress registration desk on Plaza Level at 10.00am. 10.00am - 5.30pm Staff will then walk all attendees to the bus departure point. Bring/wear: water bottle, camera, comfortable walking shoes and sun protective clothing 10.40am – 11.15am Morning Tea & Exhibition
Location: Plaza Ballroom
11.15am - 12.15pm
Concurrent Session 1 - Healthcare Planning, Design and Construction Plaza Auditorium, Plaza Level
Concurrent Session 2 - Sustainability P6 & P7, Plaza Level
Appropriate Sizing of Operating Theatres with High Satisfaction - a Japanese Model Hiroshi Yasuhara, University of Tokyo Hospital
Improving sustainability in hospital wastewater management – a Danish case study Jakob Søholm, GRUNDFOS BioBooster A/S
The Rehabilitation and Upgrading of Mulago National Referral Hospital, Uganda Sam SB Wanda, Isaac Ilukor & Joel Aita, Uganda National Association for Medical and Hospital Engineering (UNAMHE)
Searching for Sustainability: Low-tech design for the Hillside Clinic in the arid Karoo, South Africa Yusuf Jacob & Ulrike Kuschke, Department of Transport and Public Works (Western Cape)
IHEA Annual General Meeting
Location: Plaza Auditorium
12.15pm - 1.45pm
Lunch & Exhibition
1.45pm - 3.25pm
Concurrent Session 3 - Healthcare Planning, Design and Construction Plaza Auditorium, Plaza Level
Concurrent Session 4 - Safety P6 & P7, Plaza Level
Precinct-based Energy Trigeneration - the large hospital experience at Lady Cilento Children’s Hospital, Brisbane Queensland Michael Campbell, Children's Health Queensland
International Standards for Electrical Safety in Healthcare - IEC60364-7-710, AS/NZS 3003 and AS/NZS 4510 Matthias Schwabe, Bender GmbH / WGKT
Engineering Queensland’s largest health infrastructure project – a Public Private collaboration Mark Reardon, Metro North Hospital and Health Service
Onsite Clinical Waste Management - the Experience of a Large New Hospital that improves Compliance and Infection Control Peter Atherton, AWS Clinical Waste
Is Change Management in Hospital Projects a Necessary Evil? The case of a Publicly-Funded Hospital Project in the City of Kampala – Uganda Ruth Sengonzi, Ministry of Health Uganda
A Risk Management Culture that works - the experience of the technical team at UZ Leuven Hospital in Belgium Eddy De Coster, UZ Leuven
Healthcare Infrastructure Planning & Design in the Ensuring Standard of Care - Compliance for Western Cape Province, South Africa – Finding Hot Water Systems appropriate solutions to inappropriate problems Marcel F. van Dijck, Armstrong International Duncan Rendall, Western Cape Government
3.25pm - 4.00pm
Afternoon Tea & Exhibition
Location: Plaza Ballroom
Location: Plaza Ballroom Continued over the page...
4.00pm - 5.20pm
BRANCH REPORTS Concurrent Session 6 - Case Studies
Concurrent Session 5 - Energy Efficient Plaza Auditorium, Plaza Level
P6 & P7, Plaza Level
New Ways to Provide Emergency Power for Healthcare: Fuel Cells & Microgrids Walt Vernon, Mazzetti
Doctors Without Borders (MSF), much more than field hospitals Elvina Motard, Medecins Sans Frontières / Doctors without Borders
Improving the Steam Plant through Maintenance Denton Smith, Western Cape Government: Department of Health
Designing the ICU for the Future - Seinäjoki Central Hospital, Finland Partnered by Tiina Yli-Karhu, Hospital District of South Osthrobotnia
Replacing High Voltage Electrical Transformers at the Copenhagen University Hospital. Improving safety and sustainability Preben Byberg & Thomas Stentoft Flackeberg, Copenhagen University Hospital
Chronic Cladding Disorder: Diagnosing and Treating the Risk of Hospital Facade Fires Oat Tukaew, RED Fire Engineers Pty Ltd
Congress Sessions Conclude
5.30pm - 7.30pm
Trade Night Location: Exhibition Area, Plaza Ballroom, Plaza Level, Brisbane Convention & Exhibition Centre Networking function in the exhibition area. Drinks and canapes will be served.
Tuesday 9 October 2018 7.30am - 5.00pm
Registration Desk Open
Location: Plaza Level, BCEC
Welcome & Housekeeping Emcee: Madonna King
KEYNOTE ADDRESS Tim Longhurst
Professional Development - A new approach to recognition of learning incorporating work based activity Dr Mark Keough, Intrinsic Learning
IFHE General Assembly Meeting
9.45am - 2.00pm
Partners Program: Brisbane City River Cruise & Lunch Tour Meeting Location: Meet at the congress registration desk on Plaza Level at 9.45am. Staff will then walk all attendees to the boat departure point. Bring/wear: water bottle, camera, comfortable walking shoes and sun protective clothing
10.15am - 10.45am Morning Tea & Exhibition Concurrent Session 7 - Management and 10.45am - 12.15pm Operation of Healthcare Facilities Plaza Auditorium, Plaza Level
Location: Plaza Ballroom Concurrent Session 8 - Healthcare Planning, Design and Construction P6 & P7, Plaza Level
Healthcare Facilities and Medical Equipment Whole-of-Life Cost Modelling Tool supporting policy makers – an eSwatini experience Claudio Meirovich, Meirovich Consulting SL
Nuclear Medicine and Radiotherapy Cyclotron - PET / CT - An Argentinian project experience Osvaldo Mario Donato, ARQ. Osvaldo Mario Donato Y Asociados, Consultora En Salud
Remote Health Engineering: Implementing Proactive Maintenance and Compliance Methods to Meet Continued Demand Andrew White, DMA Engineers
Taking control of your Building Management and Control Systems and delivering the ‘new digital promise’ David Oakeshott, A.G. Coombs
Strategies for sustainable maintenance Addressing backlog maintenance and critical infrastructure risk in UK’s NHS assets Efthimia Pantzartzis, ASSET Puglia and Loughborough University
Changing Normal Patient Rooms into Simplified Airborne Infection Isolation Rooms to a Minimized Cost Merethe Cecilie Lind & Trond Thorgeir Harsem, Norconsult AS
Certified Healthcare Facility Manager (CHFM), the Malaysian Experience Tauran Zaidi Ahmad Zaidi, Ministry of Health Malaysia
Improving Critical First-Aid Response at time of Disaster - an empirical assessment Kana Egawa, Tokyo Denki University
12.15pm - 1.15pm
Lunch & Exhibition
Location: Plaza Ballroom Continued over the page...
BRANCH REPORTS Concurrent Session 10 - Management and
1.15pm - 2.15pm
Concurrent Session 9 - Technology & Case Studies Plaza Auditorium, Plaza Level
Operation of Healthcare Facilities P6 & P7, Plaza Level
Cloud Computing - facilitating excellence in the Health Care Sector Ryan Milne, Ecosafe International & Colin Nicol, Do Diligence
Sustainable Procurement Strategies for Healthcare Laura Vernon, Blue Environmental Performance
Modern Challenges in Hospitals with Ancient Foundations - Installing LinAccs and Solar PV in the UNESCO protected San Giovanni Addolorata Hospital, Rome Virginia Caracciolo, Azienda Ospedaliera San Giovanni Addolorata
Creating an Internet of Things-enabled Building: St. John of God Murdoch Hospital Roy Arindam, BuildingIQ
CASE STUDY - Redevelopment of Cattinara Hospital and the establishment of the Burlo Garofolo Paediatric Hospital in Trieste, Italy Neil Logan, BVN
Learning from National Initiatives within the National Health Service - a UK case study James Hayward, York Teaching Hospital NHS FT
2.15pm - 2.45pm
Afternoon Tea & Exhibition
Location: Plaza Ballroom
2.45pm – 3.45pm
Maintaining a First World Hospital Afloat (literally) John & Sue Clynes, Mercy Ships
3.45pm – 4.05pm
International Building Award Presentation
Closing Remarks & Awards Peter Easson, IHEA
IHEA National Conference 2019 Presentation Jon Gowdy, NSW/ACT Branch President
IFHE 2019 Presentation
IFHE Congress 2020 Presentation Daniela Pedrini, S.I.A.I.S. & Europe IFHE President
5.45pm - 11.30pm
Congress Gala Dinner Partnered by Location: Brisbane City Hall, 64 Adelaide Street, Brisbane City Time: 5.45pm for 6.00pm bus departures Meeting Location: Meet at the entrance of the Brisbane Convention & Exhibition Centre, Cnr of Merivale and Glenelg Streets. Buses will return guests progressively throughout the night from 10.00pm to the meeting point at BCEC.
Wednesday 10 October 2018 Joint Plenary Session & Morning Tea with the 42nd World Hospital Congress 2018 Disease, Disaster and Destruction: Providing Health Services in Times of Catastrophe, Epidemic and Conflict 8.30am - 10.00am
Glenn Keys, Executive Chairman, Aspen Medical Pty Ltd, Australia Bronte Martin, Nursing Director, Trauma & Disaster, National Critical Care Trauma Response Centre (NCCTRC), Australia Berna Marcelino, Provincial Director, Standardization, BC Clinical and Support Services, Canada Optional Technical Site Tours Time: All tours are to meet at 10.00am for a prompt 10.15am bus departure Meeting Location: Meet at the entrance of the Brisbane Convention & Exhibition Centre, Cnr of Glenelg and Merivale Street • Technical Tour 1 - Lady Cilento Children’s Hospital - bus will return to BCEC at 1.30pm • Technical Tour 2 - Gold Coast University Hospital - bus will return to BCEC at 3.30pm • Technical Tour 3 - Royal Brisbane & Women’s Hospital (Hyperbaric Medicine Service) - bus will return to BCEC at 12.45pm • Technical Tour 4 - Queensland Emergency Operations Centre - bus will return to BCEC at 12.45pm • Technical Tour 5 - Royal Brisbane & Women’s Hospital (Skills Development Service) - bus will return to BCEC at 12.45pm
Optional Dinner: Australian Outback Spectacular Dinner & Show Time: 4.30pm for a prompt 5.00pm bus departure 4.30pm - 10.30pm Meeting Location: Meet at the entrance of the Brisbane Convention & Exhibition Centre, Cnr of Merivale and Glenelg Streets. The bus will depart at 9.30pm & return guests to the meeting point at BCEC at 10.30pm. Continued over the page...
Thursday 11 October 2018 8.15am - 5.30pm
Optional Social Day: Australia Zoo Time: 8.15am for a prompt 8.30am bus departure Meeting Location: Meet at the entrance of the Brisbane Convention & Exhibition Centre, Cnr of Merivale and Glenelg Streets. The bus will depart Australia Zoo at 3.30pm & return guests to the meeting point at BCEC at 5.30pm.
Please note the IFHE Congress program will be presented and printed in English. This program is an outline only and the organisers reserve the right to change the topics, times and presenters if necessary. For the most up-to-date version of the program, view the congress website: www.IFHE2018.com
REGISTER NOW Visit www.ifhe2018.com to secure your attendance at IFHE 2018!
Brisbane Convention & Exhibition Centre
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Come and see our full display of Smart Flow™ technology at the IFHE Conference 2018
BIOMEDS’ VITAL WORK IN AFRICA’S FLOATING HOSPITAL The lack of access to safe surgery results in more deaths worldwide every year than HIV, tuberculosis and malaria combined, according to The Lancet Commission on Global Surgery.
or nearly 40 years, Mercy Ships, the hospital ship charity, has quietly made it a priority to provide safe surgery for people in developing nations who otherwise would have no options. The field of service for the Africa Mercy is primarily West Africa, where the international volunteer crew of 450 spend 10 months at a time in a nation at the invitation of the local government. The protocol promises the provision of free surgical care in ophthalmic, maxilla facial, burns and plastics, obstetric fistula, cleft lip and palate and orthopaedic specialties for people in poverty. Building the capacity of countries’ existing health care workers is a second track of growing emphasis for Mercy Ships. The Africa Mercy has five operating theatres, five wards and all the required axillary services such as radiology, pharmacy and pathology. Ponseti, physiotherapy and rehabilitation services, ophthalmic and dental clinics are facilitated ashore – all without charge to the patients. Senior biomedical technician Tony Royston has volunteered with the Africa Mercy for a decade. “The Mercy Ship is a first world hospital with good quality, modern and appropriate equipment. Unlike the hospital locations ashore, we have stable power and environmental control that keeps the equipment optimal,” he said. He explained that locating a hospital on a ship provides its own unique challenges. “Storage space is very limited, so we rationalise the equipment’s make and standardise. Most items are shipped in containers which take a few months to arrive, so we keep the necessary spare parts.” Tony describes how the nature of the crew also adds a dimension of complexity.
“A major consideration when choosing equipment for this environment is for it to be user friendly. The international clinical crew may be seeing that specific model for the first time and need to use it soon after they arrive.” While the surgeries are conducted on board the ship, Tony and the team are also responsible for maintaining the equipment used by Mercy Ships teams ashore. “Dental, eye and other clinics are set up ashore each field service. Because of unstable local power supplies, and dusty, hot and humid conditions, the equipment has to be rugged and durable. A different country each year may require modifying building infrastructure, adding temporary cables, air hoses and other items. Everything must ensure safety and reliability for the patients and clinical teams.” Tony recalls one of his most technically demanding assignments. “Getting our single slice CT working after a hard drive failure was a major trial. The part was impossible to find, so I persuaded the machine to work with a modified newer drive. I discovered a programmer had long ago written an error message for a toolarge drive capacity that said, ‘No way, you can’t be serious, that’s humongous!’ Every piece of software including the calibration backups had to be reloaded. At the time I was the only Biomed on board. A patient needed a CT ASAP. It took many long hours.” Tony found his role on the hospital ship to be both compelling and rewarding. In recent months during the current field service in Cameroon, West Africa he was called upon to help out a local hospital. “We found out that a hospital had an x-ray machine that was not working despite three attempts to repair it. It was the only x-ray machine in a region with a
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Building medical capacity is a key part of the strategy Mercy Ships develops for each developing nation they serve
very large population. The machine was brought from the other end of the country to the port city for us to look at. The machine was almost 30 years old, and we had to do the repairs to component level, which is uncommon these days. We were able to fault find and repair it. We replaced some other old parts and gave it some much needed general maintenance.” “Biomed training is so important,” Tony declared passionately. “Medicine and surgery rely on diagnostic and therapeutic equipment. Unless there are capable, trained and supported Biomeds in the countries we visit, much of the other medical capacity building work we do on behalf of the local Ministry of Health will not be sustainable. Many of the local Biomeds are very capable people but have not received any specific Biomed training. It’s a privilege to help them apply knowledge and skills in their own environment. They are certainly able to teach us how to be resourceful in sometimes challenging circumstances.” During each field service in a different African nation, Mercy Ships provides Biomedical Technician training. It is a means to improve a country’s overall health care ecosystem and to improve biomed services by providing assignments and projects designed to help technicians improve their understanding of equipment diagnostics and repair techniques. It helps the local participants to take ownership of their biomedical engineering service, to learn and apply these skills to enhance their professional interactions with clinical personnel and hospital management. They often need to be reminded that they are a valuable part of the health care team. During the recent August 2017 to June 2018 field service in Cameroon, Mercy Ships collaborated with the capital city’s hospital and with the Ministry of Health to provide repairs and renovations. This work was done in line with the hospital’s planning that was carried out for the biomedical workshop. Once the renovation work was completed, Mercy Ships returned the facility to the hospital and the Ministry of Health for their continued use. This increased the sustainability of the mercy Ships field service as the facility will remain in operation long after the Africa Mercy departs.
Tony Royston, Senior Bio Medical Technician, volunteered his vital technical skills on the Africa Mercy for over a decade
Crew members Tony Royston, his wife Patricia and son Elliot hail from the UK
The Mercy Ship docks for 10 months in one African nation, providing essential surgery and medical capacity building services
The facility was used during the field service for the Biomedical Technician Training project, during which 28 Cameroonian biomedical technicians attended training courses run by Mercy Ships. During the 10-month tour-of-duty in Cameroon, more than 2,500 people in poverty received free essential surgery on board the Mercy Ship. For a complete field service overview see https://youtu. be/40HBIlCMjbc or visit www.mercyships.org.au
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WATER BORNE PATHOGENS PSEUDOMONAS AERUGINOSA By Sarah Bailey, QED Environmental Services
With the publication of the enHealth Guidelines for Legionella control at the end of 2015, there has been much emphasis on this particular bacterium as a potential cause of disease in hospital patients. However, any facility that is producing a water quality management plan would be very unwise not to assess the risks for other waterborne pathogens at the same time as they carry out a risk assessment for Legionella within their premises.
t could be argued that some of the other waterborne bacteria actually cause a much higher burden of disease than Legionella does. This is especially true of a bacterium named Pseudomonas aeruginosa. The Pseudomonas group of bacteria and some of their close relatives are renowned for proliferating in damp places within any environment. They are also particularly good at living in environments where there are very low levels of nutrients, for example in potable water. They have been found in a large variety of places within hospitals, including the tap fittings, showers, spa baths, sink and other drains, medical equipment, flower vases, damp cleaning cloths, swimming pools, on the surfaces of toys, mop heads, and on staff hands. Drugs themselves can also become contaminated, either at the production facility, as in the case of current recalls of nasal spray in the USA, or during preparation and storage within the health facility. Pseudomonas can also survive in disinfectant solutions if these are not changed regularly. The disease burden and death rates from Pseudomonas aeruginosa are not officially recorded, like they are for Legionella, so the cost of infection from waterborne Pseudomonas within a hospital is very difficult to quantify. Pseudomonas is very commonly found causing a wide range of infections, from minor to fatal bloodstream infections. In normally healthy people, it causes ear infections (swimmer’s ear) and folliculitis – sometimes known as “Hot Tub Folliculitis”, an inflammation of the hair follicles that can be found after swimming in a contaminated hot
tub or swimming pool. With its ability to survive and even grow in liquids containing disinfectants or very few nutrients, it can also establish itself in contact lens solutions, causing eye infections that can severely damage the eye. Pseudomonas aeruginosa infection in a patient with an impaired immune system, for example those undergoing a bone marrow transplant, with cystic fibrosis and other at risk groups, can be catastrophic. It is a cause of blood stream infections, which can be fatal, along with lung infections, colonisation and sometimes infection of sores and wounds. It is also a serious problem in burns units, and particular care should be given to include the risk from Pseudomonas aeruginosa and other similar pathogens when a risk assessment is carried out in these areas. Pseudomonas aeruginosa easily infects burn wounds and can cause very significant disease and mortality. Colonisation of these wounds by Pseudomonas can also slow down the healing process. Along with the wide variety of infections and issues caused by Pseudomonas, it can also be very difficult to treat. The organism is resistant to many antibiotics, and the majority of antibiotics that can treat it cannot be taken in a tablet form but have to be administered IV. The cost of treating Pseudomonas aeruginosa infections can therefore be quite high. In response to these issues, the UK has produced Guidance as part of the Safe water in healthcare premises (HTM 04-01) series specifically on
Part C: Pseudomonas FEATURE ARTICLES aeruginosa â&#x20AC;&#x201C; advice for augmented care units Pseudomonas aeruginosa. HTM 04-01 Part C: Pseudomonas aeruginosa â&#x20AC;&#x201C; advice for augmented care units gives advice on producing risk assessments for the augmented care areas of the hospital premises where Pseudomonas aeruginosa can cause particular harm. The main areas that are targeted, and that should have a risk management plan for this organism are areas that contain the following at-risk patients: a. Those patients who are severely immunosuppressed because of disease or treatment: this will include transplant patients and similarly heavilyimmunosuppressed patients during high-risk periods in their therapy; b. Those cared for in units where organ support is necessary, for example critical care (adult paediatric and neonatal), renal, respiratory (may include cystic fibrosis units) and other intensive care situations;
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c. Those patients who have extensive breaches in their dermal integrity and require contact with water as
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part of their continuing care, such as in those units caring for burns. Pseudomonas aeruginosa colonises and grows within a water system in a different manner to Legionella. While Legionella can colonise the whole water system, from hot water storage to the tap outlet, Pseudomonas aeruginosa is usually limited to colonising the tap fittings, drains and outlets of the water system, along with any damp areas and standing water. This is because Pseudomonas aeruginosa must have the presence of oxygen to survive. Understanding this is vital to producing a risk assessment and especially a sampling plan for a facility. Pseudomonas aeruginosa is also a very ‘sticky’ bacteria. It produces substances called polysaccharides, often in large amounts – a slimy, glue-like sugar-based substance that allows it to stick to pipes and other plumbing materials very effectively to form a biofilm. The presence of the sticky biofilm is also very effective at protecting the bacteria from chlorine or other disinfectants. Pseudomonas aeruginosa also grows at a much higher temperature
than Legionella, and is very likely to proliferate within the system at the 42-45°C temperatures that are found after the Thermal Mixing Valves (TMVs). Tapware and wastes are a particular risk for harbouring this organism. Experiments carried out in the UK in response to an outbreak in a neonatal unit showed that the more complex the tapware, the more likely it was to harbour biofilm and Pseudomonas aeruginosa. Sensor tapware, with its’ complex internal structure was colonised by biofilm containing Pseudomonas aeruginosa much more often than tapware that had simpler internal structures. Consideration should be given to the tapware being chosen for a particular clinical area, as it will need to be cleaned and serviced regularly and may need to be autoclaved to reduce the risks from Pseudomonas aeruginosa. Tapware in situ already should be cleaned effectively, and TMVs should always be regularly serviced and descaled. Stagnant water is a risk for Pseudomonas aeruginosa, as low chlorine levels and lack of movement can
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lead to the build-up of biofilm and an increase in the numbers of bacteria at the outlet. Regular flushing will help prevent colonisation by Pseudomonas aeruginosa, along with many other organisms that may cause issues within healthcare facilities. Pre-contamination of plumbing fittings should also be considered when producing a risk assessment for Pseudomonas aeruginosa. Fittings that have been factory tested using water and not dried before being packaged can harbour significant biofilm containing Pseudomonas aeruginosa, which can then be introduced into a water system. Sourcing fittings from reputable suppliers that only test with either potable grade water followed by a drying step, or those that are air tested should be selected. The positions of the sinks and associated plumbing and soap dispensers are also important. The waste should not be directly below the water outlet, to prevent splashing of water from the waste into the sink. Soap dispensers, and especially hand cream dispensers should also be positioned so that they do not allow soap or hand cream to drip onto the outlet, either from the dispenser itself or from hands. Soap, and especially had cream are a significant source of nutrients that can allow bacterial growth around and on a sink. As with any risk assessment, the production of an effective assessment requires the input and cooperation of many specialist groups within the facility from engineering or estates, to infection control and clinicians. Of particular importance when producing a risk management plan for Pseudomonas aeruginosa is the input from, and the training of, the cleaning staff. Cleaning protocols are of vital importance when attempting to control Pseudomonas aeruginosa within a hospital, especially the cleaning of clinical handbasins. The drain of the sink is almost always contaminated with Pseudomonas aeruginosa, and cleaning protocols should be implemented to prevent transfer of bacteria from the waste to the tap outlet. Separate cloths should be used for wastes and taps. Disinfectants should always be freshly prepared, unused diluted disinfectants should also be disposed of at the end of the cleaning shift, and water used for cleaning and mopping should never be disposed of in a clinical sink. The ability of Pseudomonas aeruginosa to survive in disinfectants that have not been freshly prepared can be a significant issue within the hospital environment â&#x20AC;&#x201C; wiping surface with contaminated water can lead to colonisation of large areas. Within the ward itself, behaviour may need to be changed. Clinical handbasins must not be used to dispose of unused antibiotics or IV fluids, body fluids
or other waste. This can act as a source of nutrients as the components of the waste coat the sink and pipework and can lead to rapid establishment of biofilm on the sink and associated areas. Once the risk assessment plan has been produced, regular verification sampling can track the effectiveness of any control implemented. However, the sampling plan must be specific for Pseudomonas aeruginosa. As noted earlier, Pseudomonas aeruginosa is found in the tap outlet, and not in the main water systems. As such, any sampling plan for Pseudomonas aeruginosa should take into account that the first part of the water that comes from the tap when it is turned on should be tested, and the taps should not be flushed prior to testing. This can be difficult in busy ward areas where the taps are in constant use. If colonisation has been found, there are several strategies that have been attempted in order to control colonisation. Point of use filters are the easiest and quickest to implement, and several hospitals have shown success in reducing Pseudomonas aeruginosa colonisation using this approach. At the St George Hospital in Sydney in 2010, use of one antibiotic that is used to treat Pseudomonas aeruginosa, Meropenem, was reduced by $22, 772 in a 12-month period. Other approaches have included aggressive cleaning regimes for wastes, using disinfectants such as chlorine, quaternary ammonium-based products and acetic acid. Due to the complexity of the internal structure of some tapware, some hospitals have implemented removable tapware that can be either autoclaved or passed through a washer-disinfector to sterilise the outlet. While Pseudomonas aeruginosa is a relatively ignored bacterium when Water Quality Risk Management Plans are being produced for healthcare facilities, there is no doubt it is an extremely important organism to control. For the health and welfare of any patients within the facility, it should always be considered when producing a plan.
REFERENCES: Department of Health UK (2016) Health Technical Memorandum 04-01: Safe water in healthcare premises. Part C: Pseudomonas aeruginosa â&#x20AC;&#x201C; advice for augmented care units. Health Protection Agency UK (2012) Investigation of Pseudomonas aeruginosa on biofilms in water tap assemblies from neonatal units in Northern Ireland. Dr Jimmy Walker et al. St Georges Hospital (2010) Loveday, C; Decker, V and Newton, S. Point of use filters: costly or effective?
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BOC: Living healthcare BOC is a trading name of BOC Limited, a member of The Linde Group. © BOC Limited 2018. Reproduction without permission is strictly prohibited. Details given in this document are believed to be correct at the time of printing. Whilst proper care has been taken in the preparation, no liability for injury or damage resulting from its improper use can be accepted. HCD287 EQA 0218
ARTICLES ISOLATION FEATURE ROOM MECHANICAL DESIGN –
ARE WE GETTING IT RIGHT AS AN INDUSTRY? By Ben Cook, MCIBSE I Associate, LCI Consultants
Isolation suites within hospitals play a key role in reducing the risk of cross contamination associated with both the airborne and physical contact routes. Typically in the order of 30m2 both negative and positive suites tend to comprise an anteroom, isolation room and ensuite.
ver the past two decades, mechanical design of isolation rooms have been subject to varying guidelines throughout different states and has continued to evolve at the national level albeit somewhat less. With the latest version of the New South Wales ’NSW’ Health Infrastructure Engineering Services Guidelines (August 2016), it is clear that NSW have adopted more stringent criteria in line with the Victorian Guidelines, however, are we getting the fundamental concept right? Or are there more flexible alternatives available used elsewhere across the globe, which better address user error and thus infection control? This article sets out to challenge the status quo and identifies a possible alternative approach to better protect staff, patients and visitors alike, both within the isolation room and throughout the hospital. Mechanical Pressure Regime Overview – The following three isolation room strategies are generally applied throughout Australia;
protection against other diseases. The general consensus throughout Australia surrounding these rooms suggest a cascading flow to the corridor (Base line) and the Anteroom (+Ve) from the isolation room/ ensuite (++ve), as illustrated in Figure 2.
Negative Pressure Isolation Rooms – Patients with an air communicable contagious disease are accommodated in a negative isolation room to protect others throughout the hospital. The general consensus throughout Australia surrounding these rooms suggest a cascading flow from the corridor (Base line) to the Anteroom (-Ve) and to the isolation room/ensuite (--ve) as illustrated In Figure 1. Positive Pressure Isolation Rooms – Patients who are considered immunocompromised are designated into a positive pressure isolation room for their own
Standard Isolation rooms – Patients capable of transmitting infection by droplet or contact routes are accommodated in a standard isolation room. No pressure gradients are suggested for this type of isolation. A Case Study & Alternative Suggestion – In 2016 my organisation was engaged to complete a survey of the existing isolation rooms throughout a large hospital within NSW. The scope of the assessment was to identify any shortfalls of the current isolation room mechanical design in accordance with both the Australian Standards / Codes & applicable Guidelines at the time. Any identified legislative shortfalls were to be addressed as a mandatory measure whilst Guideline shortfalls were to be addressed by establishing an agreed cost effective baseline to which all isolation rooms would be required to achieve through refurbishment. Through this process, we unexpectedly found that the most challenging issue was not to establish benchmarking criteria for performance to be agreed with by the users, rather the key challenge was associated with achieving user consensus re the type of isolation rooms to be implemented throughout the differing departments. It was noted that an alternating pressure arrangement (switchable +ve to –ve rooms) were discouraged by all parties due to the potential for human error associated with incorrect switching between room types. Acutely aware of the limited number of isolation suites throughout the hospital, the users struggled to agree on the type for implementation due to the varied nature of illnesses suffered at different times by the local population. While the above posed a contentious issue, it was quite evident that all parties unanimously agreed that the isolation rooms should be designed mechanically, if possible, to enable the placement of an immune compromised, contagious or the combination of the two, into any one isolation room without the risk of human error due to the primary reasons as listed below. 1. C linicians unable to appropriately locate an undiagnosed patient - When a patient enters a hospital their illness or immune system strength is unknown, as such, they cannot be allocated with 100% accuracy until diagnosis is undertaken which can take some time. 2. C linician unable to appropriately locate a patient emitting a contagious disease whilst also immune compromised – As discussed above, a positive isolation suit is design specifically for an immuno
compromised patient while a negative isolation room is design specifically for a patient emitting an air communicable contagious disease, therefore, a patient subject to both cannot be placed appropriately without compromising infection control. llowance for a Pandemic Scenario – During a 3. A pandemic, it is typically found that all patients will be immune compromised or emitting an air communicable contagious disease, and as such, it would be the preference that all isolation rooms are of a positive or negative arrangement. 4. G eneral Clinician error in allocating a patient to the incorrect isolation room type – Unfortunately human error does occur in this high pressured environment. Placing a patient in the incorrect room has significant infection control issues as it promotes the spread of disease throughout the hospital, or hinders the immune suppressed patient. As part of our engagement, we suggested our literature review cover those guidelines applicable to isolation rooms within the United Kingdom and United States of America. In doing so, we were able to provide an insight into how other countries overcome such issues, and also seek toHospital validate the Assessment Australian AECOM Wollongong - -Isolation WollongongHospital IsolationRooms Rooms- -CriteriaCommercial-in-Confidence - Criteria Assessment Criteria Rooms Assessment approach. Legislation Isolation and guidelines reviewed is listed Commercial-in-Confidence Illawarra Shoalhaven Local Health District DRAFT inD Table 01-Jul-2016 R A F T1.
Doc No. RPT_MECH_001
Table 1 – Legislation and Guidelines applicable Origin
The Australian Building Codes Board - National Construction Code 2016 – Volume One – Building Code of Australia Class 2 to Class 9 Buildings
Standards Australia – Australian Standard 1668.2-2012 – The use of ventilation and air conditioning in buildings – Part 2; Mechanical Ventilation in buildings
Standards Australia – Handbook HB 260 – 2003 – Hospital acquired infectionsEngineering down the risk
Australia NSW Government Health Infrastructure – Engineering Services Guidelines – August 2016
NSW Health - Engineering Services and Sustainable Development Guidelines – Technical Series TS 11 Version 2.0– December 2005
TS – 11
Guidelines for the classification and design of isolation rooms in health care facilities – Victorian Advisory Committee on Infection Control - 2007
UK - Department of Health – Heating & Ventilation Systems – Health Technical Memorandum 03-01; Specialised ventilation for healthcare premises – November 2007
UK – Department of Health – Health Building Note 04-01 – Supplement 1 Isolation facilities for infectious patients in acute settings – 2013
ASHRAE – HVAC Design Manual for Hospitals and Clinics – Second Edition
ASHRAE HVAC DM
USA ASHRAE/ASHE Standard170-2013 – Ventilation of Health Care Facilities
An order of precedence was highlighted to the client thus managing the expectation associated with establishing the benchmark criteria as illustrated in DRAF Figure 3.T AECOM
Wollongong Hospital - Isolation Rooms - Criteria Assessment Isolation Rooms - Criteria Assessment Commercial-in-Confidence
Second stage Legislation
Referred in NCC 2016 as a requirement
Referenced Information Document
ASHRAE HVAC DM
We produced mechanical design criteria matrices which cross referenced all standards and guidelines to further assist the clinicians in establishing the bench mark criteria. It was found that there was general consistency throughout the guidelines associated with positive and negative isolation rooms, however, both HBN 04-01 and ASHRAE HVAC DM addressed the concerns listed above through the suggestion of a fundamentally different arrangement. ASHRAE HVAC DM classed the alternative as a combined Airborne Infectious Isolation (AII) and Protective Environment (PE) room. Two options are suggested for room pressurisation, 1) the room is negative to the anteroom with the anteroom positive to the adjacent corridor, or 2) the room is positive to the anteroom with the anteroom negative to the corridor. HBN 04-01 referred to the isolation suite as a Positive Pressure Ventilated Lobby (PPVL), the principle being that the anteroom is nominally 10pa greater than the corridor, the isolation room is nominally 0pa greater than the corridor and the ensuite is negative in relation to the isolation room. This arrangement has been illustrated below.
The main down side of the alternative arrangements outlined within HBN 04-01 & ASHRAE HVAC DM occur if the patient enters the anteroom, thus jeopardising infection control however, this can be easily addressed through the implementation of interlocking doors (see figure 4).
A BETTER WAY? It is clear that the PPLV approach has the potential to address the four main user concerns noted above. It also comes with minimal disadvantages, and it enjoys the support of health professionals in a number of countries including the UK and USA. It does however challenge the way we approach mechanical services pressurisation regimes in Australian hospitals, and to make the necessary changes will also require legislative changes. Whether there is an appetite for change amongst the Health Regulators remains to be seen, but as engineers we should always question the status quo, and when a seemingly better approach presents itself, it would be remiss of us to not at least canvas the ideas.
ABOUT THE AUTHOR Ben Cook is a Chartered Engineer and Member of CIBSE, and an Associate at LCI Consultants.
This article first featured in Engineering Buildings, Winter 2018.
Are Your Theatres And Isolation Rooms Safe From Airborne Pathogens? Many Hospitals and Healthcare Facilities have Pressure Controlled Rooms that remain Unchecked and Non-Compliant, a potential HAI catastrophe waiting to happen... EPES can offer a range of solutions to ensure your Critical areas are Compliant and Safe. Healthcare providers have a “Duty of Care” to Staff and the Public to ensure that Pressure Controlled Rooms such as Operating Theatres and Isolation Rooms are effective and Compliant with Legally Mandated Codes, Standards and Health Facility Guidelines. “The most dangerous HAI pathogens are those that have the potential to spread by air” (Kowalski 2012, Hospital Airborne Infection Control). “It has been suggested that 175,000 HAI’s occur annually in Australia” (CSIRO Publishing, Australian Health Review, 2015, 39, 37-43). The major causes of Pressure Controlled Room failures are flawed design, poor commissioning, maintenance, and lack of ongoing monitoring and verification. This results in a super reliance on reactive maintenance, all of which is preventable.
To avoid a potentially disastrous airborne pathogen outbreak, the following is recommended: • Adhere to diligent testing and commissioning practices • Have proper oversight and control of commissioning • Compliance and Certification with current Standards • Satisfy Australasian Health Facility Guidelines (AusHFG) monitoring and annual validation requirements
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REFLECTING ON THE CONVENTIONS OF LIGHTING IN HOSPITALS By Simm Steel I Principal Lighting Designer, Steensen Varming Our specialist lighting work covers a lot of sectors at Steensen Varming, but one common factor is that our approach does, by necessity, focus on the welfare of occupants and visitors which is, in turn, predicated on upholding, constantly questioning, and setting benchmarks of design against the ever-changing industry and social background.
ospitals are also environments that have to function as critical workspaces, centres for patient well-being and recovery as well as assist with intuitive wayfinding for transient patient visitors, and sterility. Uniting aesthetics with functionality is crucial to the optimum habitability of any environment and seeking savings without diminishing quality of design or materials delivers a structure and institution of longevity and sustainability. These principles should be the focus and the true meaning and responsibility of value management. Recently there was a call for comment on AS/NZS 1680.2.5:2017 Interior and workplace lighting Hospital and medical tasks (a revision of AS/NZS 1680.2.5:1997) relating to safety and task performance efficiency within hospitals and medical premises. Three changes were recommended to this standard. All are pertinent, but the most thought provoking relating to the welfare of occupants is the topic of cyanosis observation lighting.
The review highlights the importance of colour discrimination and the importance of specification of light sources with an appropriate Cyanosis Observation Index (COI) under the current thinking. But in light of why the standard was created and the quality of new technologies should we instead be calling into question the relevance of cyanosis observation lighting altogether? As we are mandated by the Codes of Conduct of most engineering and design institution to stay within our sphere of expertise, Steensen Varming acknowledges that we do not possess clinical or medical expertise to conduct the necessary research or scientific evaluations however our input into Engineering Services Guidelines does advise that clinical staff should decide on the locations where COI is to be specified. Of course, recommending â&#x20AC;&#x153;... that all members of the health care team discuss and decide upon those areas where provision should be made for the visual detection of cyanosis.â&#x20AC;? places
the onus of responsibility on the staff and the likely conclusion is that it would be specified everywhere. How relevant are the methodologies used to decide the value of COI? How is cyanosis observation affected by the presence of anaemia, genetic skin pigmentation or colour deficient observers? It is certainly becoming clear that colour vision deficiency is an issue1. Advice also exists regarding skin colour evaluation where cyanosis â&#x20AC;&#x153;may present as grey or whitish (not blueish) in dark skinned patients2 but it does not relate to LED technology lighting itself and it hard is to find significant scientific research pertaining to light and cyanosis detection since the J.O, Morgan Hughes paper of 19683 when the increased use of fluorescent lighting brought about recommendations in the use of fluorescent with appropriate Spectral Power Distributions, and it is not clear if skin pigmentation was even considered, proving to be historically and societally outdated both in its western bias and embedded cultural myopia. There is also reasonable argument that areas where pulse oximeters are not in use, such as emergency waiting areas, there is equal justification for high colour rending to aid in cyanosis observation. Until these factors are understood the value of cyanosis lighting is unknown and it would be beneficial to develop an approach of undertaking academic/ clinical studies where the decisions/conclusions are made by qualified experts/scientists with assistance from unbiased lighting consultants to interpret and recommend based on the data provided.
Which brings us to the question of the use of colour tuneability, and its use to reduce sleep disorders such as Seasonal Affective Disorder (SAD) and the support of circadian rhythms of shift working in the Australian context. The intrinsically photosensitive retinal ganglion cell (ipRGC’s) of which there are currently 5 types, were discovered in 2002 and play a part in influencing biological rhythms (even in the blind), pupil constriction and some image forming vision, and are particularly responsive to the wavelength of 480nm (toward cyan)4-5. Although there is much talk about how blue light from LED light sources can play a part in sleepless behaviours, and as evidenced by a sample Spectral Power Distribution (SPD) graph from a Cree datasheet 2008-20186, the blue spectrum between 400-490 nm peaks at approximately 450nm and drops significantly
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at the 480nm, the wavelength associated with circadian rhythm response. So, if we suggest this peak lies outside the zone of influence are there other factors we are not paying enough attention to such as illuminance levels, mental focus and exhaustion? Assuming “tuneable” lighting does have an impact on circadian rhythms, how does “tuning” to a circadian responsive level where a CCT may be as low as candle light (resulting in low rendering of colours) impact on the shift worker who is carrying out detailed work within a hospital? And how does circadian lighting make a lasting difference if occupants still have to navigate the value managed lighting of restrooms, corridors, elevators, entry foyers and street lighting, not to mention daylight when they might be expecting to go home and sleep? Are there other ways to support circadian rhythms? Outside trying to emulate a balanced diurnal cycle in environments where the solar day can be extremely long or short there is little evidence that trying to control or support circadian rhythms of shift workers is entirely effective. There are simply too many variables, however it has been noted that a reduction in illuminance is equally effective and this allows for specific task areas to have a focussed lighting that does not impact on the ambient light levels or CCT. With a considered design approach, the role of focussed lighting may also play a dual role in wayfinding for visitors and patients alike. In wards it is also possible that the application of paint colour that absorbs the higher energy spectrum of higher CCT ward task lighting employed at night would reduce the ambient colour temperature and reduce the assumed impact of blue light. During the day direct daylight penetration would trigger the daytime circadian response of patients looking out through windows while controlling the circadian spectrum when privacy curtains are closed. So how does this then relate to the importance of value management in the hospital and should we be honest and admit that “value management” is a term misused to make the act of “cost saving” more palatable rather than managing value. It’s not entirely clear how “colour Tuneable” and COI lighting is of benefit to clients. It’s a simplified question, but if circadian rhythms can be supported by other means and Cyanosis observation is being superseded by the use of pulse oximeters, why would we specify these light sources when the standardisation of high quality
light would enhance the welfare of patients, staff and visitors within our hospitals?
ABOUT THE AUTHOR Simm Steel is the Principal Lighting Designer at Steensen Varming specialising in Museum lighting, and as part of the Steensen Varming holistic lighting approach, considers electric lighting and daylighting as intrinsically linked. He has worked on major projects with acclaimed international artists and leading architects on projects that have received numerous awards from the Illuminating Engineering Society of Australia and New Zealand and the International Association of Lighting Designers. Simm teaches the Subjective Analysis in Lighting Design unit for the Illumination Design Master’s program at The University of Sydney, is a member of the judging panel for the Illuminating Engineering Society LiSDA and LiDA awards, and has authored a number of articles in lighting magazines and publications, and presents at various international lighting conferences and technical seminars.
The SLL represents the interests of all those interested in the application of light. It is open to everyone with an interest in lighting.
CITATIONS 1. Color changes in cyanosis and the significance of congenital dichromasy and lighting Stephen Dain. First published: 15 October 2007 https://doi.org/10.1002/col.20353 https://onlinelibrary.wiley.com/doi/pdf/10.1002/col.20353 2. Color awareness: A must for patient assessment https://www.americannursetoday.com/color-awareness-a-mustfor-patient-assessment/ 3. LIGHTING AND CYANOSIS J.O. MORGAN-HUGHES. https://doi.org/10.1093/bja/40.7.503 4. Melanopsin-Positive Intrinsically Photosensitive Retinal Ganglion Cells: From Form to Function Tiffany M. Schmidt, Michael Tri H. Do, Dennis Dacey, Robert Lucas, Samer Hattar and Anna Matynia Journal of Neuroscience 9 November 2011, 31 (45) 16094-16101; DOI: https://doi.org/10.1523/JNEUROSCI.4132-11.2011 5. Berson DM, Dunn FA, Takao M (Feb 2002). “Phototransduction by retinal ganglion cells that set the circadian clock”. Science. 295 (5557): 1070–3. doi:10.1126/science.1067262. PMID 11834835. 6. http://www.cree.com/led-components/media/documents/ XLampXPE.pdf
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AIR FILTRATION AND ITS PRACTICAL APPLICATION IN THE HOSPITAL ENVIRONMENT By Kristian Kirwin (B.ENG Mechanical) and Shannon Roger (B.Ed) for Airepure Australia
The essential functions of air filters are to improve indoor air quality and to protect downstream equipment and facility components. Within hospital environments, air quality has a more direct impact on patients and hospital staff.
his article seeks to cover air filtration and its practical application in the hospital environment.
and below this size (0.3μm) are generally easier to capture.1
Gaseous filtration methods commonly used by air filters are adsorption or chemisorption. Activated carbon media, which consist of micro-pores within larger granules, use the adsorption method. Small gas molecules find their way inside these pores where various forces adsorb the gas molecules to the media and hold them there, therefore removing them from the airstream (like a sponge adsorbing water). Chemical infused media such as potassium permanganate use the chemisorption method – whereby small gas molecules find their way inside these pores and are molecularly changed by chemical reaction when they contact the media. This chemical reaction permanently converts odorous/ toxic gas molecules into a harmless salts and gases.
The two main streams of filtration employed by air filters are particulate and gaseous filtration. Particulate filtration typically uses a randomly arranged mesh of fibers to capture small particles via the methods of impaction, interception and diffusion. In a simplistic way, particulate filtration relies on the probability that as a particle passes through these fibres in the direction of bulk airflow, they will either impact onto a fibre (A) or come close to and be drawn onto a fibre through interception (B). Smaller particles that are closer in size and mass to gaseous molecules tend to move radially to the direction of bulk airflow, resulting in a longer residence time and more random pathway through the fibres; and therefore greater opportunity to be captured – diffusion (C).
Figure 2: Activated Carbon Adsorption of Gas Molecules
Figure 1: Particle filtration mechanisms – impaction, interception & diffusion
The particle size of 0.3μm (commonly referred to as MPPS- most penetrating particle size) is typically selected as the test point for rating filtration efficiency in particulate air filters. This is because particles above
Whilst chemical infused media can be targeted to react with specific contaminants, activated carbon media is not selective with the gas molecules it adsorbs – it will adsorb whatever contaminant that it is exposed to, including water vapour. If activated carbon media or chemically infused media are subject to particle contamination, the outer surface of the granule becomes coated, creating a seal. This seal results in the ineffective adsorption of gas molecules due to the unused pores inside the
granule being inaccessible. Therefore, it is best practice to ensure that particle pre-filters are used before activated carbon filters to ensure optimal performance.
FILTRATION PERFORMANCE There are several aspects of air filter design that impact on filtration performance. The important parameters include:
Air filtration media Material / Type
Different media types can have various effects on efficiency. Synthetic filter media are resistant to moisture build up and ideal for preventing the proliferation of mould and mildew. Glass fibre is typically a finer filter media, more tolerant of chemicals and high temperatures, but can be quite fragile.
Thickness / Density
Thicker or denser filter media have higher filtration efficiency and higher pressure drop. Deeper, graduated filter medias can hold more contaminants, than thin media grades.
Fibre Quality / Size
Quality air media lasts longer and does not shred fibres in the duct. Fibre size can have various effects on efficiency.
Higher media surface area equates to a lower pressure drop and higher contaminant holding capacity. Pleated air filtration media has a greater surface area and contaminant holding capacity than flat air filtration media. The higher the number of pleats, the larger the surface area it can contain. Ultimately, the higher surface area maximises the filtration and contaminant holding capability and reduces energy consumption.
Filter construction Frame (Metal, Plastic, Cardboard)
Strong, durable filter frames should withstand the force of the air stream and support the filter media. A stable housing module helps to achieve a longer filter service life.
Media Bonding / Frame Seal
Air filter media should be safely and tightly bonded to the filter frame to prevent air and contaminant bypass (where contaminants can escape through the small gaps on the sides of the filters).
Some filters are required to perform under high heat or constant high humidity – and these filters have frames, media and glue specially designed to withstand these conditions. Within hospitals, exposure to cleaners, decontaminating agents and UV can cause a breakdown of some types of filter media.
Filters are generally designed for a maximum velocity of 2.5m/s, however filters can be designed to withstand higher velocities, and in some cases specialised filters will have a maximum velocity below 2.5m/s. Maximum suggested velocities for HEPA filters would be 0.5m/s in a terminal application, 1.0m/s in an exhaust application and 2.5m/s for an in-line application – however at 2.5m/s the air pressure across the filter would be extremely high and increase energy usage.
The geometry of the filter also impacts performance. Typically, an even laminar airflow across the filter face will result in a lower pressure drop, reducing energy consumption. Adding excessive pleats can reduce free airflow and increase pressure.
Factors affecting the contaminant holding capacities of a filter include filter construction, type of contaminants/dust, temperature and humidity. Filter performance may vary between different filters or manufacturers, and different locations.
Static pressure is a recognised measurement to indicate appropriate air filter change out times. A common rule of thumb for when to change a filter is 2-2.5 times the original pressure drop of the filter. It is however recommended to consider the energy used (costs) compared to the filter change-out cost.
Suitable access is required for the removal, replacement and testing of air filters. This is particularly important when locating filters in ceiling spaces (FFU’s/inline housings) and wall cavities (low level HEPA modules).
FILTER EFFICIENCY, RATINGS AND STANDARDS
COMMON AIR FILTERS IN HOSPITAL ENVIRONMENTS
Accepted filter performance rating systems are EN779:2012 (G1 to F9), EN1822:2009 (E10 to U17), ASHRAE 52.2 (MERV 1 to 16) and ISO16890 (ISO coarse to ISO ePM1).
Based on the successful removal of airborne particles by size, these ratings provide a relative measure of filter effectiveness; whereby lower rated filters remove larger sized particles and higher rated filters remove smaller sized particles. Higher rated filters will remove more airborne particles; however this is almost always at the cost of energy and more frequent filter changes. Similarly, lower rated filters will impact air quality, duct cleanliness, coil/heat exchanger performance, and in some cases safety.
Metal Framed Flat Panel Filter (20-25mm deep G4) Flat panel filters are the most basic type of air filter, whereby a panel of flat surface air filtration media is enclosed within a metal frame. Commonly used in hospital applications as a pre-filter for terminal mounted exhaust HEPA housings where there is limited space for pre-filtration (such as isolation room ensuite areas), they serve to protect the HEPA filter and prevent large particles from entering the system. Figure 3: 20mm deep metal framed flat panel filter with G4 efficiency rating
Inspection of your current filters will reveal their rating, and you should replace these filters with (at minimum) a comparable rated filter. Over time, it is worth consulting with a knowledgeable and trustworthy filter manufacturer, to see if higher performance filters can result in higher IAQ and lower energy costs. Often by making a change to a modestly more expensive filter that provides lower pressure drops and larger dust holding capacities, you can actually reduce total costs of your clean air equation.
HOSPITAL FILTRATION REQUIREMENTS There are many hospital design standards and guidelines – nearly all states within Australian and New Zealand have their own. Some standards and guidelines vary, but generally they all follow the same basis and often refer to each other. Some areas also refer to international guidelines (eg. operating theatres – HTM03 / DIN9016, commercial buildings – Greenstar / Nabers / Wells). All hospital design standards and guidelines are open to interpretation and must consider the actual requirements of the area, and ultimately, a risk based design element is required. In any given state, both 1668.2 and state guidelines may apply. AS 1668.2 are documented in legislation via BCA, and its guidance should be adhered to in all cases.
Cardboard Pleat Filter (100mm deep G4-F7) Cardboard disposable filters are constructed from pleated air filtration media bonded to a cardboard frame (typically moisture resistant beverage grade cardboard). Diagonal cardboard supports across the filter face are included for rigidity and durability. Typically used in hospital AHU’s and applications as a pre-filter for inline containment exhaust filtration systems where there is sufficient space for higher grade, high capacity pre-filters, which protect high capacity HEPA filters. Figure 4: 100mm deep cardboard framed pleated panel filter with G4-F7 efficiency rating
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Glass Fibre Pleated Panel Filter (100mm deep F8-F9)
Rigid/Hybrid Media Filter (100mm deep F8/F9)
Glass fibre pleated panel filters are constructed from fine, paper thin micro glass fibre media, formed into packs of closely spaced pleats and bonded to a cardboard frame (typically moisture resistant beverage grade cardboard). Suited to variable air volume systems or turbulent flow conditions, they typically provide high pressures for a given airflow. Commonly used in hospital applications as a final filter within FCU’s, where space is a premium due to size and media limitations.
Rigid, formed hybrid media filters are constructed from self-supporting, layered filter media that uniquely incorporates pre filtration, medium and fine filtration layers, bonded to a metal frame. These filters have excellent contaminant holding capacities and reasonable pressure resistance– particularly for high efficiency grades. Within hospital applications, these filter are selected to replace glass fibre pleated panel filters as a final filter within restricted space locations (bed bays or location specific FCU’s).
Figure 5: 100mm deep glass fibre pleated panel filter with F8-F9 efficiency rating
Constructed from finely pleated air filtration media with high surface area properties for high efficiency filtration, HEPA filters are typically manufactured from the highest quality of materials under strict quality control conditions, and are factory certified to ensure filtration performance to EN 1822:2009 standards.
Multi Pocket Bag Filter (380mm deep F8/F9) Multi pocket bag filters are constructed from a six / eight pocket (full size) or three / four pocket (half size) deep bed bags, constructed from electrostatically charged filter media bonded to a metal header frame, and generally have excellent contaminant holding capacities and reasonable pressure resistance. They are bulky, and take a significant duct length to house them. Commonly used in hospital AHU’s. Figure 6: 380mm deep multi pocket bag filter with F8/F9 efficiency rating
Figure 7: 100mm deep rigid formed hybrid media filter with F8/F9 efficiency rating
HEPA (High Efficiency Particulate Air) Filters
HEPA filters are typically sealed into their housings via mechanical or gel/knife edge methods. Refer to “Effective HEPA Design and Operation for Hospital Environments” for further details.2 Specialty separator style and dimple-pleat/separatorless style HEPA filters are factory tested to meet the requirements of IEST RP-CC001.3 for Type A, B, C, D, E or F filters (industrial grade, nuclear grade, laminar flow grade, bio/hazard grade, VLSI, ULPA or pharmaceutical grade); and can be certified to UL586 or UL900 standards. Mini-Pleat HEPA (H14) Mini-pleat HEPA filters are constructed from fine, paper thin, micro glass fibre media, formed into packs of closely spaced pleats that are separated by a continuous thermoplastic cord and bonded to a metal frame. Typically used within terminal supply or exhaust HEPA housing within hospital applications. Figure 8: mini-pleat HEPA filter with H14 efficiency rating
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Separator Style HEPA (H14/U15 or specialty) Separator style HEPA filters are constructed from fine, paper thin, micro glass fibre media, formed into packs of closely spaced pleats that are separated by corrugated aluminium separators and bonded to a metal frame. Within hospital applications, these filters are used within in-line HEPA housings, AHU mounted HEPA housings or high efficiency exhaust BIBO (bag/ in-bag/out) airborne containment systems. Figure 9: separator style HEPA filter with H14/U15 efficiency rating or specialty
Dimple Pleat, Separator-less HEPA (H14/U15 â&#x20AC;&#x201C; specialty) Dimple pleat, separator-less HEPA filters are constructed from a self-supporting and self-separating layered filter media bonded to a metal or wooden frame. These filters are typically used in high efficiency exhaust BIBO (bag/in-bag/out) airborne containment systems or nuclear medicine / cyclotron areas, due to their relatively low pressure and high volume characteristics. Subject to the application, the filter media packs and frames can be incinerated if required. Figure 11: Dimple pleat, separatorless HEPA filter with H14/U15 efficiency rating or specialty
Gas-Phase / Carbon Filters Activated Carbon Filters
V-form Mini Pleat HEPA (F9-H10, 95% DOP & H14) V-form mini-pleat HEPA filters are constructed from fine, paper thin, micro glass fibre media, formed into mini-pleat media packs that are arranged into a V-bed configuration and bonded to a box style metal frame that provides strength and durability for high velocity applications. F9-H10 and 95% DOP rated V-form mini-pleat HEPA filters are typically used as a final filter within critical care areas, or as a final pre-filter for HEPA filtered areas. H14 rated V-form mini-pleat HEPA filters are typically used in high volume duct mounted HEPA applications (within a supply AHU or exhaust plenum).
Activated carbon filters, which use activated carbon filter media are typically available in flat panel style, cardboard pleat style and V-form mini-pleat style. Some filter types use hybrid particulate/activated carbon media for combined particle and gas filtration. Commonly used to remove VOCâ&#x20AC;&#x2122;s and other inorganic gases that are generated from indoor and outdoor sources to improve IAQ. They are particularly useful when outdoor air intakes are near roads, loading docks or helicopter pads. Figure 12: Activated carbon V-form mini-pleat filter
Figure 10: V-form mini-pleat HEPA filter with F9-H10, 95% DOP or H14 efficiency rating
High Mass Carbon / Chemical Infused Media Filters
Figure 14: HEGA carbon adsorber filters
High mass carbon or chemical infused media filtration is available through carbon / chemical media pellets installed into housings / canisters, and through filters constructed from composite structure, extruded monolithic blocks of carbon / chemical media inserted, supported by wire mesh within a metal frame. Typically used where bulk or high percentage gas/odour removal is required, these filters are commonly used within animal laboratory areas and helipad areas to remove odours and jet/ diesel fumes. Figure 13: High mass carbon / chemical infused media filter
FILTER MAINTENANCE AND TESTING HVAC filters Dust, temperature, humidity and other contaminations are all factors affecting the contaminant holding capacity of a filter – which again may vary between different filters or manufacturers. Actual historic data will be your best guide regarding filter replacement frequency. Location specific calculations should be undertaken to facilitate the most economical change out point (change-out cost Vs energy usage).
HEGA (High Efficiency Gas Adsorption) Filters HEGA filters are manufactured from the highest quality of materials under strict quality control conditions as custom targeted high mass carbon media installed into V-bank style housings, and are factory tested to meet the requirements of IES RP-CC-008- 84, “Recommended Practice for Gas Phase Adsorber Cells”. HEGA filters are commonly used in conjunction with HEPA filters in high efficiency exhaust BIBO (bag/in-bag/out) airborne containment systems or radioactive dispensing / cyclotron areas. They are typically type tested and media is batch tested. Where required, field testing to confirm performance can be undertaken. The primary thing to consider is the handling of these filters – they are bulky and extremely heavy due to their construction and carbon mass.
In well-designed systems, static pressure is a recognised measurement to indicate appropriate air filter change out times. The appropriate static change-out value for filters change significantly depending on the airflow rate, type of filter, grade of filter, hours of use per day and the contaminant concentration of the air being filtered. A common rule of thumb for when to change a filter is 2-2.5 times the original pressure drop of the filter. In general, it’s always better to change filters early – rather than late. HEPA filters – Annual NATA testing and validation The annual retest of HEPA filters by NATA accredited testing agents is necessary to validate performance. These independently certified Technicians will, during certification testing, expose the HEPA media and housing to a challenge agent/aerosol. A regulated and calibrated amount of “smoke/mist” is pumped into the upstream side of the filter, and the filter and housing are scanned on the downstream side for leakage. To perform testing, adequate access needs to be available to physically view and scan the HEPA face. Access to, or a connection point upstream of the filter is needed to introduce the challenge aerosol. Gas-phase / carbon filter testing It is more difficult to monitor the life of gas phase filters, as the pressure drop over a gas phase filter does not increase over the life of the filter. Common methods for checking life include; media samples sent to a
test lab to determine remaining life, observation of increasing levels of VOC’s from VOC sensors located indoors, or replacement after a set period of time based on manufacturers recommendations.
FINAL THOUGHTS • All filters have a finite capacity and benefit from staged filter sequencing i.e. pre filters followed by higher efficiency final filters – allowing inexpensive filters to be sacrificed to protect more expensive and difficult to replace final filters (HEPA/HEGA). • Allow space for filters and filter banks, as they are the biggest consumers of energy. • Consider the initial and final pressure drops when selecting filters. Plants should be sized off the loaded filter pressures. • Subject to filter selections, changing out one stage of a higher rated filter more often (monthly) may be better from an energy usage perspective than changing our two stages (quarterly and yearly).
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REFERENCES 1. M. K. Owen and D. S. Densor, “Airborne particle sizes and sources found in indoor air.” Atmospheric Environment., vol. Part A., no. General Topics, 26(12), pp. 2149-2162., 1992 2. Airepure Australia, “Effective HEPA design and operation for hospital environments.” Healthcare Facilities Journal Vol 40, No 1, p 29-32, March 2017.
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MAINTENANCE CONTRACTS FOR 21ST CENTURY BUILDINGS By Vince Simpson
Big data and analytics is becoming widespread thanks to the ready availability of cloud computing technologies. Buildings and the services within these buildings are complex systems that are a ready source of data where analytics can provide useful insights. This paper explores the rise of analytics in the built environment and more specifically the impact on traditional building service maintenance.
odern buildings built in the last ten years are heavily dependent on advanced control systems to monitor and control many aspects of the environment and operation. Lighting, airconditioning, security, lifts and utility metering systems are just some of the systems that rely on computerised control systems for their regular operation. The complexity of these systems and the volume of data they can generate creates additional challenges and opportunities to maintain and manage these systems. Organisations that have traditionally operated and serviced this sector are struggling to adapt to the new world. The speed of change and advancements have caught the building services industry unprepared. Some of the new challenges confronting traditional building facility management teams include: 1. Increasing deployment of ICT technology and the associated risks of cyber-attacks. 2. Demands from tenants and owners for more information and improved services and features that can be sourced from the building data. 3. Overloading operation and maintenance teams with excessive uncontrolled data from multiple building system silos. The capacity of these new systems to deliver data far exceeds that of systems of 10-20 years ago. 4. Numerous product offerings from multiple vendors all promising sometimes â&#x20AC;&#x153;magicalâ&#x20AC;? improvements in energy consumption and plant optimisation.
Figure 1 - Information overload
BUILDING ANALYTICS DEFINED Chris Peters (It Peer Networks) presents a common model that I have adopted to describe the evolution of analytics that is readily applicable to building services. Chris proposes that there are three levels of analytic maturity that describe this progression. Once one understands the primary stages and types of analytics, it is easier to conceptualise some of the opportunities for how this might change and impact maintenance in the building services sector in the 21st Century.
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data that is being fed into the model. The key to even be able to consider this type of analytics is to ensure systems designed and delivered into the building allow high volume data transfer. Typically, commercial buildings of today are incapable of high-volume data unless the IT infrastructure and hardware are designed from day one to support this requirement. A HVAC example might be to track the performance of a compressor performance as a means to determine potential failure or reduced efficiency. This prediction might use multiple sensors and variables over extended periods (years) (tracked against a model) as a means of tracking performance decay. The use of this style of analytics is currently not common within the building services industry. Ref: Turning raw data into smart insights (Chris Peters 2015 â&#x20AC;&#x201C; IT Peer Network)
Descriptive analytics: This style of analytics uses historical data to show what has occurred in the past. This is typically provided by reports and/ or dashboards. This style of visualisation can be provided suitably well by all current generation BMS systems. Typical examples of this include energy dashboards or plant summary graphics. The use of this style of analytics is common and offered by many organisations including dedicated analytical platforms.
Figure 3 - Predictive Analytics Data Flow diagram
Prescriptive analytics â&#x20AC;&#x201C; This form of analytics is all about providing advice. Typically, this involves calculating multiple possibilities and futures. The process involves the use of computational modelling, machine learning and fixed rules. Whilst typical applications in this area tend to be focused in manufacturing and production industries, Google has implemented this style of analysis to assist in managing data centre air-conditioning use and energy utilisation (https://www.euractiv.com/section/energy/news/ google-taking-ai-to-the-next-level-to-cut-data-centreenergy-use/).
ANALYTICS PLATFORMS IN THE BUILDING SERVICES INDUSTRY
Figure 2 - Typical Dashboard
Predictive analytics utilises pattern analysis to predict what could happen. This type of analytics attempts to predict outcomes from the considerable volume of
Building control systems have been slow to evolve, especially in comparison to other areas of technology. Consolidation of the industry in the 1990s and 2000s into the hands of a few multinational manufacturers led to stagnation in innovation and product development. The industry is only now benefitting from low-cost hardware (sensors, controllers), increased capability to capture data and more advanced software. These newer control systems support or contain self-diagnostic and fault detection
capabilities at the field hardware level, but typically these are not programmed or configured. The failure to use the newer advanced functions of control systems has been driven by a number of factors: 1. T he systems are seen as more of a commodity offering with little differentiation. Cost pressures tend to lead to these functions being sacrificed on many jobs. 2. A lack of expertise and training both on the customer side and the supplier side. 3. O perations staff rarely have the time to dedicate to analysing the alarms generated by these advanced strategies. Whilst the technology for control systems has progressed and become more reliable, the service contracts for building control systems haven’t evolved from the era of pneumatic control systems. Building owners pay large sums for unnecessary maintenance tasks that provide no value to the owner. The failure of traditional building controls providers to address the issue of innovation of their products and services has left the building services market lagging other industries in relation to using advanced data management through smart analytics and algorithms as a means to optimise efficiency and reduce maintenance outgoings. This allowed a different category of company to be created to address the gap with new product Building Systems Analytics. This new service offering relies on the competitive advantage provided by the Cloud to provide the functionality that has been lacking in traditional building systems. These higher-level functions require an advanced set of skills that many traditional building service companies typically cannot deploy at the site level. These skills include data base management, web design and data manipulation and visualisation skills. If one carries out a simple search on the internet for Building Analytics platforms, there are a plethora of platforms available. Systems like these can provide the capability to achieve excellent energy savings and improved plant performance. A sample of platforms/companies that utilise or offer an Analytics platform targeted into the building services sector (predominantly HVAC and energy focused) within the Australian Market are shown below:
Figure 4 - sample of Analytics platforms in Australia
Whilst there are many products available in the Australian market offering analytics overlays, the significant portion of these offerings appear to offer an unsustainable pricing model. The majority of these services are offered as a cloud-based subscription service with little consideration for the “law of diminishing returns” i.e. the gains initially justify the cost but once you have addressed all the low hanging fruit the return on investment becomes questionable without significant lowering of cost model. In most cases, the BMS and mechanical service providers have not adjusted their service contracts or pricing models. The analytics component becomes an additional cost impost to the building’s running costs. So, whilst we have control systems that are smarter, and we have third party providers offering analytic overlays, we have not really seen an equivalent evolution in the service offerings and cost structures from the traditional providers. I would assert that there are a number of key reasons for this: 1. T he technology and the operating models are still in an early stage of deployment. This new industry has attracted too many products and players. It will take some time for the industry to mature and for the real value propositions to be realised. 2. O wners and facility staff are not yet seeing the benefits or are simply overwhelmed with the changes in technology and cannot envisage how it could improve their business operations
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3. Considering analytics platforms predominantly address HVAC plant (BMS control systems), building owners and operators are not getting any reduced maintenance costs or scope from their BMS/DDC or their mechanical contractors when analytics are installed. Having a control system maintenance contract and an analytic overlay are not sustainable. 4. The industry is struggling with the skills required to both analyse data and service control systems. Whilst
you can outsource fault detection and opportunity to improve operations, it still needs skilled technicians and engineers to change and fix systems. 5. T he combination of the new cloud based analytics solutions with earlier generation building control systems still presents technical challenges. There have been a number of cases where poor design has led to the analytics package interfering with the basic operation of the control system.
Mechanical Maintenance Contracts Traditional Approach
High cost local inspection of filter by technician
Local sensor into BMS to flag alarm when change required
track changes in readings over time and based on trend lines schedule changes to coincide with batch work changes
High cost physical inspections and tests
local sensor/switches to monitor position and generate alarm
chamber pressure and temperature sensors measure conditions as a means of determining damper positions. Changes over time can advise degrading performance
BMS/DDC maintenance contracts Historical Context
Field sensor calibrations
High cost calibration carried out by technicians on a periodic basis
Profiling of multiple sensors to identify those outside the normal boundaries â&#x20AC;&#x201C; alarms generated to identify sensors required to be changed or calibrated
track changes in readings over time and based on trend lines schedule changes to coincide with batch work changes
Checking field valves and dampers
High cost physical inspection
Check devices and loops against setpoints. Generate alarms and flags when outcome outside expected
track performance overtime to predict degrading performance
Electrical maintenance contracts Historical Context
High cost physical inspections with IR thermometer
- local sensor to monitor temperature and generate alarm. - log and alarm current and voltage alarms
track changes in readings over time and based on trend lines and schedule inspections and maintenance only when required
Pump/fan bearings vibration inspections
physical inspections with specialised instruments
- monitor motor performance and VSD data direct from device. Inspect based on alarms
track changes in readings over time and based on trend lines and schedule inspections and maintenance only when required
Lamp blows and light is no longer produced
Current sensor on lighting circuit measuring increased/decreased current consumed
Smart lighting producing useful operational data to allow prediction of when lamp is likely to fail.
Security Systems maintenance contracts Battery changes
local load test inspections to demonstrate battery load capability
system monitors battery voltage and flags alarms
track changes in readings over time and based on trend lines and schedule inspections and maintenance only when required
Utility Metering Systems maintenance contracts Water, gas and electricity meters
Simple daily/weekly profiles and when exceeded generate alarm
track profiles in real time to predict excessive consumptions or plant running
IMPACT ON BUILDING SERVICES MAINTENANCE CONTRACTS Building maintenance contracts for many of the typical building services are simplistic and stuck in a time warp requiring high cost labour intensive tasks that could be carried out much quicker and in real time by either the control system and/or by an analytics platform. Typical maintenance contracts or labour agreements in the building services sector charge labour at a premium rate (often in excess of $150 p/hr). Many service providers charge callouts in minimum 4-hour blocks. Some simple examples of this can be found in Mechanical, electrical, security, and BMS controls maintenance contracts. In the table opposite I have provided simple examples of existing maintenance tasks versus what could be considered using analytics overlays with appropriate data capabilities. When considering opportunities for improving maintenance practices into a more automated environment one must also consider the monetary impact on existing providers during the transition. Simply expecting to overlay analytics with a thirdparty provider and funding this through savings with existing contracts can create an unacceptable risk where the contractors required to fix systems walk away from site due to unacceptable reductions in traditional maintenance contract values. One must not forget you still need the field people to rectify and implement and changes identified. A number of organisations understand this model and are repurposing the function of the analytics platform as a means to optimise and focus maintenance tasks and priorities. The analytics platform is simply viewed as another tool in the toolbox, and the customer is not charged for it other than through the normal charge process associated with any skilled contractor. With considered thought and a good understanding of the components that are used, the building, maintenance contracts can be restructured. The focus can then be shifted away from ineffective labour-intensive tasks to analysing key elements of the building operation. The overall goal - to reduce costs, optimise efficiency and improve outcomes, can then be achieved
MOVING TO OUTCOMES BASED MAINTENANCE Migrating or moving towards a maintenance regime requires a number of steps and there are a number of
organisations that can offer advice in achieving this transition including that of the author of this article. Whilst most of these step are sequential, some can be undertaken without dependence on other steps: 1. U nderstand what is in place currently in terms of the systems, processes, costs and outcomes from existing maintenance contracts. What maintenance is being carried out and are the outcomes measurable. Can they be compared to a suitable metric? These could include equivalent full-time students/beds or dollars per sqm. 2. A ssess and or determine the existing technology baseline. Is it capable of being upgraded or extended to both allow embedded analytics or data sharing? The older the system, the bigger the impact in terms of ability to open/share data with other systems. Overlaying an analytical platform on a system not designed to deliver data to external sources can be a frustrating exercise. 3. W hat are the opportunities to overlay or embed analytics? What are the existing key tasks and costs and will analytics provide better outcomes in terms of performance or cost. 4. How are the existing systems being used? Do you have a BMS system where the alarms and dashboards are not used? Overlaying additional dashboards and alarm sources might simply overwhelm operators Carrying out an analysis underpinned by the above questions allows you to build a technology strategic roadmap to maximise the value from implementing an analytics platform. Sometimes the initial answers might only require a number of simple alarm algorithms using the existing data and systems installed currently. Other applications might require more extensive changes to infrastructure to achieve the desired results
AUTHORâ&#x20AC;&#x2122;S BIOGRAPHY Vince Simpson has been involved in the design, construction, service and sales of technology and controls to the building and construction industry since 1986. This included senior management roles in tier one BMS contractors and 15 years as one of the founding directors of IBMS who are considered trusted specialists who apply technology in the built environment to improve efficiency and usability with the aim to continually deliver innovative high value results. The views expressed in this paper are solely those of the author and IBMS as a specialist consultancy focussed in this sector.
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BURNING ISSUES AFFECTING THE HEALTHCARE INDUSTRY By Justin Morris, Technical Director, Wormald
The sheer diversity of uses and demands that most healthcare facilities encompass, make fire protection a complex issue. From sterile operating theatres, laboratories, and specialist equipment, to multiple public areas, retail outlets, offices, storage units for equipment and supplies, including combustible materials, there is a lot to consider.
rofessional fire protection providers have a wealth of specialist knowledge and expertise that is directly relevant to healthcare facility managers. The ability to carry out work in sensitive areas, with lots of competing systems and infrastructure, with limited down time, all while providing practical solutions and avoiding false alarms, only comes from experience. Regular inspections are mandatory to ensure that equipment and systems comply with the latest standards and are functioning properly. Frequent inspections on a monthly, six monthly and annual bases cover maintenance and testing of the fire detection and sprinkler systems. They will also pick up any obstructions to the safe operation of the system or locations where there’s been a change of use that requires different fire protection provision. Keeping up to date with ever developing fire protection issues is a challenge for facility managers. Currently there are a number of developments, both in terms of new regulation and next generation products, of which managers of health care facilities should be aware. Specialist solutions include specific application sprinklers for operating theatres that have tighter seals to prevent the ingress of dust and preserve sterile environments, and strobe lights that provide a visual emergency warning for staff instead of audible fire alarms.
There’s also innovative equipment available that has been specifically designed for use in healthcare facilities. For example, fire extinguishers that come in a non-magnetic stainless steel housing, which are suitable for use in Magnetic Resonance Imaging suites. Filled with Novec™ 1230, a clean gaseous extinguishing agent that leaves no residue, and prevents damage to valuable equipment. They also have very low environmental impact with no greenhouse gas content and nil ozone depletion.
CHANGES TO THE SPRINKLER SYSTEMS STANDARD Following several years of work by FPA Australia representatives and numerous industry stakeholders, the Australian Standard AS2118.1:2017 for automated fire sprinkler systems is all but complete and are currently being considered for inclusion in the National Construction Code (NCC). The process of developing the revised standard has been a long time coming. Since 1999, it has been apparent there was a need to simplify, clarify and consolidate the standard. Standards Australia committee FP-004 has been busy developing the revised standard and pushing for adoption in the NCC amendment. In effect, this represents a significant improvement to the design and installation of sprinkler systems in Australia. The existing standard meant that sprinklers were only required on balconies that were both over 2m wide and at least 6m in length. This provided a bit of a
loophole as balconies of any length but just under 2m wide did not require sprinklers. Similarly, very wide balconies less than 6m in length also did not require sprinklers. Building designers could therefore adapt their balcony designs accordingly, factoring in the extra cost of sprinkler systems and avoiding the need for them. Melbourne’s Lacrosse fire illuminated the fire hazard presented by balconies, being used for storage creating extra ‘fire loading’. This led to calls from the nation’s fire brigades to have sprinklers on all balconies. This almost stopped the long awaited Australian Standard for automated sprinkler systems from getting across the line after so many years of work. However, after conducting a “regulatory impact study” the team behind the new standard for sprinkler systems, AS2118:1:2017 changed one word to get the approval of the nation’s fire brigades – changing “and” to “or”. Therefore, sprinkler systems are required on balconies over 2m wide or at least 6m in length. The new Australian Standard AS2118.1:2017 specifies requirements for the design, installation and commissioning of automatic fire sprinkler systems in buildings. It also provides for occupancy classification. Among other things, the revised Standard aims to remove references to third party standards, helping users have all their information in one place. The standard has also adopted current developments in sprinkler technology with certainty as to what is a ‘Deemed-To-Satisfy (DTS) installation’. Additional information for designers and installers is also included to prevent inadvertent under or over design of sprinkler systems. The key changes include: • Incorporation of amendments from the 2006 edition, like the removal of ’grades’ of water supply and replacement with single or dual supply; addition of a section on commissioning and acceptance testing; and inclusion of appendix E, a graphic representation of hydraulic characteristics and worked examples • Significant changes to exposure protection in Section 3 and protection of concealed spaces in Section 5
• A complete rewrite of the light hazard class systems section (Section 9) for ease of use and based on updated information • New Sections 11,12 and 13 for high hazard (includes key design, installation, operation and performance requirements from FM Global datasheets within the Standard itself to ensure AS 2118.1 meets the Australian Building Codes Board’s protocol for NCC referenced documents) • Inclusion of informative text for occupancy classification (Appendix A). Other changes will mean sprinkler systems may be required on more balconies, and revised requirements for lift shafts and motor rooms are expected to remove some unnecessary complexity. These changes will affect the healthcare industry as new facilities are being built or upgraded. https://www.wormald.com.au/
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THE IMPORTANCE OF INDOOR ENVIRONMENTAL PROFESSIONALS IN INVESTIGATIVE AND REMEDIAL PROJECTS By Greencap
Together with experience, a critical aspect of using the services of an IEP on a project is their independence from the restoration contractor.
he term Indoor Environmental Professional (IEP) is used to describe a professional who assesses building-related microbial and associated impacts. The phrase was originally coined by the Institute of Inspection, Cleaning and Restoration Certiﬁcation (IICRC) in December 2003 in the ‘Standard and Reference Guide for Professional Mold Remediation, Standard S520’. The IICRC have conﬁrmed that the deﬁnition of an IEP is a generic industry term for:
“An individual who is qualiﬁed by knowledge, skill, education, training, certiﬁcation, and experience to perform an assessment of the microbial ecology of structures, systems, and contents at a job site, create a sampling strategy, sample the indoor environment and submit to an appropriate laboratory and interpret laboratory data… for the purpose of establishing a scope of work and verifying the return to a normal microbial ecology”.1 There are number of Australian guidance documents for mould management including the Australian Mould Guideline (AMG-2005-1) produced by
Mycologia Australia and the Guidelines for Managing Mould and Dampness Related Public Health Risks in Buildings produced by the Western Australia Department of Health (WA Health).
INDOOR ENVIRONMENTAL PROFESSIONAL (IEP) IEPs come from many backgrounds and professional disciplines such as: • Occupational (Industrial) Hygiene Building Biology • Engineering • Indoor Air Quality • Health and Safety In order to protect the term ‘IEP’ against use in certiﬁcation programs that fail to adequately measure competence, experience and education, the IICRC have stated that there is no single designation, license, or certiﬁcation that qualiﬁes an IEP. The qualiﬁcations required for an IEP are often gained through years of formal study at university level, speciﬁc training related to mould and the indoor environment, and years of on-the-job work experience, or a combination of these factors.2 The IEP must provide unbiased, independent third party advice and in no way should have ownership or affiliation with the remediation/ cleaning contractor used in the restoration project.
So what technical knowledge does an IEP have? The American Industrial Hygiene Association (AIHA) has identiﬁed eight technical areas in which IEPs should have knowledge in: 1. Exposure Assessment 2. Indoor Environmental Quality 3. Microbial Assessment and Remediation
The IICRC state that an IEP must be considered where: • There is microbial contamination that could cause harm to occupant health; • High risk occupants are present (e.g. healthcare, elderly care or childcare facilities); or • Public health issues exist
WHAT DOES AN IEP DO?
5. Heating, Ventilating, and Air Conditioning (HVAC)
IEPs generally perform the following three tasks:
6. Building Science
• Initial Investigations to determine the nature and extent of microbial contamination in order to develop an independent scope of remedial works.
7. Legal/Communication 8. Health Effects It is rare for an IEP to have expert knowledge across all 8 areas. An experienced IEP is often a member of a multidisciplinary team or has access to suitably qualiﬁed experts who can complement their own expertise.3 A multi-disciplinary approach is also considered by the IICRC to be especially important for complex microbial assessments and remediation projects.
• Interim Assessments during the remedial process in order to provide ongoing advice into the reﬁnement of a scope of works due to site or project complexities. • Independent Post Remediation Veriﬁcation (PRV) of remedial works. IEPs Assessment Tools & Techniques: • Visual Inspection (generally non-destructive) using the naked eye and photographic means including borescope inspection cameras for the hard to inspect areas.
COMMON ISSUES IEPS ARE ENGAGED TO INVESTIGATE/MANAGE The following are examples of common building issues IEPs are engaged to investigate/ manage the remediation process. Poor Drainage & Subﬂoor Ventilation The issue of uncontrolled subﬂoor microbial growth can be found within timber subﬂoor areas where there isn’t sufficient ventilation or drainage provided. A build up signiﬁcant airborne moisture or water inundation as a result of a one off event or ongoing poor ventilation can result in signiﬁcant mould growth to subﬂoor materials and soils. These conditions can have a dramatic impact on indoor air quality within the occupied areas of a building due to air transfer between subﬂoor and habitable areas as a result of pressure differentials caused by external/internal conditions. Dew Point Condensation Inadequate insulation to building materials/structures can result in mould growth as a result of dewpoint condensation occurring from warm moist air interacting with colder surfaces. The mould growth can either occur directly on the cooler surfaces themselves e.g. plasterboard ceiling linings where no insulation is present, or manifest on adjacent surfaces to the colder surfaces e.g. within ceiling voids. Experience in psychometry, the properties of air and water vapour mixtures, and how this impacts building materials is required to understand and ultimately rectify these issues. Ongoing Source Undetected moisture ingress from leaking pipes/roof coverings into building materials can provide an optimal environment for ongoing mould growth. Leaks can occur due to pressure increases in supply pipework, pipework corrosion/degredation, or pipe breakage which may occur as a result of structural movement. Each event may cause water leakage that may not be detected for extended periods. Such events will not only provide the ideal moisture for mould growth but the water may also be a source of signiﬁcant pathogenic bacteria. A detailed understanding of the level of moisture/ microbial impacts and the required cleaning/restoration techniques to return levels to within a range considered normal ecology are needed for successful remediation. Independence from the remediation process in order to determine what works are required is critical for economic and successful remediation of such issues.
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• Real-time Measurements including airborne moisture and building material moisture levels. • Representative Airborne and Surface Sampling for microbial contaminants (mould and bacteria). The experience of the IEP and information provided by the owner, occupier and manager of the property will dictate the complexity of the assessment required. Many variations of assessments exist within the IEP market place. For example some IEPs only collect viable mould samples (agar plates used for culturing mould which is indicative of the reproduction level of mould) without sampling for total moulds (the combination for viable and non-viable mould - living and dead moulds).
WHY ENGAGE AN IEP? IEPs are engaged to provide guidance/ undertake assessments because they are industry recognised experts in the ﬁeld of microbial assessment and post remediation veriﬁcation who can: • Provide unbiased, scientiﬁc, independent advice from the assessment and throughout the remediation process
Even on the limited available data, the adverse health implications of indoor air quality have very signiﬁcant economic effects. A CSIRO estimate (CSIRO 1998) is that poor indoor air quality costs Australia $12 billion per annum.
– Indoor Air Quality in Australia 4
Safety and Health) have undertaken studies and have estimated productivity loses in the tens of billions of dollars annually due to poor indoor air quality. These loses are associated with: • Health care costs Absenteeism • Reduced worker productivity Lower earnings • Costs of investigative improvements
WHAT ARE SOME PROJECTS THAT IEPS ARE INVOLVED IN? Water damage building (WDB) assessments Assessments are generally undertaken after the discovery of water/ moisture intrusion which has occurred within buildings and as a result microbial growth (mould and or bacteria) has potentially occurred.
• Greatly assist with protecting health and wellbeing of the occupants and remediation/ cleaning contractors
The assessment should:
• Mitigate loss (time, money, reputation etc)
• Develop a remedial scope works in accordance with industry best practice
• Prevent litigation and also reduce remedial costs/ settlement amounts in insurance claims When IEPs are not engaged there is greater risk of the following consequences occurring: • Structural damage Infrastructure degradation Microbial off-gassing (odours) Occupant complaints • Reduced productivity and increased absenteeism • Damage to contents and belongings
Industry experience has shown that human health can be affected by both living and dead mould and therefore reliance on viable mould sampling could fail to characterise the full extent of mould impacts. In the US, the EPA (Environmental Protection Agency) and NIOSH (the National Institute for Occupational
• Determine the extent and nature of microbial impacts
• Verify that these works have been conducted adequately General remediation principles that should be employed during such a project include: • Determination of extent and nature of microbial impacts • Make safe works and an assessment on the suitability of ongoing occupancy • Rectiﬁcation of water/ moisture ingress • Containment or other suitable engineer controls • Determination of what materials can be restored • Removal of mould impacts • Cleaning • Structural Drying • Post Remediation Veriﬁcation (PRV) • Reinstatement works after sucessful PRV Assessment
Heating Ventilation and Air-conditioning (HVAC) System Assessments HVAC assessments determine hygiene levels within plant and ductwork, which components and areas need cleaning and by what techniques. Post remediation veriﬁcation (PRV) of such plant and systems prior to recommissioning is recommended. Guidance can also be given with regard to ongoing inspection and maintenance requirements in accordance with local and national standards/ guidelines. High Risk Manufactured Water Systems Legionella Assessments Assessment generally comprises a combination of inspection (plant and systems) and desktop study (maintenance records/ laboratory results) in order to determine compliancy with local and national standards and guidelines.
Situation: Maintenance contractors caused major water ingress to a shop front. The contractors then attempted to rectify water impacts themselves using the wrong equipment and techniques. By using heating and air movement equipment only, they were not undertaking airborne moisture extraction procedures. This resulted in elevated humidity levels which had caused moisture to condense on nonﬂood impacted surfaces and content. If not rectiﬁed quickly would have resulted in mould growth. The Role of the IEP: The property manager enaged an IEP who attended site with an experienced remediation contractor within 48hrs of event.
Indoor Air Quality Assessments for Clean Rooms
The IEP developed and implemented a safe scope of works (including water extraction/ drying) and then managed the remedial works from the onset so no subsequent mould growth could occur on building materials and the remaining shop contents.
Assessments are generally undertaken after the completion of detailed cleaning of clean rooms e.g. theatres and pharmacies and their HVAC systems, following building works, in order to verify cleaning has been to appropriate standards.
Beneﬁts: The IEP mitigated mould growth and therefore signiﬁcantly reduced losses for the property manager/ building owner by preventing mould re-occurance and minimising structural damage.
Veriﬁcation works are conducted in accordance with facility requirements and or local health department guidelines.
Cost savings have been estimated to be in the tens of thousands of dollars in loss of rent, replacement of contents, project remedial works and contractor costs.
Greencap has developed a quick guide to Professional Mould Assessment & Remediation which is available for download from our website.
CASE STUDY 2: ONGOING SUBFLOOR WATER LEAK
For further information, please visit: greencap.com.au or email: email@example.com
REFERENCES 1. Institute of Inspection, Cleaning and Restoration Certiﬁcation S500-2015 Standard and Reference Guide for Professional Water Damage Restoration - Third Edition December 2015
CASE STUDY 1: DRAINAGE WATER FLOODING
Situation/ Role of the IEP: The Restoration Contractor engaged an IEP from the onset of an insurance claim allocation who detected major subﬂoor moisture and mould impacts resulting in a detailed independent scope of works being developed.
Scope of works was implemented in full by an experienced Remediation Contractor who was is regular communication with the IEP throughout remedial works (2.5 months project duration - from ﬁrst engagement to ﬁnal mould remediation veriﬁcation).
Post Remediation Veriﬁcation assessment was undertaken and passed.
4. Indoor Air Quality in Australia: A Strategy for Action Federation Of Australian Scientiﬁc and Technological Societies 2002
Beneﬁts: Project time and costs were signiﬁcantly reduced as a result of engaging an IEP to carry out a full assessment from the onset. Cost savings have been estimated to be in the vicinity of $60,000 - $80,000 in accommodation, project remedial works and professional/trade.
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INTRODUCING THE CLEANING ACTIVITY LEVELS (CAL) By Bridget Gardner, Fresh Green Clean
The Cleaning Activity Levels (CAL) is an innovative model that can improve the way we set Cleaning Standards for specifying and measuring environmental cleaning services. Its developer, Bridget Gardner, discusses the problems with the current way cleaning standards are set in healthcare facilities, especially for out-sourced services, and explains how the CALs model could be used to deliver greater quality, consistency and measurability.
leaning is one of the few professions that isn’t judged by what has been done, rather, it is judged by what has NOT been completed. For example, when I take my car to my mechanic complaining about a rattle or that it is a bit ‘sluggish’, they will run some diagnostics and come back with an itemised quote for the actions proposed to fix it. If I accept, I will pay them for the hours worked and judge the results on how quietly and well my car runs when I get it back. Similarly, cleaning specifications are essentially an itemised list of duties. But that is not how contracted services are priced, or how many in-house services are scheduled. Instead, productivity rates are based on the size of the building and accepted industry benchmarks for how long it should take to clean according to nominal levels of ‘quality’, not by the list of duties to be undertaken or the surfaces to be cleaned within them.
Conversely, the outcome is assessed by what tasks were not completed - by how much dirt can be seen on each surface. This cannot factor in how dirty the surface might be due to its use, or whether it is frequently touched or highly contaminated, or the time, effort, skill, equipment and process required to clean it. This disparity restricts an Environmental Services Manager’s (ESM) capacity to accurately control and measure the performance outcomes of cleaning services. Furthermore, it underpins a range of systemic issues that are leaving healthcare facilities wide open to risk.
OUTCOME-BASED CLEANING STANDARDS In the desire to make cleaning services more accountable and professional, cleaning specifications have evolved from simple lists of duties, such as: ‘clean toilets’ or ‘dust window ledges’, to complex performance standards that detail every possible type of
soil that must not be found on a surface after cleaning. For example, the ‘Cleaning Standards for Victorian Health Facilities, 2011’, which is referenced by several other States as well, contains a breakdown of building surfaces and elements which are to be cross-referenced against the following five aspects: 1. Building areas / elements / surface materials 2. Risk categories and priority areas 3. Cleaning outcomes 4. Frequencies and timeframes 5. Auditing and scoring methodologies Despite the rigour of this excellent document, the Cleaning Outcomes required for every building element are simply a list of every type of soil that must be removed from them, and the Auditing and Scoring Methodologies are based on visual assessment. The only way a standard that requires “the floor
shall be free of dust, debris, spillages, scuffmarks and smears” can be measured, is by looking at that floor and assessing how much of this soil is left behind: • 1 = lots of soil (fail) • 5 = no soil (excellent).
PROCESS AND OUTCOME-FOCUSED CLEANING STANDARDS Yet visual assessment is neither objective, consistent nor evidence-based. While it can detect gross soil such as marks and spillages, it cannot measure surface hygiene because germs and bio-film are invisible. Furthermore, the term ‘evidence-based cleaning’, implies that the cleaning methodology has been scientifically proven to be capable of removing surface contamination. This evidence is not required for current outcome-focused Cleaning Standards.
As a result, cleaning services do not have to prove that their cleaning process is effective. The method of measuring their performance is limited at best. And the delivery of out-sourced cleaning services cannot easily be measured against the cost. I propose that it is time for a new Australian Cleaning Standard. Late one night, 2am to be precise, I woke up with a question: “why do cleaning standards always focus on the dirt that is left behind?” Doesn’t that just describe an unclean surface, not a clean surface? What if cleaning standards could list each surface element, then define the outcome as the level of activity that should be carried out on it and how the effectiveness of this activity should be measured?
INTRODUCING THE CLEANING ACTIVITY LEVELS (CAL) As I pondered these questions, I wrote down three core principles that I hold to be true:
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1. A surface cannot be accurately defined or measured as ‘partially clean’. 2. T he cleaning outcome is determined by the cleaning process. 3. C leaning standards must define how cleanliness is measured. Then adopting common industry terminology, I drew a diagram of a model I called the Cleaning Activity Levels (CAL), consisting of five distinct cleaning activity levels. As shown in the diagram below: • The top half shows how the Cleaning Standards are defined by the degree of cleaning activity and performance of the method, and how this should be measured. • The lower half shows how the Cleaning Scope simply lists each building element / surface, and how frequently each Cleaning Activity Level is to be carried out on it.
USING THE CAL MODEL TO SET CLEANING STANDARDS The CAL Model offers Healthcare and Aged care facilities a consistent structure for defining their cleaning requirements and processes to be applied to each building area, surface type (elements) and materials. In the table above, I have written nonprescriptive Cleaning Standards that are based on the CAL Model.
THE POTENTIAL BENEFITS OF THE CAL MODEL
By defining the cleaning process as well as the way the outcome will be measured, CAL removes the ambiguity and subjectivity around the standard of cleanliness required.
Once the CAL Standards have been set for the organisation, the required cleaning levels and frequency can then be specified in a simple matrix, and varied according to the level of risk, usage and budget. As healthcare facilities become smarter, this matrix could be integrated into Building Information Systems (BIMs), Maintenance Information Systems (MIS), and Task Scheduling apps, giving the ESM far greater control over Environmental Services providers with accurate pricing, scheduling and performance data.
As English is a second language for many Environmental Service Personnel (ESP), CAL provides an accurate yet simple way to communicate their duties. Because the same outcome for each level of activity can be applied to soft or hard surfaces, CAL can be used to hone their skills and focus their time more efficiently. For example, if the requirement is to spot clean a carpet, it is the ESP’s responsibility to identify recent spots and select the correct method to remove them, whether it be vacuuming up lint or damp-blotting a spill. My reason for sharing CAL with you is to start a conversation. Do you think that the CALs Model has potential to underpin muchneeded National Cleaning Standards for Healthcare in Australia? To find out more, go to: www.freshgreenclean.com.au or contact Bridget Gardner at: email@example.com Author: Bridget Gardner is the principal trainer and consultant at Fresh Green Clean Pty Ltd.
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RECENT CHANGES TO EP&A REGS IN NSW AND HOW IT AFFECTS YOUR AFSS By Trevor Burrows I NSW/ACT Compliance Manager, AESC
In 2016 the NSW Government responded to the statutory review to the Building Professionals Act 2005 with the intent to improve fire safety in new and existing buildings and strengthen the building regulation system.
he NSW Government introduced changes to the Environmental Planning and Assessment Regulation 2000 (EP&A Regulations) through the Environmental Planning and Assessment Amendment (Fire Safety and Building Certification) Regulation 2017 which came into effect on 1st October 2017. These changes significantly impact how Annual Fire Safety Statements (AFSS) are issued for buildings as well as putting more onus on building owners with the AFSS process. The 8 key areas are as follows: • Introduction of competent fire safety practitioners (CFSP), with removal of the term “properly qualified person” • Submission of fire safety system plans and specifications and their retention on site in Class 2-9 buildings • Limited exemptions from compliance with the BCA for minor fire protection system works • New critical stage inspections for buildings where people sleep
• Additional inspections by FRNSW in Class 2-3 buildings • Documenting, endorsing and checking nonstandard fire safety designs (alternative solutions) for Class 1b-9 buildings • Fire safety statement assessments • Standardising the form of fire safety certificates and annual fire safety statements More information can be obtained from the NSW Government Department of Planning and
Environment website. http://www.planning.nsw.gov.au/Policy-andLegislation/Buildings/Building-Regulation-andCertification-Reform?acc_section=fire_safety_ regulation_reform
ANNUAL FIRE SAFETY STATEMENTS (AFSS) There is now more onus on building owner’s involvement with the AFSS process to ensure that they are engaging the appropriate contractors to carry out their individual tasks, whether it be service and maintenance of essential safety measures or acting as the owner’s agent. One of the more difficult challenges faced is the fact that there is no regulatory framework to deem persons as competent fire safety practitioners, the owner is responsible in this interim period to consider each contractors competency, specific to the tasks that they are engaged for. How does an owner take responsibility for this in a triple net lease situation where the tenant is responsible for maintaining ESM? This would need to be clarified by owners for existing lease agreements to ensure that the lessee is considering competence of their various contractors. Other areas that prove to be difficult are getting owners to sign the AFSS as the owner or endorsing their agent to act on their behalf, in some cases the owners are based overseas or buildings are strata owned. There have been some cases where councils will not accept an AFSS signed by the strata manager, they expect the body corporate to sign. These constraints can significantly delay the AFSS submission.
The changes have led to uncertainty and inconsistencies from Councils who are deemed to be the “gatekeepers” in the AFSS process in NSW. Submission of the AFSS can be somewhat of a bureaucratic nightmare with some councils and we believe that it is up to NSW Planning to ensure that councils and the industry are well advised in this transition period. Whilst NSW Planning are providing some guidelines we believe that they should be providing councils with specific direction in the AFSS processes. To date, we know of a number of councils in NSW who do not actively pursue an AFSS for buildings under their jurisdiction. Nor will they provide essential safety measures (ESM) Schedules as required by the regulations, this makes it difficult for building owners and corporations who are trying to be proactive in issuing an AFSS for their building. Overall, we generally believe that these changes are being well accepted by most in the industry as it is seen to be a positive step in tidying up some grey
areas that have existed previously and improving life safety for building occupiers.
COMPETENT FIRE SAFETY PRACTITIONER (CFSP) It appears that the NSW Government “put the cart before the horse” by implementing the changes before the CFSP regulatory framework was developed. As mentioned previously, this puts more responsibility on building owners to determine whether their contractors and agents are competent and fit for purpose for maintaining the essential safety measures (ESM) installed in their buildings. It is not uncommon to have more than a dozen different contractors maintaining ESM in a building and the onus is on the owner to consider and deem them competent in the interim period. http://www.planning.nsw.gov.au/~/media/Files/ DPE/Guidelines/selecting-a-competent-fire-safetypractitioner-a-guide-for-building-owners-2017-10.ashx
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STANDARDISING FORMS The changes have introduced standard forms for Fire Safety Certificates and Annual Fire Safety Statements to ensure consistency of the content and presentation. These forms came into effect on 1st December 2017. These standard forms are readily available through the NSW Planning and some councilâ&#x20AC;&#x2122;s websites. These forms cannot be altered from the NSW Government template, although we have seen examples of Councils issuing them on their own letterhead as part of the reminder sent out to the building owner.
and Councils may influence decisions for a review in light of the recent, significant incidents involving cladding fires both here and overseas.
ABOUT ME Over 30 years in the fire industry, 17 years as a career fire officer before moving into consulting in the private sector. Currently NSW/ACT Compliance Manager with AESC.
http://www.planning.nsw.gov.au/~/media/Files/ DPE/Other/annual-and-supplementary-fire-safetystatement-form-2017.ashx http://www.planning.nsw.gov.au/~/media/Files/DPE/ Other/fire-safety-certificate-form-2017.ashx
INDUSTRY BODIES INVOLVEMENT Industry bodies such as Fire Protection Association Australia (FPAA) are working hard and desperately trying to introduce a transitional accreditation scheme to enable persons to be deemed a CFSP in this interim period, until such a time that the proper accreditation framework can be developed and implemented. I have been part of an industry reference group made up of over 20 members from across the industry working on developing assessment questions for a range of examinations. The intent is to have a few levels of competence based on the size and/ or complexity of the buildings and whether or not there are systems installed in those buildings as a key factor. As an example, small buildings without sprinkler, detection or hydrant systems would be considered under a restricted level whereas large and/or complex building with these systems installed would be considered under a non-restricted level.
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We are aware that the industry bodies are in constant communication with the relevant government departments to air concerns raised by them and their members.
LIKELY AFFECT FOR OTHER STATES AND TERRITORIES Recent tragedies and risk to lives from recent highrise building fires has put a lot of focus on building fire safety as a whole and it is likely that other states and territories may follow suit to these recent changes in NSW. Pressure placed on Federal, State Governments
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