Healthcare Facilities Summer 2018 Volume 41 No. 4

PP 100010900

VOLUME 41 I NUMBER 4 I DECEMBER 2018

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CONTENTS REGULARS 5

Editor’s message

6

National President’s message

9

CEO’s message

41 New ways to provide emergency power for healthcare

74 News

45 Appropriate sizing of operating theatres with high satisfaction

BRANCH REPORTS

53 Designing the ICU for the Future

10 WA

20

61 Onsite clinical waste management

13 VIC/TAS 14 QLD 16 NSW/ACT

FEATURE ARTICLES

18 SA

65 Independent security audit

2018 IFHE CONGRESS

69 Reducing high electricity bills and blood pressure

53

20 2 018 IFHE Congress International standards for 25 electrical safety in healthcare

Visit the Institute of Healthcare Engineering online by visiting www.ihea.org.au or scanning here ➞

IHEA NATIONAL OFFICE Direct: 1300 929 508 Email: IHEA.members@ihea.org.au Address: PO Box 6203, Conder ACT 2900 Website: www.ihea.org.au Conference: www.hfmc2019.org.au 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, Peter Klymiuk, Mark Hooper

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IHEA ADMINISTRATION Chief Executive Officer Karen Taylor Finance Jeff Little Membership Tom McKernan (FMA), ihea.members@ihea.org.au 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: neil@adbourne.com Adelaide: Robert Spowart T: 0488 390 039 E: robert@adbourne.com PRODUCTION Emily Wallis T: (03) 9758 1436 E: production@adbourne.com ADMINISTRATION Tarnia Hiosan T: (03) 9758 1436 E: admin@adbourne.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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REGULARS

EDITOR’S MESSAGE

W

elcome to the summer edition of “Healthcare Facilities” – the post-conference edition featuring news and stories from the very successful 2018 IFHE Congress, held in Brisbane in early October. As we’ve been saying for the past few editions, the success of the Congress relied on the input of IHEA members, the planning committee and supporters, together with contributions from the global healthcare facilities community. A special thank you to Iceberg Events who went “all out” to help the IHEA produce an event that has been loudly applauded by attendees from around the world.

As incoming IFHE President, it was great to be part of another International event that was as good as any I’ve been involved with. The images on P20-24 don’t do justice to the breadth of the program, events and networking, however we look forward to sharing the technical papers as published articles in coming editions. The partners program was well balanced and provided opportunity for partners to enjoy the sights sounds and beauty of Australian culture, renewing acquaintances and making new friends. Other than Brisbane putting on an unusually cool autumn, the opportunities to network with international colleagues was appreciated by all. The gala dinner at the Brisbane Town Hall was a spectacular evening of great food, live music and a few interesting dance moves, and the interactive experience of Outback Spectacular was enjoyed by about 100 delegates on the final night of activities. Technical tours were booked out weeks in advance of the Congress, and

delegates appreciated seeing how Australia does healthcare and emergency management.

The attendance of a number of Australia’s iconic native animals was a highlight at the opening welcome function – including some delightful birds, a couple of pythons, a pigmy crocodile and a friendly wombat amongst the attendees. For many international delegates it provided a unique opportunity to handle and hear about the creatures that still call Australia home.

It was exciting to be able to announce the winner of the 2018 IFHE International Building Award. The Sunshine Coast University Hospital was adjudged by the international jury as being worthy of the recognition this Award offers. Announcing this whilst in Queensland to the international delegates was a great pleasure and testimony to the good work being done in Australia and brought international attention to the design, engineering and construction teams.

I hope you enjoy the reflections on the recent Congress together with other branch news and activities from around Australia and from your local IHEA members in this edition of “Healthcare Facilities”.

On behalf of the editorial team and the IFHE, I wish you and your loved ones a happy and safe holiday season.

Regards Darryl Pitcher

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REGULARS

NATIONAL PRESIDENT’S MESSAGE

As we approach the festive season, it is an opportune time to reflect on the past 12 months.

O

ur biggest focus during the past year was without doubt the International Federation of Hospital Engineering (IFHE) Congress which we hosted at the Brisbane Convention and Exhibition Centre during October.

The conference was a resounding success, and I must thank both the organising committee and the event planners for what turned out to be a very memorable week or so for visitors and delegates who attended from around the globe.

The comments and feedback I personally received both during, and after the event were all very positive. The key note speakers, Professor David Hood and Tim Longhurst provided many thoughtprovoking views during their presentations. One presentation of particular note was that provided

by Sue and John Clynes who took the audience on an emotional journey telling the tale of their experiences and life on board the New Zealand Mercy Ship “M.V. Africa Mercy” This Journal features memories and a summary of the 2018 IFHE Congress.

As the National President it is my honour, along with our Vice President, Jon Gowdy, to represent Australia on the Council of the International Federation of Hospital Engineering. Alongside

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representatives from like organisations from around the world Jon and I attended the 2018 IFHE Council Meeting. During the proceedings, three presentations were received from countries wishing to host the 2022 IFHE Congress, with the Canadian bid ultimately getting the vote.

It was a great recognition for the Institute of Healthcare Engineering Australia when the outgoing IFHE President, Douwe Kiestra handed over the Presidential reins to our own Darryl Pitcher who will hold the office until 2020.

While the conference was at the forefront of our activity, it was not the only area of activity this year.

Our rebranded website was launched in February, as was our expanded presence on Social Media, which despite slow beginnings has started to show promise, with at least two new members joining the IHEA as a direct result of finding us via our Facebook page.

A significant amount of work was undertaken to cleanse our membership database, tidying up old or inconsistent information and re-baselining our membership register to reflect actual financial members. Following this substantial undertaking I can report, with a degree of confidence, that our membership numbers are showing steady

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Under the stewardship of our CEO, Karen Taylor, a number of governance policies and procedures have been reviewed and updated during the year.

The IHEA has been represented on a number of Australian Standards and Technical Review Committees during the year, including; • HE-017 Medical Gas Systems • ME-003 Sterilising Equipment • Revision of DA19 - HVAC&R Maintenance

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• ME-060 – Controlled Atmospheres We formally announced our collaborative approach with Intrinsic Learning, to develop and implement professional development services and systems for the IHEA. Dr Mark Keough presented “A new approach to recognition of learning incorporating work-based activity” at the 2018 IFHE Congress and hosted a booth in the trade hall that proved to be very popular, not just with delegates, but also our partners. The IFHE expressed a desire to be involved with the development of the programme realising, that the initiative could provide benefits on a global scale to all members of IFHE affiliated organisations. Twenty-five individuals, from around the world have been selected to provide input and trial the product over the next few months. An options paper on the outcomes of the trial is expected to be presented to the National Board in February 2019. Watch this space!

Our relationship with the Facilities Management Australia continues to grow, and we are beginning to receive the benefits of fulltime resources undertaking administrative functions for the IHEA. In the coming months we will be exploring other opportunities and synergies between ourselves and the FMA for the benefits of members.

What a great year it’s been. Wishing you and your families all the very best for the holiday season.

Have a great, safe, happy and prosperous new year, and I look forward to catching up with you next year as and when the opportunity arises.

Peter Easson IHEA National President

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REGULARS

CEO’S MESSAGE

A

s we come towards the end of what has been another exciting and busy year for myself and the Board, it is perhaps prudent to reflect on the journey we have undertaken.

The voluntary work and dedication of the 2018 IFHE Organising Committee in bringing what ultimately turned out to be a prodigious event to fruition, is testament to their commitment to the organisation.

The professional conference organisers, Iceberg Events have been and remain a delight to work with, and I look forward to building on our relationships as we progress towards the National Conference to be held in Sydney next year.

As is normal and correct in member organisations such as the IHEA we see a number of new faces stepping on to the Board replacing those who, by rotation or choice step down. Over the last twelve months or so Peter Easson has taken on the mantle of President. One of the first real tasks undertaken

by Peter and myself was to organise the strategic planning day in February for the Board of Directors to determine the high-level priority outcomes for the IHEA. The day included discussions around; • A Review of the current strategy • What have we achieved, what is still to be done • Results of the survey • Membership offerings • CPD Program • Building membership numbers During the year we have been working closely with Nucleus to develop and increase our involvement with digital technologies across a number of social media platforms and revised web site.

organisation to those outside the IHEA’s historic core business areas.

At the Annual General Meeting we saw Mr Greg Truscott step down as the West Australian elected representative on the Board. Greg is replaced by Mr Peter Klymiuk as the recently elected WA State President and I look forward to working with Peter over the coming months.

Through our Director, Mark Hooper, we are investigating the use of various applications to deliver webinars to our members with the intent to ensure that all of our members, particularly to those in remote locations, can access the same development opportunities afforded to our metro-based members.

There is a real air of anticipation around the benefits of our relationship with Intrinsic Learning who, in conjunction with ourselves, are progressing with the development of a new approach to the recognition of learning incorporating work-based activities. This programme will provide the IHEA with a real strength in offering members a robust pathway towards their own professional development and professional recognition. It is a worthy point that the interest expressed by others, outside our organisation, in the collaborative approach and the expected outcomes of the project bode well for the future profile of the IHEA. In closing may I wish you and your families joy, peace and happiness over the festive season and I look forward to the new year which promises to be full of exciting challenges and the continued realisation of our strategic initiatives.

Karen Taylor – CEO

Our ongoing social media campaign and active management is starting to provide the benefits we seek in increasing general awareness of the

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BRANCH REPORTS

WA BRANCH REPORT Branch Meeting - September 2018, Norman Disney and Young

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lex Rodger, IHEA Corporate member, of Norman Disney and Young (NDY), a multidisciplinary building services consultancy, welcomed 22 members to their Office where he delivered a compelling power point presentation and Q & A session on their use of BIM/ Revit and data driven design tools on recently completed large Healthcare projects and other building/infrastructure projects.

The use of the BIM process (compared to 2D CAD) to deliver on Clash Detection, Data Management, FM and Cost Model Interfaces, Energy and Infrastructure Modelling, Daylight Study, Indoor Environmental Quality, Space Modelling and Visualisation (among others) makes it a ‘no brainer’ for new developments.

Graeme Knowles and Alex Rodger of NDY

On the matter of Visualisation, NDY also had their virtual reality goggles for all to try simulated building walk throughs of recently completed projects.

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UPCOMING IHEA WA EVENTS November 2018 – Christmas Sundowner This event is a celebration of our achievements across the year and as such we will be presenting the IHEA WA Achievement Awards at this gathering.

February 2019 – Visit to 5D Clinic, Robotic Radiosurgery Cyberknife Unit A talk on Men’s Health specifically related to prostate cancer.

The venue has the first private robotic radiosurgery Cyberknife unit in Australia. http://5dclinics.com. au/clinic/ The address will include:

The Virtual Reality

In addition and given that most existing hospital precincts have buildings of different ages and sometimes with limited 2D drawings and record information, NDY offer a service to scan existing information across disciplines via both hard copy/pdf 2D drawings and 3D scanning surveys and collate it digitally to provide a new, conveniently accessible digital record of such buildings.

• John Pereira – a brief overview of journey of detection, diagnostics, prognosis, treatment selection and experience as the first patient in Australia to be treated for pc using “virtual brachytherapy”; • Professor David Joseph (till recently Head of Oncology SCGH) and a pioneer in brachytherapy treatment, to present and discuss his clinical findings on 20 years of brachytherapy treatment for pc; • Peter Podias – Medical Radiation Therapist on Cyberknife technology and treatment delivery; • Walk through facility to see the system.

Finally, NDY are also making use of smart metering records on energy consumption and max demand profiles to add value to feasibility/concept stage infrastructure assessments which can lead to accurate data driven decision making on future capital investments and master planning.

At the end of the session attendees enjoyed refreshments and networking.

IFHE Conference - October 2018, Brisbane Convention Centre On behalf of the WA IHEA I would like to thank the International Federation of Hospital Engineering, the Institute of Healthcare Engineering Australia, the IHEA National Board, and Iceberg Events for delivering such an informative and worthwhile Congress, Healthcare Engineering – Building on Sustainable Foundations.

The diverse and dynamic group of keynote speakers, presenters and plenary sessions provided an in-depth insight into Healthcare Engineering at the international level. The Congress provided the opportunity for members to network with industry professionals and to be informed of the latest industry news and standards.

Members were able to extend their connections across the healthcare industry and beyond, reacquaint themselves with old friends and establish new friendships.

WA IHEA Members at the IFHE 2018 Welcome Reception

I would also like to take this opportunity to sincerely thank the 33 Western Australian delegates, and their partners who attended the International Congress.

The trip from Western Australian to Queensland is a considerable distance and your presence helped to make this event a great success. Your enthusiasm and positive spirit also helped make our time together both productive and fun.

To contact the WA branch please email us at ihea.WA@ihea.org.au Peter Klymiuk WA Branch President

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BRANCH REPORTS

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VIC/TAS BRANCH REPORT

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s the IHEA nudges towards it’s 70th anniversary, the Victoria Tasmania Branch would like to formal recognise this years’ service award winners and look forward to seeing as many members and partners at our Christmas lunch Saturday 1st December at Cargo in the Docklands at 12:30pm to 3:00pm.

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Terry Lindsay, Barry McKernan, Derrick Melder, Kevin Moon, Patrick Ryan.

40 Years Gerard Rebeiro 50 Years Bryce Thomson

Branch Committee of Management Branch President

Michael McCambridge

Branch Secretary

Peter Crammond

Branch Treasurer

Steve Ball

CoM

Howard Bulmer

CoM

Sujee Panagoda

CoM Meeting Convenor

Simon Roberts

CoM

Mark Hooper

CoM Communications

Roderick Woodford

National Board Reps

Michael McCambridge Mark Hooper

To contact the Vic-Tas Branch please email us at ihea.VICTAS@ihea.org.au Michael McCambridge – VIC/TAS Branch President

As a founding branch of IHEA we are looking at opportunities to celebrate its 70 anniversary in 2019 (1949 – 2019) The Branch Committee of Management are seeking input from our long-serving members to assist with photos / memorabilia from our history and a feedback on options to celebrate the milestone such as an event in 2019 dedicated to the occasion.

A number of Vic Tas Branch members enjoyed the 2018 IFHE Congress, including the local wildlife!

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2. Strategically align with Department of Health & Human Services / the Victorian Health & Human Services Building Authority.

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BRANCH REPORTS

QLD BRANCH REPORT WHERE’S THE YEAR GONE

R

eflecting back on the year that’s since gone, despite all the efforts that was put in we were delighted to achieved a couple of our key objectives, and this was augmented by the very successful IFHE 2018 Congress recently held at the Brisbane Convention Centre.

Our work places across the state are becoming more complex, busier and workloads seem to increase daily, and our resources remain the same. I’m sure this is no different across the nation; however there is great benefit in taking time out to enjoy being an active IHEA member, either in a committee role or a participant in the Professional Development Program.

We understand that it’s becoming increasingly challenging to commit to IHEA activities as the daily pressure has the potential to isolate us within our own bubble. You’re not alone … regardless if you are working in the far outback reaches of the state or just around the corner, the IHEA can provide assistance, advice or simply someone to bounce ideas off – pick up the phone or send us an email.

2018 Professional Development: We enjoyed our first PD activity in March on Changing Technologies in Facility Management where we explored BIM modelling and Electrical Switching.

The Special General Meeting and Midyear PD was held over two days in June in the gorgeous Sunshine Coast and was a excellent outcome from the effort put in by the Committee of Management, our Sponsors and our Shine Coast colleagues. This PD session looked at topical issues of Digitisation, Indoor Air Quality and the impacts of AS 4187.

Our final PD session for the year was held in November at the Victoria Park Golf Club.

We were privileged to have an international LV power system expert, Jean-Eudes Baly from the Socomec group in France presenting a white paper on Neutral Switching and the MEN system.

Jean-Eudes holds two masters degrees in Mechanical Engineering and Electrical Engineering. Throughout his engineering career spanning more than a decade, Jean-Eudes has developed a broad knowledge of all electrical and control issues.

His field of expertise primarily focuses on LV networks, switching, protection gear, and reliability, but also expands to B2B marketing, R&D and project management.

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BRANCH REPORTS

The Neutral Switching topic is complicated due to the variation of parameters involved (differences in earthing systems, confusion between Earth and Neutral, and the MEN connection). Clarity and consistency is of utmost importance as a loss of Neutral can be destructive to critical loads within the electrical installation.

We concluded the day with an enjoyable networking function and dinner at the Bavarian Beerhaus Restaurant at Bowen Hills.

He covered topics such as:

Looking ahead to 2019 we will hold:

• The role of Earthing systems and Neutral connection

• Monthly CoM meetings, targeting membership, communication & bridging the distance problem

• Detail of AS/NZS Earthing standards • Applicable AS/NZS standards for multiple source connection • Practical examples with UPS solutions • Benefits and shortcomings of Neutral overlapping • Application of the new AS/NZS 3000 on Earthing system design and specification Plus an overview of Socomec’s new “No-Break” critical equipment by-pass switch Jean not only presented to NHP’s application engineering staff but also a number of electrical engineering organisations. Jean’s presentation was very well received by the electrical engineering delegates present.

The attending IHEA delegates enjoyed the presentation and would like to express our thanks and appreciation to NHP & Socomec for supporting the PD session.

Membership: We welcome Graeme Perry and Byron Martin from the Qld Flowtech office as a Corporate members.

• March Country PD and Tech Tour of the Townsville Hospital, our host and IHEA member, Mike Ward, is preparing a program and social outing that will be an event that can’t be missed. o Anticipated date is March 19, over a long weekend, dates to be confirmed – but watch this space.

• May PD – local hot topics such as addressing AS/NZS 4187 & AS/NZS 3003 implications • June Special General Meeting and PD Seminar • August PD – Theme TBC • October – National Conference in Sydney, NSW • December – PD & XMAS Function – Theme TBA To contact the QLD Branch please email us at ihea.QLD@ihea.org.au On behalf of the COM and the QLD members – have a Merry Christmas and a Happy New Year Brett Nickels President, QLD Branch

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BRANCH REPORTS

NSW/ACT REPORT Activities

I

t was great to see a strong contingent from New South Wales/ ACT branch attend the recent IFHE Congress in Brisbane. The opportunity to network and share knowledge with healthcare facility professionals from around the globe was a remarkable experience and I’m sure all of our members will have gained some valuable insights.

I had the privilege of being invited to be part of the IFHE Board meeting and came away impressed at the level of professionalism within this organisation. On behalf of the NSW/ACT branch I would like to extend our congratulations to the IFHE organising committee for hosting a world class event, and also to IHEA member Darryl Pitcher who was announced as the new IFHE president.

On a sadder note, Darren Green has announced his resignation from the NSW/ACT branch Committee of Management (CoM). Darren has been a powerhouse for promoting the IHEA cause at both a state, national and international level for many years holding a variety of executive roles including national president and has worked tirelessly to foster the IHEA’s importance as the leading organisation within our industry. On a personal note I would like to thank Darren for his friendship, support and encouragement to me during my journey with the IHEA and I’m sure all IHEA members will join me on wishing Darren and his family all the best for the future, noting he has promised to pop up at the occasional event….

Speaking of events, the 2019 national conference is being organised by the NSW/ACT branch and will be held at the ANZ Stadium in Sydney (former Olympic Games site) from the 9th – 11th October. The branch COM is currently working on the program and technical tours. Calls for abstracts and sponsors are now open.

Also in this vein, the next branch professional development day is being held on the 22nd March 2019 at Coffs Harbour Hospital, the theme will be centred around contractor and external supplier management. We all look forward to seeing a strong showing at this exciting event.

Please visit the IHEA website for further details or contact any of the CoM members regarding these events, we also welcome and encourage suggestions from members for future areas of interest for professional development Membership Membership interest from both industry groups and health facility management practitioners is increasing and it’s been great to see some 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.

Committee of Management President

Jon Gowdy

Vice President

Robin Arian

Treasurer

Mal Allen

CoM

John Miles

CoM

Robin Arian

CoM

Jason Swingler

CoM

Marcus Stalker

CoM

Brett Petherbridge

CoM

Peter Lloyd

CoM

Greg Allen

To contact the NSW-ACT Branch please email us at ihea.nswact@ihea.org.au Jon Gowdy – NSW State President Director Engineering Services SLHD MIHEA

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BRANCH REPORTS

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BRANCH REPORTS

SA BRANCH REPORT Activities

O

ver the last few months, a broad range of professional development opportunities have been made available to members across the SA Branch. These have included: • A panel presentation / discussion on Combustible Cladding – Compliance, Challenges, Risks • What can South Australia learn from Grenfell Tower?

• Earthquake Restraint and Design Requirements

allows us to offer a further range of subjects to interest our members. Planning is underway to deliver events such as: • A member Christmas event • New Royal Adelaide Hospital site visit • Site visit to a tri-gen project at a major private hospital • Calvary Hospital redevelopment • A site visit to review a solar power project at a smaller hospital

A number of members took up the opportunity to attend these events and, in addition, the presentation on earthquake restraint & design requirements was shared with members who were unable to attend.

• Latest developments in microbial research in water quality

The Branch Committee of Management continues with planning efforts to develop an interesting and varied program of professional development and networking events for members. Our own planning is supplemented by our collaboration with CIBSE and related engineering services organisations, which

• Energy upgrade project at a major commercial site in Adelaide

• Developments in electrical vehicle infrastructure • Seminar on EnHealth Legionella Control Guidelines

• Cyber security developments • Building certification Q&A session A number of members attended the IFHE Congress in Brisbane during October, with participation highly regarded by these members. We look forward to these members sharing their experiences and lessons learnt through future journal articles, professional development events and the possible development of new offerings by Institute of Healthcare Engineering Australia to members and the industry generally.

Membership:

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Following 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 a growing number of new members since July, the Branch has membership has been sustained and expanded its numbers and involvement in activities.

The Branch Committee is following up a few currently unfinancial members, while continuing to pursue potential new member opportunities, with several good corporate and individual member prospects.

Actions: While continuing to work with CIBSE and related organisations, the Branch Committee is also exploring and progressing discussions to establish contacts with other membership organisations with exposure to the engineering / facilities management fields within healthcare. A number of initial discussions have taken place to explore opportunities to work cooperatively

18

BRANCH REPORTS

with these organisations with a particular desire to offer and share relevant professional development activities.

Recent work by the National Board around the possible introduction of formal processes to acknowledge and recognise continuous professional development (CPD) through academic processes and recognition of skills acquired through on-the-job activities has been noted with much interest. Similarly, the pending development of nationally-consistent processes for the administration of professional development events looks to be a worthwhile development of great benefit to local Branch activities.

It is pleasing to see the recent greater use of the network of SA members to seek and share information, advice and support between members of the Branch.

This highlights an often under-estimated value of membership, as members draw on the experience and expertise of their fellow members.

Committee of Management: The current Committee of Management membership is outlined below: President

Peter Footner

Vice President

John Jenner

Treasurer

Peter Footner

Secretary

Michael Scerri

National Board Rep

Peter Footner

Committee Member

Vince Russo

Committee Member

Darryl Pitcher

Committee Member

Tony Edmunds

Committee Member

Michael Frajer

Committee Member

Ross Jones

Committee Member

Richard Bentham

The expansion of the Committee and the obvious enthusiasm of the members augurs well for the growth of the Branch and continues to allow the provision of an expansive, exciting range of events for members.

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19

2018 IFHE INTERNATIONAL CONGRESS Presentation to the Iceberg Events team – for a job well done!

Tauran Zaidi (Malaysia) presenting on their CHFM experience.

The IFHE Executive Committee meeting.

Keynote – Futurist, Tim Longhurst challenged us to think differently.

John and Sue Clines – presenting on their Mercy Ships experience.

20

The assembled IFHE Council Members.

CONFERENCE Claudio Meirovich (Spain) presenting on maintenance modelling.

Delegates enjoying the Gala Dinner.

SCUH winner of the 2018 Building Award.

Welcome To Country by Songwoman Maroochy.

Dr Mark Keough presenting on workplace professional development.

IFHE General Assembly – ExCo presenting to members

The Canadian delegation experience the ‘wild side’ Down Under.

Keynote - Prof David Hood urges action on climate change.

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2018 IFHE INTERNATIONAL CONGRESS EXHIBITORS

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2018 IFHE CONGRESS

INTERNATIONAL STANDARDS FOR ELECTRICAL SAFETY IN HEALTHCARE – IEC60364-7-710, AS/NZS 3003 AND AS/NZS 4510

By Matthias Schwabe and George Kotenko

INTRODUCTION – THE ELECTRICAL SAFETY CONCEPT FOR MEDICAL LOCATIONS

• Defective or broken-down devices/equipment

lectrical installations and equipment used in medical locations are subject to extraordinary demands. The life and health of a patient are at risk if only small electrical currents are flowing through his/her body or there is a break-down of life-sustaining apparatus and equipment used for diagnosis, monitoring or treatment.

The aim of all electrical safety measures is the safety of patients, staff and installations.

E

When safety and technical requirements are established, special considerations have to be given to the fact that patients may be connected to electro-medical equipment, their physical conditions may be restricted and that the application of electrical apparatus on or in the heart may be extremely dangerous, because of the high sensitivity of the heart muscle to electric currents.

During an operation or medical examination, the following technical conditions to the patient may have to be considered: • The electrical resistance of the skin may be reduced through the insertion of catheters.

• Incorrect handling of electrical equipment

Safety can also be described in terms of risk minimisation.

The safety objective for patients, staff and installation may only be achieved, if the following requirements are simultaneously achieved: • The site and the installation is safe; • Devices and equipment are safe; • Procedures are defined and suitable training is provided for the handling of devices/equipment; • Regulations and instructions on hygiene are carried out.

To achieve these goals, a good sense of responsibility, competence and know-how, assignment as well as a good deal of willingness to cooperate by all involved, are essential.

• Body functions may be taken-over by apparatus, e.g. during surgery.

• Natural reaction may be reduced through analgesia or switched off when anaesthetised.

These risks have to be understood before objectives and measures for electrical safety may be established.

The complete picture of the dangers involved with the application of electrical equipment in high-tech medical locations, is made up by many sources: • Electrical and mechanical energy • High temperatures • Fire

Figure 1: The safety concept in the hospital environment

• Chemicals • Micro organisms

25

2018 IFHE CONGRESS

STANDARDS AS A GUIDELINE FOR FULFILLING THE ELECTRICAL SAFETY CONCEPT FOR MEDICAL LOCATIONS

Figure 2: World map standards for medical locations

Worldwide two philosophies

ELECTRICAL SYSTEMS: ISOLATED (UNGROUNDED) – GROUNDED

• IEC 60364-7-710 • NFPA99 ---- AS/NZS 3003 Both standards require the use of isolated (AS/ NZS3003) or ungrounded (IEC 60364-7-710) systems

ELECTRICAL DEVICES/EQUIPMENT USED IN MEDICAL LOCATIONS In view of the application of a multitude of electrotechnical equipment in the medical environment, measures must be taken to prevent electrical accidents. There are two essential arguments for the installation of isolated (ungrounded) power supply systems (medical IT systems) in hospitals: • reliability of power supply; • low leakage current to ground

26

Figure 3: different electrical systems (isolated – grounded)

2018 IFHE CONGRESS

GROUNDED SYSTEM

• Maintenance as planned 2nd Advantage - in case of a first fault Rf • The touch current It or the touch voltage produced Ut ≤ 10 mV • No mortal danger for patients e.g. during open heart surgery or heart catheter examinations

1st risk – in case of a first fault Rf • An insulation fault current If flows dependent on the value of the insulation fault resistance Rf • The fuse / RCD will be triggered • danger to life of patients due to failure of the power supply and/or life-sustaining ME systems and ME equipment • Immediate action required 2nd risk - in case of a first fault Rf • A possible high touch current It or a high touch voltage Ut • Value based on experience 80…115 V • danger to patients due to touch voltages ≥ 10 mV • Irreversible harm possible

ISOLATED (UNGROUNDED) SYSTEM

The electro-technical industries worldwide with their intricate knowledge about fault conditions in electrical installations see it as their responsibility to work with various national and international committees to establish safety standards. The application and monitoring of isolated (ungrounded) power supply systems (medical IT systems) in hospitals are reflected in the different national standards.

The following are still valid basic statements according to IEC TC 62A: • A patient may not be able to respond normally in a hazardous event (illness, unconsciousness, anaesthesia, or connected to electrical apparatus for therapeutic reasons).

• The natural electrical resistance of the skin normally provides an important protection against electrical current. With some treatments however this protection may be short-circuited, e.g. through the insertion of a catheter into the patient’s body or by treating the skin when an electrode has to be placed on a patient’s body. The human heart is more sensitive to electrical current than other parts of the body. Electrical current could inhibit the natural heart activity and could lead to heartfailure.

• Electro-medical equipment could be used to partly or permanently support or substitute vital bodily functions. A fault of the device/equipment or a power failure could be life-threatening.

• Interferences, e.g. from the power supply, could disturb the reproduction of action potentials, such as ECG or EEG. The use of the isolated (ungrounded) power supply system may be desirable for the following reasons:

1st Advantage - in case of a first fault Rf • Only a very small current flows Id through the insulation fault Rf • monitoring device (IMD or LIM) signals an insulation fault • No hazard for the patient, power supply is retained

• Improves the reliability of power supply in areas where power failure may cause safety hazards for patient and user (doctors, nurses,…..).

• Reduces the leakage currents of devices/ equipment to a low value thus reducing the touch voltage of the protective conductor through which the leakage current may flow. Lower ground leakage current levels substantially reduce the

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touch voltage of the protective conductor under fault conditions.

• Reduces the leakage currents of devices/ equipment to a low value, if approximately balanced to earth.

It is necessary to keep the impedance of the system to earth as high as possible.

This is achieved by restricting:

Through the increasing application of electrical medical devices/equipment and non-stop operation became more and more popular the IT system became part of the important standards.

ELECTRICAL SAFETY IN MEDICAL LOCATIONS ACCORDING TO IEC 603647-710 IEC 60364-7-710: 2002 the present standard for medical locations was published in Nov 2002.

• The physical dimensions of the medical isolating transformer

In 2013 IEC/TC 64 MT 40 maintenance team started to prepare a new edition with the title “Low voltage electrical installations Part 7-710: Requirements for special installations or locations - Medical

• The system supplied by this transformer • The number of medical electrical devices/ equipment connected to the system; and through • High internal impedance to earth of the insulation monitoring device connected to such a circuit.

STRUCTURE OF AN ISOLATED POWER SUPPLY SYSTEM (MEDICAL IT SYSTEM) The operation of the medical IT system with MEDIMD or LIM and alarm forms the centre of the power supply. The base for the medical IT system is an isolated power source.

The essential advantage of a medical IT system is already evident in the case of a single fault condition.

Only a small current If flows, the value of which is determined through the system leakage capacitance Ce. This does not trigger a fuse, the supply voltage is maintained and the operation of the installation kept up.

The down-time safety is not the only argument for the use of an isolated power supply system or a medical IT system. It also reduces the leakage currents of the system to a low value, if the medical IT system is approximately balanced to ground.

STANDARDS AS A GUIDELINE FOR FULFILLING THE ELECTRICAL SAFETY CONCEPT FOR MEDICAL LOCATIONS The application of medical IT systems (ungrounded power supply systems) in hospitals started in 1920 to 1930 in America. Alarming numbers of fires and explosions in operating theatres, in which flammable anaesthetics were used shocked the experts. In 1939 the NFPA began with developing regulations for the safe application of electro-technical equipment in hospitals. In 1944 the first regulation was published in the US titled: “Safe practice in Hospital Operating Rooms”.

locations”.

A Committee Draft for Vote (CDV) “64/2281/CDV” was circulated in July 2018 by the secretary of IEC TC64 to all IEC member countries for their voting. As the topic “Medical Locations” is a rather complex subject and in many countries linked with legal requirements, the secretariat of TC 64 asked for the longest possible voting period for this CDV which 20 weeks is.

Closing date for this voting is: 2018-11-30. The proposed stability date for the new edition is 2030.

In medical locations patients are likely to be subjected to the application of ME (medical electrical equipment). Measures for safety of patients and medical staff need to be enhanced due to: • the reduction in body resistance, since the skin is often cut or broken • the risk associated with loss of supply, especially to life supporting equipment • the increased risk due to the presence of liquids, such as blood, saline and water (e.g. for irrigation) For every activity and function in a medical location, the particular requirements for safety, including supply continuity needs to be considered. Safety can be achieved by the application of this IEC standard and the safe operation and maintenance of ME equipment connected to it.

The particular requirements of this part of IEC 60364 apply to electrical installations in medical locations so as to provide safety of patients and medical staff. These requirements refer to hospitals and

29

2018 IFHE CONGRESS

clinics or equivalent institutions (including equivalent transportable and mobile locations)

TRANSFORMERS FOR MEDICAL IT SYSTEMS (710.512.1.1)

EC 60364-7-710.3.5 classifies medical locations in three different room groups:

Transformers shall be

• Group 0 medical location; • Group 1 medical location; • Group 2 medical location.

Group 2 has the highest demands as is defined as medical location where applied parts are intended to be used in applications such as intracardiac procedures, operating theatres and vital treatment where discontinuity (failure)of the supply can cause danger to life The following table (table 1) lists examples from IEC 60364-7-710:2002-11

• installed in close proximity to, inside or outside, the medical location • placed in cabinets or enclosures to prevent unintentional contact with live parts.

• Rated voltage Un on the secondary side of transformers ≤ 250 VAC • according to IEC 61558-2-15: • short circuit voltage ≤ 3% • no-load input current ≤ 3% • inrush current ≤ 12 x rated input current with additional requirements: • The leakage current of the output winding to earth and the leakage current of the enclosure, when measured in no-load condition and the transformer supplied at rated voltage and rated frequency, ≤ 0.5 mA. • Rated output of the transformers 0.5 kVA … 10 kVA. • For three-phase loads with an IT system a separate three-phase transformer shall be provided for this purpose with output line-to-line voltage not exceeding 250 V.

INSULATION MONITORING DEVICES (MED-IMD) The medical IT system is to be equipped with an insulation monitoring device in accordance with IEC 61557-8. Present version is Edition 3.0 which was published in 2014-12.

Clause 710.413.1.5 demands the medical ungrounded power supply system (medical IT system) to be used in group 2 medical locations: “In group 2 medical locations, the medical IT system shall be used for circuits supplying medical electrical equipment and systems intended for life-support or surgical applications and other electrical equipment located in the ‘patient environment’ excluding equipment listed in 710.413.1.3 For each group of rooms serving the same function, at least one separate medical IT system is necessary.

30

Annex A specifies the requirements for insulation monitoring devices (MED-IMD) which permanently monitor the insulation resistance to earth of unearthed medical a.c. IT systems in group 2 medical locations according to 710.413.1.5 of IEC 60364-7-710:2002.

2018 IFHE CONGRESS

REMOTE ALARM INDICATIONS 710.413.1.5

IFL (INSULATION FAULT LOCATION SYSTEM)

The Local insulation warning (LIW) function shall include the measurement of the insulation resistance RF of an IT system including symmetrical and asymmetrical components, an assessment of this resistance RF and a local warning. For each medical IT system, an acoustic and visual alarm system incorporating the following components shall be arranged at a suitable place, so that it can be permanently monitored (audible and visual signals) by the medical staff:

IEC 60364-4-41 Chapter 411.6.3.1 Note 1: recommends that a first fault has to be eliminated within the shortest practicable delay. Modern monitoring systems will allow identifying the exact location of faulty electrical systems by on-line fault location => defect medical devices can be identified without switching off the supply system

• a green signal lamp to indicate normal operation • a yellow signal lamp which lights when the warning indication of the insulation monitoring device takes place. It shall not be possible for this light to be cancelled or disconnected • an audible alarm which sounds, when the minimum value set for the insulation resistance RF is reached.

This audible alarm may have provisions to be silenced under alarm conditions • the yellow signal and the audible alarm shall be cancelled on removal of the fault and when normal condition is restored

PREVENTING POWER LOSS Regardless of the implementation of a medical IT system and management of the total selectivity of the protection devices, a total loss of power in group 2 medical locations shall be prevented. This may be achieved either More and more clear text instructions to the medical and technical staff will be required.

Annex B specifies requirements for devices designed for monitoring overload current and temperature rise of the medical IT transformer according to 710.413.1.5 of IEC 60364-7-710:2002.

To avoid overloading of the isolating transformer, monitoring of load and temperature is desirable, in order to protect the transformer and supply conductors between primary and secondary terminal and the distribution bus from overload or overheating.

When the rated current or the temperature is over ranged an acoustic or optical alarm is released.

Provision of two independent supply lines • Normal power supply • Safety power supply (≤ 15s) e.g. Generator • Special safety power supply (≤ 0,5s) Provision of a ring-structure, capable to back up the mains supply, or local additional power supply unit, or an additional power supply unit for several rooms of group 2

ELECTRICAL SAFETY IN MEDICAL LOCATIONS ACCORDING TO AS/ NZS3003: SIXTH EDITION 2018 Australian/New Zealand StandardTM: Electrical installations—Patient areas

31

2018 IFHE CONGRESS

CLASSIFICATION OF PATIENT AREAS - 2.2 cardiac-protected electrical areas - 2.2.3 The following areas shall be wired as cardiacprotected electrical areas if cardiac-type procedures are undertaken there: (a) Cardiac catheter laboratories. (b) Cardiac ICU. (c) I CU with regular thermodilution Swann-Ganz monitoring. (d) Neo natal ICU. (e) Operating theatres for cardiac surgery. (f) CCU. Locations other than those listed above, in which cardiac-type procedures will be regularly performed, shall also be wired as cardiac-protected electrical areas. In such cases, the responsible organisation shall provide documentation outlining the specific requirements.

Body-protected electrical areas - 2.2.4 The patient areas, as determined by the responsible organisation, in any facility, building, institution or medical practice that are not wired as cardiacprotected electrical areas shall be wired as bodyprotected electrical areas: Low voltage isolated supplies (2.9) 2.9.1 General Where a low-voltage isolation transformer is used as an LPD to satisfy the requirements of this Standard, the supply shall include a line isolation monitor and, where required by Clause 2.9.4, an overload monitor.

The isolation transformer, line isolation monitor and overload monitor shall be in accordance with AS/NZS 4510.

Each isolated power system shall be provided with a Line Isolation Monitor that indicates possible leakage or fault currents from all isolated conductors to ground Overload monitor 1.5.18 and 2.9.4 Each low-voltage transformer-isolated supply that is connected to any socket-outlet shall be provided with an overload monitor in accordance with AS/NZS 4510 to monitor the load current. The alarm current setting of the overload monitor shall be identified on the monitor in accordance with Clause 2.12.1 to facilitate testing.

Line isolation monitor (LIM) 1.5.15 and 2.9.5 is an instrument in accordance with AS/NZS 4510 that monitors the prospective hazard current of a transformer-isolated supply and actuates an alarm when this exceeds a set level.

Each transformer-isolated supply shall be provided with a line isolation monitor (LIM), in accordance with AS/NZS 4510 to monitor the prospective hazard current (PHC).

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Prospective hazard current 1.5.24 and 2.9.6 Prospective hazard current is current that would flow, in a transformer-isolated supply, between one of the active conductors and earth if the active conductor were solidly bonded to earth.

NOTE: Although prospective hazard current does not flow until a line-to-earth fault occurs, a line can be described as having a prospective hazard current of a particular value because the cumulative effect of the

2018 IFHE CONGRESS

imperfections in the line isolation will cause current to flow as soon as a line-to-earth fault occurs

ISOLATED POWER SYSTEM – BASIC (FULFILLING THE STANDARD)

The prospective hazard current of the supply, LIM and circuit wiring shall not exceed 2 mA when measured in accordance with AS/NZS 4510.

• 2 mA PHC • Mains load monitoring

Metal conduit provides some protection against electrical interference and may be used if it does not cause the prospective hazard current to exceed that permitted by this Clause.

The length of isolated supply circuits should be as short as practicable in order to minimise the total prospective hazard current.

For routine testing and commissioning, the PHC requirements shall be verified by applying process listed in 2.9.5.1 (a) Prospective hazard current display (PHC display) and

••••

2.9.5.1 (b) Prospective hazard current alarm (PHC alarm). to each transformer isolated supply.

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2018 IFHE CONGRESS

ISOLATED POWER SYSTEM – ADVANCED OPTIONS • Branch circuit load monitoring • Branch circuit ground fault location identifies on-line faulty medical equipment • Clear indication and advanced instructions to medical and technical staff

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Thewheel wheel lock lock isispermanently activated and can be can release The wheel wheel lock permanently activated and can can be bebetween release by bythe hand/foot lever. lever.

-- release The isis permanently activated and release hand/foot by lock hand/foot lever. The connection The connection between themade castorbyandoperator. the trolley is made by operator. castor and the trolley is The The connection connection between between the the castor castor and and the the trolley trolley isis made made by by operator. operator.

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CONCLUSION The patient is the focus of attention in the hospital. Even the slightest power failure can impair a successful diagnosis and therapy and therefore may be life-threatening to the patient.

That is why isolated power supply systems with IMD or LIM technology are used, because this guarantees a comprehensive protection for patient, doctors and medical staff.

• Added safety at no additional cost • No power interruption at first fault • Early warning of faulty medical equipment • Visual and audible indications of hazardous situations

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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

2018 IFHE CONGRESS

NEW WAYS TO PROVIDE EMERGENCY POWER FOR HEALTHCARE: FUEL CELLS & MICROGRIDS

By Walt Vernon

I

nexpensive, reliable electricity is fundamental to providing quality affordable healthcare. Utility power quality & reliability varies around the world.

Historically, the healthcare industry has relied heavily on diesel generators as an inexpensive, relatively reliable source of power for onsite generation (when utility power is unavailable). However, we have long known that diesel generators produce significant air quality problems.1 One study found: Diesel exhaust and many individual substances contained in it (including arsenic, benzene, formaldehyde and nickel) have the potential to contribute to mutations in cells that can lead to cancer. In fact, long-term exposure to diesel exhaust particles poses the highest cancer risk of any toxic air contaminant evaluated by OEHHA. ARB estimates that about 70 percent of the cancer risk that the average Californian faces from breathing toxic air pollutants stems from diesel exhaust particles.2 Globally, new forms of on-site, distributed power generation are emerging, many of which avoid harmful environmental impacts, while yielding affordable, quality power to facilities. Chief among these are fuel cells and microgrids. Unlike traditional power systems which consist of large blocks of supply in the form of a utility, or a large diesel generator, both fuel cells and microgrids consist of many interrelating smaller sources of both storage and generation, with varying operating characteristics -- meaning that traditional conceptions of supply and distribution must evolve in response. Differences include everything from the power source to the load. And thus, these differences, just by nature of being different, cause challenges for the “regulatory world.�

Interesting tangential note -- the design of power systems in health facilities in many parts of world are unregulated, and thus, application of these alternative power systems are more easily applied and are demonstrating effectiveness. Successes in these applications is a feat o3, and can provide insight into future opportunities for the more developed world.

FUEL CELLS Fuel cells have been developing slowly as an energy supply system for healthcare, despite the clean, reliable power they produce and their low emissions.

Many environmentalists suggest fuel cells as strategies for replacing emergency generators. Yet, hurdles of cost, system performance, size, fuel limitations, and lack of familiarity have prevented the effective implementation in healthcare settings.

A fuel cell is a device that converts the chemical energy from a fuel into electricity through a chemical reaction with oxygen or another oxidising agent. Fuel cells are different from batteries in that they require a constant source of fuel and oxygen to run, but they can produce electricity continually for as long as these inputs are supplied.

From an air quality standpoint, fuel cells are easier to permit than diesel generators. For instance, some individual fuel cell installations do not require permitting with air quality requirements such as South Coast Air Quality Management District (SCAQMD).

With more hospitals including sustainability in their business strategy, and with the advances in technology, fuel cells can become a power source for future hospitals, as long as the challenges are addressed and overcome.

Fuel cells are heavily subsidised and will need to become more price competitive. In addition, building and healthcare codes will need to change. Despite the challenges, fuel cells have tremendous potential to provide clean, reliable power (both as backup and primary sources) to hospitals. Fuel cell technology is advancing quickly, and with each succeeding generation, its capability, efficiency, and reliability is improving.

But still, the solution tantalises. Data centres, comprised of buildings most in need of clean, reliable power, have begun to implement fuel cells on a wide scale, thus showing the promise of the technology.

Microsoft, Apple, and eBay are among those leading the use of fuel cell technology for critical data centre power.

41

2018 IFHE CONGRESS

Distributed generation is expected to become more important in future generation systems. (Distributed generation is a decentralised model with extensive power distribution networks, many smaller, local generation systems, often dedicated to serving a single site.) Unlike diesel generators, fuel cells are designed in a decentralised fashion -- strings of modules, providing greater built-in redundancy – resulting in significant reliability advantage. We place a high value on human life; ironically, it’s the data centres that are investing in fuel cells (not Healthcare).

Indeed, costs for fuel cell solutions, coupled with potential creative financing mechanisms, have begun to suggest that certain implementations for fuel cells could, in fact, become feasible. Indeed, if a hospital were to replace its diesel emergency generators with fuel cells, then it could buy down the cost of the fuel cell, and, by running it continuously; the fuel cell could start to make real economic sense.

One barrier to this implementation to date has been the source of fuel. Traditionally, fuel cells have run only off of natural gas, which is notoriously difficult and expensive to store. As a result, this could (potentially) render fuel cells a poor choice for an emergency source of power. Fortunately, newer fuel cell technologies, running on different fuels, offer better fuel storage options, and thus, viable replacements for diesel generators.

MICROGRIDS A microgrid is a group of interconnected loads and distributed energy resources within clearly defined electrical boundaries, acting as a single controllable entity with respect to the grid. It can connect and disconnect from the grid to enable it to operate in both grid-connected or island-mode. (From IEEE Std. 2030.7-2017 IEEE Standard for the Specification of Microgrid Controllers) Microgrids use power from a number of sources, matching energy supply with building demand. Sources of energy include utility energy, on-site generation such as CHP and solar energy, and on-site storage. Note that the “official” definition of a microgrid, from the IEEE, describes the microgrid as a system separate from the utility; but, at their best, microgrids continually interact with the grid, as well as being able to act entirely independently. (i.e. Microgrids are comprised of both the off-site and the on-site generation and storage systems.)

Microgrids are intelligent systems controlled by highly advanced software that optimises and synchronises various pieces of equipment and energy transmission elements. This provides maximum intelligence

42

and efficiency to building energy planning and management. Additionally, the system can determine the appropriate combination of energy resources to employ at any given time, as well as, when stand along operation is required (based on hospital management targets).

Microgrids are increasingly gaining attention across the energy sector, including in Healthcare.

As hospital energy consumption increases and operating margins decrease, and as healthcare organisations increasingly work to improve the public health impacts of their own operations, opportunities for effectively managing energy use is becoming an increasingly higher priority. The overall cost of producing energy is expected to increase from 10.6 cents/kWh to 23.5 cents/kWh in 2050, creating even greater strain on hospital budgets. With intelligent switching, a microgrid can employ peak saving and load-shifting, leveraging on-site assets against that of utility energy to determine when to buy and when to use on-site power (without any action from the user).

Reliability is another critical factor. Disconnecting from the grid or ‘islanding’ with a microgrid can happen instantaneously with back-up storage to support local generation. This occurs seamlessly, without disruption of service. So, in the event of sudden utility grid collapse, the microgrid can switch to on-site generation and storage instantly and without any interruption in equipment function.

Funded by the California Energy Commission, Kaiser Permanent’s hospital in Richmond, CA has the first renewable energy microgrid for hospital emergency power. “We combine onsite generation with battery storage in a number of places,” said Seth Baruch, national director of energy and utilities for Kaiser Permanente. “That is [a strategy] tied to resilience and grid reliability, [and] it will also help optimise the economic benefits of our solar projects.” Charge Bliss, who, with Mazzetti, designed the renewable microgrid for Kaiser, notes unprecedented facility savings from the synergistic application of load management, energy arbitrage, and time-shifting of solar energy usage.

REGULATION HURDLES The old paradigm for energy management distills down to: step function on or step function off (the utility or the diesel generator). A design with a fuel cell or microgrid serving both as a prime power source and a backup power source would be conceptually different from, and difficult for those accustomed to the historic design paradigm. And, if one were

2018 IFHE CONGRESS

catch them before they fall® to design a system that used these sources in lieu of diesel generators for emergency use, it would require a re-think of the entire electrical power and distribution system.

In a distribution system, the concept of all sources ‘off’ or all sources ‘on’, forces certain kinds of design and operational norms, and, therefore, regulated from that perspective. But, both fuel cells, with multiple paralleled strings of multiple paralleled modules, and microgrids with multiple smaller, paralleled sources always running (but with different kinds of operating and reliability characteristics), presents a challenge within existing regulations. This is a qualitatively different kind of generation system. With fuel cells and microgrids, many small parts add up to capacity. This, in effect, changes how we think of reliability of the system. In a distributed system, losing minor capacity is possible (vs. an “all or nothing”). It’s conceptually very different.

We have submitted proposed changes to the NFPA to help clarify the concepts, allowing and guiding the use of fuels cells and microgrids as appropriate power sources in Healthcare. The comment period is scheduled later in 2018.

Mazzetti, with others, is encouraging a performancebased approach rather than prescriptive. We’re suggesting a reliability modelling process that will use the reliability theory to consider any potential energy generation source and reliability of the distribution system to ensure appropriate power delivery to important life-safety loads.

SUMMARY

Are falls from beds a problem?

If so, INVISA-BEAM Bed Monitoring systems can help.

Invisible beams monitor both sides of the bed with the Dual Beam system.

When the patient attempts to exit the bed, the invisible beam is broken and transmits the alarm.

The nurse wears either an Entry Pass or Invisalert to respond. This cancels the alarm.

Though significant barriers remain, opportunities to use fuel cells in hospitals will continue to increase in the future. Waste-to-energy systems, which would utilise hospital waste to produce electricity, are particularly promising. So are improvements in the technology of fuel cells.

REFERENCES 1. See, e.g. Michael McCarthy, et al, “Characterization of the Chronic Risk and Hazard of Hazardous Air Pollutants in the United States Using Ambient Monitoring Data,” Environmental Health Perspective, 117:790–796; http://dx.doi.org/10.1289/ehp.11861.

The beam reactivates automatically, when the nurse leaves the bed.

2. California Environmental Protection Agency, “Health Effects of Diesel Exhaust,” accessed August 22, 2018, at https://oehha. ca.gov/air/health-effects-diesel-exhaust.

3. See, e.g. Vijay Govindarajan and Chris Trimble, Reverse Innovation; Create Far from home, Win Everywhere, 2012.

INVISA-BEAM INTERNATIONAL 02 6251 1374 info@invisabeam.com I www.invisabeam.com

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2018 IFHE CONGRESS

APPROPRIATE SIZING OF OPERATING THEATRES WITH HIGH SATISFACTION – A JAPANESE MODEL

By Hiroshi Yasuhara, MD

ABSTRACT

T

he 2014 Facility Guidelines Institute (FGI) guidelines include a method to calculate the minimum size of operating theatres (OTs).1 However, the rationale behind the guidelines has not been clarified. The purpose of this study was to create a universal model for the design and structure of OTs. Our major assumption was that OT size can be calculated by adding the areas occupied by medical equipment, healthcare workers and their traffic pathway. The area designated to healthcare workers was set as a circle with a 2.0-meter diameter, compatible with a human’s height according to the ancient model of the ideal human body. The remnant corners of the 2.0-meter square outside of the circle were designated to the traffic space.

Routinely used medical equipment was included in the model beforehand, together with the operating table, part of which was included later as the patient’s area. The shape of the OT was set as square as possible. Ordinary surgery was considered to be performed by a surgeon, first/second assistants, an anaesthesiologist/assistant and an assistant/ circulating nurse. Using our model, the proposed sizes of OTs measured 36, 48, 64, 80, 90 and 100 m2 for the minimum OT, standard OT, ideal OT, OT for cardiac surgery, OT for specific surgery and OT for multisubspecialty surgery, respectively.

In the next step of our research, the proposed model was justified using the degree of satisfaction of OT directors of national university hospitals nationwide.

We sent them a questionnaire on their satisfaction with the size of OTs that were presently used for 13 representative types of surgery. They were asked to provide the floor maps of the surgical suites, in order to measure the sizes of OTs for each type of surgery.

The calculated sizes of the OTs were almost identical to those of OTs the directors were satisfied with.

Our results demonstrated that the proposed model

could estimate the appropriate size of OTs with high satisfaction.

INTRODUCTION The design and architecture of operating theatres (OTs) have developed together with the invention of new surgical procedures and technologies. The design of an OT is influenced not only by the surgical disciplines prevailing during the era when the OT was built, but patient characteristics and even the historical background of hospitals. Above all, OT size is one of the most important fundamental issues determining the performance of an OT and the quality of surgery.2-4 More recently, a number of administrative regulations and standard guidelines of healthcare facilities have been established and have become one of the most important factors determining OT size. HBN 26 in the UK5 recommended that a standard inpatient OT should have an area of 55 m2. On the other hand, The 2018 FGI Guidelines for Design and Construction for Hospitals state that a standard operating room (OR) requires an area of 37.2 m2 and an OR for imageguided surgery, which requires additional personnel and/or large equipment, should have an area of 55.7 m2.6. However, the rationale behind these guidelines has hardly been clarified.

The Surgical and Endovascular Services Design Guide7 presents several room templates to provide a specific OR design plan adhering to standards related to ORs. In the room templates, the size of a general OR, orthopaedic OR, urology/cystoscopy OR, cardiothoracic OR, monoplane hybrid OR and neurosurgical OR is 62.4, 71.5, 62.4, 71.5, 85.7 and 71.5 m2, respectively. However, again, it is hard to understand how these OT sizes were derived from many complicated standards.

Another issue of those models is that most of the designs do not appear to reflect the user’s viewpoint or the healthcare workers in the OT. Therefore, we

45

2018 IFHE CONGRESS

do not understand how the recommended OT sizes would affect the performance or safety of OTs. Thus, a universal model to determine appropriate OT size has not yet been established. The purpose of this study was to create a universal model for the design and construction of OTs.

METHODS

The area designated to the patient was also set as a similar circle with a 2.0-metre diameter. The circle area was considered to consist of the area of the patient’s body/operating table, the area of the patient’s movement for positioning and the area of healthcare workers’ practice. (Fig. 2b) We set the size of the operating table as 0.6 metre by 2.0 metres, again using the model of the ideal human body. (Fig. 2a)

At the first stage of the present research, we attempted to create a rationale to estimate appropriate OT size. We then tested the validity and practicality of the proposed model.

The area designated to a healthcare worker was set as a circle with a 2.0-metre diameter, compatible with a human’s height according to a model of the ideal human body in the ancient literature. (Fig.1a) The two-dimensional square may include the area physically occupied by the human body and that of their minimal movement. The remnant corners of the 2.0-meter square outside of the circle were designated to the traffic space. (Fig.1b) Fig 1a

1.8 m

Vitruvian Man

Area of Human’s Body and Movement

Fig.1a, b: A model of the ideal human body (a) and two-dimensional square designated to the human body, their movement and traffic space (b).

Area of Patient’s Body and Positioning

Vitruvian Man

Fig.2a, b: A model of the ideal human body (a) and twodimensional square designated to the operating table/ patient’s body and healthcare workers’ practice (b).

Area of Patient’s Body and Operating Table

Area of Healthcare Worker’s Traffic

Area of Patient’s Positioning of Extremities & Healthcare Worker’s Practice

Fig 1b

Fig 3

Fig.3: Minimum OT Trolley for anaesthetic drug Anaesthesia machine

Area of Healthcare Worker’s Traffic 6m

Area of Human’s Body and Movement

6m Trolley for surgical instrument

46

Fig 2b

The equipment routinely used for operations was incorporated beforehand into the model, together with the operating table. The equipment is considered to be carried through the traffic space. Ordinary surgery is considered to be performed by a surgeon, first/second assistants, an anaesthesiologist /assistant and an assistant/circulating nurse. (Fig. 3) The shape of the OT was assumed to be as square as possible and shelves were embedded in the wall.

2.0 m

2.0 m

2.0 m

2.0 m 0.6 m

2.0 m

Our major assumption was that the appropriate OT size consisted of the area occupied by surgical equipment and healthcare workers such as surgeons, nurses, clinical technicians and their traffic and the movement area depending on the type of operation.

2.0 m

1.8 m

1) Development of universal model for appropriate OT size

Fig 2a

36 m2

2018 IFHE CONGRESS

In the present study, we excluded specific types of OT that are equipped with large equipment, such as an X-ray machine for angiography, CT or MRI, or surgical robot. Since these types of OT are intended to be used exclusively for specific types of operation, it is hard to differentiate the equipment from part of the OT facilities.

Table 1. Main equipment and its size

Type of equipment

Equipment footprint (m2)

Routinely used equipment Operating table

1.16

Overhead instrument table

0.60

Mayo stand

0.72

2) Calculation of OT size using our model

Prep stand (L)

0.41

We classified OT type into six categories according to the size, i.e. minimum OT, standard OT, ideal OT, OT for cardiac surgery, OT for specific surgery and OT for multi-subspecialty surgery. In our model, an additional area besides the area of the standard OT was assigned to the movement of equipment and humans, rather than footage of equipment alone.

Prep stand (S)

0.36

Generator for coagulator

0.39

Surgical field suction

0.16

Anaesthesia machine

0.56

Anaesthesia supply cart

0.45

Vital sign monitor

0.45

Intravenous pole

0.20

EMR cart for nurses

0.25

Chair for anaesthesia care provider

0.19

Footstool

0.15

Rubbish container (L)

0.28

Rubbish container (M)

0.14

Case cart

0.43

For the sake of research, we selected 13 representative surgical procedures, including lens surgery, brain tumour surgery, head & neck surgery, coronary bypass (CABG) surgery, thoracic/ abdominal aortic aneurysm surgery, lung cancer surgery, oesophageal cancer surgery, hepatobiliary/ pancreatic surgery, colorectal cancer surgery, spinal surgery, arthroscopic surgery, obstetrics/ gynaecological (OBGY) surgery and urological surgery.

Temporarily used equipment

We assigned lens surgery to the standard OT, head & neck surgery, lung cancer surgery, oesophageal cancer surgery, hepatobiliary/pancreatic surgery, colorectal surgery, OBGY surgery and urological surgery to the ideal OT, and brain tumour surgery, spinal surgery and arthroscopic surgery to OT for specific surgery. Cardiac surgery included CABG and surgery for thoracic/abdominal aortic aneurysm. No procedure was assigned to either a minimum OT or an OT for multi-subspecialty surgery.

Heart lung machine

0.96

Cardioplegia

0.21

PCPS (percutaneous cardiopulmonary support) system

0.30

IABP (intra-aortic balloon pumping) system

0.20

Bed cooling machine

0.12

Patient warming machine

0.12

Cell SaverÂŽ

0.30

3) Validity of our model

Trolley for endoscopy

0.42

Since our model is mainly based on the area of healthcare workers and their movement/traffic pathway, the remaining area is considered to be the equipment area. To validate our model, we used the ratio of this equipment area to total OT size as an indicator.

C-arm X ray machine

2.06

Surgical microscope

1.13

Surgical navigation system

0.63

Generator for vessel sealing device

0.09

Sonic scissors

0.24

Equipment used in the OT consisted of the equipment routinely used in ordinary surgery and that temporarily used for specific surgery. The former equipment includes the operating table and anaesthetic machine, and the latter includes heart lung machine, surgical microscope or surgical navigation system.

We calculated the average equipment size and OT size using the operative records and equipment usage

in April 2011 of our hospital. The actual footprint of equipment was measured beforehand as listed in Table 1. On the other hand, we estimated the ratio of equipment size using our model according to the type of OT. The total equipment area was calculated by subtraction of the total area related to healthcare workers, the patient and their movement/traffic

47

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2018 IFHE CONGRESS

pathway/practice from the estimated OT size, using the following equation.

(Total equipment area) = (OT size) – { (area of healthcare workers’ bodies / movement / traffic pathway)} – { (area of patient’s body / patient’s positioning / healthcare workers’ practice)} + (size of operating table) We compared the measured ratio of the operative record with the calculated ratio according to the OT classification.

Fig.5: Ideal OT

4) Practicality of our model In the next step of our research, we assessed the practicality of our model using the degree of satisfaction of the OT directors (medical or nurse OT directors) of 43 national university hospitals nationwide. We sent them a questionnaire on which OT was most frequently assigned to 13 representative procedures. They were asked whether they were satisfied with the size of OTs currently used for the above-mentioned procedures. They were also asked to provide the floor map of surgical suites so that we could measure OT size.

Fig.6: OT for cardiac Surgery

For each surgical procedure, the university hospitals were grouped according to the directors’ answer, i.e. “satisfied” or “dissatisfied”. We then calculated the average OT size with which the OT directors were satisfied or dissatisfied for each procedure.

RESULTS 1) Calculated OT size for each surgical procedure Using our model, the OT sizes measured 36, 48, 64, 80, 90 and 100 m2 for minimum OT (Fig. 3), standard OT (Fig. 4), ideal OT (Fig. 5), OT for cardiac surgery (Fig. 6), OT for specific surgery (Fig. 7a-7c) and OT for multisubspecialty surgery (Fig. 8), respectively.

Fig.7: Three types of OT for specific surgery

Fig.4: Standard OT

49

2018 IFHE CONGRESS

surgery, head and neck surgery, CABG, thoracic/ abdominal aortic aneurysm surgery, lung cancer surgery, oesophageal cancer surgery, hepatobiliary/ pancreatic surgery, colorectal surgery, spinal surgery, arthroscopic surgery, OBGY surgery and urological surgery, respectively. (Table 3) The OT sizes that did not satisfy the OT directors appeared to be close to the recommended minimum sizes in the 2018 FGI guidelines.6 On the other hand, the calculated OT sizes in our model were almost identical to those with which the directors were satisfied.

DISCUSSION

Fig.8: OT for Multi-subspecialty surgery

2) Validity of our model According to the actual equipment usage, the average area of routinely used equipment measured 11.87 m2. The average area of temporarily used equipment measured 1.52 m2. As a result, the average OT size was 78.46 m2 with an overall ratio of 0.17.

(Table 2) On the other hand, the calculated ratios of the equipment were 0.14, 0.19, 0.14, 0.12, 0.19 and 0.11 for the minimum OT, standard OT, ideal OT, OT for cardiac surgery, OT for specific surgery and OT for multi-subspecialty surgery, respectively.

Table 2. Average ratio of area of equipment in OT

Area for routinely used equipment (m2)

Area for temporarily used equipment (m2)

Average OT size (m2)

Ratio of area of routinely used equipment

Ratio of total area of equipment

11.87

1.52

78.46

0.15

0.17

3) Practicality of our model The OT directors of all 43 university hospitals answered the questionnaire. The average unsatisfactory/ satisfactory OT sizes were 40.1/47.3, 52.4/65.9, 41.3/56.5, 53.4/75.5, 54.2/74.3, 44.1/62.8, 46.7/66.3, 46.8/59.6, 45.5/58.4, 52.1/66.8, 44.3/66.5, 41.3/50.6 and 46.9/55.2 m2 for lens surgery, brain tumour

50

Our results demonstrated that OT size could be determined by summation of the areas occupied by equipment, healthcare workers, their movement/ practice and traffic pathway. The 2014 FGI Guidelines for Design and Construction of Hospital and Outpatient Facilities1 presented a detailed basic concept to determine minimum requirements of OT space for the first time. Although the 2018 FGI Guidelines also adopt the concept of total combined area, the circulating pathway and movable equipment zone were defined in a different way from ours. In addition, neither the exact figures of equipment footage nor the detailed alignment of the elements in the OT were provided. The OT size was not stratified according to the number of healthcare workers or need for surgical equipment. As a result, the final formula of our model was distinctive from the previous one.

Regarding OT size, there are so many standards to adhere to that we are unable to understand the rationale easily. The Surgical and Endovascular Service Design Guide7 provides room templates to overcome these complexities, but it is still difficult to understand how these standards are integrated into the recommended OT size. We believe that our model has a practical advantage of feasible applicability.

In the present study, we validated our model using the ratio of equipment size to total OT size. Although the ratios varied from 0.11 to 0.19 depending on the OT type, these figures were close to the ratio of 0.17 observed in our hospital. Regarding OTs for multi-subspecialty surgery, nevertheless, the ratio of 0.11 appeared to be far lower than 0.17. The difference is likely to indicate the difficulty creating a universal model for collaborative surgery. In fact, the collaboration of surgical teams varies according to hospitals and even changes as new technology emerges. Furthermore, these types of surgery are

2018 IFHE CONGRESS

Surgical Procedure

Satisfactory OT space (m2)

Unsatisfactory OT space (m2)

Calculated space (m2)

Space recommended by 2018 FGI Guidelines (m2)

Lens surgery

46.3

34.9

48

≥ 37

Brain tumour surgery

69.6

53.2

90

≥ 56

Head & neck surgery

56.2

41.5

64

≥ 37

CABG

75.5

51.8

80

≥ 56

AAA/TAA surgery

74.3

51.7

80

≥ 56

Lung cancer surgery

61.7

44.4

64

≥ 37

Oesophageal cancer surgery

66.7

46.7

64

≥ 37

Hepatobiliary/ pancreatic surgery

62.3

46.4

64

≥ 37

Colorectal surgery

57.7

43.4

64

≥ 37

Spinal surgery

68.0

51.6

90

≥ 56

Arthroscopic surgery

66.5

45.5

90

≥ 56

OBGY surgery

50.3

42.4

64

≥ 37

Urological surgery

54.7

46.5

64

≥ 37

Table 3. Satisfactory and unsatisfactory OT space according to type of operation

relatively rare. We do not believe that a universal model for this type of surgery is necessary at present.

OT size may be influenced by the OT layout, which is based on the cultural background.4 In the UK, HBN 265 demonstrated a different layout of OTs and claimed that each OT should have its own anaesthetic room and integral scrub room. In this model, they roughly depicted the alignment of equipment and personnel in the OT. Nevertheless, the minimum required OT size in HBN 01-01-Cardiac facilities8 was close to the size in the 2018 FGI guidelines regardless of the basic OT layout. Thus, there is a possibility that our model can be applied to the UK model.

cleanliness, rather than efficacy. Our model should be tested regarding efficacy or functionality using OT performance in the future.

ACKNOWLEDGEMENT This study was partly supported by Working Group 1 of the Congress of OR Management, National University Hospital, Japan.

REFERENCES 1. The Facility Guidelines Institute (2014) Guidelines for Design and Construction of Hospital and Outpatient Facilities. 2014 edition. Dallas; p.168-71.

There are many measurement scales to justify the model of appropriate OT size. Previous guidelines for OTs were based on functionality and architectural structure. However, they hardly incorporated the user’s viewpoint as in the present study. In fact, the minimum required space adhering to previous guidelines was almost identical to the unsatisfactory OT size in the OT directors’ responses, while satisfactory OT sizes were nearly identical to the OT sizes in our model. We believe that high user satisfaction is another major advantage of our model.

2. Essex-Lopresti M (1999) Operating theatre design. Lancet 353:1007-1010.

User satisfaction is different from efficacy of the OT. The results could have been different according to the questionnaire given to the surgeons. Nevertheless, our study sheds light on the user’s standpoint on OT design. Previous studies have focused mainly on OT

7. US Department of Veterans Affairs (2016) Surgical and Endovascular Services Design Guide.

3. Clemons BJ (2000) The first modern operating room in America. AORN Journal 71(1):164-170.

4. Essex-Lopresti M, Hubert D (1962) Planning operating-theatre suites. BMJ i:1470-1473 5. NHS Estates (2004) HBN 26 Facilities for surgical procedures: Volume 1. The United Kingdom for The Stationery Office.

6. The Facility Guidelines Institute (2018) Guidelines for Design and Construction of Hospitals. 2018 edition. St. Louis; p.180-3.

8. Department of Health (2013) Health Building Note 01-01: Cardiac facilities. p. 16-18.

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DESIGNING THE ICU FOR THE FUTURE SEINÄJOKI CENTRAL HOSPITAL, FINLAND

By Tiina Yli-Karhu, Design Coordinator at the Hospital District of South Ostrobothnia PhD Candidate at University of Tampere

The process of designing the new intensive care unit (ICU) of the Seinäjoki Central Hospital, Finland started with the pre-occupancy evaluation and the research study to find out the best practices and design models. It was obvious from the start to move to single patient rooms, to elaborate evidence-based design, and to exploit all the possible technological innovations. Although single patient rooms provide several advantages there were many issues to be solved like visibility, audibility and assistance.

To solve these issues the new technology offers good opportunities.

EVICURES PROJECT

T

he aim of Evicures project (2014-2016) was to develop a new user-friendly design model of intensive and intermediate care unit (ICU) in order to improve the quality of care and effectiveness with functional care environment and establish positive impact on wellbeing of users, both the patients and the staff. The model supported the participation of the staff in designing the new ICU and drawing all the possible information from the research and from the expertise and practise of the staff. To support the work, a multidisciplinary group of the partners of the project was gathered from hospital managers, staff, patients and their families, other hospital districts, research institutes and companies. The EBD was familiar to the staff and it was used in former building projects in the Seinäjoki Central hospital. So, in this project all possible EBD information was used to design the first ICU in Finland based on single patient room concept.

One should take into account multiple alternatives when designing a new ICU. Firstly, there are many guidelines and recommendations for design.

Secondly, several issues big issues must be considered like the culture of the hospital and the current clinical practise. The best qualities of present premises and clinical practises should be kept, but the new possibilities of design, workflow and technology must be utilised. Also, the number of patients in intensive and intermediate care is predicted to increase up to

20-25 percent during next decades due to population aging and innovations in medical care. Hence, the new premises should cover space requirements, convertibility, usability, and hygiene requirements through a long lifecycle.

METHODS USED IN THE PROJECT The Evicures project utilised multiple methods to ease the participation of the staff to the design process. The methods enabled the staff to express their knowledge and expertise and make them feel equal with designers. The design process of new facilities applied co-design in virtual environment (CAVE). The design process in virtual environment took place in spring 2015 in three separate phases.

There were 47 multi-professional groups including 4-6 persons each (Figure 1). In each phase the architect introduced a virtual model of patient rooms (intensive and intermediate) with bathroom and the nurse station. After introduction there were vivid conversation of the spaces and the way how the nurses and other staff work in these rooms and the participants proposed changes to the models. It was easy for them to give reasons for their opinions, because they could show the shortages and partly demonstrate their requirements. After each phase the architect transferred the requirements to the new virtual model for the next evaluation round. After the third phase the model of rooms was ready to put forward to the actual architectural design and to

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CONFERENCE Figure 1. A multi-professional group in CAVE commenting virtual model.

start the construction project. Besides all the details to the room models, a lot of valuable information was collected for the construction project (e.g. placement of the rooms, routes, accessories and furniture).

There were almost 250 participants commenting the design models of forthcoming premises in the virtual environment.

The pre-occupancy evaluation was used to get information of the present premises and functions.

The results from pre-occupancy evaluation revealed the problems of the old premises built in 1977. The staff evaluated the premises old-fashionable and crowded. There were shortcomings in lighting, acoustics and ventilation. The space round the patient was insufficient with all the new technology.

There were no possibilities for privacy. Only the safety got good marks. The doors of the unit were closed, unit was small with good visibility, and policies for security actions were familiar.

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The staff participated also workshops to study the forthcoming change in their work. In the first workshop they outlined and reflected on the action of ICU, identified factors to retain and anticipated the changes to collaborative nursing practise. In the second workshop they created new prototypes for action, to be applied when nurses need support and help from colleagues. In the third one they finalised and cleared common policies and visualised guidelines. During the construction phase the staff had possibilities to job rotation to orientate the functions of unified wards. This way the work and cooperation in the new unit were facilitated.

Furthermore, there were physical studies and questionnaires of individual thermal sensation for the staff to evaluate individual thermal satisfaction.

In addition, there were measurements of individual skin temperature levels. The calculation to obtain the optimum temperature of rooms was done using the

2018 IFHE CONGRESS

Human Thermal Model (HTM). It was recommended that building service systems should operate so that the indoor temperature value is 23 °C and it should be adjustable by ±3 °C to guarantee individual thermal satisfaction.

The impact of noise was assessed to be a source of stress both for the patients and staff and it has negative effects on patients sleep and recovery.

Sound levels of the old intensive care unit were measured, and the level was all the time over 50 dB and the maximum peaks were over 90 dB. The better acoustics was a clear goal in new premises.

The introduction of new technology demands the staff readiness to exploit it. The use of the Sensors-as-aservice questionnaire for the staff studied what kind of services and technologies they would like to use. The top services were door opening, water tap opening, computer opening and setting the glass-wall opacity.

The top technologies were a smartphone, ID card or access control token, and a wristband or other smart ‘accessory’. Technology that supports the work or increases the safety of patients is needed and it is partly used, but in the future technologies like robots and artificial intelligence will bring new outlook.

From EBD studies multiple advantages of the single patient rooms were obtained. Many of these advantages met the shortcomings discovered in old premises. The Table 1 states the studied benefits of single patient rooms.

Table 1. Benefits of single patient rooms (Ulrich et al, 2008).

The benefits of single patient rooms 

Fewer hospital-acquired infections



Fewer medical errors



Improved patient sleep



Fewer falls



Improved patient privacy and confidentiality



Improved communication



Increased patient satisfaction



Better social support



Fewer patient transfers

So, did we obtain the expertise and tacit knowledge from the staff? The methods we used provided the staff an opportunity to show their expertise and tacit knowledge. There were many issues that designers could not understand without the explanation of the work in intensive care unit. The project was an opportunity for the staff to improve the process of care and LEAN thinking. From each of these methods a lot of information and demands were obtained to

the actual architectural design process of the new intermediate and intensive care unit.

THE CONSTRUCTION PROJECT OF THE NEW ICU There were many requirements to the design of the new intensive and intermediate care unit from the previous EBD studies and from the Evicures project to implement. There were challenges as well. One challenge was the decision of the hospital management before the actual architectural design phase started to unite all the intensive and intermediate care to this new unit. There were research results showing that this size of the central hospital benefits from unification, because the wide expertise of the staff can be utilised efficiently, and the quality and the results of care improve. The intensive care unit, the neurological intermediate care unit, the coronary care unit and the gastrosurgical observation unit formed one united intensive and intermediate care unit. Also, the Interventional Cardiac unit was included to plans with six observation beds.

The second challenge was whether all the rooms should be single rooms because the original place for new unit was not big enough. Single patient rooms and the number of rooms were held out and negotiation of new extension for design started. The new ICU includes 24 single patient rooms for intensive and intermediate care patients. The layout of the new unit forms of refurbishment of an old ward with two extensions. The area of new unit is 2400 square meters and partly situated in two floors. The actual new ICU is situated at the same floor, and offices, meeting room and staff cafeteria are situated one floor below.

Figure 2. Patient room’s windows and doors can be changed opaque to provide privacy.

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FEATURE ARTICLES

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2018 IFHE CONGRESS

In order to provide good visibility, the walls between patient rooms and the doors were made of glass.

To maintain the privacy of patients the electric glass windows can be changed opaque within seconds.

Nurse station provide good visibility to patient rooms too (Figure 2).

All the rooms are standardised, and mobile cabinets have the same medical equipment.

Adequate space around the bed, ceiling supply system, conveniently located sinks and hand disinfection dispensers, and ceiling lifts ease the work of the staff (Figure 3). In all patient rooms dialysis is available.

Figure 3. All the patient rooms are standardised.

Figure 4. Naturethemed photographs are showing local scenes.

Figure 5. The display terminals of the smart control centre.

The requirements of natural light and windows were impossible to implement in all the rooms. All the patient rooms provide dynamic lighting to support circadian rhythm, which is important to patients. As well they have naturethemed photographs on the walls (figure 4).

Special attention has been paid to acoustics in the new unit and acoustics is evaluated excellent. The observation and the monitoring of patients are very valuable tools for nurses and doctors and they were supported many ways. You can lock the doors partly open to hear better the patient if it is necessary. Staying by the bedside is not always possible, but technological innovations like alert systems transfer information.

Alerts from the monitoring devices are automatically directed to smartphones. The display terminals of the smart control centre show the shift-leader the situation in all the patient rooms (figure 5) and ease the supervision of the unit.

Besides technological innovations the new layout of the ICU is very crucial. The layout must be designed so that it minimises the steps of the nurses. The rooms were divided in four modules, six beds in

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Figure 6. The new unit has smart medicine cabinets.

each. All the modules have their own office and small supplies.

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There were many other technological innovations. The doors of patient rooms can be opened fully, partly or locked open. These functions operate without requiring touch. Temperature control implemented as well to give the staff the possibility to adjust the temperature.

To support safe medical treatment the new unit has the first smart medicine cabinets (electronical) in the Seinäjoki Central Hospital (figure 6).

DISCUSSION During the Evicures project only patient rooms, nurse station and bathroom were designed in virtual environment. There were discussions in virtual environment to design the whole unit virtually.

Technically it would have been possible, but it was impossible due to lack of time and money in this project. The chosen rooms were crucial for the design of the new unit, because they were large number of rooms and the size of them must be big enough.

The methods used in the Evicures project supported the staff and facilitated the staff for the big change in working conditions. The use of co-design and virtual models contributed the mutual understanding and made possible to express one’s views by showing the shortages of the virtual model. Thus, the virtual reality (VR) and augmented reality (AR) offer the new technology to health care facility design and also for simulation of processes in the future.

CONCLUSION The new intensive and intermediate care unit and the interventional cardiac unit became operational in April 2018. Prior to start-up there were three months’ time of

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2018 IFHE CONGRESS

practical training for the staff to be familiar with the new unit. All the medical equipment was new, the layout was three times bigger than the old premises, and the new patient data management system was installed at the same time. The start-up needed a lot of training for the staff. Overall the staff was satisfied with the premises with pleasant indoor conditions and because everything was new. The success of the design will be evaluated in autumn 2019 when the post-occupancy evaluation will be conducted to the staff. Also, the statistics of patient care will be carefully studied and compared.

Finland’s biggest reform in health and social services will start at 2021 and the preparations are underway all over Finland. Finland will be divided in 12 emergency service units. The Seinäjoki Central Hospital is one of these twelve extensive round-the-clock emergency service units in Finland after reform. Construction and refurbishments in the Seinäjoki Central Hospital provide good premises to offer health and social services in the future.

The Seinäjoki Central Hospital provides care for 200.000 inhabitants in its area. The new ICU with six intensive care beds and 18 intermediate care (including two isolation rooms) beds it serves best available care in new premises with 10 doctors and 100 other staff members. The unit has about 3200 patients per year, but the number of patients may increase up to 25 percent as it is predicted.

MORE INFORMATION

Figures: Esa Nykänen (1), Samuel Hoisko (2-6)

A user-orientated, evidence-based design project of the first Finnish single room ICU, Results of EVICURES project (2016). VTT Technology 252. https://www.vtt.fi/inf/pdf/technology/2016/T252.pdf https://www.youtube.com/watch?v=TC-wrfP6TQY

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2018 IFHE CONGRESS

ONSITE CLINICAL WASTE MANAGEMENT THE EXPERIENCE

By Peter Atherton

INTRODUCTION

H

ealth Facilities are required by state regulation in Australia to dispose of waste classified as biohazardous in compliant manner.

Hospital incinerators have mostly all been decommissioned in Australia due to tighter emission standards.

In Australia this has led to most health facilities opting for offsite treatment with waste contractors.

This service can be expensive, can involve biohazardous transport over long distances and doesn’t provide the health facility with any control over treatment and disposal.

Onsite treatment alternatives to offsite treatment and to replace onsite incineration have been slow to eventuate due mainly to the requirement for conventional systems to be manually operated and other onsite impacts like safety, odour and noise.

The Fiona Stanley Hospital prided itself on innovative design with robots being introduced for hospital services and a cogeneration central power plant to name some of the innovations.

2. C onventional manual onsite biohazardous waste treatment systems

FEATURES AND BENEFITS This case study for the Onsite Clinical Waste Management System installed at the new Fiona Stanley Hospital, Perth Western Australia includes the following unique and innovative features and benefits researched and developed over a long period by AWS Clinical Waste who have for 30 years successfully provided biohazardous waste treatment systems: 1. The System has the technical innovation of agitating the waste suspended in water 2. The need for manual processes required of the conventional steam sterilising system of placing a probe in the centre of the waste load and lining the autoclave waste containers to stop waste plastics sticking were eliminated by the above innovation 3. Bins are processed onsite, do not go offsite and thereby eliminate the possibility of bin returning from offsite with contamination from other hospitals

The new innovative AWS totally automated and fully enclosed onsite biohazardous waste treatment system fitted this design model and was adopted by the hospital.

INNOVATION The Onsite Clinical Waste Management System at Fiona Stanley Hospital is a unique, innovative totally automated biohazardous waste treatment system based on steam sterilisation that aims to overcome current biohazardous waste management issues and improve infection control in hospitals when compared to the traditional methods of: 1. Transporting untreated biohazardous waste offsite

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4. The process is automated and enclosed and therefore eliminates the possibility of contamination and physical risk to operators, hospital staff and the general public

UNLOADING

5. B ins treated are automatically recorded and stored in the Cloud giving detailed documentation of effective treatment cycles 6. E ffective treatment and instrumentation is NATA certified with annual testing backed up by monthly Biological Indicator testing

INNOVATION AND ONSITE ISSUES Being a new and innovative onsite System there have been some issues including: 1. C ommunication and training of Client staff in fully utilising all the benefits of the System 2. I ntegration into the hospital waste management arrangements with regard to segregation of untreated waste delivered to the Onsite Clinical Waste Management System (the future is robot delivery and loading) 3. I ntegration into the waste industry with regard to disposal (the future is recycling of the treated waste) 4. T raining of System supplier staff in the Technical Support of the System (vital for reliable operation and to avoid expensive downtime) 5. Documentation for onsite Client procedures 6. Onsite safety documentation LOADING

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As with all new and innovative System installations new ideas come from the experience and are incorporated into future installations (refer to animation above with its new features)

COST CONSIDERATIONS A new innovative onsite clinical waste treatment System such as this can cost more upfront than conventional onsite systems and offsite treatment However, rather than looking solely at upfront cost Clients should evaluate their options by including the higher cost of conventional systems including: 1. The higher risk of manual operation 2. Risks associated with disposing of waste without satisfactory treatment documentation Sample first page

2018 IFHE CONGRESS

3. bin returning from offsite treatment with risk of contamination from other hospitals

Introduction of total automation allowed full enclosure of the treatment area.

4. e scalating prices of offsite treatment over time whereas the onsite System costs are locked in for a longer term

All this led to a safe low impact automatic onsite waste treatment System at a new large innovative hospital.

SITE DOCUMENTATION

The following problems associated with offsite treatment were solved by introducing this onsite System:

Site Documentation - Site Procedure Being located on the Clients premises it is necessary to follow their procedures for carrying out work onsite (Technical Support of the Onsite System).

Much time and effort could be taken out of this procedure if it were to be an electronic procedure that could be carried out online.

Site Documentation – JSEA Safety for the Technical Support staff, Client staff and the general public is essential and the Client requires a JSEA for all Technical Support work which is also requested by the Client, developed by the onsite System supplier to the Clients format and approved by the Client.

The document is periodically reviewed.

This document would benefit from being online plus being interactive on the System subcontractors mobile devices.

Site Documentation – SWMS The JSEA is supported by a more overarching Safe Work Method Statement (SWMS) which is also requested by the Client, developed by the onsite System supplier to the Clients format and approved by the Client.

1. b ins are processed onsite, do not go offsite and thereby eliminates the risk of the possibility of bin returning from offsite with contamination from other hospitals 2. b ins treated are automatically recorded and stored in the Cloud giving detailed documentation of NATA certified effective treatment cycles eliminating the risk of disposal of waste not treated effectively or recorded 3. e scalating prices of offsite treatment over time are eliminated Thereby the implementation of this safer, more effective and automatic onsite System developed over time and introduced at the Fiona Stanley Hospital has been operating successfully under a Client and Supplier safety regime and technical support agreement for three years and has addressed issues with innovation and onsite procedures such as safety documentation.

Energy for the process ideally comes from waste heat from onsite cogeneration or renewable energy (neither yet implemented by this Client).

The document is periodically reviewed.

Again, this document would benefit from being online plus being interactive on the System subcontractors mobile devices.

IN SUMMARY Problems associated with conventional downward displacement waste sterilisers requiring manual processes of placing a probe in the centre of the waste load and lining the autoclave waste containers to stop waste plastics sticking were solved by introducing this new onsite System with the technical innovation of agitating the waste suspended in water.

Elimination of the above manual processes enabled implementation of total automation

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FEATURE ARTICLES

INDEPENDENT SECURITY AUDIT

By Simon Hensworth BSc (Security Science) ICCP (Advanced) How do you know if your security is effective? Do those responsible for providing your security effectively manage your security risk? Is the security of your assets of concern to those who maintain your security arrangements or is it just another job? If these questions instil even the slightest of doubt about the effectiveness of your security then please read on.

M

any organisations outsource the security function to external contractors. This can be a way to minimise permanent employed staff and reduce costs but it also has the potential to degrade the effectiveness of security in a number of ways. The following sections outline a few.

DEDICATION OF PERSONNEL Those at the coal-face of operational security such as security officers, if outsourced, do not directly work for you. Therefore there can be outside factors that motivate their performance. If there is an issue with the level of service provided, rather than losing their employment, they may simply be moved to another client with little real impact to them personally. This may have an impact on their motivation and loyalty, which are important factors for those given the responsibility of managing your security risk.

LACK OF RISK MANAGEMENT Organisations can sometimes assume that a security contractor is providing effective security that will address relevant security risks. If the contractor is technically based, such as an Alarm, Access or CCTV technician they may not get involved in security risk management at all. Their primary role may be to ensure the electronic security systems are functioning.

It is very different to ensure that the security systems are effectively managing the organisation’s security risk.

Contractors can often assume that a client is happy with the level of security provided if they are not informed of issues or require improvements by the client. These assumptions can lead to a situation where each party (contractor and client) assumes that security risk is being managed by the other, but in fact is not being managed by either.

If a rare but significant security risk is one day realised, the impact generally only affects the organisation.

There is generally no impact on the contractor other than the potential to sell further products/services following a raised perception of risk.

INCENTIVES IN SECURITY’S LACK OF PERFORMANCE Whilst most security service providers are upstanding citizens with a genuine interest in providing top level service, it should be noted that some may see a lack of security performance as a way to sell more of their products/services. If their performance (or lack of performance) results in security failures that appear to be outside of their control they may end up selling their client more security.

LACK OF DOCUMENTATION IN ORDER TO BUILD RELIANCE When security is outsourced, contractors can sometimes limit the level of documentation on security systems as a way to maintain their control of the facility and make it difficult for a competing contractor to replace them. The contractor can often become the only one who knows anything about the security systems that are managing the organisation’s security arrangements. This can build a reliance on the contractor to make even the most simplest of changes to the system. This can be exacerbated by contractors who deliberately withhold information and/or documentation regarding security systems in order to develop a position of total dependence.

EXTERNAL SECURITY EXPERTISE AND KNOWLEDGE When knowledge of the organisation’s security only resides outside the organisation, an organisation can lose sight of whether security arrangements are effective, efficient, or even operational. This can

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make security risk management very difficult for the organisation.

INDEPENDENT SECURITY AUDIT The above issues can be overcome by either employing the security function internally within the organisation, retaining a limited internal security role to oversee and manage contractors such as a knowledgeable fulltime Security Manager, or ensuring a sufficient independent security audit is carried out to verify the effectiveness of security service and performance.

INDEPENDENT SECURITY RISK ASSESSMENT If it cannot be conducted internally, an independent security risk assessment can be conducted. Even though independent, the security risk assessment will rely heavily on input and involvement by personal within the organisation who can provide details regarding organisational risk criteria, operations, criticality of assets, potential threats and vulnerabilities and their likely impacts. An independent security risk assessment can provide advantages over an internal assessment due to an external perspective which may bring fresh ideas and solutions to the process.

CONTRACTUAL CONTROLS Elements of an independent security audit should be incorporated into contractual documentation.

For example, when new security systems need to be implemented, the scope of work for the project should be clearly documented and stipulate requirements for deliverables which assist in auditing security and the contractor’s performance. This may include the provision of As Constructed documentation, independent inspections by the project Superintendent during testing and commissioning, and final inspections prior to the end of defects liability.

VERIFICATION OF INSTALLATIONS Following the installation of a security system, independent verification of the conformance of the installation to the contractual documentation is vital.

Without independent verification contractors can miss details or even intentionally underperform to save costs.

During such inspections it is not uncommon to find omissions such as installation of products that are inferior to those specified and priced, failure to correctly configure security resulting in ineffective performance, failure to program systems to client’s requirements or even missing out whole elements from the scope of work.

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VERIFICATION OF DOCUMENTATION Review of As Constructed documentation and manuals as part of an installation of new systems is equally important as physical inspections.

Documentation often misses the detail required for effective ongoing management of systems and should be carefully assessed to ensure accuracy and suitable level of detail.

SCHEDULED AUDITS Scheduled audits of security arrangements should also be considered to assess effectiveness and highlight areas where improvements may be required. This can be very important if such a review has not been conducted for a number of years and the security function has not been critically assessed as to whether it is effectively managing the organisations security risk.

SUMMARY While outsourcing can appear to be the simplest and cheapest option to maintain a security function, the reduction in security risk management, service and performance should be factored into the equation.

Organisations need to be mindful that managing security risk should be in the hands of those who have a personal interest in the organisation’s risk minimisation, and not managed by a party who could benefit from a security failure. Depending on the risk profile of the organisation the right balance of inhouse security, outsourcing and independent testing needs to be carefully weighed and decided.

NOTE: The issues discussed in this publication are of a general nature for the purposes of increasing Security Awareness throughout industry and the wider community. It is recommended that organisations undertake their own security risk assessments in order to determine the most appropriate action and arrangements to minimise loss and maximise their security performance.

ABOUT THE AUTHOR Simon is a Senior Security Professional with Security Consulting Group – SCG. Simon has over 13 years’ experience in providing security advice, design and consultancy services for a range of clients with major assets in Western Australia. He is a registered Security Professional on the Australasian Security Professionals Registry and one of 10 CPTED practitioners certified by the International Crime Prevention Through Environmental Design Association (ICA), worldwide. Simon is involved in all aspects of Security Management, security design and documentation, CPTED and promoting Security Awareness.

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FEATURE ARTICLES

REDUCING HIGH ELECTRICITY BILLS AND BLOOD PRESSURE

By Paul Antony M.Eng. (Elec), Applications Engineer, Power Parameters Pty Ltd

A new energy and electrical parameters monitoring system, adaptable to switchboards and distribution boards is described to monitor excessive electrical energy consumption, incipient electrical problems such as imbalance cause by partially shorted motor stator coils, excessive compressor energy use, condenser fan failure, and a host of situations including suspicious energy use in certain circuits. The system described, provides opportunities to save on electricity consumption and to flag the onset of problems that, if unchecked, can lead to catastrophic breakdowns and high blood pressure for maintenance personnel.

T

he electrical energy tariffs for hospitals are generally lower than for commercial operations.

However, reducing energy consumption is equally important if not more so than for organisations that can lift prices to cover increased costs.

Hospital electricity bills are provided on unbundled basis with the cost of megawatt-hours shown separately from network costs and demand costs.

The latter can be based on kVA or kW. Networks are going over to kVA monthly charges for customers with annual consumption below 600 megawatt-hours because the additional losses in the networks through poor power factor are not part of the network costs that are either included in the energy tariff or shown separately.

SAVING ON ELECTRICITY REQUIRES ENGINEERING SOLUTIONS Saving on electricity is a manifold process with ‘walk throughs’, building insulation reviews, needless lighting identification, etc.—and, very much the subject here, attention to the electrical plant including boilers, autoclaves, pumps, air conditioning, lifts, as well as lighting. Keeping a tab on all the electrical gear in a hospital is a tough task, but there is monitoring equipment that can make those tasks practicable.

The need for monitoring is obvious: many problems in electrical plant initially show up by way of increased energy consumption, imbalance in phases, excessive

inrush current, etc. presaging failure at some future point, but until then, often unnecessarily costing more in electricity.

In addition to extra energy cost attributable to plant malfunction, there is the blood pressure of engineering personnel—and the cost of maintenance. The blood pressure factor is critical as are the lives of patients when critical plant fails catastrophically, and maintenance crews are put under tremendous pressure to restore service. Regular monitoring and reporting of anomalies reduces these pressures enormously.

EFFECTIVE, LOW-FOOTPRINT MONITORING ADAPTABLE TO CIRCUIT BREAKERS Continuous monitoring of current, imbalance, voltage, power and power factor, once installed, provides for the spotting of excessive energy use and incipient failure, particularly for motors. Combining such a monitoring system with a computer-generated exceptions report provides plant engineers with invaluable data as to the condition of plant.

It is sometimes argued that regular plant maintenance avoids the use of monitoring but this is not a valid argument. Condition monitoring provides the basis for inspecting plant that is showing up in exception reports and may be headed for failure in the short

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term, rather than shutting down plant in order to facilitate inspection on some arbitrary time table that may well miss the start of a problem.

The practical problem with monitoring current, imbalance, voltage, power and power factor, quite apart from the cost of instrumentation, is where to install instrumentation and how to interface it to a reporting system. Installation requiring switchboard space, current transformers, and instrumentation power makes for more capital expense. To provide practical solutions there are now switchboard monitoring systems that attach to individual circuit breakers. They take up little additional board real estate and obviously require connection via data busses to data collection and reporting computers.

These monitoring devices have come about through the development of the (industrial) internet of things, the IIoT.

A MONITORING SYSTEMS AVAILABLE THROUGH DEVELOPMENTS IN IIoT There are, however, some impediments in that some systems only attach to certain make circuit breakers, and others do not provide complete data. The experience with IIoT is at a very sophisticated level, and has given rise for the to the development of highly expandable, modular monitoring systems that are adaptable to all manner of circuit breaker makes, and provides current, imbalance, voltage, power and power factor information.

A typical example is an electrical measuring and monitoring system expandable to over 100 nodes, or individual circuits permitting comprehensive energy, power, reactive power, apparent power, voltage, and current monitoring system that readily integrates with control hierarchies such as Ethernet communication protocols. Such a complete set of electrical parameters available gives access to sophisticated control and condition monitoring possibilities.

Fig 1, a distribution board fitted with energy monitoring (outlined in the red box)

As shown in the illustration sensors are mounted directly in distribution boards as shown in the photograph (fig 1) of a typical installation. Mounted on top of circuit breakers, the options include modules that monitor three phase and single phase wires. A generic basic layout of the analysis scheme is shown in fig 2.

The data from the individual current transformer transmitters is processed by a communication module with Ethernet connectivity.

Fig 2 The basic operating structure of a switchboard monitoring system

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FEATURE ARTICLES

In terms of the monitoring task, it is important to make this comprehensive. Here again some systems available limit the monitoring task to current, or current and voltage.

Computation of individual phase powers P3 = V3 I3 cos φ3 P4 = V4 I4 cos φ4 P5 = V5 I5 cos φ5 Calculations required in a monitoring system W = P3 + P4 + P5

USEFUL POWER

POWER FACTOR (cos φ)

S = V3 I3 + V4 I4 + V5 I5 w cos φ = s

REACTIVE POWER

kVAr = √S2 – W2

APPARENT POWER

In addition to phase voltage and line current, the individual phase angles should be taken into account, and real power calculated for each monitored line.

In the case of a three-phase motor, whether star or delta-wired, total real power consumed should be available, as well as apparent power, overall power factor and reactive power.

As will be evident, a comprehensive monitoring program is provided, capable of signalling over-rated motors by virtue of low power factor, unbalanced operation because of line current discrepancies, significant load variation, as well as suspicious over or under consumption in mission-critical circuits.

The scope of applications of this innovative energy and power measurement system is extremely wide. In hospital environments, monitoring of equipment such as positive air pressure pumps for operating theatres, isolation wards and other areas where contamination must be avoided, and critical refrigeration plant for biological and pathology material, as well as climate control, standby power supplies, sterilising apparatus, fire control and emergency lighting, etc. is essential.

The measurements made by a circuit breaker monitoring system can be sent via Ethernet to a data management computer. Suitable software packages are commercially available to store data in open system data SQL base for easy access. Choosing appropriate software provides a ready energy consumption trail and detailed electrical condition information.

OUR COLUMNLESS FLOOR BED IS FINALLY HERE! MAIN FEATURES

Smooth rounded corners for added safety Shorter overall

• NO BULKY END COLUMNS to facilitate external length full view of patient and room environment.

• ONLY 130 mm HIGH to the top of platform when lowered • OH&S FRIENDLY 75mm CASTORS tucked under the bed frame for safety.

No tripping hazards • German made HIGH QUALITY ‘DEWERT’ ELECTRONICS • Sealed bed head and foot board for infection control • MANUFACTURED IN AUSTRALIA to AS/NZS3200.2.38.2007 & IEC60601-2-52. TGA Registered.

Optional side rails, self help pole and IV pole

Optional Trendelenberg tilt in the sitting position

Standard head and foot boards (pictured in optional woodgrain)

MIN HEIGH ONLY 130 MM to the top of platform when lowered

Light weight slimline construction whilst maintaining maximum strength

8 x 75 mm castors for easy maneuvering

Support those who support you

Australian made toughness and reliability Unique Steel Design Pty. Ltd., 17 Moon St, Moolap VIC 3224

(03) 5248 8369 | www.uniquecare.com.au

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FEATURE ARTICLES

Hear what people have to say about Emprevo

“Emprevo has been one of the simplest system implementations that I have been involved in. After 3 weeks our employees and business are already seeing the benefits with over 4000 people taking advantage of Emprevo.”

Glen Hurley, COO, Allity

“Staff replacement has always been difficult but since the introduction of Emprevo we spend less time on the phones and our staff have more time doing what they do best, caring for our residents.”

Kerri Rivett, CEO, Shepparton Villages

“Our tech savvy, and not so tech savvy, staff embraced it with shifts being quickly snapped up. Coupled with some robust systems to ensure fairness, in particular around planned leave, Emprevo has been a great success.”

Janet Moore , COO, Yallambee Aged Care

“This is a user friendly shift management system. Managers are able to fill shifts with just a few clicks. Staff replacement has become much more efficient since the implementation of Emprevo.”

Selina Lie, Human Resources Manager, Thompson Health Care

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Care Systems and Emprevo deliver a true end-to-end solution FEATURE ARTICLES

A simple, easy solution for managing your business, setting rosters and ensuring shifts are filled!

Integrated Rostering and Automated Shift Filling Solution We have solved the frustrations for managers dealing with multiple systems that don’t talk to each other. Care Systems and Emprevo have developed a seamless integration that will ensure you save time, money and frustration across your business.

Find out more Interested in improving your business and reducing costs?

Contact Paul Johnston at Care Systems to find out more and get started. paul.johnston@caresystems.com.au Mobile: 0431 396 399

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NEWS

100MM DEEP, HIGH EFFICIENCY FILTRATION FOR RESTRICTED SPACES Airepure BLU Hybrid 100 series filters are a new generation of rigid, formed hybrid media air filters with excellent contaminant holding capacities and pressure resistance – particularly for high efficiency F8/F9 grades.

For more information on the Airepure BLU Hybrid 100 series, please visit www.airepure.com.au or call 1300 886 353

Rated at F6 to F9 efficiencies (MERV 11-MERV 15) and UL 900 certified, these 100mm deep filters are a perfect final filter option for hospital applications with limited space for higher grade filtration or where UL certified filters may be required.

Suitable applications may include hospital bed bays, staff stations and location specific FCU’s.

Featuring a unique 3-layer filter media design that effectively triples the filter surface area, Airepure BLU Hybrid 100 series filters provide high dust holding capacity and low pressure drop resulting in longer filter life and lower energy usage.

Suitable for use in all areas, including humid, tropical areas and coastal areas, Airepure BLU Hybrid filter media is synthetic with humidity and microbial resistant properties.

THE MARKET LEADING POOL WATER TESTING METER, WATERLINK SPIN TOUCH NOW TESTS ALL TYPES OF WATER: INDUSTRIAL WATER, POTABLE, POOL AND SPA LaMotte have developed the most advanced system for the precise use of wet chemistry ever. Water analysis no longer has to rely on time consuming tests and clean-up procedures. It’s almost idiot-proof, with no vials to fill, no prep time or guessing involved. The test results are available quickly and with the release of the testing of potable and industrial water is now made just as easy as pool and spa water.

All the user has to do is fill a sealed reagent disc which contains the precise amount of reagent needed to run a complete series of tests. The user places the disc in the meter, taps “start” and all results are shown via the touch screen. All that is needed is less than 3 ml of water and the vital tests are done automatically—in just 60 seconds!

With a built in lithium ion battery, there’s no need for a power connection, either, The meter is truly portable for out in the field

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Test results are displayed on the touch screen, which can also be transferred via Bluetooth to mobile apps and then to WaterLink Solutions or DataMate Web software for instant analysis, with step-by-step treatment instructions supplied.

Test history is then stored via Cloud database for real time monitoring.

Reagent discs have up to 11 test parameters per disc.

Parameters cover Chlorine/Bromine, Chlorine/Bromine plus Phosphate, Chlorine/Bromine plus Borate and Biguanide plus Borate, as well as pH, total alkalinity, total hardness, Cyanuric Acid, Copper and Iron. The new industrial discs also test for total iron, ferrous and ferric iron, plus more test follow in the very near future.

REGULARS

Port Douglas

CAIRNS MACKAY

BRISBANE Armidale

South Pacific Laundry specialises in the provision of quality linen and supplies for the customer service, hospitality and healthcare industries

Coffs Harbour

PERTH

PORT MACQUARIE Newcastle

ADELAIDE

SYDNEY

ALBURY Colac

Geelong

MELBOURNE

Currently, the South Pacific Group is establishing a strong network of modern laundries across Victoria, New South Wales, Queensland, Western Australia and South Australia with plans for several more facilities up the East Coast of Australia.

The relocation of our Sydney operations to a new larger facility in Bankstown together with the relocation of our Brunswick plant to Broadmeadows will establish South Pacific Laundry as the single largest privately owned laundry in Australia and in the Southern Hemisphere.

Contact Robert Teoh National PR & Marketing P: (03) 9388 5300 M: 0421 716 888 Coverage Australia wide

• A 365 day service to all its clientele with a 24 hour turnaround (depending on location).

Sale

Warrnambool

South Pacific Laundry (SPL) has been a provider of commercial laundry and linen services to the hospitality industry in Melbourne for the last 20 years.

SPL provides:

Pricing Information Contact supplier direct Delivery Free daily delivery within 25km city metropolitan areas Minimum Order Contact supplier direct

• A leading edge technology in RFID to assist housekeeping and managerial staff in time reduction and efficiency.

• Dedicated account managers and experienced support staff who are available 7 days a week.

• A dedicated software design package and centralised billing system enables seamless transactions, paperless and customised reports.

• Delivery rationalisation systems, providing and streamlining efficient delivery routes which will reduce the company’s carbon footprint.

• Building of partnerships and sharing benefits with the customers from savings made through its constant laundry process innovations and group purchasing power of linen products.

• Dry cleaning and uniform cleaning services.

• Provision and supplying of corporate uniforms/work wears and customised hotel room amenities.

Full Contact Information South Pacific Laundry 9-23 King William St Broadmeadows VIC 3047 P: (03) 9388 5300 F: (03) 9387 2399

*Melbourne, Albury only

E: customerservice@southpacificlaundry.com.au robert.teoh@southpacificlaundry.com.au

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AH-CSG Clean Steam Generator

■ Clean Steam to AS/NZS 4187:2014 4 ■ Clean Steam operational pressure of 3 to 5 barg ■ Delivers up to 300kg/hr of clean steam ■ Typically supplying up to 3 sterilisers ■ Efficient compact design ■ On-board water degassing and heating ■ Designed and built in Australia

Spirax Sarco offers installation and turnkey solutions available for clean steam generation including clean steam distribution systems, plant steam modifications and steam quality testing to AS/NZS 4187:2014. Providing tailored maintenance and service agreements for your business. Contact us for more information on the AH-CSG. 

1300 774729 (SPIRAX)



info@au.spiraxsarco.com



spiraxsarco.com/global/au