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Aligning sustainability with patient care Managing buildings for climate change Inspecting hospital building envelopes PP 100010900

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IHEA NATIONAL BOARD OF DIRECTORS National President Darren Green National Immediate Past President Mitch Cadden National Vice President Brett Petherbridge National Treasurer Peter Easson (State Elected – WA) National Secretary/ CHCFM Coordinator Scott Wells (State Elected – QLD) Membership Registrar Alex Mair (Nationally Elected) Standards Coordinator Steve Ball (Nationally Elected) Asset Mark Coordinator Mark Stokoe (Nationally Elected) Director Rod Woodford (State Elected Vic/Tas) Communication Darryl Pitcher Secretariat/Website Administrator Heidi Moon Finance/Membership Jeff Little Editorial Committee Mitch Cadden, Darryl Pitcher, Scott Wells




National President’s Message


CEO’s Message

11 State Branch Reports


20 IHEA Conference 2015


22  Cooling coil cleaning using germicidal UV technology 29 Air filtration for critical care environments

36 How safe is your Building Management System from a cyber attack? 38  Energy savings obtained using the online automatic tube cleaning system (ATCS) in HVAC systems 46 Designing for hospital efficiency 51 Aligning sustainability with patient care 55 Architectural leaders focus on efficiency, safety and technology

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66 Managing resilient buildings for a changing climate

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32 Maximising performance of hospital clinical alarm

IHEA MISSION STATEMENT To support members and industry stakeholders to achieve best practice health engineering in sustainable public and private healthcare sectors.



61 HVAC selection for health care facilities 64 Emergency Procedures – Part 1

68 Emergency planning and the question of indemnity


70 Hospital construction success factors 74 Inspecting hospital building envelopes 78 Enabling technologies beyond 2015


80 Product news


Visit the Institute of Hospital Engineering online by visiting or scanning here ➞

The views expressed in this publication are not necessarily those of the Institute of Hospital 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.





National President’s Message INTRODUCTION


elcome all to this edition of “The Australian Hospital Engineer” another quality, interesting and technically sound journal aimed at keeping members informed of new and impending challenges and technology in our healthcare engineering space. Writing this Report comes with mixed emotions as my two year tenure closes I formally hand over to our incoming National President Mr Brett Petherbridge at the Perth Annual General Meeting in September.

NEW CEO FOR THE IHEA It is with great pleasure I recently announced to our members that recruitment processes for the new IHEA Chief Executive Officer have concluded and Ms Karen Taylor has joined our Executive team. This appointment will now set a solid foundation for progressing the important business of the IHEA which has been in abeyance during the period of vacancy. As stated previously I would also take this opportunity to more broadly thank the Board and our former CEO Jim Cozens, all of which assisted me to maintain a reasonable level of activity since late last year.

Above is an image of Karen and myself officially signing the I.H.E.A. CEO Contract.

Your IHEA National Board Members




Darren Green

National President

Brett Petherbridge

Vice President (VP)

Mitch Cadden

Immediate Past President (IPP)

Peter Easson

National Treasurer

Scott Wells

National Secretary

Executive Committee

Alex Mair

Membership Registrar

Karen Taylor

Chief Executive Officer

Mark Stokoe


Darryl Pitcher

Director and IFHE Council Executive

Steve Ball


Rod Woodford



JUNE BOARD PROCEEDINGS AND SUMMARY OF KEY ACTIVITY • The June Board meeting was kindly hosted at the Royal Melbourne Hospital, a special thanks to Michael McCambridge for his assistance with these arrangements. • Planning for the 2018 International Federation of Hospital Engineering (IFHE) Congress has commenced and the sub-committee are currently conducting tender review for engagement of a Professional Conference Organiser (PCO). The Organising committee was also confirmed with Brett Petherbridge as Convener, THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2015


Darryl Pitcher, Peter Easson, and myself as the initial members, as we move into the process the committee will include the CEO and 2 or 3 other members as the workload increases. • The May Finance Report was presented to the Board by our Treasurer (Peter Easson) with a good result reported for the period similar to the previous. It was however noted that there is a need to focus on membership growth born from improved Member’s services. • The Board endorsed entering into another 12 month contract from December 2015 with “The Australian Hospital Engineer” publishers, Adbourne. • The draft Risk Register, Delegations Manual, Travel, Social Functions and Reimbursement Policies were reviewed and endorsed by the Board for progress. • The Board was presented a revised membership framework and fee structure and these were endorsed to be considered at the Perth AGM. • A planning update on the 2015 WA National Conference (September 9 -11) was presented by Mark Stokoe and endorsed by the Board with a commendation on the advanced preparation to date. • Early planning for the following 2016 SA National Conference was also presented by Darryl Pitcher.

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• Darryl Pitcher provided the Board an update on the upgrade of our website; our external consultancy now fully engaged with the required updates and new functions including financial transaction capability which is hoped to be completed prior to the 2015/16 subscriptions.

SUMMARY In closing, I have thoroughly enjoyed my time as National President and believe I have personally grown from the assignment. I now move into the role of Immediate Past President and know the business interests of the IHEA are in the professional and enthusiastic hands of Brett and Karen both of whom will serve with the Board and Branch Committees of management, for the collective betterment of our organisation. “I can’t change the direction of the wind, but I can adjust my sails to always reach my destination.”

Kind regards, Darren Green M.I.H.E.A., C.H.C.F.M. IHEA National President

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• Reports on AssetMark, ANZEX, Standards, and Membership were all tabled as read.


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CEO’s Message

Successful associations facilitate communication between themselves and between members to enable the creation of relationships that increase the ability of members to create value for themselves and others” (Belinda Moore SMS).

and thrive on ensuring these contribute to the achievement of organisational objectives. I have a dedication to excellence and the creation and maintenance of positive relationships first and foremost.

That’s how I see myself and the IHEA. Facilitators of communication, conversations and meaningful connections between and for our members. As I write this I have been in the CEO role for 3 weeks and am genuinely heartened by the level of commitment and passion I have witnessed from the National Board. I have also been overwhelmed with welcome emails from branches and members. Communication and engagement is absolutely alive and well at the IHEA and I thank you all for such a warm welcome! This level of engagement and connection, combined with the great foundations already established over many decades, provides an outstanding environment in which together we can take your association to the next level.

Associations need to be instigators of meaningful conversations and connect members in a way that provides positive outcomes. In conjunction with Board and Branch members my aim is to encourage forward thinking and clearly articulate a strategic vision that enables positive, appropriate change within the IHEA.

As members you all expect an outcome from your participation in the IHEA, a return on your investment if you like. I am keen, in conjunction with the Board and Branches, to understand your expectations in order to articulate an increasing value from your membership. It is already clear to me that the value placed on members and the desire to provide an outstanding service for them is central to the IHEA philosophy.

Membership organisations face significant generational, cultural and economic challenges over the coming decade. Those which choose not to innovate and adapt will decline into obscurity. Having just arrived at the IHEA it is already very clear that we are well placed to not just tackle these challenges but to grow and prosper from. I look forward to communicating and engaging with each of you. Karen Taylor CEO

I have had a successful senior management career, working in diverse environments and with multi-disciplinary teams. My career has been almost entirely in the not for profit sector including membership organisations, exposing me to the key strategic and operational challenges. I have a passion for the development and implementation of genuinely effective strategies, plans, policies and procedures,





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State Branch Reports WA BRANCH REPORT – CRAIG AGGETT, BRANCH PRESIDENT Branch Meeting May 2015, Wood & Grieve Engineers combined branch meeting was held with the Australian Institute of Hotel Engineering (AIHE) association at the CBD offices of Wood and Grieve Engineers, as both Institutes share many deliverable commonalities across their respective industries. These meetings present a notable opportunity to network and share knowledge for all the members’ mutual benefit.


As the evenings sponsor, three of Wood & Grieve’s key Engineers presented to the 55 members their individual specialist fields, comprising the appealing topics of Sustainability, Acoustics and Hydraulics coupled with case studies. Wood and Grieve Engineers is a national firm specialising in multi-discipline engineering ranging from civil to acoustics and delivering to a range of market sectors such as health, aged care, retail, sports, culture and the arts.

Load Shedding, Power Management System etc, and over 40,000 graphical user interface pages have been individually created covering the campus wide Energy Management System, with over 1,100 meters monitoring site utilities such as gas, water and electricity usage. Also, Stephen highlighted the Security System comprises of some 1,600 card readers, 1400 monitored doors, and 460 HD IP CCTV cameras with security integration to the 49 lifts, again all devices being available to be viewed on the IELVS dashboards. Matthew Wood, the ICT Business Applications Manager took the floor next to discuss and present the Agility Software platform, performing works management at the Hospital, with key electronic automatic job deployment to the onsite staff and KPI management to maintain the contractual operational conditions for the facility.

Branch Meeting June 2015, Fiona Stanley Hospital Host John Pereira warmly greeted the 45 members to the breakfast meeting at the recently opened 783 bed Fiona Stanley Hospital. John is the Serco led Estates FM Maintenance Manager overseeing the daily running of the largest Government Health Infrastructure project ever in Western Australia, having an equivalent foot print of four city blocks and a construction price tag of $2 Billion. The State Government has engaged Serco to manage 23 services on behalf of the tertiary Hospital and Serco employ over 1000 staff members to achieve their contract service commitments. As well as delivering comprehensive clinical services, the Hospital is also a leader in research and education having the most advanced medical equipment and state-of-the-art information and communications technology.

Dispatched AGV with a ward-bound food trolley

To support WA Health’s vision of making the Hospital a leader in clinical care, Serco has created services to provide patients with an exceptional hospital experience. These include procurement of all goods and services, engineering, building maintenance, security, grounds maintenance, linen, cleaning, catering, managed equipment services, transport and reception services.

Automatic guided vehicles contribute to the control of infection, as they can keep clean and dirty tasks separate. They also help to support an efficiently run hospital as they can be programmed to make deliveries to wards at the most appropriate times for individual wards and areas.

The Hospital benefits greatly with the introduction and development of an innovative Integrated Extra Low Voltage System (IELVS), operating across the campus and Stephen Brown, the FM Reliability Manager granted the members to an online ‘live’ presentation. The IELVS servers displayed connect to over 150,000 field device points, gathering data from over 65 ELV Systems such as Nurse Call, Medical Gas, Pneumatic Tube, Emergency Lighting,

Automated Guided Vehicles (AGV) 18 automated guided vehicles are used to help staff with routine and heavy lifting tasks, such as the movement of linen, waste and medical supplies throughout the hospital. They complement the work of support services staff and help to reduce the number of occupational health and safety injuries as they move many of the heavy and regularly distributed items.

AGV Recharging Station



STATE BRANCH REPORTS Mr Rishi Wakle Mr Steve Dallas Mr Peter Easson (immediate past Treasurer) Mr Mark Stokoe (immediate past President) The Committee wish to give thanks to both immediate past State President & Treasurer Mr Mark Stokoe and Mr Peter Easson respectively and recognise their invaluable contributions during their service to the WA branch. Also, after 8 years continuous service to the committee, Mr Neil Oliver retired from his role and the CoM wish to express their gratitude and thanks to Neil for his valuable services rendered during this time. The evening was sponsored by Habitat 1 and Shaun Sugars, CEO presented their market strength comprising of architectural, interior design and construction services being offered under the one company structure. The result for their clients is a fast, efficient process that produces an exciting design solution with high quality finished products, on time and on budget. Retired Scottish trio Roy Aitken, Jack Oswald and Frank Woods at Fiona Stanley Hospital

The AGV’s are being used largely in behind-the-scenes service corridors to move supplies throughout the hospital. They use separate service corridors that are out of view of patients, visitors and most staff, helping to maintain an efficient hospital and they cover a collective average distance of 50 Km’s each day. Special General Meeting July 2015, St. John of God Hospital The branch special general meeting, attended by 27 members was called to order by the State Vice President Mr Craig Aggett, who tabled the Presidents Annual Report on behalf of the State President Mr Mark Stokoe and acknowledged the work undertaken by the CoM during the past 12 months. Next, Mr Peter Easson tabled the Branch Treasurers Report and Mr Peter Klymiuk tabled the Branch Secretaries Report. Mr John Doherty was called upon to dissolve the current committee of management members and the results from the election of the new WA branch office bearers and committee of management members for 2015/2016 are as follows: Branch Office Bearers State President

Mr Craig Aggett

State vice President

Mr Greg Truscott

State Treasurer

Mr Rohit Jethro

State Secretary

Mr Peter Klymiuk

Radio Lollipop If you have been involved in Facilities Management for long enough you find events repeating. Such was the case with Jack Oswald in his role as a Staff Induction Guide at the New Children’s Hospital in Perth. Attendees at a recent site visit included representatives from Radio Lollipop. Jack recognised the name of one representative, Hedley Finn, stating he had met him in London in 1982! Hedley was visiting from London in an advisory capacity and was as surprised as Jack to renew their acquaintance. Jack was the Chief Engineer at Princess Margaret Hospital for Children from 1976 until 1992. During the early 80’s he commenced planning the first Radio Lollipop station in Australia. He attended the IFHE International Congress in London in 1982 and took the opportunity to visit Radio Lollipop there, meeting with Hedley at their London headquarters to gain an insight into the operation of the UK-based organisation. Since that time, Radio Lollipop has become a world-wide organisation established in a number of Australian hospitals and around the world. Such an event demonstrates how networking is one of the many benefits of participating in the Institute with long-term friendships being established.

State National Representative Mr Greg Truscott Committee of Management Members Mr Alex Foster Mr Robert Falls Mr Robert Foley Mr John Dransfield



Radio Lollipop Representative Hedley Finn, with PCH Staff Induction Guide, Jack Oswald

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irst I would like to acknowledge and thank the outgoing QLD Branch President Alex Mair for his leadership and services in steering the QLD Branch through some difficult years recently. One of the biggest challenges I see as President of the QLD Branch is the geographic spread of members, and whilst we have many members within a couple of hours of Brisbane, we also have many who are not. The goal going forward is to provide our members with more services, with networking opportunities and Professional Development (PD’s). We have tried through the use of the webinar, but this has been poorly received and the plan is to fully engage our valued country members by having them on the CoM to support the activities further. The newly elected CoM office bearers include country members for Qld Branch and these members are to provide the conduit for having PD’s in regional areas and adding IHEA membership value. Our PD for October will be held in Brisbane at the Pineapple Hotel sponsored by Dulux, followed by Xmas social function and PD at the Greek Club in December. Looking forward in 2016, planning underway for the Annual Country meeting in Toowoomba and planned PD’s for Townsville. Worthy of mention is the great effort by Peter White and conference committee for the IHEA National Conference that was held at the Brisbane Convention and Exhibition Centre in October 2014. From feedback surveys from delegates and sponsors it was a resounding success.

This year the QLD branch conference, themed “Innovation in Facility Management” was held at the Victoria Park Golf Course. The conference was well attended and the major sponsors and exhibitors were very happy with the program. The presentations from industry leader was varied and held the interest of the conference delegates with discussion of the following topics, Fire • Update on AS 1851 and supporting standards • Changes in fire panel design • Setting detector sensitivity and alarm modes • Aged care requirements into the future Oral Health • Building design standards for dental clinics • Dental chairs • Dental Compressed air • Wet and Dry suction Data Capture and management • The need to capture baseline data • What data needs to be captured? • How to hold data Central equipment stores • The advantages and disadvantages of pooling mobile medical equipment • Program space and Support requirements

Elections for positions on the Committee of Management were held at the Queensland Branch Annual General Meeting, Friday 10th July, 2015 at the Victoria Park Golf Club. The elected office bearers as are follows: Position


Nominated by

Nominee Acceptance


Scott Wells

Peter White


Vice President



Peter White

Brett Nickels



Brett Nickels

Peter White


National Board Rep

Alex Mair

Scott Wells


Assistant Secretary

Jeffery Turner

Peter white


Committee No.2

Jason Ward

Peter White


Committee No.3

Mick Ward

Alex Mair


Committee No.4

Kevin Eaton

Peter White


Committee No.5

Stuart Hentshel

Alex Mair


Committee No.6

Cliff Pollock

Alex Mair


Committee No.7

Scott Summerville

Peter White




STATE BRANCH REPORTS SA STATE BRANCH REPORT – PETER FOOTNER, STATE BRANCH PRESIDENT Activities n July 9th the SA Branch was treated to a site visit of the New Royal Adelaide Hospital, currently under construction in the northwestern corner of the city. The South Australian Government is developing the new Royal Adelaide Hospital under the SA Public Private Partnership (PPP) framework. On completion in 2016, it will be the largest, most technologically advanced hospital in South Australia and one of the most advanced in Australia, employing close to 6,000 people and accommodating 85,000 inpatients per year. Upon completion, it is set to be the 3rd most expensive building in the world, costing approximately $2.1 billion AUD.


About a dozen members attended the site tour which included the plant areas, technical suites and recovery areas, ICU and general hospital accommodation areas. The commitment to privacy and infection control is obvious with every in-patient being provided with their own room with ensuite. The patient rooms are arranged in “pods” around a nurses base area. The hospital will boast some radical new ideas on the old department based models of clinical care which are intended to improve efficiency and outcomes for patients.

Committee Members: Darryl Pitcher, Tony Edmunds It was pleasing that the same “crew” have signed up for another year – this continuity will allow us to get cracking on various initiatives and planning for the national conference in SA in October 2016. Membership A number of new and returning memberships were approved in the last quarter and there remain a number of other potential corporate memberships that the Branch executive is continuing to follow up. We look forward to welcoming the Spotless facility managers as members shortly. Spotless as an organisation, being the new FM provider to SA Health sites,are committed to IHEA membership and the AssetMark program. Once these members come on board, we will organise a networking/development session for all SA Branch members.

Following our very successful Water Quality PD earlier in the year, the SA Branch is in the process of refreshing a rolling program of professional development and networking events. The Branch held its AGM on 7 August. Whilst numbers were low it is pleasing to note that a number of our newer corporate members were able to attend. The new Branch Committee of Management was elected, with the following appointments made: State President: Peter Footner Vice President: Mike Frajer Secretary: John Jenner Treasurer: Mike Ellis National Board Nominee: Peter Footner



Actions The Branch committee of management also form up the 2016 National Conference Organising Committee, with additional input from the new IHEA CEO, Karen Taylor and our PCO partner, Iceberg Events. Planning is well underway now and we are confident of developing a thought provoking, rewarding and enjoyable conference. The Branch is also pleased to see the refreshment of the AssetMark program and welcomes the decision to offer new and returning subscription holders a ‘2 years for the price of 1’ deal, enabling participants the capacity to benchmark both the 2013-2014 and 2014-2015 financial years. Together with the improved reporting format and new KPI explanation page, these changes will make it easier to market AssetMark to member and other organisations.



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Formal information and registration pack will be to hand in the coming weeks.

Introduction n behalf of the NSW/ACT Branch I take this opportunity to welcome present the NSW-ACT IHEA 2015 Spring Branch report and acknowledge the continued support of the NSW/ACT IHEA Branch Committee of Management (COM), all Branch members, National Board and our many and varied sponsorship partners.

Members Communications and engagement As part of both State and National directions all NSW/ ACT members should be receiving regular communiques via emails, E-Bulletins, postal notices, journals and the like, if you or someone you are aware of is not receiving these important members updates I encourage you to contact myself, or the branch secretary for assistance.

AFM Online AFM online (NSW Health, Computer Maintenance Management Program) is progressing state wide with training and familiarisation occurring for each Local Health District occurring leading up to rolling the system out through 2015/16.

NSW members recently received detail re the Schneider Online University signup and login via e bulletin and I encourage all to review and continue learning.


Young Hospital has been chosen as one of two early rollout Hospitals in NSW with onsite training to commence very soon.

Summary On behalf of the NSW/ACT IHEA I wish to acknowledge the new committee and look forward to working with them to move forward for the IHEA NSW/ACT Branch with the various initiatives the COM have taken on board to build the branch.

Committee of Management Contact details





Peter Lloyd


0428 699 112


Vice President

Darren Green


0418 238 062

Mal Allen


0467 761 867

Peter Allen


0408 869 953

Helmut Blarr


0411 152 898

Glen Hadfield


0409 780 228

Trevor Stonham


0414 899 363

Brett Petherbridge


(0418 683 559

Jon Gowdy


02 95158041

Steve Dewar


0428 119 421

End of year function,

NSW/ACT BRANCH END OF YEAR CONFERENCE Institute of Hospital Engineering Australia Saturday 24th & Sunday 25th October 2015 Berida Manor, 6 David Street, Bowral NSW The NSW/ACT Branch of the Institute of Hospital Engineering Australia (IHEA) will be holding an End of Year Conference, at Berida Manor, Bowral on Saturday 24th and Sunday 25th October, 2015. I would ask that you save this date in your diaries and attend if possible, this will be a great opportunity for catching up, networking and discussing the year’s events in NSW-ACT Hospital Engineering. I also request that if any member has any papers or presentations that they be forwarded for review/inclusion into the program. THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2015


Institute of Hospital Engineering Australia Conference 2015


9th September – 11th September 2015

Pan Pacific Hotel, Perth, Western Australia

Confirmed Keynote Speakers:

Dr Richard Charlesworth AM

Lindsay Albonico

John Holland Project Director and Contractor’s Representative, Perth Children’s Hospital

Throughout his 25 year career in the building industry, Lindsay has been heavily involved in complex building services installations and commissioning for numerous hospital projects including Peel Health Campus, Mercy Hospital, Rockingham Hospital, Sir Charles Gairdner Hospital, Fremantle Hospital and Bethesda Hospital. Lindsay joined John Holland in 2011 in a senior, strategic operational role of Manager – General Building. In 2013 Lindsay took on the role of Project Director for the $1.2billion Perth Children’s Hospital project and is John Holland’s main representative with the Office of Strategic Projects. Lindsay sits on the Project Advisory Group and reports on project progress, financial analysis, challenges and milestones. He chairs the Project Leadership Team, consisting of the project’s senior management team, and oversees the John Holland project team of 150 people, plus a site work force of 1000 people. Working closely with the State, Lindsay is responsible for the delivery of this highly complex project, driving the performance of multiple work streams including design, program, construction, commercial, safety, quality, HR/IR, environment and community relations. Lindsay is a highly respected leader and team member at John Holland. He is a positive role model for younger employees and drives accountability and integrity as his highest priorities to deliver projects, and develop strong relationships with his clients and industry peers.

Richard Charlesworth is one of the best-known hockey players and coaches in Australian hockey history. He has worked with the Australian Institute of Sport as a mentor coach to 5 national team coaches. He was Australian Coach of the Year in 1994, from 1996 to 2000, and again in 2010. Ric has been technical advisor to Indian hockey teams and High Performance Manager of New Zealand cricket. Ric is also a Doctor of Medicine and the author of 3 books on coaching. Described as one of the world’s best coaches, in 2001 he was appointed Master Coach by the International Hockey Federation. In 2003 he received an Honorary Doctorate of Science at the University of Western Australia and completed a Bachelor of Arts majoring in Philosophy and History at the University of Western Australia.

Registration Prices Registration Fees for Full Conference (per Delegate in AUD)

Standard *IHEA Member




*Retired IHEA Member


*One Day Member Rate


One Day Non-Member Rate


Additional Dinner Ticket


Additional Welcome Reception Ticket


*Appropriate identification must be provided to qualify for a concessional and member rate. Visit registration.php to register for the conference.

Promaco Conventions (Conference Secretariat) PO Box 890, CANNING BRIDGE WA 6153

Phone: +61 8 9332 2900 Email:





Day One: Wednesday 9th September 2015 1400 Technical Tour to Fiona Stanley Hospital (Departing from Pan Pacific Lobby) 1400 Technical Tour to New Children’s Hospital (Departing from Pan Pacific Lobby) 1700 Registration Desk Opens 1730 Welcome Reception (Grand River Ballroom, Pan Pacific)

Day Two: Thursday 10th September 2015 Exhibition open to public: 10am-12pm 0800 Registration 0830-0930 Official Conference MC Welcome Welcome to Country Welcome address from Brett Petherbridge, IHEA National Vice President Conference address from Dr David Russell-Weisz 0930-1000 ANZEX Zane Lee Presentation 1000-1030 Morning Tea- Group Photo Opportunity 1030-1130 Keynote Dr Ric Charlesworth AM, High Presentation Performance Consultant- RC Sports (WA) P/L Integrate your infrastructure; improve 1130-1150 Platinum the patient experience Sponsor David Hipkin, SoftSols Group Presentation BIM Trends - A new way for existing 1150-1220 Presentation buildings Don Hitchcock, Advanced Spatial technologies Pty Ltd 1220-1250 IHEA Annual General Meeting 1250-1340 Lunch Using BMS maintenance contracts to 1340-1410 Presentation achieve plant optimisation Vince Simpson, IHEA If it ain't broke why fix it? 1410-1440 Presentation Roderick Woodford, Castlemaine Health Replacing the Main Switchboard with 1440-1510 Presentation minimal impact Kim Bruton, Northeast Health Wangaratta 1510-1540 Afternoon Tea Sponsored by IBMS Pty Ltd Energy Management and Revenue 1540-1610 Presentation Recovery Justin Shute, J D Shute So You Want to Open a New Hospital? 1610-1640 Presentation Glen Fraser 1640-1655 Gold Sponsor Bespoke Australian Made Flooring complements changing Health Care Presentation interiors Rob McLorinan, Armstrong World Industries 1700-1900 Trade Night (Golden Ballroom, Pan Pacific) Partner Program- Perth Laneway Arcades Tour & High Tea Departing from Pan Pacific Lobby at 0900 Returning to Pan Pacific at 1600 Day Three: Friday 11th September 2015 Exhibition open to public: 2pm-4pm 0800 Registration 0830-0915 Keynote Lindsay Albonico, Principal Project Address Director John Holland - Perth Children's Hospital Project 0915-0930 Gold Sponsor Schneider Electric Presentation Robina Hospital Chiller Plant 0930-1000 Presentation Optimisation Kieran McLean, Siemens 1000-1030 Morning Tea Sponsored by Liquitech

1030-1100 Presentation

1100-1130 Presentation

1130-1200 Presentation

1200-1300 Lunch 1300-1330 Presentation

1330-1400 Presentation 1400-1430 Presentation 1445-1515 Afternoon Tea 1515-1545 Presentation


Evolution of Plumbing - What is the Australian Phenomenon Andy Smyth & Phil Woolhouse, WACHS Great Southern (Regional Facility Manager) Hospital Pharmacies - Compounding Cytotoxics – Facility Design Opportunities Frederic Jeunet, Amec Foster Wheeler Specialty Consulting Legionella - solutions and explanations Mark Collens, Veolia Water & Scott Wells, Queensland Health The modern approach to indoor air quality management in health care Mark Graham, QED Environmental Services Building a High Performance Culture Cliff Chalon, Chalon Performance Consulting Where the ....... hell are we (finding a way to way find) Greg Truscott, Royal Perth Hospital

Transparent performance management in outsourced services at a new public hospital Bill Cotter, Serco Australia Delivering the Lady Cilento Children's 1545-1615 Presentation Hospital Matthew Skeen, Aurecon 1615-1700 Close of sessions, 10 minute presentation of 2016 Conference & Exhibitor Prize Draw 1800

Bus to leave for Frasers Restaurant

1815-1915 Pre-dinner drinks with roving entertainment 1900-2300 Conference Dinner & Awards Night with entertainment (Frasers Restaurant) Partner Program- Cruise to Fremantle & Fremantle Prison Tour Departing from Pan Pacific Lobby at 0900 Returning to Pan Pacific at 1600

IHEA Social

Welcome Reception at Pan Pacific Hotel- Wednesday 9th September

The perfect opportunity to enjoy canapés and fine wine, renew old friendships and make new acquaintances, as we welcome you to Perth and the start of the 2015 IHEA Conference. Conference Dinner at Fraser’s Kings Park- Friday 11th September Join us for a fabulous night with friends and colleagues at Perth’s Fraser’s Restaurant with magnificent views overlooking Perth’s Swan River and city skyline. Enjoy a delicious set menu with a selection of beers and wines before you dance the night away. Fraser’s Restaurant is located in Perth’s highly visited King’s Park

IHEA Tours

Fiona Stanley Hospital and the New Children’s Hospital Technical Tour- Wednesday 9th September

IHEA delegates have an opportunity to visit one of two major hospitals in Perth. Fiona Stanley Hospital, which offers a high standard of patient care to communities across the State or The New Children’s Hospital, which is near to completion and will have the latest in technology/ infrastructure facilities dedicated to children. THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2015



Cooling coil cleaning using germicidal UV technology:


ABSTRACT Nearly every HVAC engineer has had the experience of opening a unit to find the drain pan and coil covered with a slimy residue of mold biofilm. Not only these conditions can be unhealthy and occasionally deliver unpleasant smell for building occupants, but it also ruins the heat transfer capacity of the system and consequently increases the energy operating cost. Various coil-cleaning methods have been used to try to control this problem. Many of those techniques involve the use of detergents or even solvents, which can pose safety issues - health and flammability, for example – and high pressure washing that diminishes the life of the coil, because sometimes acids are involved. Often coil cleaning isn’t done with regularity and even when it is done on schedule, the mold growth can return in a very short time, usually less than a month. The use of germicidal ultraviolet light (UV-C) technology in air-handling systems now allows for a proactive method of keeping the coil clean and operating in “as new” performance all the time. UV-C lights can be added to air handlers and other pieces of equipment through a relatively simple and low cost retrofit kit. Energy based payback ranges from 2 years to as low as 6 month depending upon the cost of electricity and the operating conditions. Interestingly, while UV-C light has been promoted for its positive impact on indoor air quality (IAQ), the “bottom line” impact - its contribution to system energy efficiency and lower maintenance costs - might ultimately be considered to be its greatest asset.



ive conditions will result in mold and fungus growth causing a biofilm that inhibits fin heat transfer:

1. A source of mold spores. Sufficient mold spores are found in nearly every environment and brought into the building through door openings and outdoor air supplies. 2. Even when HEPA filtration is used, the filter replacement causes a momentary breach of the sterility barrier that allows airborne mold spores to contaminate and colonise the coils. 3. O  rganic material on which the mold can grow. Dust and particles of organic material are also readily available in every system, even with the best filtration systems. 4. T he right temperature range. Temperatures from 10° C to more than 38° C provide the right incubation range. 5. M  oisture, which is in more than adequate supply on cooling coils and drain pans of all air conditioning units. Even when filtration is provided, a large part of the build-up on the cooling coil is the result of biological growth.

EFFECTS OF BIOFILM GROWTH ON A COOLING COIL The presence of a biofilm on the fins of a coil has two direct effect:



1) Major Heat transfer loss to the fins due to the much lower thermal conductivity of the organic biofilm covering the aluminium fins. 2) S  light Pressure drop increase due to the restriction of the flow area and consequently a reduction of the air flow delivery capacity. As we will see in the following example, a biofilm growth can have significant impact on coil performance, putting it considerably off design specification. If we consider the case of a cooling coil of 2 m high by 4 m wide that has consequently 8 square meter of face area and 58,500 m3/hr our gross face velocity is about 2 m/sec. But this is not the actual velocity inside the coil between the fins. The fin and tube material do block a significant portion of the face coil area. Let’s consider a typical coil of 12 fin/inch i.e. 4.72 fins/cm of 0.145 mm thickness with copper tubes of 13 mm on a vertical Row Tube Spacing of 38 mm and horizontal Face Tube Spacing of 33 mm. As the air flowing at 2 m/sec enters the fins, it has to accelerate up to 2.18 m/ sec to maintain the rate due the blockage of the free cross section area. If we also consider that there are 61 face rows of tubes, the available free area is further squeezed down and the resultant inner coil velocity goes up to 3.76 m/sec. How does a bio-film build-up affect the performance? If the bio-film thickness is 0.38 mm (i.e. half the thickness of a common paper sheet) on the fin and tube surfaces, this will reduce the free area down some more and increase

TECHNICAL PAPERS the velocity up to 4.03 m/sec. What will this increase of 0.27 m/sec (4.033.76) mean to pressure drop ? Well, surprisingly, not much. Calculation shows that the pressure drop of his fouled coil will increase by only 18 Pascal or 1.8 mm of water column which is hardly noticeable and quite difficult to measure. This means that when a high pressure drop due to fouling is observed, a coil is then extremely fouled. If we now consider the effects of biofilm fouling on the heat transfer coefficient, we will see that this is where the performance loss is significant. Although the apparent face area of the coil described above is only 8 m2, its total fin surface is a stunning 1,972 m2 which represents the area of 7 ½ tennis courts or half an acre! A cooling coil is a liquid to air heat exchanger and as such its heat duty Q is the product of a heat transfer coefficient U, a heat transfer surface A, and the temperature difference between the hot air and the cooling fluid often called “delta T”and written ∆T. Hence the well-known basic heat transfer formula: Q = U A ∆T When a tiny biofilm builds up on a coil, it adds an insulating layer on the heat transfer surfaces. This additional layer reduces the heat transfer coefficient U. Because the physical heat transfer surface cannot be changed, in order to maintain the heat exchange duty Q, only the temperature differential ∆T can be increased to compensate. The only way to do this consists in decreasing the cooling fluid temperature and consequently make the whole HVAC system (compressors, chillers, auxiliary equipment, etc.) work harder to produce a cooler fluid. Otherwise, the cooling heat duty of the coil is lost in the same proportion as the heat transfer coefficient reduction. Now let’s look at how much drop in heat duty a 0.4 mm biofilm can cause. Such as biofilm is hardly visible as it is about half the thickness of a paper sheet. Straightforward fluid flow calculations show that this thin biofilm will have a

negligible impact on the coil pressure drop and therefore goes on unnoticed unless the coil fouling is extremely severe. Nevertheless, this tiny biofilm coating will significantly interfere the heat transfer efficiency.

Where: Th = Temperature of the Hot environment where heat is rejected

The flow in the small gap between fins has a low enough Reynolds number to be laminar and as such a constant Nusselt number can be used to calculate the convective heat transfer coefficient. The overall heat transfer coefficient U is calculated by adding the thermal resistance of the biofilm to the air boundary layer convective resistance.

Hence the new COP will be calculated according to the following relation:

U =

1 1 t + h k

Where h = convective heat transfer coefficient of the air stream on the clean fins k = thermal conductivity of the biofilm material t = biofilm thickness Using well-known heat transfer data from available literature, the clean U value of the coil described above is found to be around 42 W/m2/oC. The presence of our 0.4 mm biofilm that has a thermal conductivity of 0.005 W/m/K brings this number down to 33 W/m2/oC, hence a huge loss of 21% of the heat transfer coefficient U!

Tc = Temperature of the chiller Cooling fluid

Th-Tc COP new = --------- COP Th-Tc_new Based on the above, the COP will decrease from 3.0 down to 2.81. This drop in COP will cause the energy consumption of the cooling system to increase by 6.9 % to compensate for the fouling of the coil. Based on the 20 years of field experience and the above described fundamental physical principles of heat transfer and fluid flow applied to HVAC coils, Sanuvox Technologies has programmed a detailed engineering calculation to estimate the energy savings by keeping coils free of biofilms and the consequential return on investment.

INPUT PARAMETERS OF THE HEAT TRANSFER CALCULATION Here is an overview of all the parameters involved in the calculation and a brief description of their importance and impact on the final result.

To maintain the heat duty performance of the coil, the temperature differential must be increased by the same ratio. This will be done by lowering the cooling fluid temperature which will negatively impact the coefficient of performance (COP) of the chiller. In order to be conservative in estimating the consequential reduction of the COP value, we will consider that the system trend is proportional to the best possible case i.e. the ideal Carnot cycle, which can be written as follows: Th COP ~ ---------Th-Tc





IMPROVE HVAC HYGIENE REDUCE ENERGY CONSUMPTION NEVER CLEAN COILS AGAIN • Sanuvox UV Coil sterilisation system • 2 year warranty on bulbs and 15 years on the ballast • Destroy viruses and bacteria • Eliminate the need for conventional coil cleaning • Reduce your running costs • AHU specific sizing and kill rate report

LED status display on each ballast BMS Connectivity UV Lamp Boots This technology has achieved extraordinary results in medical, commercial, military and residential installations. Tested by the National Homeland Security Research Centre with studies published by The Medical Research Council and Mc Gill University

WHY IS OPIRA THE PERFECT PARTNER? The medical and healthcare sector is our specialty. Your key partner for operating theatre performance testing, indoor air quality testing, HVAC hygiene management plans, HEPA filtration and now SANUVOX ultraviolet light sterilisation systems for surface and air treatment. As a team of qualified Scientists we know what works best. Contact us today to learn more about how SANUVOX UVc can save you money.




RETURN ON INVESTMENT Applying the heat duty based calculation program on the cooling coil described above provides a payback of a 13 MONTHS. The payback will be faster for systems with: • larger heat transfer surface (width, height, thickness, number of fins per inch) • higher electricity cost • higher % operating load • higher % operating time • higher relative humidity/dehumidifying process • lower cooling system COP value

COMMENTS ABOUT THE CALCULATION INPUT PARAMETERS 1) C  oil height, width and thickness are essential values along with the number of fins per inch to calculate the heat transfer surface A of the coil. An error on any of these 3 parameters will significantly and proportionally affect the final operating cost. Great care must be taken for these values. 2) A  ir temperatures in and out as well as cooling fluid temperatures in and out are used in the calculation of the temperature differential ∆T and since they are the second multiplier in the heat duty equation, they will affect

based on average local climate conditions, there is a significant safety margin taken in the design. Therefore, in extremely rare hot conditions, the operating load can occasionally reach 90% of installed capacity, but in general, the average operating load throughout the cooling season is expected to be somewhere around 60% + or – 10%. Here again, it will directly affect the final operating cost and should be revised accordingly if the cost seems too high or too low.

directly the final operating cost. Also very important to have reasonably accurate values. 3) C  ost of electricity is very important, needless to say. The higher it is the better the return on investment by keeping the coil performance to its optimum. 4) %  Operating Time: the real cooling requirements (not free cooling) typically occurs during the hottest season. A season theoretically lasts 25% of the year, but the real cooling season can be as small as 15% of the year ( i.e. about 50 days) in northern climates such as Canada and be as high as 80% of the year as we get near the equator. We suggest to pick 25% as a default guess value. Here again, it will directly affect the final operating cost and should be revised accordingly if the cost seems too high or too low.

6) C  OP: Coefficient of Performance of the chiller unit that supplies the cold fluid for the coil. This value is the ratio of the amount of free energy that a heat pump can grab in the ambient outside air to the energy consumption required to drive the cycle. It varies considerably from as low as 1.5 for small single stage heat pumps used in light commercial/residential units up to 5 for large industrial ultra-efficient cooling cycles. A conservative default value of 3 is used in the calculation. Its value will significantly affect the final operating cost. 7) B  iofilm thickness is a default value that should not be played with too much. It has been set conservatively at a default value of 0.38 mm which is less than half a standard paper sheet. Its value can have evidently a huge effect on performance and final results. 8) A  ll the other parameters do not have as much impact on the final results and unless there are very clear and specific information provided by the clients, they shall remain untouched at their default values.

Here’s a suggested list of values based on reported monthly Cooling Degree-Days1 (CCD) from the literature:


Canada and North USA:


UV coil cleaning can bring performance back to the original operating conditions.

Mid USA: 


Southern USA: 




5) %  Operating Load: given that HVAC engineers design the systems

Typical coil cleaning methods include chemical treatments and/or steam cleaning. However, recent evidence suggests that both methods can be ineffective. Chemical cleaning may only remove surface growth while leaving material still embedded in the centre of



TECHNICAL PAPERS the fin pack. Some reports indicate that high pressure steam cleaning can actually force the surface growth deeper in the fin pack compressing the growth material so tightly that the only solution may be a new coil. Both methods can also be detrimental to most of today’s heat transfer enhanced fins surfaces. Coil cleaning is certainly necessary, but cannot be done economically with the frequency and level that will keep the coil operating at design conditions on a daily basis. In essence, with UV-C lights, coil cleaning becomes a continuous, automatic and labor-free alternative. The UV-C light works by attacking the DNA of the mold and rendering it sterile so that it cannot reproduce. UV-C technology is not new, as it has proven itself for years as a way to provide sterilisation in medical and food processing applications.


The effectiveness of the UV-C light is a function of the light intensity and exposure time. Aluminium coil fins are a good reflective surface and, as a result, the UV-C energy is capable of penetrating three- and four-row coils with excellent results. Given continuous exposure, UV-C lights can clean up a coil already contaminated by mold growth and keep the coil cleaner far better than any other methods. Comparing physical cleaning methods to the use UV-C light is analogous to the difference between treating the symptoms rather than curing the disease.

REFERENCES 1. D  efinition of ‘Cooling Degree Day – CDD’ The number of degrees that a day’s average temperature is above 18oC and people start to use air conditioning to cool their buildings. To calculate the CDD, take the average temperature of a day and subtract 18. For example, if the day’s average


temperature is 30oC, its CDD is 12. If every day in a 30 day month had an average temperature of 30oC, the month’s CDD value would be 360 (12 x 30).

ABOUT THE AUTHOR Normand Brais holds a mechanical engineering degree, a Master of Applied Sciences, and a PhD in Nuclear Engineering from Polytechnique of Montreal. He was appointed Professor at the Energy Engineering Institute after he graduated. He has founded several technological companies in various fields such as atmospheric pollution due to stationary combustion equipment, biomass combustion, water treatment, photonics, and air/surface UV disinfection. In 1995 he founded Sanuvox Technologies, which is now a worldwide technological leader in UV disinfection of air and surfaces for hospitals and office buildings.








Air filtration for critical care environments DR. ALLAN HECKENBERG (PHD) I BDM FOR AIREPURE AUSTRALIA 2015

There are few environments within a hospital where air quality has a more direct impact on patients and hospital staff than in operating theatres and isolation rooms.


hankfully there are well established and very practical steps that guide the design and implementation of these important environments. However, the reliable achievement of these goals is complicated by variations in the stateby-state standards and sometimes by the interpretation of these guidelines to save short-term costs. It should be noted that the behaviour of hospital staff and other environmental factors have massive impacts on the control and transmission of various infections. The professional behaviour of staff and cleaning protocols has proven to be reliable in Australia, so the ventilation system can perform its part of the overall disease control landscape.

case can be made for bag-in-bag-out systems to further protect the public from exhausted pathogens. Any discussion of ventilation for medical environments must include HEPA filtration. Most state and Australian standards are very prescriptive about the nature and efficiency of these important items. Rigorous testing of filters by NATA accredited testing services adds a further level of protection for the patients and hospital staff.

Gel Sealed HEPA

Of course the supply air to HEPA filters should be pre-filtered to prolong the life of the HEPA filter, and normal guidance is to comply with AS 1324.1. Suitable pre filtration is obtained by using a combination of filters with a rating of G4 followed by higher efficient filters with ratings of either F7 or F8. However, this standard requires filters to be tested and validated every 5 years. The author is not aware of any Australian independent NATA certified testing authority that can test and certify filters to AS1324 so manufacturers and specifiers need to rely on overseas facilities that can provide acceptable data to ASHRAE 52.1 or 52.2 or EN779.2012.

GENERAL DESIGN PARAMETERS Design parameters that have measurable impact on the hospitals ventilation system include, relative room pressurisation, grade and location of filtration, air change rates, the source of air (external/ recycled), temperature and humidity. Information contained in Standards Australia HB 260-2003 is particularly informative as a general reference. AS/ NZS 1668.2 is also an invaluable and prescriptive reference. A number of clear and rational criteria are outlined in these references – such as the requirement for a “respiratory isolation” room having a dedicated air conditioning, single pass and dedicated exhaust ventilation system that are then isolated as much as possible from air inlet systems. In some quarantine rooms – a THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2015



Focus (UCV) Ultra Clean Ventilation Systems for Operating Theatres

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airepure australia

TECHNICAL PAPERS In many cases the HEPA filter that supplies air to a given room will be housed in a simple HEPA module, and these units will be sized to achieve an effective airflow to the room at approved face velocity rates. Generally these plenum boxes will have side or top air inlet spigots, and sometimes have options of inspection plates and damper adjustment units for air flow balancing. The fascia sections of these units are precision devices to afford a flat, square mounting for the HEPA filter. Materials of construction are typically 304 grade stainless steel with protective mesh covers which serve to diffuse air flow from the HEPA and protect the delicate HEPA filter from in house cleaning processes. In more specific circumstances such as operating theatres, HEPA filters are often arranged in purpose built, multi-filter housings to promote superior laminar air flow control and simplified installation. Refinements such as accommodation of various pendants and lighting systems are further enhancements. Laminar Airflow System for Operating Theatres

STATE BY STATE AND NATIONAL STANDARDS In any given state, both 1668.2 and state guidelines may apply. AS 1668.2 is documented in legislation via BCA, and its guidance should be adhered to in all cases. As an example – for a protective isolation room, the standard indicates that designers “shall”, have at least 15 air changes per hour, negative pressurisation to half that of surrounding rooms, HEPA filtration to 99.99%, and specified outdoor air rates of the greater of 10L/s per person or 2L/s.m2. There are some excellent state level guidelines such as the Queensland Health –Infrastructure Design Guidelines that deliver very specific information on fine details of design. The guideline values for an airborne infection isolation room augment those above for 1668.2.

Negative pressure, air changes per hour: as per 1668.2, total air changes per hour 12, full outdoor exhaust, Humidity a max of 60% and design temp 21 to 24C.

FINAL THOUGHTS Some state guideline may be less stringent, but it is worth noting that these are critical facilities, and erring on the side of “best possible practice” may be a wise direction, even if it results in modest short –term cost increases. The designers, specifiers and suppliers should pause to ask themselves the question “when I am lying on this operating table” do I want best practice or lowest price above me? Written by Dr. Allan Heckenberg (PhD), BDM for Airepure Australia 2015 Airepure Australia offer a range of products, services and consulting expertise that can assist you with your compliance to ACHS, DHS VIC Guidelines (and equivalent for QLD, WA and NSW), ISO/IEC 17025:2005 Requirements, AS/NZS 2243.3:2010 and AS/NZS 2243.8:2014. Airepure is a leading national air filtration company providing unique, powerful and integrated air filtration solutions, ranging from basic HVAC filtration and odour control right through to high end HEPA/ULPA filtration and airborne containment technologies. For more information, visit or call 1300 886 353




Maximising performance of hospital clinical alarms RIKIN SHAH I SENIOR HEALTH CARE SOLUTIONS ENGINEER

Medical device alarms alert caregivers to unsafe conditions or changes in a patient’s condition that require a response, but the caregiver needs to be within range to hear the alarm.


ome medical devices, such as physiologic monitors, can be networked so that alarm notification not only emanates from the bedside device, but also triggers alarm notification from central stations typically located at the nurses’ station. Other enhancements include enunciators that provide audible alarms in locations where it may be difficult to hear device alarms and remote displays in strategic locations that mirror the central station display. More recently, health care facilities have been considering alarm integration systems as a way of enhancing alarm notification for a wide variety of clinical devices or systems such as physiologic monitors, ventilators, infusion devices, bed exit alarms and nurse calls. Today’s clinical alarm integration systems are highly automated and facilitate the propagation of alarms to a clinician’s wireless device, remote displays or even enunciators. If implemented correctly, alarm integration systems can lead to better response times and coverage. However, if incorrectly designed, they can add multiple failure points and place a patient in jeopardy.

INTEGRATION SYSTEM DESIGN Alarm integration systems are complex and require a multidisciplinary approach to planning, design and implementation. Each hospital’s system must be customised to the specific area’s workflow to effectively enhance alarm notification


and facilitate prompt alarm response. Because of this, hospitals must take a deep look at their care areas and alarm management practices as well as their culture, infrastructure and technology. Each system is designed for a specific facility. However, all clinical alarm integration systems take all or a subset of alarms from a monitoring system and communicate them to a desired location and all have software and hardware components. In general, alarm integration systems share the following building blocks: Alarm source. This includes nurse call systems, physiologic monitors, ventilators, infusion pumps and many other clinical devices. Middleware. These are systems or engines that reside between the medical device and a communication device worn by clinicians. The tasks of these systems are to collect all alarms from the source device and to distribute them to the communication devices. Middleware is typically customcon¬figurable and allows a user to program which alarms will be sent to the communication system, the priority of alarms, the nurse or caregiver assignments and the alarm escalation scheme. The alarm escalation scheme designates which caregiver will receive the initial notification for an alarm, which caregiver receives backup notification if nobody


responds to the alarm and the time intervals between each escalation. Communication devices. Whether they are Voice over Internet Protocol (VoIP) phones or pagers, these are the end devices that are carried by caregivers and are a critical part of an alarm notification system because they directly notify the appropriate caregiver or caregivers. Video monitors. These are displays that provide visual or audible alarms and alarm information for a variety of devices. Located in strategic locations in the care area, these monitors provide caregivers with alarm notification and specific alarm information.

DESIGN TEAM AND ITS ROLES One of the most important tasks a hospital has in the clinical alarm integration selection process is the formation of the design team. Getting the right team together and facilitating multidisciplinary discussion/planning sessions will lead to the selection of an effective alarm integration system and better alarm management, response times, reduced alarm fatigue and improved patient safety. A good design team comprises both internal and external team members. The internal group should include representatives from the facilities department, clinical engineering (CE), nursing, clinical staff, and professionals in charge of information technology (IT)

TECHNICAL PAPERS infrastructure and IT telephones. External participants should include staff from the middleware company that will be capturing alarm information, architects (if the project is part of a new building or renovation), a medical equipment vendor and a communication system vendor.

about incorporating a brief delay in alarm notification so that an alarm is not provided for conditions that resolve themselves quickly. It is important to ensure that the delay will not jeopardise prompt response should the alarm condition not resolve itself.

The CE and facilities departments play a critical role from the outset of any alarm integration system project. Whether part of a new construction project or a renovation, the CE and facilities representatives need to communicate clearly with the hospital’s architect. Early on, the architect’s team needs to be informed that an integration system is being in¬stalled and certain structural considerations must be made — hallways should be designed with backings and cable to facilitate spaces for equipment and monitors in the corridors and walls, and network equipment closets also need to be installed.

Hospitals should develop an alarm escalation scheme that is acceptable with their cultures and practices. It should include first-alarm notification, backup alarm notification, and the time intervals that need to be programmed between each escalation scheme.

Another important role that facilities departments will play is running cabling conduits for these systems. Whether the cables are for video, power or network, they will be required in many areas, including on walls for remote monitors, in hallways for enunciators, or on the ceiling for access points. Making sure these conduits are run may seem expensive, but will be worthwhile in the long run if the system needs to be expanded or if new cabling needs to be installed for other system components. Like infrastructure, clinical technology is an essential part of designing this system. At this stage, it is critical to seek the whole team’s input. The team must decide which technologies will be integrated. Three technologies typically included in an alarm integration system are physiologic monitors, ventilators and nurse call systems. CE and nursing input also are vital. Because alarm desensitisation is an important issue, it is imperative that CE, and the nursing and IT teams come to a consensus on which alarms (e.g., crisis alarms or system alarms such as “leads off”) will be transmitted to the middleware. Additionally, nurses and physicians need to provide input on decisions

IT teams also play a critical part in this process as the need for the network and telephone infrastructure is a key for successful implementation of this system. A proper wireless infrastructure is critical. To avoid missing any alarms on communication devices, there should be no dead zones in the care areas where these systems are being integrated. Integration of the wireless system, especially to telephony systems, is essential for proper response time. The alarm integration system should be designed based on getting the right information to the right nurse at the right time, and getting the right telephony system is essential. In most cases this would be a VoIP system. These systems consist of a Session Initiation Protocol (SIP) server. SIP is an Internet protocol that allows for establishing and terminating VoIP telephone calls. VoIP systems also require the installation of an IP private branch exchange server, which registers all VoIP phone numbers and allows a connection to be established. The external team members also are a critical part in the process of designing an alarm integration system. The vendors for medical devices identify the alarms and how they are packaged and sent, thus helping the middleware vendors to build the correct bridge to collect these alarms. The middleware vendors are instrumental in setting up the business rules that will be dictated by the alarm management policies and practices that the nursing

team formulates. These business rules then will help parse the alarms to the communication devices effectively. The communication device vendors ultimately need to ensure that the quality of experience and service provided are on par with the expectations of the clinical team and the internal teams, and that no alarms are being missed.

FIVE KEY DESIGN AREAS Private patient rooms are now the trend when designing new hospitals as they allow for both patient and family privacy. As such, the care areas are increasing in physical size. This creates alarm management challenges and can affect the efficacy of an alarm integration system. To improve the effectiveness and efficiency of alarm notification and response time and to minimise alarm fatigue while propagating alarms to the nurse communication device, the design team should consider the following issues: Architectural layout. Consider creating zones that are naturally consistent with the floor design. For example, fire doors can be good architectural boundaries that designate one zone from another. Physical distance between the start of the unit and the end of the unit also should be considered as the nurse could be responsible for patients on either end of the care area. Creating smaller, more intimate care areas out of larger areas will create smaller footprints, helping to maintain a reasonable distance to see, hear and respond to any alarms. Alarm escalation plan. Creating an alarm escalation plan will be easier with clear and consistent divisions between zones. For example, the alarm notification may start with the primary care nurse and then escalate to a buddy nurse. Without a response within a specified period, it would escalate to another designated subset of nurses or all nurses in the zone, thus enabling prompt attention for any patient alarms. Team coverage environment. Creating practices such as nurse buddies or forwarding alarms to the charge nurse when the primary clinician is busy will allow for prompt attention to any alarms.



TECHNICAL PAPERS The key is being consistent with practices, thus improving alarm management and safety as well as creating a better alarm integration system. Nurse-to-patient ratio and staffing. Consider the staffing ratio for each care area and help determine the number of communication devices needed during peak census. It also may be beneficial to consider adding inventory of these devices to accommodate for shift changes, when some nurses may forget to put their communication devices back. Not having enough communication devices in this model of alarm coverage can lead to inefficiencies in alarm response and jeopardise patient safety. Technology limitations. A monitoring system may have a limited number of outputs. For instance, there may be a certain number of video outputs if a hospital decides to use video monitors as part of the integration system for visual alarms.


Phone and paging system limitations also must be considered for very large units. These systems can be affected by latencies in alarm notification to the communication devices. This is particularly true in situations with multiple, simultaneous time-sensitive alarms occurring for a larger patient population in a large care area with more nurses. Some of these issues can be eliminated by looking at the architectural layout and subdividing a large care area into zones. In this scenario, the number of individual alarms will be sent to significantly fewer phones (e.g., eight nurse phones in a zone versus 24 within the care area). Finally, make sure to test the system to handle the current level of alarms and the anticipated growth in the hospital’s size. It also would be advisable to purchase components that are expandable and easily upgradable and invest in the most up-to-date technology that the project’s budget can afford.


HIGH-QUALITY CARE While integrated alarm systems are not going to reduce the number of alarms that are being generated, they do have the potential to increase the speed at which caregivers can respond because the alarms will be sent directly to their communication devices. And if a proper alarm management strategy is in place, it can also greatly reduce nuisance alarms being sent to caregivers, because only a subset of the alarms will be sent to them, instead of every single alarm. Both considerations are important when ensuring the highest quality environment of care. Rikin Shah is a senior health care solutions engineer for the applied solutions group at ECRI Institute, Plymouth Meeting, Pa. He can be reached


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How safe is your Building Management System from a cyber attack? GREGORY STRASS I JON WILLIAMSON

“Cyber crime is a $400 billion criminal enterprise worldwide — making it bigger than global drug trafficking.”


he last two decades have seen tremendous growth in the integration of building management systems. With networked information systems becoming more commonplace, facilities managers of buildings that often include access points to corporate or organisational networks must be vigilant of the risk of cyber attacks on their Building Management Systems (BMS). BMS that were once proprietary and stand-alone now are integrated with other systems. Today’s intelligent building management systems (iBMS) are networked with IT data centres, remote access servers, and utilities through open protocols. While these iBMS provide significant benefits, they also open companies up to greater cybersecurity vulnerabilities. Avoid becoming a victim of cyber criminals by employing five best practices to improve cybersecurity in BMS. One international law enforcement agency estimates that victims look at a loss of about $400 billion each year worldwide – making cyber crime a bigger criminal enterprise than the global trade in cannabis, cocaine, and heroin combined. Another report states that globally, the cost of malicious cyber activity ranges from $300 billion to $1 trillion. Financial impact on companies varies from country to country, with the average cost of cyber crime to companies in Australia averaging $3.67 million.


successful because a password has been compromised. There are many passwordrelated subjects that could be covered. This paper addresses the two most important: changing default passwords, and ensuring password complexity.


The financial consequences of a cybersecurity attack include direct costs — forensic investigation into the breach, technical support, lost revenue, upgrading cybersecurity technologies and activities — and indirect costs such as loss of productivity, regulatory noncompliance, loss of intellectual property, service or product quality degradations, and, harder to quantify but perhaps most costly of all, the damage to the company’s reputation and/or customer desertion. The white paper ‘Five Best Practices to Improve Building Management Systems (BMS) Cybersecurity’ discusses in depth, practices and procedures, that will lead to more secure iBMS in the field. Areas covered include:

PASSWORD MANAGEMENT While it is a given that changing default passwords on devices is mandatory, there are many out there who overlook this vulnerability. Properly managing users and passwords is critical to securing any BMS. Most attacks on BMS devices are


Once all devices have adequately secure credentials, the next step is to safeguard other places and ways a hacker could get into the system. Such other points of entry include the Web interface, USB ports, open IP ports, and building automation devices communicating over open protocols.

USER MANAGEMENT Once the BMS has been cyber-secured from external threats, the next issue to address is safeguarding the system from within. Over the past several years, BMS have evolved from “single user – command line” systems to full-blown, multi-user GUI systems. Along with this expansion in functionality has been a significant increase in the types of operations a user can perform. In order to secure systems from within several steps must be taken such as limited privileges and giving each user only enough access privileges to allow them to do their job. User accounts must also be managed and for devices without services to automate this process there are several practices that need to be implemented such as auto-expiring all accounts, disabling accounts immediately for employees who

TECHNICAL PAPERS leave, and changing accounts when employees switch roles.

SOFTWARE MANAGEMENT While it is common sense to ensure systems are up-to-date with the latest security updates, this is an area that sometimes is overlooked. Hackers, when attacking a device, first determine if all security patches have been installed. When these features are not up-todate, there are usually areas that can be exploited to compromise vulnerable devices. Another good practice to put in place is to ensure only authorised users deploy software. This means that only highly trusted users will be able to install software, thus reducing the risk of attacks.

VULNERABILITY MANAGEMENT Patching devices with vulnerabilities requires planning. Different companies have different policies for performing

BMS updates. It is important to understand these requirements as well as to determine any operational impact caused by the temporary service outage needed to complete the update process. A Vulnerability Management Plan takes into consideration all aspects of the vulnerability update. It is an established fact that hackers are more likely to attack weakly defended systems, ignoring systems that require too much effort to crack. Learn the ‘best practices’ to thwart such attacks, or at least make things significantly more difficult for hackers. Some are simple, commonsense tactics while other measures will require more sophisticated technical IT skills. Effective and regular cybersecurity training makes everyone aware of vulnerabilities. Ultimately, the level of cybersecurity is directly related to the effort expended in making it difficult for hackers to access valuable systems. Download the white

paper ‘Five Best Practices to Improve Building Management Systems (BMS) Cybersecurity’ from Schneider Electric here: datawallcontent Gregory Strass is the Building Systems IT Cybersecurity Lead at Schneider Electric. He holds degrees in Electrical Engineering and Computer Science from the University of Illinois in Urbana. Additionally he holds CISSP and CEH certifications. He has worked in the embedded field for over 35 years. Jon Williamson is the Schneider Electric Building Systems Communication Officer. He holds a degree in Mechanical Engineering from the University of New Hampshire in Durham. Active in the BMS market for over 19 years, he has practical and product management experience in system deployment, networking and protocols. In his current role as Communication Officer, he is responsible for system architecture, communication protocols and cybersecurity requirements. This article also appeared in FM magazine


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Energy savings obtained using the online automatic tube cleaning system (ATCS) in HVAC systems DR DAVIDE ROSS1 I DR ADINA CIRTOG1 I ALEX SWANSON1

In this report, I will summarise results of energy savings obtained from the installation of the ATCS to the condensers of the centralised plant chillers of four A-grade commercial office buildings located in the Sydney CBD. This is an exert of a paper that was recently presented at the Heat Exchanger Fouling and Cleaning – 2015 conference, June 07-12, Enfield (Dublin), Republic of Ireland.


efore going over some of the theory and then the results it is important to make mention that the ATCS has been installed at 4 major hospitals in the country with a 5th currently commencing under an EPC. Unfortunately for various individual reasons, formal measurement and verification (M&V) was not conducted by the stake holders at each of the locations. However, a 6-week validation test is now being undertaken at Westmead Hospital using a Clima Check thermodynamic COP analyser. In the interim some qualitative feedback of the ATCS performance at Westmead is discussed at the end of this paper. I am certain it comes as no surprise to the readership of this journal that 40% to 52% of the total energy consumption for commercial buildings is used in HVAC (Brodribb et al., 2013). Chillers are usually the single largest user of electricity in most commercial and institutional HVAC facilities. In many cases, they are the single largest user of any form of energy in buildings. For these reasons, maintenance and engineering managers looking for ways to improve the energy efficiency of their buildings should start by improving the efficiency of chillers. Managers have three primary options to improving chiller performance: replacement, control strategies and maintenance. As chillers are required to reject heat to complete the vapour-compression cycle, a condenser heat exchanger is used which allows heat

to migrate from the refrigerant gas to either water or air. Heat transfer has the greatest single effect on chiller performance. Large chillers can have more than five miles of condenser and evaporator tubes, therefore high heat transfer is fundamental to maintaining efficiency (Piper, 2006). Water-cooled chillers incorporate the use of cooling towers, which improve the chillers’ thermodynamic effectiveness as compared to aircooled chillers. One of the most common types of water-cooled refrigerant condensers is the shell-and-tube, where the chiller refrigerant condenses outside the tubes and the cooling water circulates through the tubes in a single or multi-pass circuit. An almost unavoidable consequence of using water is that fouling of the heat exchanger surface may result from sediment, biological growth, or corrosive products. Scale can also result from the deposition of minerals from the cooling water on the warmer surface of the condenser tube. As stipulated in the Guide to Best Practice Maintenance & Operation of HVAC Systems for Energy Efficiency, “It is estimated that a build-up of a 0.6mm thick layer of fouling on the condenser water tubes will reduce chiller efficiency by 20%. For larger chillers, the installation of automatic tube cleaning systems may be cost effective”. The formation of process-related deposits on heat transfer surfaces bears an estimated economic price tag of about 0.25% of the GDP of industrialised countries.

Table 1. A summary of hospital ATCS installations


The Westmead

The Royal Brisbane

The Alfred

The Austin

No. Chillers installed with ATCS





Chiller Make/





ATCS unit size

4 x 12”


1 x 8”

1x 8”

Date of installation

2008 & 2011






TECHNICAL PAPERS What may come as a surprise to readers of this journal is the impacts of fouling on heat transfer surfaces is generally already considered in the design of heat exchangers by using a socalled “fouling factor” in the calculation of the overall heat transfer coefficient, U. Fouling will reduce the overall heat transfer coefficient and thus leads to the reduction of the heat duty of an existing heat exchanger or to additional surface area requirements in the design of new heat exchangers. The prevalence of fouling in heat exchangers has been clearly demonstrated by several surveys that have reported that more than 90% of industrial heat exchangers suffer from fouling problems (Muller-Steinhagen, 2011; Steinhagen et al., 1992; Garrett-Price et al.,1985). Figure 1 shows the percentage of operating heat exchangers confronted with fouling problems, as found in the detailed study for New Zealand.

as water is bled from the cooling tower and or evaporated from the cooling tower, there is continual requirement to top up the chemical dosage as fresh water is introduced into the system.

Fig 2. Excess fouling factors (HTRI) Fig 1 Percentage of operating heat exchangers confronted with fouling problems.

When a water-cooled condenser is selected, anticipated operating conditions, including water and refrigerant temperatures, have usually been determined. Standard practice allows for a fouling factor in the selection procedure. The major uncertainty is which fouling factor to choose for a given application or water condition to obtain expected performance from the condenser. As fouling is a major unresolved problem, it is a normal practice to oversize the heat transfer surface area to account for fouling. Design engineers frequently over compensate by arbitrarily increasing the fouling resistance or by multiplying the calculated overall heat transfer coefficients with a “safety factor” (Muller-Steinhagen, 2011). This has been exemplified in practice whereby over specifying fouling resistances has increased the heat transfer surface above clean conditions in the range of 20–300%! (Garrett-Price et al.,1985). This was confirmed by a major Heat Transfer Research, Inc. (HTRI) study into the fouling-related excess area of 2000 recently designed heat exchangers (Muller-Steinhagen, 2011). This is reproduced in Figure 2. In layman terms, your chiller’s condenser heat exchanger is very likely to be way over sized by the chiller OEM. As fouling builds up in a condenser, the condensing temperature and subsequent power consumption increases while the unit cooling capacity decreases. This effect can be seen in Figure 3. At some point in the operating cycle, the increased cost of power will be offset by the cost of cleaning. The general techniques for fouling mitigation of heat exchangers are shown in Figure 4. Chemical inhibitors are commonly introduced to the water loop to reduce and/or mitigate the deposition rates of selected fouling problems. While chemical cleaning is effective,

Fig. 3 Effect of Fouling on chiller Capacity and Energy Usage (ASHRAE, 2000)

Fig 4 Fouling mitigation pathways

Use of chemicals adds to the plant operating costs, and their application may be restricted by environmental legislation or by product specifications (Muller-Steinhagen et al., 2011). As alternative to chemical inhibitors, mechanical treatment of the heat exchange surface may be undertaken. The most common mechanical method is the use of projectiles that are propelled THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2015


TECHNICAL PAPERS through the heat exchanger tubes to remove deposits. Commonly referred to as an automatic tube cleaning system (ATCS), this mechanical method of cleaning heat exchanger tubes occurs while the equipment remains in operation and in full production. There are two types of ATCS: the brush and basket type and the more common recirculating sponge ball type. Recirculating sponge balls consists of slightly oversized elastomer balls that are periodically or continuously injected upstream into the condenser cooling water inlet. The balls are passed through the tubes by the water flow. A strainer or ball collector is installed at the water piping exiting the condenser. For any that say we don’t have a problem but still undertake a once a year tube clean regardless, interesting proposition. Sure, you may not have a scaling issue but can you see the biofilm? You may like to suggest your water quality is different as you undertake regular services. As New Zealand being “well known” for its exceptionally deleterious water quality and poor service maintenance standards, this surely must explain in isolation the greater than 95% fouling found for shell and tube heat exchangers observed in the study. In the end, perhaps you are just the keen gambler and like to back yourself to have no problem. If you take prima facie that NZ actually is not that dissimilar to Australia, using the above results a facility operating three chillers would then have the very low odds that no fouling exists in any of the units of only 1 in 8000. Before discussing the results, a quick overview for those not familiar with ATCS. The featured case studies in this discussion have the common components that constitute an installation of this type; injector, strainer and recycle pipe work which connects the strainer to the injector to return the sponge balls. An actual installation of the sponge ball ATCS for Case 1 is shown in Figure 5. In the foreground the injector can be seen. In the background is the strainer with connecting pipework coming to the foreground. The standard operating procedure for the injector is to hold the equivalent number of sponge balls equal to a third of the number of tubes in a single pass. Sponge balls are released from the injector on set intervals of every 30 minutes. The sponge balls ought to be replaced every 1000 hours of chiller run time. In practice, this may not occur if the site has poor maintenance scheduling and will impact the results as shown in Case 3. Table 2 summarises key aspects for each Case number. Sponge balls are generally 1mm larger in diameter than the I.D. of the condenser tube. The dominant independent variable on cooling load is the outside weather. Weather has many dimensions, but for whole-facility analysis, the outside air temperature is sufficient. The standard practice of using a referenced base temperature cooling degree day (CDD) was used in the present study. Cooling degree days are based on the average daily temperature. The average daily temperature is calculated as follows: [maximum Fig. 5 The sponge ball ATCS installed in Case 1



daily temperature + minimum daily temperature] / 2. As HVAC load is seasonal, one full cycle is required for analysis thus, a minimum of 12 months. Degree days are a simplified form of historical weather data outside air temperature data relative to a base temperature, and provide a measure of how much, and for how long, the outside temperature was above that base temperature. In degreeday theory, the base temperature is effectively the “balance point” of a building when the outside temperature is below which the building does not require cooling. Naturally different buildings will have different base temperatures depending on its thermal performance. For this analysis, a reference base temperature of 18oC was used. Climate data was referenced from the BOM, Sydney Observatory Hill, weather station ID 94768 (151.21E,33.86S). A simple linear model was used to correlate energy consumption without any adjustments, to a single independent variable, CDD. Daily CDD data is summed into monthly totals. Energy consumption is then computed such that the best fit linear regression equations fitted to the baseline and post ATCS installation data are multiplied by the 10 year average degree-day value for the corresponding month. The difference between the adjusted baseline and the post ATCS normalised consumption totals is the normalised energy saving based on the 10 year average degree-day. Figure 6 summaries the year to year monthly electricity consumption data for the four buildings. A comparison of the energy consumption versus CDD for all four commercial office buildings is displayed in Figure 7. In all cases there was an observed reduction in net energy consumption following installation of the ATCS. The normalised energy savings resulted in a decrease ranging between 24.5% to 26.5%. These results compare favourably with theoretical and experimental results reported by Lee and Karng (2002) for a similar sponge ball ATCS. The authors determined a predicted theoretical maximum energy saving for the ATCS of 28%, with an average energy saving of 24%. Their field data measured a saving of 26% for the year. Results for Case 1 were also uniquely affected by additional energy conservation measures post the ATCS installation. This initiative saw the installation of VSDs to the numerous pump motors in the plant room, including the condenser water pump. In order to segregate the impact of the introduction of the various energy conservation measures, the post ATCS data was further separated to pre and post VSD installation. The results for Case 3 were impacted by several events. The energy savings anticipated for the summer months of December 2010 to February 2011 were below expectations. Following a basic investigation it was identified that the ATCS was not serviced as required since commissioning in June 2010 by the mechanical service contractor. The major factor being the nonreplacement of the sponge balls at the maximum of every 1000 hours of chiller operation. At the very most, a fifteen minute task. New sets of balls were inserted into the system on March 2011. In May 2011, the Investa Property group acquired the site from ING property, which affected the service regime due to a change in the site mechanical contractor. A new service regime


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Case 1

Case 2

Case 3

Case 4

No. floors





Building type

Category A office building

Category A office building

Category A office building

Category A office building

NABERS energy rating





Net Lettable Area





No. Chillers installed with ATCS





Chiller Make/



3 x Trane

2 x Powerpax

Condenser Type

Double pass

Double/single pass

Double pass

Double pass -split system

Tube I.D. (mm)


22; 15

2x 22; 1x 15


ATCS unit size

2 x 6”


2 x 10” / 1 x 6”

1x 12”

Date of installation

04/2010 & 10/2010




Table 2. A summary of the ATCS Case studies 1 to 4

was established in September 2011 and maintained since then on a regular basis. For Case 4, monthly kVA demand data was supplied and analysed for savings. The maximum monthly demand has been plotted against CDD in Figure 9. On average, the demand has been decreased by 55kVA. Placing this into context, each Powerpac WA096.2H.22N twin compressor chiller has a nominal cooling capacity of 960kW with a full load COP of



5.5. This equates to an approximate full load electrical draw of 175kWe or 218kVA (assuming an average power factor of 0.8). It is noted that variations are higher with demand and reflected in the lower regression coefficients (below 0.8) when compared to energy consumption. This confirms natural expectations where maximum demand (kVA) and overall energy consumption do not have to correspond. The resulting financial savings reward from an ATCS will depend on the regional demand price structure. For some states in Australia, the average

TECHNICAL PAPERS maximum demand achieved in any given 30min interval is charged indefinitely as an annual demand capacity. The rational being the network must have spare capacity to meet this demand as it could happen anytime thereafter once achieved. Under this pricing regime, from Figure 8 no demand benefit would accrue with the ATCS. However, other state network operators charge a monthly price based on the maximum demand attained in each month. Under this pricing structure, on average, an ATCS would be expected to save the customer additional money. As an example, the cleaning performance of the sponge ball ATCS fitted to one of four chillers at Westmead Hospital is highlighted in Figure 9. As part of the annual AS/NZS-3788 pressure equipment inspection, the hospital chillers are opened for an internal inspection to occur by an independent examiner. Aside from preventative maintenance tasks, preparation for inspection had involved the internals and tubes to be cleaned by brushing and flushing with water to remove any deposits in order that the surfaces of the vessel are presented in an inspectable condition. Since the installation of ATCS, the improvement to the condition of the tubes has been commented on by both the maintenance technicians, and the pressure vessel inspector to a standard where the tubes clearly did not require additional manual cleaning for the inspection to occur. [Hely, 2014]. An example of the clean tubes as maintained with ATCS is shown in Figure 10. The first photograph in Figure 9, supplied by the hospital’s mechanical maintenance supervisor, of the opposite shell-end of the double pass condenser to the injection side, shows the appearance of staining due to calcium deposits from the condenser water system [Hely, 2014]. There is a clear zone free from staining in the central region across the shell-end where the sponge balls are impacting the plate. The second figure is a close-up view of the image, where one can note the ‘mottled’ appearance from the impaction of the balls removing the calcium deposits. It can be seen from the distribution profile of the impacts that the balls are focusing in a central band across the full face, which demonstrates the balls are travelling radially across the whole diameter of the tube bank.

Fig 6 Yearly electricity consumption profiles for Cases 1 to 4

Fig 7 Monthly consumption versus CDD for Cases 1 to 4

Fig 8 Maximum monthly demand versus CDD

By keeping your condenser tubes clean, its no wonder why such large efficiency gains of over 26% will be extracted; improved heat transfer in combination with full utilisation of the available surface area as inherited from the original over-specified design. Hopefully this paper sheds some light that there is no mystifying logic to how and why such large savings can be made with ATCS when added to your chiller.

Fig 9 A view of the condenser shell ends






TECHNICAL PAPERS Guide to Best Practice Maintenance & Operation of HVAC Systems for Energy Efficiency, Council of Australian Governments (COAG) National Strategy on Energy Efficiency, 40, 2012. Bott, T.R., Fouling of Heat Exchangers. 1995: Elsevier Science & Technology Books. 529. Muller-Stinhagen, H., Heat Transfer Fouling: 50 Years after the Kern and Seaton Model, Heat Transfer Engineering, 3291:1-13, 2011. Steinhagen, R., Muller-Steinhagen, H., and Maani, K., Problems and Costs Due to Heat Exchanger Fouling in New Zealand Industries, Heat Transfer Engineering, vol. 14, no. 1, 19–30, 1992. Garrett-Price, B. A., Smith, S. A., Watts, R. L., Knudsen, J. G., Marner, W. J., and Suitor, J. W., Fouling of Heat Exchangers, Characteristics, Costs, Prevention, Control and Removal, Noyes, Park Ridge, NJ, pp. 9–19, 1985. Kuppan, T., Heat Exchanger Design Handbook, Section 9. Fouling, Published by Marcel Dekker ISBN: 0-8247-9787-6, New York, 2000. ASHRAE 2000 Systems and Equipment Handbook, section 35.4. Muller-Steinhagen, H, Malayeri M.R. and Watkinson, A.P., Heat Exchanger Fouling: Mitigation and Cleaning Strategies, Heat Transfer Engineering, 32(3–4):189–196, 2011. IPMVP Volume 1 EVO 10000-1:2012. Lee, Y.P. and Karng, S.W., The Effect on Fouling Reduction by the Ball Cleaning System in a Compressed Type Refrigerator, Int J of Air-Conditioning and Refrigeration, Vol 10. No. 2, 88-96, 2002. Fig 10 A view of the condenser tubes cleaned by ATCS


Hely, N., Mechanical Maintenance Supervisor, Westmead Hospital, NSW, Australia. Personal communication, August 2014.

1. Pangolin Associates, 46 Magill Road, Norwood 5067 South Australia ( Brodribb, P., and McCann, M., 2013, Cold Hard Facts 2: A study of the refrigeration and air-conditioning industry in Australia, Australian Government, Department of Sustainability, Environment, Water, Population and Communities (SEWPaC), Environment Quality Division, Ozone and Synthetic Gas Team. J. Piper, Chiller Challenge: Energy Efficiency, Maintenance Solutions, April 2006.




Designing for hospital efficiency KERRIE CARDON I R.N. ARCHITECT, HERB GIFFIN AIA ACHA

This feature is one of a series of quarterly articles published by Health Facilities Management in partnership with the American College of Healthcare Architects 06 May 2015.



ealth care environments can be supportive of efficient care processes, a hindrance to them or something in between. Care delivery models must constantly change to meet the demands of an aging population, a shortage of care providers and new treatment modalities, such as mobile technologies. Coordination of care to empower patients, improve patient outcomes and reduce readmissions requires robust multidisciplinary care collaboration, both physically and virtually. Healing environments for patients and staff also must incorporate supportive environments for families and care partners. There are eight health care flows that provide a comprehensive foundation from which inspiring and healing environments can be built.

SPACES AND CONDITIONS Health care architects rely on staff input during user group sessions to learn about workflow and processes. However, nurses often do not realise that many tasks they are performing involve workarounds, and staff may try to recreate inefficient current work environments. This input may lead to incremental change, but cannot lead to the innovation necessary to create a paradigm shift in planning and design that truly optimises the environment to support safe and efficient patient care. For instance, a spaghetti diagram from a recent shadowing exercise reveals how


nurses utilised the medication rooms and central staff work station as circulation paths due to lack of circulation paths in the solid support core [see graphic above]. The disruption created by constant traffic through a central staff work space intended for heads-down and distractionfree work is problematic because it can lead to increased medical errors. Architects often design nursing units based on pods and neighbourhoods to distribute support services. In the facility illustrated in the spaghetti diagram, a nurse on the medical unit was in charge of seven patients distributed throughout the medical unit. There are several reasons why patients are dispersed: They are assigned based on acuity level, nurse skill sets and the desire for continuity of patient care. Daily admissions and discharges also play a significant role. In fact, nursing units transfer or discharge 40 to 70 percent of their patients every day. Nurses travel greater distances with all-single patient rooms, and are also walking miles to retrieve items necessary for direct patient care. Support spaces often are not standardised, requiring nurses to travel to different areas to retrieve items for care. Staff work spaces have not changed appreciably over the years. Although the concept of centralised vs. decentralised space is discussed during programming, the design of these areas remains very traditional. Traditional central stations and decentralised alcoves still are widely utilised. Nurses must


walk around the bullpen configurations and tend to chart on the outside, because walking to the inside of the station can add hundreds of steps to an already long travel day. Linear bar configurations are traditional in the zone between the support core and the circulation path and this configuration adds numerous steps. Decentralised alcoves have proliferated in nursing unit design over the past few years. Keeping caregivers at the patient room is desirable, but designing that area with a fixed counter and chair creates a singleuse space. The ability to utilise that space for other purposes can be achieved if the space is flexible and not built-in. Windows into the patient room from the alcove give nurses a direct view of the patient. Those same windows also enable direct views of patients by anyone who walks down the hall, compromising patient dignity and confidentiality. This is why blinds are almost always closed. Innovation must be the catalyst to enable a paradigm shift in the planning and design of these crucial spaces to keep nurses close to their patients while maintaining patient dignity and privacy. GRAPHIC CONCEPT BY KERRIE CARDON; IMAGE COURTESY OF HERMAN MILLER INC. This medical unit spaghetti diagram, based on an eight-hour nurse shadowing exercise, shows that staff utilised the medication rooms and central staff work area as travel routes due to a lack of circulation paths through the core of the nursing unit.

TECHNICAL PAPERS HEALTH CARE FLOWS Adherence to Lean principles, efficient workflow and the removal of wasteful processes and workarounds is paramount to creating safe, effective and efficient patient care environments. The foundation of Lean rests on the notion that continuous process improvement requires continuous change — driving the need for flexible and adaptive health care environments. Understanding Lean, and wasteful processes inherent in health care, is key to laying the foundation from which to launch innovation in new health care environments. The planning process provides an opportunity for transformational change, while the design process incorporates and embeds the efficient and innovative characteristics necessary to support and sustain future care delivery models. Incorporating Lean and leveraging the eight health care flows into the early stages of the planning process are pivotal to envisioning spaces that are healing, inspirational and efficient. Utilising these health care flows as a checklist ensures an efficient, human-centered experience for all users. 1. Flow of staff. This involves creating a safe, efficient, calming and attractive health care work environment. Such environments can aid in recruiting and retaining nurses. Front-line nurses are at the centre of all patient care delivery, and staffing shortages have a direct effect on patient safety. Inadequate staffing has shown to increase patient mortality and increase the incidence of health care-associated infections. The most effective and efficient team enables all members to practice at the top of their licenses. Tasking nurses with stocking supplies is just one example of taking a highly valued care team member away from direct patient care. Nursing burnout can be attributed to many factors, including workarounds and wasteful processes. Design considerations include decentralised support spaces that aid the act of caregiving. Work space considerations must accommodate a multigenerational workforce and aging caregivers, as well as a variety of work styles, needs and activities. Planning offstage spaces must incorporate technology

to support virtual consultations and collaboration. Off-stage spaces provide staff with a secluded place for respite, even if only briefly, to recharge the spirit, rejuvenate the body, and replenish the soul — important aspects that also support recruitment and retention. 2. Flow of patients. The focus of patient care has centered on the patient room, but we also can envision the entire health care environment as a place of healing. Ambulation aids in the healing process, but patients may be reluctant to leave the proximity of their rooms if they do not have a place of respite when away from their rooms. Places of respite encourage and support periodic independent ambulation. Decentralised respite spaces promote patient safety by providing patients with a comfortable seat outside of their rooms. These areas also can be used for goal-setting. Patients can ambulate to more distant places of respite as part of their recovery process. The alcove between every two patient rooms can be used as a “front porch” respite area with comfortable furniture if not designed with fixed, built-in casework. Flexible planning dictates the need for multiuse space versus dedicated space. 3 Flow of families and care partners. Families and care partners are taking on more of the patient care activities that traditionally were part of nursing care. Caring for a loved one 24/7 creates the need for a space that accommodates multiple functions — working, eating and a place of quiet respite. Family zones, which support this need, traditionally have been designed near the exterior window. The stress of caring for a loved one can be alleviated by creating a comfortable and healing place for families and care partners. This space can be designed at the footwall to enable families and care partners to remain in proximity to the patient, while enabling the space to be closed off with a curtain from the rest of the room without eliminating the patient’s view of nature. Creating this nest also helps to prevent waking the family and care partner if staff attend to the patient in the middle of the night. A good night’s sleep is as healthy for the family and care partner as it is for the patient. The ability

for the family caregivers to close the curtain to watch TV without disturbing the sleeping patient also is beneficial. 4. Flow of information. Information can be categorised in three forms — paper, electronic and verbal. Although paperless environments are the goal, paper still is utilised and must be accommodated and organised. Also, planning spaces that enable the undisturbed and uninterrupted exchange of verbal information reduces medical errors. Technology is pervasive in caregiving activities, creating the need for an environment that supports both fixed and mobile solutions. Leveraging lessons from other vertical markets like education helps to optimise environments for mobile workers in health care environments. Collaboration is crucial to support multidisciplinary teams and consultations that may occur both on-site and via virtual gatherings. 5. Flow of medications. Most medications are stored in decentralised locations within a pod or neighbourhood of patient rooms. Even these decentralised locations unnecessarily increase travel distances for nurses. Automated dispensing machines are intended to ensure safety protocols and inventory controls. However, nurses many times perform workarounds with medication administration processes due to travel distances, inefficiencies and having to wait to access the medication dispensing machine. Bar code technology is intended to be a safety net for safe patient medication administration, but this strategy does not always work due to wireless dead spots. Processes and environments must be designed to place routine patient medication at the point of use. This will help to remove reliance on faulty human behaviours, avoid the need for backup processes that do not always work and ensure patient safety. Architects can design environments that encourage staff to do the right thing by bringing patients’ routine medications closer to the point of care to minimise the potential for a medication error. 6. Flow of supplies. Hoarding is a huge red flag that the supply distribution





TECHNICAL PAPERS process is not working. At times, nurses hoard supplies because they are not always confident that they will have what they need where and when they need it, and they worry that patient care will be compromised. Locating supplies at the point of use reduces hunting and gathering, and shortens staff travel distances. One solution is to triage supplies to place the majority of frequently used supplies at the patient room with backup supplies located in decentralised places throughout the unit. Mobile carts for supply storage provide the most planning flexibility and eliminate unsafe ergonomic conditions of having staff attempt to get supplies in upper cabinets that are out of reach. 7. Flow of equipment. Health care environments present unlimited opportunities to improve processes and prevent the spread of pathogens. For instance, when a piece of equipment is removed from a patient room, the potential exists for patient equipment to be contaminated. Moving potentially contaminated equipment throughout the hospital could be averted by cleaning select pieces of equipment along with other items in the patient room. Equipment program requirements are now greater with an older and more acutely ill patient population. IV poles and pumps are standard equipment items for the sicker patients who now occupy inpatient beds; commodes for patients who cannot walk to the bathroom are common; and walk devices are necessary for aging baby boomers. Designing a small storage space adjacent to the patient room, much like storage spaces designed for labour, delivery and recovery rooms are now

necessary to accommodate the equipment needed for today’s older and sicker patient population. Likewise, the location of lift equipment determines whether such equipment will be used or ignored by nursing staff. 8. Flow of output. Hospitals generate more than 26 pounds of waste material per staffed bed per day, which must be segregated by type. The process of waste removal requires thoughtful consideration to ensure that adequate space is planned in both the patient room and decentralised soiled holding spaces.

IDENTIFYING INEFFICIENCIES All of these influences are driving the need for a paradigm shift in the planning and design of space that will identify and eliminate inefficient processes and workflows. Health care designers must leverage innovative planning and design concepts to create holistic, healing, efficient and safe environments for all users to create truly human-centred experiences. Kerrie Cardon, R.N., is a registered nurse, health care architect and a consultant with Bison Creek Innovations, Whitefish, Mont., and Herb Giffin, AIA, ACHA, is a health care architect and principal with GBJ Architecture, Portland, Ore. They can be reached at and, respectively.

LOCATING MEDICATIONS TO HELP PREVENT ERRORS Nurses access patients’ medications several times throughout a shift, and automated dispensing machines can create bottlenecks as nurses queue up, waiting to access the machine. Distractions occur in the medication room because nurses interact with each other while waiting for the machine, increasing the potential for errors. A red-taped area on the floor in front of the machine is one workaround, but nurses still hear conversations in the vicinity. What’s more, once nurses access the machine, they may be tempted to pull all patients’ medications scheduled at the same time, but this shortcut could result in additional medication errors. Fluorescent sashes used as a “do not disturb” visual signal during medication administration are another example of a workaround. Workarounds are indications that the medication administration process must be improved. Medication interruptions impact cognitive work and frequently occur as nurses travel from the medication room to a patient’s room. A medication study found direct correlation between interruptions and medication errors. Bar code technology has been adopted to increase patient safety; however, relying on technology as a safety net does not always work due to wireless dead spots. Physical spaces that embed safe processes into the design by decentralising routine patient medications in a “no-interruption zone” at the patient room eliminate waiting for automated medication dispensing machine access; reduce nurse travel distances; avoid the waste of hunting and gathering as well as the need to create workarounds; eliminate the need to rely solely on technology to prevent injuries; create an efficient environment that promotes staff retention; and increase patient safety. Decentralising medications to the point of use at the patient room can reduce errors by eliminating interruptions, travel distances and wasteful processes.




WORK ENVIRONMENTS TO SUPPORT LEAN OPERATIONS The central workstation historically was used for charting and social interaction, which made the workstations lively and noisy. The move from centralised to decentralised charting has placed nurses closer to patients, but has left them feeling isolated. While decentralised alcoves between two patient rooms have become prevalent in recent years, the fixed, built-in counter creates spaces that are underutilised because they are not flexible, ergonomic or adjustable; nor do they accommodate alternate forms of technology, such as workstations on wheels. Additionally, the space between the support core and circulation traditionally has been designed using long, linear bar configurations that add staff steps. Changes in technology have altered the way staff members handle information. Wireless technology allows staff to document in spaces that support their respective work patterns and styles. Leveraging planning strategies utilised by educational environments supports the approaches needed for the multidisciplinary collaborative spaces. Work environments must support many competing needs and complex issues, such as the different work styles and preferences of a multigenerational workforce. Visibility and openness must be balanced with privacy and confidentiality. Environments must be free from distraction, while also supporting the need for socialisation and camaraderie. Collaboration includes both physical congregation and virtual connections. Multiuse workstations are approachable and technology-enabled. Flexible and adaptable spaces support Lean operations and the ability to be reconfigured for continuous process improvement. On-stage spaces are exposed and active, while offstage spaces are reflective, support uninterrupted work and create a place of staff respite. Designers should envision space as a blank canvas and craft the staff work environment through an innovative lens. To the extent possible, they should plan an open-core concept to maximise flexibility and reconfiguration potential. Modular solutions should be applied to accommodate the competing needs, complex issues, functions and workflow processes necessary for efficient and effective work.

REFERENCES AND FURTHER RESOURCES Try the following resources used by the authors in preparing this article: • Pallarito, K. “Interrupting a Nurse Makes Medication Errors More Likely.” Health Day, April 26, 2010. • Hendrich, A.; Fay, J; Sorrells A. “Effects of Acuity-Adaptable Rooms on Flow of Patients and Delivery of Care.” American Journal of Critical Care, January 2004, Vol. 31, No. 1 • “Why are those nurses hogging so much of the hospital budget?!” March 25, 2011. • Cimiotti, J. “How Nurse Burnout Affects Hospital-Acquired Infections.” Physicians Weekly, Feb. 20, 2014. • Robert Wood Johnson Foundation. “Wisdom at Work: The Importance of the Older and Experienced Nurse in the Workplace,” June 2006. • Iyer, Pat. “Preoccupation, Interruptions & Multitasking Lead to Medical Errors.” Medical-Legal Topics, Dec. 2, 2014. • ”Hospital Bar Codes not a Perfect Rx.” Philadelphia Inquirer, July 1, 2008. • ”To Err is Human.” Institute of Medicine, 2006. • Eldlich, Richard F.; Winters, Kathryne L.; Hudson, Mary Anne; Britt, L.D.; Long, William B. “Prevention of disabling back injuries in nurses by the use of mechanical patient lift systems,” Journal of Long-Term Effects of Medical Implants, 2004, Vol. 14, No. 6 • Wadhwa, S. “Connection Between Pollution and Health Care,” Sept. 1, 2013, blog post





In partnership with the Better Buildings Challenge, three hospitals diagnosed their energy use and prescribed new ways to improve patient care while saving energy.


he energy to operate the buildings in which we work, shop, study and live costs the United States about $200 billion annually and, on average, 30 percent of this energy is wasted. Health care facilities are among the most energy-intensive of commercial buildings, costing more than $9 billion to operate each year. Some health care organisations, including the University of Pittsburgh Medical Center (UPMC), New York-Presbyterian Hospital and Ascension Health, have committed to energy-saving strategies and are sharing their solutions through the Department of Energy’s Better Buildings Challenge. By employing energyefficiency strategies, they are lowering their costs, improving facility performance and reducing their carbon footprints. These hospitals’ investments to make their operations more efficient align with their primary mission of excellent patient care. Each of these organisations is pursuing efficiency in different ways, but all are making significant progress as Better Buildings Challenge partners through ambitious portfolio-wide commitments.

UNIVERSITY OF PITTSBURGH MEDICAL CENTER: AN ALL-INCLUSIVE VIEW ON ENERGY EFFICIENCY UPMC’s health care system portfolio contains 20 hospitals and more than 400 outpatient centres, totalling more than 13 million sq. ft. Drew Chidester, UPMC’s senior director of energy and environmental engineering initiatives, and his staff take a longterm, comprehensive view on energy-efficiency projects across the UPMC health system. “Holistically, we look at putting together an entire program, something that looks at physician needs, patient needs, as well as operating staff capabilities, and bring all that together as we move energy-efficiency projects forward,” he says. From an operational perspective, UPMC tries to implement automated processes, which are easier for staff to maintain and produce greater environmental results. For example, motion sensors on lighting and automatic setbacks on HVAC systems ensure that equipment is automatically turned off when not in use, including in hallways and even operating rooms.

PHOTO COURTESY OF UPMC UPMC developed a holistic sustainability plan that integrates physician, staff and patient needs into its energy-saving solutions.

According to Chidester, “The name of the game in energy savings right now is sustainability. We are well beyond lighting and steam trap upgrades; that low-hanging fruit is yesterday’s news. Today, our staff have to strategically plan around longterm sustainability and conservation projects, many of which have us changing the way we manage daily operations.” As a public entity, Chidester feels it’s important to be a good steward financially and environmentally. The reduction of UPMC’s operating cost through energy conservation results is a twofold benefit for the organisation. “One is it reduces costs,” he explains. “But it also helps to keep the environment clean by reducing kWh or Btus that we’re consuming, ultimately providing lower costs.” The medical centre’s involvement in the Better Buildings Challenge has enabled it to engage better with staff on goals they all can contribute to, and “grow our energy-savings opportunities,” Chidester says. New York-Presbyterian Hospital: Empowering employees to identify energy-savings opportunities Based in New York City, New York-Presbyterian is one of the nation’s largest hospitals with some 2,600 beds. The hospital’s 6,000 affiliated physicians and 19,000 employees provide inpatient, ambulatory and preventive care in all areas of medicine. The hospital’s six campuses encompass 35 buildings THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2015





TECHNICAL PAPERS and 10.5 million sq. ft., making it a top energy user in the New York metropolitan area. PHOTO COURTESY OF NEW YORK-PRESBYTERIAN NYP kicked off its sustainability efforts by benchmarking its energy usage, giving it a better understanding of its energy consumption.

To join the Better Buildings Challenge, the hospital needed to have a good understanding of its energy consumption, so benchmarking energy-usage data was key. From its work with the Challenge, the hospital was able to gain support from senior management to help implement and execute energy-conservation projects, including benchmarking and an employee engagement program. The key to facility wide savings is engaging employees and encouraging them to find ways to reduce energy, says Kathia Benitez, corporate energy program manager at the hospital. Benitez and her staff developed the Gallery Walk Checklist as part of its Green Champions initiative. It includes items that the team can check as they walk the hospital’s hallways, such as ensuring that computer monitors are turned off and noncritical equipment is unplugged when not in use. The team also identifies areas that would benefit from installation of occupancy motion sensors for lights. “Our employees have all these wonderful ideas, but we need to formalise them somewhere,” Benitez says. “And that’s how the Better Buildings Challenge has really helped us.” Employee recommendations gathered through the hospital’s Gallery Walk initiative are key to implementing energy-saving measures, including the installation of more than 300 motion sensors in areas with fluctuating occupancies. These efforts, in partnership with the hospital’s engineering staff, are key to driving down energy use.

PHOTO COURTESY OF ASCENSION Ascension set an initial goal to reduce energy usage by 5 percent. It has since upgraded that goal to achieve a 20 percent reduction by 2020.

and construction, existing facilities improvement projects and portfolio-wide energy-management strategy. Ascension’s facilities encompass a broad range of hospitals — large and small, new and old — as well as acute care facilities and critical access hospitals. The smaller, older facilities typically do not have the necessary infrastructure to implement building automation systems and other energy-saving measures, such as monitoring energy usage. Tracking energy was the first step on the path to helping the organisation implement an energy program. “When we started tracking energy use in 2008, we initially set a goal of reducing energy use by 5 percent across all of our facilities,” Sechrist says. Ascension accomplished that goal

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Through their participation in the Better Buildings Challenge, partners also commit to sharing their strategies and successes so others can replicate them. “It’s always good to hear about what other peer hospitals are doing outside of New York-Presbyterian, just to leverage our program and improve what we’re doing,” Benitez adds. “I’m constantly learning from other hospitals. It’s a nice, friendly competition.”

ASCENSION HEALTH: SETTING EVERAGGRESSIVE GOALS Ascension Health employs more than 150,000 associates who provide health care services at nearly 1,900 locations nationwide. The company’s Environmental Stewardship Program seeks to improve the energy efficiency of its hospitals and health care facilities. Lois Sechrist is a sustainability senior analyst for Ascension’s Facilities Resource Group, which is responsible for design


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in June 2011, mostly by making behavioural changes and measuring and monitoring energy use to manage consumption better. “And once we met that goal, we said, ‘well, what should we do next? We need a bigger goal,’” she says. Enter the Better Buildings Challenge. In 2011, Ascension set a goal to achieve a 20 percent reduction in energy usage (kBtu/ sq. ft.) by 2020. “It got us very focused,” says Sechrist. “And then it required that we come up with a game plan of exactly how we were going to accomplish our goals. So, we allowed our hospitals to work on their own for a couple of years to make improvements and changes.” For its improvement projects, Ascension hired engineering firms to retro commission all of its hospitals. The initiative was tremendously successful. In the third year of the four-year program, efficiency jumped from achieving 9.1 percent energy reduction in 2013 to 13.8 percent in 2014. “We went from $30 million in cost avoidance a year ago to $43 million cumulatively,” says Sechrist.

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“If you don’t set a baseline and measure monthly, quarterly and yearly, you don’t know where you’re going or where you’ve been,” Sechrist says. “I absolutely stress the importance of tracking your usage and your cost.”

TRANSFORMING THE HEALTH CARE INDUSTRY The goal of the Better Buildings Challenge is to make American commercial buildings, multifamily housing and industrial plants at least 20 percent more energy efficient in the next 10 years. As Better Buildings Challenge partners, each of these hospital systems is helping to meet that goal via portfolio-wide implementation of innovative energy-saving solutions that also make good business sense. The more organisations share their results and lessons learned, the more the health care industry can transform knowledge into energy and cost savings. The recently launched Better Buildings Challenge Solution Center helps organisation to find a solution by topic, building type, solution type, building size, sector, technology, location and more. Users can explore more than 200 solutions tested and proven by partners, and learn how a variety of organisations finance their building solutions projects, implement emerging technologies, build their team’s energy expertise, motivate staff, get buy-in from management or establish communitywide initiatives. Since 2011, 250 organisations have committed to improving their energy intensity by 20 percent in 10 years. Partners represent more than 3.5 billion sq. ft., 600 manufacturing facilities and $2 billion in financial investments. Sara Schoen is the commercial real estate lead for the U.S. Department of Energy’s Better Buildings programs. Learn more at

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First published Health Facilities Management 02-06-2015


Architectural leaders focus on efficiency, safety and technology 2014 Health Facility Design Survey Planning priorities REBECCA VESELY I SUZANNA HOPPSZALLERN



nhancing operational efficiencies, improving patient and caregiver safety and integrating health information technology (IT) are major influences driving changes to health care facility design, according to the Health Facilities Management/ American Society for Healthcare Engineering 2014 Health Facility Design Survey. The Affordable Care Act (ACA) is having a major impact on nearly every aspect of health care — and facility design is no exception, according to the survey, which was completed online by 582 participants in July.

ENHANCING EFFICIENCY “The biggest thing that surprised and excited me was the word ‘efficiency’ and the major focus on technology,” says Andrew Quirk, Skanska USA senior vice president and national director of its Healthcare Center of Excellence. “Those were the two big ideas circulating through this survey.” Enhancing operational efficiencies edged out improving patient and caregiver safety and improving patient satisfaction as the top factor in driving changes in health care facility design, with 91 percent, 89 percent and 88 percent of respondents, respectively, choosing these as the major influences. The ACA is causing hospitals to seek all possible ways to become more

efficient, and to provide better care and service to the community, Quirk says. “It was a perfect storm of the economic downturn, reimbursement cuts and the Affordable Care Act. Fiscally, you just have to be more responsible, and building facilities has gotten more expensive.” The ACA’s focus on reforming payment models from volume-based care to value-based care is “a very strong driver for facility design in the near future,” says Joseph G. Sprague, FAIA, FACHA, FHFI, principal and senior vice president at HKS Inc. an architectural/ engineering firm in Dallas. With the rise of accountable care organisations and other payment-reform models brought to the fore by the ACA — as well as non-reimbursement for never-events and greater transparency on medical errors — patient quality and safety are more paramount than ever, experts say. As for the focus on patient satisfaction in design, intense competition for customers is one factor. Additionally, patient satisfaction scores are playing a greater role in reimbursement, so more attention is being paid to making sure patients and families have a good care experience than ever before. “There are very few fundamental drivers in health system facility design,” says D. Kirk Hamilton, FAIA, FACHA, EDAC, professor of architecture at Texas A&M University, College Station. “Hospitals look to improve efficiencies wherever

they can; far too many patients suffer from infections or safety issues; and transparency in reporting is something we are seeing more than ever before.” Some prior trends seemed to be old hat this year. For instance, a third or fewer respondents said that hospital mergers (33 percent) and acquisition of physician practices (31 percent) are important factors driving change. Aside from a few notable exceptions, most communities already have experienced large hospital mergers in years past, so these are not current design issues. “Our health networks are pretty well-established,” says Scott Reifeis, director of design and construction at Nationwide Children’s Hospital in Columbus, Ohio. “What is happening is more movement into communities and building ‘hospitals within other hospitals’ to serve neonatal patients.” Outpatient facility design was a hot topic in the design survey results [see sidebar, Page 24]. Some 60 percent of respondents said that creating “facilities that are easy for the community to access” was a major influence in design. “Some things we do to improve safety and satisfaction are counter to improving efficiencies,” Reifeis says. “When we look at a design challenge, we have to have balance. We balance patient experience, cost and available space with efficiencies.”



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TECHNICAL PAPERS A SAFE EXPERIENCE Patient safety and patient experience features will have a big influence over facility design in the next five years, including design interventions to reduce falls (62 percent), design considerations to facilitate patient mobility (62 percent) and multiple locations for hand sanitising and hand washing (59 percent). Making rooms accessible and safe is a major trend, says Sprague. “One of the biggest challenges I see is that you have a situation where you need motivation and mobility to move from the patient bed to the toilet area,” he says. “Handrail placement and ways to reduce falls are really strong considerations in the design of the patient room.” Hamilton says he would like to see more emphasis on infection prevention, especially in light of major worldwide outbreaks like Ebola. “I would have bet that there would have been more emphasis on infection prevention,” Hamilton says. “The physical environment plays a role, but I would have liked to have seen more about antimicrobial materials like copper.” Slightly more than half (53 percent) of respondents said antimicrobial surfaces would have an emphasis in hospital and facility design over the next five years. Fifty-five percent of respondents said that creating or expanding observational units in the emergency department or for psychiatric patients (49 percent) would be a priority over the next five years. William Hercules, AIA, FACHA, ACHE, LEED AP, president of WJH in Orlando, Fla., expresses surprise that it wasn’t higher. “Emergency departments are in a transformational stage,” Hercules says. “I believe the number of observation beds is going to increase because the amount of care and its associated expense is higher if patients ultimately are admitted as inpatients.” Some are moving forward with additional psychiatric beds, like Nationwide Children’s Hospital,

which is opening a 16-bed behavioural health unit for patients younger than 18 within the next year. “We look at this as a responsibility to the community,” Reifeis says.

Another emerging trend may be modular construction, with 51 percent of survey respondents saying they plan to put more emphasis on modular construction over the next five years.


“Modular construction has a bright future,” Sprague says. “A lot of large hospitals are looking at prefab toilet rooms because they can save money on construction costs.”

Technological advances and investments in IT were high on the list of factors driving change in facility design, with 72 percent and 65 percent of respondents, respectively, having said these are major influences. Over the next five years, respondents said the following IT features would be incorporated: • Design space and infrastructure to accommodate point-of-care technology (handheld devices); • Expanded mobile and cable networks for telehealth services; • Larger operating rooms to allow for increased technologies; • Created or expanded space for physicians and nurses to deliver telehealth services; • Created or expanded space and infrastructure to accommodate robotic equipment. Technology is driving the health care industry and that is increasingly reflected in design, says Quirk. “But I’ve never seen technology integrated into the architecture of the facility,” he adds. “How does a facility change to reflect technology? Does the room change if you are walking into it with an iPad? Do the buildings that we now have in service respond to the technology sea change happening?” Quirk asks. “A lot of buildings can’t adapt to this new environment. But you will see a blending of technology and architecture. It’s a huge opportunity.” Likewise, Reifeis says he was surprised that more respondents did not see robotics as a major factor in the next five years. “I think robotics will come on strong in the near future,” he says. “I believe we will see robotics used to deliver food carts and move trash. It is an opportunity to improve efficiencies and reduce costs.”

Patient comfort Not surprisingly, noise reduction in hospitals is top of mind in hospital facility design. Some 71 percent of respondents said that over the next five years noise-reducing construction materials would be incorporated into design features. And 60 percent of respondents said they are incorporating noise-reducing materials into patient room design. Noise reduction is an area of focus because of the increased emphasis on patient satisfaction and Facility Guidelines Institute (FGI) Guidelines for Design and Construction of Hospitals and Outpatient Facilities issued earlier this year that has a new section on acoustics, including the use of noiseabsorbing materials and reducing the amount of hard surfaces in facilities, which can create unnecessary noise, Sprague says. The FGI is a volunteer-run organisation and its guidelines, published every four years, are used by 40 states as a hospital licensure requirement. “It’s amazing how noisy hospitals have become,” Sprague says. To that point, 71 percent of survey respondents said that regulatory requirements are a major influence in driving change to health care facility design. Another FGI guideline involves medication safety zones to reduce medication errors. This can include guidelines on lighting, security and access, Sprague says. Nearly half of survey respondents (48 percent) said they would put more emphasis on medication safety zones over the next five years. Top features in room design include wireless technology for staff (71



TECHNICAL PAPERS percent), conversion of semiprivate to private rooms (69 percent), technology integration (65 percent) and bar coding for medication administration (63 percent). Other items that could influence patient satisfaction include individual temperature control (59 percent) and patient control of room lighting and shades (57 percent). “That’s a lot,” Hamilton says of the results. “The research shows these are helpful in terms of patient satisfaction.” An important aspect of facility design these days is energy efficiency because it can reduce overhead costs, some experts said. For instance, 68 percent said better energy usage and efficiencies were a major influence in driving changes in facility design. However, just 37 percent of respondents said that selecting environmentally friendly materials was a major influence in design. “Energy is the biggest opportunity to make an effect on the financial well-being of a hospital,” says Quirk. “It gives you better control over swings in commodities like gas, water and electricity. Hospitals and health care organisations need to push the industry and, on the client side, clients need to be willing to take professional recommendations and step up and take a little bit of a risk.”

IMPROVING THE PROCESS Process improvement is an underlying theme in health facility design today — from improving patient flow to reducing unnecessary steps and tasks for staff. All improve the patient and caregiver experience and can improve quality, Sprague says. “Everybody is interested in process improvement,” he explains. “You don’t want to design a building with an old, inefficient process.” Rebecca Vesely is a freelance health care writer based in California. Suzanna Hoppszallern is a senior editor of data and research for



Health Facilities Management’s sister publication, Hospitals & Health Networks. First published Health Facilities Management (HFM,) 01-10-2014 and sponsored by: Mitsubishi Electric Cooling & Heating


RESPONDENTS REPORT INTEREST IN OUTPATIENT FACILITY DESIGNS Hospitals and health systems are paying careful attention to outpatient facility designs these days to improve care coordination and meet the multifaceted needs of patients while extending their brands, according to the 2014 Health Facility Design Survey. A major trend emerging over the next five years is expanded health system-branded general medicine and family care centres in the community, with 63 percent of respondents having said this change is on the drawing board. “A consistent brand across the continuum is a major trend,” says William Hercules, AIA, FACHA, ACHE, LEED AP, president of WJH in Orlando, Fla. “If hospital systems are now going to be responsible for the overall health of communities, they have to be responsible for the continuum of care for an illness or an event. So outpatient settings are only going to be called outpatient settings within the health system. To the community, hospitals are trying to make it look seamless.” So-called “intermediate care” facilities — community-based facilities for patients well enough to leave the hospital, but too sick to go home — are one such area that hospitals and health systems are exploring, with 45 percent of survey respondents having said this is on the drawing board for the next five years. Children’s Hospital Nationwide in Columbus, Ohio, for instance, is investigating intermediate care, says Scott Reifeis, director of design and construction. “The adult market has a lot of these types of facilities, but it is just emerging in paediatric care.” Nearly half of respondents (49 percent) said that rehabilitation centres are on the drawing board for the next five years as well. Any unfulfilled needs expressed by patients are driving outpatient trends because of an increased focus on consumerism and patient satisfaction, experts say. “The patient really is now the consumer,” says Andrew Quirk, senior vice president and national director for Skanska USA’s Healthcare Center of Excellence. “Everyone is starting to shop for the delivery of health care. Everyone better deliver the quality and price. Now you have to brand yourself.” More than half of survey respondents (54 percent) said that expanded immediate care facilities like urgent care are on the drawing board for the next five years. Urgent care is another area of focus for the consumer — allowing them to see a physician quickly at a convenient location near home or work.

years. And 36 percent said retail health centres are on the drawing board as well. “As big chain retailers like Best Buy are closing up, health care providers are renovating these spaces as outpatient specialty clinics,” Quirk says. “It’s really a smart branding opportunity for health care.” Patient flow in the outpatient setting is another area of focus to maximise efficiencies for staff and to move patients in and out as quickly as possible. With that in mind, emerging trends over the next five years appear to be expanded technology to support registration pre-visits (52 percent); boutique space for integrative medicine so patients can see multiple providers during a single visit (24 percent); concierge integrated health (34 percent); and flexible, multipurpose post-acute buildings that can accommodate a broad spectrum of patients (37 percent). “Whether the care is interventional or diagnostic, it is important that the design flow reflect the points of care,” says Joseph G. Sprague, FAIA, FACHA, FHFI, principal and senior vice president at HKS Inc. in Dallas. Yet to catch on appears to be self-rooming — where patients guide themselves to exam rooms without assistance — with just 14 percent of respondents having said this is on the drawing board over the next five years. Telemedicine booths in primary and specialty care are not yet a major trend, with 29 percent of respondents having reported that this is on the drawing board.

Additionally, expanded health system-branded clinics in retail spaces like strip malls, corner stores or big box retailers is another emerging trend, with 43 percent of respondents having said this is on the drawing board for the next five







HVAC selection for health care facilities CRAIG BUCK PE, LEED AP, HFDP

Identifying a health care facility’s specific goals in patient care and energy efficiency is critical in choosing the right HVAC system.


ospital HVAC system designs present unique challenges to facility managers due to the sensitivities of the hospital environment. The selection process is not straightforward, because in health care facilities there is an increased level of demand, a variety of required thermal conditions, and codes regarding reliability and hygiene. On top of that is increasing pressure to reduce energy consumption while maintaining a safe environment.

and maintenance, such as whether the project will seek any voluntary or mandatory certification programs like LEED or Green Globes. Also, identify whether there is an overall energyuse intensity target, or a percentage of energy-use reduction the project is seeking. All goals should be identified, grouped into “required” and “nice to have” categories, because some may not be feasible due to project constraints.

No two hospitals are alike, and while the facilities often contain the same program, varying size, location, priorities or goals can lead to completely different HVAC systems. The goal, then, is not to designate a universal HVAC system for all health care facilities, but rather to identify the various factors and general processes that need to be considered when selecting HVAC systems for health care. Identify project goals. The initial step in the HVAC selection process is to meet with the project stakeholders to fully understand the facility’s specific or desired goals. The engineer should document the client’s measurable expectations and define any critical success factors. Establish whether there are specific infection control risk assessment goals the facility might be seeking, such as a departmental reduction in airborne contamination or a reduction in the number of hospital-acquired infections. Identify any quantifiable sustainable and energy-efficiency goals to improve the building environment and provide cost savings for long-term building operations

PHOTO COURTESY OF RMF ENGINEERING Recognise the specific pressurisation requirements for the various medical programs within the building – isolation rooms, procedure rooms, waiting rooms – before selecting an HVAC system.

Identify program requirements. Next, review the program requirements with the architect and medical staff. Discuss the temperature and humidity conditions for the various medical programs within the building, for example, in patient rooms, operating rooms, examination rooms and radiology — specifically whether any exceed the minimum requirements of ANSI/ ASHRAE/ASHE Standard 170 —

Ventilation of Health Care Facilities. Recognise the specific pressurisation requirements for all the various medical programs, such as isolation rooms, procedure rooms, waiting rooms, kitchens and laboratories. Identify special filtration requirements of the medical programs — third-stage filtration, ultraviolet filtration, and bag-in bag-out infectious exhaust. Distinguish the specific ventilation requirements for each medical program, including minimum supply and outdoor air change rates. Discuss the need or desire for central facility wide smoke control and the ability to provide pressurised compartments. Review the specific redundancy requirements for the project and consider hazard vulnerability analysis, including uninterruptible HVAC service above and beyond code minimum for all or part of the facility. Finally, identify the specific acoustic requirements for the various medical programs within the building. Identify constraints. The engineer needs to fully understand the financial and physical constraints of the project and how they could limit the available HVAC system options or prevent the hospital from achieving any of its project goals. Prior to design, establish the allotted construction and mechanical costs for the project. The early programming and schematic phase of design can indicate the type and complexity of the budgeted HVAC system. Also, of greater importance, the mechanical costs may identify a disconnect between the HVAC scope and budget. Be sure to determine and understand the spatial limitations of the proposed or existing building. The



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TECHNICAL PAPERS size of the mechanical rooms, the method of vertical distribution, the floor-to-floor height, the desired architectural ceiling height and even the type of structure all will impact the HVAC design and may narrow the options. Identify facility desires and expectations. It’s important to meet with the facility manager and associated staff to understand the needs, desires and expectations of those who will operate and maintain the HVAC system. Since the owners’ priorities do not always align with the priorities of individual departments, identify and resolve obvious disparities prior to design to satisfy all parties. Determine what is important to personnel in the HVAC design. Preferred equipment manufacturers, requirements for equipment accessibility, scheduled maintenance, historic reliability, controllability, system complexity, ability for measurement and verification, and system equipment size all can have an impact on the selection of the HVAC system. Thermal and ventilation loads. Perform the cooling, heating and ventilation/air change loads for all of the individual program areas within the facility. Confirm the ambient outdoor design conditions based on the location of the facility, as well as the indoor temperature and humidity design conditions for each program or functional department. Integrate with the users, architect and other consultants to develop the optimal thermal resistance of the building envelope, building orientation, program occupancies, anticipated light and power loads, equipment loads, ventilation and infiltration/exfiltration. Developing accurate load calculations is an iterative design procedure that will have a direct impact on energy efficiency, occupant comfort, indoor air quality and building durability and, ultimately, will dictate the equipment selection. So, it is of significant importance that this process be performed correctly and that the results/outputs be fully understood. Identify HVAC systems. Where possible (and initially based on the programmatic stacking diagrams), work with the design team to group the common program areas into functional

departments with common HVAC requirements. Consider each functional department independently based on its differing HVAC needs, requirements and constraints. Through fact-gathering meetings and thermal and ventilation calculations, identify feasible HVAC systems that are appropriate for each functional department considering the project goals, requirements, constraints and expectations. It is likely that one specific system won’t satisfy all the criteria for each department, so all possible systems should be considered to determine which are most applicable and best suited for further evaluation. Several possible HVAC systems to consider as part of the analysis may include various configurations of the following options: • Central air handling units (variable or constant air volume) • Terminal heating and cooling systems (terminal reheat units, fan coil units, chilled beam units, radiant panels, water source heat pumps) • Dedicated outdoor air systems • Heating and ventilation systems • Heat recovery systems/components (runaround system, fixed-plate system — air-to-air, heat pipes, heat wheel, enthalpy wheel) • Exhaust systems (dry, wet, containment, infectious, kitchen hood)

Instead of focusing solely on upfront cost, perform a life-cycle cost analysis to narrow the list of HVAC options.

Life-cycle cost analysis. Once the viable HVAC systems are determined for the facility, perform a life-cycle cost analysis (LCCA) on the selected systems, including factors such as first cost, annual energy usage, yearly maintenance, equipment lifespan and replacement costs to evaluate and quantify the performance of each system over a desired period (typically 30 years). At this stage, the information available is generally not detailed or fully developed; however, the results should represent fairly the estimated

overall costs of the system alternatives for comparison, and identify the ideal system for an entire facility or systems for individual functional departments that will provide the lowest overall cost of ownership while achieving most or all of the project goals and expectations. Understand that the lowest resulting life-cycle cost may not necessarily be the ideal system, particularly if budget is not a high-ranking priority, and if the LCCA is simply another measurement to consider when developing the proposed system. Owner review. After completing the LCCA and considering all the information gathered at this stage, the preliminary system that most satisfies the facility requirements can be selected. Depending on the functional departments within the facility, it is not uncommon for several different systems to be provided. It is important to present the design options from a performance and financial perspective to the project stakeholders for review, discussion and agreement. When possible, all process participants should be present and all parties should fully understand the results so that at the conclusion of the review, there is a clear agreement and a path forward regarding the HVAC systems to be designed. There are many challenges related to selecting the proper health care HVAC system, and these challenges expand beyond those for a typical building. There is a direct connection among HVAC, patient outcomes and staff satisfaction, and while there is agreement that patient and staff safety are the first priority in health care design, beyond that the priorities differ. Design professionals must partner with stakeholders to study and identify the facility’s various needs, goals and objectives, so that a well-developed HVAC system can be designed to achieve the ultimate goal of improving patient care and maintaining health and wellness. Craig Buck, PE, LEED AP, HFDP, is a mechanical engineer and associate at RMF Engineering with extensive experience in designing HVAC, plumbing and medical gas systems for health care facilities. For more information, email First published Health Facilities Management 04-05-2015




Emergency Procedures Part 1


In November 2011 an arson attack ripped through a Quakers Hill aged care centre resulting in the deaths of fourteen people. The blaze was started by a drug-dependent employee in his attempt to cover the theft of dangerous drugs. The subsequent evacuation and recovery process was subject of criticism at various levels, with lack of sprinklers and employee checks high on the agenda. The incident is a good example for emergency planning and the inclusion of risk mitigation practices in that process, with particular emphasis on maintenance of fire-fighting equipment, procedures and recovery.


lthough this article is restricted in providing a more in-depth study of the incident it is suffice to say that managers need to incorporate risk management strategies for employee selection and plant and equipment maintenance within emergency prevention strategies.

WORK HEALTH AND SAFETY LEGISLATION AND EMERGENCY MANAGEMENT In most States prior to 2011, emergency management in facilities relied on vague OHS requirements and the guidelines provided by Australian Standards 4803 and 3745. 2011 saw the harmonisation of work health and safety legislation, including the introduction of Clause 43 of the Regulations relating to emergency procedures. Clause 43 states that any person conducting a business or undertaking (PCBU) must prepare, maintain and implement an emergency plan, with appropriate training and testing of procedures. The Code of Practice for Managing The Work Environment and Facilities 2011 specifically mentions AS3745:2010 and how emergency plans can be implemented (Section 5). AS4083:2010 Planning for emergencies in healthcare facilities relates to the hospital environment but is similar in design and content to the other Standard. It is recommended that any planning process involves the use of a competent person to ensure compliance.

BUILDING CODE OF AUSTRALIA There are a number of related issues that should be considered in any emergency plan. The Building Code of Australia (BCA) was first introduced in 1988 and provided technical provisions for the design and construction of buildings and other structures, covering such matters as structure, fire resistance, access and



egress, services and equipment, and energy efficiency as well as certain aspects of health and amenity. Building surveyors and fire safety engineers have been able to identify Alternate Solutions for areas of construction design that do not comply with the BCA. Common areas include distance of travel between alternate exits, fire resistance levels (FRL), compartmentation and separation. The Alternate Solutions may include the installation of a verbal sound system for emergency purposes (SSEP), fast response sprinkler heads, thermal detectors, 24 hour alarm monitoring or similar. Lately, there has been an increase in the requirement for an emergency management plan in compliance with AS3745 and/or AS4083.

AUSTRALIAN STANDARDS IN EMERGENCY PLANNING As already mentioned AS3745 relates to planning for emergencies in facilities. The elements of that Standard, to be mentioned in detail, have been defined as preparedness, prevention, response and recovery. AS4083 relates to planning for emergencies in healthcare facilities and AS1851 relates to the maintenance of fire protection systems and equipment. It is important that managers are aware of the need for compliance with the latter Standard to ensure that equipment is operationally ready at any time. AS31000 relates to managing risk through control measures to minimise the likelihood and consequence of any incident.

EMERGENCY PREPAREDNESS Emergency preparedness is the arrangements made to ensure that, should an emergency occur, all those resources and services that are needed to cope with the effects can be efficiently mobilised and deployed.

TECHNICAL PAPERS The secret to being prepared is through the initial planning phase, the identification of how complex the plan needs to be within the facility. Factors to consider include the size and nature of the facility, the fire engineered or life safety features, security management, the number and nature of occupants and visitors, and the hours of occupancy.

The actions could range from a return to normal business or occupancy to a complete relocation due to structural issues. The use of competent persons during the assessment process is crucial, as well as timely liaison with your insurance broker.

Areas to be included in this section are –

Part II of this article will look at the roles and responsibilities of facility managers in developing, implementing and maintaining emergency plans.

• Structure of the Emergency Planning Committee (minimum of 2 persons, one being management);


• Identification of emergencies that may impact on the facility or neighbouring facilities; • Structure of the Emergency Control Organisation, including an Emergency Response Team if required; • Specific emergency procedures; • Training; • Phased evacuation procedure; • Life safety and rescue procedures.

EMERGENCY PREVENTION Emergency prevention is the measures taken to eliminate the incidence of emergencies. Areas to be included in this section are –

Work Health & Safety Act and Regulations 2011 Australian Building Codes Board ( AS3745:2010 Planning for emergencies in facilities AS4083:2010 Planning for emergencies in healthcare facilities

ABOUT THE AUTHOR Greg Muir is the Managing Director of Beaware Solutions Pty Ltd and has over 40 years experience in risk management relating to buildings and procedures. He has qualifications in Public Safety (Emergency Management), Work Health & Safety, and Security and Risk Management. Beaware Solutions has provided emergency procedures and training, as well as evacuation diagrams, for both commercial and residential buildings, as well as Aged Care and Healthcare facilities.

• Appropriate policies and procedures; • Maintenance of equipment in compliance with AS1851; • Alarm systems; • Maintenance of plant and equipment; • Training in the safe use of equipment; • Correct storage practices of dangerous goods, hazardous substances, combustible material etc; • Good house keeping.

EMERGENCY RESPONSE Emergency response is a documented scheme of assigned responsibilities, actions and procedures within a designated section of the emergency plan, to respond to and manage emergencies. As mentioned previously, this may involve a dedicated Emergency Response Team, specially trained in emergency and/or rescue activities for the facility.

EMERGENCY RECOVERY Often an oversight in the planning process, emergency recovery is aligned with any business continuity plan. It requires the documentation of key contacts for the process, including key personnel, alternate accommodation and/or offices, insurance broker/s and policy details, structural engineer/s, contractors, and mandatory notifications, e.g. statutory bodies. The recovery process should commence as soon as practicable after the initial response and during the time between containment and handover by emergency agencies. Initial assessments and information provided by the responsible agency should identify the required level of recovery action.




Managing resilient buildings for a changing climate

An extreme hailstorm followed by very heavy rain on Christmas Day 2011 in Melbourne caused very significant damage to rooftop plant and blocked gutters resulting in extensive building leakage, internal damage and substantial business disruption. Image provided by A.G. Coombs.


As the effects of climate change become more evident, it is apparent that facilities and their operation need to adapt. Built environments must become more resilient and whilst designers are increasingly focused on this issue, facility management also has a significant role in identifying and implementing the appropriate changes to existing building infrastructure and management practices. Edwards gas boiler


ncreased incidence of extreme storm events, rising temperatures, estuarine flooding, sea level rise and storm surges, and even smoke impact from bushfires, are some of the obvious direct impacts. These events can also lead to the increased likelihood of serious disruptions in the provision of energy, water, telecommunications, waste and transport utilities further affecting buildings and their occupants. To produce improved facility resilience, an objective identification of the possible impacts and their likelihood, and subsequent impact to the facility and its operation, should be followed by the development of an appropriate plan for both enhancements to the building and its systems, and the establishment of business continuity plans for operation and management. Objectives: at the outset it is important to have a clear definition of the objectives of the exercise. The safety of the facility’s occupants is usually the prime concern followed by some level of ‘essential’ business continuity. Compliance with legal obligations is also a basic requirement. Potential Events: direct events can include the potential for storm damage and building leakage, localised flooding due


to overwhelmed stormwater systems, extraordinary estuarine flooding or coastal storm surges and extended periods of extraordinary heat. In some facilities the impact of smoke from large bushfires or dust from extreme dust storms may be a concern. Events caused by failure of external infrastructure can include prolonged electrical power, gas, water and even sewage disruption; telecommunication failures may affect landline, mobile and data services. Transport failure whether the road system or public networks are also a consideration. Impacts and Risks: scenario planning can be used to ascertain the possible impacts to the facility from the identified events, their likelihood, and the consequent assessment of risk. Judgement can be applied to determine the level of investment and preparation that may be prudent to address the perceived risk to the building, the business operations therein and the occupants. For example, higher likelihood of extreme rain or hail events can increase the risk of localised flooding or building leakage; increasing incidence of high temperature days may compromise the building’s ability to maintain internal temperatures; prolonged electricity supply failure will deem buildings requiring mechanical ventilation to be non-habitable.


Building and System Enhancements: what can be done to modify the building and its systems to reduce the impact of events deemed to be tangible? Bunding and stormwater diversion works to protect infrastructure such as substations and switchboards; review of and modification to guttering; protection of storm-exposed rooftop plant; review of mechanical plant capacity and its controls to address consecutive high temperature days; alternative ventilation strategies where possible. Facility Management and Operation: the management of the facility, in pre-empting and preparing for an event, and during and immediately after an event, is critical. Preestablishing, aligning and communicating situation management and response protocols to stakeholders, including facility occupants and service providers, agreeing event and post-event communications arrangements, and immediate physical response plans and post-event plans are all important elements in successfully achieving a more resilient facility. Remembering also that for this planning to remain effective, it will require regular review and communication to ensure arrangements remain in place and up-to-date.


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Emergency planning and the question of indemnity DEREK HENDRY I HENDRY GROUP PTY LTD

AS 3745 is the Australian Standard utilised in the preparation of emergency planning for most States and Territories in Australia apart from Queensland, which utilises the Building Fire Safety Regulation 2008 as the instrument governing emergency planning compliance.


ince AS 3745 is not directly referenced in Commonwealth, State or Territory legislation, the Standard acts as a guideline for those involved in the preparation of emergency planning. This said, NOT following these guidelines would place emergency planning stakeholders at serious risk of legal action should any emergency occur that impacts on the safety of their building occupants or visitors. Over the years there have been changes and updates made to AS 3745 and some of these changes that have been of concern to a number of hospital engineers, property owners and property managers involved in emergency preparedness concerns the statement regarding legal liability. Specifically, Clause 2.1.3 in AS 37452002 stated:

“Both the EPC (Emergency Planning Committee) and the ECO (Emergency Control Organisation) personnel shall be indemnified by their employer against civil liability resulting from workplace emergency assessment, education, training sessions, periodic exercises or emergency evacuation of a building where the personnel act in good faith and in the course of their emergency control duties.’

Clause 5.5: ‘Facility owners, managers, occupiers and employers should obtain professional advice on the level of indemnity provided to ECO members. The ECO members should be advised of the level of indemnity provided.’

These words have been deleted from the 2010 version and new wording in Clauses 2.5 and 5.5 has been inserted:

• The EPC issues the Emergency Plan and is responsible for outcomes from its implementation.

Clause 2.5: ‘Facility owners, managers, occupiers and employers should obtain professional advice on the level of indemnity provided to EPC members. The EPC members should be advised of their level of indemnity provided.’


• The responsibility of safety in facilities comes from both State and Federal legislation for Workplace Health and Safety or Occupational Health and Safety (for employers to their employees), and common law (from those in control of facilities to those who obtain access).

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TECHNICAL PAPERS The indemnity of members of the EPC and ECO will generally fall into two categories:

as an employee and then the nature of the negligent act or omission.

• Those who are acting as employees, whose liability will almost certainly be covered by their employers under the respondent superior doctrine, for negligent acts or omissions by their employees in the course of employment.

Employers who provide indemnity to their employees or property owners who retain liability should ensure that the Emergency Plan does not expose them to liability. They can do this by:

• Those, perhaps property owners, who are not employees, whose liability will be determined by the nature of the negligent act or omission in preparing the Emergency Plan. The liability or indemnity of members of the ECO, who follow the Emergency Plan, will be determined in the same way. Indemnity does not flow from the Standard. The Standard is not law, but a guide to best practice. Any past statements made by the Emergency Response Procedures under the 2002 Standard would have had the same weight as statements made under the current standard, with liability or indemnity of an individual determined by their status

• Seeking legal advice (as suggested by AS3745-2010); and • Using a respected Emergency Plan contractor who has a responsibility to provide an Emergency Plan that addresses the liability in a professional manner. In summary, the new standard has not really changed the status of liability of individuals involved in emergency preparedness. Employers and property managers should obtain legal advice regarding the Emergency Plan or use a respected contractor as they would for any specialised work with legal liability. The unique mix of membership of the EPC (typically building owners, agents, occupiers, lessors, employers) may mean it contains individuals

who are not employees and so should ensure their liability is not increased by using the same measures. However, the majority of EPC and ECO members will be employees who will be indemnified by their employer. Hendry Emergency Planning can assist your EPC in upgrading the emergency preparedness of your facility to AS37452010 while limiting the legal liability or owners, employers and occupants. Derek Hendry is the COO of the HENDRY Group Pty Ltd, a multi-disciplinary consultancy whose services includes buildings surveying, disability access, essential safety measures , emergency planning and workplace health and safety. HENDRY pioneered the private certification system of building approvals in Australia and operates nationally in all facets of building control. HENDRY publish an e-newsletter entitled ‘Essential Matters’ and a suite of web and blog sites designed to assist property practitioners in understanding their regulatory obligations. Visit to locate more information relating to your property requirements.




Hospital construction success factors

Considerations that apply to all project delivery models PATRICK DUKE

Alternative project delivery models have been the talk of the health care construction industry over the past decade. Integrated project delivery and its variants have occupied speaker time in all of the premier conferences and academic circles while demonstrating positive outcomes in the field.


s the industry continues to seek the ideal project delivery method, however, has it lost focus on fundamental success factors in capital project delivery? Experience allows health facilities professionals to understand which factors equate to project success.

SEVEN KEY ELEMENTS As health care planning design and construction professionals embrace new models of delivery for capital projects and utilise new tools that can enhance collaboration, there still remain seven foundational elements that are key to project success. 1. Ensure that the capital project is part of the strategic plan. One of the encouraging outcomes of health care reform is that there is much more scrutiny over the deployment of capital than ever before. Perhaps at times, there is a tilt on the scale toward more planning than doing, but gone are the days when projects lacked any proven connection to a health care system’s strategic plan. The question now becomes, “How do you know that a project is truly connected to a strategic plan?” All professionals engaged in the capital project delivery process have a responsibility to ask questions at the beginning of any project. Is there a


master facility plan that identified this project as a priority? What was the process that resulted in that master facility plan? These questions can provide an indication that the project has a connection to the organisation’s strategy. Despite its seeming like a no-brainer, some organisations still restrict certain information to only those that they feel “need to know.” While it has never been good practice to have a project that is not clearly connected to a health care system’s strategic plan, the stakes are much higher today. Professionals who recognise this stand a greater chance of becoming trusted advisers. This sometimes means telling leadership that they are better served to spend capital on other system priorities. For instance, a health system recently purchased a hospital and in the agreement included a $50 million commitment for capital improvements. But, instead of tapping the money as improvements that were needed, the system and the hospital agreed to develop a strategic master facility plan that resulted in a scaled-down requirement of $25 million in capital improvements. The balance of funds was set aside for physician practice integration in the


PHOTO COURTESY OF THE BOLDT COMPANY A pull-scheduling session during construction of a children’s hospital.

market, which proved to be a much better long-term investment. 2. Understand that benchmarking is an art. The scariest position on the capital project delivery roller coaster is up front when early conceptual costs for an undefined project are needed. The Internet has compounded the fear factor by providing easily accessible information to untrained individuals who mean well, but can create more work for everyone involved in the process. Project teams that clearly convey the process of developing conceptual costs from benchmarks and understand that it is both an art and a science are much more successful. Typical benchmarking mistakes are wellknown. They start with a comparison of projects that may seem similar but have vastly different characteristics. One example recently encountered was the development of capital costs for a

TECHNICAL PAPERS new hospital. The health system spoke to another system that had delivered a new hospital for a number that seemed too good to be true. After further investigation, it was.

how the team plans to work and creates alignment on expectations for each member. It also ensures agreement on scope, schedule and budget targets for the project.

On the surface, the two projects were similar in size and scope. They were new hospitals, each with fewer than 150 inpatient beds. But one was built in a state with low-cost labor and the other would be built in a state with some of the highest labour costs.

4. Develop a team-selection process. Success on any capital project is a direct result of the people on the team and the support they receive from their respective firms. However, the team selection process often is disjointed with a variety of firms based on classification of expertise hired using separate requests for proposals that may or may not be coordinated with the correct project details. Often, a mountain of responses is received, evaluations are made after reading only a portion of each proposal and a scripted interview is used to make the decision.

The real difference was noted when it was revealed that the space cost per patient bed was based on a future bed count complement that opened as shell space. While this seems like a simple example, it happens consistently across the country and causes much angst among professionals tasked with delivering the project. It is imperative to project success that a process for conceptual cost development be defined and proper use of benchmarks be implemented. 3. Avoid premature launch. The beauty of working on capital project delivery is the ability to see a tangible product at the end. However, health care systems often are in such a reactive rush to produce the tangible results that critical steps are missed and the process is not followed. This can lead to unmet expectations and/ or delay or deferment of a project. Trying to take shortcuts can completely derail the project. For instance, in a quest to start a design and show tangible results to its board, a hospital system launched a project without first considering all factors that could impact the program. By neglecting to understand the gaps in their planning, the hospital presented a plan that was not feasible and resulted in rework in planning and design that cost approximately $2 million and delayed the project for 18 months. Teams that resist the urge to launch the design of a project prior to alignment of scope, schedule and budget can avoid expensive rework and potential delays. All project delivery teams should take part in an initiation process immediately upon coming together to deliver a project. Project initiation focuses on developing

Despite this being one of the most important decisions a health care system will make on any given project, team selection is seldom given adequate investment in time and money. The root of all project problems begins with selecting the wrong team members. The most successful projects involve taking the time to develop a coordinated team selection process and investing time and possibly additional funds in that process. The ideal scenario is one in which the process allows for integrated teams to be selected vs. one in which firms are selected individually, thus resulting in a “forced marriage.” Though this concept may seem foreign, it provides owners with confidence that their team has a history of working together, is aligned along common goals and has a culture conducive to collaboration.

appears to increase coordination by making one entity responsible for the communication among many. However, the results can be quite different. The silos created by this model often stifle creativity and create a bureaucratic decision-making process. To manage the risk, architects and construction managers often act as communicator in chief but things often get lost in translation. Owners’ representatives and project managers can exacerbate the problem by setting the expectation that they are holding the architect and construction manager fully responsible for any errors their subcontractors may make. Fostering an environment and organisational structure that allows for communication across party lines can allow professionals to meet at the intersections where value is created. 6. Create team accountability for the budget, scope and schedule. People typically embrace accountability. However, the process and structure of capital projects often does not afford individuals that opportunity. Owner’s representatives and project managers often assume they know which information and responsibilities everyone else should have to complete their tasks but creating accountability and sharing information across the project delivery team will drive project success.

In comparing two recent projects, one using a traditional team selection approach and one using an integrated model, the integrated model saved three months over the life of the project and resulted in a more collaborative and aligned team upon selection.

Dictating a budget instead of collaboratively developing it creates an opportunity for gamesmanship among the team members and typically provides no motivation for high performance. Similarly, the same type of approach to a schedule likely will get the answer the organisation wants to hear, but the results can be far different from the plan. A successful project harnesses the innovation and experience of the team to develop and validate the schedule and budget in alignment with the scope desired by the health care system.

5. Communicate across party lines. A project organisational chart typically predicts the communication flow. In the push to allocate risk, the common response is to bundle services primarily under the architect and construction manager. At first blush, this practice

For example, leadership within one health care system recently developed a project budget based on fragmented input from industry professionals and peers. Instead of informing the project team on all elements of the budget, scope and schedule, the leadership team felt



TECHNICAL PAPERS it should control the information flow according to its own guidelines. The result was a lack of accountability among the team and it was discovered that required elements for the project were projected to cost $40 million over the established budget.

end clearer than before and become comfortable with the model.

To gain alignment and create an accountable project delivery team, the development of the budget and schedule should be a team sport. Processes like target value design and pull planning are built around this concept and can yield benefits. Early involvement by the construction manager, architect, engineer and key trade partners can pay dividends on the back end of the project.

The emphasis on operational improvements to align with the final design should not end once design is complete. Successful projects create a structure and process to manage this effort throughout the life of the project through activation. Failure to prepare operationally, prior to moving into a space designed for a set workflow, can upset the financial parameters on which the project was approved. It also can create a negative perception of the project delivery team’s performance even if all building systems are functioning properly.

7. Plan for facility activation in advance. With health care systems focused on cost-containment, there has been more emphasis on workflow design influencing space requirements and adjacencies. This requires all team members to think with the end in mind. With an everincreasing use of virtual design tools and 3P (production, preparation, process) events during the design process, hospital system stakeholders are able to see the

Successful project delivery teams start the capital project delivery process with the end in mind. They not only focus on integrating operations into the design process, but also ensure that the facility is prepared for its intended use. Understanding all the requirements from authorities having jurisdiction for inspections and certifications from the various accrediting bodies is necessary to develop a responsible schedule.

TEAM SELECTION AS OPPOSED TO TEAM FORMATION Hurley Medical Center, Flint, Mich., completed a master plan for its campus that identified needs greater than the ability for Hurley to fund them. After prioritising the emergency department (ED) for funding, Hurley officials knew the $30 million they had to spend must achieve maximum value for the dollar. Not only was an expanded ED required, but Hurley also wanted to create a better patient experience when entering the facility as well as enhance its paediatric care offerings by dedicating a portion of the new ED to that patient population. With an old physical plant, there was a high risk that unforeseen conditions and infrastructure renewal that previously had been deferred could take capital away from the desired clinical programs. Realising this, Hurley officials were determined to utilise integrated project delivery (IPD) to foster the required collaboration to get the greatest return on their investment. They took the time to develop an IPD educational program for their board, organised labor and the community.



Creating an integration strategy up front in the project with health care system support teams such as biomedical, facilities, information systems, procurement, environmental services and others cannot be overlooked. Successful projects recognise that facility and operational readiness must be aligned and a focused structure and process should be developed.

FOUNDATIONAL TO SUCCESS The challenge for health facility planning, design and construction professionals is not to get caught up in the delivery models or the tools as an end. Instead, develop a delivery model that will support these factors and others that are foundational to the success of a capital project. Patrick Duke is managing director at CBRE Healthcare, Richmond, Va. He can be reached at First Published Health Facilities Management 05.08.2015

This paid off given their decision on how to engage a project delivery team. An integrated team selection process was developed as opposed to a traditional team formation. Hurley officials determined that they wanted to hire not only the construction manager, architect and engineer, but also trade partners and specialty consultants. Hurley officials created an interdisciplinary committee to lead a selection process during which every interaction with each team was measured, including their conversations with administrative assistants who were helping to organise the effort. There were two workshops with each team and the selection committee. These were followed by a formal presentation of the team’s implementation plan for the project. The early engagement of the integrated team provided for more due diligence on existing conditions that allowed for discovery and solutions that minimised dollars being diverted to replace aging infrastructure. The team completed the project as programmed on schedule and 2 percent under budget. As a result of the incentive clause adopted on the project, Hurley and the integrated team shared savings at the conclusion of the project.





Inspecting hospital building envelopes

Maintaining the integrity of roofs, walls, windows and doors RICK ZIEGLER PE, RRO I GREG ISAACS PE

Maintaining and preserving the building envelope is an important part of a successful operations program, especially for facilities with critical interior spaces.


he building envelope represents an essential boundary between the exterior environment and interior conditioned space. It must effectively control and respond to the environmental loads to maintain environmental separation and prevent problems related to durability, water intrusion and indoor air quality. Through a fundamental understanding of architectural concepts and implementation of an effective maintenance program that’s aligned with product manufacturers’ warranties, a facility will sustain performance, identify problems early, and extend the service life of the envelope materials and components.

ENVELOPE FUNDAMENTALS Health facilities professionals must have a fundamental understanding of how the building envelope is designed and constructed to provide environmental separation, especially when attempting to resolve a problem or failure. For example, one common mistake of a facility maintenance staff is to install sealants or caulking where they do not belong. If a weep hole, which is designed to allow water to drain from an assembly, is observed opposite an interior leak, it seems intuitive to simply seal that hole. However, sealing weep holes may exacerbate the problem. With a proper understanding of how the wall system


works and is designed to function, mistakes like this can be avoided. Building envelope wall systems often are designed as barrier, drainable cavity or mass assemblies. Barrier systems rely solely on the outer surface of the wall to control and shed exterior precipitation. These systems must maintain a fully sealed, watertight exterior surface to effectively control water. Common barrier systems include precast spandrel panels and fully sealed metal panel systems. Cavity assemblies employ an exterior cladding or layer that sheds most exterior precipitation and rely on an interior drainage plane that functions as the primary control layer. An example of a cavity or drainage assembly is a drained masonry or other clad wall. Although mass assemblies rarely are designed on new projects, they have been used successfully throughout much of history. In general, they rely on the capacity of the envelope material to store moisture. Most mass walls are constructed with masonry. Roof systems can have similar design concepts. Some systems rely on an exposed outer membrane that is responsible for controlling air and water intrusion, while ballasted or protected membrane roof systems maintain a protection material on the exterior side of the primary control layer. Generally, envelope systems designed as barrier assemblies require and facilitate more maintenance than concealed


PHOTO COURTESY OF SMITH SECKMAN REID INC. Infrared thermography can be used to identify thermal anomalies associated with heat transfer, air leakage or moisture.

layers of cavity assemblies. Concealed materials must be durable because they are not accessible. However, if a concealed control layer was not properly manufactured or installed, the resolution of the problem can be costly because exterior or interior finishes must be removed to access the material.

INSPECTION AND MAINTENANCE With demanding occupant requirements and frequently overworked operations staff, a proactive inspection of a building’s envelope without an obvious problem may seem like a waste of time, but it’s not. Sometimes, envelope failures already have occurred and are only unnoticed. For instance, a leaking roof could be quietly draining water into the building where mould and rot are degrading

TECHNICAL PAPERS building materials, but hidden from view with a fresh coat of paint. With an inspection program, that failure could have been identified prior to its becoming a serious issue. This early detection could result in the availability of a patient room that otherwise would have been closed. Preserving the envelope, catching problems and minimising large capital expenditures are a few of the benefits of a successful maintenance program. It is generally accepted that an effective building envelope maintenance program is part of every high-performance building, especially health care facilities. A building owner can design a building envelope maintenance program in a number of ways. However, development of a comprehensive maintenance log is often the first step in implementation. Most logs include original or as-built design documents, warranty documentation and maintenance checklists. The checklists typically include a list of systems to be inspected such as the roof and sealants, along with a list of things to look for. Many manufacturers provide maintenance inspection checklists for building owners, so this may be a good place to start. The checklists must summarise typical failure or distress mechanisms, but also leave space for a description of an issue that isn’t captured within the checklist. The documentation can be valuable when analysing repair strategies and for anticipating replacements.

often can be attributed to the level of exposure and movement, such as thermal or structural. Therefore, the frequency of inspections may be based partially on the anticipated rate of degradation and associated risk. Vertical sealant joints do not have the exposure of the roof and, therefore, may not require an inspection cycle as frequent. Conducting the envelope inspection a minimum of twice a year is likely a best practice. Severe weather events also may initiate an inspection. Many building envelope visual observations are performed from the exterior, and are not intrusive on the operations of a facility. However, care must still be taken to notify all appropriate staff of the work being performed, however minor. Security personnel should be fully aware that one or more people will be photographing the property. Privacy of hospital tenants and staff during the execution of these tasks should be reviewed with appropriate personnel. Communication prior to performing investigative tasks can help to prevent unnecessary distress. Certainly, the safety requirements also should be fully understood by maintenance staff prior to conducting an inspection. Subsequent to adequate training and preparation, an inspection can begin. Based on access and building geometry, binoculars may be helpful to provide the magnification required to identify a deficiency. If closer examination is required, lifts or swing stages may be needed. Some envelope systems can be complex. If it appears that something is wrong, document the condition, and research it later. Sometimes, conducting the

A large portion of building envelope maintenance issues and failures often occurs at the interfaces between systems. Inspection checklists should include items associated with individual systems, but also focus on the system interfaces. Hospital complexes often consist of multiple buildings, constructed at various times throughout the life of the property, with each building consisting of a different building envelope system that was popular during the time of the facility expansion. This ongoing construction results in transitions between many different envelope systems. Transitions between different building envelope systems commonly require maintenance or repair. The transition between a 1930s-era mass masonry wall and a 1980s-era drainable brick cavity wall may be more prone to failures than the transition between two similarly constructed systems. Interconnected properties also have a high number of expansion joints where the envelope will move while remaining air- and water-tight. Evaluations should not exclude parking structures common to many hospitals. Parking structures are unique in that the structural components are exposed to the elements and therefore require similar considerations as building envelope components on occupied buildings. Identification of the inspection regimen and schedule is next. Most roofing manufacturers recommend that their roof systems be inspected twice per year at minimum, commonly in late fall and early spring. Degradation of building envelope components



TECHNICAL PAPERS inspection immediately after a rain can be helpful to indicate how systems are draining. For example, ponding water adjacent to roof drains may indicate a clogged drain or improper slope. Photographs during the inspection not only document a condition, but can help identify changes during future inspections. Some failures or issues are not easily observable. Missing or displaced insulation or air leakage can contribute significantly to energy losses, but easily can go undetected. In these cases, the building automation system frequently is overridden to sustain comfortable interior conditions in areas of the building that have difficulty maintaining set points. Tests can be conducted to identify air leakage or missing insulation. Some methods include infrared thermography or air leakage testing. Most qualitative tests like thermography rely heavily on the experience of the person conducting the test. Finally, consider printing 11-by-17-inch sheets with elevations and plans of the building. Each observation can be noted on the sheet so the location is clearly identified. Programs also are available on handheld electronic devices that facilitate electronic notations.

ADDRESSING FAILURES After a failure is identified, the next step is to consider repair options to correct the building envelope deficiencies found during the evaluation. Most involved parties will be anxious to implement repairs, which should be performed in a timely manner. Immediate safety measures can be addressed quickly and small maintenance items addressed in the short term. Larger long-term repairs however, may require time for thorough evaluation and design. This tends to be especially true for water leaks. Finally, it is important for all staff to recognise that repairs or modifications should never be conducted on a material or system that is still under warranty without consulting the manufacturer.


It’s not surprising that building failures related to the envelope represent a large portion of overall building failures. Commonly cited statistics often claim that envelope failures are responsible for 50–75 percent of construction defect claims. These types of envelope failures are commonly related to moisture or durability with severity ranging from barely noticeable to tremendously dangerous. A failure can be initiated through numerous mechanisms, including any or a combination of design or construction defects, weather exposure, material reaching the end of its service life and inadequate maintenance. Some failures clearly may be related to a specific material while other failures may not be as easily discernible. Identifying the source of water leakage into a building can be challenging and often requires extensive investigation. While the water may enter the building at one location, the actual cause may be completely unrelated to where the leakage was observed. Once a failure is observed, the first step is to identify potential safety risks. The difference between a building enclosure failure that is a safety hazard and a component that merely requires routine maintenance may be difficult to diagnose. If there is any question about the severity of a condition, an expert or specialist can provide the information that a facility manager needs to make the best decision regarding safety. For example, cracks in a wall surface in a highly visible area near a hospital entrance may result in a high number of concerned calls to property management, but may not necessarily be a cause for concern. Shrinkage cracks in a concrete spandrel panel, while unsightly, might not require immediate attention. Meanwhile, smaller, less visible cracks in the same concrete spandrel panel near a structural connection could be a safety hazard or lead to water intrusion. While structural issues can pose immediate safety hazards, water leakage


also can result in health hazards because wet materials are significantly more prone to biological growth. If mould or other biological growth is discovered, an industrial hygienist or similar professional can help to diagnose the type and extent of growth. An extensive abatement, investigation and repair program could be required immediately for these situations. If the failure is not an immediate safety concern, documentation of the conditions when the failure occurs can be important to beginning an investigation. For water leakage, interior and exterior air temperatures and relative humidity levels, wind speed/direction, building pressures, location of water leakage, and quantitative descriptions of the leakage are all important factors to document.

AN INTEGRAL PART Building envelopes often are considered static and durable systems that require little or no maintenance. This is becoming less true as many new facilities are designed and built with lower budgets, tighter schedules and more complex materials. Building owners are becoming more sensitive to existing building preservation, costs associated with failures and energy consumption. Likewise, occupants are becoming more sensitive to healthy buildings and indoor air quality. It has never been clearer that an effective building envelope maintenance program is an integral part of operating a highperformance health care facility. Rick Ziegler, PE, RRO, is a principal and Greg Isaacs, PE, is an engineer with Smith Seckman Reid Inc., Nashville, Tenn.; both specialise in building enclosure consulting and commissioning. They can be reached at and, respectively First Published Health Facilities Management 03.06.15

Considering state of the art in-room technology?


Ensure you install future proof fibre infrastructure to support it. GPON a solution to match your expectations. For more information contact Sean Serin Tel: +61 (0)7 3399 5280




Enabling technologies beyond 2015

Health Care set to take advantage of Carrier Grade Technologies SEAN SERIN I GPON SYSTEM DESIGNER, OPTICAL SOLUTIONS AUSTRALIA



n the January issue of Hotel Engineer magazine, Ted Horner1 told us about current technology trends in Hotels. In Ted’s article he mentions many technologies that he believes will become ‘required’ within the modern tech savvy Hotel. You may ask: “What has this got to do with the Health Care sector?” I am glad you asked, it has a lot to do with health care, it portrays the wants and needs of customers within the Hotel industry, the same customers that will, at some point, visit your health care facilities, their wants and needs will not change. Enabling patients to take care of their own minor needs will enable greater nurse patient contact hours, and as many studies have shown us the high the patient staff contact hours the happier the patient, the happier the patient the quicker they recover and leave the facility. The same can be said for patient access to technology, the more services they have access to, the happier patients are. Enabling these modern conveniences is to the betterment of your patients. All these modern conveniences work effortlessly by themselves, but when it comes to combining all these tech goodies in one location, on one system, and have them seamlessly interact with each other, this is the real problem for today’s health care operators. What is needed is a converged system that supports today’s technology seamlessly,


and has the capacity to support future technologies. Traditional networking technologies have supported our Health care facilities for many years, but are starting to feel the strain from the demands of guests, ‘always connected’ BYOD2 BYOC3 technologies, let alone the new video standards, with 4k & 8k in the market place, 16k and 32k currently under investigation it won’t be long before content for these standards flood the market4. Additionally the ever increasing bandwidth requirements for diagnostic imaging and remote collaborative expert consultation session, both in and out of the operating theatre, are taking their own toll on our aging network infrastructure. Help for our facilities come from an unlikely sector – Carrier Networks.

CARRIER ASSISTANCE Telecommunications carriers have been utilising a technology for many years that has enabled vast amounts of information to be transmitted over limited numbers of medium.

THE GPON ADVANTAGE There are many advantages to this technology; • Reduction of physical space requirements on the Hospital floors based on NO requirement for active distribution switches to meet the 90m copper rule per floor. Splitters are completely passive, and able to be placed in nearly any accessible space (floor, ceiling box, closet, manholes). Communications rooms (FDR/ TR) can be reclaimed entirely or become passive spaces for the fibre splitter, or simply a fibre pass through. • Reduced power requirements for the network equipment. NO active equipment on the floors for distribution and the ONT’s per room only draw 750mA each. Therefore reducing your carbon foot print and assisting in higher green star ratings. Additionally these can be DC powered from a centralised ELV DC supply source over new powered fibre technologies, further reducing infrastructure space and installation costs. • Reduced number of cables therefore reducing cabling pathways. Reduced cable diameters – assisting in retrofits

This medium is Fibre and the technology is Wave Division Multiplexing (WDM) this technology was migrated into the non-carrier space as Passive Optical Network (PON).

• Future proofed infrastructure – the medium utilised for GPON is single mode fibre optics, giving your facility the ability to upgrade bandwidth without changes to the infrastructure.

One of the PON technologies used throughout Australia is Gigabit Passive Optical Networks or GPON, the NBN has embraced this GPON technology to deliver the Australia National Broadband Network, but this technology can be utilised in many other verticals than residential. One such vertical is the Health Care sector.

• Carrier grade equipment, giving carrier level of reliability, previously unseen in non-carrier space.


• Truly converged networking, all IP devices sitting on one network, enabling single point system control. Central global firmware upgrades management. Central management minimises required field

TECHNICAL PAPERS technician expertise and supports high volume Moves, Adds and Changes. • GPON utilises single mode fibre which supports over 69Tbps of throughput making it a ‘future proof’ transport medium. • Benefits of fibre plant vs. copper: o Not susceptible to EMI o Unmatched security from tampering and intrusion o Lower material and installation cost o Smaller cable footprint than copper infrastructure

ANYTHING OVER IP With the proliferation of IP connected devices, be they physically connected or wirelessly connected, has led to ever increasing IT infrastructure to support these services. Ten years ago the catch phrase in the consulting industry was ‘consolidated networks’ a great idea which met little success and failed in execution due to traditional technologies inability to handle some of the service traffic then being injected into the network layer5.

different approach, as these applications are the opposite of data; this traffic is constant and continuous and must be reliable.

GPON FLEXIBILITY GPON takes the opposite approach, it is designed “out of the box” for streaming media applications such as audio and video, and delivering it with 99.999% reliability, as well as accommodating the erratic nature of internet traffic. So gone are the days of running a separate network for BMS, CCTV, Access Control, RF TV, etc. These can now all run across the same network infrastructure, namely GPON.

REPUTABLE GPON technology is not new; in fact its suitability for a Hospital environment can be assured by its current use in modern networks, with 10’s of millions of users paying for, and expecting 99.999% reliability, from these networks, and is delivering spectacular results.

implement GPON as their future proof infrastructure solution.

GPON RELIABILITY So when OSA claim reliability, it is backed by the fact that our same GPON infrastructure is delivering the same services as the hospitality industry are required to deliver for their clients, in some of the most harshest environments in the world that networks can possibly be deployed in. GPON not only delivers, but delivers at a price point that is competitive with traditional network systems.

FINAL THOUGHTS I would like to leave you with this final thought. In 2008 I remember a harsh lesson being delivered by the CEO of one of the world’s largest organisations: Ivan Seidenberg of Verizon technologies.7 His message was this;

Now this is not a failing of the existing network active infrastructure, just a realisation that current network equipment is based on fairly old technologies and has not been updated to incorporate nontraditional network traffic6.

It should be noted that any network system installed into a Hospital environment should be treated as permanent infrastructure, it is not acceptable for this network equipment to be made redundant in the future, further increasing pressure on future OPEX and CAPEX spreadsheets in such a highly price sensitive industry as Health Care.

“To any organisation irrespective of your field of endeavour, research and find your partners and embrace them. Share your concerns and your ideas. We tried to do it ourselves and took Verizon to the brink; it was our partnerships that have enabled us to reclaim the best of breed service we were renowned for. Nobody, and I mean nobody, can do this all yourself.”



So is GPON the right choice? Following is a few words from the CTO of Optical Solutions Australia, Greg Outridge, to address this point.

Like any technology, there can be pitfalls. It is important to select reputable companies with experience. For example, OSA’s GPON solutions are currently delivering multiple services to over 35,000 customers in Australia. These customers are highly demanding, as these locations are in some of the most remote and hostile regions of Australia. I am referring to mine camps, where in 2007 OSA was asked to commence replacement with GPON of the traditional Ethernet networks in these accommodation camps. This was due to the cost, and reliability, of existing technologies that did not meet the demands of the entertainment and services that were required.

OSA has embraced this philosophy and has partnered with multiple industry leaders.

“In my travels I often get asked the same question: ”GPON vs Ethernet, copper vs fibre, how do I mitigate the risk for me and how can I ensure its viability for not only now but into the future?” Thankfully, that question is easily answered.”

TRADITIONAL NETWORK Traditionally Ethernet networks were designed for data traffic which is random and variable in its nature. Delivering video and audio over these networks requires a

We are ready, now it’s over to you!

REFERENCES 1. T he Hotel Engineer Volume 19 Number 4 January 2015, page 26 2. BYOD Bring Your Own Device 3. BYOC Bring Your Own Content 4. N  ETFLIXTM currently offer a 4k package into Australia 5. Radio frequency traffic being but one such service 6. New moves into Application Defined Networking (ADN) shows some promise for an aging traditional network vendors 7. From an address to the FTTX council 2008

Many Health Care facilities around the world have already, or are looking to, THE AUSTRALIAN HOSPITAL ENGINEER I SEPTEMBER 2015


Product News Mini Pleat Paper Filter Panels Mini Pleat filter panels MFP for the separation of fine dust and suspended particles such as aerosols, toxic dusts, viruses and bacteria from the supply and extract air in ventilation systems. Use as fine dust filters, i.e. as prefilters or final filters in ventilation systems; or as particulate filters, i.e. main or final filters for the most critical requirements of air purity and sterility in areas such as industry, research, medicine, pharmaceuticals and nuclear engineering. Compact depth construction, suitable for systems with high volume flow rates and a requirement for long filter life. The filter media is made of high-quality, moisture-resistant glass fibre papers, with

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TENTE CASTORS AUSTRALIA... NEW INTERACTIVE WEBSITE FOR HOSPITAL CASTOR REQUIREMENTS TENTE’s new interactive website gives an insight into our virtual TENTE World and the various areas in which our TENTE products are used. We offer the appropriate solution for every area of a hospital. Simply click on the “ icons” in the picture and you will be taken directly to the area of the hospital concerned. TENTE Castors are suitable for almost every application and area of a hospital, Nurses Room, Pathology, Emergency, Kitchen, Birthing Room etc. The new website takes the guess work out of finding the right castor for the right application. TENTE also has the know how in special castors such as electro conductive, steam sterilisation and non magnetic castors. TENTE also offer a cad service and technical advice to customers. Our staff have industry knowledge and can so onsite consultations. Our Lidcombe warehouse stocks hundreds of lines

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Malmet releases new WDS – THE ONLY AUSTRALIAN DESIGNED AND MANUFACTURED COMBINATION BEDPAN AND UTENSIL WASHER DISINFECTOR After an exhaustive R&D and site trial program, Malmet have released the new WDS to the Australian market. The WDS is a purpose built machine, combining the capacity of Malmet’s well regarded ES/ ESD series Bedpan Washer Disinfector with the robustness and capability of its WDT2 Utensil Washer Disinfector. It has a large capacity of 2 Bedpans and 4 Urinals, or in a separate program 2-4 Bowls, or 6 Kidney Dishes, or various Utensils etc. This product effectively combines two units in one, which offers great space and cost savings in your facility. The WDS has only 3 simple programs, each one that fully disinfects to the higher Ao600 level, as recommended in the latest

R22 PHASE-OUTS – REPLACE YOUR OUTDATED UNIT WITH SPECIALIZED AIR CONDITIONING If you have an existing rooftop unit operating on R22, chances are that it has almost reached the end of its operating life, or is scheduled for replacement due to the phase-out of R22. The question is: how can you quickly and easily replace these units with something that’s far more cost-efficient? The answer comes from a Perth-based company that specialises in building air conditioning systems for some of the harshest conditions in the world – our outback mining communities.

RUDPLAS ROTOMOULDERS RP1300 TROLLEY Rudplas Rotomoulders is a family owned and operated business that has been manufacturing plastic trolleys and materials handling equipment for hospitals and the hotel and laundry industries for over twenty years. The model RP1300 trolley has a capacity of 400 litres and can be fitted with a back saver scissor lift platform. The

AS4187-2014. Malmet’s own design sensors prohibit the use of the incorrect program being selected due to human error. Also the WDS dumps all water between each program, further minimising the infection control risk of possible crosscontamination. The machine has also been independently micro-biologically tested to verify that the unit provides the efficacy required by infection control and clinical staff. The WDS also has a USB interface, to enable uploading of usage history, temperature and cycle validation, in line with the latest Australian and ISO Standards.

So it should come as no surprise that the name of the company is Specialized Engineering. And, as Chris Miller, the Managing Director of Specialized, says, ‘If our units can perform in the mines 24/7, and with proven high efficiency, imagine what they will achieve in the city’. Specialized is the perfect match to APAC The benefits of replacing an APAC unit with a Specialized one are hard to ignore. Specialized not only offers the same footprint, it also uses the same ductwork, mains power and controls, so that there are no costly modifications to worry about. The Specialized commercial range includes 15 models, from 12-kilowatt to 95-kilowatt capacity. There’s even a free cross-reference chart that gives you direct replacement

Being locally made, the availability of spare parts and service is a simple and quick process. Malmet also have available a Preventative Maintenance Agreement (PMA) to further protect your investment. The machines are available in two versions – the WDS1 (240V 1 phase 20A) or the WDS3 (415V 3 phase 20A). This means that the WDS1 is a simple upgrade from an existing Malmet ES or ESD machine, whereas the WDS3 is a simple upgrade from a Malmet BP or FS machine. For more information contact Malmet on (02) 6953 7677 or

Specialized  VS 045kW Roof Top Unit (with supply air transition plate)

APAC 045kW Roof Top Unit

equivalents covering most existing APAC models. Furthermore, Specialized is very competitively priced and, in most cases, the old APAC unit can be swapped over with the new Specialized one on the same day. Visit for more information.

scissor lift action raises the platform to a convenient working height which aids in the prevention of back injuries. The scissor lift can be fitted with either a 25kg, 45kg or 65kg rated spring, depending on the customers requirements. The RP1300 tub is ergonomically designed, easy to clean and easy to manoeuvre. The trolley is available in a range of colours and can be fitted with different castor arrangements.


Case Study – Casey Specialist Centre Casey Specialist Centre is a new purpose built medical specialist facility located in the South East suburbs of Melbourne Victoria. A major tenant of the building is Genesis Care – Radiation Oncology Victoria (ROV) with a state of the art cancer treatment facility within the building. This treatment facility consists of two (2) Linear Accelerator machines (Linac’s), magnetic resonance imaging machines as well as reception, doctor’s offices and patient waiting areas. As this was a new, green field facility Genesis Care ROV were determined to design the mechanical plant with a strong reliability focus based upon the lessons learnt from other Genesis Care ROV centres based around Victoria and interstate. The major issues and concerns that Genesis Care ROV raised included: • Need for high reliability of the plant and particularly the air cooled chillers supplying chilled water to the Linac machines • 100% standby of the chiller plant with a simple and quick changeover procedure. Also a quick service response should one chiller fail. • The ability of the air cooled water chillers to operate at high ambient temperatures to +45oC. Unfortunately Genesis Care ROV have had issues with other facilities where the air cooled water chillers failed at ambient temperatures of around 40oC, this of course leads to a shutdown of the Linac machines and the result of Genesis Care ROV not being able to treat patients. This not only results in lost

revenue but also the inconvenience of rescheduling patients. Based upon the above criteria, Genesis Care ROV selected two industrial process designed air cooled chillers supplied by MTA (Australasia) to supply chilled water to two Varian Linac machines. Each chiller was selected with enough cooling capacity for the two Linac’s, hence if any chiller should fail for whatever reason the facility has 100% cooling capacity redundancy whilst the failed chiller is being repaired. As the Varian True Beam Linac machine only operates at full capacity (beam on) for approximately 10 minutes every hour, special consideration was given to the chilled water piping configuration and system water volume. The reason for this is to prevent the water chiller from short cycling improving reliability and lifetime whilst building up the system’s thermal mass and reducing the water’s temperature variance to the Linac’s. The MTA water chiller has an inbuilt 255 litre water tank assisting the system water volume. Another key advantage of the MTA water chiller is that its integral chilled water pump was capable of up to 500kPa pump head, as the chiller was installed at roof level with the Linac bunkers located within the basement the water pump needed enough capacity to handle the high lift needed.

performance thus far of both the chillers and mechanical plant. Please see our advertisement opposite.

In summary the MTA water chillers, Linac’s and associated plant have been operating without fault since November 2014 despite some days well over 40oC ambient and Genesis Care ROV are very happy at the

Sensitive and Secure Sensitivity and compassion are essential qualities in a security officer working in the sometimes unpredictable health environment. To ensure the safety of patients, staff and visitors at all healthcare facilities, MSS Security’s officers are trained in customer service, mental health awareness and cultural diversity before beginning work. As a result, our officers are better prepared to approach problematic situations equipped with skills that are likely to ensure safe outcomes.


Specialist healthcare training, provided via the MSS Training Academy, our Registered Training Organisation, is an important part of the service we provide our healthcare clients; it is our officers’ ability to identify and defuse tense situations before they escalate to a physical altercation that provides the best outcomes. Techniques our officers are trained to use include identifying aggressive body language, approaches for dealing with

unpredictable behaviour, and open and inclusive communication. MSS Security’s 20 years’ experience providing security to health facilities around Australia has enabled us to establish an integrated approach to this specialist service, extending protection to patients, clinical staff and health facility visitors alike. For more information, contact: Janine Hill, General Manager Business Development, MSS Security, 0417 319 886 or



Compact clean steam generator (unwrapped)

Spirax Sarco, the world’s leading steam system specialist, has combined modern technology with package design expertise to create a compact generator capable of producing clean steam to the highest quality standards. The microprocessor-controlled unit uses treated feedwater and plant steam to produce steriliser-grade clean steam. The standard range covers clean steam duties up to 600 kg / h at 3 bar g. The pre-assembled, skid-mounted package arrives factory tested and ready to be connected to your utilities.

The CSM - C is a compact unit. It will fit through your plantroom door, offering maximum output for mimimum footprint

The standard range of outputs are up to 600 kg / h

PLC controlled with touchscreen commissioning for simple operation

Factory tested The CSM - C is fully maintainable from all sides

All wetted parts on the secondary side are 316L stainless steel

The CSM - C is fully HTM 2031 compliant


The preheat system heats and circulates the feedwater, ensuring the removal of soluble gases prior to entering the boiler

Spirax Sarco Pty Ltd Australia 14 Forge Street, Blacktown NSW 2148, Australia T +61 (2) 9852 3100 F +61 (2) 9852 3111 E Š Copyright 2015 Spirax Sarco is a registered trademark of Spirax-Sarco Limited

Hospital Engineer Vol 38 No 3  
Hospital Engineer Vol 38 No 3