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Innovative and efficient health care design, the greening of healthcare and facilities management. An update on the impact of information technology on health care delivery. Advancements in infection control in hospital settings.

INSIDE From the CEO’s desk ......................... 14 Evidence Matters ...............................15 Safe Medication .................................18 Trends in Transformation...................20 Doctors Without Borders ................... 21 Nursing Pulse ..................................... 24 Careers ............................................... 27

Canada’s first smart hospital

Mackenzie Vaughan Hospital is becoming a reality Story on page 6





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In Brief

Why do some people develop ALS? Canada joins international research partnership to find answers and better target the disease

Canada has become the 17th country to join an international research partnership that is working to determine why some people develop ALS while others do not, with numerous Canadian ALS researchers stepping up in a cross-country collaboration that is among the first of its kind in the country. The ALS Society of Canada (ALS Canada), in partnership with provincial ALS Societies across the country, is spearheading efforts for the Canadian component of Project MinE, a multi-national initiative that gained momentum following the Ice Bucket Challenge. Project MinE will map the full DNA profiles of 15,000 people with ALS and 7,500 control subjects, establishing a global resource of human data

that will enable scientists worldwide to better target the disease by understanding the genetic signature that leads someone to develop ALS.

Potentially avoidable breast cancer surgeries cost patients and healthcare system The number of breast cancer patients that have to be reoperated on in Canada is too high and impacts patient wellbeing and healthcare costs, according to UBC research. A recent study by UBC medical researchers examined the healthcare costs associated with lumpectomy patients requiring reoperations. A lumpectomy, known as breast conservation surgery (BCS), is a procedure that removes tumors, aims to conserve breast tissue, and is followed by radiation therapy.

Having to reoperate, makes a positive cosmetic outcome more difficult to achieve and can lead to additional stress and anxiety for patients and their families. The study concluded that with Canadian reoperation rates being more than double recommended targets, the additional cost to BC’s healthcare system alone is $2 million-per-year. One of the problems, says study author Chris Baliski, a clinical assistant professor at UBC and surgical oncologist at the BC Cancer Agency in Kelowna, is the lack of clinical guidelines, targets and report cards provided to surgeons themselves.

“In Canada, 23 per cent of women require additional procedures, ranging from further BCS’ to full mastectomies and breast reconstruction,” says Baliski. “With reoperation rates varying widely between surgeons, it would be interesting to see if a systematic focus on health quality and improvement could minimize the number of surgeries being performed.” Having to reoperate, adds Baliski, also makes a positive cosmetic outcome more difficult to achieve and can lead to additional stress and anxiety for patients and their families. In compiling the study, Baliski and fellow researcher Reka Pataky compared Canadian reoperation averages, calculated by the Canadian Institute of Health Information, with the 10 per cent target advocated by the European Society of Breast Cancer Specialists. Based on current research, the pair then developed multiple scenarios to measure how patient management is influenced by excessive reoperations and analyzed the monetary impact using financial data from British Columbia’s health system. According to the Canadian Cancer Society (CCS), cancer is the country’s leading cause of death. Earlier this year, the CCS estimated that 99,500 Canadian women would be diagnosed with cancer in 2016, with 26 per cent of those cases being breast cancer. Baliski and Pataky’s research was recently published in the journal Current H Oncology. ■

By accumulating such a large amount of data that no one country could achieve alone, it is expected that Project MinE could identify new genetic causes of the disease. The discoveries gained through Project MinE have the potential to significantly accelerate our ability to advance treatment possibilities that could slow down or even stop ALS. Canada’s goal is to contribute up to 1,000 DNA profiles to the international effort. Research expertise for Canada’s Project MinE effort is being provided by four of the country’s leading ALS geneticists in Québec City, Vancouver, Toronto and Montréal: • Dr. Nicolas Dupré, Neurologist; Assistant Professor, Faculty of Medicine, Université Laval; Clinician-Scientist, Axe Neurosciences, CHU de Québec - Université Laval, Quebec City • Dr. Ian Mackenzie, Professor at the University of British Columbia; Staff Neuropathologist at Vancouver Coastal Health, and a Consultant Neuropathologist, BC Cancer Agency, Vancouver • Dr. Ekaterina Rogaeva, Chair in Research on Dementia with Lewy Bodies at Tanz Centre for Research in Neurodegenerative Disease, and Professor, Department of Neurology, Faculty of Medicine, University of Toronto, Department of Medicine • Dr. Guy Rouleau, Director of the Montréal Neurological Institute and Hospital and Department of Neurology and NeuH rosurgery, McGill University, Montréal. ■


Competition seeks

healthy aging ideas

A national ideathon competition launched by AGE-WELL and HACKING HEALTH will take place in five Canadian cities in 2017. The goal is to identify and invest in great new technologies and services to support healthy aging. Prizes awarded at the AGE-WELL–HACKING HEALTH National Ideathon will total $75,000 in cash and in-kind services. Local ideathons are being held in: Toronto (Feb. 3), Montreal (Mar. 3), Halifax (May 13) and Vancouver (date to follow). One winning project from each local event will be eligible for the final round at the AGE-WELL 2017 Annual Conference in Winnipeg on Oct. 17-19, 2017. People interested in taking part can sign up at An ideathon is a collaborative, workshop-like event where diverse stakeholders harness their collective knowledge and creativity to brainstorm innovative solutions to pressing challenges. Participants use user-centric design techniques and methodologies (such as ideation, journey mapping and prototyping), and the creation of an initial business case, to propose a novel solution. “AGE-WELL and HACKING HEALTH share an interest in bringing people together to develop creative solutions to healthrelated challenges,” says Dr. Alex Mihailidis, Scientific Director, AGE-WELL. “By partnering to host this competition, we will trigger more innovation and much-needed solutions to support the independence, health and quality of life of older people, and to support their caregivers.” Luc Sirois, Managing Director and CoFounder of HACKING HEALTH, a global initiative, says the partnership and competition will help to bring together tech and medical communities and “catalyze the inH novation spirit.” ■

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Going green: A challenge for health leaders By Neil Ritchie


hen asked about what they’re doing to protect the environment, most health executives will point to a number of initiatives, undertaken over the years, in energy, water and waste management. Hospitals, nursing homes and clinics have been making incremental improvements in their environmental record since the oil crisis of the 1970s and should be commended for their efforts. But today, its simply not enough. After all, health, the environment and healthcare are inextricably linked and we need to be doing more to recognize and integrate these realities in our day-to-day delivery of care. There is growing evidence of the link between cancer, birth defects, respiratory and cardiovascular diseases and the kinds of solid, liquid and gaseous wastes that are produced by hospitals. Also, there is growing recognition of the significant contribution that hospitals’ green house gas emissions are making to man-made climate change. Yet environmental stewardship is rarely on the meeting agendas of hospital or nursing home boards, executive teams or medical staffs and is seldom mentioned in their strategic plans. Healthcare institutions need to be leaders not laggards on issues of environment sustainability and climate change resilience. Going green can improve an organization’s corporate image and reputation, and in the long run, it can save money. In 2009, recognizing the important leadership role that healthcare plays in environmental sustainability, the most prominent organizations involved in delivering health services to Canadians, and national environmental groups, including the Canadian Healthcare Association, Canadian College of Health Leaders, the Canadian Healthcare Engineering Society and the Canadian Coalition for Green Health Care, came together in an unprecedented show of support for the Joint


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But, as the environment takes centre stage nationally and internationally, the healthcare industry needs to step up, show more leadership and set examples for other energy intensive industries and toxic waste generators. Big, complex organizations do not change easily. They need to be skillfully guided on a new path, gaining momentum as staff are informed of the need for change and become both engaged in and take ownership of the change process. Healthcare organizations need to build a Board-approved plan with defined targets and accountabilities. The plan needs to focus on the key areas that will improve corporate image and reputation, namely, sustainable and wholesome food, water conservation and green transportation.

Helen Reilly,

Publicist Health-Care Communications

Jane Adams,

President Brainstorm Communications & Creations Director, Public Affairs, Community Relations and Telecommunications Rouge Valley Health System







As well, the plan should consider key areas that can reduce costs and free up resources for patient care, such as energy, waste and supply chain management. And the plan should consider how to build resilience and manage risks of extreme weather events associated with climate change. Measuring progress against established goals throughout the enterprise is essential. “What get’s measured get’s improved,” according to management guru, Peter Drucker. Finally, engagement of staff in behaviour change and communication with all stakeholders, including the Board, government, staff, patients and the public will improve accountability and transparency and build confidence in the effort. As a creative means to achieve green goals, publicly funded healthcare organizations can also consider entering into low cost agreements with private sector clean tech companies that are a growing part of the low carbon economy. This would provide important proving grounds and reference showcases for emerging companies and ultimately increase the tax base that funds healthcare. By taking a more systematic approach and using more intentional design, hospitals, nursing homes and clinics can really have a positive impact on the environment and become leading examples for others. That’s all important, not only for us now, but also for future generations. A good first step on your journey is to join the Canadian Coalition for Green Health Care and become a voice in the national discussion on environmental stewardship and climate change H resiliency. ■ Neil Ritchie BSc. MHSA, a former hospital executive, is Principal of the Green Health Leader’s Institute, a project of the Canadian Coalition for Green Health Care.

Bobbi Greenberg,

Health care communications

Sarah Quadri Magnotta, Health care communications

Dr. Cory Ross,

B.A., MS.C., DC, CSM (OXON), MBA, CHE Dean, Health Sciences and Community Services, George Brown College, Toronto, ON

Akilah Dressekie,

Ontario Hospital Association

David Brazeau




Going green can improve an organization’s corporate image and reputation, and in the long run, it can save money.



Position Statement: Towards an Environmentally Responsible Canadian Health Sector ( images/pdf/jps.pdf). Together, they issued calls to action for governments, healthcare organizations and individuals in the industry to minimize their negative impact on the environment. Largely, these calls have fallen on deaf ears and little action has been taken. Competing priorities, a lack of resources and few C-suite-supported champions with knowledge and clout, means environmental stewardship is sadly placed at the bottom of the large pile of things that need to get done.


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Mycobacterium chimaera infections associated with heater-cooler units By Bruce Gamage


n July 2015, Health Canada issued a medical device advisory for Sorin 3T heater-cooler units (manufactured by LivaNova, Germany) related to the possibility of non-tuberculosis mycobacteria growing in the unit’s water reservoir. Heatercooler units (HCUs) are used to regulate the temperature of patients’ blood during open-heart surgery. In October 2016, this advisory was expanded to all heater-cooler devices licensed for use in Canada. Health Canada had received reports of possible non-tuberculous mycobacteria infections in patients with a history of open-heart surgery. Non-tuberculous mycobacteria do not typically cause infection in healthy people but in rare cases they can cause infections in very ill patients including those with compromised immune systems, and chronic diseases or health conditions.

Recognizing the health hazard associated with mycobacterial contamination of HCUs used in open-heart surgery, national health authorities in Europe, the US and Canada continue to call for increased vigilance. While the risk of getting this infection from a heater-cooler device during surgery is extremely low, several health authorities across Canada have notified patients, healthcare providers and the public of this risk of infection in patients who have undergone open-heart surgery. Invasive infections by the non-tuberculous mycobacterium, Mycobacterium chimaera, were first detected in patients who had undergone open-heart surgery in Switzerland in 2011. M. chimaera was also detected in the water reservoirs of the HCUs and in air samples from the operating room when the HCUs were running. An epidemiological link with use of a specific model of HCUs, the 3T device, was confirmed by the detection of M. chimaera in these devices in use at affected cardiothoracic surgery centres. Studies showed that the exhaust air from contaminated HCUs can create aerosols

contaminated with M. chimaera in the operating room. Testing at the manufacturing site also found contamination with M. chimaera in water reservoirs of the 3T HCUs, as well as water from the pump assembly area of the facility, with the strain identical to that recovered from affected patients. These findings supported the likelihood of a common-source, multicountry outbreak related to contamination of 3T devices manufactured before September 2014. Cases of infections by M. chimaera potentially linked to HCUs have also been detected in the Netherlands, Germany, the United Kingdom, the United States and Canada. In October 2016, two cases of M. chimaera linked to the 3T device were identified in patients who underwent open-heart surgery at the Montreal Heart Institute. Other jurisdictions in Canada have identified M. chimaera in the water reservoirs of HCUs but no other cases have been discovered that are associated with the use of these machines. M. chimaera is commonly found in the environment – including in tap water and soil. The true extent of the 3T device-associated M. chimaera infections is yet to be determined. Recognizing the health hazard associated with mycobacterial contamination of HCUs used in open-heart surgery, national health authorities in Europe, the US and Canada continue to call for increased vigilance. These actions include active case-finding and implementation of strategies to decrease the risk to patients. It is recommended that HCUs be removed from the operating room to a side room if possible, that the exhaust vent of the machines be directed away from the surgical field, and that the updated decontamination and cleaning protocol as provided by the device manufacturer be implemented. Health Canada recommends that patients who have undergone cardiac surgery and who have questions or concerns should contact their healthcare professional. A non-tuberculous mycobacteria infection can only be diagnosed in symptomatic patients by clinical laboratory tests. Screening of non-symptomatic patients is not useful since the bacteria cannot be detected. If a patient does get an infection from non-tuberculous mycobacH teria, antibiotic treatment is available. ■ Bruce Gamage RN BSN CIC is Network Director, BC Provincial Infection Control Network. FEBRUARY 2017 HOSPITAL NEWS




Cover Story

Canada’ first smart hospital is becoming a reality By Catalina Guran


ackenzie Health marked the largest milestone to date for the Mackenzie Vaughan Hospital project with the beginning of construction in October 2016. Mackenzie Vaughan Hospital will be the first new hospital to be built in Ontario’s York Region in the last 30 years. As part of Mackenzie Health’s two-site hospital model, Mackenzie Vaughan Hospital and Mackenzie Richmond Hill Hospital will provide increased access to state-of-theart healthcare for its growing communities, closer to home. Upon completion in 2020, Mackenzie Vaughan Hospital will provide a state-ofthe-art emergency department, modern surgical services, advanced diagnostic imaging, ambulatory clinics and intensive care beds. Other specialized services will include Medicine, Birthing (Obstetrics), Paediatrics, Mental Health and the York Region District Stroke Centre. The new hospital will have approximately 350 beds

on opening day – with capacity to expand to 550 – and the majority of patient rooms will be private, a best practice in infection prevention and control.

Smart hospital vision and smart workflows Mackenzie Vaughan Hospital will be the first hospital in Canada to feature fully integrated ‘smart’ technology systems and medical devices that can speak directly to one another to maximize information exchange. To achieve this, Mackenzie Health is re-visioning its care delivery model. A connected health strategy, utilizing unified communications and the Internet of Healthcare Things (IOHT), will enable intuitive, patient-centred, highly-efficient, quality healthcare. The smart hospital vision will be applied at Mackenzie Health’s new Mackenzie Vaughan Hospital as well as at the existing Mackenzie Richmond Hill Hospital, for a seamless care experience.

The Vic De Zen Welcome Centre. Seventy-five smart workflows are being developed to improve the way staff work, to ultimately allow caregivers more time with patients. One example of such smart flow currently under development focuses on Code Blue (cardiac arrest) response. Through integrated technology, the vital signs monitor will send a silent alert directly to the Critical Care Response Team. The team members will be wearing smart real-time location services (RTLS) badges that will automatically override the elevators once they are in proximity, saving valuable time. At the same time the alert is triggered, the bed will automatically return to a flat position, to allow for resuscitation, and the IV pump will stop dispensing narcotics that may cause respiratory depression. A summary of the patient’s medical

record will also appear on the room display, for caregivers’ easy reference. Once the Response Team has arrived, the alerts will stop automatically.

Designed through the eyes of the patient The new Mackenzie Vaughan Hospital is being designed through the eyes of the patient, connected to nature and enabled by smart technology. Eight kilometres west of the existing Mackenzie Richmond Hill Hospital and just north of Canada’s Wonderland, Mackenzie Vaughan Hospital will have generous drop-off areas and dedicated entrances for emergency and labouring patients, respectively. Continued on page 7

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Labour, delivery and post-partum room featuring warm, natural wood accents, floor-to-ceiling windows and ample space for family members.

Continued from page 6 With its double-height ceiling and filled with daylight and warm, natural materials, the Vic De Zen Family Welcome Centre and main lobby will be a relaxed, welcoming environment for patients, visitors and staff. The Welcome Desk, Registration and the main public elevators will be visible upon entering the hospital, making wayfinding simple and clear. When arriving at Mackenzie Vaughan Hospital, patients will have the option of using an information kiosk or smartphone application to schedule and register for appointments and find their way within the hospital, including accessing information about nonmedical services (i.e. coffee, food, retail). A feature stair will be set against a large, multi-storey glazed wall overlooking the main courtyard. Visitors will also have orienting views to the outside at each public elevator lobby across the facility, a key component of intuitive wayfinding. Inpatient rooms will be efficiently organized with communication stations nearby, ensuring that staff are readily accessible to patients, while respecting patient privacy. Electronic status boards will be displayed in patient care areas and will automatically include details on infection prevention and control, as well as patient information, including allergies and falls risk. Designed for the needs of patients and families, rooms will also feature natural

wood accent materials to bring a sense of home and warmth, and ample space for family and visitors. A proven aid in recovery, large windows will provide expansive views to the outside. Through an Integrated Bedside Solution (IBS), patients, physicians and staff will have access to medical and non-medical information at the patient’s bedside. Examples of these services could include: patient entertainment, meal selection, room controls such as temperature and lights, video conference capabilities for remote consulting or speaking with family, real-time translation services, as well as an electronic medical record portal for staff that will display medications, allergies, vital signs, diagnostic reports and images.

What’s next? With the implementation stage well underway, the design of Mackenzie Vaughan Hospital’s interior space continues to be developed with construction ramping up in early 2017. For more information and to view the renderings and fly-through video of the future Mackenzie Vaughan Hospital, visit H ■ Catalina Guran is a Communications and Public Affairs Consultant at Mackenzie Health.

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Water reduction project

A case study: Headwaters Health Care Centre By Thinusha Param


s the water supply on our planet becomes increasingly scarce, the need to educate our peers within the healthcare community about the importance of the waterenergy nexus grows. The production of energy requires the use of water, and the distribution of clean water to end-users requires the use of energy. Understanding this relationship will not only help hospitals reduce their operating costs, but it will also help them play a proactive role in decreasing their facility’s ecological footprint and ultimately mitigate the risks they may face associated with climate change. This article will look at how one healthcare facility in particular is implementing a Water Reduction Project to decrease their overall water and energy consumption. The Headwaters Health Care Centre located in Orangeville, Ontario serves a population of over 135,000 people and has served its community for over 100 years. This hospital has around 168,000 square feet of hospital space and produces approximately 26,298,000 lbs of steam a year. The team at Headwaters has worked with Klenzoid to implement a Water Reduction Project that identifies system improvement opportunities and optimizes the treatment program to get the steam system operating as efficiently as possible. In addition to lowering operating costs and reducing the water and energy consumption at this facility, this project has also played a key role in extending the lifespan of the facility’s infrastructure. Project Location: Headwaters Health Care Centre (Orangeville, Ontario) Project Goals • Decrease facility water and energy consumption • Reduce steam system operating costs • Protect equipment and maximize lifespan of infrastructure

Initiative 1 – Automating blowdown The water quality present in the town of Orangeville poses a risk for scaling and corrosion tendencies within the steam system. Pre-treatment equipment and a chemical treatment program were in place for the system comprised of three boilers

and an extensive condensate network. No improvements had been made to the steam system’s configuration at this facility since it’s installation in the 1990’s. The steam plant operators were manually blowing down the boilers which was resulting in a significant waste of water, energy and treatment chemical. The first phase of the Water Reduction Project was to automate the blowdown process. Automating blowdown allows for the continuous control of surface blowdown rates using the system’s conductivity levels. It also reduces the risk of scaling and corrosion through the optimization of the cycles of concentration and total dissolved solids in the system. This initiative resulted in an immediate and significant decrease in the volume of daily blowdown and a corresponding savings in the energy, water and chemicals consumed by the steam plant.

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Outcome: Major water, energy and treatment costs savings

Initiative 2 – RO system configuration Reverse osmosis systems improve boiler make-up water quality by preventing dissolved inorganic solids from entering the system. At this facility, a RO system was being used to treat the water entering clean steam humidifiers. As a part of the Water Reduction Project, the piping for the existing RO system was reconfigured to treat the feedwater entering the steam system. The resulting increase in steam purity and heat exchange efficiency translated into a direct increase in operational efficiency. The decrease in the dissolved solids entering the system allows the boilers to operate at higher cycles, markedly dropping the make-up and chemical treatment requirements. Outcome: Major treatment costs and natural gas savings (includes rebates)

Initiative 3 – Optimizing chemical handling This project also included improving chemical inventory management and operator safety. Switching from the use of chemical pails to the Klenzoid’s Demand DeliveryTM service eliminated unnecessary container waste without compromising adequate dosage control. Delivery of chemicals to the point of use utilizing on-site containment tanks allowed for operators to participate in higher value activities such as on-site water testing and online logging. Prior to this change, team members would carry pails of chemical up three flights of stairs to the boiler room located in the penthouse. Demand DeliveryTM minimizes

the number of deliveries required annually, ensures that there is always inventory on site and eliminates any breaks in the treatment program resulting from low inventory. Outcome: Treatment costs savings, improvement of the treatment program and on-site safety The Water Reduction Project taking place at Headwaters is a great example of how greening healthcare can be achieved from within the facility while also optimizing operating costs. Since the implementation of this project, spending on water, energy and treatment chemical has decreased by $47,548 and the hospital has received natural gas rebates for their environmental success. The continual success of the project would not be possible without the effort put forth by the strong partnership between the facility team and Klenzoid. It is essential to work together to get applications operating efficiently through continuous improvement opportunities and an effective treatment program that will ultimately preserve and extend the lifespan of the facility infrastructure. Hospitals consume mass volumes of water and energy and therefore our decisions bear great weight. We must take into account the water-energy relationship to create sustainable systems that are resilient to climate change and the variability of our water resources. To tackle our planet size issue, we must proactively drive change at the hospital level and focus on projects that aim to reduce our ecological footprint and creH ate a greener tomorrow. ■ Thinusha Param provides Business Development support for Klenzoid Canada Inc.




Alternative composting technology reduces

organic waste By Roxanne Hathway-Baxter


t Runnymede Healthcare Centre, there is a long-standing commitment to improving environmental sustainability, as was laid out in the 2015 Strategic Plan, Vision 2020/Redefining Possible. In this plan, a pledge was made to implement strategies and technologies that would lessen the hospital’s environmental impact, cut operating costs, and improve the health of the community as a whole.

Using this device for a year will divert nearly 50 metric tons of solid waste from landfills By using tools like the OHA Green Hospital Scorecard, which tracks a hospital’s environmental efficiencies, and the results from the annual waste audit that Runnymede completes, it was determined that there were some gaps in the waste management process that was occurring at the hospital. Large amounts of organic waste were being sent to landfills because there was no viable green bin strategy in place to recycle these materials. After the issue was identified, Runnymede decided that it

would be a top priority to implement new strategies that would help to efficiently manage its organic waste production and improve its environmental footprint. The solution came for Runnymede in a new technology called a bio-digester, a fully enclosed machine that can be used as an alternative to traditional composting. The device takes hundreds of pounds of solid food waste, including both raw and cooked leftover foods, from patients’ plates each day and converts it into filtered waste water in a totally chemical-free process. “It works like a large mechanical stomach,” says Bruce Westwater, Runnymede’s Director of Information Services. “It combines leftover food with water, plastic bio-chips and enzymes to break the waste down. The filtered waste water that is produced can then be safely sent down the drain.” The whole process, from collection of waste to environmentally-friendly output, takes approximately 24 hours, and the biodigester constantly monitors the output. Statistics on the usage and the amount of food being digested will always be shown, so the hospital can see exactly how much waste is being recycled. The environmental benefits provided by the bio-digester are huge and the impact can be seen as soon as six months after installation. Using this device for a year will

The bio-digester takes hundreds of pounds of solid food waste and converts it into filtered waste water in a totally chemical-free process. divert nearly 50 metric tons of solid waste from landfills, and will only need around the same amount of electricity required for seven compact fluorescent lightbulbs. Cost benefits to Runnymede are evident, as well. “Sending solid food waste to landfills was costing Runnymede over $1000 each year,” says Westwater. “By using the bio-digester this expense will be significantly reduced.” The money that is saved can be reinvested to better serve patients at the hospital, and the community in general. Additionally, because solid waste can be transferred directly from patients’ plates into the bio-digester, less garbage disposal units will be needed, which will bring down costs over time. Moreover, kitchen staff can focus their attention on other facets of their jobs, rather than having to

devote time to taking food waste to outdoor containers. The many benefits of the bio-digester are apparent, and will make it a perfect addition to the hospital. New technologies like this are enabling hospitals like Runnymede to improve their sustainability, which in turn is beneficial for the environment, as well as more cost-effective for the institutions themselves. By being more sustainable and cost-effective, Runnymede is working towards achieving one of its strategic objectives of lessening its environmental impact, thereby proving its commitment to its patients and the comH munity as a whole. ■ Roxanne Hathway-Baxter is a Communications Specialist at Runnymede Healthcare Centre.


10 Focus


Collaborative project implementation:

Delta Hospital success story By Kori Jones


elta Hospital is a Fraser Health community based hospital located in the lower mainland of British Columbia. This facility supports 150 beds and provides a combination of acute and extended care services to the surrounding communities.

Involving the FMO team early in the system design and throughout the project delivery allowed direct input from the people who will be operating this system after the project is considered complete. In the spring of 2014, Delta Hospital’s Facilities Maintenance & Operations (FMO) team were investigating options to upgrade the existing aged and inefficient heating plant. What started as a necessary upgrade, resulted in a collaborative project management opportunity, as the Energy and Environmental Sustainability (EES) team were in the process of identifying cost effective emission reduction projects to apply for Carbon Neutral Capital Program (CNCP) provincial funding. “Building relationships with the FMO teams across Fraser Health is inherent to the success of many of our projects. On sites with established strong relationships and open communication, we have been rewarded with a better understanding of facility needs, and greater opportunity to identify and implement projects that en-

Hot water condensing boilers at The Delta Hospital. hance operations and improve healthcare facilities,” says Robert Bradley, Energy Manager for Fraser Health. The FMO and EES teams allocated resources and coordinated responsibilities in a team focused approach. A dedicated FMO Project Leader managed the site coordination along with the direct support of the Delta Hospital FMO team. The EES team managed the project finances, provided technical and project management support, and successfully secured a significant CNCP grant for the project. The EES

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team also partnered with the regional electricity and natural gas utilities to capture financial incentives to support the energy saving measures of this project. Stage 3 Renewables was engaged as the mechanical engineering consultant and the prime contractor role was awarded to Innovative Mechanical. The project team, with guidance from the engineering consultant, worked closely to design a high efficiency condensing boiler plant with a consolidated hot water storage system. The final design required detailed system engineering to address the site specific challenges of replacing a completely new heating plant into an existing facility. An innovative re-piping strategy was developed to ensure that the boilers dual return water inlets had an average water temperature of less than 55° C. This low return water temperature, which allowed the boilers to condense and operate at an optimal efficiency, was possible through the integration of double coil heat recovery hot water tanks, variable speed re-circulation pumps, heating coil energy valves and variable frequency drives on the hot water supply pumps. Project success was monitored after a year of collecting trend data from the site Energy Management Information System (EMIS) and the Building Management System. The trends confirmed a six per cent electrical saving and an 11 per cent natural gas saving; compared to the weather adjusted pre-project energy consumption baseline. The estimated annual energy and maintenance savings from this project are $25,000 and reduction of over 80 tCO2e greenhouse gas emissions. The success of this project was largely due to the active participation of the FMO team and clear communication throughout this project – the team operating the new plant was involved at every project stage. This holistic view was built into the project goals listed below:

• To provide Delta Hospital with a reliable and highly efficient modern heating plant upgrade that is delivered on schedule and budget. • To integrate the FMO team in the project design and implementation to develop system knowledge and provide a comprehensive project hand over. • To improve patient comfort while reducing the energy consumption, environmental impact and heating plant maintenance requirements. Dave Simmons, the FMO Project Leader, notes that “Involving the FMO team early in the system design and throughout the project delivery allowed direct input from the people who will be operating this system after the project is considered complete. This approach also streamlined the decision making process and identified design risks early on which saved time and reduced project costs when compared to traditional project delivery methods.” The FMO and EES teams continue to meet quarterly, as part of a regional FMO Engagement program, to review the energy performance data from the EMIS, identify further energy saving opportunities, and build awareness of the site challenges. An expanded building automation system, which has improved control and trending capabilities, and the implementation of a successful pilot of an Automatic Fault Diagnostic Detection system are the result of this ongoing team work. This collaborative project implementation approach has been so successful that it has since been emulated at other Fraser Health sites. A high efficiency boiler plant upgrade and ventilation optimization project will be completed at Mission Memorial Hospital and Ridge Meadows H Hospital in 2017. ■ Kori Jones is the Energy Manager at Vancouver Coastal Health.


Focus 11

(left) Multi-disciplinary and cross-departmental front-line staff analyze flow and space requirements for West Park Healthcare Centre’s new hospital. (right) Patient Paul Feldman tours West Park Healthcare Centre’s Design Lab and provides comments on how future patient rooms can accommodate different disabilities.

Hospital users take ownership of facility design By Lijeanne Lee


nvolving patients, families, staff, physicians and volunteers to help design and build new hospital spaces has been key to empowering them to take ownership of West Park Healthcare Centre’s new hospital. In 2016, more than 250 people representing various departments visited the hospital’s Design Lab to critique full-scale, cardboard mock-ups of four patient spaces. Seeing the proposed room size, layout and placement of furniture and equipment enabled visitors to make informed comments.

“Everyone has different perspectives, knowledge and understandings critical to helping us design a hospital that will truly improve the patient experience.”

“We can talk about the square footage of a patient room but users won’t really grasp what it means for their care, living or workspace until they see, feel and touch it,” says Shelley Ditty, Vice-President of Planning and Development. “So mock-ups, even if they are basic, are a great opportunity for users to provide concrete feedback starting early in the planning stages.” Created by a cross-section of patients, clinical and non-clinical staff in a full-day workshop, the mock-ups consist of a single and double room, exam room and communication centre (nursing station). The mock-ups considered design elements that would meet patient care needs, comfort and safety, as well as staff requirements to meet healthcare standards like infection control and emerging technologies. The hospital community was then invited to help refine the spaces. Visitors were given a marker and sticky-notes to post their comments on how the space could be better.

“The rooms are much improved over our current situation,” says patient Paul Feldman. “It had all the comforts of home.” Feldman made many comments related to room layout and technology specifications. Like many West Park patients, Feldman uses a large powered wheelchair that requires a large turning circle to manoeuvre and access items. No longer able to use his limbs he wants to ensure the rooms can accommodate the different requirements of each patient’s disability. “Everyone has different perspectives, knowledge and understandings critical to helping us design a hospital that will truly improve the patient experience,” says Ditty. After the open houses, West Park’s planning team carefully catalogued over 900 comments. Depending on the nature of the feedback, comments were further explored, brought forward to the corresponding person or groups responsible for consideration, or incorporated into the design documents. The mock-ups are not the first initiative where patients and staff had the opportunity to create tangible models. Even earlier in the planning, a three-day, offsite Design Innovation Workshop was organized for 60 multidisciplinary frontline workers, patients and family members to develop preliminary building footprints and layouts, and test patient/staff flow and space requirements. The workshop helped to establish clear design requirements for key program areas. Also known as a 3P (Production -ProcessPreparation), a method rooted in Lean methodology, the workshop is an alternative to conventional design processes where multidisciplinary and cross-departmental groups work in deep collaboration. The process empowered participants to bring their experience to create and refine future layouts. Since starting its functional programming stage in 2014, West Park has engaged more than 450 individual patients, staff, family members and volunteers totalling more than 700 hours of formal meetings, workshops and open houses. Keeping in mind many of the same individuals participate in multiple meetings, collectively

West Park has logged thousands of hours towards engaging users in facility design. Located in Toronto, West Park helps patients get their lives back by providing inpatient, outpatient and outreach services in specialized rehabilitative and complex care as a result of lung disease, amputation, stroke, traumatic musculoskeletal injuries and other life-altering and life-long injuries and illnesses. It currently operates 270 beds and employs about 950 staff and physicians. West Park is transforming its 27-acre site with two major capital projects that will create an integrated campus of care to meet Ontario’s future healthcare needs. The main capital project is the new, sixstorey, approximately 720,000 sq. ft. hospital facility that will operate 314 beds with 80 per cent of beds in single rooms and the remaining in double rooms. With

green space a top priority, West Park will also maintain or increase its green space on campus with extensive landscaping for outdoor therapy, walking paths and therapeutic gardens. The second capital project will extend West Park’s spectrum of services by creating a vibrant community with housing and related services for seniors and people with disabilities. As both projects continue to move forward, West Park will continue to look for creative opportunities to empower and engage its users, so that patient care and the staff experience can truly be H enhanced. ■ Lijeanne Lee is the Communications and Documentation Coordinator, Campus Development, West Park Healthcare Centre.


12 Focus


Setting new benchmarks for hospital energy efficiency By Lorie Pella


rom the very beginning Humber River Hospital’s redevelopment project was driven to be sustainable under the guiding design principles of Lean, Green and Digital When the new facility opened in October of 2015, it heralded a new era not just for the use of technology in North American hospitals – it also set a new standard for energy efficiency for comparable hospitals.

The new HRH is the most energy efficient acute care facility in Canada. Using data from Toronto Region Conservation Authority’s Greening Health Care Initiative which includes over 60 hospitals in their network Using an integrated design approach for the energy-consuming systems across the new building, Humber set an aggressive target of achieving 50 per cent energy savings based on a model building with similar features. The key indicator for measuring this is Energy Intensity, the total amount of energy used divided by the building area. Since opening, Humber River is leading the industry in this category. It is expected that the efficiency will improve by an additional 30 per cent as we continue to calibrate the new building systems.

Lorie Pella in the Building Control Centre at Humber River Hospital. In order to achieve this level of industry leading energy efficiency performance, Humber had to go beyond the traditional design and device selection, particularly because of the uniqueness of the new hospital having a 100 per cent fresh air supply – no recirculated air. We had to dig deeper. We targeted the ‘waste’ heat emitted by people and equipment, recapturing it from the exhaust air before it leaves the building, and reusing it for preheating of water and new fresh air entering the building. This is done by forcing exhaust


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air through energy recovery wheels that spin slowly within the air handling units. The heat is captured and transferred back into the building systems. One of our ‘Eureka’ moments came by discovering that, by slowing the air flow through the wheels enough, the efficiency of the heat wheels increased by 10 per cent, effectively making the 100 per cent outside air system cost-neutral. Facilities already pay to run equipment and keep occupants comfortable by running systems: the heat generated is the byproduct of the day-to-day operations – it only makes sense to reuse it to reduce consumption and operating costs. The use of waste heat also allowed the hospital to install snow melting capability within the sidewalks at main entrances, helping prevent slips and falls for little to no cost beyond the minimal initial capital cost. Our HVAC (heating ventilation air conditioning) design is geared to reduce the fan power required to move air through the building – at 1.8M square feet it’s a lot of air to move. The combination of oversizing the ductwork, slowing down the air flow and the use of secondary fans leads to a significant drop in electricity to power the fans. This is important because there is an exponential drop in electricity use when fan motor speeds are lowered. When fan operations are coordinated so off-hours use is reduced, a domino effect is created, further enhancing utility reductions since less heating, cooling and humidification are required during those times. Lighting design uses digital technology and intelligent controls: occupancy sensors; off-hours lighting level controls where it makes sense (e.g. some clinics); motion sensitive lighting; daylight harvesting; all controlled centrally to minimize electricity use (and costs) while using schedules that suit the building’s occupancy needs. LED lighting and high

efficiency fixtures are used throughout and have digital ballasts to allow building operators to adjust and set each light fixture correctly. The system also pushes data back to building operations so performance indicators can be reviewed and further adjustments made. Humber employs a leading-edge window tinting system in our inpatient rooms: VIEW dynamic glass. Each pane has a nano-thin coating that tints when a direct electrical current (DC) is applied to it. Each piece of glass has its own controller with an IP address traced back to the central server, where algorithms allow optimized daylighting and comfort by tinting windows according to on-demand patient control overrides from the bedside terminal. Unoccupied rooms are automatically controlled using daylight sensors and preset scheduling. This improves efficiency by controlling the amount of sunlight penetration to suit the season by leveraging the heat gain in winter and heat reduction in summer, mitigating heating and air conditioning needs. In many ways this is similar to occupancy controls for lighting. Outdoor views are never blocked while privacy is always maintained based on the tint level. These and other energy efficiency systems are all tied into the building’s operations centre, where they are viewed on a dashboard monitored 24/7 by the facility operators. This high level of integration across the physical plant, the result of a rigourous focus on green as a primary principle for the design and operations of the new Humber River Hospital, has achieved industry-leading performance, setting new benchmarks for hospital design across H North America. ■ Lorie Pella, P.Eng. is Director of Planning at Humber River Hospital.


Greening green spaces

Focus 13

By Laura Bristow


hen it comes to being green, Sunnybrook Health Sciences Centre has one huge advantage over many other hospitals in Toronto; and that is access to green spaces. Sunnybrook’s, vast green lawns, healing gardens, and the hospital’s close proximity to Sunnybrook Park provide many places where patients, visitors and staff can connect with the natural environment and reap the benefits. This is important because hospital green spaces serve as a place of sanctuary and recuperation for patients, visitors and staff. It has long been established that general health, mental fatigue and physical injury all recover faster when patients have access to natural “green” areas. At Sunnybrook, we cherish our green spaces, and this is not only evident in the staff participation of annual events such as the Earth Day 20 Minute Campus Clean-up and the Arbor Day Tree Planting Team Challenge, but it is also evident in the hard work and dedication of the grounds team that maintains these green spaces. Sunnybrook’s grounds team is very passionate about sustainability and over the past few years they have implemented many new initiatives that promote sustainable landscaping including: • The use of drought tolerant and slow growing grasses to reduce the amount of watering and mowing required when maintaining the lawns.

Hospital green spaces serve as a place of sanctuary and recuperation for patients, visitors and staff. • The practice of integrated pest management by paring certain plants within gardens to deter insect infestation on other plants to reduce pesticide use. For example onions are planted next to roses to deter aphid attacks on the rose plants. • Creating pollinator-friendly environments for bees and butterflies by mixing vegetables and herbs with traditional horticultural plants. This also has a benefit of increasing garden yields and flower production as having nectar from flowers attracts more beneficial insects that protect edible plants and the pollinators than increase flower production. • Avoiding monoculture plantings. Planting diverse plant species within gardens to help the gardens better withstand attacks from both insects and diseases.

• On-site composting of landscaping debris. One of the most impactful new initiatives has been the on-site composting of landscaping debris. By composting yard waste on-site, Sunnybrook has not only reduced a significant amount of landscaping waste, but also applied the compost and other organic matter to our landscapes, including our lawns. This has reduced the need to purchase products such as mulch. This regenerative approach contributes to the ecosystem rather than depleting it by keeping landscaping debris out of the waste stream. It improves drought resistances due to greater water holding capacity, improves nutrient availability and promotes biodiversity which ultimately promotes sustainability. Our goal is to have zero landscaping waste. Here are a few examples of how Sunny-

brook aims to keep all landscaping debris out of the waste stream: • shredding dead annuals and perennial prunings to use as mulch, or composted and incorporated into the soil for added nutrient • leaf & grass cycling – the mowers are also used to mulch the leaves and grasses, returning nutrients to the soils to feed the turf, reducing our organic fertilizer requirements • small limbs and shrub prunings are run through a chipper by our Arborist, creating mulch that keeps moisture in and reduces weeds in the gardens H • composting all other yard waste ■ Laura Bristow is a Communications Advisor at Sunnybrook Health Sciences Centre.


14 From the CEO's Desk

Undergoing a digital transformation By Barb Collins


Housekeeping staff who completed the professional development course.

Professional development

for sustainability By Christie Nairn


ealthcare employees are faced with life or death decisions every single day. The decision to recycle or turn out the lights when leaving a room usually is not top of mind for many of these same people. However, small behavioral choices such as recycling can make a real difference in a hospital’s environmental sustainability practices – which in turn affect the surrounding community’s health. At HSC Winnipeg, Housekeeping staff are an indispensable component of the sustainability program. The department of 350 staff have the unique advantage of being the only population in the hospital who visit every room on the 32-acre campus every single day. They make a huge difference in the success of the sustainability program at HSC Winnipeg. In spring of 2015, 10 Housekeeping staff volunteered to be part of participatory professional development pilot project focused on environmental sustainability practices in healthcare. Throughout the 8-week trial period (one full day session, HOSPITAL NEWS FEBRUARY 2017

three half day sessions), Housekeeping staff explored the meaning of environmental sustainability, how it relates to human health, how it relates to their work at HSC Winnipeg, and what they can do to help improve practices within the hospital.

Small behavioral choices such as recycling can make a real difference in a hospital’s environmental sustainability practices The group decided that educating other housekeepers and staff was the best way to promote, encourage and improve sustainability initiatives on site. At the end of the professional development course participants worked together to create a onepage checklist, which would be included on all cleaning carts for housekeeping staff to view throughout their shift. The checklist covers important points such as turning out the lights when leaving the room,

aperless charts, sophisticated imaging, low cost genomics, robotics, mobility, wearables, the Internet of Things – this is all of the ‘stuff’ that healthcare has available to become ‘digital’. Where lies the benefit in all of this? At Humber River Hospital we have deployed much of this ‘stuff’ to drive efficiency, quality and safety. We are undergoing a digital transformation to become a Highly Reliable Organization (HRO) that delivers world class care in a respectful and patient-first manner. Humber River started its digital transformation in 2010, culminating the first phase of our metamorphosis with the opening of our new 656 bed hospital in October of 2015. We have lived the digital world for over a year and not only are we seeing value, but we have greater conviction to further our digital transformation. We have moved to a fully electronic record, albeit that we are not completely “paperless” – that has yet to come. We have implemented many of the measures articulated in the HIMSS EMR Adoption Model, reflecting a Stage 6 capability. We have gone beyond the ‘digitizing’ concept and deployed solutions that drive true transformation. These are characterized by connecting the circle of care through closed loop communication and collaboration, driving effectiveness through actionable real-time data, and moving to an online world that empowers and enriches our patients. Informing the right people at the right time with the right information is a foundation for driving better decision making and better care. At Humber River we connect people with people using smart phones, instant messaging, video calls and voice calls. This makes for fast, efficient and reliable connection which significantly improves the immediacy of decision making and quality of care. We leverage real time data from systems to inform and drive action. By connecting systems to people and using closed loop concepts: you must accept and acknowledge; we ensure rapid response and action. Continued on page 15

checking the taps to see if water is dripping and even ensuring waste and recycling are thrown in the correct disposal bins. The staff who participated in the professional development session are proud of the work they conducted during the course. One of the participants even joked, “I used to not know anything about sustainability and now I know too much! I have to share this knowledge with my coworkers.” The group is now able to help to educate their peers about the importance of environmental sustainability and they are seen as champions of sustainability within their department at HSC Winnipeg. HSC Winnipeg plans to create a condensed version of the course to other departments within the hospital, customized for how sustainability applies to different H departments in the hospital. ■ Christie Nairn is the Environmental Sustainability Coordinator at Health Sciences Centre Winnipeg. For more information contact Christie Nairn at

Barb Collins is the President and CEO of Humber River Hospital.


Infection control



Infection Control

Study authors Dr. James Mahony (left) & Dr. Christopher Stone analyze samples in the lab.

Researchers working on the first vaccine against Chlamydia By Michael Oreskovich


esearchers at St. Joseph’s Healthcare Hamilton have taken the first steps towards a widely protective vaccine against chlamydia. Chlamydia is one of the most common sexually transmitted infections and affects 113 million people around the world. The disease causes pelvic pain in women, leads to other infections, and can cause irreversible damage resulting in infertility. As many chlamydia infections are asymptomatic, they can go untreated and cause damage without the patient being aware of the infection. While chlamydia is currently treated with antibiotics, a vaccine would prevent

the infection from occurring in the first place. This could potentially protect millions of people from chlamydia. The researchers successfully tested a new recombinant antigen called BD584 in animal models with a common strain of chlamydia. The vaccine was delivered into the nose and protected the mice from genital tract infection as well as its damaging symptoms. “The BD584 vaccine candidate is a fusion protein consisting of three genetically engineered proteins fused together,” says Dr. James Mahony, virologist at St. Joseph’s Healthcare Hamilton and the study’s senior author. “The vaccine elicits the production of antibodies that can block an essential virulence factor of chlamydia required for infection of cells therefore rendering the bacteria incapable of infection.”

The vaccine elicits the production of antibodies that can block an essential virulence factor of chlamydia required for infection of cells therefore rendering the bacteria incapable of infection. The study showed that BD584 reduces chlamydial replication and shedding in the lower genital tract by 95 per cent, which is what enables the bacteria to spread to the upper genital tract. The vaccine also decreased pathology of the fallopian tubes by 87.5 per cent. Dr. Mahony explained that chlamydial infection of the upper genital tract leads to fluid filled fallopian tubes

that block fertilization of eggs. “The advantage of our vaccine is that it provides protection against all strains of Chlamydia that infect the genital tract. It is the first vaccine to provide this wide scale coverage,” says Dr. Mahony. “It will also protect against those strains of Chlamydia trachomatis that cause conjunctivitis in the eye leading to scarring trachoma and blindness which affects between six to nine million people around the world.” Dr. Mahony notes that future research on other animal models will need to be done before the vaccine is tested in human trials. Further research will also test the effectiveness of this vaccine against different H strains of chlamydia. ■ Michael Oreskovich is a Communications Specialist at Runnymede Healthcare Centre.

Preparing for the next superbug By Erika Vitale


e’ve all heard the recent CDC headlines – “Woman dies from superbug resistant to all antibiotics.” Experts have been warning us about this, and and stories like this and the recent endoscope related outbreaks in the US are bringing the issue to the forefront. The bugs are known as CRE (Carbapenem Resistant Enterobacteriaeceae) or CPE in Ontario (Carbapenemase producing enterobacteriaceae). Enterobacteriaceae includes species such as Escherichia coli, and Klebsiella pneumoniae – normally found in the gut and are easily spread preson to HOSPITAL NEWS FEBRUARY 2017

person on the hands or through contaminated food and water. People can carry the organisms in their gut without any signs or symptoms of infection but these are among the most common disease causing bacteria. They can cause virtually any infection from urinary tract and wound infections to pneumoniae, sepsis, meningitis and device-associated infections. The enzyme carbapenemase is responsible for the resistance making all cephalosproins and carbapenems ineffective. This means that everything from our first choice drugs all the way to our last resort are useless for treating infections. These resistance genes can also be spread to other species of bac-

teria – increasing the resistance in the population and making outbreaks of the organism difficult to detect. Prevalence of CPE has been increasing worldwide over the last 10 years with certain strains associated with specific countries. Isolated outbreaks have occurred in healthcare facilities in the Middle East, Asia, Europe and the United States. In Canada, CPE have only been identified as single isolates. Patients admitted to a facility that has had CPE are at the greatest risk of acquiring the organisms and developing infection. Mortality rates during outbreaks have been reported as high as 50 per cent. Travel to the Indian sub-continent also increases the risk of acquiring CPE.

There have been less than five isolated cases of CPE identified at Windsor Regional Hospital (WRH) – most carried by patients with very short lengths of stay, and luckily cared for briefly in private room accommodation. All have had a clear risk factor reported. WRH has been preparing to care for a patient with CPE over the last few years and has developed procedures that include the following infection prevention and control measures based on the Best Practice Guidelines form the Provincial Infectious Disease Advisory Committee: • All admitted patients are asked about a history of CPE, hospitalization outside of Canada, and travel to the Indian subcontinent. Continued on page C8

Infection Control



Representing infection prevention and control professionals


ost workplaces are useful venues to connect with other healthcare providers. However there is nothing quite the same as learning and networking with your peers at national and provincial conferences and workshops in the field of infection prevention and control (IPC). Many IPC professionals work in isolation thus exposure to new ideas from like-minded professionals is limited. It is through these inspiring forums that professionals have often claimed they “foundâ€? their best ideas and fostered professional relationships that have been germane to their success in any number of IPC initiatives. There are so many exceptional opportunities to learn, so many networks to leverage and build, so many people to mine ideas from‌.and so little funding or support to attend. The Institute of Medicine (2010) conducted an interesting literature review that examined the correlation between continuing professional education and quality of healthcare. Albeit challenging to define reliable outcome measures, the authors cited evidence that continuing professional education improves ones’ knowledge base and skill level, can change healthcare provider behaviors and attitudes, and can

Suzanne Rhodenizer Rose is the President of Infection Prevention and Control Canada (IPAC Canada). She is the Health Services Manager, Infection Prevention and Control, for the Nova Scotia Health Authority. improve clinical outcomes. Is this not the goal of every healthcare organization in Canada? Is evidence-based practice not a foundational element of healthcare delivery? Then why is professional development and continuous learning all too susceptible to budget cuts in the times of fiscal constraint. Is it seen as a perk rather than a professional necessity? It would seem that this is low-hanging fruit; a fairly cost-effec-

tive method to improve patient outcomes with the added bonus of improved job satisfaction. Many institutions do not provide the money or even the time professionals need to attend continuing education opportunities. As professionals, we do need to invest in our own personal commitment to continuing education as part of our professional responsibility; however organizational commitment is essential to sustain a

professional’s lifelong learning endeavors. Florence Nightingale’s Notes on Nursing addresses the fact that nurses must learn constantly, through observation and experience as well as through actively seeking new knowledge and new evidence. A commitment to continued learning is a professional and an organizational responsibility if the highest degree of high- quality H healthcare is to be achieved. â–

Politics Versus Science: Brace Ourselves Yet Again?

FRIENDS AND COLLEAGUES IPAC Canada is a multidisciplinary professional association of those engaged in the prevention and control of infections in all healthcare settings. IPAC Canada represents its members in the pursuit of patient and staff safety and in the promotion of best infection prevention and control practices. We work regularly with other professional associations and regulatory bodies to develop guidelines. Our members come from across the continuum of care. Visit our website to see the many benefits and resources that are available to members.

At a United Nations meeting in the fall of 2016, UN Secretary-General Ban Ki-moon was quoted as describing antimicrobial resistance (AMR) as a “fundamental long term threat to human health, sustainable food production and developmentâ€?. The parallels to the global threat of climate change were not lost on the audience. The November 2016 issue of The Lancet, while drawing excellent comparisons between antimicrobial resistance and climate change, acknowledged disparities as well. Politics HUKTV]LTLU[ZHNHPUZ[[OLZJPLU[PĂ„JLZ[HISPZOTLU[[OPURHU[P]H__LYZ think recent Republican election doctrine) have the ability to thwart global progress on these two similar and potentially intertwined issues. ;OLZJPLUJLILOPUKHU[PTPJYVIPHSYLZPZ[HUJLOHZUV[LUK\YLKHZPNUPĂ„JHU[ public movement to refute it, as seen with the climate change issue. In this new world where science, common sense and critical thinking do not appear to be immune to political rhetoric and fear-mongering, we need to develop newer strategies to communicate to the global public and its SLHKLYZ(JVUJLY[LKLɈVY[T\Z[ILSH\UJOLKHNHPUZ[JSPTH[LJOHUNLHUK AMR but also against those detractors who can do as much damage as a lack of antimicrobial stewardship or increasing the concentrations of global atmospheric carbon dioxide.




Infection Control

Viva hand hygiene! Creative Compliance – St. Joseph’s Health Care London is jazzing up an age-old message to protect everyone from the spread of infection. By: Amanda Jackman


ospitals across Ontario have been tasked with increasing their hand hygiene compliance rates – that is to ensure clinical staff are cleaning their hands at the right moment. St. Joseph’s Health Care London (St. Joseph’s) has taken the clean hands message to a new level by using creative ideas to increase awareness. “We have seen hand hygiene police – auditors with lights and sirens – we’ve seen handprint pledges and most recently Elvis was in the building spreading the word,” says Rhodora Laylo, coordinator, Infection Safety. “We have been reenergizing our message to move results – and it’s been working.”

Elvis, Rev. Matthew Martin of Holy Trinity Anglican Church in Lucan, Ontario, arrived at St. Joseph’s during National Infection Prevention Week, working his way through several St. Joseph’s sites. With a dazzling teal jumpsuit, Elvis-esq sideburns and curved lip, Martin serenaded staff, patients and visitors with his impressive vocals only pausing to pump alcohol-based hand rub into people’s hands and to crack the occasional quip. “We’re saving lives, one squirt at time!” Martin’s Southern drawl echoed in cafeterias, lobbies and patient care areas much to the delight of onlookers who took

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Creative Compliance: Rev. Matthew Martin (Elvis) sang and sanitized as he visited several St. Joseph’s Health Care London sites bringing awareness to the importance of infection prevention.

videos and photos and joked around with the ‘King of Rock and Roll’. “Clean hands are always the first line of defense in preventing infection,” says Laylo. “This was an opportunity for us to send the same message we always do, but in a creative and eye-catching way.” Eye-catching indeed. As Martin made his way through the halls, the silver on his suit gleaming, he struck a chord for those who heard him. Elvis and his “entourage” of St. Joseph’s staff members, crashed meetings, participated in impromptu dances and mini-concerts and embarrassed staff in cafeterias and coffee lines as Elvis swooned in with his bottle of hand cleaner.

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“It truly was an amazing day,” says Laylo. “People were drawn in by the music and the appeal of Elvis but Matt imparted the hand hygiene message to everyone we encountered. No one got past him without washing their hands!” The clean hands movement even impacted Martin, the newest member of St. Joseph’s Spiritual Care Advisory Committee. “I really enjoyed meeting so many people and spreading the word. And my hands never been cleaner,” he laughs. As part of St. Joseph’s refreshed hand hygiene campaign there is also a strong focus on patient and resident involvement. “We want those we care for to be advocates in their own care,” says St. Joseph’s CEO, Dr. Gillian Kernaghan. “Our clini-

cians wear buttons that say “Please Remind Me” with our hand hygiene logo. We have added new signage to our sanitizing stations and even wrapped our elevators with larger-than-life images of our care providers and patients – calling out the importance of clean hands. We want patients and family members to know that it is absolutely ok to ask their care provider if they washed their hands,” states Dr. Kernaghan. As part of St. Joseph’s strategic plan, the relentless pursuit of safety is a key focus for staff and physicians. Because of this commitment, and the creative ideas from across the organization, St. Joseph’s took a giant step forward in their hand hygiene rates from moment one – before initial patient contact. “We set a goal of 95 per cent,” says Laylo. “And we surpassed it!” “The dedication of our teams is obvious,” says Dr. Kernaghan. “Moving an organization of more than 4,000 people by three per cent, since we began our extra efforts, is no easy task. Our staff and physicians have aspired to do better, to go further, to challenge each other and attain this significant goal.” St. Joseph’s takes its responsibility to protect the vulnerable patients they care for very seriously by ensuring they don’t spread healthcare associated infections; and hand hygiene is the most effective way to prevent the spread of disease. In order to keep the energy up St. Joseph’s created the Hand Hygiene High Achievers Club, where departments who achieve the goal of 95 per cent or higher are inducted into the club and featured every quarter. They also receive a certificate of recognition. Now, St. Joseph’s is tasked with keeping the momentum going, continuing the relentless pursuit of safety and always doing as Elvis does – being ‘hound dog’ for hand H hygiene. ■

Infection Control


Standardized discharge process leads to safer care By Alicia Hall


n innovative new discharge process led by a multidisciplinary team at St. Joseph’s Health Centre is helping keep patients safer from becoming sick with super bugs. Carbapenemase-producing Enterobacteriaceae (CPE) are antibioticresistant bacteria that can spread from patient to patient in a hospital environment when appropriate precautions are not in place. Current guidelines recommend patients colonized or infected with CPE be placed in a private room on infection control precautions, and upon discharge, their rooms thoroughly cleaned to reduce the chance of CPE spreading to other patients. “Our cleaning practices are rigorous when a patient known to be CPE positive has been discharged,” says Dr. Jennie Johnstone, Infection Control Officer, “but we recently realized that CPE is hiding in new places in hospitals across the country — sink drains (in patient rooms) seem to be an increasingly common mode of transmission for CPE because if contaminated fluids are dumped down the drain, they stay there where they can then be spread to others.” “Once we discovered this, we immediately looked at two things: how we could

limit the ways that sinks were becoming contaminated and, after knowing that a sink was contaminated, how we could clean it so that it was safe for patients to use again.” We created a multidisciplinary team led by our Infection Control Practitioners who came up with several strategies to solve this issue, including: moving to waterless bathing for any patients known to be CPE positive to eliminate the need to dump any fluids down the drains; increased education about the importance of using sinks in patient rooms strictly for cleaning hands; and developing a discharge process checklist to be followed when a patient known to be CPE positive has been discharged from a room. “The discharge checklist has been incredibly helpful and successful because it provides a step-by-step guideline of how to clean a room after a patient with CPE has been moved from it,” says Dr. Johnstone. “Everything has to be completed before we allow another patient to go into that room, preventing patients from acquiring CPE.” The checklist – which includes shutting off the water to the sink, swabbing the sink to test for contamination, and cleaning it using a special disinfection process – has now been shared with hospitals across Canada. Our teams have presented at

Dr. Jennie Johnstone, Infection Control Officer at St. Joseph’s Health Centre. multiple conferences, and our Infection, Prevention and Control Team team routinely receives requests for the discharge checklist so that it can be adapted and implemented in other hospitals. “This is just one of the ways we’re delivering high quality care to our community,” says Dr. Johnstone. “And by working with


our partners and sharing our learnings and new process for standardizing the discharge process and room cleaning of patients who have CPE, we are helping other hospitals create a standardized approach to create a H safe care environment for all patients. ■ Alica Hall is a Communications Associate at St. Joseph’s Health Centre.




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Infection Control

Flu prevention is a shared responsibility By Roxanne Hathway-Baxter & Michael Oreskovich


ospital patients with existing health conditions face a greater risk of being seriously affected by influenza (the flu) than otherwise healthy individuals. This is especially true at Runnymede Healthcare Centre, where the majority of patients are seniors suffering from medically complex conditions, and are therefore more vulnerable to infection. Runnymede proactively addresses this risk with an annual flu campaign that promotes vaccinations for all patients, staff and volunteers. The success of the hospital’s campaign has grown each year and has helped distinguish Runnymede as a leader in infection prevention among its peers in the Greater Toronto Area (GTA). In the 2015/2016 flu season, Toronto Public Health reported that the average staff vaccination rate among acute care and complex continuing care/rehab hospitals in the city was 56.2 per cent, despite the fact that the Government of Ontario cites the flu vaccine as the best defence against the flu. Why such a low number? Reasons vary. Some individuals are skeptical of the safety and effectiveness of the shot, while other reasons boil down to logistics and convenient access to the vaccine. Runnymede soared above this rate in the same flu season, with a staff vaccination rate of 83 per cent, placing it second among its peer hospitals in Toronto. However, more impressively, at the midpoint

of the 2016/2017 flu season, the hospital’s staff vaccination rate is currently sitting at an outstanding 92 per cent. The hospital’s flu campaign can be credited with the high rates of vaccination at Runnymede. The campaign is launched early in the flu season, and this year it was tied in with the annual Infection Prevention and Control (IPAC) Week in October 2016. The campaign is organized by a team of employees, led by occupational health and safety and human resources, with support from infection control. The aim of the team is to mitigate the challenges that prevent healthcare employees from getting vaccinated and meet the hospital’s vaccination targets. “We realized that we had to do more than just tell staff and volunteers to ‘get your flu shot.’ We weren’t going to reach immunization targets that way,� says Richard Mendonca, VP of Human Resources and Organizational Development. “We had to educate staff on what the flu really is and why it is so important for our patients that they get the vaccine. We did this by providing easy access to information on the flu shot, and by providing them with ongoing opportunities to get the vaccine.� In the weeks after the launch, the team continues to promote the flu campaign and increase its visibility in a variety of ways. Hospital-wide messaging pops up through email, intranet and bulletin boards, but

Runnymede’s flu campaign promotes staff vaccinations by facilitating access to the flu shot, providing education and raising widespread awareness at popular hospitalwide events, like IPAC Week celebrations. there is also a more hands-on approach to reaching all staff – a mobile flu shot cart. The mobile flu shot cart, led by the occupational health department, can be

dispatched to specific areas of the hospital, with staff being notified in advance of its presence. “The mobile flu cart has seen every corner of the hospital,� says

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Infection Control

Michael Ampem, occupational health practitioner. “We take the cart right to where staff members are, and with the cart we bring educational resources that can help alleviate any concerns that staff members might have about the vaccine, promoting a more positive attitude towards it.� Having the cart in addition to the regular availability of the vaccine in the occupational health department makes it easy and convenient for staff to get their flu shots, pushing vaccination rates higher and higher. Throughout the course of the campaign, up-to-date vaccination records are kept by the occupational health department. The rates are regularly reviewed by the team to analyze the hospital’s progress and if there is a department with a low participation rate, the team tailors additional education and increases mobile flu shot cart access for staff in that department. Runnymede’s continual commitment to its annual flu shot campaign is a demonstration of how seriously it takes the health of its patients, staff, volunteers and visitors. “The decision to bring both education and the flu shot directly to staff has really had a big impact on this year’s campaign,� says Ampem. “The fact that such a high number of our staff have rolled up their sleeves to get the vaccine really highlights the dedication to patient safety that exists at H Runnymede.� ■Roxanne Hathway-Baxter & Michael Oreskovich are Communication Specialists at Runnymede Healthcare Centre.


A new weapon against infection By Elaine O’Connor

lin-resistant Staphylococcus aureus), and vancomycin-resistant enterococci (VRE).


urnaby Hospital has a new weapon against infection: the Germinator. That’s the light-hearted name employees have given to the new Xenex Light Strike Robot cleaning machine. Yet it means serious business for patient care. Fraser Health Infection Prevention and Control launched the Ultraviolet Germicidal Irradiation (UVGI) machine trials last month in three facilities: Burnaby, Ridge Meadows, and Abbotsford Regional Hospitals. UVGI machines are cutting edge technology designed to reduce bacteria and viruses in healthcare facilities in tandem with traditional housekeeping and chemical cleaning methods. The machines emit short pulses of UV light which have a germicidal effect on stubborn microbes that normally linger on surfaces. The light damages the DNA and RNA of antibiotic-resistant pathogens including C. diff (Clostridium difficile), MRSA (methicil-

UVGI machines are cutting edge technology designed to reduce bacteria and viruses in healthcare facilities in tandem with traditional housekeeping and chemical cleaning methods Hospital-acquired infections are a global concern. US Centres for Disease Control and Prevention statistics show one in every 25 patients contracts an infection while in hospital such as MRSA or C. diff and one in nine of these patients will die from their infection. In Canada, more than 200,000 patients contract infections in hospital each year and an estimated 8,000 will die. The three robots, (dubbed “Violet� at Ridge Meadows and “The Force� at Abbotsford Regional) began their cleaning

rounds in mid-November in selected units where there have been issues with hospitalacquired infections. The machines will be trialed for six months through to mid-May. “Environmental cleaning is an essential component of our multi-pronged approach to reducing hospital-acquired infections,� says Executive Medical Director of Infection Prevention and Control, Dr. Elizabeth Brodkin. “The Germinator adds an additional layer on top of the good work our staff and cleaners do every day to keep our patients safe.� The hospitals expect to see reduced rates of hospital-acquired infections along with a reduction in the costs associated with treating them, plus fewer outbreaks, better patient outcomes, decreased patient lengths-of-stay and a reduction in congestion at the sites. Some studies have shown that UV disinfection achieves a 99.4 per cent reduction in MRSA and a 100 per cent reduction in VRE. An earlier trial at Surrey Memorial Hospital demonstrated an 80 per cent reduction in bacteria cultured from surfaces in patient rooms, following disinfection with UVGI. Continued on page C10

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Infection Control

Posters by patients

A reminder of hand hygiene importance By Tenney Loweth


ike saying a quick “thank you” or holding a door open for someone, cleaning your hands is a small thing that makes a big difference. No one understands this more than our patients and families, who rely on everyone at the hospital, staff and visitors alike, to clean our hands to prevent the spread of infection. Posters drawn by patients were introduced as part of the Clean Hands Prevent Harm campaign last year to remind others how simple but important hand hygiene is at SickKids. As part of our current Quality Improvement Plan, SickKids aims to improve how often our healthcare providers

We wanted to involve patients in the poster campaign to create the reminder that kids here rely on everyone else to keep them safe from germs and infection .clean their hands from 85 to 89 per cent. The posters have no doubt helped us reach the current year-to-date compliance rate of 90 per cent.

SUCCESSFULLY INCREASING HAND HYGIENE COMPLIANCE Hospital-Acquired Infections (HAIs) are a harsh reality for many healthcare facilities, but it doesn’t have to be this way. Research shows a direct link between increased hand hygiene compliance and reduced HAIs, but sometimes that is easier said than done. Many facilities are currently struggling with this issue – finding a successful hand hygiene program and accurately monitoring compliance to drive necessary improvements. A successful hand hygiene program incorporates three essential elements: effective products, proper training and education, and accurately measuring compliance rates. Selecting effective skin care products that the staff enjoys using, and ensuring proper placement are essential in increasing compliance. Providing valuable training and education will reinforce the importance for hand hygiene at the proper times to increase patient and staff safety. However, compliance improvement can only be recognized if it is properly measured. Traditionally, direct observation has been the gold standard for monitoring hand hygiene even though it is known that the data generated from this method is incredibly flawed. More recently, electronic hand hygiene compliance monitoring has emerged in healthcare and is proving to be an asset in simplifying the compliance measurement challenge. The DebMed Electronic Hand Hygiene Compliance System is clinically proven to increase compliance and reduce HAIs. It captures 100% of all hand hygiene events, and provides accurate, real-time data, based on the Four Moments for Hand Hygiene – representing a higher clinical standard. The option to automate hand hygiene compliance monitoring is often overlooked by hospital leadership, sometimes even IPs. However, putting such technological advances to work results in multiple benefits, including reducing the time needed to collect and report compliance data. This in turn drives up compliance by giving visibility to true performance results, making hand hygiene a daily priority for staff and ultimately saving lives.


“We wanted to involve patients in the poster campaign to create the reminder that kids here rely on everyone else to keep them safe from germs and infection,” says Renee Freeman, Infection Control Practitioner. “We wanted to include their ideas and perceptions about the importance of cleaning hands and what it means to them. We felt it was important to have patients as partners to create a culture of safety.” Seven posters were created this year and can be seen around the hospital. Here’s what some of the artists had to say about their creations and why they’re so important: “I had fun drawing my picture. I liked putting happy faces on the water, soap and

the clean hand. It’s important to me that the staff who take care of me have clean hands and so I don’t get sick and other patients too. I make sure I clean my hands too,” says Revan, a patient at the hospital. “I feel proud when I see my poster because I feel like I am making difference by encouraging everyone to wash their hands. It makes me feel comfortable and safe knowing the nurses and doctors clean their hands after they see other patients before they see me. I made the poster fun for kids to encourage them to wash their hands H too,” adds Yasmine, another patient. ■ Tenney Loweth is a Communications & Public Affairs intern at The Hospital for Sick Children.

The next superbug Continued from page C2 • If a patient answers yes to any of these, then a rectal swab or stool culture is obtained and tested for CPE. • The patient is placed in Contact Precautions until the test results are back. • If the testing is suspicious for CPE then the patient remains in Contact Precautions and a room by themselves until the CPE is confirmed, which can take an additional four days. • If positive the patient remains in primate room accommodation and Contact Precautions for the remainder of their stay, all equipment is dedicated, and no transfers are allowed (unless medically necessary). • Any roommate has follow up testing done to ensure they did not inadvertently acquire CPE while sharing the room with the positive patient. WRH recently received a patient on a surgical ward from a nearby US hospital who had acquired CPE in that facility. This was the first time that a patient had tested positive for CPE from a facility that we regularly transfer patients to. The patient was going to have a long recovery. We had to have a very stringent plan in place to ensure that no other patients acquired the organism. We added the following measures above and beyond the best practice guidelines: • Any suspect CPE patient was placed in private room accommodation and Contact Precautions until lab results were finalized and negative. • The patient’s room was cleaned twice

daily by housekeeping, with the housekeeper cleaning this room as the last clean of their shift. • All equipment remained inside the patient’s room (e.g. blood pressure cuffs, vitals machine, walkers, etc.). • Dietary staff did not deliver meal trays – all trays were brought to the patient by nursing staff. • Proper personal protective equipment use, Contact Precautions, hand hygiene, and aseptic technique were strictly followed by staff – with formal reviews provided regularly by Infection Control staff and the Clinical Practice leader on the unit. • Infection Control provided detailed education regularly to the patient as well as the staff. • All patients on the unit were tested weekly for CPE to ensure that all measures were effective and there was no further spread to other patients. Unfortunately if patients are not tested to identify a carrier state regularly, then transmission will only be identified when a patient develops an infection – and given the high mortality rate associated with CPE infections we could not wait for this to happen. Following discharge a rigorous cleaning protocol was used to clean the patients room and equipment which included a double clean, vapourized hydrogen peroxide (Nocospray), and speH cial sink drain treatments. ■ Erkia Vitale is the infection prevention and control manager at Windsor Regional Hospital.

Infection Control


Emergency department Improving hand hygiene and communication

By Kaitlyn Patterson


isiting the Emergency Department can be a scary experience, especially if patients don’t know the name or role of the healthcare professional treating them. Focus surveys conducted in the ED with patients and staff at St. Michael’s Hospital found that being able to identify staff and their roles is highly important to patients. To address this, an ID badge pilot project with an education component called NOD and Wave is underway in the ED. When staff meet with a patient, they now introduce themselves with NOD: name, occupation and duty, a concept adapted from Thunder Bay Regional Hospital. For example, “My name is John. I’m a nurse and I will be taking your blood pressure.” “Wave” is an original component that was added to the project at St. Michael’s to remind staff to wash their hands before interacting with a patient. “It can be confusing for patients because we all wear the same uniform and often have crossover in our roles,” says Lee Barratt, a clinical nurse educator in the ED. “NOD and Wave reminds us to identify ourselves to patients, explain what we will be doing and to practice hand hygiene.” New colour-coded ID badges with larger occupation titles, larger names and smaller photos are being used to identify staff.

The colours on the badges match posters in the ED, which provide patient-friendly descriptions of the project and the role of each occupation. For instance, if a staff member is wearing a badge with a light blue stripe, it means he or she is either a resident doctor or medical student. Patients can read one of the posters to gain a better understanding of what the health professional’s role involves and with whom he or she typically works. “Our goal for this project is to minimize patient confusion,” says Anthea Tseng, a quality improvement analyst. “We’ve emphasized the provider’s name and role on the badge and selected a handful of colours to identify the different groups of providers who work in the ED.” Other departments such as the Diabetes Clinic and Breast Centre have also administered surveys to patients to determine if the project should be extended beyond the ED. “So far, we’ve received all positive feedback regarding the ID badge project and the NOD and Wave component,” says Tseng. “It gives patients comfort knowing that the staff is focused on improving open communication and hand hygiene within H the hospital.” ■ Kaitlyn Patterson is a writer at St. Michael’s Hospital.

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New weapon Continued from pageC7 In December, Fraser Health President and CEO Michael Marchbank, Vice President of Patient Experience Linda Dempster and Dr. Brodkin visited Burnaby Hospital to catch the Germinator in action. Burnaby Executive Director Sheila Finamore, Director of Clinical Operations Coralei Still and Infection Prevention and Control consultant Fuad Ibrahimov gave a demonstration of the robot at work in a Medicine ward, where the machine disinfected a patient room with germicidal UV light.

Patients have been enthusiastic about the enhanced cleaning, despite the fact they must be moved from the room during the treatment, which can take about 20 minutes for a small patient room and more for larger areas Still, the Clinical Operations Director, said the pilot has been well received by patients. “We’re really seeing the comfort that a deep clean of the environment brings to patients and their families,” she says. “The Germinator is a unique and very tangible way of showing our Burnaby community how much we care about their health and wellbeing and we’re thankful to our Ara-

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mark team, which has been so willing to support this quality initiative and to go the extra mile.” The UV light that is used is bright, and while UV doesn’t penetrate deeply into tissues, it could cause slight damage to skin in the form of sunburn-like redness or retina sensitivity. For this reason, the disinfection units are operated by specially trained personnel and only in unoccupied rooms. The UV rays can’t penetrate doors, glass or plastic, and no UV radiation remains once the unit is turned off, so there is no issue with exposure to individuals outside of the room – it’s safe to watch through a window. To prevent accidental exposure, the machine is also equipped with motion sensors to shut it down if they detect movement, and warning signs are posted outside the door during cleaning. It gives off a faint, harmless scent of ozone after cleaning. Care aide Harjit Thind agreed patients have been enthusiastic about the enhanced cleaning, despite the fact they must be moved from the room during the treatment, which can take about 20 minutes for a small patient room and more for larger areas. “I explain to them that it is a deep clean and their room will be more germ-free because we are trying to control the infection more,” Thind says. “As soon as they enter the room again and know it is really clean, you H can see it on their face, they really love it.” ■ Elaine O’Connor is a Senior Communications Consultant at Fraser Health.

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Infection Control C11

HealthCareCAN’s and PHAC’s visit to MSH-UHN Antimicrobial Stewardship Program in August 2015.

Toward an action plan for antimicrobial stewardship By Charles Thompson


lation signs slapped on rooms because of methicillin-resistant Staphylococcus aureus (MRSA). Routine surgeries, medical procedures, and cancer treatments such as chemotherapy are becoming more dangerous due to the risk imposed by AMR that increasingly overwhelms the set of currently available antimicrobials. Indeed, the past year saw the emergence of E.coli strains that are resistant to the very last an-

tibiotic available to treat such infections. Against that background, it is clear that we need to take action. Now that Canada has an Action Plan, the time has come to commit to that action. Putting the Pieces Together: a National Action Plan on Antimicrobial Stewardship H can be found at â– Charles Thompson is Policy and Research Analyst at HealthCareCAN.

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he Public Health Agency of Canada (PHAC) reports that at least 18,000 Canadians are hospitalized annually with drug-resistant infections. Our best guess is that anywhere between 3,000 and 3,500 Canadians die each year from drug-resistant infection and this number can only be expected to grow at current rates. The Director-General of the World Health Organization calls it a “slow moving disaster� and the O’Neill Review on Antimicrobial Resistance (AMR) has estimated that by 2050 the global death annual toll attributable to AMR will be 10 million per year. This is higher than the global mortality rates for all cancers and road traffic accidents combined. The cumulative cost between 2014 and 2050 of unchecked AMR is projected to be 100 trillion USD. Now, Canada has an Action Plan for combating AMR through Antimicrobial Stewardship (AMS): the practice of promoting the appropriate use of antimicrobials to preserve their future effectiveness. The collaboration that would bring the Action Plan to fruition was born in the summer of 2015, when HealthCareCAN CEO Bill Tholl traveled from Ottawa to Toronto with the President of PHAC and Canada’s Chief Public Health Officer to visit the Mount Sinai Hospital and University Health Network (MSH-UHN) healthcare facilities. He was on a fact-finding mission. Sometime earlier, Bill had been on a call with the new Chief Public Health Officer Dr. Gregory Taylor. “What can I do to help you out in your new role?� Bill asked. “Help speed up the development of an Antimicrobial Stewardship Action Plan,� replied Dr. Taylor simply. This was a new term with an old history and Bill was at MSH-UHN to learn from some of the doctors, nurses, pharmacists and staff who knew it best. The aftershocks of the tour were dramatic. By January 2017, a national Action Plan on Antimicrobial Stewardship AMS entitled Putting the Pieces Together was released. The Action Plan was developed by HealthCareCAN in collaboration with the National Collaborating Centre for In-

fectious Diseases and with the support of PHAC. It builds on the work of experts, key influencers and stakeholders in the fields of AMR and AMS who convened at a national roundtable in June 2016. “This Action Plan is a crucial step towards preserving the effectiveness of antibiotics, and in reducing the threat of AMR. We need to act now before we have lost our ability to fight common infections,� says Tholl. Putting the Pieces Together identifies ten key areas for action in AMS. Under that umbrella, three priority activities for immediate action have been identified: developing an evaluation protocol to ensure progress is measured consistently, improving professional practice through the development of guidelines for primary care prescribing, and improving professional and public education on AMS. A network of healthcare leaders, government representatives and healthcare stakeholders and influencers called ‘AMS Canada’ has emerged to collaborate and guide these programs and others identified under the Action Plan. The MSH-UHN Antimicrobial Stewardship Plan (ASP) and many other programs across the country have grown out of the recognition that if we are to stem the tide, we need to work towards better stewardship of our antimicrobial arsenal, both in and out of hospital. Leadership has been an essential success factor towards developing the Action Plan, and much of the credit for its launch must go to Dr. Greg Taylor as well as to Dr. Andrew Morris, Yoshiko Nakamachi and their team of the MSH-UHN Antimicrobial Stewardship Program (ASP). They and other Champions of Change in AMS are at the vanguard of a growing national movement to use antibiotics and other antimicrobials more sensibly. Reflecting on the road that led to the Action Plan, Bill Tholl is amazed at how MSH-UNH ASP’s journey also had unexpected consequences. “It was a pretty extraordinary team effort,� says Tholl after his tour in 2015, “they got into this business to improve quality and they ended up saving a lot of money along the way.� That being said, saving money isn’t the point. Canadians visiting an ailing relative or friend in hospital now expect to see iso-

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Evidence Matters 15

Diagnosing the flu on the fly:

Point-of-care tests for Influenza

By Barbara Greenwood Dufour


ost of us take measures during “flu season” to avoid catching the influenza virus (the flu), such as getting the flu shot and using proper handwashing, sneeze, and cough etiquette. But each year, an estimated 10 to 20 per cent of Canadians become infected with influenza. Most will get better by staying at home to rest. But, for others, influenza can be much more serious – even deadly.

There are two types of rapid influenza tests: rapid antigen tests that detect the presence of influenza infection, and rapid reverse transcriptionpolymerase chain reaction (RT-PCR) tests that detect the influenza virus’s RNA. In Canada, about 12,000 people are hospitalized and 3,500 die as a result of serious complications from the influenza virus every year. Those at a higher risk of developing complications include very young children, people over 65 years of age, pregnant women, and people with chronic illnesses or weakened immune systems. When these people get the flu, they sometimes need antiviral medications to recover. For patients at high risk of flu complications who are experiencing flu symptoms, a lab test is sometimes used to confirm the diagnosis before antivirals are prescribed. Flu symptoms can be similar to those caused by

a bacterial infection. Although lab tests are very reliable, they can take several hours to several days for results. Because of this delay, clinicians often send patients home on antibiotics, just in case the test comes back negative. However, antibiotics are not effective at treating the flu virus, and overuse of antibiotics can lead to antibiotic resistance. But what if a flu test provided results to the clinician before the patient even leaves the office? A number of newer influenza testing devices have recently been developed that provide test results in less than 30 minutes right in the doctor’s office – at the point of care. This alternative to the conventional lab test could be used in other settings as well, such as a nursing home or at a pharmacy. How effective are these tests at improving appropriate prescribing? Are they reliable? The CADTH Horizon Scanning service recently looked at the available evidence to find out. CADTH is an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures to find out what the evidence says. Its Horizon Scanning service identifies new and emerging technologies that are likely to have a significant impact on health care in Canada and reports on what is known so far about these technologies. The CADTH Horizon Scanning report Pointof-Care Testing for Influenza is focused on a specific test (cobas Liat System, not currently available in Canada) but, as part of its assessment, looked at other rapid influenza tests as well and provides some insight on this topic. There are two types of rapid influenza tests: rapid antigen tests that detect the

presence of influenza infection, and rapid reverse transcription-polymerase chain reaction (RT-PCR) tests that detect the influenza virus’s RNA. One rapid RT-PCR test available in Canada is the Alere i Influenza A & B. Rapid antigen tests available in Canada include QuickVue Influenza A+B, FebriDx, BD Veritor System, and RAMP Flu A + B. CADTH found a few studies that suggest rapid influenza tests do result in more appropriate prescribing. Although the studies are small, they indicate that when patients test positive for the flu at the point of care, clinicians are less likely to prescribe an antibiotic. Interestingly, this doesn’t seem to be the case with children – according to a study involving pediatric patients in the emergency department with acute respiratory infections, rapid testing didn’t reduce antibiotic use. When CADTH looked for the available evidence on the accuracy of rapid influenza tests compared with lab tests, it found that they don’t appear to perform quite as well. This means that patients who test negative for the flu might in fact have the flu and need antivirals. On the

other hand, those who test positive for the flu at the point of care might be less likely to be prescribed antibiotics “just in case.” But, of the two types of rapid tests, it seems that the rapid RT-PCR test (Alere i Influenza A & B) might be more accurate for detecting the flu virus. Until evidence shows that rapid tests are as reliable as traditional tests, however, it’s unclear to what extent they could replace conventional lab testing. If you’d like more information about CADTH’s Horizon Scanning report on point-of-care tests for influenza – or on a variety of other new and emerging devices, procedures, diagnostics, and other health interventions – visit To learn more about CADTH, visit, follow us on Twitter @ CADTH_ACMTS, or talk to the Liaison Officer in your region: To suggest a new and emerging technology for CADTH review, email us H at ■ Barbara Greenwood Dufour is a Knowledge Mobilization Officer at CADTH.



Undergoing a digital transformation

Continued from page 14 Our current solution is focused on meaningful events such as nurse calls, code calls, bed alarms, patient monitoring and special purpose alarms. All of these trigger response and action that drives efficiency, quality and a patient-first focus. At Humber River we have deployed a patient portal, on-line check-in, and we are on our way to on-line registration, scheduling, and booking. The value of putting these services on-line is not in question: it empowers the patient, it reduces cost, and it increases efficiency of patient flow. But what is the real objective? We want our community to be connected to Humber. We see the power of having a relationship with our patients and community before and beyond a visit. Getting connected is not just about online transactions, but engaging in conversation. We continue to push technology and the power of social media to create awareness, to drive wellness and to help make better care management decisions We are moving to the next phase of our metamorphosis and in pursuit of an HRO: we will drive better quality measures with real time dashboards to inform

and influence behaviors. We will further increase efficiency and reduce LOS using real time analytics that inform organizational flow. We will improve care process and intervene in never events before they occur through predictive analytics and real time notification of patient status. We will connect the constellation of care providers from primary, to acute, to community and long-term care so that action is coordinated and smart decisions are made by those who are best to make them. Including the patient and the family in the collaboration allows care to be provided where it is most efficient for the patient to receive it. The digital transformation Humber River has accomplished only occurs with a commitment to great patient care, inquiring minds and a willingness to join the journey. I remain ever grateful to our Board of Directors, Staff, Physicians, IT team and Partners who embraced the journey and continue to seek out new opH portunities each day. ■

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16 Focus


There are 14 outdoor courtyards at Providence Care Hospital, including one for each inpatient unit, allowing individuals with mobility challenges to go outside without taking the elevator or stairs.

Innovation at the water’s edge By Brynna Leslie


rovidence Care Hospital was designed with input from patients, families and frontline staff – resulting in a building that feels less like an institution and more like home. The amount of natural light that streams into every corner of the new Providence Care Hospital is one of the first things you notice when you walk through the building for the first time. At every level, off each 30-bedroom inpatient unit, there is 5,000 square feet of accessible outdoor space with terrace, gardens and views of Lake Ontario. As architect Cameron Shantz explains, this is a reflection of a building that was designed to bring the outside in. “Hospitals tend to be big, deep buildings,” says Shantz, Principal Architect at Parkin Architects Limited. “We made some very specific moves in this building to make sure there was natural light in all elements.” Much of the early design process focused on integrating the hospital into its natural surroundings, he explains. The goal was to offer a bright and vibrant atmosphere that both maximizes healing and rehabilitation and also invites families, visitors and the community into the building as an extension of Lake Ontario Park. “It’s important for the patients and clients to feel a connection to the community and to the outdoors and to feel the natural landscape that they’re on,” says Shantz. “We really believe it’s important to their healing journey. There is a lot of seminal research that demonstrates the impact of views to the natural environment and how that can help in recovery.” The best views have been reserved for patients and their visitors. Many inpatient rooms overlook the lake or the surrounding historic buildings, visible whether an individual is in bed or mobile. Each 10-bedroom corridor has access to a windowed sunroom as well as a screened porch. There are nine 5,000 square-foot terraces, equipped with barbecues, tables and gardens and extending off patient dinHOSPITAL NEWS FEBRUARY 2017

ing rooms. Shantz explains that outdoor terraces have also been optimized for the distinct patient populations they serve. “For the mental health areas, we have incorporated more active type spaces, such as basketball courts,” says Shantz. “For those in complex care and rehabilitation, the outdoor terrace doubles as an extended therapy centre. Clinicians can take them outside and help them navigate different types of surfaces – smooth or rough ground on which they can circulate – and there are handrails.”

Providence Care Hospital is the first hospital in North America to fully integrate long-term mental health, complex care, palliative care and rehabilitation in the same building, with both inpatient and outpatient services. By opening up the building to the natural landscape, there is a sense that patients and the community are more fully integrated, something that is at the heart of Providence Care’s philosophy, explains Shantz. “Providence Care has a mentality of ensuring that rehabilitation is at the forefront of everything they do for their patients in the interest, as much as possible, of getting patients out of the hospital and back into the community,” he says.

Breaking down barriers Providence Care Hospital is the first hospital in North America to fully integrate long-term mental health, complex care, palliative care and rehabilitation in the same building, with both inpatient and outpatient services.

“That was the driver of the entire planning process of this facility,” says Krista Wells Pearce, vice-president of planning and support services at Providence Care. “We wanted to make sure that we very intentionally intermingled the patient populations to ensure everybody had the ability to access all amenities of the building.” To that end, there is a single main entrance. Staff, volunteers, inpatients and those coming for outpatient appointments will purposely enter the building through one door. “Whether you’re coming for a mood disorder clinic, a seniors mental health clinic, or a rehabilitation medicine clinic you’re going to one waiting room,” says Wells Pearce. “We’re not segregating people based on diagnosis.” Providence Care volunteer Beryl Dodd believes having a hospital that puts mental and physical rehabilitation on par with one another will put Kingston on the map as a leader in healthcare innovation. “Everybody that’s here is working toward getting well or having the best quality of life possible. It’s very good for all patients to interact with one another, to be around one another. Sometimes there’s such a stigma around mental health, but now everyone will be together and will be able to see that they’re all here to get well.” Wells Pearce acknowledges that the varying needs of patient populations required some critical thinking on the part of those planning the facility. Chief among those concerns was providing an environment that was accessible for all patients, but also safe for everyone. The forensic mental health unit, for example, is purposely located at ground level to allow for secure patient transport when it is required. The unit is also adjacent to indoor recreational facilities. “We’ve worked with the engineers to develop what we call a flexible security perimeter which allows the secure perimeter of the forensic unit to be maintained while still allowing access to the pool and

the gym at designated times,” says Wells Pearce. In the rehabilitation units, staff safety has also been prioritized. “Providence Care received support from the province to install mechanical lift tracks which go directly from bed to the en-suite toilet and showers. “Your classic ceiling lift installation is over bed and gets patients from a bed to a stretcher or from bed to wheelchair, but then the staff have to get them to the next room and do it again,” explains Wells Pearce. “Having the lift that goes from bedside to the bathroom reduces the risk of doing two transfers. It reduces the fall risk for patients and decreases the likelihood of staff back injuries, which is a cost avoidance measure.”

From the ground up There are several innovations at Providence Care Hospital, distinguishing it from other Canadian hospitals. Integrated bedside terminals, for example, will act as a central control system, letting patients operate window blinds and temperature, at the same time giving online access. They have the potential for bedside charting and on-screen education. Inset monitors outside each patient bedroom can offer critical information to staff and visitors or be a unique electronic bulletin board for the patients, themselves. As the architect, Shantz is modest about taking full credit for the interior design of the building. He is resolute in emphasizing that the drawings Parkin Architects put to blueprint represent the remarkable vision of Providence Care’s frontline staff. “Very rapidly in this process we started meeting with each one of the user groups, which is the part we enjoyed most and is a unique and fantastic part of this project,” says Shantz. “Providence Care has very committed staff who really have their patients’ and clients’ best interests at heart and have offered such creative and practical input into the designs of the building.” Continued on page 17


Focus 17

The main lobby of the new hospital is inviting with areas for patients, clients, and visitors to socialize with one main entrance for patients, clients, visitors and staff to enter the hospital through. Continued from page 16 For nearly two years, 11 employees have been seconded from frontline positions, including nurses, therapists and other clinicians. As ‘Subject Matter Experts,’ their role has been to liaise between their teams, management and the designers. “It allows the staff to have a voice and to have their concerns heard and their ideas put forward,” says Andrea Almas, a physiotherapist and subject matter expert for community care. “We are the ones in contact with patients and clients the most.” The subject matter experts advocated for on unit therapy rooms, for example, which increases interaction between nursing and other clinical staff. It also has the potential to give extended access for patients to use treadmills and other

exercise equipment outside of scheduled therapy hours. Supply cupboards outside each inpatient room – another frontline innovation – means less waste, reduced chance of cross-contamination and the elimination of carts cluttering hallways. Extra wide doors to the terraces means palliative patients and their families have access to the outdoors. Even something as simple as window vents that will allow patients to have fresh air circulate in their bedrooms was central to many planning meetings, says Wells Pearce. “We had long conversations with the clinical team about whether the windows needed to be operable or not,” she explains. “Most said they’d rather maximize the view. But it was the forensic

mental health team who were really vocal about having vents – not just to have the feeling of fresh air coming into your room but to smell the grass being cut, to hear kids playing, to hear birds singing. Hearing children playing is healing in itself. For most people, when you’re at home, you can open the window. The team made a strong argument that it was in the best interest of our patients and clients to have this full sensory access to nature as part of their healing.” Wells Pearce believes one of the exciting features is the design of the main lobby. The open concept design, with doublestorey windows and a cafeteria patio that seamlessly blends into the adjacent park land purposefully welcomes residents and visitors to Kingston into the hospital.

“This facility is our community’s facility; our municipality and residents donated funds and our tax dollars were invested in the building,” explains Wells Pearce. “We’ve got this great space next to a fantastic park that has a lot of traffic now. The cafeteria patio, the healing garden and the staff memorial garden will no longer be separated from the park by a chain link fence.” “We want the public to come in and have their coffee after their morning walk. We want them to use our main cafeteria, use our shops, sit on the patio, or rent the gymnasium and the therapy pool. Providence Care Hospital belongs to H all of us. ■ Brynna Leslie is a communications consultant and writer in Ottawa.


18 Safe Medication

Healthy savings for a Hamilton hospital By Margo Northcote


hen St Joseph’s Healthcare Hamilton (SJHH) opened its West 5th Campus early in 2014, the 856,000-square-foot facility offered a new model of integrated medical and mental health services, with 305 inpatient beds, as well as outpatient clinics, diagnostic imaging resources and spaces dedicated to research, academics and therapeutic treatment. Designed and built with a focus on sustainability, energy efficiency and emission reduction, the building earned LEED® Gold certification. As the costs to provide patient care continue to rise, operating budgets for healthcare facilities in Ontario remain very tight. Hospital administrators are under increased pressure to create efficiencies, reduce energy use and maximize savings. In older buildings, identifying opportunities for improved efficiency is relatively easy. But for managers of high performance, energy efficient buildings, the target of significant energy savings is particularly challenging.

Continuous improvement pays big dividends The staff at SJHH partnered with Union Gas and service providers [Honeywell] to identify and implement energy conservation measures at the relatively new facility. Understanding that major savings can be achieved by paying close attention to the minute particulars of equipment operation, the team worked to optimize the efficiency of the facility’s heating and cooling systems. They determined that significant energy savings – as well as substantial CO2 reductions – could be achieved throughout the hospital when the HVAC equipment was more appropriately scheduled, according to the specific needs of each area. Energy management actions undertaken by the team included fine-tuning the HVAC system, calibrating heat wheels, monitoring and adjusting the low and high temperature heating loops, implementing hot water boiler demand control, as well as maximizing the efficiency of the hot and chilled water pumps. All equipment was already in place, so project improvements focused primarily on assessment and adjustment. No new equipment was purchased. The savings were achieved with no capital outlay but through the commitment of hospital personnel and their time. And the savings were substantial. Natural gas consumption in 2014 was 8.3 million cubic metres per year. Post-project, usage of natural gas decreased by 1.2 million cubic metres per year* – an annual savings of 14 per cent. That accounts for a corresponding reduction of 2,278 metric tonnes of CO2 emissions every year. And the improvements will continue to generate those benefits for years to come. Most satisfying of all for the team at SJHH, the energy efficiency improvements earned the facility a welcome infusion of $100,000 in cash from the Union Gas Incentive Program. Other facilities within the St Joseph’s network are currently working closely with Union Gas to investigate opportunities for reducing energy use and maximizing savings. “We worked to identify and implement energy conservation measures at this relatively new facility. The success achieved HOSPITAL NEWS FEBRUARY 2017

St Joseph’s Healthcare Hamilton. was reflected with a major reduction in the natural gas usage. These savings qualified for a Union Gas incentive of $100,000, which will be used to research and finance additional savings opportu-

nities at the site,” says Karen Langstaff, Chief Planning Officer, SJHH. *Savings determined through a cumulative sum of differences (CUSUM) analysis, using weather as the variable to

determine actual gas conserved by the H project. ■ Margo Northcote is a Senior Copy Writer at The Sandbox Agency.

Five questions to ask about your medications By Carol Nguyen and Certina Ho

−“Let’s review the new medication – Tiazac®XC– it is to be taken once daily at bedtime and it will be continued longterm, as long as it is well-controlling your blood pressure and you are tolerating it well.”


edication errors can occur at transitions of care, such as hospital discharge, following-up with a specialist or family doctor, and updating medication regimens at the pharmacy. Incidents often occur when there are medication changes that are not properly communicated among healthcare providers within the circle of care of the patient. The “5 Questions to Ask About your Medications” is a tool developed by ISMP Canada, the Canadian Patient Safety Institute, Patients for Patient Safety Canada, the Canadian Pharmacists Association and the Canadian Society for Hospital Pharmacists. It was designed for patients and healthcare providers to use as a guide when discussing changes in medications. These questions will help both patients and caregivers start a conversation about their medications and become knowledgeable about their medication therapy management. Below is a patient case scenario that is used as an example to illustrate the application of this tool. “A patient admitted with uncontrolled hypertension had been discharged from hospital with changes to her blood pressure medications. She was sent home with a new script for Tiazac®XC 120 mg once a day and advised to stop her metoprolol which she had been taking before admission. She filled the prescription and started the new medication. One week later, she had a follow-up visit with the family doctor, who was unaware of the recent changes in hospital and increased the dose of metoprolol, which had previously been stopped. The metoprolol prescription was filled. The patient was re-admitted to the hospital a few days later due to a low heart rate and it was discovered that she was taking both Tiazac®XC and metoprolol. Her metoprolol was discontinued; she was stabilized and discharged home on Tiazac®XC.” The opportunities for the patient and healthcare providers to use the tool in this case could have been at the moment of discharge from the hospital, at the fam-

4. Monitor? • How will I know if my medication is working, and what side effects do I watch for? −“You want to meet your blood pressure target of less than 140/90 mm Hg and to avoid the medication’s side effects. Side effects of Tiazac®XC include, for example, dizziness, lightheadedness, and edema.”

5. Follow up?

ily doctor’s office, and at the community pharmacy. For the purposes of this demonstration, the questions will be applied to the patient when she was discharged from the hospital the first time.

1. Changes? • Have any medications been added, stopped or changed, and why? −“Yes. Your metoprolol has been stopped and we are starting a new medication called Tiazac®XC. Your blood pressure was not well controlled on the dose of metoprolol you were on. Therefore, we have switched you to a different agent that will hopefully work better for you.”

2. Continue? • Which medications do I need to keep taking, and why? −This would be the opportunity to ensure that you (as the healthcare provider) and your patient are on the same page about which medications they need to keep taking. −Assess the appropriateness of the patient’s other medication(s) and explain which ones can be continued safely with the new medication, Tiazac®XC.

3. Proper use? • How do I take my medications, and for how long?

• Do I need any tests and when do I book my next visit? −“Yes, you need to follow-up with your family doctor in a week to check your blood pressure and to make sure that Tiazac®XC is working for you.” At the end of the dialogue, remind your patient that it is also important to keep his/her medication record up-todate. The record should include medications and changes made, and also the patient’s drug allergies, vitamins and minerals, herbals or natural health products, and any other non-prescription medications, such as over-the-counter medications. Keeping an up-to-date medication list is one way to keep track of changes and this also helps patients communicate the changes to healthcare providers in their circle of care. Lastly, encourage patients to initiate a dialogue with their healthcare providers to assess for the possibility of reducing or stopping any of their medications in order to optimize their medication therapy management. If every patient can ask about his/her medications at hospital discharge, during visits to the doctor’s office and the community pharmacy, a significant number of medication incidents can H be prevented. ■ Carol Nguyen completed a PharmD rotation at the Institute for Safe Medication Practices Canada (ISMP Canada) in 2016; Certina Ho is a Project Lead at ISMP Canada.


Focus 19


20 Trends in Transformation


The secret sauce

By Kate Sellen


Lisa Caldana, Service Coordinator and Mariam Salama, Physiotherapist at Toronto Rehab.

Five tips from the front lines for

transformational change By Michael Ronchka


ransformational change can seem daunting, but it doesn’t have to be. Ambitious goals are often reached by making incremental changes every day. That’s the philosophy at the Toronto Rehab Outpatient MSK Clinic. A year ago some patients waited as long as 77 days from the time they were referred until their first appointment. Since then, the inter-professional care team set a goal of patients waiting no more than 30 days and they reached it. Now they’re aiming for 14 days. Two members of the clinic team, Lisa Caldana, Service Coordinator, and Mariam Salama, Physiotherapist (PT), share five tips for making big changes with small steps:

1. Set a stretch goal and when you reach it, set a new one “We know if people receive treatment sooner they can recover more functionality in less time,” says Mariam. “That’s why we’re always striving to do better.” The clinic team’s first Lean Rapid Improvement Event (RIE) in September last year was focused on reducing wait times to a maximum of 30 days. Once the standard was set, the RIE team discovered barriers to clinic flow were limiting the number of patients that could be seen. Before the clinic team could start bringing patients in faster they had to think about making the discharge process more efficient. A lot of teamwork went into streamlining documentation, eliminating redundant forms, adding barcodes and replacing text fields with check boxes. “After we reached 30 days, we set a new goal for patients to have their first appointHOSPITAL NEWS FEBRUARY 2017

ment within 14 days of the referral,” says Mariam. “Aiming for 14 days was scary but it’s a goal and we’re working towards it, not reaching it doesn’t mean we’ve done a bad job. In fact, we’re seeing further improvement. Our data shows wait-time numbers are dropping significantly and some of our patients are now seen in less than 14 days.”

2. Reflect on what you are doing and why After the team held the RIE they were tracking the number of patient visits, but after a couple months they realized they were not taking action to move the metric. “Don’t be afraid to question the way you work,” says Mariam. “Often we’re so busy we don’t take time to step back and ask why we’re doing what we’re doing. You have to periodically question what metrics you’re looking at, and if they’re not driving action, stop tracking them

3. Understand what drives your performance As part of the team’s visual management system they have a graph on the huddle board showing the time each patient waited for their first appointment, making it easy to see when the 30 day target is exceeded. When patients were over the line the team recorded their condition to see if there was a pattern. They determined that most patients waiting longer than 30 days were trauma patients, inpatients and oncology patients waiting for both Occupational Therapy (OT) and PT. “The data we collected indicated we needed to look at our scheduling process,” says Lisa. “We changed the way we schedule oncology patients because scheduling them for an OT and PT at the same time

was increasing the wait times. Now we book them with an OT and ask a PT to join the case if necessary.”

4. Verify the change had a positive impact Even small changes sometimes encounter resistance. The long-term benefits from doing a little bit more work in the beginning to save time later on aren’t always obvious. Some changes really aren’t an improvement, but they stick unless there is a mechanism in place to evaluate them and roll them back if necessary. That’s where measurement can make the difference. “It helps if we say we will try something and evaluate it,” says Lisa. “If the data shows it doesn’t work we’ll go back to what we were doing before.”

5. Change your behavior to change your thinking The most significant change, and often the most difficult one to make, is thinking differently. Seeing and solving problems is a skill that takes practice to develop, but it inevitably leads to a change in thinking. Every day becomes an opportunity to find a creative solution to a problem and to do something better than the day before. “We never used to think about what we could do differently,” says Mariam. “Now we constantly think about what we can improve. That’s the real change.” Healthcare is full of passionate people and when focused on a meaningful goal, even the toughest challenges can be overcome by teams solving one problem a day, H making one improvement at a time. ■ Michael Ronchka is a Communications Associate – Lean Process Improvement at University Health Network.

ell recognized are the challenges to our healthcare system. Not so well recognized is the role of design in finding

solutions. Design sits at the intersection of expertise informed by the evidence base, clinician expertise, and the lived experience of patients, family and caregivers. Design uses techniques to uncover unmet needs, workarounds and adaptations that can be refined and scaled. Design also uses techniques to bring stakeholders’ perspectives as well as particular product and clinical requirements together. Taking a design approach from project inception to adoption while involving all stakeholders in the process has been successful both in Canada and elsewhere. The experience of the UK National Health Service, for instance, has shown a design approach to developing a best practice care pathway for breast surgery can reduce the length of stay from four days to one day/one night. The pathway has saved the NHS an estimated $15 million (10 million GBP) to date.

Design sits at the intersection of expertise informed by the evidence base, clinician expertise, and the lived experience of patients, family and caregivers. Design meets health system challenges wherever there is an element of a designed experience, environment, service, product, communication or tool. These include the need to leverage technology to connect health information and enable digital delivery across organizations and individuals, through design of interfaces and interactive experiences that fit the needs of clinicians as well as support patient experience. It includes the need to provide tools for clinicians to support what happens at discharge, which can include design of communications, visual tools, checklists, and services. In addition, the management of chronic diseases requires design of supportive tools and devices, and solutions that address access and inclusiveness for an increasingly diverse population. This is where design using the latest techniques for accessibility can include everything from architecture and interior design to graphics and illustration. Canada has a growing number of design success stories to share, including among others: • Developing a mobile system of breast screening in Manitoba using interior design, product design and service design methods, by CancerCare Manitoba. • Designing materials to support cardiovascular event recovery – a collaboration between Toronto’s Pivot Design and the Heart & Stroke Foundation of Canada. Continued on page 21

Doctors Without Borders 21

The gift of a safe delivery for moms By Dr. Karthika Devarajan


have always been interested in Global Health, but medical training takes up a lot of time in the beginning. I did some international work here and there, but eventually, I reached a point where my career was stable, and I wanted to try something new. Doctors Without Borders/ Médecins Sans Frontières (MS) has an incredible reputation for delivering good medical care where it is needed the most and I felt that I finally had the experience, but also still had the energy, to work with them. A colleague covered my practice and I went to work as an MSF obstetrician gynecologist for six weeks, long enough to do something worthwhile, but short enough not to derail my practice at home. I was posted to Timergara, a very traditional community high in the mountains of Northern Pakistan. Going to Timergara feels like going back in time in some ways. The living is hard and having a baby can be dangerous business. At first, the new culture was disorienting. It was unnerving to work without the technology, expensive drugs and support of the big teams that I was used to at home. Women would start bleeding during labour at home, and it would then still take hours for them to get to us. I would operate, terrified that they wouldn’t make it, worried about how they would do post-surgery without an ICU or individual nursing care. To my everlasting astonishment, these women made it more often than not, determined to get home to their other children. The resilience of the human mind and body is truly a kind of magic. As time went on, I started to trust that we had what we needed to do a good job. Most pregnant women are young and healthy. It was humbling to see that a basic OR and some essential drugs were all we really needed to save their lives. There

Design: The secret sauce Continued from page 20

Dr. Kate Sellen while working on the overdose project with St. Michael’s Hospital.

The Timergara District Hospital in Northern Pakistan. were people we couldn’t save and situations that shocked me, but there were also so many things that went so much better than I could possibly have imagined. So many people who did so remarkably well despite all odds – and that put the final balance hugely into the positive.

The resilience of the human mind and body is truly a kind of magic. I cannot describe how powerful it was to know that each day really, truly meant something. I realized all over again what a gift my surgical training has been and I have a new appreciation for the immense freedom that has defined my own life. I met many new people, both local and international, and these easy friendships

• Using design methods and industrial design to develop a personal home-based cervical smear test kit and service by Eve Medical that replaces physician office visits. • Collaborating to create a first aid kit for overdose response – a combination of design expertise from OCAD University, community partner knowledge and expertise at St Michael’s Hospital. The design process can be validated through engagement with stakeholders,

have helped enrich the way I see the world. The local staff were unfailingly kind and treated me with nothing but courtesy and warmth. It is really not so difficult to come for a short time, work hard and then disappear back into a comfortable first world life, but the local staff stay and manage these struggles day in and day out for years. I have no words for their courage and commitment. The last baby I delivered in my time there sums up everything I loved about working for MSF. All four of Mariam’s babies had died. All of them had tried to enter this world some way other than head down and the midwives had not been able to deliver these children alive. For her fifth delivery, she made the four hour trek through the mountains to our hospital. I examined her and a tiny hand grasped my finger. We did a c-section and delivered a gorgeous, healthy girl. She had an oddly shaped uterus that had probably forced all her children into their dangerous sideways

stances. A c-section, just a basic procedure, was all she needed to take her baby home alive. As I left the ward that night, I saw Mariam sitting in her bed, gazing at her little baby with such wonderment and I remembered what sparked my love of obstetrics in the first place. Whatever your culture or social strata, the love of a mother for her baby is so remarkably constant. The women in Timergara are no different. They want to go home with a healthy baby the same as any woman in downtown Toronto. Having a baby is having a baby, no matter where you are. Healthy mothers raise healthy children and this has benefits that affect the whole family, community and beyond. As obstetricians and midwives, we are so lucky to able to help give people this H gift of a safe delivery all over the world. ■

field testing and evidence-based techniques to ensure the final design has undergone multiple iterations and refinement. Designing with end users, including patients, service delivery organizations and frontline healthcare providers, helps ensure that solutions are designed for feasible implementation and effective practice. In this way, design methods and expertise are the secret sauce – combining key ingredients of stakeholder focus, inclusive processes, evidence, and implementation. OCAD U is the largest art and design university in Canada with focused design engagement in the health sector. Through our recently launched Design for Health Master’s degree program, students develop the design competencies required to tackle the complex issues faced by the Canadian healthcare system and the communication skills needed to work on multidisciplinary teams. Design provides a different way to view a problem, propose and explore alternatives, and to prototype solutions. Meeting the needs of a changing and emerging societal, structural and technological context of health requires design and design expertise. Design methods and approaches are poised to make a positive impact on challenges and opportunities in the health

sector. [This article is abstracted from a H larger manuscript.] ■

Dr. Karthika Devarajan is an obstetrician at North York General Hospital (Toronto).

Kate Sellen, PhD is an Assistant Professor in the Faculty of Design at OCAD U. She leads the Healthcare and Resilient Experience Research Group and is Director of the Design for Health Master’s Program. Her PhD is in Human Factors in Industrial Engineering (University of Toronto).

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22 Focus


Hospital News’ 12th Annual Nursing Hero Awards



Have you been inspired, encouraged or empowered by an employee or a colleague? Have you or your loved one been touched by the care and compassion of an outstanding nurse? Do you know a nurse who has gone above and beyond the call of duty? Hospital News will once again salute nursing heroes through our annual National Nursing Week (May 8th to 14th) contest. Nominations can be submitted by patients or patients family members, colleagues or managers. Please submit by April ril il 7th and make sure that your entry contains the following information:

Along with having their story published, the winner will also take home:


$1,000 Cash Prize


$500 Cash Prize


$300 Cash Prize

• Full name of the nurse • Facility where he/she worked at the time • Your contact information • Your nursing hero story

Please email submissions to or mail to: Hospital News, 610 Applewood Crescent, Suite 401, Vaughan, ON, L4K 0E3 vޜÕ`œ˜œÌÀiViˆÛiVœ˜wÀ“>̈œ˜܈̅ˆ˜Ó{…œÕÀÃœvi“>ˆˆ˜}ޜÕÀ˜œ“ˆ˜>̈œ˜] «i>ÃivœœÜÕ«>Ì œÀLÞÌii«…œ˜i905.532.2600 x2234. HOSPITAL NEWS FEBRUARY 2017


Focus 23

Winterlab: Underground state-of-the-art research facility finds most winter boots not safe on ice By Erica Di Maio


team of researchers from the iDAPT labs at Toronto Rehabilitation Institute-University Health Network are dedicated to keeping Canadians safer this winter by offering evidence-based ratings on footwear that may reduce the risk of slips and falls on ice. The team has developed the first test of its kind in the world – the Maximum Achievable Angle (MAA) Testing Method – to validate slip resistant footwear on icy surfaces using real people in a simulated winter environment. With the help of WinterLab, an underground, state-of-the art research facility located at Toronto Rehab, researchers have tested the slip resistance of 98 winter boots, including both safety and casual footwear. The results have been published on – with only 10 per cent of the 98 different types of footwear meeting the minimum slip resistance standards set out by the MAA test. For the first time, consumers will have winter slip resistance ratings available when they purchase winter footwear – similar to the ratings available for winter tires. Consumers are encouraged to request winter footwear they would like to see put to the test. It’s estimated that more than 20,000 Ontarians visit the emergency room every year due to injuries related to falling on ice or snow. A recent Toronto Public Health report revealed that over 40 per cent of those aged 35-59 years and 60 per cent of those aged 60-85 years said they would go out less as a way to cope with the winter weather. “This is another example of how research at Toronto Rehab provides practical help to prevent accidents and disability. I expect that many serious and life-changing injuries will be prevented this winter by people choosing to buy better non-slip footwear,” says Dr. Geoff Fernie, Research Director, Toronto Rehabilitation Institute. “I also expect the impact to grow with future winters as more manufacturers strive to develop products that score well in our system and can be recommended to consumers.”

MAA Test: How it works WinterLab has the ability to recreate typical Canadian winter conditions, for example sub-zero temperatures, snow and ice covered surfaces and winds up to 30 km per hour. WinterLab can be tilted to create slopes, or can be moved suddenly to challenge a participant’s balance while safely fastened into a harness. The MAA test is conducted in four basic steps: • Participants begin on a level icy surface in WinterLab. • Participants are asked to walk up and down the icy walkway as WinterLab is tipped and the slope of the walkway gradually gets steeper. • The angle of the slope continues to increase until the participant slips. • The largest angle where the participant did not slip is called the Maximum Achievable Angle (MAA). Testing in WinterLab is completed on both bare ice and melting ice to simulate diverse outdoor surfaces Canadians

(Main) Winter boot testing happening inside WinterLab. (Inset) WinterLab, an underground, state-of-the art research facility located at Toronto Rehab. may come across in the winter months. Combined with walking uphill and downhill, four conditions are tested for each pair of footwear. The overall score is based on the minimum performance over the four conditions.

shoes and working with manufacturers to develop new footwear that functions well on snow and ice. They have been testing footwear prototypes that have scored two and, even, three snowflakes,

and hope to see these available for sale H within two years. ■ Erica Di Maio is a Senior Public Affairs Advisor at Toronto Rehab.

The snowflake scale Toronto Rehab has created a ‘snowflake’ scale to rate the slip-resistance of winter footwear. Ontario’s accessibility guidelines specify a curb ramp of at most seven degrees. Footwear that achieves at least the minimum angle of seven degrees is awarded one snowflake. Two snowflakes are given for 11 degrees and three snowflakes for 15 degrees – although none of the footwear tested to-date has achieved two or three snowflakes. The most surprising finding was that 90 types of winter footwear tested failed to even achieve seven degrees and could not be awarded any snowflakes. Toronto Rehab researchers have found that two technologies stood out among successful MAA-approved boots – Green Diamond and Arctic Grip. Shoes outfitted with Green Diamond or Arctic Grip soles have special outsole materials designed to provide better traction on wet ice, which may reduce the risk of slips and falls on slippery icy surfaces. These shoes and boots were awarded one snowflake. Researchers are excited by the possibility of providing ratings for winter




24 Nursing Pulse


Educational & Industry Events To list your event, send information to “”. We try to list all events and information but due to space constraints and demand, we cannot guarantee it. To promote your event in a larger, customized format please send enquiries to “” Q February 13-17, 2017 National Institute on Nursing Informatics Toronto, Ontario Website: Q February 21, 2017 Virtual Healthcare & Telemedicine: Managemnet of Legal Risks Toronto, Ontario Website: Q February 19-23, 2017 2017 HIMSS Annual Conference & Exhibition Orange Country Convention Centre, Orlando FL Website: Q March 1-5, 2017 Canadian Critical Care Conference Whistler, British Columbia Website: Q March 8-9, 2017 Mobile Healthcare Holiday Inn Toronto Airport, Toronto Website: Q March 20-22, 2017 Neural Dynamics and Brain Health Conference and Workshop Toronto, Ontario Website: Q March 21-22, 2017 Industrial Autonomous Vehicles Summit Calgary, Alberta Q April 3-5, 2017 Together We Care Toronto Congress Centre, Toronto Website: Q April 7-8, 2017 Innovative Approaches to Optimal Cancer Care in Canada Toronto, Ontario Website: Q April 23-25, 2017 Hospice Palliative Care Ontario Conference Richmond Hill, Ontario Website: Q April 26-27, 2017 Healthy Canada Conference 2017: Access to Affordable Medicines Old Mill, Toronto Website: Q April 26-27, 2017 Canadian Healthcare Infrastructure West Metropolitan Hotel, Vancouver Website: Q June 4-7, 2017 eHealth Conference & Tradeshow Toronto, Ontario Website: To see even more healthcare industry events, please visit our website HOSPITAL NEWS FEBRUARY 2017

Rowena and David Fox helped to save the life of drummer and friend Mike Osborne (centre).

Nurses to the rescue Emergencies can strike at any time. Jarring, chaotic and often life-threatening, they startle the senses and send adrenaline soaring. In this three-part series, you will meet three registered nurses and one nurse practitioner whose peaceful off-hours were catapulted into frenzied encounters on planes, in quiet living rooms, and even in a community bar. These nurses jumped into action without hesitation. By Kimberley Kearsey


avid Fox and his wife Rowena – both RNs – had just arrived at their local watering hole to watch a friend’s band perform during the summer of 2014. They were settling in for the first set and David noticed his friend, the band’s drummer, looked a little unwell. Suddenly, he stopped playing and collapsed on his drum set. As David and Rowena ran towards him, most of the other patrons headed in the opposite direction. With extensive experience in emergency nursing, the NICU and ICU, David knew he had to begin compressions immediately while Rowena calmly called 911 to notify them of a cardiac arrest. “My office is down the street from where this happened and where I would have had access to the drugs and the equipment,” David says. “I was sitting there with my bare hands, and that’s all I had.” Fortunately, the seasoned RN had just updated his CPR training two weeks earlier and knew about the new protocols for CPR. Rather than 15 compressions, then a breath, the new standard is to offer continuous compressions with no breath. “People were heckling my CPR,” he remembers. Even the fire officials and paramedics told him he didn’t know what he was doing when they arrived. “I knew what I was doing the whole time,” he says confidently. And it paid off. His friend recovered and returned to drumming within a year of the incident.

Knowing survival rates for an out-ofhospital cardiac arrests are extremely low, David says he’s “…happy to see the guy is up walking around and having a normal life because that’s not the norm.” In fact, his recovery was being watched carefully by researchers at Sunnybrook who were conducting a study several months later, and interviewed David about the CPR he gave. When the conversation turns toward fate, and being in the right place at the right time, David is reluctant to speculate that it was anything more than luck. He says he wouldn’t abandon a stranger, let alone a good friend. “I just kept doing what I was supposed to do to keep him going.” It’s not lost on David just how lucky his friend is to be alive. But he won’t take any credit for it. “I don’t want anyone to feel they’re indebted to me for something like that,” he says. “I feel that…I’m obligated to help. I have the ability and the knowledge to do it. I shouldn’t be the person running away.” He’s also adamant that it takes more than one person to save a life. “I did what I could do. The paramedics did what they could do. Then a whole bunch of people at the hospital did what they could do. A hundred people saved his life. The guy who taught me the new CPR saved his life. My wife, who was telling EMS what was going on… all of that made a H difference.” ■

Kimberley Kearsey is managing editor/communications project manager for RNAO, the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. This article was originally published in the November/ December 2016 issue of Registered Nurse Journal, the bi-monthly publication of the Registered Nurses’ Association of Ontario (RNAO).


New online medical record portal for patients:


Focus 25

By Magdalena Stec


omen’s College Hospital (WCH) proudly launched myHealthRecord – a new online medical record portal for patients – during Digital Health Week last November. myHealthRecord allows patients to view and update their personal health information and medical record based on the clinical and personal information captured at WCH.

We also expect that the portal will reduce unnecessary testing, adverse drug complications and, by allowing patients to manage their appointment schedules, reduce appointment no-shows WCH patients who register for myHealthRecord have convenient, online access to their health information securely stored in the hospital’s electronic patient record, including test results, medical history and personal health summaries. Patients can also manage their appointments, complete some pre-appointment questionnaires and securely communicate with members of their care team – all online, at their convenience. “The portal is receiving positive feedback from our patients and providers alike,” says Brendan Kwolek, director, MI/ IT, WCH. “We’re thrilled with the results so far: we already have nearly 6,000 users, and that number is growing every day.” MyHealthRecord is completely private and secure, and uses the same encryption

technologies used by financial institutions for online banking. The portal is accessible online on any mobile device as well as through a free app available at the Apple App Store and Google Play – the app is just one of the ways in which myHealthRecord differs from other patient portals. “In addition to helping our patients manage their health information effectively, we also expect that the portal will reduce unnecessary testing, adverse drug complications and, by allowing patients to manage their appointment schedules, reduce appointment no-shows,” says Andrew Schroen, myHealthRecord project lead. “It will help strengthen the patient-provider relationship and give our clinicians more time to focus on delivering care to their patients.” In addition to the great features already offered in myHealthRecord, the hospital is continuously working on adding new and exciting elements that will be offered in the near future, such as an electronic wait list for some clinics and proxy access, allowing patients to share their health information with others. “As a leader in offering innovative health system solutions and providing equitable access to healthcare, we introduced myHealthRecord to help our patients get access to their health information and become active participants in their own care,” says Heather McPherson, executive vice-president, patient care & ambulatory innovation, WCH. “By giving our patients the tools to access to their health information, myHealthRecord allows them to be involved and engaged – and truly become H partners in their own healthcare.” ■ By Magdalena Stec, Communications Lead, Strategic Communications, Women’s College Hospital.

Earning LEED Gold Certification ®

Hamilton Health Sciences’ newest facility pairs exceptional patient care with environmental sustainability

By Calyn Pettit


amilton Health Sciences has achieved another significant milestone in its path to environmental sustainability, earning LEED® (Leadership in Energy and Environmental Design) Gold Certification for the new Ron Joyce Children’s Health Centre (RJCHC). “The Ron Joyce Children’s Health Centre is a reflection of years of thoughtful, innovative planning by our staff and construction partners,” says Dr. Peter Fitzgerald, president, McMaster Children’s Hospital. “It’s this collaborative approach that allowed us to create a purpose-built facility that positively impacts our young patients and their families, while minimizing the environmental footprint on our surrounding community.” The building is uniquely designed to suit the needs of its clients and families. With a spacious four-storey atrium, full height windows, and outdoor terraces, the facility makes the best use of natural light. The overall design of the facility is intended to create a space where children,

youth and adults feel welcomed, engaged, and encouraged, while receiving exceptional care. The project was certified gold, under LEED® Canada New Construction standards, earning 64 points. “As design-builder, PCL is extremely proud of the collaborative team effort that has secured LEED® Gold status to provide Hamilton Health Sciences with a facility that balances energy efficiency with occupant comfort, enabling the health system to provide care for children and their families in an environment that is as healthy as possible, for years to come,” says Mike Wieninger, vice president & district manager for PCL Constructors Inc. (Toronto).

Highlights include: • Achieved exemplary performance in innovative design through: – 32% of construction materials utilized recycled content – 45% of construction materials were sourced or manufactured locally within

800 km of the project, or within 2400km if shipped by water. – An energy model predicts 58% less energy use due to implementation of energy efficient technologies such as individual lighting controls for at least 90% of building occupants, and efficient heating and cooling equipment. • The project benefits from its location in an area characterized by development density and community connectivity, including efficient access to public transit • Installation of low-flow fixtures to achieve a water use reduction of 36% • 86% of construction and demolition waste was diverted from landfill • Building envelope designed to increase thermal resistance • Building’s HVAC systems do not use CFC-based refrigerants • Project offers sufficient space for storing and collection of recyclables • Indoor air quality management plan includes use of low-emitting materials • White roof membrane reflects heat, rather than absorbing it

As design-builder, PCL delivered the Ron Joyce Children’s Health Centre on time and on budget under the Government of Ontario’s Alternative Finance and Procurement (AFP) model.

About Ron Joyce Children’s Health Centre – Hamilton Health Sciences The Ron Joyce Children’s Health Centre is Hamilton Health Sciences’ newest facility. A variety of programs and health care teams are located in one building, allowing everyone to work together to provide the best care possible. This four-storey outpatient centre is the first of its kind in Canada. It houses a range of services for children, youth and adults in the region, many of whom are dealing with life-long health H issues. ■ Calyn Pettit is Manager, Digital Communications Public Relations & Communications at Hamilton Health Sciences. FEBRUARY 2017 HOSPITAL NEWS

26 Focus


New e-tool gives patients secure access to personal health info online By Erin Toews


nterior Health residents are the first in B.C. to be offered access to their personal health information online via a new tool called MyHealthPortal. MyHealthPortal provides patients with 24-hour secure online access to their health information via their smart phone, tablet or computer through a portal on the Interior Health website.

This will help patients be more proactive in looking after their health – an important element of patient empowerment which leads to better health outcomes Features include the ability to view IH lab results, diagnostic imaging reports (such as X-rays, scans, and ultrasound), certain upcoming appointments, recent hospital visit history, and the opportunity to update address and phone number information. Most recently the team was at Royal Inland Hospital in Kamloops and Vernon Jubilee Hospital to enrol users. The team will be in the Okanagan and Kootenays next as

part of MyHealthPortal’s phased roll-out to communities. To sign up, patients present to the project team in person with legal photo identification and their Care Card or B.C. Services Card in order to verify their identity. They are given a login username and password that they use on their own device. Then they simply login to the MyHealthPortal page on Interior Health’s web site at “I have spent a bit of time with the new portal and I think there are certain important things it accomplishes. The portal gives patients some element of control when it comes to reviewing their lab and diagnostic imaging results,” says Dr. Simon Treissman, Chief of Staff, Royal Inland Hospital. “This means that in some straight-forward cases, the patient may not need to book an appointment with their family doctor’s office specifically to review results. This capability is important today as there is a shortage of family physicians. The portal also helps to reduce the overall review and response time, improving access to care.” Okanagan resident and Patient Voices Network volunteer Diane Edlund agrees that MyHealthPortal will help put information into the hands of patients. “This will

Adam Smith (L) and Drew Dawson, clinical information analysts, have been enrolling patients at hospitals throughout the Thompson, Cariboo and Shuswap areas. They will be in the Okanagan next. help patients be more proactive in looking after their health – an important element of patient empowerment which leads to better health outcomes,” she says. “For example, having access to information from emergency room visits ensures information flows through transitions in care; this can reduce the need for follow-up emergency visits for test results.” MyHealthPortal is currently available to patients who have enrolled at sites in the Shuswap, Cariboo, and Thompson-Nicola areas of the province. To date, close to 5,000 patients have enrolled in MyHealthPortal. The service will eventually be avail-

able to all Interior Health facility patients. MyHealthPortal is a secure patient health portal. Protecting and safeguarding patients’ personal information is among Interior Health’s highest priorities. In addition to stringent privacy practices, Interior Health uses a diverse range of technologies and security mechanisms to ensure the safety, confidentiality, and integrity of patient information. For more information visit www.interiH ■ Erin Toews is a Communications Officer at Interior Health.

Protecting patient information By David Masson


f you were to guess the industry most targeted by cyberattackers, you might guess financial services. But in 2015, the healthcare industry overtook financial services to become the biggest target for cyber-criminals. The shift was driven by the rise of internet-connected devices in hospitals and the digitization of patient records. Despite these technological innovations, and in many ways because of them, healthcare IT is roughly five years behind IT departments in other industries. Healthcare organizations are now playing catch-up with a threat landscape that is becoming exponentially more complex and sophisticated. Canadian cyber security incidents are occurring at an alarming rate, and healthcare IT decision-makers need to pay attention. After all, healthcare organizations face an average cost of $355 USD per breach – the highest of any industry. In addition to monetary concerns, institutions also suffer major reputational damage following a security incident. For an industry that deals with sensitive personal data, the reputational damage is often worse than the operational disruption. Connected devices are one of the key reasons that the healthcare industry faces such serious cyber security issues. Nearly HOSPITAL NEWS FEBRUARY 2017

70 per cent of clinicians use mobile devices to view patient information, and over 41.8 per cent use them to get clinical data. Moreover, internet-connected medical devices tend to have major vulnerabilities and are highly susceptible to security threats.

In 2015, the healthcare industry overtook financial services to become the biggest target for cybercriminals.

This is due to a combination of long product lifespans, regulatory oversight, and niche usage. IT decision-makers in healthcare providers need to consider next-generation cyber security methods to catch breaches and device vulnerabilities before it’s too late. When breaches do occur, they usually fall into one of two categories: insider threats or ransomware attacks. A 2016 report found that 60 per cent of all attacks come from the inside, making it critical for

the Canadian healthcare sector to be vigilant. One of the key challenges posed by insider threats is that they come down to human behavior – be it intentionally malicious or entirely accidental. A 2015 case in the Rouge Valley Health System saw two clerks accessing inappropriate patient records. However, due to the way the network was configured, it was impossible to determine how many patient records were compromised. This forced them to notify 14,000 people that their records may have been compromised. And this past November, the Winnipeg Regional Health authority saw its largest ever patient privacy breach when a file with over 1,000 patients’ personal information went missing – all due to an insider breach. With systems in place to better monitor and ensure normal business functions, both of these breaches could have been stopped before there was ever an issue. In addition to insider threats, hospitals are also prime targets for ransomware. Due to the urgency involved in losing access to sensitive patient information, hospitals are particularly vulnerable to these attacks. Ransomware is a form of malicious software that blocks access to a network and the files on it until a ransom is paid for the decryption key. Access to patient records is critical, and a medical emergency can

persuade hospitals to quickly pay up rather than risk patient health while waiting for a resolution. This problem is magnified by hospitals’ tendency to prioritize spending on expensive medical equipment over cyber security measures. The best way to mitigate the risks posed by ransomware attacks and insider threats is to continually monitor the network for abnormal behavior. Unsupervised machine learning is an emerging technique that allows organizations to automatically detect the typical ‘pattern of life’ for a network. By comparing network traffic to that ‘pattern of life’, organizations can quickly flag anomalies and unusual network activity. This method draws inspiration from the healthcare industry itself – the technique act as an ‘immune system’ for the network. The healthcare industry is unique. Highly regulated, highly specialized, and in possession of highly confidential information, it’s a natural target for cyber-attacks. With the rise of internet-connected devices and the industry lagging behind modern cyber security, now more than ever IT decisionmakers in healthcare need to think about how to best protect patient information in H the modern threat landscape. ■ H

David Masson is Darktrace Canada Country Manager.


Focus 27

Technology’s impact on healthcare By Fawzi Behmann


ealthcare is one of the largest industries with five to 18 per cent of GDPs spent on healthcare globally. The healthcare budgets of the vast majority of nations continue to outgrow their GDPs. Social, demographic, economic and technological factors are the drivers for ever-changing healthcare models. While the demographic shifts in populations display significant socio-economic challenges they trigger opportunities for innovators in the areas of sensor technology, the Internet of Things (IoT), Robotics, e-health, m-Health, Cloud Computing and emerging technologies such as 5G, Big Data, SDNs, NFV, Precision and Personalized Medicine. By 2020 there will be 30 times more mobile internet traffic as there was in 2010. But this will not be the same type of traffic as now – Internet usage will not only have grown thanks to the number of smartphones and tablets in use, but also because of the massive growth in machines and sensors using the Internet to communicate, and which require more efficient and ubiquitous technology to carry the data traffic.

By 2020 there will be 30 times more mobile internet traffic as there was in 2010.

5G Impact on healthcare services 5G is a new network technology and infrastructure that will bring the capacity needed to cope with the massive growth in the use of communication (especially wireless) technologies by humans and machines. 5G won’t just be faster, it will bring new functionalities and applications with high social and economic value. Tele-surgery made international news in 2001 when the first transatlantic surgical procedure took place between New York City and Strasbourg. This remote surgery experiment required extremely expensive high capacity leased lines. Commands triggered in the US were controlling surgery devices in France, with some small delay. 5G will make this scenario much easier and also mobile. 5G specificities will make the command-response time close to zero and provide the practitioner with great operation comfort and accuracy. In the near future, a practitioner remotely located could operate on a patient who needs an urgent or specific operation. In recent years we have seen an explosive growth of research that questions, analyzes, and suggests solutions to the future growth of mobile telecommunications. Wireless devices are becoming more diverse with not just over six billion wireless phones but also possibly a much larger number of sensors and machines contributing to communication, and practically everything in the so-called Internet of Things (IoT). With the anticipated major

growth of the number of these devices by year 2025, more dense radio networks are emerging. Both data and signaling from mobile devices are expected to grow exponentially over the next five or more years. The cellular networks serving cellular phones and mobile devices globally have employed centralized control with different network functions arranged in a hierarchy. Some of the core goals of 5G are to allow smooth functioning of applications that require high speed, better coverage, reduced latency, and to support bandwidth-intensive and time-sensitive multimedia. All these would be beneficial for improvement of the healthcare sector. Meanwhile networks are being transformed with software defined networking as well as network function virtualization and cloudification as the technologies in communication and information merge. Standards to define 5G technologies are underway. And while 5G is still a few years away from standardization, let alone widespread commercialization, many carriers are more focused on the next incremental development in LTE, which is LTE-Advanced Pro, branded as 4.5G. Companies are positioning CloudRAN (Cloud based Radio Access Network) as facilitating a movement from 4G to 4.5G while also setting the stage for interoperability with future 5G networks. As enterprises migrate core applications, the hybrid cloud will become the mainstream deployment form for enterprises. Thus, Cloud based IoT will provide the framework for collecting, processing and analyzing healthcare information including patient records, diagnoses, treatment, clinical care, hospital care, homecare, prescription drugs, insurance and other records. As technology continues to advance at an accelerated rate, researchers will be looking at how to handle disconnections, maintain the security and realiability of communications over IoT, as well as the integration and smooth functioning with other parallel technologies.

support more advanced capabilities, rising to 90 per cent by 2020. Such wireless technologies are inspiring companies to make connected devices to monitor health and fitness. For example, with Nokia’s acquisition of France’s Withings, Nokia is strengthening its position in IoT. Withings sells scales, activity trackers, thermometers, blood pressure monitors, home and baby monitors and other health-related products that use Wi-Fi and Bluetooth to connect to smartphones. Withings has proprietary apps for IOS and Android devices, and has made its application programming interfaces available for free to developers who want to create apps that will work with Withings devices. There are already more than 100 apps that are compatible with Withings devices, according to the company. Analysts expect mobile health to be the fastest growing part of the overall healthcare market between 2015 and 2030. Whether through medications or “disruptive” technology, new ways of treating people, preventing disease and of interacting with the healthcare system will continue to multiply in the years to come. Ongoing advances in both technology assessment and “best practices” development among physicians offer reasons to be optimistic. By focusing on effectiveness we need not be restricted to those methods


Fawzi Behmann, is President TelNet Management Consulting, Inc; Vice Chair, IEEE NA Communications Society and Co-Founder IoT & Healthcare Consortium, Intelligent Health Association.




WiFi Technology As a technology, Wi-Fi use continues to boom, and the technology has established itself as a crucial part of connectivity in the home, workplace, and in public spaces. Wi-Fi standards continue to advance, with multiple projects in development to improve speeds and efficiency. Carrier-grade Wi-Fi is expected to gain momentum. According to the Wireless Broadband Alliance’s most recent annual report by Maravedis Rethink, carrier-grade hotspots will outnumber the traditional, “best effort” access points in the installed base by the end of next year. Maravedia Rethink says that at end of 2017, 57 per cent of APs will

of treatment that we currently envision as part of the healthcare system. As we call for collaborative IoT, we need to call for collaboration between physicians and other health professionals in identifying best practices and making decisions about optimal resource use. We need physicians to participate in the management of the system. The best healthcare institutions have strong physician leaders who collaborate with administrators. Under such a model, physicians and other health professionals (including nurses) would play a pivotal role in identifying best practices and making decisions about optimal resource use. Maintaining a high quality healthcare system in the current era of slower economic growth and greater healthcare demand will be a huge challenge for Canada. The task of addressing and managing this challenge falls largely to public sector decision-makers (since the public sector currently provides 70 per cent of Canadian health services financing). Such decision makers must cope with the combined effects of two key factors: (i) an aging population and higher dependency ratios but also (ii) the vast number of new healthcare interventions, both diagnostic and in treatment, and the seemingly boundless public appetite for these. It is not aging per se that is the problem but aging in the context of increased healthcare options. 2020-2025 will represent a period where collaborative technologies can result in smart connected systems that can serve H healthcare in a more efficient way. ■


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Denise Hodgson 905-532-2600 ext. 2237

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28 Focus


Reimagine Your Career in the Dynamic Healthcare Sector

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To learn more, contact: Amin Mawani, Program Director: Joseph Mapa, Executive Director: /mba /himp

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Hospital News 2017 February Edition  

Focus: Facilities Management and Design, Health Technology, Greening Healthcare and Special Infection Control Supplement.

Hospital News 2017 February Edition  

Focus: Facilities Management and Design, Health Technology, Greening Healthcare and Special Infection Control Supplement.