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INSIDE

INFECTION CONTROL SUPPLEMENT See page C1

FOCUS IN THIS ISSUE

Canada's Health Care Newspaper FEB. 2015 | VOLUME 28 ISSUE 2 | www.hospitalnews.com

INSIDE

FACILITIES MANAGEMENT AND DESIGN/HEALTH TECHNOLOGY/ GREENING HEALTHCARE/ INFECTION CONTROL:

Evidence Matters ................................. 5 Ethics .................................................... 9 Data Pulse .......................................... 17

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.

Safe Medication .................................20 Nusring Pulse .....................................22 From The CEO's Desk ........................23 Careers ............................................... 27

The digital health Ninety-nine per cent of Canadians have at least one hospital clinical report or immunization record available in electronic form

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At the new Breast Health Centre, Humber River will have two fully digital mammography units with a Sensory Suite environment where patients have the option of choosing from different scenes using an iPad – to create an ambiance specific to their interests and comfort levels that will last for the duration of the testing.

Cutting-edge technology to create world class care and diagnostics at Humber River By Sarah Quadri Magnotta herryl Tanteras has hope for the future. Three years ago, as a newcomer to Canada, Cherryl, 33, arrived in Toronto with a plan: to work hard, support her mother and two young children living in the Philippines, and eventually bring them to Canada. That plan quickly changed when she received a shocking diagnosis. “When my doctor told me I had breast cancer and that it had spread to my lymph nodes I thought I was going to die. I immediately thought about my children – I was really worried. But my fears were eased by the gentle care I received. Humber River gave me a lot of assurance and I knew they were going to take good care of me. Cherryl is one of many patients benefitting from the exceptional care in Humber River’s Medical Imaging Department. Next year, when the new Humber River Hospital opens its doors, that care will be enhanced by state-of-the-art technology and a Breast Health Centre that will help patients like Cherryl to receive the same quality care, more efficiently. Unique Portals of Care will facilitate that efficiency, making receiving care safer and easier for patients and their families. “Our new hospital will have one of the most technologically-advanced diagnostic facilities in the world,” says Dina Longo, HRH Director of Medical Imaging. “We will be able to navigate our patients through their testing process quickly and easily without them having to travel to different areas in the hospital. Top-notch imaging quality is going to help our physicians and staff to enhance care in ways we’ve never seen before.” As part of the Breast Health Centre, the hospital will have two fully digital mammography units with Tomosynthesis technology, a Sensory Suite environment, two dedicated ultrasound units, a bone mineral densitometry unit, a specimen imaging unit and surgical consultation rooms all in one location.

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HOSPITAL NEWS FEBRUARY 2015

“The idea of coming to one place for diagnosis and treatment is fantastic,” says Dr. Laura Whiteacre, HRH General Surgeon who specializes in breast health. “This will allow us to diagnose breast cancers much more rapidly, reducing wait times for our patients and ensuring fast, safer and seamless care,” she adds. “Congratulations to Humber River for having a centre dedicated to breast health – that’s amazing,” says Dr. Rene Shumak, Radiologist and Breast Imaging Lead for the Central Local Health Integration Network (LHIN). “Good quality technology is so important in breast health and having a centre that has the testing and treatment in one place provides an efficient and one-of-a-kind experience for the patient.” “We’re focusing on becoming a highrisk diagnostic assessment centre and our Breast Health Centre is an important part of our commitment to patient centred care,” says Longo. “Working with the latest technology will also allow us to strengthen our relationship with Cancer Care Ontario to ensure we are providing our patients with outstanding, quality care.”

Sensory Suite

Creating an optimal health care experience for women is at the heart of Humber River’s Breast Health Centre. A big part of that experience comes from the Sensory Suite, designed to stimulate a woman’s senses, distracting her from the possible discomfort or anxiety of having a mammogram. Humber River will be one of only a handful of hospitals in Canada to utilize the Sensory Suite technology with the goal of enhancing care for women on many levels. “Prevention and patient-centred care are key priorities in our Breast Health Centre,” adds Longo. “By implementing the Sensory Suite, we are hoping to encourage women to come for mammograms, and in return, make the experience as pleasant as possible.”

In the Suite, patients have the option of choosing from different scenes using an iPad – seaside, garden or waterfall with gentle complementary sound – to create an ambiance specific to their interests and comfort levels that will last for the duration of the testing. With the Sensory Suite, Humber River will be empowering patients to play a leadership role in their own care delivery.

Digital Breast Tomosynthesis

A technology called Digital Breast Tomosynthesis will enhance care delivery for patients in the Breast Health Centre. What is Digital Breast Tomosynthesis? It’s a technology that takes multiple xray images of a breast from many angles. The digital data information is then transformed via computer to produce three dimensional images. “Tomosynthesis is valuable for detecting very small breast tumours, breast cancer in young patients and tumours in dense breast tissue,” says Dr. Russell Blumer, HRH Chief of Radiology. “It’s a new technology that’s recently been approved for use in Canada, and it’s showing great promise,” he adds. “We are excited to be able to offer this cutting-edge technology to our patients and community.” “The Breast Centre as a whole is especially wonderful because it’s coming out to the periphery, it’s in a neighbourhood where there are lots of people that live and work and therefore they are going to be able to get their care much closer to home,” adds Shumak. That care isn’t limited to female breast health. If a male patient requires a breast exam there will be a separate entrance for male patients to enter and exit from the Centre. In addition to breast health, the new medical imaging department will also be a digital hub for interventional radiology, nuclear medicine and emergency medical imaging – all with fully digital

equipment that will keep Humber River at the leading edge at all times. That new and digital equipment is the result of a unique multi-year technology and service partnership between Humber River and GE Healthcare called a Managed Equipment Services (MES) agreement – the first agreement of its kind in North America. It’s a flexible and tailored technology and service agreement to provide long term, sustainable access to innovative medical equipment and services. The MES model is widely used outside Canada and has proven to be successful in a number of countries including the U.K., Germany, Spain and Australia. Two years ago, Humber River and GE Healthcare announced their 15-year MES agreement that will ensure Humber River’s equipment remains refreshed and on top. As part of the agreement, GE Healthcare will manage the ongoing acquisition, installation and replacement of medical technology for Humber River and provide maintenance services – for the duration of the agreement – on over 1300 pieces of equipment in the Hospital’s Medical Imaging, Surgical and Emergency Room Departments. “Having an equipment agreement like this is a huge benefit in a medical imaging department,” says Longo. “We are really lucky and we look forward to bringing this remarkable care to our community. Cherryl Tanteras feels lucky to have found such a great and sensitive care team at Humber River. She is eagerly awaiting the new hospital. “Flying half way around the world to give your kids a better life is hard. But I am so thankful to Humber River for extending my life and giving me hope for the future. The new hospital will allow my wonderful care team to help many more people H like me.” ■ Sarah Quadri Magnotta is a Senior Writer/Communications Specialist at Humber River Hospital. www.hospitalnews.com


In Brief

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Would you tell your manager you had a

Sinai mental health problem? Mount Hospital, Although nearly four in 10 workers wouldn't tell their manager if they had a mental health problem, half said that if they knew about a coworker's illness, they would desire to help, a new survey by the Centre for Addiction and Mental Health (CAMH) shows. The survey, headed by CAMH Senior Scientist Dr. Carolyn Dewa, reveals that workers have both negative and supportive attitudes about mental health in the workplace. The study was published in the International Journal of Occupational and Environmental Medicine. "A significant number of working people have mental health problems, or have taken a disability leave related to mental health," says Dr. Dewa, head of CAMH's Centre for Research on Employment and Workplace Health (CREWH). Annually,

almost three per cent of workers are on a short-term disability leave related to mental illness. "Stigma is a barrier to people seeking help. Yet by getting treatment, it would benefit the worker and the workplace, and minimize productivity loss," she says. In the survey of 2,219 working adults in Ontario, two key questions were asked: First, would you inform your manager if you had a mental health problem? And second, if a colleague had a mental health problem, would you be concerned about how work would be affected? Researchers then probed more deeply depending on the answers. Among the 38 per cent who would not tell their manager, more than half were afraid that it would affect their careers. Other reasons for not disclosing were the

bad experiences of others who came forward, fear of losing friends, or a combination of these reasons. Three in 10 people said they wouldn't tell because it wouldn't affect their work. A positive relationship with their manager was the key reason given by those who would reveal that they had a mental health problem. Supportive organizational policies were another factor influencing the decision to come forward, which was cited by half of those who would disclose. Some findings in the current survey underscore why people may be reluctant to reveal a mental health problem at work. When asked if they'd be concerned if a worker had a mental illness, 64 per cent said yes. More than four in 10 also indicated concerns about both reliability H and safety. ■

Data indicators report on the Mental Health of Canadians The Mental Health Commission of Canada (MHCC) released the first phase of Informing the Future: Mental Health Indicators for Canada - the first-ever national-level set of indicators that identifies and reports on the mental health of Canadians. This pioneering project reveals the current landscape of the mental health of Canadians and will serve to promote discussion of how to improve mental health across the country. Working in partnership with Simon Fraser University’s Centre for Applied Research in Mental Health and Addiction under the leadership of Dr. Elliot Goldner, the Canadian Institute for Health Information and the Public Health Agency of Canada, the objective of this MHCC-led project is to accurately show the state of mental health in Canada. “Informing the Future: Mental Health Indicators for Canada will paint a more complete picture of mental health in this

country. More important, these indicators will tell us how well – or poorly – the health system is responding to Canadians’ mental health needs. And what, collectively, we need to do about it,” says Dr. David Goldbloom, Chair of the Mental Health Commission of Canada. Today’s release of the first 13 indicators focus on subjects outlined in MHCC’s Mental Health Strategy for Canada. Each indicator is followed by the colour of its present status: green (good performance) yellow (Some concerns) red (significant concerns): •Children and Youth examines Anxiety/ Mood Disorders (yellow); Intentional Self-Harm among College Students (red) and School-based Mental Health Promotion (yellow). •Seniors measures Anxiety and/or Mood Disorders (yellow) •Economic Prosperity indicators includes

Online service to connect patients to clinical trials New funding for the Canadian Cancer Clinical Trials Network (3CTN) will be used to establish the Network's sites at cancer centres conducting clinical trials across Canada. Network sites will receive financial support and other resources to be able to increase trials available to patients. The 3CTN has also launched a new online service that will assist patients and clinicians in finding cancer clinical trials that may be of benefit. "This funding is great news for Canada's cancer clinical trials infrastructure, which is essential for bringing the most promising therapies and technologies to the clinic," says Dr. Tom Hudson, President and Scientific Director of OICR. "Connecting patients to clinical trials is important in moving the science forward, but also allows us to provide avenues of treatment for those patients who have exhausted standard treatment options." www.hospitalnews.com

3CTN is a pan-Canadian initiative to improve patient access to trials and the efficiency and quality of clinical trials activities in Canada. Its aim is to provide support and coordination for a network of teams at cancer treatment centres and hospitals and enable the sites to increase their capacity and capability to conduct academic trials and increase access for patients to participate in trials. Seven Network Regional Coordinating Centres and 15 Network Cancer Centres will be established by 3CTN with the funding. In the future 3CTN will expand to include many Network Affiliated Cancer Centres. Currently 3CTN has 229 clinical trials in its portfolio including 60 pediatric trials, with more to be added as they are ready to be opened for patients. These academic trials supported by 3CTN reflect the priorities of clinicians, researchers, patients, H ministries of health and funders. ■

Stress at Work (yellow) and Mental Illness-Related Disability Claims (yellow) •Recovery examines Self-Rated Mental Health in people with common mental health conditions (red) •Caregiving measures Stress Associated with Family Caregiving (red) •Diversity includes Sense of Belonging Among Immigrants (green) and Experienced Discrimination (yellow) •Suicide examines Suicide Rates in the General Population (red) •Access and Treatment includes Unmet Need for Mental Health Care Among People with Mental Disorders (yellow) and Mental Illness Hospital Re-Admissions within 30 days (yellow) “Working together is important because mental illness touches all parts of the health system, and all parts of society. No one organization can tackle this complex issue alone. Our continued collaboration with the Mental Health Commission and others will improve available information and fill information gaps, a priority in the Mental Health Strategy for Canada,” says O’Toole. The full report, which covers the remaining 50 indicators, will be released H later this Spring. ■

Bridgepoint Active Healthcare and Circle of Care to form

Sinai Health System

Mount Sinai Hospital and Bridgepoint Active Healthcare are pleased to announce the formation of the Sinai Health System, a new organization resulting from the voluntary amalgamation between the two hospitals. Joining as an affiliate is Circle of Care, a leading provider of home care and community support services. Mount Sinai, Bridgepoint and Circle of Care share a vision of creating a premier exemplar of an integrated health system that enables patients to move seamlessly across different care settings. By leveraging the combined strengths of each organization, patients will have access to a better, more coordinated continuum of care: from acute care, through to rehabilitation, complex care, primary and community-based care. Sinai Health System will focus on innovation and integration to address the challenges and opportunities arising from a rapidly aging population and the growing number of people living today with complex health conditions. Fueled by best in class research and education, Sinai Health System will elevate the standards of clinical practice and excellence. Research to improve care for complex patients will be accelerated by integrating Bridgepoint's Collaboratory for Research and Innovation into Mount Sinai's internationally recognized Lunenfeld-Tanenbaum Research Institute. While working together as a system, Bridgepoint and Mount Sinai will continue to deliver their excellent programs and services, and retain their names and unique identities. Circle of Care will operate as an affiliate organization, linked into the Sinai Health System at the governance, planning and system development H level. ■

Effective. Compassionate. Experienced.

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Guest Editorial

UPCOMING DEADLINES

MARCH 2015 ISSUE EDITORIAL FEB 6 ADVERTISING: DISPLAY FEB 20 CAREER FEB 24 MONTHLY FOCUS: Gerontology/Alternate Level of Care/ Home Care/Rehab:

Geriatric medicine, aging-related health issues and senior friendly strategies. Best practices in care transitions that improve patient flow through the continuum of care. Programs and advancements designed to keep patients at home. Care in rural and remote settings: enablers, barriers and approaches. Rehabilitation techniques for a variety + Long Term Care Supplement

APRIL 2015 ISSUE EDITORIAL MARCH 5 ADVERTISING: DISPLAY MARCH 26 CAREER MARCH 30 MONTHLY FOCUS: Gerontology/Alternate Level of Care/ Home Care/Rehab:

An examination of hospital funding and pay-for-performance models. Financial planning and issuance options for people in the health care industry. Innovative approaches to fundraising and the role of volunteers in health care delivery. Programs designed to promote wellness and prevent disease including public health initiatives, screening. + Financial Health Care Supplement

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Why implementing health reform in Canada remains a challenge One major hurdle is that we need to decide exactly what changes we want to make By Greg Marchildon and Livio Di Matteo

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anadian economists received a pleasant surprise recently: expenditure growth on public healthcare in Canada finally appears to be slowing down. However, it is unclear if this slowdown is the result of explicit success in sustainably bending the cost-curve or more short-term cost-cutting in response to slower economic growth or future federal health transfers. So is it a blip on the healthcare horizon or the beginning of a trend? With the continued aging of the Canadian population, the diffusion of new healthcare technologies, and increased pressure for other public spending, we anticipate healthcare costs will continue absorbing the energies of governments in Canada for years to come. And bending – or breaking – the cost curve, will remain a perpetual challenge. Here’s why: 1. Bending the health care cost curve is a long-term process that is much more than a quick cost-cutting exercise or yet another “structural re-disorganization.” But the voting public is impatient for change. Governments have a time horizon that operates within four-year cycles and are expected to demonstrate substantive improvement in the short run. 2. When it comes to cost control, there must be an emphasis on prices as well as volume or numbers of health providers. To date, cost control attempts have focused mainly on the number of service and health-providers with “prices” (the fees paid by government to providers per service) remaining the undiscovered country. At the same time, however, one person’s health spending is another person’s income, and constraining fees will likely be vigorously opposed

by those affected (doctors and health providers), even if a clear public benefit can be demonstrated. 3. While health system sustainability is about revenues (how much tax money a province has at its disposal) as much as it is about spending, most provincial governments have seemingly determined that they are not prepared to increase tax revenues. The basis for this decision seems to be rooted in a general public aversion to higher taxes and a need for competitive tax systems. At the same time, there is an inconsistency in public attitudes that desire more and better public health services but with fewer or lower taxes. 4. While policy should be evidencedinformed rather than belief-based, the complexity of health-system change makes it difficult to draw a straight line from one evidence-based improvement to health-system change as a whole. Indeed, improving the quality and quantity of evidence-based decision-making is perhaps the greatest challenge in systematically devising policies for bending the cost curve. 5. While comparative evidence is essential for a better understanding of policy problems, you cannot bend the health-care cost curve by cherry-picking reforms from other jurisdictions with other political and social contexts. Ultimately, solutions are devised within the context of specific political, economic and policy environments. Grafting quick fixes onto one health system based on experiences in another can quickly generate new problems to replace those they were intended to fix. A major hurdle for health reform is that we need to decide exactly what changes we want to make in our health

system. While there remains room to increase efficiencies and gain greater value for money, bending the cost curve requires fundamental reforms to the way we manage and deliver health services in Canada. This is a reality many Canadians seem reluctant to face. Another challenge is getting federal, provincial and territorial governments to agree on the basic values or principles we want to preserve and enhance as we reshape policies, structures and the regulatory environments of healthcare in Canada. Both challenges are formidable but surmountable barriers to ensuring the sustainability of publicly-financed healthcare in Canada. Addressing these challenges will fall mainly on the shoulders of our provincial governments, and of course, the electorates they serve. However, the federal government also has both the potential and the responsibility to play an important role. One thing is certain: whoever wins the next federal election in 2015 will have to meet these challenges head on. Greg Marchildon is an expert advisor with EvidenceNetwork.ca, Professor and Canada Research Chair in Public Policy and Economic History (Tier 1) at the Johnson-Shoyama Graduate School of Public Policy at the University of Regina. Livio Di Matteo is an expert advisor with EvidenceNetwork.ca and Professor of Economics at Lakehead University. They are the editors of the newly released, Bending the Cost Curve in Health Care (University of Toronto Press). Reprinted with permission from TroyMedia.

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Evidence Matters

Making the cut:

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reducing the risk of surgical site infections By Barbara Greenwood Dufour ny surgery carries with it some degree of risk, and a significant one is the risk of developing an infection at an incision site. In Canada, it’s estimated that more than six per cent of surgical incisions become infected, which can lead to complications, delay in recovery, more time spent in hospital, and increased health care costs. The sutures used during surgery have long been thought to be a key contributor to surgical site infections (SSIs). Bacteria can adhere to the sutures, where it can multiply and be transferred into the wound. Antimicrobial sutures coated with an antibacterial agent were developed to reduce the incidence of SSIs. Those currently available in Canada are coated with triclosan. CADTH – an independent agency that assesses health technologies finds and summarizes the research on drugs, medical devices, and procedures. CADTH’s Rapid Response service provides summaries and critical appraisal of the evidence in as little as 30 days and had recently been asked to update a previous CADTH review of the evidence on antimicrobial sutures for the prevention of SSIs. Whereas the earlier CADTH review

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didn’t find enough evidence to conclude that antimicrobial sutures reduce the risk of SSIs, the update found some new evidence suggesting that they might – by about 30 per cent compared with conventional, non-coated sutures. The benefit shown in the new studies was specifically in patients undergoing abdominal surgery, colorectal surgery, and the closure of leg wounds – surgeries where infection is more likely. Antimicrobial sutures were not shown to reduce SSI risk for surgeries with a lower risk of infection such as breast or cardiac surgeries – or for surgical sites that are al-

ready contaminated or dirty. However, the new evidence has a number of limitations. If antimicrobial sutures do reduce the incidence of SSIs compared with less expensive conventional sutures, are they worth the extra cost? The answer is, we’re not sure. The available cost-effectiveness information is from a non-Canadian context, so whether the money saved by averting the added health care costs associated with SSIs would offset the higher cost of antimicrobial sutures is unclear. In addition, the risk of adverse events with antimicrobial sutures, including the development

of drug-resistant bacteria, is not known. Many other strategies are used to prevent SSIs, with proper hand hygiene being the most effective and least expensive. A CADTH review found that the current, evidence-based hand hygiene guidelines include removing artificial nails and jewellery then washing visibly soiled hands with plain soap and water prior to hand antisepsis, using an antisepsis product that is both effective at killing organisms and at preventing their regrowth for an extended period of time, and ensuring the product is applied to the hands for the length of time recommended by the manufacturer. Another long-standing practice to reduce SSIs is for surgical staff to wear masks in the operating room. According to a CADTH review on this topic, although there have been few studies to measure the effectiveness of wearing masks, clinical practice guidelines based on expert opinion are consistent in recommending their use. The use of preoperative skin antiseptic products to prepare a patient’s skin at the surgical site is another well-established way of preventing SSIs. CADTH conducted a systematic review of the three main types of topical antiseptics – chlorhexidine, povidone-iodine, and alcohol – to see if they reduced SSIs and the available evidence on their effectiveness was inconclusive. Continued on page27

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FEBRUARY 2015 HOSPITAL NEWS


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McMaster Children's Hospital

rooftop playgrounds

(Inset) Aisak Sapsford in one of the spaces being transformed into a rooftop playground at McMaster Children’s Hospital.

By Erin Young hat used to be unused outdoor space on the third floor of McMaster Children’s Hospital, a site of Hamilton Health Sciences, is in the process of being transformed into three unique, fully accessible rooftop playgrounds expected to open in the spring. This collaborative home-grown project is a result of the hard

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work and research of a team off d dedicated edic ed icaatted d staff at the hospital, and was made possible with donations from the community. The team set out with a vision to create outdoor space that is fully accessible, safe, and durable to give all children in hospital the opportunity to get outside and play. The spaces have been divided into three unique environments: an interac-

ttive ti ive v pplayground, ve layyggro la layg roun un nd a sserene eren er en sp ene sspace, acce aand nd d aan n area for organized activities. All three playgrounds are located in the center of the inpatient wards on the third floor, allowing access all year round. The child life specialists working on the project helped ensure the playgrounds are geared towards all age groups as McMaster Children’s Hospital cares for patients 17 and under.

Some of the playground features include giant checkerboards, toys, a running track, and accessible musical instruments; all built on padded springboard astroturf that allows for easy rolling of IV poles and wheelchairs. In the warmer months, they plan to organize outdoor yoga, as well as hold movies under the stars. Continued on page 7

We see the big picture Representing more diagnostic imaging professionals than any other union in Ontario, OPSEU gets you RESULTS. www.joinopseu.org

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Chatham-Kent Health Alliance Becomes First 3RCertified Hospital By Emily Field

hatham-Kent Health Alliance’s (CKHA) continued excellence in environmental initiatives were recognized with a Gold Level certification from the Recycling Council of Ontario’s (RCO) 3RCertified Waste Reduction and Diversion program. The organization was presented with its certification at the RCO Awards in Toronto on October 23. CKHA is the first hospital in Canada to participate in the 3RCertified program. “The continuous effort of our Green Team and contributing staff has been recognized once again,” says CKHA’s Carrie Sophonow, Manager of Housekeeping. “It was an honour to be chosen as the first hospital in Canada to participate in the provincial 3RCertified program.”

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Ministry of the Environment requires health care workers to handle multiple streams of waste including anatomical, biohazard/ infectious, cytotoxic, pharmaceutical, hazardous, regular landfill, and recycle. 3RCertified is a unique and voluntary program in partnership with the RCO and the Ministry of Environment for buildings in the industrial, commercial and institutional sectors. The certification program uses a points-based process that reviews how organizations manage solid waste reduction and diversion operations. Certification is valid for three years, conditional upon annual assessments at 12 and 24 months. CKHA’s waste auditor, Taylor Purdy of Waste Reduction Group, recognized the value of 3RCertified and was instrumental in CKHA’s successful application to the program. CKHA received the 3RCertified Gold Level certification based on established criteria and a third-party

evaluation of waste management and reduction practices. Regulations for handling waste set by the Ministry of the Environment requires health care workers to handle multiple streams of waste including anatomical, biohazard/infectious, cytotoxic, pharmaceutical, hazardous, regular landfill, and recycle. The complexity of handling all of these streams of waste is a reality for health care professionals. Auditing the waste provides CKHA with a benchmark to measure their current state and with this data, the facility establishes a recommended plan for increasing their diversion rates. Beside the obvious environmental and health benefits, there are financial savings in waste reduction. These savings translate to funds that could be better spent on patient care. The RCO certification requires a completion of the application which demonstrates compliance with established measures. This information is reviewed by the RCO to determine if the facility has met the requirements and then recommends a third party auditor to complete a site visit to review waste reduction strategies and verify the programs in place. To maintain 3RCertified status, CKHA is required to update their waste stream data by filling in an annual assessment survey, site profile and waste stream profile. A short on-site evaluation to confirm ongoing waste reduction and diversion performance will be performed annually. CKHA continues to work with their partners like the RCO and shares information and programs with other healthcare facilities regionally, provincially and nationally, which is the key to greening the health care industry. The organization used this opportunity to make recommendations on the certification program to RCO to improve the application process for other hospitals. “Being the first hospital in Canada to achieve this recognition is another example of our excellence in environmental stewardship,” says CKHA President and CEO, Colin Patey. “The outstand-

Rooftop playgrounds Continued from page 6 “The guiding principle while developing the spaces was selecting safe playground equipment that would support the diverse abilities of our patients,” explains Donna LaForce, director, acute pediatric inpatient, critical care and ambulatory services, and one of the project team members. “With this in mind, we’re ensuring patients and parents have the opportunity to enjoy the outdoors while remaining close to the inpatient units.” This project was made possible thanks to the kind donations from the Dianne Baboth memorial golf tournament, the Foresters, the Baboth-Toth family, BridgeForce Financial Group inc., Canada Protection Plan, Dennis & Melissa Beraldo & family, and Nadirshah, Shahila, & Jenna www.hospitalnews.com

Khoja. The passionate hard work of these individuals resulted in over $200,000 raised. What do these bright and cheery environments mean to the children and their families? One mother explained that “It’s exciting to have an oasis for them to escape to that isn’t so ‘hospital-like.” Donna added that she believes “the playgrounds give the children something to look forward to and work toward.” These groundbreaking outdoor areas allow children the opportunity to escape the hospital environment each day and have some fun just H being kids. ■ Erin Young is a Public Relations Intern at Hamilton Health Sciences.

Amy Zoumboulis, Housekeeping Supervisor (left) and Carrie Sophonow, Manager, Housekeeping, proudly display the 3RCertified Award CKHA received from the Recycling Council of Ontario. ing work of our Green Team continues to display that we are an exceptional community hospital leading the way in green healthcare.” Achieving the Gold Level certification builds on the previous successes of the Green Team, who are recognized on a national, provincial and community level. In 2013, Carrie Sophonow, the Manager of Housekeeping and Linen was awarded the individual leadership award for Green Healthcare. Additionally, CKHA won the Ontario Hospital Association’s (OHA) Green Health Care Award for Waste Management, and was a finalist for OHA’s Green Hospital of the Year Award. “CKHA’s Green Team is committed to pursuing effective, responsible and sustainable ways to handle waste management as

we know it has a tremendous impact on the ecological, social and economic health of our hospital and community,” says Beth Hall, Director of Support Services. “It is also very important to acknowledge that without the support of our staff and our partners who share the same vision, we would not be able to accomplish all that we have achieved. Their commitment and forward thinking has allowed CKHA to have a pivotal role in reducing its footprint, encouraging other health care organizations to review their waste management processes and be a national leader in waste reduction and diversion practices,” H Hall adds. ■ Emily Field is a junior communications officer at Chatham Kent Health Alliance.

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8

Focus

FACILITIES MANAGEMENT AND DESIGN/HEALTH TECHNOLOGY/GREENING HEALTHCARE

Green in Action: Markham Stouffville Hospital By Tamara Wright espite the promising trend of increased environmental awareness in healthcare, hospitals still produce waste at a rate unparalleled by most industries and remain as some of the most energy intensive facilities in many Canadian communities. Distancing itself from the norm, Markham Stouffville Hospital (MSH) leaves behind the familiarity of old practices to establish new procedures and encourage practices that positively affect behaviors and values. While it is widely recognized by health care facilities that sustainability is crucial to their future success, the hurdle of skepticism, that of believing that one’s organization is actually able to make a difference, is one that can be challenging for many organizational leaders to help their staff overcome. “As an organization, we believe that we can make a difference and it’s our responsibility to do so. The belief starts with our board and is built into all parts of our organization,” says Janet Beed,

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President and CEO, Markham Stouffville Hospital. “Greening is a hospital-wide responsibility and is one that our staff has embraced.” The sustainability vision of MSH’s leadership team rests on two basic premises. First, caring for the community extends well beyond the walls of the organization and second, championing sustainability and utilizing innovative environmental practices complements as well as promotes the patient experience. As such, the multidisciplinary greening committee promotes the sustainability values of the leadership team through both formal and informal methods in order to infuse the core principles of environmental responsibility into the hospital’s culture and safeguard the trust of their community. “We have made the commitment to become the greenest MSH possible,” says Maria Pavone, director of facilities and support services and chair of the MSH greening committee. “Being mindful of this

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HOSPITAL NEWS FEBRUARY 2015

Paul Butler, Refrigeration Mechanic with Markham Stouffville Hospital is reviewing the operation of the chiller plant at the Markham District Energy Bur Oak Centre with Bruce Brown, Chief Operating Engineer with Markham District Energy. makes us accountable in seeking ethically sound, safe and environmentally responsible practices in our everyday roles.” During the past few years of the organization’s growth, several strategic measures were used to make certain that the organization would not lose its environmental vision. Apart from expanding the recycling and green purchasing programs, the newly expanded and renovated MSH features a state-of-the-art building automation system, high efficiency light fixtures and a green roof. Additionally, the Mondo Harmoni rubber flooring that is found throughout the buildings is entirely free of PVC, chlorine, plasticizers and heavy metals. These and a host of other green features have contributed to MSH’s pursuit of Leadership in Energy and Environmental Design (LEED) silver certification.

Championing sustainability and utilizing innovative environmental practices complements as well as promotes the patient experience. Though the organization took such tactical steps, still it went further in order to embed sustainability into the culture. “Our corporate belief statements as well as our strategic plan underscore our commitment to environmental sustainability,” explains Pavone. “Environmental conservation is leveraged and recognized not only as a core competency but also as the right thing to do. It’s our way of contributing to the long-term sustainability of the health care system and ensuring that we continue to expand and enhance our greening programs well into the future.” Highlights of MSH’s greening initiatives and programs include its partnership with Markham District Energy (MDE) which supplies all of the hospital’s steam, hot water, chilled water, emergency and primary power. MSH also pioneered a dedicated high occupancy vehicle (HOV) parking lot to encourage staff carpooling. Another

highlight was the recent organization-wide call to action by MSH’s leaders for each department to reduce paper usage by at least 10 per cent, creating an appreciation for the need to be green as well as emphasizing the ecological consequences of unnecessary printing. Within this environmentally friendly facility, the MSH green team fosters commitment by creating sustainability milestones and stretch goals, engaging staff and the community and celebrating achievements. Employees that distinguish themselves as environmentally conscientious in their roles become eligible to be nominated and recognized by their peers as “MSH Green Champions”, an award endorsed by senior management. The hospital community is further engaged by the annual Greening and Sustainability Expo held each year on or around Earth Day. Staff, physicians and volunteers are educated about the resources available to them to incorporate sustainability into their day-to-day activities and patients and visitors are helped to appreciate how MSH partners with industry leaders to keep the hospital green. As MSH works to lead by example, its greening efforts continue to be recognized and awarded. Last November, MSH was the proud recipient of the Ontario Hospital Association’s (OHA) Green Hospital of the Year award. The OHA’s director of innovation and adoption, Anthony Jonker, explains that the Green Hospital of the Year award recognizes a hospital that has “demonstrated a significant organizational commitment to environmental sustainability.” The win was an especially great achievement for MSH as the hospital was cognizant that each vote that contributed to their success was inextricably linked to awareness of and confidence in their greening programs. “Ontario hospitals play an important role in being leaders in greening,” says Beed. “This isn’t an additional part of our work, this is our daily work. By working together and sharing ideas, we make hospitals greener and our communities greener H and in the end, we all benefit.” ■ Tamara Wright is a member of the Markham Stouffville Hospital Greening Committee www.hospitalnews.com


Ethics

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Balancing conflicts of obligation by design By Kevin Reel

he most recognizable ethical principles associated with building design are those associated with greener, energy efficient buildings. It is hard not to support such clearly ethical aims, as they make financial sense as well. There are other ethical goals that building design can support, too, that are precisely aligned to the needs of specific client groups. The design of London Centre of the Medical Foundation for the Care of Victims of Torture in the UK reflects the Foundation’s awareness of their clients' experience of torture-related trauma. The corridors are curved, unlike those in the detention centres and prisons where torture typically happens. Consulting rooms are larger than usual – avoiding the potential anxieties that come from feelings of confinement. Decades of experience have informed this design aimed at minimizing the chances of inadvertent re-traumatization – doing good, while very consciously avoiding doing harm. For CAMH (the Centre for Addiction and Mental Health), similar considerations inform our ongoing redevelopment. With transforming lives as our vision, the transformation of our campus must serve that same end. The close attention to cre-

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ating buildings that help provide transformative care meant that the first phase of our redevelopment won an International Academy for Design and Health Award. Now in the throes of our third round of redevelopment, the same principles continue to inform the design. Recovery orientation, trauma informed care, community integration...all of these readily align with the ethics of care in mental health.

How do we preserve the liberty and autonomy of different clients while also ensuring the safety of all? One principle, however, occupies a more complex place at the heart of planning our healing spaces. The most central of all guiding principles at CAMH is safety. Like many ethical principles, it can conflict directly with other important principles. Safety most often comes at the cost of autonomy. Or liberty. Or trust. Or equity. Safety is essential to care and to recovery, but the balance between safety and other essentials of a therapeutic space and a healthy workplace is often difficult to determine. Evidence may point in both direc-

tions; moral responsibilities certainly do. While a safe workplace is the primary concern, so, too, are the individual liberties of clients. Some clients have had those liberties justifiably restricted, but not all. How do we preserve the liberty and autonomy of different clients while also ensuring the safety of all? In a context that includes forensic services (where clients have become enmeshed in the legal system, often as a result of behaviours associated with their illness), the complexity increases. Like all modern forensic psychiatric hospitals, CAMH must navigate the inherent conflicts of obligation between both providing the best therapeutic environment for people living with complex mental illnesses and assuring the safety and security of staff, clients and the public as well. Equally, there is an ongoing challenge of avoiding the stigmatization of the people with whom we work. Building design can reinforce stigmatizing stereotypes and interactions. In creating shared spaces, to be used as collective resources, how do we best address those competing duties? Planning must factor all these duties together – protecting the vulnerable, preventing harm, ensuring safety for all, maximizing the therapeutic possibilities of the built environment and clearly justifying our alloca-

tion of resources. In the final tally, limiting the liberties of some might need to be the lamentable cost of the safety of others. Sometimes a little creative re-thinking and a few well-considered changes in conventional design can make a significant difference. Technology can also assist with crafting spaces that engender calm rather than anxiety, ensure privacy, facilitate recovery and maximize autonomy while also safeguarding the welfare and security of all. New technologies may emerge that help balance safety and restriction of freedoms. When our planning of the new spaces for forensic services begins in earnest some years from now, balancing the competing obligations to both those who are working and those who are recovering in these environments will be a central concern. Safety will be the central principle – evidenceH based and ethically informed. ■ Kevin Reel, MSc, OT Reg. (Ont.) is an Ethicist at The Centre for Addiction and Mental Health (CAMH), an Assistant Professor and Associate Graduate Faculty Member, Department of Occupational Science and Occupational Therapy Associate Graduate Faculty Member, Institute of Medical Science, University of Toronto.

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FEBRUARY 2015 HOSPITAL NEWS


10 Focus

FACILITIES MANAGEMENT AND DESIGN/HEALTH TECHNOLOGY/GREENING HEALTHCARE

Cover story By Michael Green anadian hospitals are amongst the most crowded in the developed world. In fact, among member countries, the Organisation for Economic Cooperation and Development reports that at 93 per cent, hospital occupancy rates in Canada in 2009, the latest year for which data is available, are second only to Israel, whose occupancy rates are 96.3 per cent. And yet health care leaders in Canada, such as Dr. Chris Simpson, President of the Canadian Medical Association (CMA), maintain that adding more beds to the system is not what is needed to bring down hospital occupancy rates. In his inaugural speech as incoming CMA President, Dr. Simpson provided, in my opinion, one of the most rational and humane reasons why when he stated: “We put people to bed instead of putting them in a care environment that lifts them up and restores them and helps them live a dignified life.” Bottom line: We need to figure out how to get people out of hospital beds and into more appropriate care settings in the community. To this end, I believe Canada is on the cusp of a second wave of health care efficiencies, fueled by digital health innovation. Remote patient care (RPC) serves as a shining example of how to move patients from hospital to community safely and effectively, all the while fostering health system efficiencies. It enables patients to remain under observation from home, rather than from a hospital bed, thanks to devices installed in their homes that enable clinicians to monitor their progress remotely. A new Ernst and Young study commissioned by Canada Health Infoway, Connecting Patients with Providers: A Pan-Canadian Study on Remote Patient Monitoring, explores the current state of

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Digital health records: A patient perspective

By Alexa Thompson

want to say digital health saved me but it didn’t. It did, however, go a long way to restoring my physical and mental wellbeing. For 15 years I suffered debilitating arthritis, my world so narrowed that a trip from living room to bathroom was a painful experience. As my world grew smaller my depression deepened. I ate too much; drank more than was good for me. In mid-2011, I had my first of two knee replacements. Six months later I underwent the second. It was the latter that went horribly wrong. I got a stubborn post-operative infection that took nine operations, six months in hospital and a further two with home care to get over — including a month on crutches, with a concrete spacer in the joint cavity. Early in the spring of 2013, while I was still on my way to recovery, my doctor invited me to take part in a digital health records pilot project in Nova Scotia. I even consented to be filmed for a government video. At first I used the new system tentatively, to book online appointments with my doctor, a welcome relief after the usual practice of hanging on a phone line, waiting to leave a message. Now I can indicate the times when I’m available! Soon I was entering my family history and tracking my medications, blood pressure and efforts to lose weight. Then my doctor began sending my test results electronically, with a note to indicate all was well, a change in diet was in order, or a visit to her office was recommended. I embraced this new technology. I bank online. I shop online. I file taxes and even pay parking tickets online. Why not converse with my health care providers through a safe, secure website from the comfort of my armchair? Gradually I noticed a change in my attitude towards my health. I started online tracking of my nutrition and, for the first time since being a chubby child, I became more concerned with eating healthful foods than following fad diets. I got into the habit of recording my daily exercise and soon found I disliked a day when I had nothing to input. (And, may

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As a patient, Alexa has embraced digital health records. I add, I’m well aware, as I now wear digital watch and arm bracelet to track my diet and exercise that I’m looking for a pat on the back for a job well done from a computer app!) As my health improved, so did my determination to face my senior years equipped with knowledge about my health needs. Today I prepare for medical appointments, armed with questions, whether I’m visiting my G.P., a heart specialist (family history) or dermatologist. Digital health records may never cure cancer, heart disease, diabetes, dementia or any of the other hazards facing the elderly. But an informed senior is better able to handle medical issues and so become a partner with his/her health care providers. As a baby boomer living in a province with an aging population, I believe knowledgeable patients will be less of a burden on the health system. Today I swim, lift weights, and just signed up for scuba diving lessons. Crazy? Probably! This is the North Atlantic, not the Caribbean. But my G.P. concurs. Digital health records aren’t going away. It’s the future of healthcare in this country. And I for one love it. As I visit family in Ontario or British Columbia, I know that if I become ill or have an accident my health records are a mere H mouse click away. ■ Alexa's a freelance writer and editor with an interest in patientcentred health care.

RPC as well as emerging solutions and critical success factors for deployment on a larger scale. The study identified approximately 5,000 Canadians enrolled in 19 Remote Patient Care programs across seven provinces and territories and found that RPM: • Improves patient satisfaction • Boosts patient compliance • Reduces condition deterioration • Improves quality of life of patients • Decreases burden on friends and family who serve as caregivers • Reduces Emergency Department visits and hospitalization • Reduces costs to the health care system Remote Patient Care ties in nicely with digital health advances that have already proven their value in Canada. While much work remains, the government of Canada’s $2.1 billion investments in digital health over the past decade have more than paid for themselves. (See figure 8) For instance, telehealth, drug information systems, diagnostic imaging systems and physician Electronic Medical Records (EMR) have produced an estimated $10.5 billion in benefits between 2007 and 2013 alone. As of June 30, 2014, 99 per cent of Canadians have at least one hospital clinical report or immunization record available in electronic form in a repository, for access by their authorized clinicians. More than 17,000 community physicians have access to EMRs. There are also EMRs in ambulatory care settings providing more than 20,000 clinicians, many in hospitals, with access to the patient information they need. And yet, we have only scratched the surface. Fortunately, Canadians have demonstrated an eagerness to leverage digital health to become more active participants in their care. Continued on page 11

Figure 3 Telehealth use (total clinical events since 2010)

*Estimated values based on updated data provided by the Ontario Telemedicine Network. Sources: Pan-Canadian Telehealth Survey 2010 and 2012, Canadian Telehealth Forum of COACH

HOSPITAL NEWS FEBRUARY 2015

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FACILITIES MANAGEMENT AND DESIGN/HEALTH TECHNOLOGY/GREENING HEALTHCARE Continued from page 10 A Harris/Decima survey commissioned by Canada Health Infoway reveals 89 per cent of Canadians feel it is important that they personally have full advantage of digital health tools and capabilities. And yet, only six to 10 per cent of Canadians can access them. This needs to change. Investments in technology made by the private sector have transformed the customer experience and resulted in empowered customers who are all too happy to run their errands from their computers and smart devices. Such investments result in happier customers by making day to day transactions much more convenient. It also helps enhance business efficiencies,

which positively impact the bottom line. Accordingly, I believe that providing digital health tools for Canadians will go a long way towards helping patients be more informed about their own health, better equipped to manage chronic illnesses, and better prepared to receive care at home or in the community. As we have observed with other digital health investments, time will ultimately tell where the bulk of the benefits and efficiencies will emerge once Canadians are equipped with digital health tools. But I believe a reduction in hospital crowding, H will be among the most welcome. ■

Focus 11

Figure 8 Estimated Aggregate Benefits of $10.5 billion since 2007 (in millions of dollars – inflation adjusted to 2013 dollars)

Michael Green is President and Chief Executive Officer, Canada Health Infoway.

Remote Patient Care programs allow for the electronic transmission of patient data (e.g., symptoms, vital signs) from a patient’s home to a health care provider for monitoring and support over a specified time period. In October 2013, Canada Health Infoway commissioned Ernst & Young LLP (EY) to conduct a pan-Canadian study, Connecting Patient with Providers: A Pan-Canadian Study on Remote Patient Monitoring (RPM), which showed that RPM programs in Canada are progressing from pilots to established solutions. • The study found evidence that RPM reduces emergency department visits and in-patient hospitalizations and bed days, and increases patient satisfaction and quality of life • Larger scale programs have demonstrated considerable economic, system-level benefits through decreased utilization of health system resources • Nearly 5,000 Canadians are enrolled in formal RPM programs and pilots

• Canadian RPM programs have been growing at a rate of 15 to 20 per cent annually since 2010 • One per cent of Canadians in 2014 used medical devices that captured and transmitted data electronically to their health care providers for chronic disease or post-surgical discharge monitoring – representing significant opportunity for growth • Four Critical Success Factors were identified to support the appropriate

design, implementation and uptake of RPM programs in Canada: engagement and collaboration, patient recruitment and retention, benefits measurement, and integrated care and carecoordination • The study suggests that even greater benefits may be realized, for both the patient and the health care system, through larger scale implementation

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12 Focus

FACILITIES MANAGEMENT AND DESIGN/HEALTH TECHNOLOGY/GREENING HEALTHCARE

HIM professionals: Your data quality experts By Fiona Hill-Hinrich

here is a growing trend in health care around the paramount importance and relevance of quality data. Our health care system depends on the availability of quality data to support quality patient care. Poor documentation, inaccurate data, and insufficient communication can result in errors and adverse incidents. Inaccurate data threatens patient safety, can lead to increased costs, inefficiencies, inappropriate reporting, poor planning decisions, and ultimately, poor financial performance. In Canada, Health Information Management (HIM®1) professionals are trained in six core competency areas that include: biomedical sciences; health care systems in Canada; health information; information systems and technology; management aspects; and ethics and professional practice. The HIM skill set covers records management; diagnosis and intervention coding classification; data analysis, interpretation, and presentation; personal health information confidentiality, privacy, and aspects of security; data quality analysis; and electronic health information management. The Canadian Health Information Management Association (CHIMA) represents approximately 5,000 HIM professionals across Canada and is the certifying body and national association that represents leadership and excellence in health information management. The Canadian College of Health Information Management (CCHIM), the professional college of CHIMA is a respected authority for oversight on the rigorous

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HOSPITAL NEWS FEBRUARY 2015

professional education and training offered by the educational institutions through an accreditation process. Certified members, with the professional designation of CHIM, provide a host of valuable information management functions to the health care system.

Importance of Data Quality

Data submitted by health care organizations ultimately populates numerous databases including those held by Provincial and Territorial Ministries of Health, the Canadian Institute for Health Information (CIHI), the World Health Organization (WHO), Statistics Canada, and Health Canada. The quality of the data is absolutely essential. While Data Quality is everyone’s responsibility, CHIMA certified HIM professionals are recognized as the leading source of HIM knowledge, encompassing the entire Lifecycle of Health Information. HIMs apply their knowledge of biomedical sciences and Canadian coding standards to capture the appropriate intervention code(s) based on the International Classification of Diseases (ICD) and the appropriate intervention code from the Canadian Classification of Health Interventions (CCI). The coded data is used in many ways and accuracy is of premium importance to support the best clinical, administrative and financial decisions. Poor data quality equates to poor decision-making at all levels, which in turn creates risks. Certified HIMs are a key resource to the health care system.

Data Quality Issues

There are many reasons why data may not be accurate, including: • Missing or incomplete clinical documentation (level of specificity not documented) • Misinterpretation of coding standards • Insufficient coding staff, and • Short turnaround times for coding submission deadlines requiring coding from incomplete charts.

Improving Data Quality

Leverage the skills and expertise of the CHIMA certified HIMs in all aspects of Health Information Management, including: • Overall Records Management (Paper/Hybrid/EHR) • Data Quality and related initiatives • Decision Support /Data Analysis • EHR • Coding and Data Capture (CIHI/MoH) • Case Mix • Activity Based Funding • Privacy, Confidentiality, Security • Documentation Improvement Strategies • HIM standards • Health Law There is a positive correlation between quality documentation and quality decision making in healthcare. Good documentation is linked to better health care planning, fewer medication errors, system error detection, appropriate funding, improved regional planning and equitable resource allocation.

CHIMA Mandate

CHIMA is actively seeking a policy statement from the various Provincial/ Territorial Ministries across Canada. They are seeking a mandate that requires all heath care facilities that provide data and information to populate various CIHI database holdings (such as the: Hospital Morbidity Database (HMDB), Discharge Abstract Database (DAD), and the National Ambulatory Care Reporting System (NACRS) and Ministry of Health databases) be coded and abstracted by CHIMA Certified Health Information Management Professionals, only. HIM professionals work in other data quality areas along side coding classification. Good documentation is linked to better health care planning, fewer medication errors, system error detection, appropriate funding, improved regional planning and equitable resource allocation. As various electronic health record (EHR) systems get rolled out across the country, the integrity, consistency, and accuracy of the data is increasingly important. As a result, the need for more rigorous data quality governance, stewardship, management, and measurement is greater than ever. For further information regarding CHIMA, CCHIM, or the HIM professional, please go to www.echima.ca. HIM® is a H registered trademark of CHIMA ■ Fiona Hill-Hinrich is Director of Marketing and Communications at CHIMA.

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FACILITIES MANAGEMENT AND DESIGN/HEALTH TECHNOLOGY/GREENING HEALTHCARE

Focus 13

Saving energy in hospitals

– It’s not what you think Greening healthcare and performance based conservation By Brian Dundas mproving energy efficiency conjures up thoughts of new technology, capital expenditures and lengthy returns on investment. Greening Health Care (GHC) members are demonstrating that it doesn’t have to be that way. Getting building systems running properly can produce greater savings at lower cost and in less time than traditional retrofit projects, delivering immediate benefits to the bottom line. Greening Health Care is a Canada-wide collective of hospitals using their energy data in much the same way a doctor would use a patient’s vital signs. As Ian Jarvis, Greening Health Care’s energy efficiency guru puts it, “a building is like a person; you have to first assess the state of the patient before you can effectively plan and take action.” In the past, a typical first step would have been a traditional energy audit. An auditor would tour the facility and note such things as old inefficient equipment and building envelope issues. The limitation with this approach is that it focuses almost exclusively on changing equipment and the associated capital investment, using theoretical engineering calculations to estimate savings. “Analyzing the data first, tells you where

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your issues lie,” Jarvis says. “The methodology is called Performance Based Conservation. It’s a practical, empowering approach that will be standard operating procedure in the years to come.” The key to the GHC method is its massive database of hospital energy data, standards and best practices. Through GHC webinars and workshops, facility managers learn to benchmark their energy use against similar facilities and analyze utility data trends over time in order to identify the specific building systems or operational practices that account for poor energy performance. At the same time, their experience gets compiled in the GHC database, adding further to the collective knowledge that drives the program. Using this approach, Greening Health Care’s members are leading the way in real energy savings. Grand River Hospital in Kitchener Waterloo has achieved $470,000 in savings across their two sites since their program began in 2012. Staff training, re-programming of automation systems and judicious applications of more efficient equipment have already lowered energy use by 13.3 per cent, and savings continue to improve every month. Best of all, the real savings are so big that the cost of the work is being paid for from the operating budget.

Grand River Hospital in Kitchener Waterloo has achieved $470,000 in savings across their two sites since their program began in 2012. Jack Coutts, Director, Engineering Services at Grand River Hospital, puts it this way: “With aging health care facilities there are many ways of achieving big savings while improving operational performance and renewing infrastructure. The key to our success has been management support, and investment in our own people to find the opportunities and make the improvements work.” Muskoka Algonquin Healthcare is taking a similar, roll-up-the-sleeves approach to capturing the savings at its two acute care facilities. The focus has been on much-needed lighting improvements, a systematic program of testing and re-balancing HVAC systems, and the inclusion of a state-of-the-art building automation system in both sites. While just recently completed, the results to date have been impressive with metered savings of $185,000. Says Harold Featherston, Chief Executive, Diagnostics, Ambulatory, Planning: “We have had previous experience with bringing in energy service contractors to

try and solve our problems which has not worked out. This time we are taking on the challenge ourselves. We have partnered with our local utility companies, and are using Greening Health Care metrics to help uncover opportunities and verify the savings. To date, we are delighted with the results.” “Acting without listening to what the energy data is saying is like operating before the diagnosis” says Jarvis. “Greening Health Care puts the understanding and control of energy savings in the hands of the facility staff.” For more information visit www.greeninghc.ca or contact Brian Dundas at bdunH das@trca.on.ca ■ Brian Dundas works in Sustainability Management and Community Transformation at Toronto and Region Conservation. Sign up for our June 24 webinar at gstott@trca.on.ca; follow us on Twitter @GreeningHealthC>

Energy efficiency at HSC Winnipeg By Christie Nairn ealth Sciences Centre Winnipeg, Manitoba’s hospital, is the province’s largest health care facility and serves populations from Manitoba, northwestern Ontario and parts of Nunavut. Harsh winters and summer temperature swings make it very important for Facility Management staff to ensure all systems are working properly and efficiently. Energy efficiency has been of the utmost importance to the hospital and the Divisional Director of Facility Management, Craig Doerksen. “Since the mid 1980’s we have measured energy consumption, and with the ongoing pressures of utility rates, increasing energy consuming technology and environmental sustainability concerns, we have renewed those efforts as we approach ongoing maintenance, operations and new construction,” says Doerksen. It has been under Mr. Doerksen’s direction that HSC Winnipeg collaborated with design firm SMS Engineering to build and commission one of the most efficient chilled water plants in Canada. The 35,000 square foot second energy

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The 35,000 square foot second energy plant at HSC Winnipeg. plant at HSC Winnipeg has 4,500 tons of cooling capacity and 6 Mega Watts of emergency electrical power generation which compliments and connects with the existing central plant. The new plant has three high efficiency variable speed chillers, variable speed cooling towers and an all-variable primary and second-

ary pumping system. All these are integrated into a new leading edge campus chilled water energy performance optimization system. The optimization system provides real-time signals to improve the overall generation of chilled water for the entire campus, connecting with the existing 7500 tons of cooling which

serves the over 4.5 million sq.ft. on the campus. In addition, an acoustic wall was put up on the roof of the building to hide the unsightly cooling towers from the surrounding residential neighbourhood. The acoustic screening also helps reduce the noise of the plant. The new optimization system is estimated to save HSC Winnipeg $185,000 per year which will grow as the existing plant is brought into full optimization. “Our environmental sustainability pursuits have been greatly enhanced by this project, but we now have further opportunities which we can and will build on with future projects and operational upgrades,” says Doerksen. The state of the art energy plant supports not only the campus growth, but also makes the site produced utilities more reliable. This reliability is kep to HSC Winnipeg’s ‘Patients First’ vision while making the health care facility an industry leader in environmental sustainH ability and energy management. ■ Christie Nairn is an Environmental Sustainability Coordinator at Health Sciences Centre Winnipeg. FEBRUARY 2015 HOSPITAL NEWS


14 Focus

FACILITIES MANAGEMENT AND DESIGN/HEALTH TECHNOLOGY/GREENING HEALTHCARE

Has your health care facility already experienced

climate-related hazards? By Linda Varangu

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any health care facilities across North America have already experienced extreme weather events (e.g. storms, floods, wildfires, extreme temperature events) that can create emergencies by damaging infrastructure, compromising access to critical resources (e.g. food and water) and have challenged the safety of patients, visitors and staff. Floods in Calgary and Winnipeg, ice storms in southern Ontario, and hurricanes in Nova Scotia have all resulted in hospitals struggling to keep their facilities open. Climate change can also increase the risks of some infectious diseases (vector-, water- and food-borne, new and emerging) and worsens air quality. Climate-related hazards can have significant implications for demand on health care facility services and are expected to create risks that can disrupt health care facility services and delivery. Prominent medical and health bodies have made their positions on climate change well known. The Lancet reports that climate change is increasingly recog-

nized as a significant threat facing society and has the potential to be one of the greatest threats to human health in the 21st Century.

The World Health Organization (WHO) has called on the health care sector to prepare for climate change impacts through efforts to increase resiliency.

Health care and public health professionals and staff, can prepare for climate change by assessing risks from extreme weather events, readiness to manage climaterelated infectious disease outbreaks or atypical cases and increasing understanding of how gradual shifts in weather can affect risk profile. The World Medical Association (WMA) Declaration of Delhi on Health and Climate Change calls for action in five main areas; advocacy to combat global warming; leadership; help people be healthy enough to adapt to climate change; education and capacity building; surveillance and research; and collaboration to prepare for climate emergencies.

In Canada, a Health Canada report indicates that Canada is likely to experience higher rates of warming in this century than most other countries in the world. Climate change scenarios predict an increased risk of extreme weather which we are already starting to experience, and other climate events for all regions of Canada, with the exception of extreme cold. The Canadian Medical Association

HealthCareCAN’s new database

features technological innovation in patient care settings By Claire Samuelson f necessity is the mother of invention, patient care organizations are fertile grounds for the development of innovative technologies. Since 2012, over 6,000 news stories from the top five per cent of the most frequently read print media sources in Canada featured groundbreaking research and innovation from health care organizations. Some of these stories focus on smartphone applications and emerging technologies. Thanks to a Community Outreach Award from the Institute of Aging at the Canadian Institutes of Health Research, these print media stories are captured in a database called Innovation Sensation. Parliamentarians had the opportunity to search this database when it was launched at a Health Research Caucus event on Medical Device Technologies, which was co-hosted by Research Canada, Senator Kelvin K. Ogilvie, MP Ms. Carol Hughes (NDP Algoma-Manitoulin-Kapuskasing), and MP Dr. Kirsty Duncan (Lib. Etobicoke North), on Parliament Hill. “HealthCareCAN, as the national voice of health care organizations across Canada, is committed to expanding overall research capacity and supporting the spread of research and innovation in support of service excellence,” says Bill Tholl, President & CEO of HealthCareCAN. Of notable mention from the database are a number of smartphone apps which aim to help health care professionals more effectively diagnose and treat patients. For example, Alberta Health Services recently developed an app which helps

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HOSPITAL NEWS FEBRUARY 2015

clinicians better manage heart failure. At Provincial Health Services Authority in British Columbia, an app is helping to predict if lung lesions seen on a CT scan are cancerous or benign. Researchers at the IWK Health Centre in Nova Scotia have designed an app which allows chronic headache sufferers to track their symptoms and access pain management solutions.

HealthCareCAN, as the national voice of health care organizations across Canada, is committed to expanding overall research capacity and supporting the spread of research and innovation in support of service excellence. Also showcased are apps designed to help parents respond to the unique health needs of their children. The Hospital for Sick Children has designed an app to help children with cancer report their pain and smartphone app from the University Health Network helps parents determine the appropriate dose of fever medication for young children. Other stories feature existing technologies used in novel ways. Research taking place at Baycrest links playing video games to improved visual attention, and a recent study at the Institut universitaire de gériatrie de Montréal used a video

game console to encourage physiotherapy program participants to dance resulting in improved urinary continence. At Kingston General Hospital and Queen’s University, robots and video games are used to teach new procedures. Medical devices and technologies are a vital component of effective health care delivery in Canada. With a rapidly aging population and rates of chronic disease on the rise, the demand for new and innovative medical technologies is intensifying. “Innovation Sensation illustrates the crucial role Canada’s health care organizations play in the advancement of health research and the promotion of technological innovation, yielding novel devices and technologies that help to solve the health challenges of the future,” says Tina Saryeddine, Executive Director of Research and Innovation at HealthCareCAN. The next phase of this project, ‘Like an e-Dragons’ Den’, seeks to engage health care CEOs and their organizations’ Patient Advisory Boards on the application, significance, and implementation potential of selected Canadian healthcare innovations. In so doing, HealthCareCAN hopes to facilitate the spread of research and innovation and promote new and ground-breaking technological H innovations. ■ Claire Samuelson, MA (Bioethics) is Policy Analyst, Research and Innovation and Editor of the Guide to Canadian Healthcare Facilities at HealthCareCAN.

(CMA) has developed a Climate Change and Human Health Policy that was written to complement the WMA declaration noted above. Health care organizations in Canada can increase resiliency by continually mainstreaming climate change into risk assessments, considering climate change when developing plans and activities, retrofitting their facilities and engaging in broader community discussions and initiatives around climate-related issues. For example, health care and public health professionals and staff, can prepare for climate change by assessing risks from extreme weather events, readiness to manage climaterelated infectious disease outbreaks or atypical cases and increasing understanding of how gradual shifts in weather can affect risk profile. Health care facilities can reduce risks of climate change through proper management of critical resources (e.g. pharmaceuticals, food, transportation, medical supplies and equipment) based on climate change considerations. A resilient health care facility is also one that commits to sustainable practices, such as water and energy conservation, promoting active transportation, and local food procurement. By investing in resiliency activities in these areas, health care facilities can reduce operating costs, increase resilience in the community and be open for business when disaster strikes. The Canadian Coalition for Green Health Care's The Health Care Facility Climate Change Resiliency Toolkit can help facilities identify where they need to target their efforts. Contained in the Toolkit are three components: • Facilitators Guide, which introduces the toolkit and guides the users through a suggested approach, • Assessment Checklist, which facilities can use to assess their resiliency, and • Resource Guide for additional informational resources. Chair of the Coalition, Kady Cowan from University Health Network, has already started to think about how climate change can impact the facility she works at. “It’s inevitable that health care facility staff will all be faced with some pretty serious consequences of climate change,” says Kady Cowan, Energy Steward at Toronto’s University Health Network. “We are trying to prepare for these now. Making sure the right people have the right information is a first step anyone can start at any time. The Climate Change Resiliency Toolkit can help get this conversation going. Especially helping staff identify where they need to target their efforts within facilities. Guiding people through these new conversations, keeping the conversation going and listening deeply to the diversity of expertise needed to plan for climate change in health care will be the best thing that individuals can do right away.” A webinar featuring the online version of this toolkit with a built-in scoring system will be provided from the Coalition in spring H 2105. Be sure to join us! ■ Linda Varangu is Executive Director of the Canadian Coalition for Green Health Care. www.hospitalnews.com


Infection control SPECIAL SUPPLEMENT


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Infection Control

Message from the Chair of CHAIR anada has one of the highest incidence rates of Healthcare Acquired Infections (HAIs) in the world. HAIs are the fourth leading cause of death taking more lives than car accidents, breast cancer and HIV combined. One in ten in-patients catches an infection. One in 20 infected patients die. That’s 200,000 Canadians infected each year and 10,000 deaths. At the current average cost for HAI treatment of $20,000, we spend $4 billion per year on treatment or two per cent of health care costs. Current prevention measures add another $2 billion or so to the equation. In 2014 the Coalition for Healthcare Acquired Infection Reduction (CHAIR) was formed as a grass roots volunteer not-forprofit advocacy group to help with this crisis.

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We believe hospital touch surfaces are the primary reservoirs of drug resistant pathogens and that improved management of these reservoirs will greatly reduce HAIs. CHAIR is committed to saving lives and supporting the creation of a safe health care environment for Canadian patients, staff and visitors by achieving an 80 per cent reduction in HAIs by 2024. We are committed to working with professionals, universities, hospital ex-

HOSPITAL NEWS FEBRUARY 2015

ecutives, facility engineers, housekeeping staff, infection control professionals, professional and trade associations, CSA, Ministries of Health and Health Canada to develop and promote transformative ideas, standards and technologies to make a real and timely difference. CHAIR volunteers are infection control practitioners, industry professionals, doctors, hospital engineers, environmental managers, and researchers, who are committed to evaluate, advocate, educate and support proven and promising strategies, case studies, clinical trials, national standards, and product and services development to reduce HAIs in Canada. It’s an exciting time. Companies and universities are rapidly developing new products and new research. Hospitals are testing and implementing UV and copper solutions. The CSA Steering Committee for Healthcare Standards has formed a task force on HAI reduction and is working towards establishing a new Technical Committee to develop national standards to support infection control practices. Future CSA standards may include such things as self-sanitizing touch surfaces for use in hospitals and UV disinfection guidance for users and device manufacturers. There are exciting new developments in this field emerging almost weekly. Work done by Dr. Bill Anderson and his lab at University of Waterloo has confirmed to us that the “antimicrobial” label on health care products is just a label and the current state of affairs is “buyer

Barry Hunt beware”. Some products provide effective protection against bacteria and viruses and others simply don’t. There is an overwhelming need for National Standards and Product Certification and CHAIR fully supports CSA taking a leadership role in this area. We believe hospital touch surfaces are the primary reservoirs of drug resistant pathogens and that improved management of these reservoirs will greatly reduce HAIs. Intermittent UV disinfection and copper are two hot topics of research in touch surfaces that offer very promising results. CHAIR is currently supporting a clini-

cal trial by Dr. Elizabeth Bryce at Vancouver General Hospital that will genetically monitor the repopulation of touch surfaces and immunocompromised Bone Marrow Transplant patients. For the first time, we will be able to watch how the microorganisms shed from staff, visitors and the HVAC system affect patient and surface colonization leading to infection. Toilet aerosols are another major area of recent study and may be significant contributors to the spread of intestinal superbugs C. Difficile, and VRE. There is even strong, although controversial, evidence for the spread of SARS through toilet aerosols. Focus on the bathroom as a source of HAIs has led to some new environmental approaches to HAI reduction including UV, copper, vacuum toilets, and downdraft toilet exhausts. 2014 was a busy first year at CHAIR. We attended 24 conferences and meetings across Canada and abroad. We met with hundreds of speakers, professionals, manufacturers and other leaders in this field. We listened, talked, and learned a lot. In particular we learned there were a lot of like-minded people across the country and internationally who want to make a difference. If you’re one of those people who would like to make a difference, please join H us at www.chair.org. ■ Sincerely, Barry Hunt Chair, Coalition for Healthcare Acquired Infection Reduction

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New and old infection control techniques work together to

conquer C. difficile By Jane Kitchen proactive approach by the infection prevention and control (IPAC) team at Rouge Valley Health System (RVHS) recently brought a Clostridium difficile (C. difficile) outbreak under control in less than two weeks. C. difficile is a bacterium and a common cause of diarrhea in hospitalized patients. It can survive for up to five months in health care settings. With the synergy of regular staff engagement on infection control principles, implementing syndromic surveillance at the unit level, and using ultraviolet microbial technology as adjunct to existing cleaning protocols, the ability to control this outbreak relied on both going back to basics and embracing the new. Going back to basics started with IPAC launching “Infection Control 101” unitbased teaching modules in 2014 to refresh and update knowledge for all staff. Module topics included chain of transmission, personal protective equipment, routine practices and hand hygiene, and additional precautions.

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C. difficile is a bacterium and a common cause of diarrhea in hospitalized patients. It can survive for up to five months in health care settings.

“Infection Control 101 supports a culture in which staff are thinking about infection control on a regular basis,” says Paula Raggiunti, director, quality & infection prevention & control at RVHS. “The front line is engaged with infection control. It moves us from being reactive to proactive,” she adds. The pilot unit for Infection Control 101 was 2 North (a continuing care unit) at the Rouge Valley Ajax and Pickering (RVAP) hospital campus. IPAC brought their 15-minute PowerPoint presentations to the unit during a weekly set time that was convenient for unit staff. So far, these staff have completed four modules of the 12 planned. Gradually, IPAC has introwww.hospitalnews.com

duced these modules on other units at both RVAP and the Rouge Valley Centenary (RVC) hospital campus. “It’s like building a house,” says Bryan Morales, infection control practitioner (ICP) at RVAP. “We pour the foundation of infection control practices by first teaching about the chain of transmission.” Adding to a regular and standardized infection control curriculum, IPAC has piloted and implemented a syndromic surveillance program on several units cross-site, including 2 North. Syndromic surveillance is a system of monitoring a group of patients on a unit for specific signs and symptoms of gastroenteric or respiratory illness. At the beginning and end of every shift, the charge nurse asks the nursing staff if there are any patients with new fever, cough, shortness of breath, vomiting or diarrhea. This has three benefits: accurate early reporting of these symptoms allows staff and IPAC to determine when a patient needs to be placed on additional precautions; it assists IPAC to determine if the unit is on outbreak; and it supports staff to intervene for patient care in a timely way. At Rouge Valley, syndromic surveillance has been strengthened with the participation of the unit staff. “Before syndromic surveillance was implemented, a patient could be tested for C. difficile but it wasn’t always reported to IPAC,” says Amanda Whyte, registered nurse and one of the unit coordinators on 2 North. “IPAC wouldn’t hear about it until they were faxed a positive result. Now, we inform them right away,” she adds. Between Nov. 6 and 20 of 2014, there was a C. difficile outbreak on 2 North. Staff informed IPAC of the first suspected case immediately. With an outbreak, rooms require additional cleaning with sporicidal agents such as bleach. Janette Henderson, support services manager at Rouge Valley, suggested using a new supplemental cleaning technology: a surface and air decontamination tool that delivers ultraviolet germicidal irradiation (UVGI) to all surfaces of a targeted space. Henderson had already overseen the use of this method for terminal cleaning in the operating rooms at both hospital campuses. UVGI works particularly well on killing C. difficile spores.

RVHS infection control practitioners Bryan Morales (left) and Michael Paetzold with the decontamination tool used during a recent C. difficile outbreak. “UVGI does not replace terminal cleaning but supplements it,” says Henderson. The outbreak lasted only two weeks, with no new cases after the initial three. “In this case on 2 North, early and aggressive intervention, including identification of cases, IPAC countermeasures, and close cooperation between IPAC, and clinical and environmental staff and managers were key to successful containment,” says Michael Paetzold, ICP at RVAP and the lead investigator of the outbreak. Next, IPAC will be launching the rest of their back-to-basics modules in 2015. They will continue embracing the new,

as they will be filming the modules and archiving them via the Ontario Telemedicine Network (OTN). Rouge Valley is also a member of the emergency department syndromic surveillance (EDSS) collaborative maintained and operated by Kingston, Frontenac and Lennox & Addington (KFL&A) Public Health unit. This provides the hospital with an overview of how many ED patients are presenting with respiratory or gastroenteric symptoms to monitor trends that may H be developing. ■ Jane Kitchen is communications specialist at Rouge Valley Health System.

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Infection Control

CHAIR'S

Top 5

Healthcare Acquired Infection Reduction Strategies for 2015

he mission of CHAIR is to ensure the 80 per cent reduction in 2014 levels of HAIs by 2024. We have identified many strategies to accomplish this goal, some of which have been shown to produce a 50 per cent reduction in HAIs. However, to meet our target of an 80 per cent HAI reduction, multiple strategies need to be employed. Some of these approaches may already be employed to some degree in a health care facility, but effectiveness depends greatly on compliance. Eliminating the human factor of compliance wherever possible is key to success in reducing HAIs.

bathrooms and equipment storage rooms. Using smart sensor technology, the system automatically disinfects the room and all equipment in sight after every room entry. No user intervention is required making implementation simple and easy and close to 100 per cent effective. Given that VRE and C. Difficile are both intestinal bacteria, it is expected that introduction of this technology into patient bathrooms will have a significant impact in reducing outbreaks. Cross-contamination of patients by equipment held in both clean and soiled utility rooms as well as equipment storage rooms should also be significantly reduced.

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1. Mobile UV Patient Room Disinfection – >50 per cent

It’s well known that the odds of becoming infected with an HAI increase if the previous occupant had an infection. Recent studies show that deploying mobile UV devices to achieve a Log6 reduction of microorganisms in patient rooms during a terminal clean typically results in a 50 per cent reduction in HAIs. Similarly impressive results can also be achieved with fogging disinfection systems but UV is the clear winner in this category for reasons of speed, safety and ease of use. UV-C has been a proven technology for disinfecting air, water, instruments and touch surfaces for over a century. Niels Finsen was awarded the Nobel Prize for Medicine in 1903 for being the first to use UV to treat disease. By the 1930s, UV had come into common use throughout hospitals and by WWII, UV was in widespread use in processing plants, water treatment facilities, and anywhere microbial contamination was a concern. UV gained fame in the 1950’s for helping to eradicate TB before fading in use in the 1960s with the introduction of new drugs and sterilizing chemicals. Now with the current crisis in HAIs, antimicrobial resistance and treatment costs, UV has once again risen to the top of the list in the war against superbugs. Well-trained housekeeping staff can completely disinfect 20 or more rooms per day depending on the UV system chosen. A Canadian company, Sanuvox, has introduced a high-powered twin unit which can be placed in the patient room with one unit on either side of the bed to disinfect an entire room in as little as five minutes. Mobile UV robots are operated only with no patient in the room and the corridor door closed. The systems are typically activated remotely via WiFi applications on smart phones or tablets. Infrared mechanisms on the units turn off the UV-C lights HOSPITAL NEWS FEBRUARY 2015

3. Fast-acting Persistent Self-sanitizing Surfaces – Copper >50 per cent

Mobile UV devices deployed in rooms during a terminal clean typically results in a 50 per cent reduction in HAIs. if any movement is detected in the room. Unlike antibiotics and many chemical disinfectants, bacteria and viruses are unable to develop resistance to UV. UV photons penetrate cell membranes and cause thymine molecules in DNA and RNA to bond, preventing further replication. Disinfection times for each organism vary directly with light intensity and vary inverse exponentially with the distance from the source to the target. Viruses have the least protection from UV and may be deactivated in seconds, while bacterial deactivation can vary from seconds to minutes. Spores can take up to three times longer than vegetative bacteria. Mobile UV room disinfection began as a concept 12 years ago with one manu-

facturer. There are now approximately 30 manufacturers worldwide. The first UV disinfection system purchased for hospital use in Canada was four years ago. The rate of adoption is now more than doubling each year. Mobile UV room disinfection should also be considered for ORs, equipment storage rooms, nursing stations, and any other areas that may harbor pathogens.

2. Automatic UV Bathroom & Equipment Room Disinfection

A new twist on the UV room disinfection theme, an inexpensive, fixed, fully automatic UV disinfection system has recently been developed for disinfecting both

Copper has long been known to have antimicrobial properties and has recently gained popularity in healthcare globally as a fast-acting, persistent self-sanitizing surface. In 2014, copper was listed by the Canadian Agency for Drugs and Therapeutics as the #1 technology to watch in healthcare. In a groundbreaking clinical trial published May 2013 in Infection Control and Epidemiology, it was reported the ICUs at three major hospitals used copper on six high touch surfaces (bedrails, IV pole, overbed table, chair arms, nurse call, and monitor). Copper surfaces resulted in a 97 per cent reduction in bioburden, a 58 per cent HAI reduction, and a 43 day ROI. Copper surfaces are now being tested and deployed in patient care areas in hundreds of hospitals all over the world. Copper and copper alloys have recently been registered with the U.S. EPA and with Health Canada to make Public Health Claims of killing 99.9 per cent of bacteria in less than two hours. An innovative Canadian company, Aereus Technologies, has recently developed a process to permanently coat surfaces with a hardened nickel-copper alloy that doesn’t scratch or tarnish and maintains the antimicrobial effectiveness of copper. The coating can be finished in a variety of colours and textures. Recent work at the University of Waterloo has shown that in a typical hospital environment, Aereus Shield continuously produces a Log3 reduction of vegetative bacterial deposits in a few minutes and a Log6 reduction in half an hour. This would have an impact similar to housekeeping staff cleaning touch surfaces in the room every 30 minutes. Continued on page C5 www.hospitalnews.com


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The Power of Copper Copper is a truly amazing element. In a 2004 clinical paper, copper was rediscovered as being bactericidal, meaning it kills bacteria. Now, copper is recognised as a proven, broad-spectrum antimicrobial material. Copper and several alloys are registered with the U.S. environmental protection agency (EPA) as antimicrobial agents. Copper does not simply prevent bacterial growth; it destroys most types of bacteria it comes in contact with. Moreover, the efficacy of copper against pathogens persists throughout the lifetime of any component manufactured from it, without developing resistance. Door handles, chair arms, toilet seats, IV poles, faucets, can all be made into naturally antimicrobial agents.

A new twist on the UV room disinfection theme, an inexpensive, fixed, fully automatic UV disinfection system has recently been developed for disinfecting both bathrooms and equipment storage rooms.

4. HVAC Improvements – UV-C, Filtration, Humidity, Pressure and Flow

UV-C has three major roles to play in hospital HVAC. First, UV-C can be used to protect the cooling coils, pans and filters in the air handling units from mold and bacterial growth that may contaminate the incoming air. Second, to disinfect the air, particularly in critical care areas such as ICU, OR, Burn Units, and Bone Marrow Transplant. And third, to treat recirculated air drawn from patient rooms, bathrooms and other areas prior to being redistributed throughout the hospital. Filters are used in HVAC to reduce particulates. MERV rated filters take out large

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particles. The higher the MERV rating, the smaller the particles that will be removed. However, even the highest rated MERV filters allow bacteria to pass through. HEPA grade filters reduce bacterial loads but have a high cost of operation due to the larger horsepower motors required to overcome the pressure drop. HEPA filters however still allow viruses to pass through. UV-C can be used downstream of the filters to eliminate viruses. Genetic studies have shown that the same microorganisms resident in hospital HVAC ducts are deposited onto the touch surfaces in patient rooms and are found in the tracheas of patients. Continued on page C6

‘If all touch surfaces in hospitals were constructed from an antimicrobial copper product, then healthcare acquired infections (HAIs) would be significantly reduced, by over 58 per cent’. (Salgado) AEREUS Technologies has invented a way to preserve the powerful antimicrobial properties of copper without its weaknesses. Aereus Shield® is a durable, attractive, patented copper alloy coating which can be applied to most hard surfaces and substrates using the company’s patented thermal spray application process. The composition of Aereus Shield® is natural, non-toxic, recyclable, non-tarnishing, and it is cost effective. Touch surfaces covered in Aereus Shield continuously kill bacteria and the biofilm which supports their transfer, through its ionic antimicrobial action. This incredible breakthrough is in the early stages of being applied in real hospital settings in Class l & ll medical devices. A “total room solution” in the fight against HAIs is coming soon. @AereusTech

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www.aereustech.com www.hospitalnews.com

FEBRUARY 2015 HOSPITAL NEWS


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Photo credit: Aereus Technologies.

A bed railing gets coated with copper. This process permanently coat surfaces with a hardened nickel-copper alloy that doesn’t scratch or tarnish and maintains the antimicrobial effectiveness of copper. Continued from page C4 Treating the air with UV-C reduces this bioburden significantly. A study published in 2011 in the Journal of Perinatology showed a 35 per cent reduction in VAIs and a 62 per cent reduction in treatment costs in the NICU at Buffalo Women & Children’s Hospital when UV-C treatment was added to the HVAC system. Hospitals currently flood the ORs with 20 room changes per hour of conditioned air in a once-through approach. If treated with UV-C, the exhaust air could in fact be safely returned to the OR or redistributed

throughout the hospital saving up to 20 per cent of the hospital’s total energy costs for HVAC conditioning. Hospital HVAC systems are designed to provide, positive, neutral or negative pressures throughout the building. In Canada, hospital corridors are neutral in pressure to patient rooms which are in turn neutral to patient bathrooms allowing the free flow of small particles, viruses, droplet nuclei and aerosols. Currently bathrooms have ceiling mounted fans that help mobilize toilet aerosols in a fecal cloud depositing aerosols including VRE

and C. Difficile for up to 90 minutes with each flush. The fecal cloud is easily swept by door swings and movement of patients and staff through the neutral pressure environment allowing passage out of the bathroom and into the patient room and corridor. Consideration should be given to evacuating toilet aerosols at floor level behind the toilet, rather than the ceiling, to automatic doors, and to pressurizing the corridor air relative to the patient room and bathroom. Studies have shown that both spreadability and susceptibility to viral transmission increases exponentially with a decrease in Relative Humidity (RH). Fiftytwo per cent RH appears to be the ideal level where both of these parameters intersect at their lowest point. Conversely, bacterial infections increase in very high humidity conditions. Current CSA standards allow RH to swing from 30 per cent to 60 per cent. Many hospitals fall outside of even this range especially in the extremes of summer or winter, or when the weather changes rapidly. To strike a balance between both bacterial and viral transmission within a hospital, RH should be maintained between 45 and 55 per cent.

compliance requires patient and family empowerment as well as technology. Studies show a pronounced Hawthorne effect in healthcare HH. When people know they are being monitored, they wash their hands. When patients and families are educated and empowered to speak up to help become compliance monitors, compliance rates dramatically improve. Suppliers of alcohol-based hand rub (ABR) dispensers are now offering electronic dispenser counters coupled with wireless technology and central compli-

4.Real Hand-Hygiene

At CHAIR, we define a successful hand hygiene (HH) program as one that achieves 95 per cent staff compliance and includes patient hand hygiene as well. Patient hand hygiene is especially important and has only recently gained attention. Interruption of the oral-fecal route is key to prevent transmission of VRE and C. Difficile. Alcohol-based hand rubs need to be well positioned for bed-ridden patients and patients must be encouraged to use them. To achieve consistent 95 per cent staff

Technology company, Biovigil, uses ceiling mounted sensors that talk to electronic chemical-sniffing badges worn by staff. Using a stoplight paradigm, the badges display red for non-compliant, yellow to show HH is required, and green to show the badges have detected alcohol based hand rub prior to patient contact.

Since March of 2014, the Ebola epidemic in Western Africa has claimed the lives of over 8000 victims. This outbreak has brought unprecedented attention to this disease and a global effort has been mobilized to help get this outbreak under control.

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 www.ipac-canada.org to see the many benefits and resources that are available to members.

Every year in Canada at least 8000 patients die from infections related to the care they receive within our healthcare system – yet these deaths receive little attention from the media or our governments. Why is this? Because for the most part healthcare-associated infections (HAI) are seen as a “cost of doing business”. They are an accepted part of our healthcare system. Every year the infection prevention and control programs within our healthcare facilities collect statistics on these infections and make them available to their senior administrators who hope to see the numbers trending down. We need a paradigm shift. We need to change the culture within our healthcare system for one of “HAIs are expected” to one of “this has got to stop!” Preventing HAIs is not solely the responsibility of the infection prevention and control program. Every member of the healthcare team, including patients and their families need to be engaged in infection prevention and control. A cardiac surgeon or a housekeeper has just as important a role to play. If either ignores the protocols in place for infection prevention his or her actions could lead to an HAI that could result in unnecessary suffering, a prolonged hospital stay, loss of productivity and even death. It’s time to make a change. Infection Prevention and Control Canada is a national, multidisciplinary association committed to the wellness and safety of Canadians by promoting best practice in infection prevention and control through education, standards, advocacy and consumer awareness. IPAC Canada is a major national and international leader and the recognized resource in Canada for the promotion of best practice in infection prevention and control. Our over 1600 members are healthcare professionals working in facilities across Canada. These people can be mobilized to help effect this change. Bruce Gamage RN BScN CIC President Infection Prevention and Control Canada (IPAC Canada)

INFECTION PREVENTION AND CONTROL CANADA (IPAC CANADA) HOSPITAL NEWS FEBRUARY 2015

www.hospitalnews.com


Infection Control ance monitoring software that can help hospitals manage and improve hand hygiene rates. This is a first step in an augmented and effective HH program. These systems are widely advertised as achieving 40 per cent HH compliance. More sophisticated monitoring systems have been developed that track position and movement of staff, and can detect and document staff’s HH compliance in accordance with IPAC’s recommended four moments. Technology company, Biovigil, uses ceiling mounted sensors that talk to electronic chemical-sniffing badges worn by staff. Using a stoplight paradigm, the badges display red for non-compliant, yellow to show HH is required, and green to show the badges have detected ABR prior to patient contact. Additional programmable audible prompts and alerts coupled with patient and family engagement reportedly lead to a 95 per cent HH compliance rate. In the future, real-time locating services (RTLS) may be used for more than just tracking hospital assets. Toronto General Hospital recently implemented a pilot project that uses high-resolution ultrasound technology to paint a detailed picture of staff hand-washing practices, potential hot spots for disease transmission and points of contact between staff, patients and equipment. Dubbed Hospital Watch Live, the system relies on more than 1,000 ultrasound devices located throughout the facility. Organ-transplant patients receive miniature badges attached to their wristbands on admission, doctors pin them to their shirts, and they are placed on hundreds of pieces of equipment ranging from wheelchairs to commodes. In addition to HH monitoring, in the event of an outbreak, associated

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patient, staff and equipment contacts can quickly be traced and the outbreak can be contained. The system was developed by Infonaut, a start-up Toronto-based company whose CEO, Niall Wallace, formed the company after developing an outbreak mapping application as part of Ontario’s response to the 2003 SARS outbreak.

5. Infection Screening – Automated Temperature Monitoring

Screening is an important tool for infection control. Today patients are often screened for MRSA or other diseases at the time of admission to the hospital, especially if they are being admitted from another health care facility. Hospital entrances and some critical care areas within hospitals such as ICUs are labeled to advise visitors to voluntarily not enter if they have the flu or cough. Mandatory screening is common during times of outbreak such as the SARS episode. More recently, temperature screening played a major role in several countries in containing Ebola outbreaks. Temperature screening can be an effective indicator for all infections, not just Ebola. Some version of mandatory temperature screening for staff and visitors may also help us protect our patients even in non-outbreak situations. There is a case to be made at least for Bone Marrow Transplant, Burn Units, and ICUs where patient susceptibility and infection rates are especially high. Recently a U.S. technology company, Wello, was called into action in Liberia and Dallas to provide complete temperature screening, documentation and manage-

80reduction %

The WelloStation™ provides quick, automated, no touch temperature screening for employees, visitors, suppliers and all others who enter a health care facility. ment during the Ebola crisis. The WelloStation™ provides quick, automated, no touch temperature screening for employees, visitors, suppliers and all others who enter a health care facility. At the point of entry, visitors or staff look into a screen which triggers an infra-red scan of a person’s face, records a picture, displays body temperature, and stores the information in

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FEBRUARY 2015 HOSPITAL NEWS


C8

Infection Control

Main: Precautions for Ebola workers were upgraded in October to include respiratory precautions. Inset: During the 2003 SARS outbreak in Toronto the ‘six foot rule’ was insufficient and additional respiratory precautions including N95 masks were required.

Is it time to rethink airborne disease transmission? By Barry Hunt he basic classifications of disease transmission have been around for close to a century. We refer to the common cold, flu, measles and tuberculosis as “airborne” transmission diseases. Similarly we refer to Ebola and HIV as “contact” transmission diseases. And we further classify “droplet” transmission of disease with some diseases overlapping. But do these simple definitions adequately define the spectrum of transmission of each disease? I would submit, no. Moreover, these definitions may also obscure our understanding, and our prevention, of disease transmission. Bacteria and virus particles can be released directly into the air as “droplets” and “droplet nuclei” through coughing, sneezing, talking, and singing. They can also be released indirectly through splashing and aerosolization from toilet flushes, and sink drains. Aerosolization and droplet formation were studied extensively in the 1940s and 50s. In general it was felt then that coughing and sneezing typically created droplet particles larger than five microns that are relatively heavy and generally fall to the floor and other surfaces very quickly. This led to the longstanding dogma that maintaining a six foot separation distance is sufficient to provide protection from “droplet” diseases like cold and flu. Of course, indirect contact via the contaminated surfaces would be another route of transmission in this paradigm. In general, as the relative humidity decreases, the proportion of smaller particles

T

HOSPITAL NEWS FEBRUARY 2015

increases. Considering that any small particle, such as a virus, can be transmitted through the air, it may be time to consider a new approach to understanding and defining “aerosol” transmission. For aerosol transmission, three things are required: 1) the bacteria or virus particle has to be released into the air; 2) the particle has to survive in the air for the necessary travel time; 3) the particle has to have a route to enter the ntext host.

We seem to be on a slow path of edging toward acknowledging some airborne viral transmission for “contact” diseases but only during outbreaks of diseases that have a high mortality rate in the general population and a correspondingly high fear factor More recent research shows that a range of “droplet nuclei” particles smaller than five microns is also produced during typical coughing and sneezing. These small particles can float for long periods and travel significant distances. Similarly, toilet aerosols have been reported to float in the air for 90 minutes and C. Difficile (CDI) can be cultured 30 cm above the toilet after every flush. Air sampling in the vicinity of known CDI patients shows a strong positive correlation with disease progression

and movement activity such as staff and visitor entry and door swings. The larger the challenge of virus particles, the greater the likelihood of infection, however, like pregnancy, at minimum it really only takes one successful virus particle to gain cell entry. In the case of Ebola, or MERS, this is a sobering thought. In July 2014, CDC upgraded precautions for MERS protection to include N95 respirators. In October 2014, CDC upgraded the precautions for Ebola workers to include respiratory precautions of an N95 respirator or a powered air-purifying respirator (PAPR). We seem to be on a slow path of edging toward acknowledging some airborne viral transmission for “contact” diseases but only during outbreaks of diseases that have a high mortality rate in the general population and a correspondingly high fear factor. It seems we go to great lengths to otherwise dismiss findings that don’t support our beliefs, especially if they have been long held in the community. So far three studies have shown “aerosol” transmission of Ebola between primates and from pigs to primates. In the first study, caged healthy monkeys in a lab were sequestered some nine feet from Ebola infected monkeys. The healthy monkeys all died. One speaker recently defended his “contact” only belief explaining that “monkeys have long arms”. During the 2003 SARS outbreak in Toronto we learned firsthand the six foot rule was insufficient and additional respiratory precautions including N95 masks and isolation rooms were required to

control the outbreak. However, many in our infection control community remain unconvinced that the SARS virus can travel greater distances under the right circumstances. Conversely, Dr. Li of the Polytechnic Institute of Hong Kong recently updated his original publication of the airborne transmission of SARS at the Amoy Gardens complex attributing toilet aerosols as the source. He and his team used an engineering approach to review plumbing and ventilation infrastructure, and to correlate source, wind patterns, and victim locations. Similarly, a dozen victims infected at the Metropole Hotel were reported to have been infected by toilet aerosols with a similarly well-thought out and plausible engineering explanation for airborne transmission. One prominent infection control professional remarked last year, “I’m not convinced. There must have been physical contact.” A speaker at another conference mis-stated, “I know Dr. Li. He changed his mind [about airborne transmission].” Studies in other industries showing long distance airborne virus transmission are well-accepted, especially in the agricultural industry. For example, studies of factory farms combine wind and weather pattern data with viral genetics to show transmission of porcine reproductive and respiratory syndrome across distances of six kilometers and more to neighbouring farms. Why then are we so resistant to accepting the paradigm of episodic airborne disease H transmission in healthcare? ■ Barry Hunt is President & CEO, Class 1 Inc. www.hospitalnews.com


Infection Control

C9

London Health Sciences Centre prepared for its role as:

Ebola treatment hospital By Bärbel Hatje

L

ondon Health Sciences Centre (LHSC) has been working diligently to refine its readiness plan and processes as outlined in the Ministry of Health and Long-Term Care’s Ebola Virus Disease directives for hospitals. LHSC has been designated as an Ebola Virus Disease (EVD) treatment hospital, one of four in Ontario, to receive any suspected and confirmed cases of Ebola. This designation builds on our role as a regional referral hospital and LHSC has been planning for some time to deal with Ebola. LHSC is a testing site for suspected Ebola paediatric cases but not a designated centre for confirmed paediatric cases. “As part of our preparedness for potential Ebola patients, LHSC has worked diligently to educate, train and prepare staff and physicians. This work is ongoing as new information becomes known,” says Laurie Gould, Chief Clinical and Transformation Officer at LHSC. Much like its peer acute care teaching hospitals, LHSC was already in an advanced stage of readiness having learned from SARS, MERS CoV and Avian Flu. The hospital’s preparation work for EVD has taken this to another level and as the health ministry provides additional directives, LHSC continues to refine its readiness plan and provide regular updates on changes and new information.

LHSC’s preparedness for potential Ebola patients includes: • Flow maps of possible entry points, priority of actions and key accountabilities • Active screening at all points of entry such as the EDs, Family Medical Centres, Critical Care Units and Birthing Centre, as well as Ambulatory clinics with screening requirements for symptoms and travel history • Personal Protective Equipment (PPE) kits provided to entry points • New guides for donning and doffing the one-piece suits as well as buddy system for ensuring correct procedure • Training sessions for entry point areas • Refresh of all PPE training • Regular practice drills • Up-to-date resources posted for all staff on the hospital’s intranet • Handout for patients who are screened as suspected Ebola • Robust communication plan and communication processes with key partners Focused consultation and planning has occurred with stakeholders including the Adult and Paediatric Emergency Departments, Critical Care, Family Medical Centres, OB Triage, Ambulatory Clinics, Occupational Health and Safety, Security, Environmental Services, Waste Management, Respiratory Therapy, Laboratory Medicine and Diagnostic Imaging, and Morgue. The hospital has and continues to conduct tabletop exercises with key areas to

At London Health Sciences Centre, EVD education for key staff and physicians includes applied training such as PPE donning and doffing using the buddy system and mock exercises in a simulated patient room. practice the EMS response and transport of a suspected patient to LHSC, the Emergency Department response, and the interfacility response. “Our preparation and training has everything to do with the provision of excellent patient care in exceptional circumstances without compromising the health of our staff and physicians,” says Gould. “Our goal is to ensure every staff member and physician has a safe working en-

vironment, and every patient and family member is protected from exposure to Ebola Virus Disease.” Remaining vigilant in patient screening, continuing comprehensive staff and physician training, and ongoing refinement and testing of its preparedness is key to LHSC’s readiness to receive and treat patients with H Ebola Virus Disease. ■ Bärbel Hatje is a Communications Consultant at London Health Sciences Centre.

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FEBRUARY 2015 HOSPITAL NEWS


C10 Infection Control

Making difficult but important changes to the program that supports safe

Hand hygiene By Michelle Tadique ou’ve heard it many times before, from many people – make sure you wash your hands! There’s good reason for it – hand washing stops germs dead in their tracks, especially in a hospital setting where germs and infections can spread easily. That’s why a simple mantra – clean hands save lives – is integral to our approach in providing the safest care to our patients. But it’s more than just a slogan that makes a campaign successful and over the last two years we have taken a hard look at our data and our program to create solutions and practices to enhance our hand hygiene compliance and reduce hospital acquired infections like C. difficile. Bold changes like inviting patients to help redesign our program and introducing new technology and working with volunteer observers to make monitoring compliance easier and more accurate are helping to improve our results. St. Joseph’s had a formal hand hygiene program in place since 2009 when Ontario began publicly reporting data. This included staff and physician education on appropriate hand washing techniques and a paperbased auditing system that tracked how often teams were following the four moments of hand hygiene (the key moments when care providers wash their hands before and after interacting with patients).

Y

St. Joe's Infection Prevention and Control (IPAC) team (from left to right): Barley Chironda, Interim Manager; Alison Brown, Infection Control Practitioner; Dr. Jennie Johnstone, Infection Control Officer; Shelley DeHay-Turner, Administrative Director, Surgery & Oncology and IPAC; Stefania Cloutier, Infection Control Practitioner; and Yuka Hutton, Administrative Assistant. In the first year of publicly reporting hand hygiene data, St. Joe’s had a compliance rate of 95 per cent. Despite our high compliance rate, we were still seeing a high number of patients who contracted C. difficile, a type of bacteria that can be found in stool and causes diarrhea, fever and abdominal pain. “Evidence-based science points to proper hand washing as being the number one way to prevent the transmission of infection,” says Stefania Cloutier, Infection Control Practitioner at St. Joe’s. “If you have a 95 per cent (hand hygiene) compliance rate, you really shouldn’t see a lot of hospital acquired infections,” says Cloutier. “And we were seeing a monthly average of about seven C. difficile cases during this time.” Recognizing this challenge, we used it as an opportunity to review our infection control data, and take some important steps to make an improvement to our hand hygiene program. Dr. Jennie Johnstone, St. Joe’s Infection Control Officer, began to design a formal quality improvement project with a num-

Patient family advisors Diane McKenzie (left) and Alies Maybee are partnering with St. Joe's as members of the Hand Hygiene working group. In their volunteer role, they are helping to evaluate activities and outcomes related to our hand hygiene program to help find opportunities for improvement. HOSPITAL NEWS FEBRUARY 2015

ber of goals that included engaging independent volunteer observers who would be specially trained to conduct hand hygiene audits so we could move away from the “colleagues-observing-colleagues” approach. It was also necessary to move to an electronic platform to collect audit data to help ensure we would receive a true picture of hand hygiene compliance across the organization and to allow us to easily analyze the numbers by unit or by healthcare provider type. In 2013, we launched this new approach to our hand hygiene program. Trained volunteers began conducting hand hygiene audits on the units, tracking their observations using an electronic tool called HandyAudit. By using this platform, it allowed them to input only what they observed with hand washing practices, with the system generating a pass or fail on compliance. With these changes, our hand hygiene compliance rate for the 2013/14 fiscal year dropped to 42 per cent. Barley Chironda, Interim Manager of Infection Control says it was a transparent move for our organization to show the change in compliance rate that resulted from removing the barriers discovered in our quality improvement processes. “This gave us the starting point we needed so our teams could do the right work that needed to be done to improve,” he says. Another change we made to our program was to bring the patient’s voice and ideas to the table. Diane McKenzie and Alies Maybe, two of our Patient and Family Advisors, are supporting our hand hygiene initiatives by helping us explore new and better ways to engage with our patients, staff and physicians to raise awareness on the importance of hand hygiene and improve our compliance. “St. Joe’s is my hospital and it’s been the hospital for my children also,” says McKenzie. “I care about my hospital and my community, so I was honoured to be accepted (as an advisor) and to know that my voice would be heard.” McKenzie has engaged directly with pa-

tients and families in several inpatient units to get their feedback about hand hygiene and to better understand their hospital experience and what they have observed. In addition to sharing this feedback with our hand hygiene working group, she teamed up with our Infection Control team for a Patient Safety Week presentation to staff, where discussions focused on how we can collectively improve compliance rates as an organization and what that means for our patients. When compliance was at 42 per cent, St. Joe’s was seeing on average five cases of C. difficile per month. “With our current hand hygiene rate of 76 per cent we are close to zero [C.difficile cases] – so we are above the ratio,” says Chironda. “There are other factors that contribute to lower infection rates including antibiotic stewardship and enhanced cleaning practices, but the data is showing us that the more people wash their hands, the lower our infection rates are.” Work continues to move the needle to improve our hand hygiene compliance and we have seen success in surpassing our initial target of 70 per cent. We’re also working closely with our partners across the system to embed best practice standards into our processes. Knowledge sharing and collaboration with national organizations like the Canadian Patient Safety Institute and the Joint Centres for Transformative Healthcare Innovation at the local level are important partnerships we strongly value and learn from in our quality improvement journey. “We’ve invested more time and effort to make positive changes,” says Dr. Johnstone. “Everyone is committed to providing safe care to our patients and I’m confident that the hard work of our dedicated teams across the organization, our Infection Prevention and Control team and our Hand Hygiene working group will continue to H drive our compliance rate even higher.” ■ Michelle Tadique is a Communications Associate at St. Joseph's Health Centre Toronto. www.hospitalnews.com


Infection Control C11

A case of scabies at HĂ´pital Montfort By JosĂŠe Shymanski and Geneviève Picard uring what should have been the quietest week of July 2014, the acting VP of Clinical Services at HĂ´pital Montfort raised a red flag: "I think we may have a case of scabies." Within a few hours, the tests came back positive: a patient was indeed infected with a particularly infectious type of scabies, known as Norwegian scabies. Compared with the possibility of an Ebola-infected patient showing up at the Emergency, scabies seemed like a mundane infection. However, this case of scabies quickly turned into a “situationâ€?, which required the full attention of the hospital’s leadership over several weeks. For HĂ´pital Montfort, a Francophone academic health care institution providing health quality care in both official languages to the population of Ottawa, the first order of business meant answering a very simple question: what is scabies? Scabies is a contagious skin infestation caused by a type of mite which is invisible to the naked eye. The mite burrows in the skin to lay its eggs, causing a pimple like rash and an intense itching sensation. Scabies can be transmitted during skin to skin contact and, for Norwegian scabies, through contact with items in the environment of the infected person. Scabies is easy to cure and does not appear on the list of reportable diseases. However diagnosis can be challenging, particularly for the rare Norwegian scabies form, and outbreaks are not uncommon in long term care facilities and hospitals. Many of the people involved admitted that the mention of the “Sâ€? word caused an immediate need to scratch.

D

Scabies is a contagious skin infestation caused by a type of mite which is invisible to the naked eye. The mite burrows in the skin to lay its eggs, causing a pimple like rash and an intense itching sensation. The staff working on the unit alerted management to the situation. It surfaced later that the patient must have been infected, undiagnosed, for several months prior to being transferred to Montfort for other health problems. The Infection Prevention team at Montfort quickly developed a fact sheet to explain what scabies was, and how to detect and treat it. Pharmacy ordered a large quantity of the recommended treatment. Meanwhile, the Health and Safety team, with the help of Human Resources, came up with a plan as to how to inform the staff members and physicians and get them treated. The cleaning team went into overdrive, thoroughly cleaning the patient’s room and the public areas on the affected unit. An administrative team got on the phone to contact all patients diswww.hospitalnews.com

charged from the same floor as the infected patient, to inform them of the case, explain the symptoms and tell them to contact the hospital if they were to develop symptoms. Public Health Ottawa (PHO) proved a very useful resource, sending two delegates at an information session open to all staff members. The PHO representatives also referred to another hospital in Nova Scotia which had recently been through a similar case; the team at Capital Health was contacted and promptly shared invaluable fact sheets, Q&As and lessons learned. An infectious diseases specialist from Halifax was also consulted. As this was happening in the dead of summer, the local media heard about the case and came looking for a story. The Communications team handled a dozen media requests in the course of a day, giving interviews to reassure the public that the situation was under control and to reiterate how benign scabies is. Cameras were allowed on site to demonstrate that it was business as usual inside the hospital. The transparency approach paid off and the media moved on to other topics on the following days, allowing management to focus on more pressing operational issues – especially the human resources challenges. The staff members working on the floor where the infected patient stayed were promptly informed of the situation. All staff members who had been in direct contact with the case or who were assigned to that unit were sent home with a dose of the treatment as a preventive measure – along with doses for each family member, if relevant; they were also given a short leave of absence to apply the cream treatment during the required period and go through the process of washing all their bedding, towels and recently-worn clothes. Several required a second dose for treatment of scabies. Infection Prevention and HR worked hand in hand to reconstruct the work shifts from the past weeks and identify who may have had contact with the patient. But it proved tricky to reach staff members who had been in contact with the patient a few weeks earlier and had since left the region to go on holiday. Another challenge came up when several clinical departments had to deal with drastically reduced teams at the last minute. Montfort does not have a dermatologist

on staff, and it was initially difficult to find a local physician with expertise in scabies. Eventually a resident in dermatology came forward and very generously spent a full day doing scrapings and checking the status of both patients and staff members. When things finally calmed down and the twice-daily scabies monitoring sessions came to an end, the management team at Montfort did a thorough debrief. They identified that key issues lied with the

Getting To Know Bleach Bleach based disinfectants are currently seeing a resurgence within healthcare settings due to the advent of â&#x20AC;&#x2DC;super-bugsâ&#x20AC;&#x2122; OLNH056$DQG&GLIÂżFLOH,QIDFW&ORUR[ Healthcareâ&#x201E;˘ Professional Disinfecting Bleach Wipes are effective against 46 pathogens with kill times of 1 minute and DUHHIIHFWLYHDJDLQVW&GLIÂżFLOHVSRUHVLQ minutes. <HWGHVSLWHWKLVH[WUDRUGLQDU\GLVLQIHFWLQJ FDSDELOLW\VRPHIDFLOLWLHVUHPDLQUHOXFWDQW to use bleach-based disinfectants. This is due to some common misperceptions. +HUHZHGLVSHOWZRRIWKHVH MYTH: Bleach Odour Has Potential Health Consequences And Respiratory Effects ([SRVXUHWRWKHVPHOORIEOHDFKVKRXOG not be a cause for concern as the sensory threshold levels for chlorine species are well below any levels recognized to cause respiratory irritation or overt health

management of human resources, much more than caring for the patient â&#x20AC;&#x201C; who responded well to treatment. The Infection Prevention and the Health and Safety teams then turned their attention to preparing for a potential case of Ebola, along with the local public health H unit and the other hospitals in Ottawa. â&#x2013; JosĂŠe Shymanski is Manager, Infection Control Program and Geneviève Picard is Director, Communications at HĂ´pital Montfort.

HIIHFWV,QIDFWWKHRGRXULVFDXVHGE\WKH chemical reaction that occurs when bleach begins to break down proteins like the ones that make up microorganisms. The more frequently surfaces are disinfected with bleach; the fewer proteins will be on the VXUIDFHIRUWKHQH[WGLVLQIHFWLRQ7KHPRUH IUHTXHQWO\WKHVXUIDFHLVGLVLQIHFWHGWKH lower the odor should be. MYTH: Using Bleach Will Damage Equipment And Surfaces :KHQXVHGDVGLUHFWHGEOHDFKSURGXFWV DUHVDIHWRXVHRQDYDULHW\RIKDUGQRQ SRURXVVXUIDFHVLQFOXGLQJVWDLQOHVVVWHHO SODVWLFVJOD]HGFHUDPLFVJODVVSRUFHODLQ and other materials. Use a Health Canada UHJLVWHUHGEOHDFKZLWKFRQÂżGHQFHWRFOHDQ DQGGLVLQIHFWVXUIDFHVVXFKDVEHGUDLOV WDEOHVHTXLSPHQWVXUIDFHVFRXQWHUWRSV Ă&#x20AC;RRUVWRLOHWVVLQNVWUDVKFDQVNH\ERDUGV SKRQHVOLJKWVZLWFKHVDQGGHVNV$OZD\V IROORZWKHSURGXFWODEHOLQVWUXFWLRQVDQG always refer to MSDS and the appropriate instructions.

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C12 Infection Control

HOSPITAL NEWS FEBRUARY 2015

www.hospitalnews.com


Focus 15

FACILITIES MANAGEMENT AND DESIGN/HEALTH TECHNOLOGY/GREENING HEALTHCARE

Caption: Medtronic Advisa MRI Surescan Pacemaker Source : Medtronic plc

New developments with

magnetic resonance imaging (MRI) and electronic implantable devices By Neil Fraser

I

n the past 50 years of medical technology, few devices have had as great or as lasting an impact as the pacemaker. The implanted device, which regulates the beating of the heart, has been implanted in millions of heart patients globally and has saved countless lives. In recent years, however, patients with pacemakers have been warned against the risks associated with magnetic resonance imaging (MRI) scans. The interaction between the tiny devices and the powerful magnetic fields generated by an MRI scan is potentially harmful, including the possibility for the device to improperly pace the heart or burn the heart tissue at the tip of the pacemaker lead. Fifty years ago, when pacemakers were first implanted, there were no MRIs. Yet, in 2012 alone, Canadians underwent 1.7 million MRI exams. MRIs have transformed the way patients are diagnosed and treated. They have proven highly effective in diagnosing cancer, Alzheimer’s, stroke, heart or artery conditions, and muscle, bone and back pain all of which are prevalent among older Canadians. Diagnostics are becoming more important as people are living longer: they are generally surviving diseases and there are much better treatment options for previously fatal conditions. After age 65, a person’s chance of needing an MRI doubles. This is the same demographic group most likely to need a pacemaker. In fact, a patient with a pacemaker has a 50-to-75 per cent likelihood of needing an MRI exam over the lifetime of their device. MRI has become the gold standard diagnostic tool because as the American Heart Association (AHA) notes it “provides excellent spatial resolution and 3-dimensional analysis, while not exposing patients to radiation, or the risks of invasive procedures, or potentially nephrotoxic iodinated contrast agents.”

Confusion And Controversy

AHA also noted that confusion and controversy regarding which patients with cardiovascular devices can safely undergo MRI examination “has led to the unsafe examination of patients with certain devices and to the misinformed www.hospitalnews.com

and inappropriate refusal to refer or scan patients with other devices”. A recent Consensus Paper between Canadian Heart Rhythm Society and the Canadian Association of Radiologists is intended to clear up this confusion and facilitate the development of hospital processes and protocols in order to ensure patient access to this diagnostic.

Next Generation Pacemaker

In 2011, Health Canada issued a license for a new generation of pacemakers, referred to as MRI-conditional, which, unlike its predecessors, made it possible to get an MRI scan when performed in accordance with the instructions for use. This meant that for the first time, the 25,000 Canadians implanted with this new generation of pacemakers each year could possibly benefit from the diagnostic benefits of MRI. Medtronic spent more than 13 years developing this new pacemaker. Engineering teams redesigned the components and circuitry of both the pacemaker and the lead to ensure that their performance was safe and predictable in the MRI environment following the directions in the instructions for use.

Newest Development

Even with the new pacemaker clearing the way for patients to have MRIs, a challenge still remained for existing pacemaker patients – the pacemaker leads. Because there is a significant risk to removing leads, typically, once a patient is implanted with a lead they have it forever. This meant that anyone with an existing pacemaker would still not be eligible for an MRI, even if they got the next generation system. That is, until now. Medtronic developed a proprietary computer modeling simulation to test the legacy leads. The robustness of the modeling framework provided sufficient assurance of safety to physicians, patients, and regulators. The company has received Health Canada licence with new lead labeling for all three legacy leads which are now licensed MRI-conditional. As a result of the MRI-conditional labeling on legacy leads, 35,000 patients implanted with these leads are now eligible for an MRI after their next device replacement if the replacement device is an Advisa SureScan MRI Pacemaker.

It’s important for clinicians and patients to know that despite these advances, not all devices are MRI-conditional, and both the leads and the pacemaker should be licenced as MRI-conditional before allowing patients to undergo an MRI. This issue doesn’t just concern pacemakers. Many other implanted devices face the same issues when subjected to MRI scans. To that end, pacemakers aren't the only devices the company made MRI conditional; others include a series of neurostimulators and deep brain H stimulators. ■

Neil Fraser is president of Medtronic of Canada Ltd. He holds leadership roles at several prominent organizations committed to Canadian healthcare innovation, including being appointed Member of the federal government’s Advisory Panel for Health Innovation, Council Member of Ontario Health Innovation Council by the Ontario Ministry of Health and Long-Term Care, and Member for the Life Sciences Division of the National Research Council Canada.

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16 Focus

FACILITIES MANAGEMENT AND DESIGN/HEALTH TH TECHNOLOGY/GREENING HEALTHCARE

A view from the northeast corner of Parkwood Institute’s Mental Health Care Building. (Inset) Outside the main entrance of Parkwood Institute’s Mental Health Care Building

St. Joseph’s newest mental health care facility an

environmental leader By Matthew Overall

uildings can have a devastating carbon footprint, generating up to 35 per cent of the Earth’s greenhouse gas emissions. What’s more, the construction and demolition of buildings can produce a significant amount of landfill waste. This is why St. Joseph’s Health Care London’s (St. Joseph’s) newest facility – Parkwood Institute’s Mental Health Care Building – is designed to meet the highest environmental sustainability standards. Its ecologically friendly design not only preserves the Earth’s environment, it also supports patients on their path to recovery. The Mental Health Care Building at Parkwood Institute, which recently opened its doors in November 2014, is expected to attain a Leadership in Energy and Environmental Design (LEED) Gold certification in the coming months. LEED is a nationally accepted certification program for the design, operation and construction of high performance green buildings. A LEED Gold certification is granted to buildings which maintain a healthy indoor environment, operate with reduced greenhouse gas emissions and use energy efficiently. This recognition was previously given to St. Joseph’s Southwest Centre for Forensic Mental Health Care. “It is probable that we will receive the certification in March,” says Terry Maslen, director, of facilities management at St. Joseph’s. “We must ensure that Parkwood Institute’s Mental Health Care Building meets the design parameters that are awarded LEED credits and points. Tests have proceeded smoothly so far and that’s why we expect the facility to achieve the LEED Gold certification.”

B

HOSPITAL NEWS FEBRUARY 2015

(left) Parkwood Institute’s Mental Health Care Building design enables natural light to brighten its rooms, corridors and hallways. (right) A common area for patients and staff inside Parkwood Institute’s Mental Health Care Building. Designers of Parkwood Institute’s Mental Health Care Building minimized the building’s ecological footprint by reducing construction waste. More than 30 per cent of the materials used to build the facility were sourced within 800 km of the site and many of these materials were made using recycled components. During construction, contractors also diverted roughly 85 per cent of the construction waste from landfills. Inside the building, staff, patients and visitors will take note of how the building conserves water, energy and other resources. Low-flow faucets and toilets reduce the building’s water usage by 43 per cent and lighting is controlled by motion sensors that conserve energy when rooms are not in use. Conservation is a core element of the building’s design, preserving water and energy where possible, as well as cutting the building’s operation costs. Conservation ensures the continued sustainability of water and energy resources for future generations.

The building’s regulated air ventilation system maintains a healthy indoor environment where occupants breathe in 100 per cent outdoor air that is filtered of contaminants. What’s more, the building contains minimal amounts of volatile organic compounds (VOCs) which are organic chemicals that can harm human health. Clean, uncontaminated air is essential for maintaining a healthy working and living environment for staff and patients. Apart from its ecologically friendly design, St. Joseph’s new Mental Health Care Building is helping front line clinicians improve care by fostering a healing environment. The layout of the building maximizes the amount of natural light that is able to enter its rooms, corridors and hallways. Three central courtyards draw natural light into the building, creating a calming environment that supports patients in their recovery. Even on a cloudy day, natural light pours into the building, improving the health

and wellbeing of everybody living and working inside. The facility’s interior design also uses colour effectively. The colour palette employed throughout the interior supports a warm and inviting atmosphere. Additionally, colours are used as a wayfinding tool. Patients and visitors are able to navigate the building by identifying colours that correspond to certain sections of the hospital. Parkwood Institute’s Mental Health Care Building marks the next era in care, recovery and rehabilitation. Patients and staff alike live and work in a healthier, cleaner environment that reduces its carbon footprint, provides an exceptional environment for clinical care and supports the reintegration of H patients back into the community. ■ Matthew Overall works in Communications and Public Affairs at St. Joseph’s Health Care London www.hospitalnews.com


Date Pulse 17

CIHI’s role in electronic health records By David O’Toole ood information is crucial to achieving a high-performing and sustainable health care system that is also safe and responsive to the needs of Canadians. The conversion of Canada’s fragmented, paper-based clinical systems to electronic records creates an unprecedented opportunity for new and richer sources of information to inform decisions about health and health systems. After consulting with health leaders across the country, in 2003, CIHI and our longstanding collaborators Canada Health Infoway delivered a shared vision for the safe and effective health system use of electronic data to the Conference of Deputy Ministers of Health. Better Information for Improved Health: A Vision for Health System Use of Data in Canada expressed a shared vision for the health system use of electronic health data that will both protect the privacy and confidentiality of patients and serve Canadians and Canada’s health care system well into the future. In May 2013, the federal, provincial and territorial Deputy Ministers of health endorsed the vision and guiding principles for future health system use of data, as well as the recommendations for moving forward with the health system use of data agenda. In December 2014, the Deputy Ministers of health reiterated their support, when they unanimously endorsed a proposal to adopt a core set of primary health care content standards across the country, and directed CIHI and InfoWay to work with the provinces and EMR providers to prepare readiness assessments and to report back with those readiness assessments in the fall 2015.

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• Social supports, environment and caregivers • Treatments, procedures and medications Care providers then receive realtime reports on the assessed individuals’ health status, progress and risks to support care decisions. With no additional data collection effort, the data then flows to CIHI. CIHI de-identifies the data, conducts analyses using this information and produces aggregate-level reports for managers and funders at organizational, re-

gional and provincial/territorial levels. We’re very proud of CIHI’s part in the process. The result: better care for patients. The most important tool in diagnosis and treatment is information, and interRAI allows that information to be quickly compiled and communicated, so we see success story after success story, which pertains specifically to the treatment of depression.

Moving Forward Together

Collecting, standardizing and shar-

ing information is crucial to the success of our health care system on a whole. What’s more, health system use of electronic health records is at the foundation of CIHI’s business. CIHI takes seriously its role in moving this agenda forward in Canada. We will continue to make progress on the work ahead, with continued healthy collaboration with our partners across the H country. ■ David O’Toole is President and CEO, Canadian Institute for Health Information.

VS.

CIHI and interRAI

Before InfoWay, CIHI was a big part of the implementation of the interRAI Resident Assessment Instrument in Canada, since the assessment instrument’s creation in the early 1990s. interRAI is an international consortium of researchers who collaborate to improve the quality of life of vulnerable persons through a seamless comprehensive assessment system. The electronic interRAI assessment instruments allow us to collect information about individuals receiving health services in facility and community settings in a standardized way. Ten of the interRAI assessment instruments have been given official status as Canadian Approved Standards (CAS) through the Standards Collaborative coordinated through Canada Health Infoway. RAI was developed to support quality of care in nursing homes. International research led to an integrated suite of assessment instruments using common language and measures across the health care continuum, including acute care, complex continuing care, home care, mental health care and palliative care. At the point of care, clinicians use RAI to assess individuals and electronically capture information including: • Health, functional and cognitive status • Nutrition, continence and skin condition • Mood, behaviour and communication www.hospitalnews.com

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FEBRUARY 2015 HOSPITAL NEWS


18 Focus

FACILITIES MANAGEMENT AND DESIGN/HEALTH TECHNOLOGY/GREENING HEALTHCARE

Benefits of sustainable design include improved care and long-term cost savings By Angela MacKenzie he new Teck Acute Care Centre in Vancouver will be a leading example of how sustainability in healthcare makes sense not only for the environment and operating budgets, but even more significantly for patient care. The new facility has been designed to meet or exceed Canadian Leadership in Energy and Environmental Design (LEED) Gold standards and is currently under construction at BC Children’s Hospital and BC Women’s Hospital + Health Centre. The project is an initiative of the Provincial Health Services Authority (PHSA) – one of several health authorities in British Columbia that support green initiatives (www.bcgreencare.ca). PHSA is committed to sustainability and has adopted a “triple-bottom-line” policy that balances ecological, societal and economic priorities within the health care context.

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The colours and textures of the new centre will also help connect patients to nature and improve the overall healing environment The Teck Acute Care Centre will incorporate energy reduction strategies that will result in significant, long-term operational cost savings. These include a high-performance lighting strategy that uses appropriate daylight, dimming and high-efficiency fixtures and thermally efficient, durable and low-maintenance exterior walls. It will also feature green roofs that will also reduce storm water run-off, windows that reduce conductive heat loss during the winter and low-flow plumbing fixtures and other water-saving equipment. “Economically sustainable environments are those that reduce the amount of time, energy and cost to maintain them, thereby making a positive impact to the bottom line,” says Eleanor Lee, Senior Director of Design and Implementation for the BC Children’s and BC Women’s Hospital Redevelopment Project. “At first glance, energy efficient building products may be more expensive, but once operating cost savings are factored in, the overall long-term savings more than offset the initial higher cost.” But the benefits of the facility’s sustainable design will extend beyond economic savings to reflect social sustainability and a patient- and family-centred philosophy of care – two approaches that often go HOSPITAL NEWS FEBRUARY 2015

hand-in-hand. A healing and nurturing environment is a key element of social sustainability and inherently important to a facility that strives to improve the health and wellness of its community. “Environmental sustainability touches all parts of the building inside and out and is an integral part of the design,” Lee says. “We are in the business of health and what better place to demonstrate this than in a healthy building.” Every patient room will have windows that let in daylight and have views to the outside. Indoor and outdoor play spaces for children will act as positive distractions, and family lounges with laundry and entertainment facilities will help support the family. The landscape design for the site also includes a Wellness Walkway that will encircle the entire hospital campus. The walkway is intended to assist in the healing of patients and contribute to the physical and mental health of staff, visitors to the hospital and those living in the surrounding communities. It will allow different individuals to find comfort in a variety of

The architectural rendering is of the new Teck Acute Care Centre and credit would go to: Affinity Partnerships, ZGF Architects LLP and CEI Architecture. environments, including secluded contemplative spaces and open social spaces. Drought-resistant, native plants will be used throughout the site to help reduce maintenance efforts and costs, and several rain gardens are planned along the walkway to capture storm water that will not only reduce pollution, but also create a calming environment that replicates natural systems. The colours and textures of the new centre will also help connect patients to nature and improve the overall healing environment. The design elements of the windows and interiors will reflect those found in the forest, starting with the co-

lours found on the forest floor, moving up through the canopy to blue sky, and the centre will also include the use of wood in the interior and exterior of the building. “Green design not only helps reduce the costs of maintaining a facility, it has a positive impact on our patients and families and helps save the planet for the next generation,” Lee says. Construction of the new Teck Acute Care Centre began in the spring of 2014 H and will be completed in 2017. ■ Angela MacKenzie is a Communications Officer, BC Children’s and BC Women’s Redevelopment Project.

Increasing your facility’s water efficiency By Dylan Dingwell

ne of the key emerging environmental issues for Canadian communities is how to conserve, protect, and make efficient use of their water resources. Historically, water conservation has been an area where Canadians have lagged behind much of the world. Canada uses more water per capita than most other industrialized nations, but is also one of the richest in freshwater, containing eight per cent of the global supply of renewable freshwater resources. The perception that Canada’s water supply is practically limitless disguises serious concerns about how inefficient water use could affect communities going forward. In the health care context, rigorous water conservation measures are often overlooked or viewed as unfeasible. In particular, the need to prioritize infection control and comply with relevant regulations can limit the use of waterefficient practices and technologies. As a result, health care facilities are often highly intensive water users, with some estimates placing the average overall water use for hospitals as high as 1200 liters per bed per day. Increasing water efficiency represents an area where sustainability-minded organizations can find huge potential

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benefits. From a financial perspective, reduced water use not only reduces any direct costs for the water supply, but also helps to reduce energy use and other associated costs. Greater water efficiency enhances emergency preparedness and resiliency to the effects of climate change, since in the event of a disaster or extreme weather event, hospital operations become dependent on the efficient use of water.

Canada uses more water per capita than most other industrialized nations, but is also one of the richest in freshwater Health care facilities can also help to reduce water pollution (especially dangerous pharmaceutical pollution) and improve water quality by reducing their water waste. Many Canadian hospitals have already implemented impressive water conservation strategies, and have realized the benefits of doing so: • Kingston General Hospital won the 2014 Ontario Green Health Care Award for Water Conservation & Protection by

reducing their water use by 25 percent, saving 76,000 cubic metres of water per year • Hôpital Sainte-Anne-de-Bellevue saved 58,000 cubic metres of water per year by installing a new cooling tower, and an additional 19,000 cubic metres by replacing their water compressors The Canadian Coalition for Green Health Care is connecting Canadian hospitals with the tools they need to undertake water conservation measures, starting with a webinar on water use and efficiency in the health care sector on Thursday, February 5th. See details at coalitionwater.eventbrite.ca and register to attend for free. The webinar will be accompanied by a new review tool on water conservation, which identifies 100+ specific water use reduction measures for health care facilities, including how to conduct a water audit. This initiative was developed thanks to Environment Canada’s EcoAction Community Funding Program, which provides financial support to locally-based, not-for-profit organizations to undertake communitylevel projects that have positive, meaH surable results for the environment. ■ Dylan Dingwell is Manager, Program Delivery, Canadian Coalition for Green Health Care. www.hospitalnews.com


FACILITIES MANAGEMENT AND DESIGN/HEALTH TECHNOLOGY/GREENING HEALTHCARE

Focus 19

Southlake receives international acclaim By Kathryn Perrier

f you ask staff at Newmarket’s Southlake Regional Health Centre why they were recognized for dramatically reducing patient wait-times, they will tell you that electronic boards sure have a lot to do with it. At first glance you might think there was a flat-screen television in each of the hospital’s patient-care areas. But if you look closely you’ll see these are not just regular televisions. They are sophisticated electronic boards that have contributed to improved flow and a reduction of up to 18 per cent in wait times in the hospital’s emergency department. Now, the hospital and its staff are being awarded for using this new technology so efficiently. Southlake was recently recognized as the first international recipient of the McKesson Distinguished Achievement Award for Clinical Excellence for the McKesson Performance Visibility project (MPV). The MPV boards give members of the health care team important safety and flow information instantly. Information like the location of patients, estimated date of discharge, a patient’s risk of falling, and whether or not a patient has been placed on precautionary measures to avoid the risks associated with infectious disease. It allows staff to better track patient safety, quality and flow, says Sue Grills, Project Manager at Southlake and a key player in the MPV Project. She’s very happy to see staff being recognized and awarded for not

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The McKesson Performance Visibility Project (MPV) boards give members of the healthcare team important safety and flow information instantly. only embracing this technology but also for using it so efficiently. “It’s made things easier because now everyone knows how many patients are coming in and out. It’s really helped ensure staff are all on the same page. Everyone can see how many beds are available to patients by taking a quick look at the screen.” Southlake President and CEO Dr. Dave Williams accepted the award and a $5000 cheque earmarked for the Southlake Regional Health Centre Foundation from McKesson Canada. For him, it is the meaning behind the award that is most important to the Hospital. “We were thrilled to learn that Southlake had been the successful re-

cipient of the 2014 Distinguished Achievement Award for Clinical Excellence,” says Dr. Williams. “For me, the award is a tangible symbol of our relentless commitment to excellence and to identifying new opportunities and technologies that can improve the hospital experience for our patients. It’s what we strive to achieve every single day in everything we do.” Southlake Chief Operating Officer and Vice-President, Relationships Helena Hutton agrees. “This technology is saving us time and allows our team members to focus their attention on what’s really important - delivering the shockingly excellent experience that patients have come to expect from us here at Southlake.” Over the past two years, Southlake has achieved tremendous outcomes for patients through the technology, including a reduction in the time it takes to admit a patient who has come into the Emergency Department for care. Overall wait times dropped by up to 18 per cent, and the average number of patients waiting in the Department dropped by as much as 17 per cent. Patients at Southlake have been benefitting from shorter wait times, a more seamless transition through the Hospital, and improved health outcomes since the new advanced technology was brought in. On inpatient units, the health care team experienced 400 fewer interruptions each day. The equivalent of 12.2 hours in phone calls related to room status and patient assignments. The MPV boards also helped staff better identify patients who are at risk

of falling and cut the total number of patient falls with associated injuries in half. The Award is presented annually by the McKesson Corporation – a health care services and information technology company dedicated to making the business of healthcare run better – to a hospital or health system that has achieved great results in improving healthcare quality and patient safety through the effective use of McKesson technology. "Southlake has demonstrated innovation in patient flow management, improving its ability to provide its growing patient population with high-quality care in a costefficient manner," says Jim Pesce, President of Enterprise Information Solutions, McKesson Technology Solutions. The winner of the 2014 Distinguished Achievement Award for Clinical Excellence was decided at a live competition in Fall 2014. The eight finalists, including Southlake, were selected from a diverse group of applicants from across Canada and the United States who underwent a rigorous application process that involved multiple phases and objective evaluation. The finalists were chosen by a panel of four industry experts based on the Institute of Medicine’s six aims of quality healthcare: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. According to the McKesson Corporation and the final evaluation, Southlake’s application H effectively addressed all six aims. ■

Kathryn Perrier is a Media and Government Relations Specialist at Southlake Regional Health Centre.

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stefan@hospitalnews.com FEBRUARY 2015 HOSPITAL NEWS


20 Focus

SAFE MEDICATION

Drug tapering schedules may titrate up medication errors By Amanda Chen and Certina Ho

rug tapering” is a common technique used in practice to gradually discontinue or reduce a therapeutic dose of a drug over a period of time. Its use is most applicable when preventing adverse withdrawal reactions with the sudden stop of certain medications. It also allows for early detection or return of condition/ symptom(s) being treated. Conversely, the term “drug titration” refers to the incremental increase in dose to a level that provides desired therapeutic effects. Both tapering and titrating processes are warranted in a variety of clinical scenarios to help increase therapeutic tolerability and overall patient comfort. However, they are often complex in nature, involving multiple doses of medication(s), extensive directions of use and complex mathematical calculations. In addition, the lack of standardized tapering guidelines in current practice may explain the fact that a wide variety of unique tapering regimens are prescribed that do not follow a homogenous, consensus-based pattern. As such, it becomes rather challenging to assess the appropriateness of these medication orders with respect to efficacy, safety, and tolerability for the patient. All of these considerations illustrate the vulnerability of drug tapering to medication incidents that may occur at any stage of the medication-use process, be it at the prescribing, order entry, dispensing, administration, and/or patient monitoring level.

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HOSPITAL NEWS FEBRUARY 2015

National medication incident reports collected from the Community Pharmacy Incident Reporting (CPhIR) program, which is operated by the Institute for Safe Medication Practices Canada (ISMP Canada) has revealed some interesting trends in medication incidents associated with the drug tapering process. Specifically, four major themes, all of which are potential contributing factors for drug-tapering errors, were identified after data analysis, as shown below and in Table 1. Lack of Standardized Tapering Guidelines – Standardized, pre-printed order forms for drug tapering prescriptions should be considered in order to encourage complete and accurate communication of information between physician, pharmacist, and patient. Inadequate Patient Counseling – Pro-

THEMES Lack of Standardized Tapering Guidelines Inadequate Patient Counseling Operational Limitations

viding patients with a tapering schedule tool (i.e. personalized calendar or booklet) for their reference, may be beneficial to clarify confusing and extensive directions of use. This should be done in conjunction with adequate face-to-face counseling, education and follow-up. Operational Limitations – A helpful feature of the pharmacy order entry queue would be an “extended labeling” function, where directions longer than the standard spacing restrictions would automatically populate into this new interface. The full directions would then be entered, printed, and affixed to the prescription vial. Similarly, during order entry, the pharmacy dispensing system could support an interface for “chained” or “linked” prescriptions, where the total drug tapering schedule is entered sequentially with start and stop

SUBTHEMES •Prescribing error •Miscommunication •Cross-taper •Multi-medication compliance aids •Labeling restrictions •Billing restrictions

Complexity of Prescription •Calculation error

•Transcribing error •Wrong selection of prescription to be filled •Prescription preparation error

Table 1 – Themes and Subthemes of Potential Contributing Factors for DrugTapering Errors

dates automatically populating as directions, durations, and quantities are entered. Another benefit of this feature is that it only allows prescriptions to be filled in a sequential order, that is, prescription in the middle of the chain cannot be selected to be filled. Complexity of Prescription – Independent double checks should be performed for each prescription during the order entry and dispensing process. More specifically, rules and policies in the pharmacy should be implemented to increase awareness and conscientiousness during the prescription preparation process. For example, calculations should be documented by both the order entry staff as well as the independent double-checker to enhance accuracy. Drug tapering can be a very long and arduous process fraught with confusion, miscommunication and medication errors involving all levels of patient care that encompass roles led by physicians, pharmacists, nurses, caregivers and patients alike. Learning from medication incidents and identifying potential systems-based contributing factors and areas of vulnerability are imperative steps in paving way for future developments in quality improvement initiatives at the local, provincial H and national levels. ■ Amanda Chen is a Post-Baccalaureate PharmD Candidate at the Leslie Dan Faculty of Pharmacy, University of Toronto; Certina Ho is a Project Lead at the Institute for Safe Medication Practices Canada.

www.hospitalnews.com


FACILITIES MANAGEMENT AND DESIGN/HEALTH TECHNOLOGY/GREENING HEALTHCARE

Focus 21

Humber River Hospital’s Meditech oncology management project team.

Fully digital management system improves the journey for oncology patients By Carla Peacock

umber River Hospital’s (HRH) Outpatient Oncology Treatment Clinic is the first MEDITECH 6.x client in Canada to launch, test and adapt their new Oncology Management software. This integrated electronic solution enhances the Clinic’s management of the unique needs of patients with cancer. “This system transformed the Oncology Clinic into a fully digital unit, taking Humber River one step closer to becoming North America’s first fully digital hospital,” says Jane Sanders, HRH Oncology Manager. “It also supports our mission to put patients at the centre of their care while focusing on improving quality of care and patient safety.” This software is a comprehensive tool that provides clinical staff with centralized status boards and online access to the most common oncology management routines. It helps care providers and patients plan months in advance with an automatic patient calendar function that includes not only appointment information, but treatment information and patient reminders. This gives patients the ability to schedule the support they need to get to appointments and to recover from their treatments. Enhanced safety features for medication administration are also embedded into the system for safe chemotherapeutic medication administration and an autocalculating weight-based dosing capability. By integrating with the hospital’s Bedside Medicine Verification and electronic Medication Administration Record (BMV/ eMAR) systems, the risk of medication errors is greatly reduced. But the most powerful feature of this program is the complete integration with other MEDITECH modules and hospital systems, connecting care teams like never before. Registration, Community Wide Scheduling, Patient Care System (PCS), and Pharmacy are all connected in real time through the patient’s electronic medical record (EMR). By having all orders, tasks and messages digital and accessible all hours of the day, there’s no paper to be lost or misinterpreted. The Oncology Clinic is now virtually paper free from patient registration through to treatment with the www.hospitalnews.com

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elimination of paper patient orders, requisitions and medical files. The system also helps streamline workflows and processes, helping care providers coordinate patient care across all hospital departments with greater efficiency so that they have more time to spend with patients. When a patient calls the clinic to renew a prescription, or when a doctor or clinician adds an order entry to the patient’s treatments, the entire care team is aware of the updates and can execute treatment orders efficiently and effectively. “This system has completely changed the way we work and enhanced the way patients are cared for,” according to Sanders. “We now have more defined processes and leaner workflows, giving us more time to focus on patients and their needs.” Patients want to have complete information to help them understand their

illness and support them with their decisions. That is why this system has links for treatment routines and literature on best practices embedded in the treatment plan as well as links to Cancer Care Ontario’s patient education information. Clinicians will be able to support patients by reviewing this information with them and providing them with material to review with their family, assisting them in navigating through this difficult life challenge. “Knowing Humber’s plans for technology in their new facility, we were delighted to have them as the first client to launch this software,” according to Lincoln Brewer, MEDITECH’s Senior Development Analyst of Product Development for Oncology. “Humber River’s scope for this implementation was far-reaching, letting us test the different functionalities. We made a great team working together to develop

a product that meets the needs of front line staff and physicians while enhancing patient care.” The implementation of MEDITECH’s new Oncology Management software is helping Humber River Hospital achieve our vision of reinventing patient care. With this system, HRH becomes a leader in digital integration for oncology management, providing a higher level of patient safety and efficient, quality patient care. Using the capabilities of our new hospital and applying a patient and family-centred focus, Humber River will change how we deliver healthcare and how we work as a team in delivering enhanced high quality, H safe, respectful care. ■ Carla Peacock is a Communications Specialist at Humber River Hospital.

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FEBRUARY 2015 HOSPITAL NEWS


22 Nursing Pulse Tech talk

Technology is reshaping health care delivery Here are just a few examples of advances that are having a positive effect on nursing practice and patients. By Melissa Di Costanzo

or years, paramedics showed up at Henry’s* house at least once a month. The man would become short-of-breath without notice. Anxious, he’d pick up the phone and dial 9-1-1. Paramedics showed up so often, he was forced to rearrange his furniture so they were able to manoeuvre around his apartment. Henry has chronic obstructive pulmonary disease (COPD). He panicked whenever he felt as though his lungs were being squeezed, like a balloon slowly and abruptly being released of air. Without a healthcare professional monitoring his coughing, wheezing and fatigue, Henry reached out to the only resource he knew: his local emergency department. Thanks to Telehomecare, Henry is now able to largely avoid the ER. Telehomecare uses a small collection of technology – a touch screen tablet connected to a weight scale, a blood pressure cuff, and an instrument that monitors the level of oxygen in blood – installed in clients’ homes (over 4,000 people across Ontario have been enrolled to date). This technology allows patients like Henry to take their vital signs, Monday through Friday, first thing in the morning. Henry answers questions like: “Is your shortness of breath worse today?” And: “Have you missed or stopped taking any of your medications during the last 24 hours?” Patients are also screened for depression. The entire process takes about five minutes, and the data is uploaded and transmitted to computers manned by about 40 RNs who monitor the information on a daily basis.

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Technology has permeated our personal and professional lives, and it should come as no surprise that health care has found itself at the forefront of innovation. At Toronto’s George Brown College, soon-to-be RNs are using simulated labs to test technology that developers hope will one day improve patients’ experiences with the system. Jaslyn Chouhan is a fourth-year student at the school. She and three other nursing students studied Sensimat, a piece of technology that aims to reduce pressure ulcers.

Technology has permeated our personal and professional lives, and it should come as no surprise that health care has found itself at the forefront of innovation. Here’s how it works: A mat, which can be discreetly placed underneath (or on top of) a wheelchair cushion, contains six sensors connected to a smart phone app. The sensors indicate the amount of pressure placed on them. When a patient sits on the mat, the sensors are activated (on the app, six green circles appear). Patients and practitioners can set the timer to 15, 20 or 30 minutes, after which the circles change to red and an alarm sounds, indicating the patient needs to be moved. Chouhan and her peers used mannequins to test the product. Their findings?

At some point, everyone can use a hand.

That Sensimat assists health-care providers in reducing pressure ulcers. The data they collected was sent to the creators of the product, who are now promoting it at conferences with a focus on technology and innovation. While today’s nursing students are embracing technology before they enter the workforce, there are plenty of nurses who already know just how important innovation is to their ability to improve patient care. In 2012, Newmarket’s Southlake Regional Health Centre implemented McKesson Performance Visibility (MPV), a surveillance system that has become a valuable tool for staff, says Jennifer McQuaig, one of two nurse educators on the medicine floor. MPV allows nurses to pull up hospital floor plans on their computers (this is also displayed on 52-inch screens on all units). The grid mirrors the hospital layout and is broken into rooms. MPV uses icons, colours and clocks to let practitioners know in an instant how many patients are on each floor, and the layout of each unit. The technology also shows how long a room has been vacant, when a bed is being cleaned, and the patient’s whereabouts. Before the hospital adopted MPV, when a patient left the floor for a test or procedure, nurses would scribble that information on a piece of paper or post it on a white board. Now, they can refer to their monitors. Staff in the hospital can also look at the system to determine the expected date of discharge for any patient. MPV allows them to track how many patients will be discharged on a given day, helping the

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team to better prepare for the arrival of new patients. In the past, there were multiple calls between the ER and inpatient units to find out if a bed was ready for an incoming patient. If it wasn’t, the nurse was usually instructed to call back in 30 minutes. In some cases, they may be forced to call again and again until it’s ready. Now, nurses in the ER can see that a room is being cleaned on an inpatient unit. They make one phone call to the appropriate unit and transfer the patient. Perhaps the biggest recent technological shift for Ontario health-care providers is the switch from paper charts to electronic medical records (EMR), or electronic health records (EHR). About two years ago, the Registered Nurses’ Association of Ontario (RNAO) teamed up with OntarioMD, adding nurse peer leaders to an existing Peer Leader Program consisting of physician and clinic manager peer leaders. The OntarioMD/ RNAO Collaborative Peer Leader Program, funded by Canada Health Infoway, supports primary care clinicians and their administrative staff in the adoption and best use of EMRs. It’s a significant change in culture, but RN Connie Wood leapt at the opportunity to mentor colleagues through the transition. She wanted to share her knowledge of EMRs and their many possibilities, including the ease of sharing information, accessing data, and monitoring trends to help target gaps in care and trigger interventions. “You have paper for this; folders for that. But in EMR, (the information is) at your fingertips,” she says. Clinicians can access lab work, diagnostic imaging reports and other test results with the click of a button. Email exchanges among nurses and others can also be saved in the EMR. Wood is a telemedicine clinical co-ordinator at the Haliburton Highlands Family Health Team. Her role as NPL is in addition to this, and is one that allows her to link providers to EMR supports, such as OntarioMD (established to support physician adoption of information technology). She also coaches nurses and other healthcare staff. “Once they realize it’s going to improve patient care, everybody’s on board,” she says. Wood says she was never fearful or wary of EMRs despite seeing some colleagues hesitant of the change. The benefits far outweigh any fears or anxieties, she insists, offering a couple of tips for anyone who may be reluctant to embrace innovation and change: understand your standards of practice, and make sure your passwords are H secure. ■ Melissa Di Costanzo is communications officer/writer for RNAO, the professional association representing registered nurses, nurse practitioners and nursing students in Ontario.

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From F rom tthe he CEO's Desk 2 23

The evolution of an organization We finished our expansion project, so now what?

Janet Beed is the President and CEO of Markham Stouffville Hospital.

By Janet Beed arkham Stouffville Hospital has undergone an extensive renovation and expansion transformation over the last five years. During this period, change became our new normal; and today, our programs and services can evolve in keeping up with the support required by our large community. The physical metamorphosis was incredibly exciting and there was energy infused into the organization throughout the project as everyone worked to make the change a success. On August 24, 2014, the project was done, the contractors were gone, the hoarding was taken down, and we went back to the singular business of being a hospital, not a hospital and a construction site. The change was welcome for many who had to wear two or more hats throughout the project. We had nurses reading blueprints, front-line staff designing workflow and managers coordinating patient moves. It was an excellent learning experience and, and while adding a substantial piece of work to everyone’s plate, it really allowed the whole team to be involved in the new building. The challenge became how to create a similar level of excitement and momentum in the absence of a project of this magnitude. It was not easy for some who really felt the post-construction let down. Their feedback told us that creating a new building, fitting up every room, ordering equipment, moving patients – was incredibly exciting. But now, they have a sense of “what’s next”. For others, they wanted the organization to go back to where it was before the project…a small, intimate, manageable and familiar work place where they knew everyone and knew every nook and cranny. Fortunately, the emphasis of the Ministry of Health and Long Term Care (MOHLTC) and the growing community we serve gave us the “next project” – a focus on organizational efficiency, quality, and patient engagement. We used the completion of the project as a great opportunity to take stock of what we did really well, where there were oppor-

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tunities for change, how we could create formal partnerships to enhance our programs and services, and how we could contribute to the sustainability of the system through an enhanced focus on innovation and creativity. We shifted our self perception so that we could see ourselves more as a partner in healthcare, developing plans to engage the community in our strategic plan and in the patient experience and not just talking to them about our construction project and our endless detours. We are maximizing the fact that our community has a high level of technology comfort as we reach out to engage them in our discussions. We are visiting our community partners and inviting our community partners into our new facility so that they can become ambassadors with their patients on what it will be like to come to MSH for an MRI , CT or for surgery.

The challenge became how to create a similar level of excitement and momentum in the absence of a project of this magnitude We redesigned our organizational structure so that the focus on quality, strategy, human resources and patient experience were aligned. We had long time leaders who stayed with us throughout the project to provide a successful transition; many of whom decided to take a well-deserved retirement following the project. To manage this change, we brought in new talent from other organizations so that we could have a fresh look at ourselves. We shifted our meeting structures and our role expectations so that leaders had time to integrate their approaches to visibility, quality and staff engagement. Quality was already embedded in everything that we did as an outcome of our Leadership for Performance Excellence (LPE) work with the Change Foundation, but we used the project completion as a chance

to push the reset button. There are daily huddles around quality boards, a broader engagement in developing our improvement plans and a significant focus on quality in our strategic plan which has quality as our differentiator and partnerships and as our method of operations. There was also the opportunity to look at our programs and services thoughtfully and to plan, from a strategic perspective, which programs would grow and when, and which programs had outgrown a hospital focus and needed a transition to our community partners. We assessed what our community needed and how we could provide it more efficiently and are currently looking at our clinics to determine how we can maximize the specialist clinics to see more patients with a shorter wait time. We are also looking at easing the congestion in our emergency department and medical units through an avoided admissions focus and earlier discharges in a manner that that will have maximum benefit for our patients. To keep pace with the City of Markham’s economic focus on innovation, we created a role of Chief, Innovation and New Ventures. We need to find a way for entrepreneurs and community hospitals to understand one another. It is my experience that entrepreneurs find hospitals resistant to their new ideas and hospitals find entrepreneurs naive about the complexity of patient care. I believe that there is an answer somewhere in between these two perceptions and that must come together constructively and realistically for the benefit of the whole system. As staff, volunteers and physicians, we also had to get to know each other in a new way. The greatly expanded facility put more physical separation between departments that had been cramped together in the past. Everyone’s travel patterns have shifted and casual opportunities to connect have changed. Many new faces have also joined us such that there are more new people than there are those who founded the hospital in 1990. We now need to use this time to reconnect with the long-time staff and to allow the new staff to infuse us with new ideas and new energy. It is engag-

ing to hear the great ideas that our longtime and new staff can bring to a unit. I am pleased to report that the post construction let down has turned into increased focus on our day-to-day operations and the energy that people had put into the construction project is now energy they are putting into expanding programs for our patients, finding new ways to work collaboratively across units, and enhancing our outreach to the community. We are finding our new identity. The challenges we have gone through over the past five years have helped us to define what our evolving organization can be today and in the future. And we will not forget that this new identity will draw on our founding mission of “making it great” for all. As the organization emerged from the project, I realized that at this point in its evolution, and in mine, it was time for a new leader. We have grown and changed together and now it is time for both of us to go in a new direction - each with our new identities and both with the foundation of kindH ness that brought us together. ■ Janet Beed is the President and CEO of Markham Stouffville Hospital.

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The quest for fast and reliable wireless By Rob Graham he dramatic increase of smart phones, tablets and wireless hospital systems has caused many wireless systems to fail their users. At a time when these networks need to be faster, more accessible and highly reliable, many wireless systems cannot meet today’s needs and are certainly not going to meet tomorrow’s needs. This situation is typically caused by a combination of three factors: The exponential growth of wireless data, the legacy approach to system design and outdated equipment. Discussing each of these: 1. Exponential Demand. One of the best sources for understanding the trends of wireless data growth is the annual Cisco White Paper on Mobile Data and it’s five year forward forecast. In it, Cisco reports recent year over year mobile (wireless) data growth of 81 per cent. More smart phones, more tablets, faster networks and more apps are driving this tremendous growth.

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Many wireless systems cannot meet today’s needs and are certainly not going to meet tomorrow’s needs. One staggering statistic is the fact that in 2013 there were 18 exabytes of data transmitted on mobile devices. Granted, it’s impossible to fathom this number, but to give you some perspective, a study at the turn of the century calculated that the sum of human knowledge to 1999 was 12 Exabytes. Granted, in last year’s wireless data, there were quite a few videos of cats flushing toilets that may not be considered ‘knowledge’. 2. System design. Many of today’s wireless systems were designed as an extension of an IT system, intended for occasional usage for a select few devices /users. With today’s new gigabit wireless Wi-Fi networks and 4G cellular systems, this is just not adequate. A far more scientific approach is required. Proper design to maximize network throughput while minimizing the many types of potential interference is crucial for mid & long-term reliability. A professional RF Engineering firm will often have hundreds of thousands invested in prediction software tools as well as highly sophisticated diagnostic tools and technical staff trained to interpret the information. 3. Modern Equipment. With the everincreasing demands by users and their wireless platforms, the tsunami of the ‘internet of things’ that is coming, wireless equipment needs to be refreshed at an increasing rate. Modern solutions for WiFi include new approaches that reimagine the technology as seen in the Meru Networks ‘Uninterrupted Care for Hospitals’. With the specific needs of hospitals in mind, Meru developed the Uninterrupted Care Network (UCN). UCN enables hospitals to create separate, dedicated application layers for each of: Life Critical Systems (patient monitoring, wireless IV pumps, imaging, etc.), Mission Critical HOSPITAL NEWS FEBRUARY 2015

Systems (physicians & clinicians) and a Consumer layer for patients and visitors. This is accomplished using Meru’s patented RF Channel Layering technology. This novel approach delivers the following benefits: •Improve patient safety and quality of care by isolating life and mission critical applications from all other wireless traffic. • Increase clinician efficiency by providing reliable, pervasive Wi-Fi coverage for mission-critical applications and by enabling

physicians to use the mobility platform of their choice (BYOD). • Improve patient satisfaction by allowing patients to stay connected with family and friends and to stream entertainment of their choice. To meet your wireless demands, it becomes increasingly important to have a wireless specialist on your team. Wireless engineers will use the tools at their disposal to understand the root cause of the issues your users are experiencing and re-

solve them. They are uniquely qualified to professionally design your future network to meet your future requirements. As we look to the future, cats will increasingly be learning new tricks and those must be H shared right away! ■ Rob Graham is President & CEO of Genwave Technologies Inc. a professional engineering firm specializing in the field of In-Building Wireless systems.

Wireless in Healthcare. Delivered. More than ever before, Hospital Staff, Physicians, Key Life Support Systems and Patients all Need Reliable Wireless. And they’re demanding it now. With the exponential increase in the use of smart phones, tablets, health apps and other wireless systems, a robust, reliable, secure and fast wireless system is no longer an option. It’s required. To get the most out of today’s sophisticated wireless systems, they have to be designed, commissioned and supported to meet their full potential. Genwave Technologies is a professional engineering firm that specializes in wireless. From Mission Critical Wi-Fi to Cellular Carrier enhancement systems or Public Safety Radio systems, Genwave will deliver reliable wireless. Wireless. Solved.

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Focus 25

Providing care during a renovation project By Yves Crehore ou hear it all the time from friends and family: living in a renovation zone is difficult. The dust, the mess, the need to improvise to complete normal daily tasks; it’s a constant struggle. Now think of running a hospital during a renovation. The list of factors to consider and risks to mitigate grows exponentially. From sealing off construction zones, to creating negative air pressure to ensure air quality, to rerouting foot traffic to ensure safety – the tasks are tedious and there is very little room for error. The success of a health care construction project is contingent on many elements. Whether designing a new health care facility from the ground up to renovating your old infrastructure to provide modern healthcare, the hospital’s Infection Prevention and Control (IPAC) team is vital throughout each stage of planning, design, demolition and construction; continuing through to final commissioning, and activating the facility or department into full clinical service. IPAC participation from the beginning of the project ensures a vital communication link between clinical user groups and contractors is established.

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Renovating an area where there are no patients is vastly different than renovating one where there are patients down the hall receiving treatment Markham Stouffville Hospital (MSH) recently finished an extensive four year expansion and renovation project, adding a new 385,000 square foot building seamlessly to the existing 325,000 square foot building and extensively renovating the existing building – all while continuing to care for patients. “In considering how we were going to manage the project and who we needed on the team, we knew that IPAC needed to be an integral part of the group, right from day one,” says Suman Bahl, Vice President, Corporate Services and Capital Development. “Making sure our construction site met all the infection prevention and safety criteria was built in from the very beginning and was a critical part of our project plan.” In order to provide critical insight and recommendations on best practices, Infection Control Practitioners (ICPs) learned how to read design plans and how to understand the needs of contractors and necessities of project phases. This knowledge allowed the ICPs to make recommendations around work associated risk related to patients and staff during phases of the work, and advise the contractors on specific requirements of working conditions in various areas of the hospital. During a www.hospitalnews.com

project where staff are working in the environment and providing care, the ICP is a key advisor, playing an important role of facilitating a safe and successful health care construction project. “Renovating an area where there are no patients is vastly different than renovating one where there are patients down the hall receiving treatment,” says Bahl. “We needed to work collaboratively to make certain the work could be done on time and on budget while making sure that it was being done in a way that wouldn’t breach any of our infection or safety protocols.” An example of this is the established requirement of putting up drywall hoardings to contain and separate the hospital environment from the construction environment. Once the hoarding is up, it needs to be monitored regularly to make certain it’s doing its job of properly separating the two environments. Part of creating a safe work environment starts with containing the construction and developing a good plan to separate the renovation areas from the patient areas. “Making sure that our patient care areas were free from any kind of debris or dust was a huge priority. The teams worked closely together to make certain the areas were contained, safe, and workable for everyone,” says Bahl. Good containment design and project management reduces the risk of infections related to construction/renovation work. The importance of documentation and record keeping is paramount. This includes the background infection rates of a unit or area. IPAC surveillance is critical to the early detection of breaches in the care environments surrounded by construction – it allows for rapid interventions and mitigation of impacts to client and staff health if required. In assessing the risks associated with renovations in a given area, the team looked at a number of variables including: • The type, duration and scale of activity (e.g. disruption of water supply and for how long, digging, demolition, fugitive dust control in and around the building sites) • Patient groups at particular risk (e.g. immunocompromised patients, especially oncology patients, including bone marrow transplant, solid organ transplant, and those with hematological malignancies) • Areas of specialty service (e.g. ORs, ICU, NICU, SPD, and pharmacy departments) • Potential pathogens (e.g. Aspergillus, Legionella, spore forming bacilli ) • Other factors (e.g. the nature of adjacent clinical areas, type of ventilation, location of air intakes and return discharge, patient movements, access for construction workers, materials protection and storage, waste removal and transportation through the facility, etc.) “A project of this size and scope requires a great deal of collaboration,” says Bahl. “We needed to make certain our IPAC team could access the construction site and our contractors needed us to make sure we understood the health and safety systems in place on the building site.” To further facilitate the partnership, IPAC

Yves Crehore (left) and Suman Bahl review construction drawings in one of the areas currently under renovation at Markham Stouffville Hospital. The close relationship between the construction and the inflection control teams is critical in a project of this size and scope. members were provided health and safety training by the primary contractor and were able to provide input into the infection control training provided to all the sub contractors. “This allowed us to make certain everyone was on the same page with regards to the understanding and the expectations related to health and safety and infection control.” As the project progresses, it’s important to continually evaluate the risks and modify plans accordingly. Having a mechanism in place to quickly bring the entire team together, review the logistical challenges and determine a plan going forward is critical. It’s also important to document the changes with photos and material samples. Records of designs are also use-

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ful in showing where specifications have changed. “Construction projects are challenging. It’s critical that both the hospital and the construction team agree on the overall goals, have a consistent commitment to patient safety and can be flexible to make changes with respect to construction logistics. This is key to a successful construction project.” says Bahl. If you would like to learn more about the expansion and renovation project at Markham Stouffville Hospital, email myH hospital@msh.on.ca ■ Yves Crehore is a Registered Nurse and Infection Control Practitioner at Markham Stouffville Hospital.

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26 Focus

FACILITIES MANAGEMENT AND DESIGN/HEALTH TECHNOLOGY/GREENING HEALTHCARE

iMedisearch: Educational The Story of a Medical Search Engine from Ontario By Hong Kao welve years ago when I started working as a clinical pharmacist at Trillium Health Centre, technology was far from what it is today. Smartphones were nonexistent and an app was something you ordered at a restaurant. The Internet was not as ubiquitous and useful. Medical websites were just starting to appear. Despite that, some of those sites were quite useful in clinical practice. When such websites were discovered, it was like discovering hidden treasures that must be protected. It was common practice to email website links to oneself or each other, scribble them on pieces of paper, or bookmark them on the Web browser. When there were few websites, this practice was sufficient to keep track of useful medical sites. However, with passing time, the number of useful clinical websites grew exponentially. Needless to say, the pieces of paper could get lost and bookmarking was not always useful if on different computers.

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iMedisearch has the same benefits as a traditional Google search engine -- deep search and fast responses A solution was needed to organize these useful resources in one common place to be accessed from anywhere, regardless of the kind of browser or computer used. That was when www.rphworld.com was conceived. It was to be a gateway website based on the same concept as that of Yahoo, where links of clinical websites were organized under different categories. Each link in this site’s repository would have a short description of what could be found in the corresponding website. RPhWorld was shared amongst colleagues and friends and over the Internet. It has been found to be quite useful in clinical practice in locating necessary resources to solve daily issues such as screening multiple medications for possible drug interactions etc. As more and more links were added to RPhWorld, the site became rather clumsy. A simple category system was no longer practical to allow users quick access to desired websites. This is because with large numbers of sites, categories had to be divided further into sub categories and even sub-sub categories. The solution was to add a search functionality to RPhWorld to help locate the desired link quickly. But even this did not prove sufficient in locating the desired resources, as the search function was only searching the description of the sites, not their contents. Another solution had to be implemented to deep-search into each of the sites in the repository and find articles that would HOSPITAL NEWS FEBRUARY 2015

help in clinical decision making. That was when Google Custom Search was used for such purpose, resulting in much improved search capabilities. RPhWorld was now able to search deeply into thousands of websites to find matching articles, not just descriptions of websites. In addition, after extensive manipulation and tweaking, the search engine was made to be able to assume that the person doing the search was a pharmacist, thereby returning results that are useful to a pharmacist, such as clinical guidelines, continuing education, drug therapies etc. The search results were noticeably much more relevant for pharmacists than those obtained using traditional Google. The feedback for this new search functionality was overwhelmingly positive. Tens of thousands more useful and trusted medical websites were added to the search engine. The search engine was further developed to include modules for physicians, one for the general public, and eventually one for nurses and allied health. This was when a new URL was needed to house this new search engine, and it was to be iMedisearch.com. iMedisearch has the same benefits as a traditional Google search engine – deep search and fast responses. But that's where the similarities end. Firstly, iMedisearch only searches from reputable medical websites (manually selected based on strict accepted criteria), in contrast to Google, which delivers results from any site, leaving users the responsibility of determining which sites are reputable. Secondly, iMedisearch caters search results to different categories of searchers – general public, physicians, pharmacists, nurses, and allied health. This leads to more relevant results for the user. For example, a doctor would not be interested in medical articles written for a lay person. For nurses, searching for a disease condition would bring up articles on nursing care of such patients. And therapists would be served with articles related to therapies and rehabs for the same medical condition used in the search query. iMedisearch went online in 2008. In 2013, it was featured in a health policy textbook – “Advancing Medical Practice through Technology” – and a medical textbook by the Association of Physicians of India titled “The API Textbook of Medicine.” Recently, the Times of India recommended using it to search for reliable medical information on the Internet. iMedisearch is available at www.imedisearch.com and as a BlackBerry 10 app. A Mobile version of the search engine is also available at the same URL. iMedisearch searches from over 80,000 reputable medical websites including UptoDate and is an especially helpful tool to search for clinical guidelines, continuing education, disease H and treatment information. ■ Hong Kao is a clinical pharmacist from Ontario.

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QFebruary 19th-20th, 2015 UofT Nursing, Centre for Professional Development presents: The Institute on Advancing Pain Assessment and Management 155 College Street, Toronto ON Website: http://bloomberg.nursing.utoronto.ca/pd/professionaldevelopment/pain-institute QFebruary 25-26, 2015 National Canadian Forensic Nursing Conference Renaissance Harbourside, Vancouver Website: www.healthcareconferences.ca QMarch 4-5, 2015 Offshore and remote Workplace Health Conference Sheraton Hotel, St. Johns, Newfoundland Website: www.healthcareconferences.ca QMarch 7th, 2015 UofT Nursing, Centre for Professional Development presents: PeriAnaesthesia Review Course 155 College Street, Toronto ON Website: http://bloomberg.nursing.utoronto.ca/pd/professionaldevelopment/perianaesthesia QMarch 22-28, 2015 Health Information Professionals Week Website: www.echima.ca/news/him-professionals-week QMarch 23-24, 2015 Canadian Hip Fracture Management Conference Renaissance Downtown, Toronto Website: www.healthcareconferences.ca QMarch 30-April 1, 2015 Together We Care (ORCA & OLTCA Annual Convention & Trade Show) Metro Toronto Convention Centre, Toronto Website: www.together-we-care.com QApril 12, 2015 HIMSS15 (HIMSS Annual Conference) McCormick Place, Chicago, IL United States Website: www.himss.org QApril 19-21, 2015 HPCO (Hospice Palliative Care Ontario) Annual Conference Toronto Sheraton Parkway Toronto North, Richmond Hill Website: www.hpco.ca QApril 27-28, 2015 2nd Annual National Telemedicine Conference Renaissance Downtown, Toronto Website: www.healthcareconferences.ca QMay 5-6, 2015 Human Resource Strategies for Healthcare Toronto Website: www.healthhrcanada.com QMay 29-30, 2015 Global Telehealth 2015 Metro Toronto Convention Centre, Toronto Website: www.coachorg.com QMay 31-June 3, 2015 eHealth Metro Toronto Convention Centre, Toronto Website: www.e-healthconference.com QJune 14-17, 2015 IPAC Canada 2015 National Education Conference Victoria Conference Centre, Victoria BC Website: www.ipac-canada.org

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Focus 27

Continued from page 5 However, it was clear that these products are effective at reducing the number of microorganisms living on the skin that could infect a surgical incision. For patients at high risk of infection or for whom an infection would have grave consequences, prophylactic antibiotics are often administered before surgery, and their efficacy in preventing SSIs in these

patients is well established. Prophylactic antibiotics are most effective when given one to two hours before surgery, but this time frame can be hard to accommodate. A CADTH review of the evidence concluded that prophylactic antibiotics might also be effective when given 30 to 60 minutes before surgery; however, better-designed trials are needed to confirm this finding.

The prevention of surgical site infection has become a topic of increased interest over recent years, and CADTH has produced several reports on this subject. Those mentioned in this article and many more can be accessed free of charge on the CADTH website: www.cadth.ca/RapidResponse.

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NOMINATE A

NURSING HERO!

Hospital News’ 10th Annual Nursing Hero Awards

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O R E H ARDS! AW

COMMITMENT  DEDICATION  COMPASSION  LEADERSHIP Look around you. 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? Now is your chance to acknowledge and recognize the nursing heroes in your facility or community. Hospital News will once again salute nursing heroes through our annual National Nursing Week (May 11th to 17th) contest. We hope you will share your stories with us so that we can highlight the exceptional work that our nurses are doing and how they touch our lives. Nominations can be submitted by patients or patients’ family members, colleagues or managers. Please submit by April 15th and make sure that your entry contains the following information:

 Full name of the nurse  Facility where he/she worked at the time  Your contact information  Your nursing hero story Along with having their story published, the winner will also take home:

1ST PRIZE: $1,000 Cash Prize

2ND PRIZE: $500 Cash Prize

3RD PRIZE: $300 Cash Prize

Please email submissions to editor@hospitalnews.com or mail to: Hospital News, 610 Applewood Crescent, Suite 401, Vaughan, ON, L4K 0E3 菏˜œ“ˆ˜>̈œ˜Ã܈ÀiViˆÛi>Vœ˜wÀ“>̈œ˜œvÀiViˆ«ÌvÀœ“̅i `ˆÌœÀ°1˜ÌˆޜÕÀiViˆÛiVœ˜wÀ“>̈œ˜̅>ÌޜÕÀ˜œ“ˆ˜>̈œ˜ …>ÃLii˜ÀiViˆÛi`]ޜÕÀ˜œ“ˆ˜>̈œ˜…>ØœÌLii˜i˜ÌiÀi`ˆ˜Ìœ̅iVœ˜ÌiÃÌ°vޜÕ`œ˜œÌÀiViˆÛiVœ˜wÀ“>̈œ˜܈̅ˆ˜ Ó{…œÕÀÃœvi“>ˆˆ˜}ޜÕÀ˜œ“ˆ˜>̈œ˜]«i>ÃivœœÜÕ«>Ìi`ˆÌœÀJ…œÃ«ˆÌ>˜iÜðVœ“œÀLÞÌii«…œ˜i™äxxÎÓÓÈääÝÓÓÎ{°

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Hospital News 2015 February Edition  

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