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Canadian

HealthcareFacilities JOURNAL OF CANADIAN HEALTHCARE ENGINEERING SOCIETY

Volume 39 Issue 4

Fall/Automne 2019

FOREST TO HEAT PM#40063056

Interior Health honoured for adoption of biomass boiler system

Facility renewal in B.C. WAHA's radiator repair Updated ASHRAE standard


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CONTENTS

CANADIAN HEALTHCARE FACILITIES Volume 39

Issue 4

Clare Tattersall claret@mediaedge.ca EDITOR/RÉDACTRICE

30

PUBLISHER/ÉDITEUR Kelly Nicholls kellyn@mediaedge.ca PRESIDENT/PRÉSIDENT

Kevin Brown kevinb@mediaedge.ca

SENIOR DESIGNER/ CONCEPTEUR GRAPHIQUE SENIOR

Annette Carlucci annettec@mediaedge.ca

PRODUCTION MANAGER/ Rachel Selbie DIRECTEUR DE rachels@mediaedge.ca PRODUCTION CIRCULATION MANAGER/ Anthony Campbell DIRECTEUR DE LA circulation@mediaedge.ca DIFFUSION

CANADIAN HEALTHCARE FACILITIES IS PUBLISHED BY UNDER THE PATRONAGE OF THE CANADIAN HEALTHCARE ENGINEERING SOCIETY.

DEPARTMENTS

INNOVATION & TECHNOLOGY

6 8

28 The Consumerization of Healthcare Macro trends and their facility implications

Editor’s Note President’s Message

SUSTAINABLE HEALTHCARE

15 CHES Gallery

31 Road to Renewal Northern Ontario hospitals address infrastructure, operational challenges with upgrade program

CHES AWARDS 20 Fuelling a Clean Energy Future Les sources d’énergie propres de demain 24 The Power of Efficiency Peter Whiteman devotes time, energy to development of sustainable healthcare 26 A ‘Family Affair’ Maritime chapter receives accolades for its contributions to CHES

CHES Canadian Healthcare Engineering Society

SCISS

Société canadienne d'ingénierie des services de santé

PRESIDENT VICE-PRESIDENT

12 Chapter Reports

18 Announcements

SCISS JOURNAL TRIMESTRIEL PUBLIE PAR SOUS LE PATRONAGE DE LA SOCIETE CANADIENNE D'INGENIERIE DES SERVICES DE SANTE.

33 Under Control WAHA staff identify, fix heating issue to save dollars, improve energy efficiency

REGULATORY UPDATE 34 On the Water Front Updated legionella standard provides some clarity, more guidance on the way

PAST PRESIDENT TREASURER SECRETARY EXECUTIVE DIRECTOR

Roger Holliss Craig Doerksen Preston Kostura Kate Butler Reynold Peters Donna Dennison

CHAPTER CHAIRS

Newfoundland & Labrador: Colin Marsh Maritime: Helen Comeau Ontario: Jim McArthur Quebec: Mohamed Merheb Manitoba: Tom Still Saskatchewan: Greg Woitas Alberta: Dan Ballantine British Columbia: Norbert Fisher FOUNDING MEMBERS

H. Callan, G.S. Corbeil, J. Cyr, S.T. Morawski CHES

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EDITOR'S NOTE

THE BEST KIND OF PRAISE FALL IS ASSOCIATED with colourful leaves, cooler weather and for members of the Canadian Healthcare Engineering Society, the CHES National Conference. This year, the esteemed event was held in Saskatchewan, marking a first for the province and chapter. As always, the gala banquet and awards presentation was a highlight. Interior Health was the recipient of the 2019 Wayne McLellan Award of Excellence in Healthcare Facilities Management for its adoption of a biomass boiler system. The innovative technology uses wood pellets and chips to produce heat, replacing the use of propane at Lillooet Hospital and Healthcare Centre and, most recently, Golden Hospital in B.C. This is the second time the health authority has received a nod for its environmental sustainability in the past five years. Fuelling a Clean Energy Future delves into this latest success. Former CHES national president and current director on the Saskatchewan chapter executive, Peter Whiteman, was recognized with the Hans Burgers Award for Outstanding Contribution to Healthcare Engineering. His involvement with CHES spans more than two decades and multiple national board positions during which time he helped expand the organization. His career in facilities management has also proven fruitful, not just for himself but for the organizations he’s worked for over the past 32 years. You can read all about his achievements in The Power of Efficiency. The final accolade of the evening was presented to the Maritime chapter. The two-time President’s Award winner (CHES Maritime was also honoured in 2015) beat out three-time backto-back champion CHES Ontario, returning the east coast chapter to the helm. A ‘Family’ Affair explores the efforts of the executive team over the last year that led the chapter to victory. Congratulations to all!

Clare Tattersall claret@mediaedge.ca

Reproduction or adoption of articles appearing in Canadian Healthcare Facilities is authorized subject to acknowledgement of the source. Opinions expressed in articles are those of the authors and are not necessarily those of the Canadian Healthcare Engineering Society. For information or permission to quote, reprint or translate articles contained in this publication, please write or contact the editor. Canadian Healthcare Facilities Magazine Rate Extra Copies (members only) 25 per issue Canadian Healthcare Facilities (non members) 30 per issue Canadian Healthcare Facilities (non members) 80 for 4 issues A subscription to Canadian Healthcare Facilities is included in yearly CHES membership fees.

6 CANADIAN HEALTHCARE FACILITIES

La reproduction ou l’adaptation d’articles parus dans le Journal trimestriel de la Société canadienne d’ingénierie des services de santé est autorisée à la condition que la source soit indiquée. Les opinions exprimées dans les articles sont celles des auteurs, qui ne sont pas nécessairement celles de la Société canadienne d’ingénierie des services de santé. Pour information ou permission de citer, réimprimer ou traduire des articles contenus dans la présente publication, veuillez vous adresser à la rédactrice. Prix d’achat du Journal trimestriel Exemplaires additionnels (membres seulement) 25 par numéro Journal trimestriel (non-membres) 30 par numéro Journal trimestriel (non-membres) 80 pour quatre numéros L’abonnement au Journal trimestriel est inclus dans la cotisation annuelle de la SCISS.


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PRESIDENT'S MESSAGE

AN INCREDIBLE JOURNEY THIS IS MY first message as CHES National president and initially I wasn’t sure what to write. Should it be motivational and inspirational? Or should it be witty? Which direction should I go (given I only have one chance to make an initial impression)? After reviewing messages written by those before me, I decided it was an appropriate time to pay homage to the past while recognizing the future potential of our organization. I am fortunate to join a long list of strong leaders who have held this position, like Preston Kostura (past president), Mitch Weimer (outgoing past president), among others. They, along with their respective executive teams, and executive director Donna Dennison have managed a number of issues over the years and ensured that CHES is not only in good standing but poised to increase its positive influence in Canadian healthcare. So, I certainly have a sense of responsibility to build on these successes and am optimistic we can continue on this journey. Thankfully, I am surrounded by a solid group of individuals, some seasoned, others up-andcomers, as well as newer members to the CHES family. I am looking forward to working with Craig Doerksen (vice-president), Kate Butler (treasurer) and Reynold Peters (secretary), along with the rest of the CHES team across the country. CHES has a rich history of expanding its influence within Canadian healthcare and building membership expertise. My goal over the next couple of years is to ensure this tradition of growth and continue our positive influence. I invite and challenge all of us to play a role in these endeavours. Roger Holliss CHES National president

EARN CONTINUING EDUCATION CREDITS FROM CHES Members of the Canadian Healthcare Engineering Society can earn free continuing education units (CEU) by reading the Fall 2019 issue of Canadian Healthcare Facilities and passing a quiz based on articles in the issue. Once you’ve read the issue from cover to cover, simply go online to www.surveymonkey.com/r/M2ZD89H to take the quiz. CHES members who pass the quiz will be able to claim one contact hour (0.1 CEU) on their CanHCC or CCHFM certificate renewals.

8 CANADIAN HEALTHCARE FACILITIES


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Proven Efficacy OF Bioassure in Drain Decontamination Clinical epidemiologists have long viewed hospital sink drains as potential reservoirs of pathogens (McBain et al., 2003). Numerous studies have identified Pseudomonas aeruginosa (Davane et al., 2014, Lalancette et al., 2017) and carbapenemase-producing Enterobacteriaceae (Kotsanas et al. 2013, De Geyter et al., 2017) as bacterial inhabitants of hospital sink drains. As further examinations of bacterial populations in sink drains occur around the globe, it appears that virtually any pathogen capable of causing a hospital-acquired infection (HAI) is likely to be found in the sink drains of any hospital.

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Despite all these investigations of bacterial populations in drains, it was not initially clear how these reservoirs can contaminate the environment. What was clear, however, was that bacteria in drains are likely to contaminate the environment if they can “escape� the drain and reach the surrounding surfaces. In 2018, Kotay et al. demonstrated that bacteria from drains and traps disperse into the surrounding environment via droplets rather than via aerosol. In another study from 2017, Kotay et al. observed that droplets can contaminate surfaces around drain openings by up to a distance of 75 cm (30 inches). Linked together, these studies indicate that patient contamination from sink drain bacteria is not as direct as it appears. Sink use must produce droplets and sinks must have bacterial counts of over 105 CFU/mL to observe contamination of the surrounding surfaces. Also in 2017, Kotay et al. demonstrated that Escherichia coli biofilm can migrate from the surface of the drain’s P-trap to the sink strainer at a rate of around 2 inches per day. In the same study, Kotay et al., showed that inoculation of the drain pipes 10 cm (4 inches) below the strainer does not seem to produce contaminated droplets on the surrounding counter.


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Drains are unusual surfaces. They are heavily soiled, wet, hard to reach and used for high soil load discharge. Sanitizing drain pipes therefore cannot be approached in the same way as sanitizing other surfaces such as countertops, desks and tables. The nature of the drain environment promotes the growth of biofilms. In some locations, biofilms are exposed to trace amounts of antibiotics and may develop resistance. In a healthcare setting, it is important to keep this breeding ground under control. Nutrients, water and microbes are constantly being reintroduced in drains. It is therefore unrealistic to expect no bacterial contamination with a single treatment or a permanent log reduction with no further interventions. Our approach is to view drain contamination from a risk management perspective. Based on the literature cited, if the drain treatment can sufficiently lower bacterial counts and if periodical treatments prevent bacterial migration (recolonization) from the P-trap to the strainer, then the risk of contaminating the surrounding surfaces will be both minimal and controllable.

State of biofilms in drain before treatment State of biofilms in drain after treatment WITH BIOASSURE

In 2016, Stjärne Aspelund et al. examined the potential of using acetic acid as a decontamination method for sink drains. In 2017, Marchand et al. also compared the in vitro efficacy of various chemicals for killing bacteria in a biofilm and for removing the biofilm structure. In 2018, Marchand et al. presented the results of a new study showing the synergistic anti-biofilm effect of peracetic acid and a blend of selected surfactants. Peracetic acid is created by the reaction of acetic acid and hydrogen peroxide. Also in 2017, Marchand et al. demonstrated the efficacy of peracetic acid for killing Pseudomonas grown in a biofilm. Marchand et al., have performed numerous other studies to demonstrate the in vitro efficacy of Bioassure, a disinfectant that contains peracetic acid and a surfactant (unpublished data). Dead biofilm residue

Antibiofilm Efficacy

Pseudomonas aeruginosa: ATCC 15442 Staphylococcus aureus: ATCC 6538

Bactericidal Efficacy

Pseudomonas aeruginosa: ATCC 15442 Salmonella enterica: ATCC 10708 Staphylococcus aureus: ATCC 6538

Our main objective is to determine if treatment with Bioassure, a DIN-registered disinfectant carrying a specific claim against biofilms, can lower the bacterial contamination in inner drain pipes and P-traps. This study demonstrates the efficacy of Bioassure on inner drain pipe contamination. Results on P-trap contamination are also conclusive. In 2017, Kotay et al., mentioned that it takes a P-trap contamination of 5 log or more for droplets from the drain to contaminate surrounding surfaces. In 2018, Kotay et al., demonstrated that bacteria can migrate quite quickly up the surface of an inner drain pipe and reach the strainer. Also in 2018, Kotay et al., demonstrated the when a strainer is contaminated, it can contaminate droplets emerging from the drain and contribute to the contamination of the surrounding areas. The results presented here show that following one complete Bioassure treatment, P-trap contamination drops significantly below 5 log and that Bioassure treatment significantly reduces contamination on the surface on the inner drain pipe, thereby limiting strainer contamination. These findings are encouraging and should support the use of Bioassure as an efficient method for controlling bacterial contamination in sink drains in a hospital setting. André Côté Assistant Director, Microbiology & Regulatory Affairs Sani Marc

Antibiotic Resistant Organisms

Methicillin-resistant Staphylococcus aureus: ATCC 33591 Vancomycin-resistant Enterococcus faecalis: ATCC 51299 Carbapenemase-producing Escherichia coli: ATCC BAA-2340 Carbapenemase-producing Klebsiella pneumoniae: ATCC BAA-1705

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CHAPTER REPORTS

NEWFOUNDLAND & LABRADOR CHAPTER

QUEBEC CHAPTER

After last year’s national conference in St. John’s, Nfld., the executive team decided to postpone the chapter’s 2019 professional development day to September from May. Our vendors are also our sponsors and they had just heavily committed to the 2018 CHES National Conference. We also agreed to reduce the cost of sponsorship by nearly 50 per cent in appreciation of vendors supporting last year’s national conference. Unfortunately, attendance was lower than we had hoped for this year’s professional development day. Extended vacations, the start of the school year and hurricane Dorian rolling across the province impacted our numbers; however, we had great presenters and a captive audience. It has been nearly two years since we had a complete chapter executive. After a nomination and voting process, two CHES members have joined the executive team. Our vice-chair and secretary roles are now filled. We look forward to the new insights, approaches and ideas they will bring. The local economy has taken a hit with the completion of major offshore projects and less money f lowing from Alberta, among other reasons. Given that the chapter executive has been small for some time now, much of our focus had been on planning the 2018 CHES National Conference and this year’s professional development day, among other events, as well as attending various committee meetings. As a result, we have not devoted much time to increasing membership. The chapter will push recruitment of vendors/suppliers, consultants, contractors and others going forward to improve membership enrolment. In addition, we hope to help with the renewal of membership dues each year, and are strategically looking at ways of attracting people from across the province. CHES Newfoundland and Labrador is sitting in a solid financial position. Because of this, we agreed to sponsor two members to go to the 2019 CHES National Conference in Saskatoon, waive the $50 fee to attend this year’s professional development day and lower the cost to $1,500 from $2,500 for vendors/presenters involved in the professional development day. We also decided that as long as the chapter is financially sound, we will sponsor the chairs and possibly vice-chairs of national committees to attend national conferences, beginning next year. The chapter executive has determined it’s time to give back to members that work and live in areas of the province that sometimes find it challenging to attend events. Starting in 2020, we will be taking our professional development day on the road, beginning in Gander. Through our travels, we hope to draw more attention to the work of the chapter and the organization as a whole. The chapter is interested in partnering with local and provincial construction agencies, such as the Newfoundland and Labrador Construction Association (NLCA). We feel that such relationships would benefit all members, and help build a smarter and safer healthcare environment. Our goal is to establish a collaborative team that includes consultants, contractors, vendors and governing agencies. —Colin Marsh, Newfoundland & Labrador Chapter chair

As we wrap up the first year of the relaunch of the chapter, we are planning the last event for 2019. The Quebec chapter will host a dinner-conference Oct. 22. Further details to be revealed soon. The chapter is actively planning events for 2020. To help us in this process, we have launched a survey to obtain feedback from members and non-members. Please go to the Quebec chapter page on the CHES website to participate, and share your suggestions and comments. For the first time, I attended the national conference as chapter chair. Held Sept. 22-24, in Saskatoon, it provided the opportunity to become more involved in CHES and to be exposed to new ideas that can help further develop the Quebec chapter. —Mohamed Merheb, Quebec chapter president

Alors que nous entamons notre première année avec un nouveau chapitre, nous organisons notre dernier événement pour 2019. La date à enregistrer dans vos calendriers est le 22 Octobre. Le sujet du dîner-conférence et toutes les détails seront révélés bientôt. En parallèle, nous planifions activement les événements pour 2020. Pour nous aider dans ce processus, nous avons lancé un sondage pour nous aider à obtenir les commentaires de nos membres et de nos non-membres. Nous vous invitons tous à consulter le site web de notre chapitre pour participer et à partager avec nous vos suggestions et vos recommandations. D'autre part et pour la première fois, j'assisterai à la conférence nationale du SCISS à Saskatoon en tant que président du chapitre. J'attends cet événement avec impatience, car cela nous permettra davantage d’être impliqué dans le domaine et de ramener des idées pour développer le chapitre au Québec. —Mohamed Merheb, président du chapitre du Québec

t

12 CANADIAN HEALTHCARE FACILITIES

CHAPITRE DU QUEBEC

The Quebec chapter will hold a dinner-conference in Montreal, Oct. 22.


CHAPTER REPORTS

MARITIME CHAPTER

BRITISH COLUMBIA CHAPTER

Planning for the chapter’s fall education day is well underway. It will take place Nov. 19, at the Best Western Glengarry in Truro, N.S. We welcome all Maritime CHES members and non-CHES front line maintenance workers in healthcare and long-term care to register for the event. The 2019 spring conference in Moncton, N.B., was such a financial success that it allowed us to cover the travel expenses for the entire chapter executive to this year’s national conference in Saskatoon, from revenue generated. It was an excellent learning and networking experience, and provided an opportunity for leadership growth. The 2020 CHES National Conference will be held in Halifax, Sept. 20-22, at the Halifax Convention Centre. Planning is well underway. The theme is, ‘Enriching Patient Experiences by Optimizing the Environment.’ The chapter is able to balance its books while offering several financial incentives to its members in the way of student bursaries, contributions to Canadian Certified Healthcare Facility Manager (CCHFM) exam fees, webinars, the fall education day and other rebates. —Helen Comeau, Maritime chapter chair

Blue skies, sunny days and rain. This summer was a welcome reprieve from the last two dry, hot and smoke-filled ones. While some areas still experienced evacuations, it was much quieter for facility maintenance staff. Next year’s chapter conference will be held in Whistler, June 7-9, at the Delta Whistler Village Suites. Planning for the event is now underway. I encourage you to go to the B.C. chapter’s page on CHES’s website to obtain up-todate information and sign-up for the CHES e-newsletter. Did you know that on April 29, 1982, a steering committee comprised of Jim Gray, Chas Easton, Geoff Blackburn, Jack Harder, Ed Marshall, David Leaney and Ken White convened to discuss the formation of the B.C. chapter of the Canadian Healthcare Engineering Society? Approval was granted less than two months later on June 22, and the CHES national executive gave its full support to start the new chapter. The first CHES B.C. meeting was held Oct. 1, in Vancouver. If you are aware of any other past events or names of people that played a role in the establishment of CHES B.C., please let me or any member of the chapter executive know. —Norbert Fisher, British Columbia chapter chair

ONTARIO CHAPTER With more than 100 delegates in attendance and a sold-out exhibit hall, the Ontario chapter’s annual spring conference in Hamilton, June 2-4, was a huge success. Thank you to the conference planning committee for another job well-done, and a special thanks to conference chair Ron Durocher. The chapter executive has seen a change with the retirement of Rick Anderson as education chair. Rick served on the executive team for more than 20 years. His commitment to CHES will be missed. Derek Lall from London Health Sciences has joined the executive to fill Rick’s past role. The Ontario chapter will host the two-day Canadian Healthcare Construction Course (CanHCC) Oct. 31-Nov. 1, in Toronto. Our fall education day will be held Nov. 6, in Cambridge. The planning committee held its first meeting for next year’s spring conference in Windsor, May 31- June 2. The 2021 conference will be held in Niagara Falls, and we will host the CHES National Conference in tandem with the International Federation of Hospital Engineering (IFHE) Congress the following year in Toronto. Planning is well underway for this 2022 event. The chapter executive met face-to-face in September, at the national conference in Saskatoon. We will convene again immediately following the fall education day in November. I’d like to congratulate the Maritime chapter for winning this year’s President’s Award, as well as past Ontario chapter chair Roger Holliss on assuming the role of CHES national president. I’d also like to recognize all chapters for their work in making CHES such a great organization, and Preston Kostura, Craig Doerksen, Kate Butler and Reynold Peters who have taken on new positions with the national executive. I look forward to seeing you at future events. —Jim McArthur, Ontario chapter chair

FALL/AUTOMNE 2019 13


CHAPTER REPORTS

ALBERTA CHAPTER The Alberta chapter executive enjoyed this year’s CHES National Conference in Saskatoon. It was my first trip to the conference as chapter chair as well as the first time I’ve visited the Saskatchewan city. It was great to see our CHES peers from the other provinces once again. The chapter has provided a three-year bursary to students attending the Southern Alberta Institute of Technology (SAIT). The bursary is for students at the MacPhail School of Energy, which provides hands-on, industry-guided training in labs that mimic job site environments, giving them the skills to find a rewarding career in the energy sector. I toured the state-of-theart facility and was very impressed. It’s not only the first school of energy in Canada, but it’s also one of a handful in North America. The chapter executive is very proud to be able to support students in this program. CHES Alberta will host the Canadian Healthcare Construction Course (CanHCC) in Calgary, at Hotel Blackfoot, Oct. 17-18. Seats are filling up fast, so I urge you not to delay in taking advantage of this learning opportunity. National Healthcare Facilities and Engineering Week is fast approaching. Held Oct. 20-26, it’s an ideal opportunity to showcase your facility’s engineering department and the work staff do in support of their healthcare institution. Visit the CHES website for more information and ideas to help celebrate this important week. —Dan Ballantine, Alberta chapter chair

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A very busy summer for the Manitoba chapter. Planning for the 2021 CHES National Conference and a fall education session on managing fire safety risks received much of our attention. We met with local university and college staff to discuss their involvement. The chapter executive also decided to expand our annual education day, which has been renamed. The new CHES Manitoba Conference and Trade Show will now be a two-day event. To be held April 20-21, it will include a banquet and entertainment. The theme is, ‘Construction and Renovations in Healthcare Facilities.’ Event details are still in the planning stage and will be revealed in the coming months. Also new to the chapter is two annual CHES Manitoba awards. The Award for Excellence in Facilities Management recognizes outstanding achievement and performance in the healthcare facilities management profession by a CHES Manitoba regular member. The Award for Excellence in Project Management recognizes outstanding achievement and performance in the healthcare project management profession by a CHES regular member. Terms of reference will be sent out to chapter members in the near future. Elections will be held for the chapter executive next year. A call for nominations will be made in December. —Tom Still, Manitoba chapter chair


CHES GALLERY

SASKATCHEWAN DRAWS CROWDS TO CHES NATIONAL CONFERENCE SASKATOON’S ARTS and convention centre, TCU Place, was abuzz Sept. 22-24, serving as the host venue for CHES’s first-ever national conference in Saskatchewan. As every year, the Great CHES Golf Game kicked off the three-day event, which attracted more than 420 attendees and 163 delegates. The sold-out trade show floor boasted 114 booths, and the educational program covered a wide variety of topics based around the conference theme, ‘The ‘HUB’ that Enables Resilience in Healthcare.’ Conference highlights included the inspiring keynote address by Mark Black, a heart and double-lung transplant recipient turned four-time marathon runner, author, coach and speaker; the gala banquet, with entertainment provided by Juno awardwinning guitarist Jack Semple, and presentation of this year’s CHES awards; and trips to the Western Development Museum and Wanuskewin Heritage Park as part of the companion program. FALL/AUTOMNE 2019 15


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And this can result in dollars-and-cents savings. For instance, ISSA notes employees’ productivity levels were found to be heavily influenced by the cleanliness of the facility they worked in.

To help trim costs, the insurance company decided to do two things:

Preserving Building Assets A major North American insurance company installed carpet in their hundreds of office locations. The carpet had to be cleaned once or twice per year and in most cases, only lasted roughly three or four years. Maintaining and replacing the carpet cost the insurance company hundreds of thousands of dollars every year. The insurance company toyed with the idea of removing the carpet, but found that when they did so, agents and customers felt a lack of privacy discussing their insurance needs. Carpet helps quiet

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They cut the carpet cleaning frequencies to about once per year, hoping to save thousands of dollars every year. They hired a cleaning consultant to suggest ways to help them find a way to keep the carpet lasting longer.

To their surprise, the cleaning consultant advised the company that they needed to increase cleaning frequencies, not decrease them. Reluctantly, the insurance company followed his advice and set up a pilot program. In a select number of locations, instead of carpet being cleaned just once per year, it was cleaned two, three, and in some cases, four times per year depending on carpet soiling.

After two years, the insurance company analyzed the outcomes. What they found was that the carpet cleaned more frequently was now lasting five to seven years, instead of only three. This meant the carpet did not have to be replaced as often which resulted in the insurance company saving thousands of dollars annually. This result was mirrored in studies by the Institute of Inspection Cleaning and Restoration Certification (IICRC) and the Carpet and Rug Institute (CRI). They found that a planned carpet maintenance program that involves more frequent carpet cleaning extends a carpet’s useful life, “well beyond the manufacturer’s estimated life cycle, ultimately paying for itself in deferred replacement costs.”

Nilfisk can help with all your facility cleaning needs, visit us at www.nilfisk.ca to learn more.


ANNOUNCEMENTS

CHANGE IN LEADERSHIP AT CANADIAN COALITION FOR GREEN HEALTH CARE THE CANADIAN COALITION for Green Health Care has a new executive director. Neil Ritchie was appointed to the position Sept. 4. “I’m delighted to work with a group of people who are passionate about their work and have accomplished so much to reduce healthcare’s carbon footprint,” says Ritchie. Previously, Ritchie led the Green Health Leaders’ Initiative for the Coalition, which focused on enabling health executives, physician leaders and board members to become better environmental stewards. He is an experienced healthcare executive who has worked as CEO, COO and vice-president of large, multi-site academic teaching centres, regional health authorities and community hospitals in Canada. He’s also worked as an executive with a number of health technology start-up companies. Ritchie succeeds founding executive director, Linda Varangu, who has stayed on with the Coalition as a senior advisor to its climate change portfolio. Varangu has been empowering healthcare facilities to improve environmental stewardship since the 1980s. She has led projects to reduce waste and use of toxic chemicals, provide healthy local foods, save energy and water, and help facilities prepare and adapt to the impacts of climate change. In 2008, Varangu joined the Coalition, first as partnership director and then as the founding executive director for an additional six years. In this role, she led the Coalition from a voluntary network to a national incorporated not-for-profit, membership-based organization that is now recognized as Canada’s primary thought leader on green healthcare and climate change resiliency. Under Varangu’s direction, important resources, toolkits, programs and pilots were created for healthcare facilities,

CHES Canadian Healthcare Engineering Society

earning the Coalition a strong and respected national voice. In addition, the Coalition explored opportunities to develop social enterprises by piloting a Green Revolving Fund and an energy services consultancy through Health Care Energy Leaders Ontario (HELO). The HELO program continues to be offered and is now available Canada-wide as HEL-C. For nearly 20 years, the Coalition has been helping those who work in healthcare facilities, government, non-governmental organizations and businesses to share green health best practices and become better prepared to deal with climate change. Recently, it was recognized as a Gold Climate Champion among 14 countries by Health Care Without Harm, and received its third Energy Star Advocate of the Year award.

SCISS

Société canadienne d'ingénierie des services de santé

CALL FOR NOMINATIONS FOR AWARDS 2020 Hans Burgers Award for Outstanding Contribution to Healthcare Engineering DEADLINE: April 30, 2020

2020 Wayne McLellan Award of Excellence in Healthcare Facilities Management DEADLINE: April 30, 2020

To nominate: Please use the nomination form posted on the CHES website and refer to the Terms of Reference.

To nominate: Please use the nomination form posted on the CHES website and refer to the Terms of Reference.

Purpose: The award shall be presented to a resident of Canada as a mark of recognition of outstanding achievement in the field of healthcare engineering.

Purpose: To recognize hospitals or long-term care facilities that have demonstrated outstanding success in completion of a major capital project, energy efficiency program environmental stewardship program or team building exercise.

Award sponsored by

Award sponsored by

For Nomination Forms, Terms of Reference, criteria, and past winners www.ches.org / About CHES / Awards Send nominations to: CHES National Office ches@eventsmgt.com Fax: 613-531-0626 18 CANADIAN HEALTHCARE FACILITIES


ANNOUNCEMENTS

IFHE CONGRESS PLANNING COMMITTEE UNVEILS WINNING BANNER DESIGN IN LESS THAN TWO years’ time, healthcare professionals from around the world will convene in Toronto for the 27th Congress of the International Federation of Hospital Engineering (IFHE). In preparation of this monumental event, the congress planning committee (comprised of Steve Rees, Preston Kostura, Craig Doerksen, Reynold Peters, Roger Holliss, John Marshman, Kate Butler, Jim McArthur and Donna Dennison) has met several times, both virtually and in-person, since the beginning of the year. Current IFHE president Darryl Pitcher travelled from Australia to Hamilton, Ont., to partake in the face-to-face meeting June 4, on the last day of the annual Ontario chapter conference. In spring, the committee undertook marketing collateral development for the congress. It reached out to the graphic arts program at Conestoga College in Kitchener, Ont., to assist with this endeavour. The college agreed to a student design competition. Four teams of four presented their creations, two of which designed two banners (with logos) for a total of six. After five days of deliberations due to the high calibre of work, the judges (Holliss, Dennison and McArthur) picked the winning submission, designed by team four (who presented two options). All six submissions were worthy of the win, which made the selection process extremely difficult. The chosen banner (with logo) had everything the committee was looking for: the city skyline, maple leaf and background grid representing engineering. Since then, the committee has been busy developing marketing materials for use at conferences, including the 2019 CHES National Conference in Saskatoon, where the banner made its official debut. In early October, McArthur, Rees and Holliss travelled to Manchester, England, for the 2019 IFHE Europe Conference (hosted by the Institute of Healthcare Engineering and Estate Management) where more than 4,000 delegates were in attendance. There, they promoted the event at a trade show booth and made valuable contacts. The trio will travel next to the 2020 IFHE Congress in Rome, May 2328, as well as various chapter spring conferences. Although there’s still much time to plan for the IFHE Congress on Canadian soil, the committee has already booked the conference location and accommodations — the Westin Harbour Castle. The opening reception will be held at the Hockey Hall of Fame and the gala banquet will take place at the Liberty Grand entertainment complex. Companion program excursions include a day trip to Niagara Falls, Ont., and surrounding wine country, and a tour of the CN Tower. Education program planning will begin in earnest in early 2020, revolving around the theme, ‘Unleashing Innovation: Healthcare Engineering Excellence.’ Before then, Gordon Burrill and Maritime chapter executive vice-chair Robert Barss will be brought into the congress planning committee fold. The 2022 IFHE Congress will be held Sept. 15-22, 2022. —Jim McArthur, 2022 IFHE Congress chair

TORONTO, CANADA TORONTO, SEPTEMBERCANADA 17 - 21, 2022 SEPTEMBER 17 - 21, 2022

UNLEASHING UNLEASHING INNOVATION INNOVATION HEALTHCARE HEALTHCARE ENGINEERING ENGINEERING EXCELLENCE EXCELLENCE Learn more at: Learn more at: www.IFHE2022.org www.IFHE2022.org

27TH CONGRESS OF 27TH CONGRESS OF THE INTERNATIONAL THE INTERNATIONAL FEDERATION OF FEDERATION OF HOSPITAL ENGINEERING HOSPITAL ENGINEERING

FALL/AUTOMNE 2019 19


CHES AWARDS

LEFT TO RIGHT: Interior Health's Steve McEwan, Trevor Fourmeaux, Ryan Galloway and Norbert Fischer with Honeywell's Luis Rodrigues.

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FUELLING A CLEAN ENERGY FUTURE Les sources d’énergie propres de demain

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n route to British Columbia’s interior via Highway 99 is the Fraser Canyon, an area known for its picturesque mountain peaks and magnificent granite walls. Amidst the gorgeous gorge is Lillooet, home to a healthcare facility that bears the name of the community within which it resides. In winter 2018, Lillooet Hospital and Healthcare Centre set out to install a stand-alone biomass boiler plant on-site, the first project of its kind to be implemented in a healthcare setting in B.C. The innovative venture garnered Interior Health this ye a r ’s Way ne Mc L e l l a n Aw a r d of E xc e l lenc e i n Healthcare Facilities Management. “It’s exciting to receive this sort of recognition, particularly given we stepped outside our comfort zone with this endeavour,” says Interior Health energy manager, Ryan Galloway, who accepted the award on behalf of the health authority. 20 CANADIAN HEALTHCARE FACILITIES

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n route vers l’intérieur de la Colombie-Britannique par la route 99, on tombe sur la région du canyon du Fraser, connue pour ses pittoresques sommets montagneux et ses magnifiques murs de granit. Au milieu de cette gorge magnifique se trouve Lillooet et, dans cette localité, un établissement de soins de santé qui en porte le nom. À l’hiver 2018, l’Hôpital et centre de soins de santé de Lillooet a entrepris l’installation d’une chaudière à biomasse autonome, le premier projet du genre dans un établissement de soins de santé de la Colombie-Britannique. Cette idée novatrice a valu à Interior Health le Prix d’excellence Wayne McLellan en gestion des établissements de soins de santé de cette année. “C’est excitant de recevoir ce genre de reconnaissance, d’autant plus que nous sommes sortis de notre zone de confort avec ce projet,” raconte Ryan Galloway, directeur de l’énergie à la régie


CHES AWARDS Like many remote sites, Lillooet Hospital relied on propane to heat the facility. Not only expensive, this fuel source also produces greenhouse gas emissions. These two issues, along with the fact that the existing boiler plant was nearing the end of its useful life and was no longer reliable, were the main drivers behind the $1.1 million project, which was funded by the province’s Carbon Neutral Capital Program. Under the program, the government provides funding to public sector organizations to invest in capital projects that reduce energy costs and lower carbon emissions. Interior Health’s original plan was to install the pre-fabricated biomass boiler plant across the road from the existing one and connect them by way of underground pipes. However, the conventional approach was modified after then-director of plant services, Steve McEwan, determined it would be more economical to stack the two and run piping tie-ins parallel to the existing boiler. “Locating the biomass plant on the roof of the existing boiler room avoided costly site work and site disruption, eased the maintenance implications and reduced project costs,” says Galloway, who gives McEwan credit for his insightful solution. In order to stack the boilers, Interior Health, working in concert with engineering consultant Stantec, had to structurally upgrade the roof of the existing plant. This was one of the many challenges the health authority came up against. Initially, the biomass plant was slated to service both the heat and hot water needs of Lillooet Hospital. But due to budgetary escalation, Interior Health had to exclude the domestic hot water heat exchanger from the project scope. As well, the new plant’s fuel source was originally supposed to be only wood pellets; however, to future-proof the plant and increase the resiliency of the fuel supply chain, a change had to be made to allow the silo and auger to accept both wood chips and pellets. While this was determined prior to the start of plant fabrication, it did result in a cost increase during construction. “We learned that understanding the fuel sources, delivery and fill methods for the future are critical for us to have successful final outcomes,” reflects Galloway.

régionale de la santé Interior Health. Galloway a accepté le prix au nom de cet organisme. Comme de nombreux établissements en région éloignée, l’hôpital de Lillooet était chauffé au propane. En plus d’être coûteux, ce carburant produit des émissions de gaz à effet de serre. Ces deux problèmes, ainsi que le fait que la chaudière existante, approchant la fin de sa durée de vie utile, n’était plus fiable, ont été les principales motivations de ce projet de $1.1 million. Celui-ci a bénéficié de financement du Programme d’immobilisations carboneutres de la province. Dans le cadre de ce programme, le gouvernement fournit des fonds aux organismes du secteur public pour qu’ils investissent dans des projets d’immobilisations qui réduisent les coûts énergétiques et les émissions de carbone. À l’origine, Interior Health voulait installer la chaudière à biomasse préfabriquée de l’autre côté de la route par rapport à la chaudière existante et les raccorder par des tuyaux souterrains. La régie a changé d’idée lorsque son directeur de l’énergie de l’époque, Steve McEwan, a calculé qu’il serait plus économique d’empiler les deux chaudières et de faire courir la nouvelle tuyauterie le long de l’ancienne. “L’installation de la chaufferie à la biomasse sur le toit de la chaufferie existante a permis d’éviter des travaux coûteux qui auraient perturbé le site, de simplifier la maintenance et de réduire les coûts du projet,” explique Galloway, qui accorde volontiers à McEwan la paternité de cette bonne idée. Afin d’empiler les chaudières, Interior Health, de concert avec l’ingénieur-conseil Stantec, a dû améliorer la structure du toit de la chaufferie existante. D’ailleurs, ce n’est qu’un des nombreux défis qu’elle a dû relever. Au départ, la centrale de biomasse devait répondre aux besoins en chaleur et en eau chaude de l’hôpital. Mais, en raison d’une escalade budgétaire, Interior Health a dû exclure l’échangeur de chaleur à eau chaude du projet. En outre, la nouvelle installation devait, à l’origine, consommer uniquement des granules de bois. Toutefois, pour assurer la pérennité de la chaufferie et accroître la résilience de la chaîne d’approvisionnement en combustible, on a modifié le silo et la vis sans fin pour qu’ils acceptent aussi les copeaux de bois. Bien qu’on

The addition of the biomass plant, which works in tandem with the propane plant and carries up to 95 per cent of the space heating load, is projected to offset 6,200 gigajoules of propane each year.

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FALL/AUTOMNE 2019 21


CHES AWARDS

The new plant’s fuel source was originally supposed to be only wood pellets; however, to future-proof the plant and increase the resiliency of the fuel supply chain, a change had to be made to allow the silo and auger to accept both wood chips and pellets.

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Interior Health encountered its greatest challenges during the commissioning process. At one point, the boiler plant sat idle for months because contractors were delayed in accessing the site due to its remote location. As a result, the auger mechanism was not fully installed prior to silo fill. This meant the entire silo had to be emptied, repaired and refilled at the contractor’s expense. Around this time, it was discovered that the wood pellets had frozen and thawed with the weather and subsequently expanded, rendering them unusable. “Now when we shut down the boiler, we have a process to burn through the fuel so no pellets are left inside the auger,” he notes. Despite these setbacks, the project has achieved Interior Health’s prime objectives of utility savings and reducing the environmental impacts of propane combustion. The addition of the biomass plant, which works in tandem with the propane plant and carries up to 95 per cent of the space heating load, is projected to offset 6,200 gigajoules of propane each year. In comparing the avoided propane against the cost of wood pellets, Interior Health anticipates it will save approximately $124,000 annually. Simple payback for the project is less than nine years. Beyond this, Interior Health expects the renewable energy for heating services to reduce the carbon emission impact of the site by 83 per cent. This supports the health authority’s current directive to reduce its emissions by 40 per cent by 2030 (across all sites), under the province’s Greenhouse Gas Reduction Targets Act. Additional successes were achieved in potentially stimulating growth of local industry in wood chip and pellet supply, and by reducing Interior Health’s truck costs associated with transporting propane to the site. “Shifting from the propane storage tank to the wood pellet silo has significantly increased the total amount of fuel storage for the hospital, which translates into fewer truck trips,” says Galloway. He adds that the availability of an alternative fuel source means previous heating disruptions due to propane supply shortages are now a thing of the past. What’s more, Interior Health has been able to defer replacement of the propane plant for the foreseeable future. “The second boiler plant will extend the life of the existing one and it allows us to switch between fuel sources,” he explains. “So, 22 CANADIAN HEALTHCARE FACILITIES

eut pris ces décisions avant le début des travaux, celles-ci ont tout de même fait grimper la facture. “Nous avons appris que, pour obtenir de bons résultats, il fallait absolument comprendre les sources de carburant et les méthodes de livraison et d’alimentation du futur,” confie Galloway. C’est au cours de la procédure de mise en service qu’Interior Health a fait face aux plus grosses embûches. La chaufferie est restée inactive pendant des mois, parce que son emplacement difficile d’accès a retardé les entrepreneurs. Par conséquent, le mécanisme de la vis sans fin n’était pas complètement installé avant qu’on remplisse le silo. Il a donc fallu vider complètement le silo, faire les ajustements et le remplir à nouveau, le tout aux frais de l’entrepreneur. Vers la même période, on a découvert que les granules de bois avaient gelé et dégelé aux intempéries. Ils s’étaient dilatés, les rendant inutilisables. “Dorénavant, lorsque nous arrêtons la chaudière, nous avons un processus pour brûler le combustible afin qu’il n’y ait plus de granules dans la vis.” Malgré ces revers, le projet a atteint les principaux objectifs d’Interior Health, à savoir réaliser des économies sur les services publics et réduire l’impact environnemental de la combustion du propane. L’ajout de la chaudière à la biomasse, qui fonctionne en tandem avec celle au propane et qui peut se charger de 95 pour cent du chauffage, devrait permettre d’économiser 6,200 gigajoules de propane par année. En comparant le propane non brûlé au coût des granules de bois, Interior Health prévoit économiser $124,000 par année. Le coût du projet sera couvert en moins de neuf ans. En outre, Interior Health s’attend à ce que cette énergie renouvelable pour les services de chauffage réduise les émissions de carbone du site de 83 pour cent. Or, elle s’est donné pour directive de réduire ses émissions de 40 pour cent d’ici 2030 (pour l’ensemble de ses installations), conformément à la Loi sur les objectifs de réduction des gaz à effet de serre de la province. Soulignons aussi que ce projet risque de stimuler la croissance de l’industrie locale des copeaux et des granules de bois, en plus de réduire les coûts générés par le transport du propane par camion.


CHES AWARDS

“WE LEARNED THAT UNDERSTANDING THE FUEL SOURCES, DELIVERY AND FILL METHODS FOR THE FUTURE ARE CRITICAL FOR US TO HAVE SUCCESSFUL FINAL OUTCOMES.”

during those peak cold days in winter, the propane boiler will come on to supplement the biomass boiler.” Since project completion in winter 2019, Interior Health has implemented a second biomass plant at Golden Hospital, and is considering utilizing a biomass district energy network for both of its facilities in Enderby and Clearwater. As other health authorities look to retrofit or replace aging mechanical infrastructure, Galloway hopes this project will encourage them to consider new and emerging technologies as options for energy generation, where feasible. “We don’t have to rely on fossil fuels to meet our energy needs,” he says. “There are alternatives that can help transition us to a decarbonized energy supply, which means we can slow the risks associated with increasing temperatures across the globe.”

“Le passage du réservoir de stockage de propane au silo à granules de bois a considérablement augmenté la quantité de combustible stocké à l’hôpital, ce qui diminue le nombre de déplacements par camion,” explique Galloway. Il ajoute que la disponibilité d’une source de combustible de remplacement signifie qu’il n’y aura plus d’interruptions de chauffage dues à un manque de propane. De plus, Interior Health a pu reporter le remplacement de la chaudière au propane pour l’instant. “La deuxième chaudière prolongera la durée de vie de la première, en plus de nous permettre de passer d’un combustible à l’autre. Pendant les journées froides d’hiver, la chaudière au propane viendra appuyer celle à la biomasse.” Depuis l’achèvement du projet à l’hiver 2019, Interior Health a installé une deuxième chaufferie à la biomasse à l’hôpital Golden et envisage d’utiliser un réseau énergétique de quartier à base de biomasse pour ses installations à Enderby et à Clearwater. Galloway espère que ce projet encouragera d’autres régies régionales de la santé qui cherchent à moderniser ou à remplacer leur infrastructure mécanique vieillissante à opter pour des technologies nouvelles en production d’énergie, dans la mesure du possible. “Nous n’avons plus à compter sur les combustibles fossiles pour répondre à nos besoins énergétiques,” dit-il. “Il existe d’autres solutions qui peuvent nous aider à décarboniser notre approvisionnement en énergie et, ainsi, à ralentir les risques associés à la hausse des températures dans le monde.”

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FALL/AUTOMNE 2019 23 2019-06-03 6:31 PM


Aqua Analytics' Patrick Racine with Peter Whiteman.

THE POWER OF EFFICIENCY Peter Whiteman devotes time, energy to development of sustainable healthcare system

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eter Whiteman is an all-too-familiar face to CHES members, having spent the better part of the past two decades serving in key posts for the society. So, it should come as no surprise (at least to those other than Whiteman) that the long-time advocate of the association is the recipient of this year’s Hans Burger s Award for Outstanding Contribution to Healthcare Engineering. “I honestly wasn’t expecting it,” admits Whiteman, who is honoured to have received the recognition, particularly given it was bestowed upon him in his home province of Saskatchewan during this year’s CHES National Conference. “A person goes about their work and doesn’t think much of it until someone says, ‘You’re doing a good job and you have been for a long time.’” Whiteman has been an engaged member of CHES since he joined in

24 CANADIAN HEALTHCARE FACILITIES

1998. In addition to holding various executive positions on the national board, including treasurer, vice-president, president and past president, he has been involved in almost every committee, as well as dedicated great time and effort to supporting various subcommittees and events. Whiteman was instrumental in the development of an emergency facilities management human resources depository, which is essentially a database of experienced healthcare professionals that can assist in time of crisis, and played an important role in the growth of CHES across the country. During his 10-year tenure on the national executive, membership nearly doubled to more than 1,100 from a p p rox i m at e l y 6 0 0 . F u r t h e r, h e welcomed two new chapters into the fold: Manitoba and Saskatchewan. “We originally tossed around the idea of h av i n g a c o m b i n e d M a n i t o b a -

Saskatchewan chapter but soon realized that wouldn’t work — Saskatchewan had the Health Facility Resource Council (HFRC) and the province wasn’t big enough to support two organizations,” explains Whiteman. “Moreover, having a multi-provincial organization can be problematic. All too often in healthcare there are budgetary constraints that restrict out-of-province travel, which meant we wouldn’t be able to go to Manitoba to attend meetings and vice versa.” In 2007, CHES Manitoba was created with assistance from its first chapter chair, Gordon Neal. It took another eight years to bring Saskatchewan onboard — an endeavour that was aided by Whiteman’s determination to see this goal through to fruition. Being a founding member of CHES Saskatchewan’s predecessor, the HRFC, also helped. “The organization promoted partnerships and collaboration amongst the then-


CHES AWARDS 12 healthcare regions in the province, as well as with hospital suppliers and consultants, so a lot of its objectives aligned with CHES, making the transition ideal and relatively smooth,” says Whiteman, who is now a director on the Saskatchewan chapter executive. Whiteman contributed to the formation of the Quebec chapter in 2017, too. Though no longer on the national board at that time, he did significant preliminary work to make CHES a truly national organization from coast-tocoast, including chairing the planning committee for the first-ever CHES National Conference to be held in la belle province. CHES is not the only association Whiteman’s involved in. He is a member of the Association of Energy Engineers, achieving the Certified Energy Manager designation in 2013; sits on the board of directors of the Canadian Coalition for Green Health Care and the Saskatchewan Industrial Energy Consumers Association; and is active within the Regina chapter of the American Society of Heating, Refrigerating and Air-Conditioning Engineer s. He also re presented Saskatchewan on the Canadian College of Health Service Executives/Office of Energy Efficiency's (Natural Resources Canada) national healthcare energy efficiency advisory committee from 20012007, which set the structure for healthcare energy efficiency programs at the national level. W h i t e m a n ’s l o n g h i s t o r y o f volunteering mirrors that of his storied Biomedical_CHF_Winter_2017_FINAL.pdf 1 32-year career in facilities management — his leadership has resulted in significant contributions that have improved the healthcare sector.

But Whiteman’s path wasn’t always in healthcare. He was previously a carpenter from northern Alberta, only moving to Saskatchewan in 1980. It was here, while working on the construction of a senior care facility in Kindersley, that Whiteman made the transition. “I had met with the owners throughout the project and when it was nearing completion, they asked if I’d consider joining their team to lead the plant and maintenance department,” he recalls. During his tenure, Whiteman directed and imbedded his energy efficiency strategies into facilities management operational and maintenance requirements, aligning them with infrastructure renewal opportunities and his overarching sustainability plan. The first project he undertook was insulating the heating pipes in the basement, which improved patient comfort. From there, he embarked on a lighting retrofit, reprogrammed the ventilation system to utilize free cooling from outside air, changed the temperature setting on the boiler, and the list goes on. Combined, these initiatives eventually reduced the facility’s annual utility consumption by more than 33 per cent and garnered the Kindersley Health District an award, The Most Successful Energy Management Program in Saskatchewan, from the now-defunct Department of Energy, Mines and Resources — an honour it claimed for four consecutive years. In 1995, Whiteman took on the role of maintenance coordinator for the Kindersley Health District and then subsequently moved to the Regina Qu’Appelle Health Region in 1999, where he was the building 2017-10-23 4:45 PM maintenance manager for Pasqua Hospital for seven years. Committed to continuous system improvements, he implemented the sustainability model he established at

Kindersley. This resulted in more than $450,000 in energy savings annually from 2006, and a Paragon Award nomination for environmental excellence from the Regina and District Chamber of Commerce. Today, Whiteman is the energy centre manager for the Regina Qu’Appelle Health Region, a position he’s held for more than a decade. Always looking for energy savings opportunities, Whiteman initiated a new natural gas procurement model in 2008, for the Regina General and Pasqua hospitals. As a result of its success, it was executed one year later at Saskatchewan’s largest seniors complex, Regina Pioneer Village, and the Southeast Integrated Care Centre in Moosomin. By 2012, all healthcare facilities in the province were adopted into the program. Through its active management, the Saskatchewan Health Authority has attained a combined savings in excess of $6.6 million over the last four years. Between 2013-2014, Whiteman also renegotiated a new steam pricing agreement at the Wascana Rehabilitation Centre, which resulted in more than half a million dollars in annual savings that continue to be realized to this day. “It’s about making the right decisions, optimizing the delivery of value, and balancing the costs, opportunities and risks against the desired performance of assets to achieve the organizational objective,” says Whiteman about carrying out an effective asset management plan, adding a quality operations and maintenance program is continuously evolving. “The program doesn’t have to be overly complex or elaborate. It can be as simple as documenting policies, procedures and related activities, with the aim of ensuring the necessary checks are carried out during the year.”

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2016-11-22 10:48 AM


CHES AWARDS

A ‘FAMILY’ AFFAIR Maritime chapter receives accolades for its contributions to CHES

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26 CANADIAN HEALTHCARE FACILITIES

LEFT TO RIGHT: Gordon Jackson, Robert Barss, Andrew Bradley, Helen Comeau, Ken Morriscey, Mark McNeill and Kate Butler.

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ne of the highlights of the CHES National Conference is the awards presentation held during the gala banquet. This year, CHES Maritime came out on top in the friendly chapter competition, unseating three-time defending President’s Award champ, CHES Ontario. “We lost by such a small amount last year that we feel redeemed,” says Maritime chapter chair, Helen Comeau. This is the second time the chapter has won the award, the first being in fall 2015. The President’s Award is presented annually to the CHES chapter that demonstrates its commitment to education, administration and representation in the activities of the chapter and national board. Each chapter is scored on accounting practices, conference/education day, membership, chapter executive practices, committee work and additional offerings (from submitting articles to Canadian Healthcare Facilities to providing extra member benefits). Specifically, points are given for activities that benefit members and the work of CHES, such as number of meetings attended in the course of committee work and special education sessions. The recipient of the muchcoveted award receives two CHES National Conference registrations and expenses to a maximum of $2,500 each, as well as a trophy engraved with the victorious team’s names. “Our continued hard work and dedication paid off,” says Comeau, who accepted the award on behalf of the chapter. “I couldn’t be prouder of our team.” Particularly given the chapter executive has not been ‘whole’ for some time, losing the vice-chair of P.E.I. in 2017, a role it is still trying to fill. “Thankfully, while our team is small, we’re close and we help each other out whenever needed,” says Comeau. “We’re like a family.” As a result, the chapter has not suffered. In fact, the opposite is true: This past spring, CHES Maritime pulled off what’s perhaps

its most successful regional conference to date. Held May 5-7, in Moncton, N.B., more than 85 delegates attended the esteemed event. What’s more, monies generated surpassed expectations, enabling the executive to cover the travel expenses of the entire team to this year’s national conference in Saskatoon. “It was an excellent learning and networking experience, and provided an opportunity for leadership growth,” says Comeau, who became chapter chair in spring 2016. Next year, the Maritime chapter will host the CHES National Conference in Halifax, Sept. 20-22. Planning is well u n d e r w a y. T h e ve n u e ( H a l i f a x Convention Centre) and all activities have been booked, and companion program selected. The conference planning committee is currently working on the education portion based around the theme, ‘Enriching Patient Experiences by Optimizing the Environment.’ At the same time, the chapter executive is busy org anizing an education day for Nov. 19, at the Best

Western Glengarry in Truro, N.S. It is open to CHES Maritime members as w e l l a s n o n - m e m b e r f ro n t l i n e maintenance and operations workers in healthcare, both of which can attend at no cost. This isn’t the only instance where the chapter gives back to its membership. CHES Maritime offers several financial incentives, including free webinars, contributions to Canadian Certified Healthcare Facility Manager (CCHFM) exam fees, student bursaries and other rebates. This past spring, Zoe Lucas was named the recipient of the 2019 Per Paasche bursary. The $1,000 grant is presented annually to a family member of a Maritime chapter member to assist with their post-secondary education. Lucas is the niece of chapter member Lane Mingo. In September, she started at the University of Prince Edward Island, where she is working toward a bachelor of science. “It’s great to be able to help the next generation pursue a career in such an exciting field,” says Comeau.


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INNOVATION & TECHNOLOGY

THE CONSUMERIZATION OF HEALTHCARE Macro trends and their facility implications By Heather Rast

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ver the last several decades, advances in technology have led to the development of increasingly sophisticated healthcare procedures and devices, from laparoscopic surgery to bionic limbs. Access to better science and resources has made providers and health systems more equipped to serve patients in the emerging complex care landscape. Staff bandwidth in many hospitals is strained by the aging patient population, pervasiveness of chronic illnesses and rise in patient volume. Several diseases that were once terminal are now survivable for the long-term. Today, 44 per cent of adults over the age of 20 have at least one of 10 common chronic health conditions, according to the Public Health Agency of Canada. Further complicating the delivery of care is the tightening skilled labour 28 CANADIAN HEALTHCARE FACILITIES

market. Job satisfaction, fulfillment and bur nout are not singularly talent management issues. Rather, employee happiness is linked to a staff member’s ability to practice at the top of their licensing scope. Repetitive and lowvalue tasks can detract and potentially lead to increased errors. While the ability to successfully treat formerly morbid illnesses is undoubtedly rewarding for patients, their families and the medical profession, it’s important to consider how treating these long-term illnesses can tax an unprepared workforce and infrastructure. The Conference Board of Canada predicts an additional 78,000 nurses will be needed by 2035, to join the current pool of approximately 64,000 to care for the aging baby boomer population. That’s a 3.4 per cent increase,

when the average growth rate for the sector is one per cent. Just as innovation and technology have influenced the healing side of healthcare, these achievements have also shaped the patient, or consumer, side. Today’s hospital patients are more informed than any previous generation, with ready access to scientific data, holistic teachings and plain-English explanations surrounding symptoms and potential therapies. Patient-driven health discovery follows a pattern of consumer behaviour demonstrated in other aspects of public life, including banking, e-commerce and mobile apps. Convenience, on-demand, intuitive functions and user-centred interfaces are experienced by consumers in their lives and work; they carry those expectations over to their healthcare.


There are benefits as well as drawbacks to the self-serve education available to patients who turn to the Internet for answers. Engaged patients who understand their responsibility and the importance of prescribed medications are more likely to follow recommended therapies postdischarge, leading to a reduction in readmissions, according to a 2017 study published in the Patient Experience Journal. But misinformation is certainly a potential risk and the algorithms surfacing search results in response to consumer queries lack the discernment provided by qualified medical professionals. Evolving in tandem with the availability of quality health infor mation are patients’ expectations for their care experience. Anxiety, common for many patients, places increased importance on hospi-

tals’ efforts to facilitate interoperability, offer user-centred care environments, integrate convenience at every touch point and consult with a choice of viable treatment therapies. While healthcare is notoriously behind the adoption curve in the march for progress due to lack of competitive pressure routinely faced by institutions in other industries, it is unwise for any hospital to underestimate the brand value to be gained by adopting a patient-centric mindset and innovative spirit. Indeed, the totality of a patient’s daily experiences have become part of the fabric of their expectations with traditional institutions, like healthcare and academics. Between banking and buying groceries online, cleaning floors with robotic vacuums, operating an oven or thermostat with a mobile phone

app and turning to a speech-enabled voice assistant device for weather information, modern conveniences minimize the mundane, tedious, timeintensive or inconvenient. The features of these assistive products free consumers to focus their attention on more rewarding or higher value activities. The blurring of lines among sectors has been accelerated by the proliferation of digital health technologies and apps available in the health and wellness space. The expansion of some retail pharmacies to include in-store clinics has introduced a retail mindset to healthcare delivery. Upcoming generations of patients will have no context for relationships with physicians prior to the introduction of the patient health portal. Forward-thinking hospitals and health systems are experimenting with FALL/AUTOMNE 2019 29


INNOVATION & TECHNOLOGY a variety of programs to meet consumer expectations. Telehealth, for instance, connects WHETHER AN AUTONOMOUS SERVICE ROBOT patients to qualified care in a convenient IS DEPLOYED TO DELIVER LITERATURE AND way. A 2017 survey conducted by MEDICATIONS TO PATIENT ROOMS OR THE HIMSS Analytics revealed 70 per cent of patients would prefer a telehealth SERVICE IS PART OF A STAFF MEMBER’S JOB, DISCHARGE MEDICATION PROGRAMS visit over an in-person one. The Kaufmann Clinic, a thriving PROVIDE PATIENTS WITH A CONVENIENT WAY internal medicine practice in Atlanta, considers telehealth an effective OF CONTINUING THEIR CARE UPON strategy for optimizing the practice by RETURNING HOME. meeting low acuity patients’ desire for convenience without adding in-office Mobile apps incorporate gamification time to staff schedules or physically extend access to care while decreasing to encourage drug therapy adherence. delivery costs. For the chronically ill, expanding the practice. Discharge medication programs seek remote health monitoring affords Wearable devices or ‘tech togs’ gento improve patient comprehension of erate exogenous health data points, patients more daily freedoms. Healthcare consumers are clearly in follow-on orders post-hospitalization such as heart rate, into everyday items like watches, headbands and athletic favour of actively participating in their and drive medication adherence to tops, while remote monitoring devices health awareness and are comfortable using provide better transitions in care. a n d s o f t w a r e c o l l e c t e s s e n t i a l technology to do so. One report by analytics Studies have shown that patients (and patient-generated health data. The and data provider, Definitive Healthcare, those who will help care for them) who information collected outside of tradi- projects the market for wearables to grow to are eng aged with education and tional care settings may increase $12.1 billion by 2021, and the remote prescriptions bedside are more likely to patient awareness of their overall patient monitoring market to increase to uphold physician instructions, thereby McGregorAllsop_GTA_June_2016_FINAL.pdf 1 billion 2016-06-23 10:16 AM improving outcomes and contributing by 2023. health, improve health literacy and $31.1 to a positive healthcare experience. Whether an autonomous service robot is deployed to deliver literature and medications to patient rooms or the service is part of a staff member’s job, discharge medication programs provide patients with a convenient way of Mechanical Electrical Building Automation continuing their care upon returning home. Technology-accelerated healthcare Em ergenc y G ener ator Sys tems cultivating infor med and engaged designed for your building health consumers is the future. Health systems and hospitals that understand and act on the transformation happening with health consumers’ behaviours and expectations will achieve higher degrees of competitiveness and drive improvements in patient outcomes, cost of care and healthcare experience.

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30 CANADIAN HEALTHCARE FACILITIES

Heather Rast is global brand and communications manager for Swisslog Healthcare, a leading supplier of solutions and services for automated material transport, medication management and supply chain management. The company has installed facility-wide transport and pharmacy automation systems in more than 3,000 hospitals worldwide. It offers integrated solutions from a single source, from consulting to design and implementation to lifetime customer service.


SUSTAINABLE HEALTHCARE

ROAD TO RENEWAL Northern Ontario hospitals address infrastructure, operational challenges with upgrade program By Jeremy Newhook

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ging hospitals must continuously f i nd way s to reduce cost s associated w it h day-to - day performance and energy consumption, while remaining operational for staff and patients. Doing so can generate substantial savings, which can then be used to improve facilities in other ways. Earlier this year, MICs Group of Health Services embarked on an 18-month energy and facility renewal program across its three sites — Bingham Memorial Hospital, Anson General Hospital and Lady Minto Hospital — to address deferred maintenance, reduce its environmental footprint, and save on utility and operational costs. The Northern Ontario hospital owneroperator had not made any energy efficiency upgrades in approximately 20 years and the buildings, ranging from 32 to 65 years old, were in various states of wear. The first step in addressing these overdue issues involved a thorough assessment of each healthcare facilit y and their respective operational and infrastructure challenges. Working collaboratively with its energy performance contracting partner, MICs developed a list of upgrades. It included replacing the 20-year-old chiller plant at Lady Minto Hospital (which was nearing the end of its useful life cycle) with a high-efficiency, water-cooled model, and installing a new air-cooled refrigeration system to replace an outdated, expensive one that ran on municipal water, in addition to low-flow plumbing fixtures. A longer term objective was the conversion of the existing steam boiler plant to hot water. To help pave the way for this goal, the current project involves eliminating the use of steam from the central boiler plant and subsequent replacement with other heat sources. Existing steam dryers are being

Lady Minto Hospital in Cochrane, B.C.

replaced with gas-fired alternatives and electric steam generators have been introduced to support new steam sterilizers. Improvements were then prioritized for each facility to ensure the most pressing initiatives would be undertaken first, with the expectation that others may be added, as needed, after the first 18 months. Additional upgrades include the installation/modif ication of electric vehicle plug controls, weather-sealing of the building envelope to reduce drafts and heating/cooling losses, and the recommissioning of heating, cooling and ventilation system controls to improve overall occupant comfort. The pr oje c t , w h ic h of f ic i a l l y commenced in February, has already seen the installation of new low-flush toilets to reduce utility costs. Chiller upgrades were completed in June. The energy performance contracting partner is expected to complete all project upgrades within one year of the launch of the program.

The upgrades are expected to save MICs approximately $123,000 in utility and operational costs per year. These savings are guaranteed by the energy performance contracting partner through a $3.1 million, 10-year performance contract, which came into effect after all upgraded equipment was installed. T he prog ra m w i l l a lso reduce g reenhouse gas em ission s b y a n estimated 334 metric tonnes per year. According to Environment Canada, this is equivalent to removing close to 113 medium-size cars from the road on an annual basis. Jeremy Newhook is a senior business consultant at Honeywell Building Solutions, which installs and maintains the systems that help keep facilities more energy-efficient. Honeywell was the successful proponent of the MICs Group of Health Services’ energy and facility renewal program through an open, competitive request for proposals process. FALL/AUTOMNE 2019 31


SPONSORED CONTENT

Take a multi-surfaced approach to disinfection. Pathogens thrive on multiple surfaces. Your disinfecting wipes should too. PHAC and PIDAC guidance highlight the importance of medical device disinfection. 2,3

In healthcare facilities, nearly any surface in the environment is susceptible to contamination with healthcare-associated infections (HAIs). Despite proactive infection control measures, many of these pathogens can still survive on surfaces long enough to be transmitted to patients and healthcare workers.1

Damage to dollars. The challenge we often face within the healthcare community is the spread of pathogens through various means – from mattresses and bed rails to furniture to laminate surfaces and medical equipment. Proper cleaning and disinfection with the appropriate disinfectants are a vital component of infection prevention. However, disinfectants that are incompatible with medical materials can result in enormous hidden costs due to surface damage.4

Types of surface damage commonly seen in healthcare:

Clorox’s® approach to compatibility testing.

Plastic fatigue – Cracks/crazing usually caused by plasticizing ingredients in formula (usually solvents). Discolouration – Can occur when a protective coating is removed and the surface is exposed to heat or sunlight.

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Metal corrosion – Occurs when acidic or alkaline disinfectants damage metal surfaces, even those with protective paints or coatings.

1. Soak test: Material submerged in disinfectant for 4 days. 2. Wipe test: Surface wiped and allowed to dry 180 times.

Residue – Streaky or salty residues are unsightly but usually can be removed by wiping with a damp cloth. Which is double the work.

3. Stress test: Hole drilled in material near edge. Material submerged for up to 72 hours.

The Clorox Healthcare Compatible™ program 3-star rating system.

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No visible surface damage or effect on the material is likely to occur when used according to label directions. No change to the integrity of the material is expected. Some visible surface damage such as tarnishing or clouding may be seen with long-term exposure. Little to no effect on material integrity is expected. Visible damage to the surface is likely to occur with long-term exposure and some effect on material integrity is possible.

Clorox Healthcare® VersaSure™ Cleaner Disinfectant Wipes provide an innovative, alcohol-free Quat solution versatile enough to use on common healthcare surfaces with the assurance of broad-spectrum disinfection. VersaSure™ kills 49 pathogens, including bacteria, viruses, TB and fungi, in 2 minutes or less. The unique, low-odour, low-residue formula features patented technology that enhances Quat activity on surfaces to deliver broader efficacy and faster kill times without co-actives.

The VersaSure™ advantage: Better efficacy – >2.5X kill claims – 49 pathogens vs. <20 for major competitor. Better compatibility – 18-star rating on surfaces commonly found in the healthcare setting. Alcohol-free, better wetness and coverage, low odour, no solid residue. References: 1. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 2006;6:130. 2. PHAC. Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings. (p31). http:// publications.gc.ca/collections/collection_2013/aspc-phac/HP40-83-2013-eng.pdf. 3. PIDAC. Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings, 3rd Edition. (p31). https://www.publichealthontario.ca/-/media/documents/bp-environmentalcleaning.pdf?la=en. 4. Surface Compatibility Resource Guide. Clorox Professional. Clorox Healthcare. 5. The Clorox Company. Clorox Professional.

Ask for Clorox Healthcare® Surface Compatibility Resource Guide CloroxHealthcare.ca | healthcare@clorox.com

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SUSTAINABLE HEALTHCARE

UNDER CONTROL WAHA staff identify, fix heating issue to save dollars, improve energy efficiency By Kent Waddington

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hen the Canadian Coalition for Green Health Care’s Healthcare Energy Leaders team first performed a facility audit of Weeneebayko General Hospital in Moose Factory, Ont., it discovered the radiator system was operating at full load with little to no control of the steam flowing through to the radiators. Consequently, an excessive amount of fuel was being consumed due to higher steam demand and staff were opening windows in order to cool the interior space. The issue was noted in the facility audit report and became a discussion topic among facility staff enrolled in the Building Operator Certification (BOC) t ra in ing prog ra m, hosted by t he Weeneebayko Area Health Authority (WAHA) and delivered by the Coalition in early 2018. WA H A’s pl a nt op er at ion s a nd maintenance staff were quick to point out the radiator controls were not functioning properly, if at all, which led to further examination on their part. During the course of the investigation, it was unearthed the radiator valves were designed for a hot water application and not the steam one it was intended to control at the hospital. As a result, the internal components were failing in the higher heat and the valves were not functioning as needed. This was leading to open failure of the valves and a high, steady f low of steam through the radiator, causing rooms to become overheated and stuffy, and the need for building occupants to open windows in the middle of winter to try to create more comfortable working and healing environments. Utilizing their newfound knowledge, BOC course participants initiated a plan

to replace the valves with ones specifically designed for steam system applications. Upon developing and presenting their business case to hospital administration and obtaining approval, staff set their project in motion. The outcome has been as predicted — the new valves are functioning properly a nd stea m dema nd ha s returned to normal. This staff-initiated repair has resulted in a decrease in boiler/steam system fuel oil consumption, while providing building occupants with a means to achieve a

far more comfortable and predictable environment of care for patients, and a much-improved working environment for WAHA staff. The cost of the radiator valve repair is estimated to have a payback of just over one year based on or ig ina l business case calculations and actual achieved results. Kent Waddington is the communications director and co-founder of the Canadian Coalition for Green Health Care. He can be reached at kent@greenhealthcare.ca. FALL/AUTOMNE 2019 33


REGULATORY UPDATE

ON THE WATER FRONT Updated legionella standard provides some clarity, more guidance on the way By Shawna McIntyre

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he American Society of Heating, Refrigerating and A irConditioning Eng ineers (ASHRAE) recently updated Standard 188, as part of its commitment to update its standards every three years to reflect changes in technology and innovation. The 2018 updates to Legionellosis, Risk Management for Building Water Systems, are minimal, with most changes involving the use of more mandator y/codeenforceable language. Other changes include the clarification of buildings that contain healthcare services, compliance requirements on training and more flexibility on diagrams for the flow of water systems throughout buildings. The standard was first issued in 2015, to complement A SH R A E Gu idel ine 12-2000, Minimizing the R isk of Legionellosis Associated with Building Water Systems (published in 2000). This guideline was developed to provide specific environmental and operational protocols for controlling legionella amplification within water systems. Standard 188 details the requirements for minimizing legionella risk in new design as well as existing building water systems. It outlines what is required to assess and determine potential legionella sources, with an annex section that has specific requirements for buildings that contain healthcare facilities as immunocompromised individuals are more susceptible to illness. The standard also provides a framework for developing a legionella risk management 34 CANADIAN HEALTHCARE FACILITIES

plan, identifying risk factors and testing considerations. However, it does not provide limits that need to be achieved in order to reduce the risk, nor recommendations to follow if legionella is present. This is where the ASHRAE guideline serves a vital role as it outlines the limits (suitable temperature ranges and ideal water droplet size, for instance), along with recommended treatments (disinfection methods). Together, the standard and guideline provide the tools required for designing, maintaining and treating building water systems to reduce the risk of legionella exposure. ASHRAE is currently reviewing the guideline. The newest edition is expected to be released by the end of 2019. UNDER THE MICROSCOPE

Legionella is a bacterium that occurs naturally in fresh water, including lakes, streams and rivers. Indoor sources of legionella are primarily water systems within occupied buildings, such as commercial, education and healthcare facilities. Generally, cooling towers are viewed as the main source of legionella growth and potential human exposure; however, all water system components can be a source, including hot water tanks, ornamental fountains, potable water distribution pipes, hot tubs and humidifiers. The primary contributor to outbreaks within water systems is biofilm, which helps protect legionella and can result in large quantities of the bacteria being released if disturbed.

Legionella becomes a concern when water containing the bacteria becomes aerosolized and produces small droplets that can then be inhaled. If inhaled, legionella can cause two types of sickness in humans: Pontiac fever and Legionnaires’ disease. Pontiac fever is a flu-like illness that typically infects 90 per cent of people exposed. Generally, complete recovery occurs within two to five days, often without medical attention. Many individuals may not realize they have Pontiac fever, suspecting it is just the common flu, and never know they have been exposed to legionella. Legionnaires’ disease is a more serious condition that involves bacterial pneumonia. Legionella pneumophila species accounts for approximately 90 per cent of reported cases of illness, and has a fatality rate of 10 to 15 per cent. Both Pontiac fever and Legionnaires’ disease are not contagious (a sick person cannot infect a healthy one). Inhalation of aerosols contaminated with legionella bacteria is the only way to contract these illnesses. For this reason, it’s critical that facilities reduce occupant exposure to legionella by minimizing opportunities for growth of the bacteria within water systems, and identifying and reducing aerosolization potential. Shawna McIntyre, P.Eng., is operations manager, indoor environmental quality and occupational hygiene, at Pinchin Ltd., one of Canada’s largest environmental, engineering, building science, and health and safety consulting firms.


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