Issuu

Canadian

HealthcareFacilities JOURNAL OF CANADIAN HEALTHCARE ENGINEERING SOCIETY

Volume 38 Issue 2

Spring/Printemps 2018

LESSONS IN HARMONY

PM#40063056

Finding the right balance between technology, patient interaction to improve care

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Shining a Light on LEDs What's Lurking in the Sink Rapid Testing of Legionella

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CONTENTS

CANADIAN HEALTHCARE FACILITIES Volume 38

Issue 2

PUBLISHER/ÉDITEUR

David McGee davidm@mediaedge.ca

EDITOR/RÉDACTRICE

Clare Tattersall claret@mediaedge.ca

PRESIDENT/PRÉSIDENT

Kevin Brown kevinb@mediaedge.ca

SENIOR DESIGNER/ CONCEPTEUR GRAPHIQUE SENIOR

Annette Carlucci annettec@mediaedge.ca

PRODUCTION MANAGER/ DIRECTEUR DE PRODUCTION

Rachel Selbie rachels@mediaedge.ca

CIRCULATION MANAGER/ Yeshdev Singh DIRECTEUR DE LA circulation@mediaedge.ca DIFFUSION

DEPARTMENTS

MAINTENANCE & OPERATIONS

Editor’s Note

President’s Message

Chapter Reports

INNOVATION & TECHNOLOGY 14 16

A Better Tomorrow Five trends transforming care Mighty Machine Bacteria-killing robot joins St. Joe’s cleaning team

A Positive Diagnosis Energy efficiency retrofit brings cost savings to light for St. Mary’s Villa

SUSTAINABLE HEALTHCARE

Time to Pipe Up Sinks, drains reservoir for gram-negative bacteria

Frequency of Genius Weekly on-site DNA testing can prevent Legionnaires’ disease outbreaks

CHES Canadian Healthcare Engineering Society

SCISS

Société canadienne d'ingénierie des services de santé

PRESIDENT VICE-PRESIDENT TREASURER SECRETARY EXECUTIVE DIRECTOR

Guiding Light Key issues when upgrading to LEDs Reinvesting in the Future Réinvestir dans L’avenir

Something’s in the Air UVC technology improves IAQ by effectively destroying unwanted germs

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

PAST PRESIDENT

INFECTION PREVENTION & CONTROL

The Power of Knowledge Critical considerations for transformer replacement

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

Preston Kostura Roger Holliss Mitch Weimer Craig B. Doerksen Kate Butler Donna Dennison

CHAPTER CHAIRS

Newfoundland & Labrador: Colin Marsh Maritime: Helen Comeau Ontario: Jim McArthur Quebec: Michel Brisson Manitoba: Reynold J. Peters Saskatchewan: Jim Allen Alberta: Peter Jarvis British Columbia: Steve McEwan FOUNDING MEMBERS

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

4 Cataraqui St., Suite 310, Kingston, Ont. K7K 1Z7 Telephone: (613) 531-2661 Fax: (866) 303-0626 E-mail: ches@eventsmgt.com www.ches.org Canada Post Sales Product Agreement No. 40063056 ISSN # 1486-2530

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Committed to service excellence and designing better performing buildings. Structural Engineering Building Science Parking Facility Design Structural Restoration rjc.ca 4 CANADIAN HEALTHCARE FACILITIES

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EDITOR'S NOTE

ADVANCED TECHNOLOGY IT HAS BEEN almost 10 years now since I underwent endoscopic surgery for a condition that plagued me for upwards of two decades. At the time of my diagnosis in the late ‘80s, I was a tween and treatment options were limited. After trying what seemed like everything with no real improvement, I eventually resigned to my fate. Approximately 20 years later, on a chance visit to a doctor’s office with a friend, I learned about a number of new technologies, both invasive and non-invasive, that offered lasting efficacy. The rest is now history. Advancements in technology, particularly since the turn of the 21st century, have transformed the face of healthcare. Of late, the pace of change has been rapid, affecting not just the world of medicine but the built environment, too. In A Better Tomorrow, the executive director of the Canadian Centre for Healthcare Facilities shares five key technology trends and innovations that are currently reshaping healthcare facilities. You can read all about them beginning on page 14. In this issue, you’ll find innovation is a thread that binds many of the articles together. Mighty Machine introduces you to one of the newest additions to St. Joseph’s Health Centre Toronto’s environmental services team — a five-foot-five robot named ‘Trudi’ that is radically changing the hospital’s cleaning game. Then, Something’s in the Air delves into the disinfection power of UVC light, while Frequency of Genius explores the world’s first on-site legionella DNA test that provides accurate quantification of live legionella bacteria from a water sample in just 45 minutes. From here, we move on to light-emitting diode, or LED, technology, which has changed the lighting landscape. Guiding Light addresses key considerations when upgrading to the more environmentally friendly lighting choice and A Positive Diagnosis looks at St. Mary’s Villa’s recent lighting retrofit project, including the associated cost and energy savings benefits. As always, if you are interested in contributing an article to the publication or there’s a topic you’d like to see covered, please don’t hesitate to contact me.

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.

W n W O n

O L “L w “ aw Ia d I g d ag

a F tF It G I iG ei pe

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.

1 6 CANADIAN HEALTHCARE FACILITIES

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HEALTHCARE HEALTHCARE VENTILATION SYSTEMS VENTILATION SYSTEMS What’s really in yours ? What’s really in yours ?

We are pleased to announce that Ventcare now monitors hospitals the We are pleased50toplus announce thatinVentcare Ontario region. now monitors 100 plus hospitals in the

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Ontario region. Labour Canada has fully “acknowledged” scopefully of Labour Canadathehas work provided in the semi“acknowledged” the scope of annual inspection work provided in program. the semiIn addition, the written annual inspection program. documentation contributes In addition, the written greatly to thecontributes hospital documentation accreditation greatly to programs. the hospital accreditation programs. Further we are always pooling the knowledge resources Further we are always poolingof Infection Control and Engineering the knowledge resources of Groups like CHES, the ventilation Infection Control and Engineering inspection is in a constant Groups likeprogram CHES, the ventilation evolution meet future needs for inspectiontoprogram is healthcare in a constant patients and staff. evolution to meet future healthcare needs for patients and staff.

The location and inspection the Some hospital your building audit thisofyear. of ventilation fire dampers may be part of you have already taken advantage yourofbuilding auditsoftware this year. program Some of our new youwhich have already taken advantage in conjunction with our of patented our newrobotics, softwareallows program us which in conjunction our to minimize ceilingwith access patented robotics, allows us requirements. to minimize ceiling access requirements. To date, of the thousands of fire doors inspected To date, of the thousands approximately 30% are of fire dampersaccessible inspected not humanly approximately are from traditional30% ceiling not humanly accessible access points. Our from traditional ceiling patented robot overcomes points.allowing Our thisaccess obstacle, patented robot overcomes complete documentation of all obstacle, allowing fire this doors within the ventilation documentation all complete system. Further, of the total,of7% fire dampers within the ventilation have been found defective, blocked system. Further, of simply the total,closed 15% with wood, wired up, or have been found defective, blocked shutting off airflow. with wood, wired up, or simply closed shutting off airflow.

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PRESIDENT'S MESSAGE

AN EVENTFUL YEAR TO BEGIN, I would like to congratulate everyone for making it through another Canadian winter. It was a rough one, filled with countless cold weather alerts and deep freezes in many parts of the country. As this is my first year as CHES National president, 2018 is going to be a busy one for me. I look forward to travelling across the country to participate in local chapter conferences and educational sessions. The Newfoundland & Labrador chapter is actively preparing for the 2018 CHES National Conference, to be held Sept. 16-18, in St. John’s, Nfld. Mark your calendar and get ready to register as chapter chair Colin Marsh and his colleagues have promised it’s going to be the best conference yet! The Ontario chapter submitted an application to host the International Federation of Hospital Engineering (IFHE) conference in 2022. It is a big commitment to host this global event. Plus, the CHES National board will be required to supply candidates to serve as vice-president, president and past president of IFHE. If CHES is successful in its application, we will be looking for sponsorship and cooperation to ensure the event is not only a great success but it puts Canada’s healthcare system on the map. I’d like to wish the Ontario chapter the best of luck on the bid. The winning applicant will be announced at this year’s IFHE congress, to be held Oct. 6-11 in Brisbane, Australia. I encourage all CHES members to take some time to check out our educational offerings on the website, from the webinars to courses offered across the country. And if you can, please consider contributing to this fine publication. Send your pitches to editor Clare Tattersall at claret@mediaedge.ca. By the time you read this, spring training will likely be well underway for the upcoming baseball season. Now that winter is behind us (cross your fingers), it’s time to get outside and exercise your body like you exercise your mind and, most importantly, enjoy life!

CMY

Preston Kostura President, CHES National

EARN CONTINUING EDUCATION CREDITS FROM CHES Members of the Canadian Healthcare Engineering Society can earn free continuing education units (CEU) by reading the Spring 2018 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/5DD7XH2 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.

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CHAPTER REPORTS

ALBERTA CHAPTER

ONTARIO CHAPTER

What a winter! With record snowfalls and extreme cold temperatures, it is refreshing that spring is just around the corner. This time of the year is extra exciting for the Alberta chapter since we moved our annual conference to spring from fall. The planning committee is working hard to ensure the 2018 Clarence White Conference and Trade Show is as successful as last year’s. I have no doubt it will be as we’ve received a tremendous amount of support from our vendors with booth rentals and sponsorship. The addition of Paul Teterneko, director of operations for St. Michael’s Health Group, to the organizing committee has certainly helped with the planning process as he brings a wealth and experience in conference and event preparations to the team. We’ve also leveraged feedback we solicited from vendors and delegates (by way of questionnaire) about the 2017 conference to improve this year’s event experience for both groups. In my role as chair, the Alberta chapter has encouraged me to become more submersed in CHES and what/whom the organization represents. Whether planning the annual chapter conference or deciding which educational session to host, I always look at the task at hand from the perspective of a frontline facilities maintenance and engineering worker. These employees are invaluable and vital to the operation of any healthcare or long-term care facility. Being a facilities maintenance and engineering worker is about more than slinging wrenches and turning screwdrivers; it has evolved into a very technical role that demands a well-rounded skill set. These people are required to maintain complex systems like fire alarms, nurse calls, patient wandering, building management, chillers and boilers while cutting the grass and greasing squeaky wheels. The variety of work necessitates a diverse, collaborative team of general maintenance workers, groundskeepers, power engineers and tradespeople like electricians, HVAC technicians and plumbers, just to name a few. It is these individuals that deserve the credit for the condition and smooth operation of Canada’s healthcare facilities. On behalf of the Alberta chapter, I want to thank each and every one of you for your hard work and dedication. —Peter Jarvis, Alberta chapter chair

Planning is well underway for the chapter’s annual spring conference and trade show. This year, it will be held June 3-5, at Blue Mountain Resort in Collingwood, Ont. The planning committee has met several times and arranged what should be an excellent event. The Ontario chapter has sponsored two other organizations’ educational offerings — the Canadian Centre for Healthcare Facilities’ conference in November 2017, attended by chapter secretary Beth Hall, and AdvantAge Ontario’s convention in April. In mid-January, past chapter chair Roger Holliss and I met with the Ontario Ministry of Health and Long-Term Care to discuss issues with halogenated drug recovery and anesthetic gas scavenging systems. From this discussion, an e-mail blast was sent to chapter facility managers who may be interested in joining a committee with members of the ministry to discuss a proposed strategy for these two issues. We continue to work diligently with members from other CHES chapters on our bid to host the International Federation of Hospital Engineering (IFHE) conference in Toronto in 2022. Our application will be submitted in April, and the winning bid will be announced in October, at this year’s congress in Brisbane, Australia. The Ontario chapter will once again compete to secure another President’s Award win. The award is currently proudly displayed in the main lobby of my facility, Albright Centre; however, soon the time will come to pass it on to another member of the executive team. Speaking of the chapter executive, our most recent meeting was held Feb. 20, via teleconference. I am looking forward to once again seeing everyone in-person at our next meeting at the chapter spring conference in June. —Jim McArthur, Ontario chapter chair

St. John's, Nfld.

NEWFOUNDLAND & LABRADOR CHAPTER Full speed ahead! The 2018 CHES National Conference is just around the corner. Much of the work of our local chapter is associated with planning this monumental event, to be held Sept. 16-18, at the St. John’s Convention Centre. Given the vast scope of planning, we decided to cancel this year’s spring professional development day so we could direct all our efforts to ensuring the national conference is a huge success. Chapter membership is at a status quo, which is good news given the current provincial fiscal climate. The chapter is actively pushing recruitment of vendors/ suppliers, consultants and other healthcare dependents to improve membership enrolment. Financially, the Newfoundland and Labrador chapter is sitting in a solid position. This year we want to give back to our membership. The executive team is tossing around the word ‘reimbursement,’ as we look at spending extra monies to enable members from across the province to attend the 2018 CHES National Conference in St. John’s. —Colin Marsh, Newfoundland & Labrador chapter chair

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CHAPTER REPORTS

MARITIME CHAPTER

MANITOBA CHAPTER

The chapter’s 2018 spring conference will be held May 6-8, at the Delta hotel in Moncton, N.B. The theme is, “Efficiency: The Positive Effects on Patient and Family-Centred Care.” We are excited to have Mark Black as this year’s keynote speaker. Born with a congenital heart defect, Mark barely survived his first week of life. He received a life-saving heart and double-lung transplant and has beaten the odds to become a four-time marathon runner. Mark uses his new gift of life to inspire people to “live life with passion and purpose.” In addition to Mark, the conference planning committee has booked a number of guest speakers that are experts in their fields. Steve Claymen of the Thermal Insulation Association of Canada will present a session on mechanical insulation; architect Benjamin Nycum of Nycum and Associates will co-host a seminar on the relocation of the Aberdeen Hospital emergency department; Edmundo Perich of I-Gard will discuss high-resistance grounding as a technology; Hamilton Health Sciences’ George Pankiw will give a presentation on the creation of a scorecard based on CSA standards applicable to healthcare operations and maintenance, review some of the ratings and discuss progress to date; and Gordon Burrill of Teegor Consulting will provide a first look at the soon-tobe released second edition of CSA Z8000, Canadian Health Care Facilities: Planning, Design and Construction. Following the conference, the Maritime chapter will host the Canadian Healthcare Construction Course (CanHCC) May 9-10, at the same Delta hotel in Moncton. The unique educational sessions are geared to contractors and facility personnel who will gain valuable information in key areas such as the planning, design and construction process, building and fire codes, infection control, mechanical and plumbing systems, medical gas systems, electrical systems and emergency preparedness. 2018 is an election year for the chapter executive. Positions to be filled include executive vice-chair, treasurer, secretary, vice-chair Nova Scotia, vice-chair New Brunswick and vicechair Prince Edward Island. Nominations closed Jan. 29. The chapter is able to balance its books while offering several financial incentives to members in the way of student bursaries, contribution to Canadian Certified Healthcare Facility Manager (CCHFM) exam fees, webinars and the fall education day. —Helen Comeau, Maritime chapter chair

The 2018 Manitoba Education Day will be held April 24, at the Canad Inns Destination Centre Polo Park in Winnipeg. The theme is, “A Safe Worker is a Happy Worker.” We have added various levels of program sponsorship to this year’s event. Be sure to check the website for delegate registration and exhibitor prospectus. It is an election year for the chapter executive. Tom Still will take over as chapter chair, leaving the role of vice-chair vacant. Other positions up for election are treasurer and secretary. We continue to seek nominations for all three roles. Please note that the vice-chair position has specific stipulations as noted in the chapter bylaws. If you are interested in one of the available positions, please feel free to contact any member of the current executive team. Changes have been made to a few bylaws, which were sent out to chapter members in an e-mail blast in January. Please ensure you read through the changes as we will vote on them at our annual general meeting, which will be held April 24, on the chapter’s education day. In order to gain more knowledge and lend support to other local CHES chapters, I attended the Saskatchewan chapter conference and trade show in October 2017. It was a fantastic opportunity to see another chapter in action and to gain additional insight into how the conference planning committee pulled off such a successful event. On the topic of conferences, don’t forget that the 2018 CHES National Conference will be held Sept. 16-18, in St. John’s, Nfld. I hope to see you there! —Reynold J. Peters, Manitoba chapter chair

Moncton, N.B., and the Petitcodiac River.

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CHAPTER REPORTS

BRITISH COLUMBIA CHAPTER

SASK ATCHEWAN CHAPTER

The chapter executive and conference planning teams are anticipating another great conference in Whistler, B.C., and a successful Canadian Healthcare Construction Course (CanHCC) to follow. Conference booths and sponsorships are completely sold-out thanks to the overwhelming support from our vendors. This year’s theme — “Healthcare Emergency Planning: Are we Ready?” — should prove to be a relevant topic given the many recent events in B.C. The keynote address will be given by Trevor Murdock, a climate scientist who currently leads the regional climate impacts theme at Pacific Climate Impacts Consortium. The B.C. chapter is doing well financially, so we have already booked conference venues in Penticton (2019), and Whistler (2020), and plan to return to Penticton in 2021. The education committee continues to top up the many college bursaries and fund the national webinars for chapter members. 2018 is an election year for the B.C. executive. The positions of vice-chair, secretary and treasurer are up for election. Call for nominations will be posted in March. I can’t express how grateful I am to members of the chapter executive for their years of service, dedication and support. It has been a pleasure to work with such a professional group of volunteers: Norbert Fischer (vice-chair), Mitch Weimer (past chair), Ken Van Aalst (treasurer), Sarah Thorn (secretary), Arthur Buse (membership director), Mark Swain (communications director) and Rick Molnar (education director). —Steve McEwan, British Columbia chapter chair

We are beginning to see some of the many changes to the province’s healthcare system. An executive leadership team has been in place since late 2017, when the new Saskatchewan Health Authority formally launched. While employees and operations of the former 12 regional health authorities officially transferred to the single provincial health authority on Dec. 4, more work needs to be done to achieve full transformation, which will serve healthcare recipients in a far better way. Every day, small strides are being taken to create a more integrated health system that thinks and acts as one. Saskatchewan chapter members are certainly contributing to these efforts. Still, many challenges lay ahead. CHES has an opportunity to play a role in the work that must be done in the province. The organization can provide support through many avenues, such as peer contact, training and access to information on emerging technologies and best practices, to name a few. This is a great occasion for CHES to grow through the leadership of its current members. Opportunities to introduce others to CHES and the benefit of membership will arise as facilities staff from across the province begin to work together in new ways. Plans are beginning to take shape for the chapter’s annual conference and trade show, which will be held at TCU Place in Saskatoon, Oct. 21-23. The chapter is also in the early stages of planning the 2019 CHES National Conference. —Jim Allen, Saskatchewan chapter chair

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HEALTHCARE DEVELOPMENT

SAVE THE DATE! The CHES 2018 National Conference will be held in St. John’s, NL at the St. John’s Convention Centre, September 16-18, 2018. The St. John’s Convention Centre is conveniently located near downtown and local amenities. A block of rooms has been reserved at the The Delta St. John’s Hotel and Conference Centre, starting at $249 plus applicable taxes single/double occupancy. The Delta is located on New Gower Street and features spectacular views of the harbour narrows, and is walking distance from downtown St. John’s. The theme of the 2018 conference is Smarter Infrastructure for Enhanced Patient Outcomes The CHES 2018 Education Program is still under development but will once again feature dual tracks with talks on relevant industry topics from high-profile experts in the field. Join us for the CHES President’s Reception and Gala Banquet again in 2018! The banquet will celebrate the accomplishments of our peers with the 2018 Awards presentations, while enjoying great food and entertainment with friends.

We look forward to seeing you in St.John’s in 2018! For more info visit our website at www.ches.org Follow us on Twitter!

@CHES_SCISS

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INNOVATION & TECHNOLOGY

A BETTER TOMORROW Five trends transforming care By Rita Mezei

he healthcare industry is in a constant state of flux. Aging infrastructure and increased demand for services driven in part by demographic changes are some of the many drivers influencing new building design. The future of healthcare is also deeply linked to technological advancements. Here are five key trends and innovations that are currently reshaping healthcare facilities.

innovation uses an ordinary cellphone connection to video link specialists with patients, allowing them to perform real-time diagnosis and monitoring. More importantly, the doctor, with assistance, can connect diagnostic equipment such as stethoscopes, ultrasounds and electrocardiograms to patients so that the specialist can see and hear them, all in the comfort of the patients’ homes.

FROM VOLUME TO VALUE

ADAPTABLE DESIGN

Virtual care, where healthcare professionals communicate with patients via phone, e-mail and video conference, and other digital health tools are transforming the way care is delivered, bringing it into people’s homes. With time, healthcare facilities will house only emergency cases, the priciest equipment and perform the most complex and costly treatments. The impact on the built environment will be more compact examination spaces with enhanced digital infrastructure. There are currently several examples of virtual care already in use across Canada. In underserviced areas of Ontario, walk-in clinics are offering healthcare through web cameras, while in Saskatchewan, Dr. Ivar Mendez, unified head of the department of surgery for Saskatoon Health Region and the University of Saskatchewan, is pioneering the clinical use of remote presence technology. This

Flexibility in healthcare facility design has allowed integrated care services to flow better. Multi-purpose spaces adapt to patient surges. Units accommodate a variety of patient acuities in one room. Adjustable rooms reduce patient transfers. To make construction as efficient as possible, more builders and designers are turning to virtual reality drones. This technology also allows for engagement earlier in the design process (through virtual reality design mock-ups), which saves time and money and can lead to reduced work order changes and improved return on investment. PATIENT EMPOWERMENT

Leveraging consumer digital technology like electronic tablets, healthcare facilities are giving patients more control over their

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TORONTO HOSPITAL’S CUTTING-EDGE TECHNOLOGY COMMANDS ATTENTION North America’s first fully digital hospital is leading the way once again. In November 2017, Humber River Hospital opened Canada’s first hospital command centre, which uses complex algorithms, predictive analytics and cutting-edge engineering to target improved clinical, operational and patient outcomes. Designed and built in collaboration with GE Healthcare Partners, the 4,500-square-foot space is outfitted with 20 workstations, 22 LED screens and a Wall of Analytics. The ‘wall’ provides advanced real-time and predictive insight that triggers cross-functional staff co-located in the command centre to take action. This team works together to synchronize care delivery activities, eliminate delays in care and resolve patient flow bottlenecks (for example, transferring patients from emergency to an inpatient bed) as soon as they are detected. The alerts and actions that come to life daily in the command centre will also provide the basis for analysis and process re-engineering by staff throughout the Toronto hospital so that certain issues can be avoided altogether. The command centre plan is a multi-generational roll-out that drives increased capacity, improvements to quality care and a high reliability environment. Future phases will allow the hospital to partner with the community so that more patients can be cared for at home.

stay. Patients can access their health records, review their treatment plan, control room lights and temperature, and even order meals — all from the comfort of their bedside. The beeps and static noises associated with nurse call systems are quieted as patients are less likely to summon assistance for ‘trivial’ matters, which reduces the number of trips to patient rooms and allows nurses to focus on more pressing issues. TECH’S IN STYLE

Wearable technology is improving quality of care, as well as staff safety and security. Leveraging a hospital’s real-time locating system, the technology reduces reliance on overhead paging systems, enabling patients to get the much-needed rest for recovery, and allows the closest available person to respond to an issue. The wearable device also enables staff to easily ‘call in’ an emergency and improves the assistance response rate as it immediately transmits the location of the person initiating the request. RISE OF THE ROBOTS

Replacement of manual carts with automated guided vehicles (AGVs) to deliver meals, trash, medical and non-medical supplies, and other

materials as needed is helping to reduce non-value added labour, maximize efficiency and cut operating costs. In some instances, AGVs improve safety, resulting in better patient outcomes. Their use to transport dirty linens helps reduce the risk of accidental crosscontamination and transmission of hospital associated infections. Selfguided pharmacy ‘robots’ also minimize medical errors. At McGill University Health Centre’s Glen site in Montreal, the automated medication dispensing system is responsible for every aspect of the medicine distribution process. It packages all medication and labels it with a barcode for inventory before its shipped to the corresponding patient’s floor. While interest in AVGs and other integrated robotic systems is on the rise, with reports indicating that approximately 350 hospitals worldwide currently use these robots, only a few hospitals in Canada have embraced them because of the high upfront costs associated with the equipment. Rita Mezei is executive director of the Canadian Centre for Healthcare Facilities, a national, not-for-profit association whose mission is to help the healthcare facility sector achieve higher quality, more patient-focused and lower cost healthcare environments. Rita can be reached at ritamezei@cchf.net. SPRING/PRINTEMPS 2018 15

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INNOVATION & TECHNOLOGY

MIGHTY MACHINE Bacteria-killing robot joins St. Joe’s cleaning team By Amber Daugherty

atients go to hospital to get healthy, not to catch something that makes them sicker. But more than 220,000 people contract hospital-acquired infections every year in Canada because of being in close proximity to others who are ill. To prevent the spread of bacteria, it’s important that healthcare teams continue to evolve their cleaning practices. This helps ensure patients recover faster and staff stay healthy. St. Joseph’s Health Centre Toronto’s environmental services team recently introduced a new piece of equipment that’s radically changing the cleaning game. After manually cleaning the room, the team wheels a machine called the Tru-D SmartUVC, or ‘Trudi,’ into it. The five-foot-five robot uses sensors to calculate how much time it will take to disinfect the room, looking at factors including overall size and objects in the room. Once everyone is out, the door is closed and Trudi delivers a precise dose of UVC light

that’s known to kill bacteria including influenza, norovirus, C. difficile, MRSA and other harmful germs and pathogens that can spread through hospital environments. “Introducing technology like Trudi is incredible because it acts as an additional layer on top of the cleaning practices we already have in place,” says Michael Rotstein, St. Joe’s infection prevention and control manager. “It allows us to guarantee our patients and staff that we’re taking an extra step to protect their health.” TRUDI IN ACTION

When UVC light hits bacteria, it essentially deactivates it, making the bacteria unable to infect or reproduce. Because of Trudi’s unique design, it’s able to cover every inch in a space, even bouncing around corners and underneath equipment, allowing it to clean an entire room without having to be moved. “Our staff are specially trained to use this piece of equipment,” says Carlo

S e b a s t a , e nv i ro n m e n t a l s e r v i c e s supervisor at St. Joe’s. “And while we’re currently using it in patient rooms, we’re also working on getting it into the operating room to do a final disinfection after the suites have been cleaned at the end of the day.” The machine is also being used to clean equipment that’s shared by staff, including mobile work stations and patient tools and supports, including wheelchairs and walkers — items that can often be the culprit for bacteria spreading between patients in a hospital setting. “When patients are in hospital, they’re impacted by the spaces that they receive care in,” says Sebasta. “So we want to make sure their rooms and any equipment that’s being used on or around them are also contributing to their recovery.” Amber Daugherty is a communications associate at St. Joseph’s Health Centre Toronto.

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PEOPLE FIRST We ensure the safety and security of everyone on your premises.

commissionaires.ca

CHES SCISS CALL FOR NOMINATIONS FOR AWARDS Canadian Healthcare Société canadienne d'ingénierie Engineering Society

2016 Hans Burgers Award

des services de santé

2016 Wayne McLellan Award of Excellence

CALL FOR NOMINATIONS FORManagement AWARDS For Outstanding Contribution to In Healthcare Facilities Healthcare Engineering

2018 Wayne McLellan Award of Excellence 2018 Hans Burgers Award In Healthcare Management For Outstanding Contribution to Healthcare Engineering DEADLINE: April 30,Facilities 2016 DEADLINE: April 30, 2016 DEADLINE: April 30, 2018 DEADLINE: April 30, 2018 To nominate: To nominate:  Please use the nomination form posted on Please use the nomination form posted  nominate: To nominate: Please use the nomination form posted on the To Please use the nomination formon posted on the the CHES website and refer to the Terms of the CHES website and refer to the Terms of CHES website and refer to the Terms of Reference. CHES website and refer to the Terms of Reference. Reference. Reference. Purpose Purpose: To recognize hospitals or long-term care facilities that Purpose: PurposeThe award shall be presented to a resident of Canada  Tohave recognize hospitals or long-term carein completion of a major award shall be presented to a resident of demonstrated outstanding success asThe a mark of recognition of outstanding achievement in the field facilities that have demonstrated outstanding Canada as a mark of recognition of outstanding capital project, energy efficiency program, environmental of healthcare engineering. success in completion of a major capital achievement in the field of healthcare stewardship program, or team building exercise. project, energy efficiency program, engineering. Award sponsored by environmental stewardship program, or team building exercise.Award sponsored by Award sponsored by Award sponsored by

For Nomination Forms, Terms of Reference, criteria, and past winners www.ches.org / About CHES / Awards For Nomination Forms, TermsNational of Reference, and past winners Send nominations to; CHES Officecriteria, ches@eventsmgt.com Fax: 866-303-0626 www.ches.org / About CHES / Awards

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Send nominations to; CHES National Office ches@eventsmgt.com Fax: 613-531-0626

2018-02-28 3:44 PM

INFECTION PREVENTION & CONTROL

SOMETHING’S IN THE AIR UVC technology improves IAQ by effectively destroying unwanted germs By Alan Pinkerton

his year’s seemingly unyielding flu season has contributed to overloading at healthcare facilities worldwide. On track to be one of the nastiest in decades, it is expected that influenza alone will cost employers billions in lost productivity. Airborne transmission of disease-causing organisms and fomites is well-proven to not only originate from sneezing or coughing droplets. There has been clinical contention

that this may be a non-factor; however, several case studies and papers, along with ample data on morbidity and mortality, clearly show otherwise. A new University of Maryland-led study examined how the influenza virus is transmitted by capturing exhaled breath from 142 infected subjects across four potential modes of transmission: natural breathing, talking, coughing and sneezing.

The study shows the virus can be easily spread through normal breathing, finding neither coughing or sneezing is necessary. It found that people with influenza generate infectious aerosols that stay suspended in the air for a long time, even when they are not coughing or sneezing, and especially during onset of symptoms. This suggests they should not remain in the workplace to infect others during that period.

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A 2013 study from the same team found that wearing a surgical mask significantly reduces the transmission of influenza via airborne droplets. So, without a good mask, it doesn’t matter whether those with influenza aren’t coughing or sneezing — they’re still effectively shedding the virus to others just by exhaling. Infectious droplet nuclei will travel near and far. Air and surfaces are contaminated as infectious aerosols move throughout spaces and entire buildings. Recommended vaccinations, strong hygiene compliance and utilizing proven engineered infection prevention technologies provide the best defence. In a 2012 study of a high-traffic university building with a hybrid HVAC (mechanically and naturally ventilated) system, the authors attempted to determine the origins of indoor airborne bacteria, discussing aerosolization of particles from surfaces. Similarly, another study actively measured norovirus in the air of medical facilities and found that it was responsible for more than 50 per cent of gastroenteritis cases worldwide, and it can spread through air up to several meters. THE POWER OF LIGHT

Indoor air purification, such as HEPA (high-efficiency particulate air) filtration, is an important first step in air cleaning but it is not effective on the smallest particles, which are now believed to be the most damaging to health. Air purifiers are widely available and most are effective against pollen, dust and smoke; however, sufficient air sterilization is also required to neutralize nano-size particles that HEPA filters cannot catch. The American Society of Heating, Refrigerating and Air-conditioning Engineers (ASHRAE) requires minimum efficiency reporting value, or MERV rating, of 14 filters or higher in patient areas. HEPA filters are used in the supply air for surgical areas but most hospitals don’t have adequate air filtration when comparatives to sterilized air are made. CSA standard Z317.2-15, Special Requirements for Heating, Ventilation and Air-conditioning (HVAC) Systems in Health Care Facilities, states that internally mounted disinfection systems using ultraviolet light should be considered as a supplemental

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measure for HVAC systems, particularly for those that serve rooms or areas where there could be an elevated risk of infection from the supplied air. System designers should evaluate the most recent available clinical evidence when deciding whether and where to install UV systems. Implementing UVC disinfection, also referred to as ultraviolet germicidal irradiation (UVGI), with photocatalytic oxidation (PCO) has proven to be extremely effective and can be installed within ductwork, added on to air handling equipment or used as portable equipment to provide higher risk areas with sterilized air. Going a step further, titanium dioxide absorbs and reacts with UVC light to create the world’s strongest oxidizing agent. Hydroxyl radicals are formed through PCO. Molecules of air pollutants are neutralized. Bacteria, viruses, volatile organic compounds, nitrogen dioxide, mould, fungi, toxic gases and more are decomposed. Har mless water and carbon dioxide molecules are emitted. HEPA alone has distinct limitations, as does PCO technology. Combining both, properly configured, will provide the cleanest air possible, especially where good carbon filtration is also included in the airflow, which aids in odour removal and assists the reaction. The best portable equipment available will pull room air through HEPA, UVC/PCO and carbon filtration very effectively. Creating a positive or negative pressure room and limiting carbon dioxide while heating/ cooling an outdoor fresh air intake are options to consider. Hospital infection control teams must become engaged with facility managers and evaluate HVAC systems, IAQ and specific clinical needs for clean air because delivery systems can be a source as well as a route to transmit disease within a facility. These sources and transfer routes are rarely considered by infection control staff. UVC treatment of air and surfaces are proven to reduce hospital acquired infections. Alan Pinkerton is president and CEO of Radic8 Canada, a leading provider of UVC indoor air purification and sterilization equipment. He can be reached at alan@radic8canada.com or 1-888-247-8001.

> SOCIAL MEDIA COLUMN Sponsored by MediaEdge

Showing your social media ROI By Steven Chester As the year winds down, a big challenge for many of us in the social media field arises as we produce our analytics reports and show our worth. Simply saying “I’ve gained 50 Twitter followers a month for the year” doesn’t translate to the business owner who needs to understand how these efforts are furthering their bottom line. The first step is to understand your goals. Was your business looking to sell a product online, acquire customers, gain brand awareness, drive traffic to a sign-up page, or increase overall traffic to your website? If the answer to this loaded question is “yes,” then you’ll have to look at several metrics and ensure you’ve built campaigns around each goal. Then, you’ll need to assign a value to those goals. Think of your hours spent – which you absolutely must be logging for ROI to work – and assign a value to each of those metrics. This is tough, but consider items such as cost per impression and clicks if you were to buy an advertisement. You’ll be able to track your referral traffic and other goals via your site’s Google Analytics dashboard, and most social platforms have decent internal analytics where you can delve a bit deeper into your numbers. There are a handful of great third-party tools that you can also use, which will provide even more insight. This is one of the more complex topics that can’t be fully covered in this space. As always, I invite you to stay social and continue the conversation via my contact info below. Happy holidays, and all the best for 2018.

Steven Chester is the Digital Media Director of MediaEdge Communications. With 15 years’ experience in cross-platform communications, Steven helps companies expand their reach through social media and other digital initiatives. To contact him directly, email gosocial@mediaedge.ca, or follow him on Twitter at @ chestergosocial.

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INFECTION PREVENTION & CONTROL

TIME TO PIPE UP Sinks, drains reservoir for gram-negative bacteria By Natasha Salt, Lorraine Maze dit Mieusement & Heather Candon

edicated hand hygiene sinks in healthcare facilities have been the mainstay of infection prevention and control (IP&C) for many years. Clean hands reduce the transmission of microorganisms that cause infection. However, there is growing evidence these sinks can pose a risk to patients. Sinks are often erroneously used for reasons beyond their intended purpose, including the disposal of wastes, such as body fluids, intravenous (IV) solutions, food and beverages. Using sinks for waste disposal supports the growth of biofilm in plumbing through the addition of microorganisms and nutrients that encourage their growth. These biofilms are notoriously difficult to eradicate and in healthcare settings may include multidrug-resistant organisms (MROs). BIOFILMS AND HUMAN HEALTH

Biofilms are formed by water-dwelling bacteria and can be disrupted by the force of flowing water when faucets are activated. Microorganisms dislodged from the biofilm can then contaminate the surrounding environment and/or hands of a healthcare worker. This is not a new problem and published literature has continuously supported the contribution of sinks to healthcare-associated infections with gramnegative organisms. There is urgency to address this problem now; MROs pose serious threat to patients since treatment options are limited and MROs are associated with increased morbidity and mortality.

PROBLEM WITH SINKS AND PLUMBING

The historic designs of sinks, plumbing and fixtures have made them a magnet for microorganisms; aerators, overflow holes and valves, pipe materials and design, drain alignment with faucet and shallow basins promote contamination and spread of microorganisms. It is also well established that sink p-traps create the perfect environment for biofilms to adhere to plumbing, proliferate and continue to grow upwards toward the drain opening on the walls of the tailpiece. Cleaning the p-trap seems like a simple solution but it’s not so easy. Environmental sampling of drains contaminated with MROs has shown that even after diligent cleaning/disinfection with chemicals or steam, microorganisms may re-contaminate the tailpiece. This likely occurs due to the inability to fully eradicate biofilms in sink plumbing. Also, the design of older sinks and drains in healthcare facilities make them virtually impossible to clean. Features such as sealed drain grates impede the ability to clean the p-trap and tailpiece thoroughly. Overflow holes are equally challenging to access and may also be a source of contamination. Even when disinfectants, such as accelerated hydrogen peroxide gel, are poured down the drain, it is impossible to ensure all surfaces of the tailpiece remain wet for a sufficient amount of time to allow complete penetration of the biofilm. Microorganisms may regroup and populate the p-trap and

tailpiece again with the addition of further nutrients. What does this mean? Entire sinks, plumbing and fixtures may need to be removed and replaced to eliminate the source of contamination, though a last resort. FOCUS ON PREVENTION

Routine cleaning is always suggested to prevent the transmission of microorganisms. Engaging facilities management (FM) colleagues is often the first step for IP&C professionals when deciding how to deal with/prevent contaminated plumbing. However, FM staff are frequently inundated with other maintenance concerns in hospitals with aging infrastructure. More importantly, the most significant questions of how and when to perform routine maintenance remains unanswered in published literature and plumbing standards. Another way to mitigate risk is to design sinks in a way that microorganisms are prevented from contaminating drains. Many new designs incorporate the use of ozone, vibration and/or heat to make pipes a less hospitable environment for microorganisms; however, the effectiveness of these is currently under investigation. Whenever a need to replace a sink arises, it should be viewed as an opportunity to ensure replacement parts facilitate access for cleaning (for example, removable drain grates) and contain features that reduce the risk of contamination as outlined in the CSA

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INFECTION PREVENTION & CONTROL standard Z317.1, Special Requirements for Plumbing Installations in Health Care Facilities. Educating staff on the proper disposal of clinical waste is likely the easiest way to prevent contamination. However, reshaping the use of sinks for their intended purpose is difficult when they are often the most convenient and accessible dumping zone close to the patient. To ensure success in reducing inappropriate disposal in sinks, appropriate, safe and convenient ways to discard fluid wastes must be incorporated into healthcare design. KEEPING IT CLEAN

Biofilms are composed of microorganisms embedded in a tough, slimy matrix that are able to withstand many cleaning/ disinfecting agents. While there are an abundance of disinfectant options on the market, many are not formulated to adequately tackle biofilm. For example, disinfectants are vertically challenged, as their fluid nature causes them to move quickly down a pipe. Manufacturers are developing more viscous cleaners/ disinfectants that can adhere to vertical surfaces long enough to break down biofilm and kill microorganisms. Disinfectant foams and gels certainly hold some promise but their efficacy and long-term effects on plumbing infrastructure need to be explored more closely. Currently, individual facilities have developed a range of innovative methods for decontaminating plumbing infrastructure using a combination of enzymatic, disinfectant and steam treatments. However, there is a lack of evidence to support any one of these methodologies in the short or longterm. Collaboratively, guidelines need to be developed to deal with this age-old problem that has become more complicated with the proliferation of MROs.

The design of shower drains, shower heads, faucets, toilets and their plumbing components should also be considered as there are reports these fixtures have been contaminated with MROs and have been implicated in transmission to patients. THINKING OUTSIDE THE SINK

DESIGN FOR THE FUTURE

Sinks that are self-cleaning and equipped with offset drains, no aerators, deep, soft sloping basins and are rimless have been blossoming with the advent of this draining concern. These features are intended to prevent biofilms and microorganisms from contaminating sink drains, minimize or eliminate back splashing from the drain to the basin, and discourage the use of sinks for storage of medical equipment and draining of IV fluids.

IP&C professionals have lobbied for the inclusion of hand hygiene sinks in each patient care area since Ignaz Semmelweis championed handwashing in the late 1800s. But with the advent of waterless hand hygiene products, is the risk of placing an unmaintained and misused hand hygiene sink in every patient care area worth the risk it may carry? There are products on the market that minimize the need to have water available in patient care areas: pre-moistened wipes that

can be used for patient bathing, and disposable bedpans and kidney basins to eliminate the need for rinsing these products after use. Perhaps the time has come to re-evaluate workflow and patient/staff needs and design healthcare facilities that consider these modern-day advances and eliminate potential MRO reservoirs in patient care areas. Natasha Salt is director of infection prevention and control (IP&C) at Sunnybrook Health Sciences Centre. Lorraine Maze dit Mieusement is the professional practice lead of IP&C at Sunnybrook. Heather Candon is manager of IP&C at Mackenzie Health. Together they have been raising national awareness of the risks posed to patients by contaminated sinks and drains. SPRING/PRINTEMPS 2018 21

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INFECTION PREVENTION & CONTROL

FREQUENCY OF GENIUS Weekly on-site DNA testing can prevent Legionnaires’ disease outbreaks By Paul Lem

ince the discovery of Legionnaires’ disease in 1976, facility managers have been plagued with the risk that their buildings will become contaminated with legionella bacteria. Legionella can infect man-made water systems, including domestic hot water systems, fountains, showers and cooling towers that are part of large HVAC systems. There are serious consequences when outbreaks occur, including hospitalizations and fatalities. In addition, outbreaks often receive significant negative media attention. The risk of legionella outbreaks in healthcare facilities is particularly high. In 2017, the Centers for Disease Control and Prevention (CDC) found that 76 per cent of U.S. jurisdictions reported cases of Legionnaires’ in healthcare facilities. According to the CDC, one in four people who become infected at a healthcare facility will die, compared to one in 10 people overall. This is because elderly and immunocompromised patients at healthcare facilities are the most susceptible to Legionnaires’ disease. Despite these facts, most water systems are not regularly tested. For cooling towers, the traditional method used to detect legionella contamination has been monthly culture testing. But outbreaks have continued even in jurisdictions with mandatory testing regulations. For example, in 2012, Quebec made monthly testing

mandatory for all cooling towers in the province but this failed to prevent an outbreak in the town of Granby last year. One reason for these continued outbreaks is that legionella can reach levels of 1,000 colony-forming units per millilitre in as few as seven days; this is the level at which the World Health Organization has found that outbreaks typically occur. So, a frequency of monthly testing is inadequate, especially considering culture testing can take up to 14 days to yield results. In addition, the CDC conducted a proficiency study and found that culture testing underestimated actual legionella levels by an average of 17-fold. After decades of continual legionella deaths, there may finally be a solution. An Ottawa company has developed the world’s first on-site legionella DNA test that provides accurate quantification of live legionella bacteria from a water sample in 45 minutes. Weekly testing of water sources such as cooling tower s, humidifiers and domestic hot water systems has the potential to quickly identify legionella contamination and allow facility managers to treat the problem before legionella grows to outbreak levels. To validate the test, the company collaborated on a scientific study with Public Services and Procurement Canada. The

study compared weekly on-site legionella DNA testing with monthly legionella culture testing for 51 cooling towers in Ottawa, Toronto and Montreal over 12 weeks. One finding was particularly striking: Eight per cent of cooling towers tested positive for legionella greater than 100 bacteria per millilitre. This is significant because most regulations call for a cooling tower to be disinfected at 10 bacteria per millilitre. The study also found that weekly DNA testing detected legionella significantly faster and more accurately than monthly culture testing. Around the world, there are hundreds of thousands of cooling towers that are at risk of legionella contamination. There are also millions of domestic hot water systems, fountains and humidifiers that are at risk. Infectious disease experts estimate that tens of thousands of people become infected with Legionnaires’ disease every year in the U.S. alone. Weekly on-site DNA testing is the first practical way to address the risk of legionella contamination in water systems. With regular, widespread testing, there is a real opportunity to dramatically lower the incidence of Legionnaires’ disease. Paul Lem is CEO and founder of Spartan Bioscience, a world leader in portable DNAbased diagnostics. He holds a medical degree from the University of Ottawa.

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• Ozonated water • Laminar flow • Self-flushing • Motion activated • Programmable • Wheelchair accessible • Prevents bacterial growth and biofilm • Drain & trap free of CPOs and other pathogens • Future data integration with hand hygiene monitoring programs • Exceeds CSA Z8000 and Z317.1-16

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2018-02-26 2:40 PM

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MAINTENANCE & OPERATIONS

THE POWER OF KNOWLEDGE Critical considerations for transformer replacement By Alan Ober

hen power transformers fail, the impact on plant operations can be debilitating. Production is interrupted, everything grinds to a halt and the effects on the bottom line can be immediate and devastating. This can put a lot of pressure on those in charge of getting operations back up to full speed. To make matters worse, since power transformers rarely go down, it is not uncommon for those in charge of purchasing replacement units to have little or no experience in the process. Transformers may be seen as more of a commodity and, as a result, sourced out to the lowest bid without regard to quality. THE RIGHT CHOICE

When replacing power transformers, it’s essential to select the proper design and construction for the application. This not only ensures a quick return to service but will reduce future costs and downtime. To maximize return on investment on what is arguably the heart of plant operations, it is important to understand some of the basics. Starting from the top, power transformers are required to stepdown the higher voltages delivered by the electric utility company. For indoor applications, dry-type transformers are by far the most common due in part to the fact that they are aircooled, so they pose lower risk of problematic leakage, environmental issues and fire. Since they can safely be used inside a facility, dry-type units can be placed right next to the equipment they are powering, which can further reduce costs.

A plant can save additional operational costs by selecting a new unit over a refurbished option. This is due to the higher efficiencies standards enacted by the U.S. Department of Energy in 2010, and then further tightened in 2016 on all new transformers. The way in which the coils are wound around the core of a dry-type transformer greatly affects its robustness and ability to survive ‘impulses’ that can occur from phenomena such as switching surges and lightning strikes. Two of the most common transformer designs today feature circular (round-wound) or rectangular windings. Many transformer manufacturers still offer rectangular windings because they are less expensive to build; however, they can develop troublesome air traps, hot spots and other problems. The round coil design, on the other hand, provides significant ongoing operational and cost-saving advantages. Round-wound transformers stay cooler, run quieter and present less risk of short circuit when coupled with a sheet wound secondary. CONSIDER THE MATERIAL

In addition to the design, the material used for the windings and insulation can greatly affect performance and prevent disastrous emergencies from occurring during the unit’s operating life. For transformer windings, the most common materials used are copper and aluminum. While copper does have a higher upfront cost, it more than makes up for that by outperforming and outlasting aluminum. The selection of proper insulation also plays a major part in ensuring transformer

reliability. Temperatures can reach 200 C in a dry-type transformer on a daily basis; hence, skimping on insulation can lead to disastrous consequences. Therefore, higher quality insulation that is heat and flame-resistant should strongly be considered. INVESTIGATE A ‘DROP-IN’ SOLUTION

The removal of the old transformer and installation of a new one can be timeconsuming and costly if not properly addressed beforehand. This is particularly important when there are existing enclosures with dimensional/clearance constraints. The transformer manufacturer should be consulted and needs to be capable of slightly modifying the transformer — either new or remanufactured — so that it can be ‘dropped-in’ or mated with the existing transformer infrastructure, meeting Institute of Electrical and Electronics Engineers (IEEE) standards plus all required clearances, within a few hours. It’s also recommended that suppliers be consulted on the specific application, present and anticipated power supply needs, and obtain an informed evaluation of the options available. This can lead to the effective selection of a transformer that will pay substantial dividends in performance and greatly reduce the total cost of ownership. Alan Ober is chief engineer at Electric Service Company (ELSCO), a leading provider of quality dry-type and padmount transformers. Alan has more than 40 years’ experience in the design and manufacturing of transformers. He can be reached at 513-271-1752 or info@electricservice.com.

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A POSITIVE DIAGNOSIS LED retrofit brings cost savings to light for St. Mary’s Villa By Janine Kamonzeki

ighting is a fundamental part of any space but in a long-term care facility it can have a measurable influence on the occupants’ well-being. With advances in LED lighting technology and the numerous benefits it provides over traditional compact fluorescents, more facilities are turning to LEDs to not only increase their energy savings but also to provide for the safety and comfort of their residents. St. Mary’s Villa in Humboldt, Sask., is one example. Like many long-term care facilities in the region, the lighting technology at St. Mary’s Villa was more than 40 years old. The facility relied on one maintenance employee to regularly change ballasts and perform a variety of other tasks for the facilities in the region. An energy audit in January 2016 identified nearly 1,000 outdated lamp troffers, lamp strips and incandescent lamps that could be upgraded to LEDs. The projected combined energy and lamp re placement cost savings: Approximately $206,000 over the maturation period of the new lighting system (nearly nine years) with a return on investment of approximately 37 per cent, resulting in a payback period of less than three years. Additionally, when comparing the outdated system’s operating costs with the

new system’s operating costs, St. Mary’s Villa would save $5,573 in materials and labour each year. Soon after the audit, the old lighting was removed to make way for modern LED lamps, wraps, strips and troffers, which were installed throughout the long-term care facility. The lighting in areas exposed to humidity and dirt (for example, refrigerators) was changed to lighting with vapour-proof seals to protect the bulbs from the elements. In addition to dollars saved, the retrofit has eliminated approximately 820 lamp failures per year and reduced total energy consumption by more than 300,000 killowatt hours, or a 67 per cent savings annually. This reduction is equivalent to taking 41 cars off the road or preventing 209 metric tonnes of carbon dioxide from entering the atmosphere. Janine Kamonzeki is global account manager at WESCO Distribution Canada LP, a leader in industrial supply with an extensive offering of electrical, data communications, MRO and electrical OEM products. WESCO’s value creation program works to help ease procurement challenges, find energy savings, and promote green and sustainability initiatives. Janine can be reached at jkamonzeki@wesco.com. SPRING/PRINTEMPS 2018 25

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GUIDING LIGHT Key issues when upgrading to LEDs By Bonnie Hartog

ight emitting diode (LED) technology offers considerable benefits to healthcare facilities — energy efficiency and associated cost savings, and reduction in lighting maintenance hours as a result of greater life expectancy, to name a few. It’s therefore no wonder that many facilities are looking to upgrade existing lighting technology to LEDs. When doing so, it’s important to select the right product for the right application as well as appropriate lighting controls. This can prove difficult as people often have different lighting demands in the same space. Staff require sufficient light to properly concentrate and perform critical tasks, while patients need light levels that are conducive to advancing health and recovery, and that are ideal for general overall comfort. Compounding the issue is many lighting upgrades are performed in stages due to budget constraints, either as part of a multi-year retrofit program or

routine maintenance. Existing purchasing habits and lack of education about lighting products further complicate the matter, as decision-makers often make choices based on initial cost and payback. The result is inconsistent lighting, multiple different brands of fixtures and lamps, and compatibility problems. In addition, many spaces don’t have necessary lighting levels, colour temperatures, types of fixtures or correct placement of fixtures. MEASURE FOR MEASURE

Product knowledge is key to selecting the right lamp or fixture for a LED lighting project. Familiarity with existing lamp base types is also integral to purchasing the correct retrofit product. Questions to ask include: How many lumens of light do existing fixtures produce for every watt of electricity used? What light levels (foot candles or lux) are required in each area and why? Watts are a measure of power consumption or the amount of energy needed to

generate a certain level of brightness. Lumens are a measure of the total quantity of visible light emitted by the source. LED technology requires much less wattage than its traditional counterpart to operate; however, when replacing existing lamps or fixtures, LEDs should have close to equal total quantity of designed lumens for the space. Foot candles and lux both measure the illuminance (amount of light) that falls onto a surface. The foot candle is an imperial measurement, while lux is a metric (or SI) measurement. The Illuminating Engineering Society of North America recommends the following light levels: nurse stations, 50 foot candles; patient rooms, 30 foot candles; task lighting, 50 foot candles; and ambient lighting, 25 foot candles. TRUE COLOURS

Colour temperature should also be considered in all lighting upgrade projects. It defines the colour appearance of the illuminance source (what the look and

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SUSTAINABLE HEALTHCARE feel of the light produced will be). The colour temperature of a lamp or fixture is assigned using the basis of correlated colour temperature (CCT), which is defined in degrees Kelvin (k). Warm light is 2600k to 3200k, moving to bright (neutral) white and then to daylight (cool) white at 4500k or more. Each colour impacts emotions, behaviours and ambience. For example, warm light is considered relaxing and best-suited for areas of rest, such as patient rooms. When determining which colour temperature to choose, questions to ask include: What is the purpose of the room and level of activity? Who will primarily use the room and what is the average age? What CCT is currently being used and why? A GOOD PLACE

Choosing the right size and placement of new fixtures is important to the success of any lighting project. Some key questions to ask include: Will the fixtures cover the existing footprint? How will they disperse light?

LED TECHNOLOGY REQUIRES MUCH LESS WATTAGE THAN ITS TRADITIONAL COUNTERPART TO OPERATE; HOWEVER, WHEN REPLACING EXISTING LAMPS OR FIXTURES, LEDS SHOULD HAVE CLOSE TO EQUAL TOTAL QUANTITY OF DESIGNED LUMENS FOR THE SPACE. Will they cause glare? Prior to purchasing any new LED fixtures, a photometric lighting layout should be reviewed as LEDs produce a much different disbursement pattern and intensity of light than traditional fixtures. The photometric lighting layout will show the anticipated light levels using the new recommended f i x t u r e s w i t h a p o i n t - by - p o i n t measurement. MISSION CONTROL

Not to be forgotten in any LED lighting upgrade project is the lighting control system as controls such as occupancy sensors, dimmers and time scheduling

can provide further energy savings, rebate incentives and improved lighting levels for staff, residents and visitors. Confirm whether existing lighting controls will work with new LED products by checking manufacturer compatibility lists. If incompatible, they will need to be upgraded. Bonnie Hartog is the lighting manager at Evolution Electrical Services Ltd., a Winnipegbased electrical contractor servicing clients throughout Manitoba. The company’s highly skilled team has years of experience with electrical installations and specializes in lighting design and education. Bonnie can be reached at bonniehartog@evolutionelectric.ca.

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REINVESTING IN THE FUTURE Réinvestir dans l’avenir By/Par Bobby Hancock

28 CANADIAN HEALTHCARE FACILITIES

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SUSTAINABLE HEALTHCARE

he grand opening of a new hospital is a time for celebration. It marks the culmination of years of construction and the countless hours of hard work by dedicated project team members to turn their vision of an innovative care facility into reality. However, achieving this milestone doesn’t mean hospital staff are at the end of their journey. In the ensuing years, there will be other projects — some a matter of necessity, others a matter of preference, but all will be undertaken to improve the healthcare environment and overall patient experience. This has been the case for facility management staff at Holland Bloorview Kids Rehabilitation Hospital. Since the hospital opened its doors in February 2006, the team has embarked on a variety of energy-saving projects, including multiple LED lighting retrofits, the installation of variable frequency drives and the adoption of linkageless boiler control systems. Opportunities for energy savings are regularly investigated by facility management staff and acted upon when the return on investment is favourable.

’inauguration d’un hôpital est une occasion spéciale, l’aboutissement de plusieurs années de construction et d’un nombre incroyable d’heures de travail de la part d’une équipe qui se dévoue à donner corps à une vision: celle d’un établissement de soins de santé novateur. Pourtant, ce jalon ne marque pas la fin du périple pour le personnel hospitalier. Les années suivantes apporteront d’autres projets, certains répondant à une nécessité, d’autres à des préférences, mais tous entrepris pour améliorer l’environnement de soin et l’expérience des patients. C’est ce qui est arrivé au personnel de gestion des installations de l’Hôpital de réadaptation pour enfants Holland Bloorview. Depuis son ouverture en Février 2006, l’équipe a mené plusieurs projets écoénergétiques, comme l’installation d’éclairage à DEL et d’entraînements à fréquence variable, ainsi que l’adoption d’un système de commande de chaudière sans attelage. Elle évalue régulièrement les économies d’énergie possibles et passe à l’action si elles sont rentables.

ENERGY-EFFICIENT AIR CONTROL

In late 2016, Holland Bloorview successfully completed a demand control ventilation (DCV) project, valued at more than $88,000. DCV ensures the optimum amount of fresh air based on occupancy level, reducing operating costs and increasing comfort. Originally, all of the hospital’s ventilation systems were constant volume supply. The design of the hospital allowed for the installation of variable air control boxes; however, these were set up as constant air at commissioning as per design. As the building evolved, it became clear that operations would allow for variable air control in most spaces, including offices, outpatient services, the on-site educational facility and cafeteria, among others. Areas that require 24-7 supply air and 100 per cent outdoor air exchanges were not considered for the project. This included the hospital’s two swimming pools, client care spaces and family accommodations. Discussions with the hospital’s building automation system provider, Johnson Controls, about energy conservation measures evolved into the pursuit of the DCV project. Holland Bloorview was provided with several examples of similar successful projects. Then, in consultation with senior building efficiency staff at Johnson Controls and Sheridan College’s faculty of applied science and technology, the hospital’s facility management team reviewed the feasibility of the project. Preliminary discussions indicated that energy savings and operational efficiency for Holland Bloorview’s air handling units were certain. The next step was to identify the investment required and the payback to the hospital. An energy consumption study was commissioned with Sheridan College, which quickly put the project in motion. In order to collect baseline data, seven air handling units were chosen for 24-7 metering. Energy analyzers were used for logging,

UN CONTRÔLE DE L’AIR ÉCOÉNERGÉTIQUE

Fin 2016, le Holland Bloorview a bouclé un projet de ventilation commandée à la demande (VCD) évalué à plus de $88,000. La VCD optimise l’apport en air frais en fonction du taux d’occupation, ce qui permet de réduire les coûts et d’accroître le confort. À l’origine, les systèmes de ventilation de l’hôpital fournissaient un approvisionnement constant en air. L’établissement était conçu pour l’installation de boîtes de commande à débit variable, mais le tout avait été programmé pour fournir un débit constant à l’entrée en fonction de l’édifice, conformément aux plans. Au fil de l’évolution des lieux, il est devenu évident que les activités se prêtaient bien à un contrôle variable, particulièrement dans les bureaux, les services ambulatoires, les installations pédagogiques et la cafétéria. On a exclu du projet les secteurs nécessitant un apport d’air frais à 100 pour cent en tout temps, comme les deux piscines, les espaces de soins et les logements familiaux. Le projet de VCD est né des discussions sur les mesures d’économie d’énergie menées avec le fournisseur du système immotique de l’hôpital, Johnson Controls, qui a présenté plusieurs exemples comparables de réussites. Puis, l’équipe de gestion des installations de l’hôpital a étudié la faisabilité du projet, en consultant les spécialistes en efficacité de Johnson Controls et de la faculté des sciences appliquées et de la technologie du collège Sheridan. Il est rapidement apparu que le Holland Bloorview pouvait resserrer l’efficacité de ses appareils de traitement de l’air. Il restait donc à calculer l’investissement requis et ce qu’il rapporterait. L’hôpital a donc commandé au collège Sheridan une étude sur sa consommation énergétique. SPRING/PRINTEMPS 2018 29

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SUSTAINABLE HEALTHCARE loaned to Holland Bloorview by Toronto Hydro-Electric System Ltd. The data loggers were connected to each air handling unit’s main hydro feed at the motor control panel by a licensed electrician. For each unit, between five to seven days of data was collected. Sheridan College and Toronto Hydro downloaded the data logger files at the completion of the reporting period. The college then analyzed the data and provided an in-depth analysis of the estimated cost savings in various scenarios. These same units were logged after the air boxes were programmed for variable air supply. Calculations were made for estimated savings and the results were very promising when projected for a year of operation. With the rebates received from Toronto Hydro and Enbridge ($43,454 and $28,853, respectively) and the cost savings realized ($65,000), the return on investment of the project was achieved within the first year.

Pour recueillir des données de référence, on a mesuré en continu sept appareils de traitement de l’air. La société Toronto HydroElectric System Ltd. a prêté à l’hôpital des analyseurs d’énergie. Un électricien qualifié les a fixés à l’entrée électrique de chaque appareil de traitement. On a recueilli cinq à sept jours de données par appareil. Le collège et Toronto Hydro ont récupéré les données à distance à la fin de la période d’analyse. Enfin, le collège a calculé les économies possibles suivant divers scénarios. On a analysé les mêmes appareils après la reprogrammation des boîtes pour un approvisionnement variable. Les calculs ont révélé des économies annuelles prometteuses. En tenant compte des rabais accordés par Toronto Hydro ($43,454) et Enbridge ($28,853), ainsi que des économies réalisées ($65,000), l’hôpital a récupéré son investissement dès la première année. DÉPENSER POUR ÉCONOMISER

SPEND TO SAVE

The DCV project enabled the hospital to reduce overall hydro consumption by 10 per cent, and natural gas consumption by 11 per cent in 2017. Money saved is being used to help offset the ancillary hydro costs that continue to rise. The project also provided an opportunity for the hospital to reinvest a portion of the utility savings and rebates into two additional energy savings projects. Last year, in an effort to continue to reduce hydro consumption, 62 parking lot light pole fixtures were retrofitted with new LED lighting. The benefits of this project include an approximately 70 per cent reduction in hydro consumption compared to original fixtures, resulting in $6,300 in savings per year; and operational savings realized in replacement lamps, labour and lift rental. The second project involved the upgrade of many of the hospital’s steam traps, resulting in an estimated annual savings of 42,993 cubic metres of natural gas, as calculated by Enbridge. The incentive for this project was $4,212. By utilizing in-house labour to replace the traps, the return on investment period was considerably reduced. 2018 will see facility management staff embark on a LED lighting retrofit project of Holland Bloorview’s pool decks and inpatient floor. Biomedical_2_CHF_Winter_2017_FINAL.pdf 1 rebates 2018-01-03 9:30 AMto finance The team will continue to utilize the and savings new green opportunities. Biomedical_CHF_Winter_2017_FINAL.pdf

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4:45 PM

Bobby Hancock is senior director, facility management, at Holland Bloorview Kids Rehabilitation Hospital, Canada’s largest children’s rehabilitation hospital focused on improving the lives of kids with disabilities. Holland Bloorview is a world-class teaching hospital that is fully affiliated with the University of Toronto and serves 7,500 families annually.

Le projet de VCD a permis à l’hôpital de diminuer sa facture d’électricité de 10 pour cent et sa facture de gaz naturel de 11 pour cent en 2017. L’argent ainsi économisé a permis d’absorber une partie de la hausse du coût de l’électricité et d’investir dans deux autres projets écoénergétiques. L’an dernier, on a transfor mé 62 lampadaires de stationnement en éclairage à DEL afin de continuer à diminuer la consommation électrique. Les nouveaux lampadaires affichent une consommation 70 pour cent inférieure aux anciens, pour une économie annuelle de $6,300. En outre, on économise sur le remplacement des ampoules (matériel, maind’œuvre et location de camion élévateur). Le deuxième projet consiste en la mise à niveau de plusieurs purgeurs de vapeur pour économiser 42,993 mètres cubes de gaz naturel, selon les calculs d’Enbridge qui offrait un rabais de $4,212. En faisant remplacer ces purgeurs par son propre personnel, l’hôpital a récupéré sa mise beaucoup plus vite. En 2018, le personnel de gestion des installations se lance dans la transformation en DEL de l’éclairage des piscines et de l’étage d’hospitalisation. L’équipe continuera d’utiliser les rabais et les économies pour financer d’autres solutions écologiques. Bobby Hancock est directeur principal de la gestion des installations à l’Hôpital de réadaptation pour enfants Holland Bloorview, le plus grand hôpital de réadaptation pour enfants qui se consacre à améliorer la qualité de vie des enfants handicapés au Canada. Le Holland Bloorview est un hôpital universitaire de renommée mondiale affilié à l’Université de Toronto. Il accueille 7,500 familles par année.

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