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Canadian

HealthcareFacilities JOURNAL OF CANADIAN HEALTHCARE ENGINEERING SOCIETY

Volume 40 Issue 2

Spring/Printemps 2020

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Collaborative design helps make health services work for Indigenous peoples

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CONTENTS

CANADIAN HEALTHCARE FACILITIES Volume 40

Issue 2

EDITOR/RÉDACTRICE

Clare Tattersall claret@mediaedge.ca

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

DEPARTMENTS

SUSTAINABLE HEALTHCARE

Editor’s Note

President’s Message

24 Wrapping Up Savings New Brunswick hospital gets quick payback from blanketing energy loss

Chapter Reports

CANADIAN HEALTHCARE FACILITIES IS PUBLISHED BY UNDER THE PATRONAGE OF THE CANADIAN HEALTHCARE ENGINEERING SOCIETY. SCISS JOURNAL TRIMESTRIEL PUBLIE PAR SOUS LE PATRONAGE DE LA SOCIETE CANADIENNE D'INGENIERIE DES SERVICES DE SANTE.

CHES

Journey to Net-Zero Working toward the low-carbon heating plant

Canadian Healthcare Engineering Society

SCISS

Société canadienne d'ingénierie des services de santé

PRESIDENT VICE-PRESIDENT PAST PRESIDENT

HEALTHCARE DEVELOPMENT 14 Cultural Healing Improving healthcare for Indigenous peoples through consultation, collaboration

TREASURER

EMERGENCY PREPAREDNESS & RESPONSE 28 Seismic Strategies Stratégies sismiques

HEALTH & SAFETY 17 It’s that Simple Hôtel-Dieu Grace Healthcare solves common PPE challenges through cooperation, creativity

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

18 Proof is in the Pudding St. Joseph’s Health Centre makes infection prevention fun with IPAC Olympics

CHES

20 Waiting to Exhale New government study explores impact of wildfire smoke on indoor air quality

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EDITOR'S NOTE

COORDINATION OF EFFORTS THE NOVEL CORONAVIRUS continues to dominate the news cycle, with 67 COVID-19 presumed and confirmed cases in Canada (at time of writing). This number is expected to grow as more people are tested for the virus. As it does, there is the possibility of a pandemic. Canadian health officials continue to closely monitor the situation and plan for the potential of local spread, informed by lessons learned from 2003’s severe acute respiratory syndrome (SARS) outbreak and ongoing infectious diseases training. This brings me to Proof is in the Pudding. Though not the ‘feature’ story, this article is timely given the coronavirus spread. In an effort to reinforce the significance of proper infection prevention practices (particularly regular hand hygiene) in reducing the transmission of germs, St. Joseph’s Health Centre in Toronto developed an education session called the IPAC Olympics. ‘Played’ by staff on the hospital’s Morrow wing, it was so well-received that other units have requested to take part in the ‘games.’ You can read all about the fun initiative beginning on page 18. Continuing with health and safety measures, the use of personal protective equipment (PPE) by healthcare staff reduces the risk of workplace exposure to highly infectious diseases and, subsequently, their spread. Recently, Hôtel-Dieu Grace Healthcare discovered its PPE storage did not facilitate best practices for donning or hand hygiene, so it embarked on an audit exercise to determine how to best remedy the situation. You can read about it and the results in It’s that Simple. Though the coronavirus is top of mind these days, sustainability and climate change are still major concerns for many. In an effort to reduce heat loss, energy costs and greenhouse gas emissions, New Brunswick’s Horizon Health Network has installed reusable blanket insulation on its steam system components at four of its hospital sites. You can read about the project in Wrapping Up Savings. Then, Journey to Net-Zero explores the transition to the low-carbon future and the impending shift away from steam to hot water heating and focus on heat recovery. To begin, however, we delve into how collaborative design can help make health services work for Indigenous peoples, as seen in two recently completed hospitals, one in the Northwest Territories and the other in Saskatchewan.

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.

NATIONAL CONFERENCE | 2020 | SEPTEMBER 20-22 | HALIFAX CONVENTION CENTRE | HALIFAX, NS

SAVE THE DATE! The 2020 CHES National Conference will be held in Halifax, Nova Scotia, at the Halifax Convention Centre, September 20-22, 2020. The Halifax Convention Centre is conveniently located in the downtown core and close to local amenities. A block of rooms has been reserved at both the Cambridge Suite Hotel, starting at $199 plus applicable taxes for single/double occupancy, and the Prince George Hotel, starting at $239 plus applicable taxes for single/double occupancy. The theme of the 2020 conference is “Enriching Patient Experiences by Optimizing the Environment” The 2020 CHES Education Program is well underway and will once again feature dual tracks with talks on relevant industry topics from high-profile experts in the field. We have booked Alan Mallory as our Keynote Speaker. Alan is a dynamic keynote whose talk is built around the two years of planning and two months of climbing that went into making the goal of reaching the summit of Mount Everest a reality. Alan will discuss focusing on results rather than tasks, being agile so we can adapt to change, overcoming adversity through resilience, building trust in professional relationships and adopting an iterative approach. The Great CHES Golf Tournament will be held at Glen Arbor Golf Course on Sunday, September 20, 2020. Join us for the CHES President’s Reception and Gala Banquet at Pier 21. The banquet will celebrate the accomplishments of our peers with the 2020 Awards presentations, while enjoying great food and entertainment with friends.

See you in 2020 in Halifax! For more info visit our website at www.ches.org Follow us on Twitter!

@CHES_SCISS

PRESIDENT'S MESSAGE

HOPE SPRINGS ETERNAL EVEN THOUGH I AM taking some literary licence with Alexander Pope’s line from An Essay on Man, the idiom ‘hope springs eternal’ is appropriate on two levels. With most of winter behind us, we look forward to the warmer days and longer hours of sun, and the feeling of rejuvenation it gives us. Then there is the appreciation that even though we all have challenges, we hold a positive mindset and know we can rise to them and do what it takes to overcome any obstacles. This is how I feel about our CHES team. After many weeks of negotiations with the Canadian Standards Association (CSA), CHES and CSA have an agreement in place that speaks to how our organizations will work together not only on the development of the two new medical gas courses, but also on the ongoing marketing and actual training itself. Even though the auspices of this contract came from changes in the medical gas standard, it is both sides’ expectation that this agreement will form the framework for other joint training initiatives. Now that we are well into 2020, I hope everyone has marked this year’s CHES National Conference on their calendar. It will take place Sept. 20-22, in Halifax. Robert Barss’s conference planning team is putting the final touches on the event and it will soon be time to start making plans to attend. Jim McArthur’s planning team for the 2022 International Federation of Healthcare Engineering (IFHE) Congress has grown in size to include new members from across the country and even one from the American Society of Healthcare Engineering (Gordon Howie). This increase is necessary for the additional planning and coordination requirements involved in putting together an international event with a separate stream of information sessions. The group has everything well in hand and is assembling their promotion itinerary for the 2020 IFHE Congress in Rome this spring. There has been lots of activity and progress at CHES, with the goal of improving membership expertise. We have committed to supporting an increase in our representation on CSA standards and look forward to leveraging our recently renewed agreement with the Canadian College of Health Leaders. The quality review of the Canadian Certified Healthcare Facility Manager (CCHFM) program continues to improve output of this initiative. With spring almost upon us, it will soon be time to lose the parka and get out to enjoy being part of an organization that helps others in our industry and, more importantly, improves healthcare for people across the country.

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 Spring 2020 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/KQD9JSK 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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CHAPTER REPORTS

NEWFOUNDLAND & LABRADOR CHAPTER

ALBERTA CHAPTER

If April showers bring May flowers, what does a single dumping of more than 100 centimetres of snow in January bring? That’s easy! Increased visits to emergency departments, smiles on the faces of chiropractors and rocket sales for the manufacturers of pain relief products. Winter can be harsh on our facilities and the grounds surrounding them. On occasion, there is an extreme weather event and no amount of planning can prepare for the aftermath. This was the case with the record-breaking blizzard that hit Eastern Canada, aptly titled Snowmageddon 2020. A state of emergency was declared, lasting eight days. We found ourselves shovelling snow from one healthcare facility’s interior and wheelbarrowing it to the closest shower stalls for melting. Essential facilities staff, who worked more than 50 continuous hours performing duties well outside their normal job duties (cooking and serving meals, removing snow, driving courtesy vehicles, and so on), went above and beyond to ensure services could be delivered to clients. It was truly remarkable to see Newfoundlanders and Labradorians come together following this epic snowstorm. The chapter executive met in December, to strategize how to better deliver CHES events to our members and others who wish to attend. Much discussion surrounded our spring professional development forum. We are considering incorporating roundtable discussions and lessons learned, keeping in mind the tight timeframe to deliver such an event over the course of one day. We are also evaluating whether to move this event across the province from year to year. As a province, we are in a low. The number of residential and commercial new builds is at a minimum, and projects related to oil and gas are wrapping up. All predictions indicate this will continue for the next two to three years, so expect the status quo moving forward. For this reason, it is challenging for people to find funding to partake in voluntary groups like CHES. The chapter executive wants to assist our members and invest in their betterment, whether that involves providing education opportunities, sending additional members to the 2020 CHES National Conference in Halifax, paying for more webinars, or supporting members who take on the role of chair of a national committee. On that note, I’d like to congratulate Wayne Stokes on becoming the new chair of the national professional development committee. —Colin Marsh, Newfoundland & Labrador chapter chair

Recently, the Alberta government presented a review of Alberta Health Services (AHS) by Ernst and Young to the province’s health authority. Many of the recommendations in the report are incentives that AHS has already implemented or is exploring. Ernst and Young also identified AHS as a “changeready organization” committed to providing excellence in healthcare to Albertans. CSA Group hosted an infection control training course Feb. 24-25, in Edmonton. Topics covered included infection control during construction, renovation and maintenance activities in healthcare facilities. The Alberta chapter’s spring conference will take place May 11-12, in Red Deer, Alta. Delegate and vendor registration can be found on the Alberta chapter section of the CHES website. Although much of the chapter’s resources are currently focused on the upcoming conference, we continue to promote CHES within Alberta and advocate education opportunities for our chapter membership. I am excited to attend the 2020 CHES National Conference this fall with other members of the Alberta chapter executive. It will be my first visit to Halifax, so I’m looking forward to experiencing the beauty and history of the region. —Dan Ballantine, Alberta chapter chair

The 2020 CHES National Conference will be held Sept. 20-22, in Halifax.

10 CANADIAN HEALTHCARE FACILITIES

MARITIME CHAPTER The 2020 CHES National Conference will take place Sept. 20-22, at the Halifax Convention Centre. The theme is, Enriching Patient Experiences by Optimizing the Environment. Alan Mallory is the keynote speaker. Educational session topics include the commissioning process and how it enhances the patient experience; a new way to manage planned shutdowns and react to unplanned service failures; improving project delivery in operating hospitals; environmental controls for hospitals and the impact on patient safety; designing and retrofitting healthcare facilities for accessibility and wayfinding; and HVAC performance optimization for improved health outcomes. The annual CHES golf tournament is scheduled for the first day of the conference, Sept. 20, at Glen Arbour Golf Course. During the evening, the opening reception will be held at the Canadian Museum of Immigration at Pier 21. The companion program includes a two-hour sailing adventure on the world-renowned Bluenose II. After the excursion is lunch at the Old Fish Factory and then an outing to the Fisheries Museum of the Atlantic. The following day, there will be a sightseeing tour of Halifax, before heading to Peggy's Cove for lunch. 2020 is an election year for the chapter executive. Nominations are now being accepted for the roles of vice-chair, secretary, treasurer, vice-chair New Brunswick, vice-chair Nova Scotia and vice-chair Prince Edward Island. If you are interested in any of these positions, contact Robert Barss at robert.barss@nshealth.ca. 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, the fall education day and other rebates. —Helen Comeau, Maritime chapter chair

CHAPTER REPORTS

QUEBEC CHAPTER

MANITOBA CHAPTER

The cold weather has not stopped the Quebec chapter executive from planning events and promoting CHES within healthcare facilities. Last year, we succeeded in making some noise in the healthcare industry. In 2020, we will push further and get our voice to all hospitals in the province. The Quebec chapter aims to increase its membership by diversifying our offerings and choosing the right technical sessions. Our first event of the year will take place at one of the biggest and most advanced hospitals in Canada, McGill University Health Centre’s Glen site. It will include a site visit to mechanical rooms followed by a conference on legionella. The chapter has many other events planned for 2020, and we will be participating in a variety of CHES events across the country. I encourage you to regularly check the Quebec chapter page on the CHES website and follow us on social media to stay informed. —Mohamed Merheb, Quebec chapter president

The Manitoba chapter’s highly anticipated spring conference is almost upon us. To be held April 20-21, it will provide a full day and a half of speakers, a trade show, banquet and entertainment (on the first evening) and a chance to network with colleagues and trades professionals from across the province. This year’s theme is, Construction and Renovations in Healthcare Facilities. The keynote speaker, Dr. David G. Barber, will present on climate change in the Arctic and its effect on lower latitudes. New to CHES Manitoba is two annual awards that recognize excellence in facilities management and project management, respectively, by regular CHES Manitoba members. The awards will be presented April 20, at the spring conference banquet. CHES Manitoba representatives held an information session at Red River College in January, for Class 3 and 4 power engineering students. Approximately 50 attended the first of what will be many upcoming information sessions at the college. The goal is to educate future power engineers on what it’s like to work in the healthcare industry. In support of our ongoing work with Red River College’s skilled trades and technology programs, CHES Manitoba has established a new student award, to be offered annually. The chapter executive is in the beginning stages of planning next year’s CHES National Conference. It will be held in Winnipeg, in September 2021. —Tom Still, Manitoba chapter chair

CHAPITRE DU QUEBEC Le temps froid n’a pas empêché les exécutifs de la chapitre du Québec de planifier des événements et de promouvoir la société à travers les établissements de santé. L’année dernière, nous avons réussi à faire du bruit dans l’industrie. Cette année, nous continuerons à pousser plus loin et à faire entendre notre voix dans tous les établissements de santé. Nous visons à augmenter le nombre de nos membres en diversifiant notre offre et en choisissant des conférences techniques ciblés. Notre premier événement de l’année 2020 aura lieu dans l’un des plus grands et les plus avancés des hôpitaux au Canada. Il s’agit du site Glen du Centre universitaire de santé McGill. Il y aura une visite des salles mécaniques suivie d’une conférence sur la légionellose. Nous avons de nombreux événements prévus et nous participerons également à d’autres événements de la société à travers le pays. N’oubliez pas de nous suivre sur les réseaux sociaux et de consulter régulièrement notre site internet. —Mohamed Merheb, président du chapitre du Québec

TORONTO, CANADA SEPTEMBER 17-21, 2022 27TH CONGRESS OF THE INTERNATIONAL FEDERATION OF HEALTHCARE ENGINEERING

SASK ATCHEWAN CHAPTER Plans continue for this year’s chapter conference. It will be held Oct. 19-20, at the Delta Hotel in Regina. The event features a one-day trade show and two days of guest speakers. More details to come. Our annual general meeting was held on the last day of the National conference, with approximately 20 members in attendance. The Member of the Year award went to Steve Kemp who has provided electrical engineering consulting on many healthcare projects over the past 24 years. Steve has been a CHES member for 17 years and serves on the Saskatchewan chapter’s board of directors. He also sits on CHES’s partnership and advocacy committee. —Greg Woitas, Saskatchewan chapter chair

Learn more at: www.IFHE2022.org

SPRING/PRINTEMPS 2020 11

CHAPTER REPORTS

BRITISH COLUMBIA CHAPTER

It’s Chaos Without Us

The words ‘emergency planning’ have become part of our everyday language. Floods, road closures, fire evacuations and system shutdowns now affect us year-round. It is with this in mind that the chapter chose the theme, The Physical Environment: Creating Patient Focused Facilities, for this year’s spring conference June 7-9, in Whistler, B.C. Registration is open and can be accessed via the B.C. chapter page on the CHES website. It’s going to be a great occasion to share experiences and learn from colleagues. The chapter is doing well financially, which has allowed us to book venues for the 2021 and 2022 spring conferences in Penticton and Whistler, respectively. We continue to have funding available for our educational bursaries and CHES’s webinar series (free for B.C. chapter members). I encourage you to take advantage of these great opportunities. 2020 is an election year. The call for nominations has closed. Should an election be required, ballots will be sent out to members soon. The current chapter executive includes myself (chair), Steve McEwan (past chair), Sarah Thorn (vice-chair), Rick Molnar (treasurer), Ken VanAalst (secretary), Arthur Buse (membership), Mitch Weimer (public relations), Mark Swain (communications) and Caroline Reid (education). Contact any member of the executive team if you are interested in getting involved in a CHES committee or the chapter executive itself. —Norbert Fisher, British Columbia chapter chair

ONTARIO CHAPTER As I write this report, we are only one month into 2020 and we’ve seen devastation in Australia from the wildfires, a major snowfall in Newfoundland, bitter cold in Western Canada and the global health risk associated with the new coronavirus, COVID-19. All of these events present challenges to CHES members and our colleagues around the world. Our thoughts go out to everyone who has been affected. On March 25, the Ontario chapter will co-host an event in Toronto with the Canadian Institute for Energy Training. It will be a networking opportunity to discuss energy efficiency best practices. The event is complimentary to CHES members. Ron Durocher and the 2020 conference planning committee continue to organize what we anticipate will be a well-attended spring conference May 31-June 2, in Windsor, Ont. Planning for the 2022 International Federation of Healthcare Engineering (IFHE) Congress in Toronto is progressing well. Steve Rees, Roger Holliss, Craig Doerksen and I will attend this year’s IFHE Congress in Rome, May 22-27. We have arranged for booth space and will host a reception to promote the 2022 IFHE Congress. The Ontario chapter executive continues to meet regularly by teleconference and looks forward to our annual general meeting at this year’s spring conference. I hope to see many of you there and at other CHES events throughout 2020. —Jim McArthur, Ontario chapter chair 12 CANADIAN HEALTHCARE FACILITIES

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HEALTHCARE DEVELOPMENT

CULTURAL HEALING

Improving healthcare for Indigenous peoples through consultation, collaboration By Macy Koochek, Golnaz Rakhshan & Barbara Budenz

esign can help improve the way people experience hospitals. Two recently completed healthcare facilities illustrate how to meet the needs of populations primarily identifying as Indigenous. STANTON TERRITORIAL HOSPITAL

Stanton Territorial Hospital is the main healthcare facility for residents of the Northwest Territories (N.W.T.) and western Nunavut. It was in need of expansion and renewal to serve projected resident population growth of up to 60,000 in Yellowknife and surrounding areas through 2050. Built in 1988 with traditional brickand-mortar methods, the facility’s design 14 CANADIAN HEALTHCARE FACILITIES

limited its physical and social transparency, integration with the environment and incorporation of Indigenous people’s cultural traditions, as well as health and healing practices. The hospital’s wayfinding was also confusing and overwhelming, adding to the stress and anxiety of patients and visitors. To fulfill the needs of the area’s culturally and linguistically diverse population, the project’s architecture and interior design team conducted a two-day consultative workshop that involved representatives from more than 14 First Nation bands from across the N.W.T. and Nunavut. The workshop explored past case studies and included interactive activities to explore their cultural values and visions behind well-being and

patient-centered care. Band representatives were asked to bring objects that embodied their cultural values, including crafts, beading and calendar wheels. The architecture of the new purpose-built facility (which is double the size of the previous hospital) was in part driven by the natural topography and contours of the site. It purposely blends indoor and outdoor space to reflect many Indigenous communities’ close connection with nature and its key role in the healing process. The strategic selection of colours, patterns, materials, artwork and lighting provide for the seamless movement between the hospital interior and surrounding landscape.

Emerging from the consultative process was the need to integrate a natural wonder that unifies the people of the N.W.T. Taking inspiration from the aurora borealis, which figures prominently in the mythology and legends of most Indigenous people living in Canada, LED lights were added to the east facade tower to mimic the movement and changing colours of the night sky. This feature serves to visually transition patients, visitors and staff from the exterior to the interior where flooring patterns and cultural motifs help weave people through the first floor’s public area. To acknowledge the many types of landscape and ways of life in the service area of

LEFT: Colour schemes and themes change according to which level you're on inside Stanton Territorial Hospital. The third floor is inspired by lakes. RIGHT: A thoughtfully designed sacred area on the first floor has ramped up ventilation to handle smoke from Indigenous smudging ceremonies.

the hospital, each of the facility’s six floors has its own colour and theme. Beginning with the aurora borealis on ground level, successive floors are inspired by the Barren Lands, rivers and forests, lakes, mountains and, finally, Arctic. This serves to aid with wayfinding and orientation. Signage further helps with hospital navigation. Easily identifiable, it offers a hierarchy of infor mation using accent colours, animal icons and patterns to assist visitors. With 11 official languages recognized in the N.W.T., the design team had to be innovative in incorporating them onto the limited signage size. It employed universal symbols in a digital directory that can switch between languages. Directions

are offered in the desired language on the directory, while hard signs are communicated in Canada’s two official languages, English and French. A non-denominational sacred space was created for meditation. Its high ceiling, sloped walls and abundance of windows create the sensation of being inside a glass-enclosed half-teepee. The room is equipped with a special ventilation system to handle the smoke from traditional Indigenous smudging ceremonies. NEW SASKATCHEWAN HOSPITAL

Located 140 kilometres northwest of Saskatoon is Saskatchewan Hospital North Battleford, a 284-bed mental SPRING/PRINTEMPS 2020 15

HEALTHCARE DEVELOPMENT

LEFT: Saskatchewan Hospital North Battleford includes 188 psychiatric rehabilitation beds and a 96-bed secure wing for individuals who are incarcerated. RIGHT: The main lobby and central hub of the facility was named the Gordon and Jill Rawlinson New Beginnings Centre in recognition of the $1 million donation made by the Rawlco Radio owners.

health facility that replaced the city’s century-old psychiatric hospital and two correctional facilities. This innovative approach to delivering mental healthcare offers support to two separate groups with significant rehabilitation needs under one roof. The new facility was built in a way to integrate required security into the design rather than applying it to the design. This method has been proven to enhance flexibility, reliability and safety. Like Stanton Territorial Hospital, community consultation was key to meeting the needs of the service population, which includes many people who identify as Indigenous or Métis. From this process, it was identified that one of the main facility requirements was the incorporation of their culture. Dialogue with Indigenous elders during the design process ensured their voices were heard and appropriately addressed. The design team also worked with approximately 50 clinical and administrative stakeholders to refine the schematic design for the facility. Materials used for the envelope reflect the local environment. The design and massing of the hospital incorporates the surrounding landscape forms of the rolling hills and prairie grasslands. Aboriginal motifs are also included in the main lobby glazing. The facility features a sweat lodge with ceremonial space, which includes a 16 CANADIAN HEALTHCARE FACILITIES

THE DESIGN AND MASSING OF THE HOSPITAL INCORPORATES THE SURROUNDING LANDSCAPE FORMS OF THE ROLLING HILLS AND PRAIRIE GRASSLANDS. sunken floor. While restrained by security requirements, the sweat lodge’s main entrance opens to the east to address Indigenous traditions. Inside, there is a fire pit aligned with the same cardinal direction. The space is clad in tongue and groove cedar. There are also smudging rooms within each client care unit. The rooms have cardinal directions embedded into the floor patterns and are equipped with different ventilation to accommodate cultural and ceremonial rituals. The key driver for the project was to create an environment where residents feel at home. An emphasis was placed on client and family-centred care and creating a non-institutional environment. Key features to support this include access to natural light, private client rooms and creating a connection to the outside. Clear wayfinding, which helps reduce anxiety, was achieved through the use of architectural elements and signage, while finishes and soft colours identify major dropdown points or areas.

Therapy and vocational programs, an open nutrition centre and laundry facilities give clients a sense of empowerment and independence. Natural light in all public and client areas promotes healing and improves circadian rhythms. Ambient and uniform lighting reduces hot spots. Spaces for quiet sitting and, conversely, social interaction are incorporated throughout the hospital, with exterior views for all client and public areas. Cluster seating promotes inclusion; however, they are far enough apart to reduce social pressure. Macy Koochek is senior interior designer, healthcare, at Kasian Architecture Interior Design and Planning Ltd. She is based in the firm’s Vancouver office, along with associate Golnaz Rakhshan. Barbara Budenz is senior project architect and project manager, healthcare, at Kasian’s Calgary office. Kasian was the architecture and interior design lead on both the Stanton Territorial Hospital and Saskatchewan Hospital North Battleford renewal projects.

HEALTH & SAFETY

IT’S THAT SIMPLE Hôtel-Dieu Grace Healthcare solves common PPE challenges through cooperation, creativity By Sarah Picco, Lindsay Samoila, Ray Elwood & Justin Quinn

n the words of American engineer Charles F. Kettering, “If you have always done it that way, it is probably wrong.” This is exactly what the infection pr e v e nt i o n a n d c o nt r o l ( I PAC ) depa r t ment at Hôtel-Dieu Grace Healthcare (HDGH) found with its personal protective equipment (PPE) storage. Regular quality checks identified that it did not facilitate best practices for donning or hand hygiene. Growing linen costs and lingering low hand hygiene compliance rates were also driving the need for a better PPE storage solution. To find a better way, an inter-professional team was created that included IPAC practitioners, environmental services, materials management, frontline staff, ergonomics, clinical practice and plant operations. The team performed process auditing, focusing on best practices for hand hygiene and donning PPE. Sixtynine PPE carts were examined over a 12-month period. The audits revealed extreme hoarding of linen, general hospital supplies and expired PPE. Manual replenishment of PPE without a def ined process of ownership, cleaning and maintenance was contributing to the hoarding and storage problem. The auditing process illustrated healthcare workers had their own ideas of the purpose of the PPE carts. As a result, the current storage system was contributing to missed hand hygiene opportunities and growing linen costs. With the audit results in hand, the interprofessional team worked to determine what best practices indicate for PPE use and location. Various frontline staff were asked where and how they used PPE. From this, a list of criteria for ideal PPE storage at pointof-care was generated, followed by extensive consultations with vendors and suppliers.

The team found it relatively straightforward to identify existing solutions with vendors for mask and glove storage and placement. Gloves were moved to in-room standardized wall storage holders and stocked in all sizes. Hand sanitizer dispensers were placed next to the storage units to enable staff to perform hand hygiene and change gloves at point-ofcare. In addition, based on a risk assessment for the hospital, only one type of facial protection (combination mask with face shield) is available to staff based on the patient population and care activities. An existing solution for gowns was not as easy to establish. At HDGH, Level 2 impermeable launderable gowns are used. This required the team to collaboratively develop innovative storage for laundered gowns. After much research and analysis, the team decided on laundered bags stored on hooks outside of each room. The garments are delivered to HDGH in prefilled bags with 20 gowns. The gown amount was calculated based on ergonomic parameters related to weight, height of the hooks and number of gowns frontline staff use over approximately 12 hours. Collectively, inter-professional team members used a ‘plan-do-study-act’ quality improvement cycle to develop and implement a permanent, self-

sustaining point-of-care PPE storage system that promotes the appropriate donning sequence and four moments of hand hygiene. Its impact was measured and indicated some significant changes, including a 27 per cent reduction in protective gown consumption, representing a cost savings of $24,707 in a one-year period; an eight per cent reduction in glove consumption, representing a cost savings of $56,000 over a three-year period; and a 10 per cent increase in hand hygiene compliance over the length of the two-year project. By utilizing a collaborative team approach, point-of-care PPE was integrated into practice at HDGH. Incorporating frontline feedback into the design motivated healthcare workers to embrace it. The successful implementation validated great ideas can come from within the organization and innovation does not need to originate from external sources or be state-of-the-art. Sarah Picco is manager of professional practice and infection control at HôtelDieu Grace Healthcare. Lindsay Samoila and Raymond Elwood are infection control practitioners at the southwestern Ontario hospital, and Justin Quinn is manager of environmental service and materials management. SPRING/PRINTEMPS 2020 17

PROOF IS IN THE PUDDING St. Joseph’s Health Centre makes infection prevention fun with IPAC Olympics By Amber Daugherty

t’s not everyday that Dianagris Balakrishnan finds herself covered in pudding at work. But one day last summer, she had so much of it on her personal protective equipment (PPE) gown and gloves that it was dripping onto the floor. The pudding had been spread by Cameron Thomas, an infection prevention practitioner, as part of an education session called the IPAC Olympics. Balakrishnan’s task was to remove the gown and gloves without getting any pudding on her skin or clothes underneath. “It was gross,” says the registered practical nurse, laughing. “But it was a good reminder that there’s a lot of other stuff we could have on us when we leave a patient’s room.” The game was meant to mimic the potential for transmission of all types of bacteria by nurses and other healthcare providers. Walking in and out of different patients’ spaces means providers may be taking more than they’d like when they leave, potentially

18 CANADIAN HEALTHCARE FACILITIES

spreading something to other areas of the unit, patients or themselves. This can be especially dangerous for those with a weakened immune system and during high volume times like flu season. The PPE and pudding game was just one of four that was brought to the Morrow wing on the fourth floor of St. Joseph’s Health Centre to help engage staff and visually show the significance of proper infection prevention practices. “Working in healthcare means you get the same information over and over again but the message gets lost because it’s always the same — clean your hands, clean shared equipment,” says the unit’s educator, Rosalyn Espiritu. “I heard other hospitals had tried this interactive way of providing education and thought it would be impactful here because it’s new and exciting. People came over curious about why there was pudding on the table.” A common issue in healthcare is people use gloves for extended periods of time,

often instead of regular hand hygiene. So, in another game, staff members put gloves on and had Glo Germ powder — a visual tool used in cleaning education that shows up only under ultraviolet (UV) light — sprinkled on top. They rubbed their hands together to mimic the friction of providing care and then had to remove the gloves without contaminating themselves. Thomas then used a UV light to see if any powder remained. “When I took the gloves off, I could still see some spots on my arms,” says Vina Magno, a registered nurse on the unit. “It’s so scary because normally we can’t see what’s there.” Many staff members also had the powder on their fingers and hands because of defects in the gloves. “People have a mistaken idea that gloves are impermeable and that’s why they don’t need to be as good about hand hygiene when wearing them,” says Thomas. “Staff were surprised to see powder on their hands

HEALTH & SAFETY

LEFT: Gloves protect from infection and contamination but proper hand hygiene is necessary upon removal as they are not impermeable. RIGHT: Glow Germ powder on one healthcare worker's hand illustrates that micro-organisms can get through protective gloves.

and the reality is that Glo Germ is still bigger than micro-organisms that could get through, which is why it’s so important that gloves be used in addition to really good hand hygiene.” Feedback on the IPAC Olympics was overwhelmingly positive from staff on the Morrow wing, known internally as 4M, so much so that other units have requested a shot at playing the games, which also included one related to cleaning shared

equipment and another that tracked bacteria growth in microlab plates before and after practicing hand hygiene. The infection prevention team is exploring ways to continue this work to engage all staff members who interact with patients in a way that will hopefully stay with them. “A lot of the time, we talk in healthcare about the moments when you’re supposed to clean your hands but not really the why,” says Thomas. “But when you think about what

CHES Canadian Healthcare Engineering Society

you touched last and what you’re touching next, it makes a lot more sense why you should stop and make sure your hands are clean. Maybe next time someone on 4M is taking their PPE off, they’ll think about the pudding and be aware that just because they can’t see something that could potentially be harmful, it doesn’t mean it’s not there.” Amber Daugherty is a senior communications advisor at Unity Health Toronto.

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.

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

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 SPRING/PRINTEMPS 2020 19

WAITING TO EXHALE

New government study explores impact of wildfire smoke on indoor air quality By Greg Nilsson

20 CANADIAN HEALTHCARE FACILITIES

different facilities, an online survey was distributed to healthcare facility management and operations (FMO) staff in Canada’s four westernmost provinces. All respondents indicated that in 45 per cent of cases, wildfire smoke had a prolonged negative impact on IAQ. The average length of a wildfire smoke event during the 2018 season was 30 days; the longest event lasted 60 consecutive days. MITIGATION TECHNOLOGIES

The most common mitigation approach to deal with compromised IAQ was to install

vidence-based information on indoor air quality ( I AQ ) at Canadian healthcare facilities is lacking and yet it is crucial in helping facility managers make adequate decisions during times when IAQ may be compromised, specifically during wildfire season. To help solve this problem, the National Research Council of Canada’s (NRC) Construction Research Centre launched a project in 2018, to identify the impact wildfire smoke has on healthcare facilities’ IAQ. The NRC’s study began by characterizing outdoor and indoor particle concentrations to establish baselines for technological responses. An advisory committee was formed to enable st a keholder consu lt at ions. Committee members included Health Canada, the Canadian Forest Service, representation from provincial health ministries, emergency management offices and facility maintenance operations from Manitoba, Saskatchewan, Alberta and British Columbia. The committee identif ied a lack of evidence-based direction in how to react to IAQ challenges during wildfire smoke occurrences, given response practices are not systematically reported to allow for the development of generic guidance. With this in mind and to better understand the response practices being used by

filters with higher Minimum Efficiency Reporting Value (MERV) ratings for the outdoor air intakes (91 per cent of respondents). Portable air cleaners were also used by 45 per cent of respondents. Participants stated that for infection control purposes, portable air cleaners were not permitted in sensitive areas as they may disturb air flows intended to minimize infection transmission risks. In 57 per cent of cases, the actions taken did not reduce the number of IAQ complaints received by FMO staff. Sites that used multiple approaches had the best outcome in terms of reported improved IAQ and

Daily averages of PM2.5 monitored during Phase 1, as listed by monitoring location.

HEALTH & SAFETY reduced complaints. However, according to the survey, no particle monitoring was performed during wildfire smoke events. As literature did not reveal any data regarding the indoor particle concentrations in Canadian healthcare facilities, field monitoring at three B.C. locations heavily impacted by wildfire smoke in 2018 was undertaken to better understand the relationship between outdoor and indoor particle concentrations. The parameter PM2.5 was chosen since it may indicate the presence of potentially harmful airborne particles. PM2.5 is tiny inhalable particulate matter, with an aerodynamic diameter of 2.5 micrometres and smaller. There are no recommended safe exposure limits for PM2.5 in Canada. The knowledge obtained from monitoring is critical for a later, targeted approach, when evaluating technologies and solutions to reduce inhalable particles. These measurements will also be helpful in creating baseline data. FIELD MONITORING

The monitoring study was set up in two phases: Phase 1 was a preliminary study conducted during winter and Phase 2 a follow-up study during fire season. The air handling units, ducting and control strategies for the monitored healthcare facilities were found to vary considerably at each location. Due to this complexity, a simple model was developed and applied. In this model, the facility was split into two basic IAQ zones: a core zone where indoor air is mainly provided through the HVAC system, and a periphery zone where there is higher potential for infiltration due to occupant movement through entrances and exits. In this case, the periphery zone monitoring location was the emergency room. Phase 1 took place at Victoria General Hospital on Vancouver Island, between December 2018 and January 2019. Data collected showed an association between indoor and outdoor particle concentrations for the periphery zone, but no correlation for interior zones. For this phase of the study, five particle counters were deployed in the indoor areas and one for the outdoors. The different particle counters deployed in each zone reported very similar data. So, during Phase 2, only two counters were deployed, one monitoring unit for each area. Phase 2 monitoring was completed between July and September 2019, at

Daily averages of PM2.5 monitored during Phase 2, as listed by monitoring locations.

three B.C. sites: Victoria General, Royal Inland Hospital in Kamloops, and Kelowna General Hospital. Data collected revealed a strong correlation between indoor and outdoor particle concentrations for the periphery zone, as was seen in the first phase of the study. The monitoring was not exhaustive as it was only completed at three sites, so a level of caution should be applied when drawing conclusions about the filtration effectiveness of the HVAC systems of these sites. However, it can be demonstrated that even with a normal background of PM2.5, concentration infiltration might be a concern. THE OUTCOME

Although this study had a limited number of monitoring sites, it did indicate that there appears to be a higher risk for the periphery zone to be impacted by wildfire smoke particles due to the increased infil-

tration it experiences. Consequently, mitigation strategies should include a focus on reducing infiltration. The combined results of the online survey and on-site monitoring reveal a need for additional control approaches to address prolonged periods of wildfire smoke. The NRC is currently in the planning process for further projects to evaluate the effects of wildfire smoke and technologies to reduce its impact. Greg Nilsson is a lead technical officer and project manager for the indoor air quality group of the Construction Research Centre at the National Research Council. He is also the current chair of CSA Group standard C22.2 No. 187, Electrostatic Air Cleaners. Greg’s expertise is in the area of measuring airborne contaminants, experimental and equipment design. He can be reached at greg.nilsson@nrc-cnrc.gc.ca. SPRING/PRINTEMPS 2020 21

SPONSORED CONTENT

The threat of emerging pathogens. Emerging infectious diseases are infections that have recently appeared within a population and can be caused by previously undetected or unknown infectious agents, or the emergence of new pathogens.1

In the news. As of January 31, 2020, there have only been four confirmed cases of the novel coronavirus (2019-nCoV) in Canada (three in Ontario and one in British Columbia). 2 The Public Health Agency of Canada (PHAC) is working with Ontario and international partners, including the World Health Organization (WHO), to actively monitor the situation. Currently PHAC has assessed the public health risk associated with 2019-nCoV as low for Canada. Public health risk is continually reassessed as new information becomes available. 2 On January 30, 2020 WHO declared that the outbreak now meets the criteria for a Public Health Emergency of International Concern. 3 Coronaviruses (CoV) are a family of enveloped viruses that were first discovered in the 1960s. Coronaviruses are most commonly found in animals, including camels and bats, and are not typically transmitted between animals and humans; however, six strains of coronavirus were previously known to be capable of transmission from animals to humans, the most well-known being Severe Acute Respiratory Syndrome (SARS) CoV, responsible for a large outbreak in 2003, and Middle Eastern Respiratory Syndrome (MERS) CoV, responsible for an outbreak in 2012.4 Dr. Alison McGeer, infectious disease specialist at Mount Sinai Hospital, Toronto, said the fact that cases are being found in other countries suggests that screening systems are working and that is good news about the work underway to prevent a wider SARS-like outbreak. 5 There have also been cases of person-to-person transmission outside of China. 3

How does it spread? Coronaviruses are typically spread through the air via coughing or sneezing, via contact with an infected person or contaminated surfaces, and sometimes, but rarely, via fecal contamination.6 2019-nCoV is thought to have originally spread from animals to humans. There has been limited person-to-person spread of 2019-nCoV. At this time, there is no clear evidence that this virus is spread easily from person to person. This pattern of transmission was also reported with SARS CoV and MERS CoV.7 PHAC has also issued an information sheet on 2019-nCoV. 8,9

Protection is paramount.

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Under conditions of a public health emergency of international concern declared by PHAC or the WHO, Health Canada permits disinfectants to make non-label efficacy claims against the emerging viral pathogen if they have a broad-spectrum virucidal claim or for emerging viral pathogens or for which the taxonomic genus of the virus has been identified, efficacy data against other viruses within that genus may be considered acceptable (e.g., any coronavirus for a claim against the novel coronavirus, 2019-nCoV).10

When the PHAC issues a public notice that an emerging viral pathogen poses a significant risk to Canadians or has been declared by the WHO as a public health emergency of international concern, manufacturers can communicate to the public about non-label efficacy of some currently available disinfectants against emerging pathogens, such as 2019-nCoV.10 PHAC recommends the following infection control and prevention strategies to prevent or limit transmission of 2019-nCoV in healthcare facilities – prompt identification, appropriate risk assessment, management (including promotion of adherence to hand hygiene, use of personal protective equipment, etc.), placement of probable and confirmed cases, and investigation and follow-up of close contacts.11 PHAC also has additional information on prevention and risk from 2019-nCoV and an information line (1-833-784-4397). 2

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References: 1. Emerging infectious disease. Baylor College of Medicine. https://www.bcm.edu/departments/molecular-virology-and-microbiology/emerging-infections-and-biodefense/emerginginfectious-diseases. Accessed January 19, 2020. 2. 2019 novel coronavirus: Outbreak update. https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html. Accessed February 4, 2020. 3. WHO declares coronavirus outbreak an international emergency. CBC News. https://www.cbc.ca/news/world/who-reconvenes-assess-latest-coronavirus-1.5445775. Accessed January 30, 2020. 4. About human coronaviruses. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/about/index.html. Accessed January 31, 2020. 5. Key things to watch for in the coronavirus outbreak. CBC News. https://www.cbc.ca/news/health/coronavirus-china-canada-questions-1.5433986. Accessed January 22, 2020. 6. Transmission. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/about/transmission.html. Accessed February 4, 2020. 7. 2019 novel coronavirus (2019-nCoV) situation summary. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-nCoV/summary.html. Accessed February 4, 2020. 8. 2019 novel coronavirus. Public Health Agency of Canada. https://www. canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/2019-novel-coronavirus-information-sheet/coronavirus-handout-eng.pdf. Accessed January 30, 2020. 9. Novel coronavirus infection: Frequently asked questions (FAQ). Public Health Agency of Canada. https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/ frequently-asked-questions.html. Accessed February 4, 2020. 10. Health Canada Guidance Document: Safety and efficacy requirements for hard surface disinfectant drugs. Government of Canada. https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/applications-submissions/guidance-documents/disinfectants/safety-efficacy-requirements-hardsurface-disinfectant-drugs.html#b5. Accessed January 27, 2020. 11. 2019 Novel coronavirus: For health professionals. Government of Canada. https://www.canada.ca/en/public-health/services/ diseases/2019-novel-coronavirus-infection/health-professionals.html#i. Accessed February 5, 2020. 12. Data on file. The Clorox Company.

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SUSTAINABLE HEALTHCARE

A reusable insulation blanket designed for and installed on a wood boiler at one of Horizon Health Network's regional hospitals.

WRAPPING UP SAVINGS

New Brunswick hospital gets quick payback from blanketing energy loss By Bill Perry

hanks to a one-time investment in reusable insulation blankets, the boiler plant at Horizon Health Network’s Miramichi Regional Hospital (MRH) has reduced its steam consumption by approximately 15 million pounds since April 2015. According to its manufacturer, the reusable insulation should last at least another 10 years. So, during the next decade, the New Brunswick hospital expects to save another 30 million pounds of steam. DIAGNOSING ENERGY LOSS

While researching opportunities for energy savings in its 12 hospitals, Horizon learned of a low-cost opportunity to reduce heat loss in steam systems by installing industrial insulation. According to the U.S. Department of Energy, installing a oneinch thick blanket on an uninsulated sixinch gate valve in a 250-pounds per square 24 CANADIAN HEALTHCARE FACILITIES

inch gauge (psig) saturated steam line yields a savings of $525 per year. In 2014, an audit of MRH’s steam system was performed by a company that designs and makes reusable thermal and acoustic insulation blankets. The audit involved tracing the steam system and calculating thermal energy loss from exposed surfaces, such as valves and fittings in the boiler room, among other places. It predicted that covering steam system components with reusable insulation would reduce steam consumption by approximately one million pounds annually. “The value of a reusable blanket is clear the first time a maintenance worker accesses a component for service,” says Todd Bryenton, energy coordinator and chief engineer at MRH. “Conventional fibreglass insulation wrapped around certain points of a steam system will initially realize

heat loss reduction; however, when a component like a pump requires maintenance, the fibreglass insulation will be removed, typically thrown out, and the component is left bare because there’s no easy way to replace the insulation.” While finding an affordable energy-saving solution was a motivation for the insulation project, staff at the hospital also saw an opportunity to improve safety. “Insulation systems appear to be simple but doing them correctly can be complex,” says John Puskar, an expert on North American codes and standards related to piping, furnaces and boilers. “Everything on a piping system should be insulated, including fittings. The most popular method is to use flexible, reusable covers custom-fit for an application.” According to Puskar, insulating steam piping prevents excessive condensate from overloading steam traps. In the case of

SUSTAINABLE HEALTHCARE

water lines, insulation prevents dew point conditions and accelerated corrosion. While piping is commonly insulated, valves, flanges and pumps are not. “High temperature and pressure applications can cause an insulation blanket’s fasteners to fail, unless designed by a supplier that accounts for the added heat,” he says.

SINCE IMPLEMENTING REUSABLE INSULATION BLANKETS IN MIRAMICHI REGIONAL HOSPITAL'S BOILER ROOM, THE MECHANICS WHO WORK IN THE SPACE HAVE NOTED A SIGNIFICANT DROP IN TEMPERATURE NEAR THE WOOD-FIRED BOILER AND COMPONENTS.

INSTALLATION AND MEASUREMENT

Working with the maker of the reusable insulation system for MRH, hospital maintenance staff installed the insulation blankets in the boiler plant, including areas such as the main header, instantaneous heater and condensate pumps. Prior to this, the insulation at MRH was largely confined to the facility’s steam system pipes, so the system’s fittings were typically not covered. After installation, Horizon used an energy management information system to measure and verify the steam reduction. To determine the initial (and ongoing) steam reduction from the reusable blankets, Kate Butler from Service New Brunswick’s health services energy management team analyzed the total steam produced from April-June 2015, and compared that to April-June 2014, using a weather normalized data analysis for two different baseline years (for example, fiscal years 2011-2012 and 2014-2015). She then compared this information to the actual steam production after the installation of the reusable blankets (April-June 2015). The annual cost avoidance in MRH’s boiler plant was measured and verified to be nearly three times greater than the one predicted by the audit. RETHINKING REUSE

According to Tim Janos, director of special projects for the Association of Energy Engineers, some facility managers forgo insulating valves and other complex fittings because they know maintenance staff need to access components. If the insulation isn’t reusable, says Janos, workers will cut it off and throw it away. But leaving a component bare is a potential safety risk. With its reusable insulation program, Horizon’s focus was on safety, standards and reusability. This ensured the blankets would not only prevent heat loss but also be easily replaced by maintenance staff once

removed, thus sustaining the energy reduction and safety. For its project, MRH decided on the following blanket standards: non-flammable; 38 millimetres in thickness to ensure exterior temperature of blankets is under 49 C; 11 pounds per cubic foot fibreglass needled mat, type E fibre (blanket insulation material); Polytetrafluoroethylene (PTFE) impregnated fibreglass cloth (blanket surface material), including metal identification tag; Velcro and strap fasteners for easily opening and closing blankets; double-sewn lock stitch for durability and PTFE-coated fibreglass thread; thread that would not melt and a break point equal to 15.8 kilograms; and stainless steel grommet to drain liquid from the low point of any blanket installed in a wet area. By requesting a product that met these specifications, it would be thick enough to insulate components and protect workers from burns, while mitigating a buildup of condensate and preventing mildew and mould from forming around components. THE JUSTIFICATION FOR EXPANSION

Since implementing reusable insulation blankets in MRH’s boiler room, the mechanics who work in the space have noted a significant drop in temperature near the wood-fired boiler and components. The measurement and verification data collected by staff quantified that temperature drop, directly correlating the reduction to the installation. Saving energy and preventing risk is possible with the reusable blankets, in part, because MRH staff can easily remove and reuse the insulation. The custom-fitted blankets have a look and shape, even when removed from a component, that mirrors the geometry of the part on which each belongs. When maintenance workers

remove blankets fitted for nearly identical components, they can reference a metal identification tag affixed to the blanket that describes the component and location. As the measurement and verification survey has shown, if a facility accurately identifies areas of heat loss and correctly designs and uses reusable insulation, the cost of ownership is little to none. The installation of reusable blankets on components beyond piping highlights the solution’s ability to reduce a steam system’s energy loss. For example, by blanketing steam traps, which separate condensate from water, facilities staff can ensure these components do not clog and lose steam. Having reusable blankets for a steam trap or pump ensures maintenance crews can easily remove them, evaluate the component and put insulation back on, which reduces energy loss. According to experts, a proper steam system audit is key to understanding exactly where the energy savings and payback opportunities lie. It’s also important to know how to compile the field data to present energy savings and get approval from utility rebate programs, if available. In Horizon’s case, rebates were not an option. As MRH has proven, installing reusable blanket insulation reduces not only heat loss but also energy costs, greenhouse gas emissions and safety risks for workers. Because of the project’s success, Horizon has installed reusable insulation at three more of its hospitals. Bill Perry is director of content development for Shannon Global Energy Solutions, which designed and manufactured the reusable insulation blankets for the H o r i z o n H e a l t h N e t w o r k ’s M i r a m i c h i Regional Hospital. He can be reached at bperry@shannonglobalenergy.com. SPRING/PRINTEMPS 2020 25

JOURNEY TO NET-ZERO Working toward the low-carbon heating plant By Ian Jarvis

ith governments across North America declaring climate emergencies, achieving netzero within 30 years is becoming a common goal and commitment. Meeting such low-carbon targets requires deep reductions in energy and emissions, far beyond what is being achieved with current approaches. The transition to the low-carbon future will drive fundamental changes in society and the economy. Nowhere will the effects be felt more than in healthcare. The biggest changes in hospitals will come in the power plant, with a shift away from steam to hot water and a new focus on comprehensive heat recovery. Recently opened hospitals in Ontario provide insight and direction on where the 21st century low-carbon heating plant is headed. Toronto’s Humber River Hospital features heat recovery chillers and hot 26 CANADIAN HEALTHCARE FACILITIES

water boilers. Only a small steam plant is used to process loads and for humidif ication. Peel Memorial Centre for Integrated Health and Wellness has an extensive geothermal installation that draws heat from the ground to further offset natural gas consumption. Both of these facilities operate at less than half the gas use intensity of the best of their peers with traditional, steam-centred heating plants. The challenge for hospitals is how to transition from their existing plant configuration to this low-carbon future. It is not economically feasible to simply rip out a functioning plant and replace it with a well-integrated new system. The Greening Health Care program has embarked on a ‘practical pathways’ applied research initiative with a number of member hospitals and industry leaders aimed at developing and demonstrating

the transition and, at least, life cycle cost. This work will be featured at the annual sustainability forum, Greening Health Care, to be held June 10-11, at the Metro Toronto Convention Centre. Headwaters Health Care Centre is among 60 hospitals taking part in this program. The healthcare facility’s low-carbon design brief and financial model will be showcased at the forum, which will take place alongside the inaugural Real Estate Management Industry (REMI) Summit whose goal is to deliver critical insight into the real issues commercial building owners and facility managers face today. PATHWAY TO SAVINGS

While every heating plant is different in terms of age, condition and configuration, the core principles of the ‘practical pathways’ roadmap are the same.

SUSTAINABLE HEALTHCARE

The first is to maximize the building systems’ efficiency to optimize peak and partial heating loads while lowering utility costs and emissions. This work begins with enhanced operation and control of air handling and hydronic systems, and then looks to all cost-effective retrofits. Next is to identify and quantify every source of recoverable heat across the hospital, including air or water-cooled medical equipment and refrigeration units, exhaust air and discharged water. The healthcare facility must determine the most practical way to harvest this heat and bring it to a usable grade and location, generally through the chilled water system. Then there is the need to document the age and condition of each part of the existing heating plant, as well as any equipment that is a target for heat recovery. Cross reference with the Facility Condition Assessment Program schedule within the Health Infrastructure Renewal Fund and verify replacement costs and timelines. Afterward, develop the conceptual design for the ultimate low-carbon plant with schematics, equipment schedules,

THE HEALTHCARE FACILITY MUST DETERMINE THE MOST PRACTICAL WAY TO HARVEST THIS HEAT AND BRING IT TO A USABLE GRADE AND LOCATION, GENERALLY THROUGH THE CHILLED WATER SYSTEM.

budget costs, and energy and emissions reduction estimates. Finally, adjust asset management and capital planning so that every power plant-related capital project becomes a step toward the ultimate plant design and performance over time. The low-carbon future presents opportunities as well as challenges. Carbon pricing can be expected to rise considerably, adding to pressures on utility budgets. At the same time, carbon funding is expected to flow back to hospitals to help pay the capital costs involved in the transition. Hospitals prepared with shovel-ready

projects that can deliver deep emissions reductions will do well. Ian Jarvis is executive director of the Climate Challenge Network, a non-profit organization managing collaborative, data-driven sectoral programs for hospitals, municipalities and school boards. Its work focuses on deep, sector-wide greenhouse gas emissions reductions, energy and water efficiency leadership, and maximizing economic returns on investment. Ian is a recognized business leader and authority on energy efficiency, green buildings and low-carbon performance. He can be reached at 416-915-1530 or ijarvis@climatechallengenetwork.org.

SPRING/PRINTEMPS 2020 27

SEISMIC STRATEGIES Stratégies sismiques By/Par Mathias Franke

he prospect of an earthquake striking without advance warning has the potential to keep hospital administrators and facilities staff in at-risk regions up at night. Most fear a massive quake (magnitude 6.0 and above) that can cause a wide range of damage and building collapse, though it is the less powerful (and more plentiful) one that is more likely to occur. While big earthquakes are not unheard of in Canada (the country has seen 16 over the last decade), more moderate quakes (5.0 to 5.9 magnitude) are the norm. These ‘lesser’ seismic events can displace plaster, open cracks and rattle everyone on-site, immediately putting patients, visitors and staff on edge. Cosmetic and minor damage can bring uncertainty about underlying structural damage and without personalized realtime data, decisions become difficult. HOSPITALS ON SHAKY GROUND

Unlike traditional business-focused structures, hospitals face unique challenges when an earthquake hits. These missioncritical facilities must remain in operation to serve the affected public and provide continued care for existing patients. Safety is a paramount concern and everyone on-site, including physicians and staff, must be protected both during and following the quake and unknown number of aftershocks. Because of this, earthquake preparedness and response needs to be a top concern for hospital leaders. An effective strategy involves gathering and understanding essential data in real-time; providing a means for by-the-second communication; 28 CANADIAN HEALTHCARE FACILITIES

a perspective d’un tremblement de terre sans avertissement préalable peut empêcher les administrateurs et le personnel des hôpitaux de dormir la nuit. La plupart craignent un séisme massif (magnitude 6.0 et plus) qui peut causer divers dommages et l’effondrement des bâtiments, bien que ce soient les moins puissants (et les plus fréquents) qui sont le plus susceptibles de se produire. Si les grands séismes ne sont pas rares au Canada (le pays en a connu 16 depuis 10 ans), les séismes plus modérés (de magnitude 5.0 à 5.9) sont la norme. Ces événements sismiques de moindre importance peuvent déloger le plâtre, ouvrir des fissures et secouer tout le monde, mettant immédiatement les patients, les visiteurs et le personnel sur les nerfs. Les dommages esthétiques et mineurs peuvent entraîner une incertitude quant aux dommages structurels sous-jacents et, sans données précises en temps réel, les décisions deviennent difficiles.

LES HÔPITAUX SUR UN TERRAIN GLISSANT

Contrairement aux structures commerciales traditionnelles, les hôpitaux sont confrontés à des défis uniques lorsqu’un tremblement de terre se produit. Ces installations essentielles doivent rester en service pour servir le public concerné et fournir des soins continus aux patients existants. La sécurité est une préoccupat ion pr imord ia le et toutes les personnes présentes sur le site, y compris les médecins et le personnel, doivent être protégées pendant et après le séisme et le nombre inconnu de répliques.

EMERGENCY PREPAREDNESS & RESPONSE

COSMETIC AND MINOR DAMAGE CAN BRING UNCERTAINTY ABOUT UNDERLYING STRUCTURAL DAMAGE AND WITHOUT PERSONALIZED REAL-TIME DATA, DECISIONS BECOME DIFFICULT.

C’est pourquoi la préparation et la réponse aux tremblements de terre doivent être une préoccupation majeure. Une stratégie efficace implique de recueillir et de comprendre les données essentielles en temps réel, de fournir un moyen de communication à la seconde près, de rationaliser les rapports après l’événement et de s’entraîner à une telle catastrophe naturelle en utilisant des simulations. LA COLLECTE ET LA COMPRÉHENSION DES DONNÉES

LES DOMMAGES ESTHÉTIQUES ET MINEURS PEUVENT ENTRAÎNER UNE INCERTITUDE QUANT AUX DOMMAGES STRUCTURELS SOUSJACENTS ET, SANS DONNÉES PRÉCISES EN TEMPS RÉEL, LES DÉCISIONS DEVIENNENT DIFFICILES. streamlining after-event reporting; and practicing for such a natural disaster using simulations. DATA COLLECTION AND UNDERSTANDING

In disaster response, real-time data becomes the overriding factor in achieving the situational awareness that is needed for prompt decision-making. Up-to-the-minute information about the kind of motion the building experienced during the shaking is necessary to ensure the right decisions are made about where to focus resources and whether a full or partial evacuation is required; without it, they are based on emotion and best guesses. One way to obtain figures is to place sensors throughout the facility and then combine that with specific performance characteristics from the structure’s building materials and design to allow for precise measurement of the manner in which the structure moves. Performance-based engineering analyses can provide meaningful thresholds to base alert levels. When coupled with measurement data, it can deliver actionable information like the probability of certain levels of damage at specific locations, as well as provide the basis for post-earthquake response actions, such as where to inspect and what to look for. REAL-TIME COMMUNICATION

It has been found that notification in the seconds following a quake can help ‘snap’ a staff member out of initial shock into understanding and a mindset of immediate action and trained next steps. Having specific magnitude and intensity data allows for an almost instantaneous means to activate response. Since most people carry a mobile phone, leveraging an app-based communications component can provide a stream of data that keeps everyone in the loop as smaller aftershocks occur. A communication link with each individual (whether a designated staff member or all hospital employees) during the moments after a quake can be valuable for immediate and ongoing structural and patient assessment

Dans les interventions en cas de catastrophe, les données en temps réel deviennent le facteur primordial pour obtenir la connaissance de la situation nécessaire à une prise de décision rapide. Des informations de dernière minute sur le type de mouvement que le bâtiment a subi pendant les secousses sont nécessaires pour garantir que les bonnes décisions sont prises quant à l’orientation des ressources et à la nécessité d’une évacuation totale ou partielle ; sans cela, elles sont basées sur l’émotion et les meilleures suppositions. Une façon d’obtenir des chiffres est de placer des capteurs dans toute l’installation et de les combiner avec les caractéristiques de performance spécifiques des matériaux de construction et de la conception de la structure pour permettre une mesure précise de la façon dont la structure se déplace. Les analyses techniques basées sur les performances peuvent fournir des seuils significatifs pour les niveaux d’alerte de base. Associées à des données de mesure, elles peuvent fournir des informations exploitables, comme la probabilité de certains niveaux de dommages à des endroits spécifiques, et servir de base aux actions d’intervention après un tremblement de terre, par exemple pour savoir où inspecter et ce qu’il faut rechercher. COMMUNICATION EN TEMPS RÉEL

Il a été constaté qu’une notification dans les secondes qui suivent un tremblement de terre peut aider à faire passer un membre du personnel du choc initial à la compréhension et à un état d’esprit d’action immédiate et de formation aux étapes suivantes. Le fait de disposer de données spécifiques sur la magnitude et l’intensité permet d’activer la réponse presque instantanément. Comme la plupart des gens possèdent un téléphone portable, l’utilisation d’un composant de communication basé sur une application peut fournir un flux de données qui permet à chacun de rester informé en cas de petites secousses. Un lien de communication avec chaque personne (qu’il s’agisse d’un membre désigné du personnel ou de tous les employés de l’hôpital) dans les moments qui suivent un tremblement de terre peut être précieux pour les rapports immédiats et continus d’évaluation des structures et des patients, le partage des photos des dommages et, si une évacuation est nécessaire, la fourniture de la logistique et des ajustements d’itinéraire en temps réel ainsi que des effectifs une fois que les zones de sécurité sont atteintes. LE BILAN

Les inspecteurs du gouvernement seront débordés après un tremblement de terre qui a causé des dégâts même modérés. Le fait de disposer de données précises pouvant être partagées pour les rapports après coup peut aider à accélérer la prise de décision concernant la réouverture de toute partie fermée d’une installation. SPRING/PRINTEMPS 2020 29

EMERGENCY PREPAREDNESS & RESPONSE reports, the sharing of photos of damage and, if evacuation is required, providing logistics and route adjustments in real-time as well as headcounts once safe zones are reached.

Les mêmes données structurelles, ainsi qu’un enregistrement horodaté des dommages subis par le site, permettent de consolider facilement les décisions et les réponses et de les relayer pour les rapports après action et l’assurance.

THE AFTER-ACTION REPORT

Government inspectors will be swamped after a quake that has caused even moderate damage. Having precise reporting data that is sharable for after-event reporting can help speed decisionmaking in reopening any closed portions of a facility. The same structural data, plus a record of time-stamped site damage, allows decisions and responses to be easily consolidated and relayed for after-action reporting and insurance use. SIMULATION-BASED LEARNING

The same earthquake response technology that can help guide personnel’s reactions should also be capable of allowing an organization to prepare for such an event. Since the system knows the location’s precise characteristics, simulations can be run using structural data and at differing magnitudes to determine areas of sensitivities and evacuation thresholds, and create secondary action plans to take existing structural issues discovered during the simulations into account. A good after-event reporting system should also allow organizations to review all actions taken during a drill to refine best practices. THE BEST LAID PLAN

Readying a hospital for a wide range of seismic scenarios is achievable. While earthquakes are unpredictable, it is possible to create systems that allow healthcare leaders to practice, prepare and develop response plans that are maximized for their particular structure. The ability to gain critical, real-time information is the lynchpin that can provide confidence in operational decisions made during planning and all phases of response. It can also make a difference in keeping patients and staff safe, and the doors open in times when healthcare facilities are needed most. Mathias Franke is vice-president, open systems and services, at Kinemetrics Inc., a California-based company that develops and delivers solutions for monitoring earthquakes and their effects on Biomedical_CHF_Winter_2017_FINAL.pdf 1 2017-10-23 4:45 PM people, business and structures. The company’s OasisPlus technology platform allows mission-critical facilities to effectively prepare response teams, avoid unnecessary evacuations and keep business processes running following a seismic event. Mathias can be reached at 626-795-2220.

L’APPRENTISSAGE PAR SIMULATION

La même technologie de réponse aux tremblements de terre qui peut aider à guider les réactions du personnel devrait également être capable de permettre à une organisation de se préparer à un tel événement. Comme le système connaît les caractéristiques précises de l’endroit, des simulations peuvent être effectuées à l’aide de données structurelles et à différentes magnitudes pour déterminer les zones de sensibilité et les seuils d’évacuation, et créer des plans d’action secondaires pour prendre en compte les problèmes structurels existants découverts lors des simulations. Un bon système de compte rendu après événement devrait également permettre aux organisations d’examiner toutes les mesures prises pendant un exercice afin d’affiner les meilleures pratiques. LE PLAN IDÉAL

Il est possible de préparer un hôpital à un large éventail de scénarios sismiques. Bien que les tremblements de terre soient imprévisibles, il est possible de créer des systèmes qui permettent aux responsables des soins de santé de pratiquer, de préparer et de développer des plans d’intervention qui soient optimisés pour leur structure particulière. La capacité d’obtenir des informations critiques en temps réel est le pivot qui peut donner conf iance dans les décisions opérationnelles prises lors de la planification et de toutes les phases d’inter vention. Elle peut également faire la différence en assurant la sécurité des patients et du personnel, et en ouvrant les portes à des moments où les établissements de soins sont le plus nécessaires. Mathias Franke est vice-président des systèmes et services ouverts chez Kinemetrics Inc., une société californienne qui développe et fournit des solutions pour la surveillance des tremblements de terre et de leurs effets sur les personnes, les entreprises et les structures. La plateforme technologique OasisPlus de la société permet aux installations critiques de préparer efficacement les équipes d’intervention, d’éviter les évacuations inutiles et de maintenir les processus opérationnels en cours après un événement sismique. Mathias peut être joint au 626-795-2220.

MEDICAL GAS INSPECTION & CERTIFICATION MEDICAL EQUIPMENT REPAIR & INSPECTION SCC Accredited third party Inspection Body with 38 years in business inspecting and certifying medical gas systems. Also, specialized in medical equipment preventative maintenance, calibration and repair. Contact us today to book an appointment for your certification or annual inspections. MW Biomedical Inspection Services Ltd. British Columbia – Alberta – Saskatchewan info@mwbiomed.ca | www.mwbiomed.ca P: 780 463 3877 30 CANADIAN HEALTHCARE FACILITIES

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