HealthcareFacilities JOURNAL OF CANADIAN HEALTHCARE ENGINEERING SOCIETY
Volume 41 Issue 2
RISING TO THE OCCASION
Calgary Cancer Centre to centralize treatment for patients in southern Alberta
EV charger stations get a boost Peer support during the pandemic Naval history informs hospital design
ASCO invites you to explore 3 to 18 cycle and 30 cycle power transfer switches 88%* of engineers agree — Selective coordination requires choice, not compromise Selective coordination demands the ability to choose. After all, since no two emergency and backup power systems are alike, why settle for a cookie-cutter selective coordination design? ASCO Power Transfer Switches: • • •
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Compare power transfer switches for selective coordination applications. Then, select ASCO. www.EmersonNetworkPower.com/ASCO, (800) 800-ASCO (2726), ascoapu.com, firstname.lastname@example.org * Results reflect the opinions of more than 300 engineers polled in a recent Webcast exit survey. ASCO Power Switching & Controls Just another reason why Emerson Network Power is a global leader in maximizing availability, capacity and efficiency of critical infrastructure.
Emerson and ASCO are trademarks of Emerson Electric Co. or one of its affiliated companies. ©2015 Emerson Electric Co. CS101 ASCO Power Technologies
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CANADIAN HEALTHCARE FACILITIES Volume 41
Clare Tattersall email@example.com EDITOR/RÉDACTRICE
PUBLISHER/ÉDITEUR Kelly Nicholls firstname.lastname@example.org PRESIDENT/PRÉSIDENT
Kevin Brown email@example.com
SENIOR DESIGNER/ CONCEPTEUR GRAPHIQUE SENIOR
Annette Carlucci firstname.lastname@example.org
PRODUCTION MANAGER/ Rachel Selbie DIRECTEUR DE email@example.com PRODUCTION CIRCULATION MANAGER/ Rob Osiecki DIRECTEUR DE LA firstname.lastname@example.org DIFFUSION
HEALTH & SAFETY
20 Life Support CovidCARE created amid pandemic to help staff, physicians at Halton Healthcare
Editor’s Note President’s Message
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.
10 Chapter Reports
HEALTHCARE DEVELOPMENT 12 Transformation of Care La transformation des soins 16 The Battleship on the Ground Lessons learned from advancements in naval technology shed light on current vulnerabilities in hospital design
22 Furniture in the Age of COVID Pandemic impacts this important healthcare design consideration 24 Critical Environment Control Systems HVAC precision where it matters most
Canadian Healthcare Engineering Society
Société canadienne d'ingénierie des services de santé
PRESIDENT VICE-PRESIDENT PAST PRESIDENT TREASURER SECRETARY EXECUTIVE DIRECTOR
Roger Holliss Craig Doerksen Preston Kostura Kate Butler Reynold Peters Donna Dennison
26 O2 in Demand Resilient bulk oxygen supply systems for healthcare facilities
SUSTAINABLE HEALTHCARE 28 Electrifying the Transportation Grid Benefits, challenges of EV charger installation
Newfoundland & Labrador: Colin Marsh Maritime: Helen Comeau Ontario: Jim McArthur Quebec: Mohamed Merheb Manitoba: Reynold J. Peters Saskatchewan: Jim Allen Alberta: Dan Ballantine British Columbia: Norbert Fischer 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: email@example.com www.ches.org Canada Post Sales Product Agreement No. 40063056 ISSN # 1486-2530
Chinook Regional Hospital Redevelopment and Expansion | Lethbridge
Committed to better performing buildings. Structural Engineering Structural Restoration Building Science Parking Facility Design Structural Glass Engineering Building Energy Modelling
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HOPE SPRINGS SPRING’S PENDING arrival feels different this year. I’ve found myself counting down the days until the season’s start (more so than usual) as it really does represent a new beginning. Around this time last year, Canada was at the outset of COVID-19, and life was full of doom and gloom. Sure, the threat of the pandemic won’t be over on March 20, especially with the emergence and spread of new virus variants that are more transmissible, but we’ll have made it through winter and hopefully the worst of the coronavirus outbreak given the vaccine rollout. Looking forward to a brighter future, it seems fitting to feature a healthcare facility that will have a transformational impact on patients when complete in 2023 — earlier detection of cancer, better treatments, better survival rates and better quality of life. The new Calgary Cancer Centre at the Foothills Medical Centre will replace the venerable Tom Baker Cancer Centre when it opens its doors after almost seven years of construction, taking healthcare for southern Albertans to new heights. On the topic of healthcare development, Chris McQuillan of B+H Architects draws parallels between one of the greatest sea kings and superhospitals, and explores how naval history can inform the future of hospital design in The Battleship on the Ground. From here, we turn to health and safety matters, all related to COVID-19. Life Support highlights CovidCARE, a program that was created in the midst of the pandemic as a way to support staff and physicians at all three of Halton Healthcare’s hospitals. Next, Carl Kennedy of Stance Healthcare addresses furniture considerations in the age of COVID and beyond. Critical Environment Control Systems compares such systems with typical HVAC, and discusses how to overcome the deficiencies of common devices. Rounding out this section is O2 in Demand, which looks at resilient bulk oxygen supply systems in light of increased demand for this life necessity amid the pandemic. To close, Kent Waddington of the Canadian Coalition for Green Health Care walks through the benefits and challenges of zero-emissions vehicle/electric vehicle charging station installations at healthcare facilities in Electrifying the Transportation Grid. If you are interested in contributing an article to the publication or there’s a topic you’d like to see covered, please contact me.
Clare Tattersall firstname.lastname@example.org
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.
24 HOUR EMERGENCY SERVICE ASPHALT PAVING CONCRETE PAVING SITE servicing LANDSCAPE CONSTRUCTION BUILDING RESTORATION WINTER SNOW SERVICES email@example.com 416.524.3000 www.forestgroup.ca
THE HOME STRETCH EVEN THOUGH we still have a little ways to go, there’s light at the end of the tunnel. Now that we are all grizzled, battle-scarred COVID veterans, it should make this last push into spring and summer easier and bring some relief. While many chapters have cancelled their face-to-face conferences for the year due to COVID-19, we are still a highly engaged association. Given how quickly healthcare technologies and processes evolve, our webinar series has continued to be a great vehicle to conveniently better ourselves during our busy workdays. Robert Barss’s team has assembled another stellar set of webinars for 2021 that are worth everyone’s consideration. Along that line, CHES has made significant inroads in adding new and adapting existing educational/training sessions to a virtual format to make sure you have access to the tools needed to operate and maintain your healthcare facilities. Another example is our newly upgraded medical gas CSA courses. These two courses were only recently completed by CSA. One of them has already been converted to a virtual format. The second is soon to follow. On the national conference front, we’ve been extremely active since late December, converting the best parts of our typical face-to-face event into a high-end virtual one. Craig Doerksen is at the helm of a highly committed planning team, which is doing a great job. Between working with our corporate partners and attending other virtual conferences like the International Federation of Healthcare Engineering (IFHE) Congress in Rome, they’re basically taking a blank template from a newly sourced virtual conference platform and assembling a virtual conference for fall. I continue to be awed by the efforts of our members who are working together and helping each other across the country. I don’t know why this still impresses me — it’s just what we do as a CHES family. Stay safe and take care of yourselves so you can take care of others. I look forward to seeing you all sooner than later.
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 2021 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 https://www.surveymonkey.com/r/TQGN7RG 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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Employ a single sign on (SSO) architecture with compliance to scalable credentialing architectures and secure tunneling methodologies such as BACnet virtual private networks (B/VPN).
Select lifecycle-centric manufacturers who minimize the negative impacts of waste with long-term warranty and repair services while adhering to WEEE, RoHS and LEED directives.
Specify integrated FDD (IFDD) that delivers real-time fault detection, step-by-step root-cause diagnostics while using all your existing cabling structures, including twisted-pair networks.
Enjoy the long-term benefits of suppliers who engineer a path forward to new technologies while remaining backwards compatible without third-party gateways or hardware replacement.
Insist on timely analytics for all stakeholders with complete control of formatting and scheduling while retaining full ownership of your data and the reports generated.
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CHAPITRE DU QUEBEC
The second wave of COVID-19 has brought drastic changes to our lives. As the number of positive cases and hospitalizations continued to increase, the government had no choice but to implement never seen restrictions, including a curfew and the closure of non-essential services and stores. With the arrival of spring, efforts will be concentrated on vaccination. Many organizations are running against the clock to ensure our population receives their dose of the vaccine. This is a very critical part of our journey and a chance to break the chain of virus transmission. On behalf of the Quebec chapter, I would like to thank everyone who has been working tirelessly to fight the virus. I had the opportunity to participate virtually in the 2020 International Federation of Healthcare Engineering Congress. It was nourishing to see how different healthcare systems around the world are dealing with similar problems. Involvement in a network like CHES is an advantage for every healthcare facility manager. It connects you with others to discuss issues related to hospital operations. This year, our energy as a society will be devoted to improving our communications with members and sensibilizing them to the advantages of being a member. The increase in virtual meetings gives us a chance to reach any member regardless of distance.
La deuxième vague de COVID-19 a malheureusement bouleversé nos vies. Le nombre de cas positifs et d’hospitalisations continuant à augmenter, le gouvernement n’a pas eu d’autre choix que de mettre en œuvre des restrictions jamais vues, notamment un couvre-feu et la fermeture de services et de commerces non essentiels. Avec l’arrivée du printemps, les efforts seront concentrés sur la vaccination. De nombreuses organisations travaillent contre la montre pour s’assurer que notre population reçoive sa dose de vaccin. C’est une partie très importante de notre voyage et une chance de briser la chaîne de transmission du virus. Au nom de la section Québec, je tiens à remercier tous ceux qui ont travaillé sans relâche pour lutter contre le virus. J’ai eu l’occasion de participer virtuellement au congrès 2020 de l’International Federation of Healthcare Engineering. Il était instructif de voir comment les différents systèmes de santé dans le monde traitent des problèmes similaires. L’implication dans un réseau comme le CHES est un avantage pour tout responsable d’établissement de santé. Il vous met en contact avec d’autres personnes pour discuter de questions liées au fonctionnement de l’hôpital. Cette année, notre énergie en tant que société sera consacrée à améliorer nos communications avec les membres et à les sensibiliser aux avantages de l’adhésion. Le recours accru aux réunions virtuelles nous donne la possibilité d’atteindre n’importe quel membre, quelle que soit la distance.
—Mohamed Merheb, Quebec chapter chair
—Mohamed Merheb, chef du conseil d'administration du Québec
BRITISH COLUMBIA CHAPTER
Despite vaccinations being rolled out, there are still COVID challenges that we need to overcome before we will have the opportunity to meet again as a CHES family. With orders still in place limiting gatherings, the planning committee has decided to hold a week of webinars that will feature a keynote presentation, educational sessions and our annual general meeting. The theme is, The Physical Environment: Creating Patient-focused Facilities. Further details will be provided soon. A note of appreciation to all CHES COVID panel members that have given their time to share experiences and trials to date of their COVID learnings and victories. The webinar series continues to be extremely educational and informative, affirming that we as healthcare staff and members of CHES are all facing the same challenges. I encourage you to visit the CHES website to sign up for the webinars. With your continued support, the B.C. chapter has remained strong, both from a financial standpoint and membership numbers. Looking ahead, 2022 is an election year for the chapter executive. If interested in serving on the CHES B.C. board or helping out with committee work, please reach out to any member of the current executive team.
We were given a reprieve from the cold weather from December to early February, and then the polar vortex arrived. This was supposed to be the year we avoided the extreme cold temperatures! (We think that every year.) The Alberta chapter is usually busy preparing for our annual conference; however, due to the pandemic, we have decided to defer the event until spring 2022. While it is disappointing for members and vendors who support CHES, next year’s event will be a special time to reconnect and re-energize. Taking advantage of this temporary ‘lull’ in activity, we are currently soliciting feedback from members to identify further opportunities for CHES Alberta to help support them in their daily work. We have also started to ‘explore’ what it means to be a CHES member, how we can be inclusive of other groups, such as clinical engineering, capital projects and property management, and what value we can offer them as an organization. Another area of opportunity that is drawing interest is leadership development. This can only make us better and provide something outside of the purely technical and engineering environment that has become so familiar. We want to develop leaders, so let’s do that.
—Norbert Fischer, British Columbia chapter chair
—Mike Linn, Alberta chapter vice-chair
10 CANADIAN HEALTHCARE FACILITIES
MARITIME CHAPTER After a wet, mild winter, spring is soon to arrive in the Maritimes. Last year’s fall education day in Truro, N.S., had to be postponed due to COVID-19. The committee is investigating educational options for 2021-2022, including an education day in fall 2021, and the Maritime chapter conference in spring 2022. The chapter executive committee will remain in place until the next annual general meeting. CHES Maritime is able to balance its books while offering several financial incentives to its members in the way of student bursaries, contributions to Canadian Certified Healthcare Facility Manager (CCHFM) exam fees, webinars, the fall education day and other rebates.
It’s Chaos Without Us
—Helen Comeau, Maritime chapter chair
ONTARIO CHAPTER With the uncertainty of an early return to normalcy, the Ontario chapter executive has made the very difficult decision to cancel/ postpone all scheduled in-person events for 2021. This includes our chapter conference. There was some thought to reschedule to fall; however, it’s too risky to plan a large event this year. Should things change, we hope to be in a position to offer something to members like an education day. Cancelling our conference in consecutive years not only affects member benefits but also our bottom line. Thankfully, we are in good financial standing to weather the storm. Given this change, the chapter’s next in-person conference will be held in Toronto, Sept. 16-21, 2022, when we host the CHES National Conference in tandem with the International Federation of Healthcare Engineering Congress. Planning has accelerated for this event. Numerous subcommittees are in place, including the program committee, which held its first meeting in December, with representatives from across Canada, the U.S., Japan, Australia and the U.K. Planning meetings around different Canadian time zones is already a difficult task, so you can imagine having to do so on a global scale. As for the pandemic, at the risk of repeating myself, I value now more than ever being a part of CHES. To have the opportunity to share challenges and successes with each other through this unprecedented time exemplifies the benefit of membership. Despite being somewhat apprehensive about vaccinations in the past, I received my first dose of the COVID-19 vaccine in January, and my perspective has since changed. There appears to be light at the end of the tunnel and hopefully with the vaccine rollout to the general public, we'll have the opportunity to see each other sooner rather than later. —Jim McArthur, Ontario chapter chair
SPRING/PRINTEMPS 2021 11
TRANSFORMATION OF CARE La transformation des soins
By/Par Adrian Lao & Dean Kaardal
ancer care is a lengthy and complex journey. For patients and families, a cancer care facility is often more than just a place for treatment. It’s also a home away from home while facing some of the most challenging times of their lives. The design of these environments can greatly contribute to patient well-being and, ultimately, their healing. The new Calgary Cancer Centre at the Foothills Medical Centre centralizes treatment and care for cancer patients in Calgary and southern Alberta. Upon completion, it will be the second largest cancer treatment and research facility in North America, designed to integrate research, education and care in one environment. From the start, the project has been a collaborative effort. Alberta Infrastructure and Alberta Health Services consulted with various stakeholders, including clinicians, facility management staff, bridging consultants, and patient and family advisors, before moving forward with the design-build competition. This comprehensive engagement process resulted in a statement of
12 CANADIAN HEALTHCARE FACILITIES
a prise en charge du cancer est un parcours long et complexe. Pour les patients et les familles, un centre de soins contre le cancer est souvent plus qu’un simple lieu de traitement. C’est aussi un foyer loin de chez soi tout en faisant face à certains des moments les plus difficiles de leur vie. La conception de ces environnements peut grandement contribuer au bien-être des patients et, en fin de compte, à leur guérison. Le nouveau Calgar y Cancer Centre du Foothills Medical Centre centralise le traitement et les soins des patients atteints de cancer à Calgary et dans le sud de l’Alberta. Une fois terminé, il sera le deuxième plus grand centre de traitement et de recherche sur le cancer en Amérique du Nord, conçu pour intégrer la recherche, l’éducation et les soins dans un seul environnement. Dès le début, le projet a été un effort de collaboration. Alberta Infrastructure et Alberta Health Services ont consulté divers intervenants, notamment des cliniciens, du personnel de gestion des installations, des consultants
Renderings courtesy Dialog
requirements that emphasized interdisciplinary care and research, patient and family-centred medicine, and biophilic design principles. PCL Construction, Dialog and Stantec were named the successful proponents of the Calgary Cancer Centre. PCL’s team has more than 15 subconsultants and 20 major trades partners, including Modern Niagara and Plan Group. Dialog, as prime consultant, leads the design subconsultant team, which includes Stantec and Smith + Andersen. The building is made up of two gently curving L-shaped forms that come together in an embrace. In the same way two people hold one another, the design wraps its arms around an exterior landscape courtyard — the ‘heart’ of the facility. All programs have a physical connection to the central courtyard, aiding in intuitive wayfinding and reinforcing the importance of daylight and nature to healing and well-being. The sweeping shape of the building provides uninterrupted views of either the mountains to the west or city skyline to the south from every patient room and research space. The intersection of the tower and podium
en transition, des conseillers auprès des patients et des familles, avant d’aller de l’avant avec le concours de conception-construction. Ce processus d’engagement global a abouti à un énoncé des exigences qui met l’accent sur les soins et la recherche interdisciplinaires, la médecine centrée sur le patient et la famille, et les principes de conception biophile. PCL Construction, Dialog et Stantec ont été désignés comme les promoteurs du Calgar y Cancer Centre. L’équipe de PCL compte plus de 15 sous-consultants et 20 partenaires commerciaux majeurs, dont Modern Niagara et Plan Group. Dialog, en tant que consultant principal, dirige l’équipe de sous-consultants en conception, qui comprend Stantec, et Smith + Andersen. Le bâtiment est composé de deux formes en L légèrement incurvées qui se rejoignent dans une étreinte. De la même façon que deux personnes se tiennent l’une l’autre, le projet enveloppe ses bras autour d’une cour extérieure paysagère — le ‘cœur’ de l’i nst a l lat ion. Tous les SPRING/PRINTEMPS 2021 13
express the interdisciplinary connections between knowledge, treatment, research and the community. To achieve key functional relationships, the radiation therapy program is located on Level 0, which contains the radiation vaults. Levels 1 and 2 include the main entry lobby and provides a welcoming environment for patients and families, combining various arrival, public amenity and support programs. Upper levels are comprised of advanced diagnostic and treatment services, outpatient c a nc er c l i n ic s , I V t r e at ment b ay s a nd r e s e a r c h laborator ies. T he i npat ient un it s a re si ngle room occupancy for patient privacy. The clinical layout of complex cancer treatment areas is designed for patients and their families to experience a comfortable and healing experience throughout their treatment journey. The collaborative design process included numerous physical mock-ups to help project stakeholders understand and envision what was being created. Given the tight schedule, it was critical for decisions to be made efficiently. The design-build process encouraged seemingly unrelated decisions to be solved together. For instance, the structural shear and torque requirements, elevator demand load and vertical transportation budget were addressed jointly by optimizing the cab and elevator shaft sizes to solve all three challenges at once. Key design decisions are leveraged by an integrated team input approach. For example, interior design finishes are evaluated as much for infection control and acoustics properties as they are for aesthetic, healing and comfort considerations. Patient exam and sleeping rooms are designed 14 CANADIAN HEALTHCARE FACILITIES
programmes ont un lien physique avec la cour centrale, ce qui facilite l’orientation intuitive et renforce l’importance de la lumière du jour et de la nature pour la guérison et le bien-être. La forme imposante du bâtiment offre une vue ininterrompue sur les montagnes à l’ouest ou sur la ville au sud depuis chaque chambre de patient et espace de recherche. L’intersection de la tour et du podium exprime les liens interdisciplinaires entre la connaissance, le traitement, la recherche et la communauté. A f in d’établir des relations fonctionnelles clés, le programme de radiothérapie est situé au niveau 0. Les niveaux 1 et 2 comprennent le hall d’entrée principal et offrent un environnement accueillant pour les patients et les familles, combinant divers programmes d’accueil, d’équ ipement s publ ics et de sout ien. L es n iveau x supérieurs comprennent des services de diagnostic et de t ra itement ava ncés, des cl i n iques de ca ncérolog ie a mbu l a t o i r e s , d e s s a l le s d e t r a it e me nt p a r vo ie intraveineuse et des laboratoires de recherche. Les unités d’hospitalisation sont des chambres individuelles pour préserver l’intimité des patients. L’aménagement clinique des zones de traitement du cancer complexe est conçu pour que les patients et leur famille puissent vivre une expérience confortable et curative tout au long de leur traitement. Le processus de conception en collaboration comprenait de nombreuses maquettes physiques pour aider les parties prenantes du projet à comprendre et à envisager ce qui était créé. Compte tenu du calendrier serré, il était essentiel que les décisions soient prises de manière efficace. Le processus de conception-construction a encouragé des décisions
with mechanical air distribution systems and medical equipment noise output in mind to achieve a quiet env i ron ment for rest i ng. A m id-level mecha n ic a l penthouse reduces the size and number of mechanical shafts while optimizing HVAC air speed to improve patient and staff comfort. Additional innovative solutions include dynamic glass to automatically shade the exterior glazing system via sun sensors in patient and staff rooms. Automated environmental controls allow regulation by patients in their private bedrooms. The facility is designed for automated guided vehicles that deliver laundry, supplies and food to key pickup points during all hours of the day. Elevators are equipped with dispatch technology to reduce wait times and improve elevator performance. The Calgary Cancer Centre is currently on time and on budget, and is scheduled to open in 2023. The integrated approach to design is being leveraged during construction. Mechanical and electrical trade partners are using the design team’s building information modelling (BIM) to further refine the fabrication and installation of service components. The building envelope trades are also developing their cladding design using BIM. Adrian Lao is a principal architect at Dialog. Adrian has worked on various healthcare and institutional projects across Alberta and British Columbia. He is the design team leader, coordinating professional and technical lead for the Calgary Cancer Centre. Dean Kaardal is vice-president and regional business leader in the buildings engineering group at Stantec. Dean helped lead the electrical and hospital technology systems team for the Calgary Cancer Centre and participated in executive level oversight.
apparemment sans rapport entre elles à être résolues ensemble. Par exemple, les exigences en matière de cisaillement et de couple de la structure, la charge de la demande d’ascenseur et le budget de transport vertical ont été abordés conjointement en optimisant la taille de la cabine et de la cage d’ascenseur pour résoudre ces trois problèmes à la fois. Les décisions clés en matière de conception sont mises à profit par une approche intégrée de la contribution des équipes. Par exemple, les f initions de la décoration intérieure sont évaluées autant pour leurs propriétés de contrôle des infections et d’acoustique que pour des considérations esthétiques, de guérison et de confort. Les salles d’examen et de repos des patients sont conçues avec des systèmes mécaniques de distribution d’air et de bruit des équipements médicaux à l’esprit pour obtenir un environnement calme pour le repos. Un penthouse mécanique de niveau intermédiaire réduit la taille et le nombre d’arbres mécaniques tout en optimisant la vitesse de l’air de la climatisation pour améliorer le confort des patients et du personnel. Parmi les autres solutions innovantes, citons le verre dynamique qui permet d’ombrager automatiquement le système de vitrage extérieur grâce à des capteurs solaires dans les chambres des patients et les locaux du personnel. Des contrôles environnementaux automatisés permettent aux patients de régler la température de leur chambre individuelle. L’installation est conçue pour des véhicules autoguidés qui livrent du linge, des fournitures et de la nourriture à des points de ramassage clés à toute heure de la journée. Les ascenseurs sont équipés d’une technologie de répartition permettant de réduire les temps d’attente et d’améliorer les performances des ascenseurs. Le Calgary Cancer Centre respecte actuellement les délais et le budget et devrait ouvrir en 2023. L’approche intégrée de la conception est mise à profit pendant la construction. Les partenaires commerciaux des secteurs mécanique et électrique utilisent la modélisation des informations sur les bâtiments (BIM) de l’équipe de conception pour affiner la fabrication et l’installation des composants de service. Les métiers de l’enveloppe du bâtiment développent également leur conception de revêtement en utilisant le BIM. Adrian Lao est l’un des principaux architectes de Dialog. Adrian a travaillé sur divers projets de soins de santé et d’institutions en Alberta et en Colombie-Britannique. Il est le chef de l’équipe de conception, coordonnant la direction professionnelle et technique du Calgary Cancer Centre. Dean Kaardal est vice-président et chef d’entreprise régional au sein du groupe d’ingénierie des bâtiments de Stantec. Dean a aidé à diriger l’équipe des systèmes électriques et technologiques de l’hôpital pour le Calgary Cancer Centre et a participé à la supervision au niveau exécutif. SPRING/PRINTEMPS 2021 15
Photo courtesy NMG Workspace Solutions
THE BATTLESHIP ON THE GROUND Lessons learned from advancements in naval technology shed light on current vulnerabilities in hospital design By Chris McQuillan
n the 19th century, rapid technological advancement gave rise to the birth of the battleship. By the mid20th century, the Japanese Yamato-class ships stretched more than 850 feet, could hit speeds of 30 miles per hour and packed 18-inch artillery. Like superhospitals, the battleship represents the ‘all in gambit.’ It had the largest guns, thickest armor, best technology and was staffed by the most senior commanders. The battleship was a flagship, both literally and metaphorically. From the first, the HMS Dreadnought, to the last, the enormously powerful Yamato, the history of the battleship spans a brief period from 1906 to 1945. The HMS Dreadnought’s claim to fame was that it was
16 CANADIAN HEALTHCARE FACILITIES
the only battleship to ever sink an enemy submarine. The ship was sold for scrap 15 years after its maiden voyage. The mighty Yamato helped take down two small vessels before being destroyed by American bombers during World War 2. What's most interesting is not what happened to these ships but why they were built in the first place. What appeared revolutionary at the time is now understood to be, at best, folly. Both were obsolete long before they put to sea. The battleship represented the pinnacle of military technology. It was considered invincible until it wasn’t. COVID-19, and the communicable diseases that preceded and will follow it, present similar challenges to the healthcare sector.
EVIDENCE OF VULNERABILITY
Like the unforeseen enemies of the battleship, superhospitals are similarly under attack by unpredictable forces — unknown viruses, climate change, natural and human-caused disasters, and exponential technological change. In August 2020, the devastating explosion in the port of Beirut put three of the Lebanese capital’s hospitals out of action. When superstorm Sandy hit New York City in 2012, several of the city’s major medical institutions had to be evacuated after multiple electrical and mechanical systems failed. Now, many hospitals are overwhelmed by COVID-19 patients amid the second wave of the pandemic. Today, hospitals are bigger than ever, packed with so many ancillary components
Renderings courtesy B+H Architects
that food courts and shopping areas need to be included. Billions of dollars of physical and, more importantly, human capital are focused in a large and vulnerable target. There is no better proof of the frailty of hospitals than the suspension of their services and the rapid construction of field hospitals in their parking lots. Battleships needed many months and years in dry dock for refits and repairs, during which all the functionality was unavailable. Large hospitals are similarly difficult and expensive to adapt. Operational experience has shown how hard it is to stream care, and assess and separate patient populations. Many of the most advanced medical systems in the world have been OPPOSITE PAGE: Patients experience a unique micro-landscape within and around the new paralyzed. The U.S. spends close to double Shenzhen Children’s Hospital in China. ABOVE: Patients are connected back to nature in the ‘urban living room.’ (per capita) on healthcare and has been one of the hardest hit nations. The emphasis on large, singular hospitals puts the healthcare TOMORROW IS ALREADY HERE vending machine fulfills 100-plus common system at the mercy of attack from the very The healthcare industry is ready for a medications. Robotic surgery techniques people they seek to help. similar transformation. The need for mean a surgeon can be working in the next flexibility in built structures must extend far room — or half the world away. Care that ADAPT TO SURVIVE beyond hospitals to include the reassessment was only recently available in a hospital lab COVID-19 has been a lesson in universal of healthcare infrastructure. and nephrology department is now a sticker unpredictability. Advances in technology, There is evidence the current health crisis on the patient’s arm communicating with medical equipment, treatments and even has driven a rapid adoption of many an app. Medical diagnostic and treatment patient expectations make rendering technologies and more progressive outlooks equipment that used to need its own room is confident predictions about healthcare on how to approach ‘health’ in society. Now, now pocket-sized. Studies using AI to irresponsible. Instead, designing spaces more than ever before, expertise is mobile. perform radiology and pathology diagnoses with a high level of adaptability will allow Diagnostics can be performed anywhere. are outperforming human experts, and physical structures to flex and respond Outpatient procedures are the majority of people are now collecting vast data sets of accordingly as situations dictate. those performed. The system already relies t he i r ow n lon g it ud i n a l he a lt h , The navy’s response to the battleship’s on data collected remotely and shared revolutionizing preventive care. unsuitability for the task at hand was to electronically. Collaboration is mainly Ultimately, the 21st century ‘battleships’ completely reevaluate its strategy. Navies virtual. What’s more, COVID-19 has are superhospitals. However, it is crucial to adopted aircraft and autonomous tools accelerated patients’ comfort with virtual understand the crisis wasn’t in hospitals; it like missiles and drones that in combination health visits. Many tests can now be was in the infrastructure outside these with stealth replaced the overt force performed at home, a pharmacy or in other facilities. COVID-19 has forced society to re-evaluate the purpose of its buildings — concentrated in large vessels. Most ships places outside brick-and-mortar hospitals. have become smaller, quicker and more The acceleration of nascent technologies from homes and workplaces to airports, and widespread innovation has been seen hotels and public spaces — and the quality focused in their functional roles. With less globally. Israel’s Leumit Health Care of human activity expected from them. The invested in each component of the strategy, Services designed and deployed a mobile question is not how design will shift to suit it has created greater adaptability and the testing unit in partnership with the country’s the pandemic but how the pandemic will opportunity to rethink inter-functionality on a fluid and ongoing basis as new army. China’s Ping An Good Doctor booths alter design thinking and elicit greater challenges arise. Battle is no longer a employ a combination of artif icial introspection on how and why to design for ship-to-ship broadside but is carried out intelligence (AI) and real-time links to the future. from great distances with detailed healthcare professionals coupled with analysis and executed with tremendous onboard diagnostics that serve more than Chris McQuillan is the healthcare principal precision. three million users. A built-in pharmacy at B+H Architects. t
SPRING/PRINTEMPS 2021 17
The truth about Healthcare-associated infections. Healthcare-associated infections (HAIs) are infections that patients get while receiving treatment for medical or surgical conditions. Many HAIs are preventable.1 Where do they happen? In the news. Some infectious diseases that start in the community such as severe acute respiratory syndrome (SARS), Middle East Respiratory Syndrome (MERS) and COVID-19, the cause of the current pandemic, may also spread in healthcare facilities. 2
HAIs occur in all types of care settings, including acute care hospitals, ambulatory surgical centres, dialysis facilities, outpatient care facilities (e.g., physicians’ offices and healthcare clinics), and long-term care facilities (e.g., nursing homes and rehabilitation facilities).1 According to the Canadian Nosocomial Infection Surveillance Program (CNISP), one in 217 patients acquired an infection while in hospital in 2017. While some HAIs were reduced over time, such as Clostridium difficile infections which were reduced by 25% from 2013 to 2017, other HAIs such as vancomycin-resistant enterococci (VRE) infections increased by 25%. 3 Device-associated infections, such as ventilator-associated pneumonia, catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs) associated with a prosthetic implant and central line–associated bloodstream infection (CLABSIs), accounted for 35.6% of all health care-associated infections in 2017.4
Common types of HAIs.
Prevention is critical.
Common types of HAIs include: 2
Environmental cleaning and disinfection is a critical strategy for HAI prevention. According to the Provincial Infectious Disease Advisory Committee (PIDAC), environmental cleaning in the healthcare setting must be performed on a routine and consistent basis to provide for a safe and sanitary environment.7
• Central line-associated bloodstream infections (CLABSI) • Catheter-associated urinary tract infections (CAUTI) • Surgical site infections (SSI) • Clostridium difficile infections • Methicillin-resistant staphylococcus aureus (MRSA) infections • Vancomycin-resistant enterococci (VRE) infections • Carbapenem-resistant Gram-negative bacterial infections
The burden of HAIs. HAIs constitute a significant burden to society, as they cause significant morbidity and mortality in hospitalized patients. More than 200,000 patients are infected every year while receiving healthcare in Canada and estimates suggest that HAIs are linked to between 8,500 and 12,000 deaths per year, making these infections the fourth leading cause of death for Canadians (behind cancer, heart disease, and stroke). 5 Treatment costs for HAIs are high as the cost of containment and control of these outbreaks can really add up. 6 Additionally, after discharge, patients with HAIs have significantly higher personal medical costs than uninfected patients. They require more visits from community nurses, greater reliance on hospital outpatient and emergency services, and more visits to their family doctor. 2
Cleaning and disinfecting products must be approved by environmental services, infection prevention and control and occupational health and safety.7 Disinfectants must have Health Canada approval and should be compatible with surfaces, finishes, furnishings, items and equipment to be cleaned and disinfected.7 Additionally, they must be used according to the manufacturer’s recommendations and be effective against the microorganisms encountered in the healthcare setting.7
Researchers estimated that about 70% of some types of HAIs could reasonably be prevented if infection prevention and control strategies are followed. 8 Make CloroxPro™ part of the process. CloroxPro™ offers multiple Health Canada–registered disinfectants based on three categories of active disinfectant ingredients – quaternary ammonium compounds (or “quats”), chlorine releasing compounds (such as bleach), and peroxygen compounds (such as hydrogen peroxide), to help meet your healthcare facility’s unique needs.
Learn more, or request a product demo at CloroxPro.ca | firstname.lastname@example.org References: 1. Healthcare-associated infections. Healthy People 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/healthcare-associated-infections Accessed March 10, 2020. 2. Evaluation of healthcareassociated infection activities at the Public Health Agency of Canada 2012-13 to 2016-17. March 2018. https://www.canada.ca/content/dam/phac-aspc/documents/corporate/transparency/corporate-management-reporting/ evaluation/HAI_evaluation-eng.pdf Accessed March 12, 2020. 3. Healthcare-associated infection rates in Canadian hospitals. Public Health Agency of Canada. Canadian Nosocomial Infection Surveillance Program (CNISP). https://www.canada.ca/content/dam/canada/public-health/services/publications/science-research-data/healthcare-associated-infection-rates-canadian-hospitals-infographic/CNISP-2013-2017-infographic-eng.pdf Accessed March 13, 2020. 4. Mitchell R, et al. Trends in healthcare-associated infections in acute care hospitals in Canada: An analysis of repeated point-prevalence surveys. CMAJ 2019;191(36):E981-8. 5. Health care associated infections: A backgrounder. Canadian Union of Public Employees, 2009. https://cupe.ca/sites/cupe/files/healthcare-associated-infections-cupe-backgrounder.pdf Accessed March 9, 2020. 6. Dik J-W H, et al. Cost-analysis of seven nosocomial outbreaks in an academic hospital. PLoS ONE 2016;11(2):e0149226. 7. Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee. Best practices for environmental cleaning for prevention and control of infections in all health care settings. 3rd ed. Toronto, ON: Queen’s Printer for Ontario; 2018. 8. The Chief Public Health Officer’s Report on the state of public health in Canada 2013: Infectious Disease – The Never-ending Threat. https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/cphorsphc-respcacsp/2013/assets/pdf/2013-eng.pdf Accessed March 16, 2020.
© 2020 The Clorox Company
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Clorox Total 360® system with Spore Defense™, when used regularly, provides your facility with invisible yet effective outbreak prevention.
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The Invisible Guardian
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♦ C. difficile in 5 minutes ♦ 42 out of 47 pathogens in just 1 minute, including MRSA, VRE, measles & polio
HEALTH & SAFETY
LEFT TO RIGHT: Louisa Nedkov, Dr. Deborah Marshall, Dr. Jonathan Sam and Dr. Meghan Daly.
LIFE SUPPORT CovidCARE created amid pandemic to help staff, physicians at Halton Healthcare By Zita Raponi
hile no one can change the stark realities of COVID-19, staff and physicians at Halton Healthcare are finding comfort and strength through a peer support program called CovidCARE. The program has helped them connect and build strong support systems so they can face the unique challenges of healthcare and self-care amid the pandemic. In April 2020, Dr. Jonathan Sam, a pediatrician at Oakville Trafalgar Memorial Hospital, noticed his co-workers were struggling with the sudden changes brought about by COVID-19. “There was a growing sense of fear and uncertainty among staff and physicians, I call it a shadow pandemic, that was even more contagious than the coronavirus itself,” he explains. With a background of working with teams to improve their performance in acute care situations through simulation and debrief ing, Dr. Sam decided to facilitate candid discussions with the care teams on the maternal child/pediatrics unit to see how he could help. 20 CANADIAN HEALTHCARE FACILITIES
“Dr. Sam cut through all the confusion and very effectively eased the fear and anxiety in the room,” says Tracey Fuller, a clinical resource nurse on the maternal child unit who attended some of the initial sessions. “He patiently answered all our questions, showed us how to sort through the new regulations and protocols, and armed us with coping and self-care strategies. He also provided simple preventive measures on how to protect ourselves, each other and our families.” Word spread quickly of Dr. Sam’s discussions and he soon received invitations to department meetings and team huddles from all across the organization. CovidCARE was born in response to this overwhelming need for support. “Our healthcare teams were looking for a human connection and Dr. Sam recognized this,” says Dr. Zeba Ansari, chief of pediatrics at Halton Healthcare. “He listened to their concerns, talked them through their fears and showed how they could support each other.” CovidCARE is comprised of seasoned debriefers from all three Halton Healthcare
sites: Oakville Trafalgar Memorial Hospital, Milton District Hospital and Georgetown Hospital. Led by Dr. Sam, the team includes Dr. Saroo Sharda, Dr. Meghan Daly, Dr. Deborah Marshall and registered nurse Nicole Cemkov. It is supported by Louisa Nedkov, program coordinator of Halton Healthcare’s wellness program, Kailo. The debriefers attend department meetings and unit huddles, by invitation, to guide group discussions and help teams build resilience. The program is offered in-person, as a hybrid (mix of live and virtual) or entirely virtual. Sessions last 20 to 60 minutes, depending on the needs of the team. “Different teams have different concerns. Healthcare providers and support staff on the frontlines in the emergency room or intensive care unit may be worried about how to care for patients or contracting the virus, while others are still struggling with adapting to their ‘ n e w n o r m ’, ” s a y s D r. S a m . “Acknowledging teams for the great work they do, especially when they are feeling particularly vulnerable, can be
HEALTH & SAFETY very powerful. Some staff also have personal problems at home that makes it very difficult for them to work — we address those too.” CovidCARE has boosted morale by spreading positivity, togetherness and resilience across Halton Healthcare. As of November 2020, the peer support team has facilitated nearly 100 sessions and reached more than 1,750 clinical and non-clinical staff. “We cannot change the outcomes or even say that everything will be okay, but we can certainly help people connect, encourage them to share their struggles and take care of each other, and we can do it all with bravery,” notes Dr. Sam. “By sharing their experiences, staff realize they are not alone. Often, the best people to help them are their colleagues because they are facing the same challenges.” Since its creation, CovidCARE has grown and expanded to provide a more robust program geared to the second wave of the pandemic. “In order to increase the program’s capacity, effectiveness and accessibility,
“THERE WAS A GROWING SENSE OF FEAR AND UNCERTAINTY AMONG STAFF AND PHYSICIANS, I CALL IT A SHADOW PANDEMIC, THAT WAS EVEN MORE CONTAGIOUS THAN THE CORONAVIRUS ITSELF.” our entire team recently completed critical incident stress management training,” says Dr. Sam, who was bestowed the Halton Healthcare VIP (Values Inspired Performer) Award last year, for his leadership in establishing CovidCARE. The award recognizes individuals who exemplify the organization’s values of compassion, accountability and respect. Halton Healthcare has also established a physician champion at each of its hospitals. Dr. Marshall supports Milton District Hospital, while Dr. Daly manages Georgetown Hospital. “We are also actively surveying all participants of the program to measure CovidCARE’s reach and impact to continuously grow and improve,” says Dr. Sam. “We have discovered the needs and emotions of participants are changing with the second wave — we have moved from
CHES Canadian Healthcare Engineering Society
fear to more frustration and people are at risk of burnout. The feedback we receive can help us gauge the pulse of the organization so we can tailor sessions to the current challenges.” B e s id e s C ov id C A R E , H a lt on Healthcare has established a number of peer-to-peer support programs over the past year for staff and physicians. These include the Schwartz Rounds, a forum where clinicians can discuss difficult or emotional healthcare situations in a safe space, and a critical incident staff support program that connects with clinical teams after a traumatic experience or overwhelming work-related stress. “While each of these programs addresses different access points and triggers, they all reach out to people when they need it most,” notes Dr. Sam. “Sometimes just knowing someone has your back is enough to see you through a difficult time.”
Société canadienne d'ingénierie des services de santé
CALL FOR NOMINATIONS FOR AWARDS 2021 Hans Burgers Award for Outstanding Contribution to Healthcare Engineering DEADLINE: April 30, 2021
2021 Wayne McLellan Award of Excellence in Healthcare Facilities Management DEADLINE: April 30, 2021
To nominate: Please use the nomination form posted on the CHES website and refer to the Terms of Reference.
To nominate: Please use the nomination form posted on the CHES website and refer to the Terms of Reference.
Purpose: The award shall be presented to a resident of Canada as a mark of recognition of outstanding achievement in the field of healthcare engineering.
Purpose: To recognize hospitals or long-term care facilities that have demonstrated outstanding success in completion of a major capital project, energy efficiency program, environmental stewardship program or team building exercise.
Award sponsored by
Award sponsored by
For Nomination Forms, Terms of Reference, criteria, and past winners www.ches.org / About CHES / Awards Send nominations to: CHES National Office firstname.lastname@example.org Fax: 613-531-0626 SPRING/PRINTEMPS 2021 21
HEALTH & SAFETY
FURNITURE IN THE AGE OF COVID Pandemic impacts this important healthcare design consideration By Carl Kennedy
s Canadians navigate the second wave of COVID-19 and intensive care units brace for a possible resurgence, healthcare facilities are looking at ways their interior environments and protocols can impact the scale at which this infectious disease is either contained or spread to keep patients and caregivers safe. As a high touch point product, hospital furnishings should be given extra consideration when creating an infectious disease control plan. Health Canada has developed a list of disinfectants that are supported by evidence to likely be effective when used on surfaces against the coronavirus. This is good news for the cleaning of healthcare furniture; however, to ensure longevity, furniture should be durable enough to continuously withstand constant cleaning with strong disinfectant products. In most cases, healthcare-specif ic furnishings have features that inhibit bacteria traps, easing the cleaning burden on housekeeping staff. Seating manufactured specifically for healthcare environments often have removable seat and back upholstery covers, components that are effortless to replace, smooth surfaces with minimal crevices and easily accessed cleanout spaces.
22 CANADIAN HEALTHCARE FACILITIES
Chair arm caps should be one-piece construction that is virtually indestructible and won’t crack or break. Popular arm cap materials include polyurethane, rigid polyester, glass-filled nylon or solid surface. During the era of COVID-19, solid surface has become increasingly popular on items such as bedside tabletops and overbed tables. The material is extremely durable, provides a seamless finish and is non-porous so fluids, dirt and stains cannot penetrate it. Marks on the surface can be easily removed with household cleaner. Another infection control strategy is to simply have less surface area to clean. This can be achieved with armless chairs and by using connecting tables to reduce the number of legs to clean around. Healt hc a re - g r ade fabr ic s of fer antimicrobial protection, bleach-solution cleanability, fluid-barrier protection, and are soil and stain resistant. Healthcare vinyl and polyurethane upholstery materials are particularly durable and compatible with effective cleaning agents. One textile company has even developed its own patented technology that fights against COVID-19. With a movement toward spaces that encourage patients to spread out, furniture can play an important role in keeping
viruses contained. High back chairs provide a barrier between patients sitting back-to-back, seating pods separate patients from potentially contagious people, and privacy panels can be inserted between chairs in crowded waiting rooms. Before the pandemic, Canadian hospitals would routinely reach and exceed 100 per cent capacity. COVID-19 has forced them to find creative ways of increasing their capacity. This has been achieved through the setup of field hospitals, use of hotel rooms and taking over areas in long-term care homes. These interim healthcare spaces require furniture that is easy to move and flexible, such as stacking chairs, bedside tables with casters, overbed tables and temporary beds. The COVID-19 health crisis has inevitably influenced healthcare design considerations for the foreseeable future. These are not trends; rather, many will remain permanent standards as part of healthcare facilities’ infection control strategies that prioritize patient and staff safety. Carl Kennedy is president of Stance Healthcare. Based in Kitchener, Ont., Stance Healthcare manufactures furniture for healing environments with a particular focus on hospitals and behavioural health facilities.
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CRITICAL ENVIRONMENT CONTROL SYSTEMS HVAC precision where it matters most By Cole Ridd
or those not intimately familiar with HVAC systems and building controls, it is easy to oversee their importance. While infrastructure considerations are certainly diverse, they often underestimate the complex science involved to manage indoor environments. The COVID-19 pandemic serves as a harsh reminder for the need to implement HVAC systems of only the highest calibre. Indeed, it has become apparent to many that these systems offer not only simple comforts but also life preserving
24 CANADIAN HEALTHCARE FACILITIES
capabilities. Anything less than optimal risks compromising human health. Critical environment control systems are specifically designed for reliability and precision to mitigate and contain airborne contaminants and provide HVAC functions where they matter most. These systems precisely control room pressure, air flow, temperature and humidity to meet the needs of specific building spaces involved with critical functions. Consider a laboratory dealing with infectious diseases and harmful substances, an operating room
protecting patients from exogenous contaminants while maintaining surgeon comfort, an isolation room containing deadly outbreaks of SARS, MERS, COVID-19, tuberculosis or other infectious diseases, or a pharmacy compounding sensitive pharmaceuticals. In each case, critical environment control systems are invaluable. So, what sets a critical environment control system apart from a typical HVAC system? Common HVAC devices that regulate airflow use an airflow measuring device in
HEALTH & SAFETY
Venturi valves with insulating wrapping installed for a critical environment lab space at the National Research Council of Canada's advanced manufacturing program facility in Winnipeg.
the air stream to modulate a damper. There are two major disadvantages with this method for a critical environment space. The first is dust and other debris commonly found within HVAC ductwork accumulates on the airflow sensor, potentially leading to harmful contaminant buildup and measurement inaccuracies. Regular cleaning of the debris poses challenges as personnel are required to shut down the system, seal off and contain the space, and enter the contaminated duct space, all of which increases operational risks and expenses. The second disadvantage is the speed at which this method operates. The airflow sensor must measure the airflow and a control signal must be sent to modulate the damper actuator. This measure and adjust sequence is repeated until the desired airflow is met. It results in a delay in control that is not acceptable for a critical space. For example, a control system attempting to maintain positive pressure in an operating room that suddenly has a door opened could fail to keep airborne contaminants from entering the space if the HVAC system does not respond fast enough to recover the pressure set point. To overcome these deficiencies, airflow control valves that can respond fast and accurately without air stream measurement devices were developed. An airflow valve specifically designed for critical environments consists of a Venturi-shaped shell, a fast-acting electric actuator and an internal spring-loaded cone. These valves are commonly referred to as a Venturi valve. By way of the Venturi effect and Bernoulli’s principle, airflow through the valve is categorized and pre-calibrated at the factory for specific actuator positions. Combined with pressure independence, this means that no flow measurement needs to take place; the fast-acting actuator simply moves to the position of required flow with no feedback loop slowing the response time. Pressure independence is achieved by the spring-loaded cone passively moving in response to the duct pressure. As the duct pressure increases, the spring compresses and pushes the cone further into the shell. The result is an airflow control valve that maintains a desired specific volumetric flow rate regardless of duct pressure. The critical environment control system is completed with a room pressure controller that monitors room pressure and controls the Venturi valve response. Controllers
A DISADVANTAGE OF COMMON HVAC DEVICES IS DUST AND OTHER DEBRIS COMMONLY FOUND WITHIN DUCTWORK ACCUMULATES ON THE AIRFLOW SENSOR, POTENTIALLY LEADING TO HARMFUL CONTAMINANT BUILDUP AND MEASUREMENT INACCURACIES. include live visual alarms and alerts for personnel and can be scaled to control humidity, temperature and auxiliary equipment, such as fans and fume hoods, as well as to connect to a building management system. Healthcare facilities demand the highest level of function to support advanced medical care and human innovation. Combatting airborne threats, both new and existing, is a crucial requirement. As demand increases for more refined indoor environments, HVAC and related
control systems must continue to offer exceptional capabilities. COVID-19 has only further highlighted the importance of implementing high performance building control systems. Cole Ridd serves in business development at Dynamic Building Control, which specializes in commercial building HVAC automation and control systems. The Winnipeg-based company is the independent distribution channel supplier and contractor for Johnson Controls products, including Triatek critical environments products. SPRING/PRINTEMPS 2021 25
HEALTH & SAFETY
O2 IN DEMAND Resilient bulk oxygen supply systems for healthcare facilities By Christine McTavish, Alex Sagatov & Sheldon Ferguson
ver the past year, many discussions have centred on the critic a l s u p pl y of ox y g en t o healthcare facilities in light of the increased demand due to COVID-19. Can all the additional respiratory support equipment, such as ventilators and high-flow therapy devices, be supported with existing hospital infrastructure? As new facilities are planned and existing sites are renovated or expanded, project teams now look to resilient design principles to determine bulk oxygen supply systems and the piping infrastructure required to accommodate such demands. By definition, resilient systems offer flexibility to cover both immediate and longterm needs, including prolonged surges in demand. It takes careful planning to ensure oxygen systems operate reliably during times of average consumption and have the ability to ramp up quickly in case
26 CANADIAN HEALTHCARE FACILITIES
of a significant demand spike. It is critical to consider not only the size of the bulk oxygen equipment but also the diameter of the piping within the hospital walls and piping network to the bulk system pad. The very nature of a bulk oxygen system incorporates many aspects of resilient design principles. Installed on a facility site, the day-to-day supply is inherently local. By building to the requirements of CSA Z7396.1, Medical Gas Pipeline Systems, the redundancy factor is also covered. All healthcare bulk facilities have a large main tank with vapourizer (main subsystem) and either a reserve tank with vapourizer or a high-pressure cylinder backup (reserve subsystem) ready to assist or take over in the case of increased demand, flow interruption or failure of the main system. A control cabinet is the set of mechanical valves and regulators intended to automatically switch the supply of oxygen from the main subsys-
tem to the reserve and back again if failure occurs, or to relieve excess head pressure in the tank instead of losing it to the atmosphere. In case of a more serious event that may impact the integrity of the infrastructure around the tank, hospitals are required to have an emergency oxygen inlet. This should be located away from the bulk installation and allow an emergency supply. The principles of cryogenic bulk tank system operations are simple. Liquid oxygen is contained within a cryogenic vessel and flows to the vapourizer where the phase changes from liquid to gas and supplies the healthcare facility. It is critical to maintain uninterrupted oxygen supply so there are no components in a bulk installation that require electricity to deliver oxygen. Even when there’s a total power outage, liquid oxygen still flows to the vapourizers, changes to a gaseous form and continues to the
HEALTH & SAFETY
hospital pipeline. That plus robust design makes the system extremely reliable. Bulk oxygen systems very rarely require service outside of planned preventive maintenance. Scalability in some industries refers to the pre-planned ability to add or subtract components, or quickly swap out different sized components. These methods are used to increase or decrease supply. Given the critical nature of medical oxygen, making changes to the bulk equipment or pipeline on the fly is impractical, so proper sizing instead of scalability should be considered in view of demand variability. Resiliency includes the ability to meet changes in demand over time. Average and peak consumption rates should still be calculated as these will represent regular operating conditions. Next, the desired surge capacity must be determined. Clinical input during this step is important to estimate how many additional devices could be activated and what the corresponding flow rates would be. A ventilator could add between 20 and 75 litres per minute (LPM) to the flow demand. A high flow therapy unit could add up to 65 LPM. Numerous hospitals have projected and, in some cases, experienced actual demand increases up to 20 times their historical average. This has required significant investment for the urgent upgrade of their bulk systems and pipelines. In other cases, hospitals have expanded with temporary facilities, which has required separate bulk oxygen supply systems as existing installations lack resilience to meet the extra demand. Resilient design impacts the overall bulk installation, including the reserve subsystem. Equipment sizing was previously based on historical facility data plus calculated increased loads from expansion. During extended periods of peak/surge usage, traditional system autonomy would decrease. Resilient reserve subsystems should be sized in accordance with the facility’s anticipated highest level of demand. The need for synergy between the bulk gas equipment and medical gas pipeline system is heightened during pandemic-type demands. The entire hospital piping network, including the supply piping from the bulk installation, must be able to support increased flow rates. Pipe sizing has also been calculated in the past based on historical data and may even have been downsized to reduce construction budget. COVID-strained facilities have experienced reduced oxygen flow and/or pressure at the medical gas outlets in patient care areas served by smaller diameter piping. The further away these areas are from the source system (bulk
A bulk oxygen system is being installed to supply a pandemic response unit at an Ontario hospital.
AS NEW FACILITIES ARE PLANNED AND EXISTING SITES ARE RENOVATED OR EXPANDED, PROJECT TEAMS NOW LOOK TO RESILIENT DESIGN PRINCIPLES TO DETERMINE BULK OXYGEN SUPPLY SYSTEMS AND THE PIPING INFRASTRUCTURE REQUIRED TO ACCOMMODATE SUCH DEMANDS. installation), the more pronounced the issue becomes. Resilient piping design decreases pressure losses and enhances the ability to care for the most vulnerable patients. Healthcare facilities have taken different approaches to their oxygen system design. Some hospitals have decided not to upgrade the entire pipeline but just the part that supplies critical wards like the intensive care unit. Others have opted to supply different parts of the pipeline from two bulk oxygen systems, which offers additional benefits. It increases redundancy — two complete systems instead of one, both capable of meeting the demand of the entire hospital. Two systems also mean two independent feeds to the hospital, so if the pipe from one system is damaged, the second
remains intact. Upgrading the critical portion of the pipeline is also less expensive than updating the entire medical oxygen pipeline. Christine McTavish and Sheldon Ferguson are technical sales representatives with Air Liquide Healthcare. Alex Sagatov is the company’s sales director of medical gases, Western Canada. Air Liquide Healthcare is a leading supplier of portable and bulk medical gases, respiratory care products, and medical gas pipeline and source systems in Canada. The company has worked with hundreds of Canadian hospitals and healthcare providers over the past 100 years. Christine, Sheldon and Alex can be reached at email@example.com, firstname.lastname@example.org and email@example.com, respectively. SPRING/PRINTEMPS 2021 27
ELECTRIFYING THE TRANSPORTATION GRID Benefits, challenges of EV charger installation By Kent Waddington
he network of zero-emissions vehicle/electric vehicle (ZEV/EV) charging stations on healthcare campuses is growing steadily across the country. A recent survey of 101 Canadian hospitals revealed 76 per cent have EV charging stations, and 26 per cent have preferred parking for low emission vehicles. Behind this embrace of the modern, efficient transportation grid is an understanding of the benefits and challenges inherent in electrification. A sound electrification plan can enhance an organization’s preparedness to deal with
28 CANADIAN HEALTHCARE FACILITIES
future climate change impacts, help reduce its ecological footprint, bolster its corporate sustainability plan, improve its perceived ‘brand’ in the community, as well as among current and potential employees, and increase staff satisfaction, which is linked to workforce participation and retention. “Electric vehicle charging stations are a visible demonstration of an employer’s commitment to sustainable business practices,” says Cara Clairman, president and CEO of Plug’n Drive, a non-profit organization committed to accelerating the adoption of electric vehicles in Canada.
“The biggest barrier to more widespread adoption of EV technology and the associated charging grid is the lack of unders t a nd i n g a b out t he s i g n i f ic a nt environmental and economic benefits of using electricity instead of fossil fuels.” According to vocal ZEV champion Dr. Pascal Gillrich, many hospitals are in the “dark ages” when it comes to the adoption of the technology. “Changing the mindset in the healthcare community will take time but at the end of the day, it just makes sense,” he says. “All of us in healthcare have a responsibility to
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SPRING/PRINTEMPS 2021 29
SUSTAINABLE HEALTHCARE engage senior leaders, together with our friends and colleagues, in the conversation and urge the opening of minds.” Dr. Gellrich encourages everyone to step out of their conventional gasoline-fuelled comfort zone and investigate ZEV technologies. From an organizational perspective, embracing EVs and an EV charger network involves more than visiting a hardware store to pick up a few off-the-shelf charging stations. Sunnybrook Health Sciences Centre’s manager of energy and sustainability, Saleh Daei, is all too familiar with installing chargers in a healthcare setting. Daei has been helping to orchestrate the growth of Sunnybrook’s charger network since 2017. Twenty-four chargers are currently in use at the Toronto healthcare facility, and 20 more are planned when funding is available. Daei cautions organizations to confirm sufficient consumer demand and the presence of adequate facility infrastructure to support the chargers and draw on the power grid before making a purchase. “You might find yourself digging up pavement and needing to install electrical infrastructure, such as transformers, power panels and heavy-duty wiring,” he explains. “The chargers themselves are only part of the total cost. And don’t forget to plan for the human behavioural element, maintenance program as well as an ongoing awareness campaign.” The 10 Level 2 dual charger units recently installed at Sunnybrook for staff use cost $67,000. They amounted to Biomedical_CHF_Winter_2017_FINAL.pdf 1 approximately 30 per cent of a total project cost, which included $24,000 in design fees and $110,000 in installation and infrastructure upgrade charges.
The University Health Network (UHN) has taken on similar EV charger installation projects. Phase 1 involved Tesla donating 36 charging stations for the Toronto General and Toronto Western hospitals. The charging stations can accommodate all types of electric vehicles and are available in both staff and visitor parking areas at no extra cost beyond regular parking fees. UHN’s energy steward Lisa Vanlint worked closely with parking management, business operations, security, facilities management, IT, infection prevention and control, and the Tesla destination charging program to make the project a reality. “We in energy and environment covered the extras, such as painting the zones green and installing electricity submeters to track the energy impacts and operational costs,” says Vanlint. “Funds saved from other energy conservation projects were committed to the EV project because we felt this was a very effective way to bring down greenhouse gas emissions.” Sparked by requests from physicians, Phase 2 was initiated and involved the installation of six more donated Tesla chargers in Toronto Western’s parkade. Vanlint says it’s prudent that organizations develop a sound written policy to govern EV charging stations. It should include a clear articulation of fees (if any), consequences of inappropriate use by nonEVs (internal combustion vehicles, motorcycles, hybrids and off-road/commercial vehicles), length of permitted charging time and common charging courtesies. While retrofitting a charger network 2017-10-23 4:45 PM into an existing healthcare facility is often fraught with unexpected obstacles, designing for a new build also has its hurdles, says Frank Deluca, chief imagineer at DCL
Healthcare Properties, developers of an innovative green medical arts centre in Niagara Falls, Ont. “(The new centre) was designed to conserve natural resources and have a low carbon footprint with electric car chargers seamlessly integrated as part of the project; however, the chargers posed a challenge,” explains Deluca. “Not all public charging stations are the same. Some are free, some are not. Some charge much faster than others. And, most importantly, different electric cars need different types of charging ports, particularly Tesla, which uses a unique proprietary charger system.” To incite EV buy-in, Deluca favoured offering free charging but had to be fiscally responsible at the same time. He considered contracting with one of the many third party North American EV charger firms that would install, manage and operate the network. He debated for weeks with his team about whether to buy or lease equipment, as well as which types of chargers and brand names to install. “I knew there was a growing list of locations in the area featuring Level 2 charger installations but I wasn’t aware of any Level 3 fast charger sites,” says Deluca, who wanted to ensure the chargers would meet user requirements. In the end, the design team opted to rough-in 15 charging station locations — five to service the general public and 10 for building tenants. A fee will not be levied for use of the chargers and tenants will be able to choose the type and brand of charger they require. Kent Waddington is co-founder and communications director of the Canadian Coalition for Green Health Care. He can be reached at firstname.lastname@example.org.
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 email@example.com | www.mwbiomed.ca P: 780 463 3877
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