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Volume 36 Issue 3

Summer/Été 2016



Healthcare facilities gear up to make sites, operations more sustainable

Next Version of CSA Z7396-12 Preventive Maintenance Program Perks Cleaning and Disinfection Best Practices

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Issue 3



Annette Carlucci




6 8

38 Expanding the Tool Box Planned preventive maintenance program well worth the investment

Editor's Note President's Message

10 Chapter Reports

40 A Spotless Record Best practices for cleaning, disinfection of environmental surfaces

20 Opportunity Knocks Timing right for St. Boniface Hospital to improve central chiller plant


Canadian Healthcare Engineering Society


Société canadienne d'ingénierie des services de santé



Mitch Weimer Preston Kostura Peter Whiteman Craig. B Doerksen Sarah Thorn Donna Dennison

Newfoundland & Labrador: Brian Kinden Maritime: Helen Comeau Ontario: Roger Holliss Manitoba: Reynold J. Peters Saskatchewan: Alan F. Krieger Alberta: Tom Howard British Columbia: Steve McEwan FOUNDING MEMBERS

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

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

34 Equipped for the Future MES program provides sustainable access to medical technology

Committed to service excellence Structural Restoration Structural Engineering Building Science Parking Facility Design





44 Time to Breathe Easy Next version of medical gas standard coming down pipeline

32 On the Green Brick Road University Health Network paves way to sustainable savings

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28 Digging Deep Project SOIL unearths fruits of on-site food production

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SUSTAINABLE HEALTHCARE 14 Operation Critical Sunnybrook replaces existing emergency power generating plant




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A TRIP TO REMEMBER TEN YEARS AGO THIS SEPTEMBER, I moved from Toronto to Vancouver. Known for its urban sophistication and great outdoors, Vancouver is consistently named one of the world’s top cities for livability and quality of life. This is what drew me to the west coast metropolis, nothing more. When I arrived in Vancouver after a seven-day car trek, all that awaited me was what the city had to offer (and a onebedroom apartment in the downtown core, which I secured weeks prior to the crosscountry voyage). I had no job (or looming prospects), no friends (other than my now-husband who threw caution to the wind and accompanied me on the journey) and just enough cash in the bank to keep us afloat for a couple months. Thankfully that’s all we needed. After just six weeks in the ocean-side city I secured a job at MediaEdge Communications, writing about the province’s most prominent infrastructure projects at the time, several related to the healthcare sector. While I have since moved back to my hometown, I have a soft spot for Vancouver (resulting in two nostalgic return trips) and am confident anyone who visits the worldclass city for the 2016 CHES National Conference this September will be nothing less than impressed. Conference-goers will be just as dazzled by the main attraction, comprised of a variety of social activities, the much-anticipated annual awards presentation ceremony and a stellar educational program. This year’s conference theme — Risky Business: Is Healthcare Sustainable? — has garnered a great deal of attention thus far, so much so that it forms the basis of this issue. In the pages to come, you’ll read about the great strides healthcare facilities have made to become more sustainable — from St. Boniface Hospital’s chiller conversion project to Nova Scotia Hospital’s water recycling system and Humber River Hospital’s adoption of a managed equipment service program — as well as ways they can further green their operations. As always, I’m interested in obtaining feedback and article proposals. If you’d like to participate in the CHES member Q&A, please e-mail me along with the topic you’d like to discuss. Clare Tattersall

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.


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

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A COLLABORATION OF EFFORTS MANY CHES CHAPTERS held their annual conferences this past spring. I had the opportunity to attend the Maritime and Ontario chapter conferences, while CHES National treasurer Craig Doerksen and vice-president Preston Kostura attended the Newfoundland & Labrador and Manitoba chapter conferences, respectively. All were well-run and exciting events, receiving positive reviews from delegates and exhibitors alike. For many years, CHES has promoted the creation of a chapter in Quebec, to realize its vision of chapters from coast-to-coast. There is renewed interest from CHES members in the province to form such a chapter, and it’s my hope that we will announce one shortly. If you live in Quebec and are interested in being part of this exciting initiative, please feel free to contact me so I can put you in touch with our Quebec members. The 2016 conference team is hard at work putting the finishing touches on this year’s event in Vancouver. The B.C. Chapter last hosted the CHES National Conference in the shadow of the 2010 Winter Olympics in Whistler. This year’s conference will be held at the Vancouver Convention Centre, Sept. 11-13. I am honoured to welcome all CHES members to my hometown to experience all the city has to offer. Following the conference, there will be a two-day session of the Canadian Healthcare Construction Course (CanHCC), Sept. 14-15. The CanHCC course is enjoying great success across the country. We’ve held two courses thus far this year and have two more scheduled for fall in Vancouver and Toronto. We try to move the course around the country to give everyone the opportunity to attend a session that is close to home. The course is a must for new employees or managers in healthcare, as well as architects, engineers, designers, contractors, suppliers and service providers. For more information on CanHCC, go to the CHES website. The Canadian Certified Healthcare Facility Manager (CCHFM) program continues to grow and has seen more members write the exam. CCHFM certification advisory panel member Gordon Burrill recently attended the Canadian College of Health Leaders’ (CCHL) National Health Leadership Conference, where he gave a seminar on the CCHFM program. We are following up with a CCHL webinar to further promote the program. Mitch Weimer President, CHES National

EARN FREE CONTINUING EDUCATION CREDITS FROM CHES Members of the Canadian Healthcare Engineering Society can earn free continuing education units (CEU) by reading the Summer 2016 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 to take the quiz. CHES members who pass the quiz will be able to claim one contact hour (0.1 CEU) on their CanHCC or CCHFM certificate renewals.




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Now that my first year as chapter chair is officially behind me, I can safely say it has been quite the experience, and a worthwhile one at that. The journey has been relatively smooth thanks to the executive team who believes in what we’re trying to accomplish and has supported me along the way. It’s been a busy couple of months for the Ontario Chapter. This year’s conference and trade show was one of the most successful to date, with 138 registered delegates and more than 70 exhibitors, 23 of which were first-timers to the chapter conference. Despite the logistical challenges of having the conference at a separate venue from the hotel, everyone enjoyed the event — a testament to the proficiency of the planning committee. The Ontario Chapter continues to regularly meet with various organizations that offer synergistic benefits to each association’s membership, including the Firestop Contractors International Association and Canadian Institute for Energy Training (with regard to the Building Operator Certification program). The chapter also maintains its support of Healthcare Energy Leaders Ontario (HELO) and the Canadian Coalition for Green Health Care (CCGHC), both as a potential user group and financially. At an advocacy level, the Ontario Chapter has been active on two Union Gas initiatives. The first involves a letter of support to upgrade a major natural pipeline’s capacity to address potential supply issues for the areas serviced along the Chatham-Kent to Windsor corridor. The other is a formal request to the provincial government for billing transparency when the Ontario Liberals launch cap-and-trade carbon fees in 2017. The chapter continues to foster its relationship with the infection control side of healthcare. A recent example is our involvement in a three-person seminar at Infection Prevention and Control (IPAC) Canada’s 2016 National Education Conference in Niagara Falls. Along with myself, presenters included Barry Hunt of Class 1 Inc. and Merlee Steele-Rodway of Eastern Health. The session was so well-received that future presentations are a distinct possibility. The Ontario Chapter has initiated a new bursary program that allows all active members (regular and associate) to apply for $1,000 scholarships if they have family (son, daughter or grandchild) in full-time post-secondary technology programs. The bursaries are currently limited to five per year and based on specific criteria as outlined in the application protocol on the CHES Ontario Chapter website. In the inaugural year, the award was granted to five applicants as a new member-benefit. This year, there were three member applicants: Chuck Meyer, Miles Buckrell and Guy Bourbonniere. They and their kin — Lucas Meyer, Steven Buckrell and Josh Bourbonniere, respectively — were invited to the CHES Ontario 2016 Conference & Trade Show in Kitchener, where they were honoured during a formal presentation. The executive team believes this new member-benefit will be a long-lasting and welcome addition to the chapter. —Roger Holliss, Ontario Chapter chair


MARITIME CHAPTER A new executive was welcomed at the chapter’s annual general meeting, held May 16, during the CHES Maritime 2016 Conference & Trade Show in Moncton, N.B. It includes: Helen Comeau (chair); Lane Mingo (executive vice-chair, and partnership and advocacy); Andrew Bradley (secretary and communications); Gordon Jackson (treasurer and membership); John Mason (vice-chair Nova Scotia); Keith Fowler (vice-chair New Brunswick); and Troy Myers (vicechair P.E.I.). Kerry Fraser remains on as the chapter’s associate chair. This year’s conference was a great success, with more than 50 registered delegates. It kicked off with keynote speaker Gordon Burrill of Teegor Consulting Inc., whose presentation addressed caring for patients in changing times and incorporated his own real-life experiences. A full slate of speakers followed, with topics revolving around the conference theme: Challenges and Opportunities in Healthcare Facilities. The trade show featured new services and products, with a focus on technology, and was supported by delegates and facilities management departments. Pub night at the Old Triangle Irish Alehouse was well-attended by 70 delegates and exhibitors, providing another opportunity to exchange information and stories. Following the event, the two-day Canadian Healthcare Construction Course (CanHCC) was held at the conference venue, Delta Beausejour. It was also successful, with 52 registrants from across the Maritimes and as far away as Manitoba. CHES members Gordon Burrill and Mike Hickey, along with Tim Adams from the American Society for Healthcare Engineering (ASHE), provided an exceptional program. The Maritime Chapter continues to balance its books while offering several financial incentives to members in the way of contributions to educational opportunities. The present bank balance is approximately $58,000. This year’s recipient of the Per Paasche bursary is Kaleb Matthews. Kaleb was recognized with a $1,000 cheque at the chapter conference. —Helen Comeau, Maritime Chapter chair



Ontario Chapter family member student bursary presentation at this year's conference in Kitchener, Ont. Left to Right: Chuck Meyer (CHES member), Lucas Meyer (recipient), presenter Rick Anderson (education and professional development chair), Steven Buckrell (recipient) and Miles Buckrell (CHES member).




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The 2016 CHES Saskatchewan Chapter Annual General Meeting, Conference & Trade Show is on track, and will be held Oct. 23-25, at TCU Place in Saskatoon. The speakers, format, agenda and venue details have been finalized and will be available on the CHES website soon. We have made slight adjustments to the format to try to make this a more value-added event for vendors and sponsors since they are key to our success. The venue and activities for the Monday evening social will be immediately adjacent to, and take place directly after, the trade show. The intent is to not lose any of the vendors, sponsors or delegates. The location and venue for the 2019 CHES National Conference has been decided. It will take place at TCU Place, Sept. 22-24. Saskatoon is a beautiful city at this time of year and we will try to live up to the high standards set by other cities. Detailed conference planning has not yet begun but will soon. —Alan F. Krieger, Saskatchewan Chapter chair

With the 2016 CHES National Conference in Vancouver quickly approaching, the planning committee and all subcommittees are busy completing the final touches. The education committee has pulled together a fantastic program, which kicks off with keynote speaker Tony Dagnone, retired president and CEO of London Health Sciences Centre. Response to the conference has been tremendous. The trade show floor sold out early so the planning committee is looking at options to add mores booths to accommodate the growing wait-list of vendors. The B.C. Chapter is very excited to host this year’s event in an amazing facility, the Vancouver Convention Centre, while showcasing the world-class city. The B.C. Chapter has opened up a sponsorship for the online medical gas course, and is once again hoping to see more requests for the $1,000 member education bursary. In addition, the chapter will cover costs for its members to attend CHES webinars. 2016 is an election year for the B.C. Chapter. All executive positions are open. Nominations have been submitted for the chair, vice-chair, secretary and treasurer positions. —Steve McEwan, British Columbia Chapter chair

MANITOBA CHAPTER April 19 was a historic day in Manitoba. The Progressive Conservative party won a massive majority in the provincial election, ending nearly 17 years of NDP government. Since then, the new PC government has allocated an additional $300 million to what’s now known as Manitoba Health, Seniors and Active Living, increasing its budget to $6 billion from $5.7 billion. Hopefully we see more dollars earmarked for capital projects and healthcare operations over the next few years. The CHES Manitoba 2016 Education Day was a huge success. The well-attended event was held April 28, at the Canad Inns Destination Centre Polo Park in Winnipeg. Sessions were based around the theme, ‘Energy Savings: Building on Past Success.’ Topics covered various energy tracking and benchmarking methods and means, and ways to make electrical and mechanical systems more energy-efficient. Next year’s education day has already been scheduled for April 27. It will take place at the same venue as the 2016 event. The new chapter executive was elected at the annual general meeting, which was held in conjunction with the education day. It includes: Reynold J. Peters (chair); Tom Still (vice-chair); Stephen Cumpsty (secretary); and James Kim (treasurer). The Manitoba Chapter will once again sponsor an education session at the Manitoba Building Expo, Oct 4. Members who register for the event through the chapter will be able to attend both the trade show and sponsored session for free. I’d like to congratulate now past chapter chair, Craig Doerksen, on achieving the Canadian Certified Healthcare Facility Manager (CCHFM) designation, after successfully passing the exam. For more information on the CCHFM certification program, go to the CHES website. —Reynold J. Peters, Manitoba Chapter chair


ALBERTA CHAPTER The wildfires in Fort McMurray/Wood Buffalo have created yet another challenge for the province and the region’s healthcare engineering teams. Lessons learned and processes created from the 2011 fires in Slave Lake, helped in developing a plan to mobilize teams and get the restoration of affected facilities on track the minute staff were allowed back onsite. I can’t begin to imagine the extra effort and countless hours staff put in throughout the ordeal, much of which will never be documented or recognized. On behalf of the Alberta Chapter, I’d like to express my sincere appreciation and thanks. The Alberta Chapter has decided it will not host the Clarence White Conference & Trade Show this year, as it is moving the annual event from fall to spring. The 2017 conference will take place in Red Deer. As an alternative to the yearly conference, the chapter is looking at hosting a couple training days/fairs in fall. Details to follow. —Tom Howard, Alberta Chapter chair

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OPERATION CRITICAL Sunnybrook increases resiliency with emergency power generating plant renewal project By Philip Chow & Michael McRitchie




mergency power systems are a lifeline for healthcare facilities. These plants provide an independent source of electricity to support vital systems on loss of normal power supply — a more likely occurrence today, given the increase in extreme weather events. It’s no wonder then that facility managers are concerned when this all-important electrical equipment needs to be upgraded. They’re faced with the challenge of replacing the critical infrastructure while minimizing service disruptions and maintaining an operational means of backup power. This is what Sunnybrook Health Sciences Centre faced when it undertook a project to replace its existing emergency power generating plant in its entirety.


Sunnybrook is a full-service, 1,100 patient bed hospital in mid-town Toronto. With an aggregate campus area of approximately 3 million square feet, it is the largest regional trauma centre and maternity hospital in the country, boasting 1.2 million patient visits each year. The hospital relies on its central utility plant to distribute emergency (backup) power, and heating and cooling services across its campus. Sunnybrook’s emergency power network is divided into two stand-alone systems: a 4,160 volt (V) generation/distribution system, which provides power to approximately 20 electrical substations throughout the campus, and a 600 V generation/

distribution system, which provides power to the hospital’s central utility plant and, in turn, powers ancillary systems that serve the 4,160 V system. With existing infrastructure dating back to the ‘70s and approaching end of life conditions, Sunnybrook recognized the urgent need to replace its existing diesel generator plant. OVERCOMING OBSTACLES

The infrastructure renewal project was constrained to building within the footprint of the existing central utility plant; constructing new space was not an option. Key design criteria included replacing obsolete equipment, increasing available capacity of emergency power systems and providing opportunities for reducing annual operating costs. SUMMER/ÉTÉ 2016 15


s LEFT TO RIGHT: Interior view of

Sunnybrook's existing generator plant. Four new 2 MW - 4,160 V and one new 750 kW - 600 V diesel generators were installed. The existing generator plant was dismantled in two phases and the new plant constructed in two phases.

s LEFT TO RIGHT: New 4,160 V distribution switchgear for the emergency power distribution system was installed. Exterior of new generating plant near completion.

Creating a construction phasing and sequence plan that facilitated infrastructure renewal and implementation of design requirements, while maintaining reliable emergency power to the hospital was a significant challenge. After performing a detailed site review, it was determined that an upgrade project could be completed in two phases. During the first phase, a portion of the existing generator paralleling switchgear could be removed to facilitate the removal of three existing generators and associated infrastructure. This would clear up physical space in the existing plant and allow for half of the existing building to undergo structural upgrades and general trades work to accommodate larger replacement generators. In Phase 2, the remaining three existing generators and paralleling switchgear would be replaced. This would free up the other half of the existing building to undergo structural modifications to ready the space for larger replacement generators. To maintain a reliable emergency power supply to critical processes throughout the campus, a number of temporary provisions and enabling works would be required. As the existing generator capacity would be diminished with the removal of generators under the first phase of the project, a 16 CANADIAN HEALTHCARE FACILITIES

temporary portable generator would be needed to supplement generating capacity, and existing 4.16 kilovolt (kV) campus distribution circuits would have to be temporarily powered from the portable generator. This would result in the need to provide temporary 4.16 kV switchgear complete with automatic transfer functionality, provisions to receive incoming utility power and power from the portable generator, and provisions to feed distribution circuits that would be affected by phased construction. Additionally, since the incoming fuel oil supply to the generator plant would be upgraded, the portion of the existing generator plant (which remained operational under the first phase of the project) would require a temporary fuel oil supply while the main fuel oil system was upgraded. To facilitate construction, a temporary fuel supply line, complete with its own independent valving arrangement, wo u l d r u n f ro m S u n ny b ro o k ’s independent heating oil supply. PLAN OF ACTION

After creating a project concept that enabled constructability and established design goals, the next challenge was implementing the design. Since the

majority of the new equipment associated with the emergency power system would have interrelated functions, it was determined that one supplier would provide the major equipment and assume responsibility for coordinating with associated sub-suppliers. Detailed engineered drawings and specifications were prepared for an equipment package that consisted of four 2 megawatt (MW) - 4.16 kV generators, one 750 kW - 600 V generator, paralleling and synchronization controls, 4.16 kV automatic transfer and distribution switchgear, a diesel emissions reduction system (DERS) for each generator and a new load management system. The engineered drawings and specifications were posted publically as part of a request for proposal (RFP) for the equipment supply package. The RFP process was instrumental in giving Sunnybrook’s plant operations and corporate planning groups direct input into the generator supplier selection process and ensured competitive pricing that conformed to the hospital’s quality, reliability and serviceability requirements. The equipment package was awarded to Toromont CAT. Following selection of the equipment package, construction of the new generating plant and equipment

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Your social media starting point By Steven Chester Perhaps you’ve finally decided that “now’s the time” to get started on social, or maybe you’re cringing at the thought of logging in to your Twitter account that hasn’t been touched in months. If this is the place you’re in, it’s time to reassess what your social media goals are and get yourself to your social media starting point. Your goals could be just one or all of the below. In the case of the latter, take the time to rank the order of importance of each. • Building your brand: Are you looking to develop new relationships? Then it’s time to listen to what others are saying, craft messages designed to inform, entertain and captivate your audience. • Increasing website traffic: Have great content to share? Craft some meaningful messages to drive traffic to your content pages. • Customer support and outreach: Your customer demographic is changing, and so are their communication needs. You’ll need a space to answer questions and gather feedback for your company. • Sales leads: Yes, you can sell on social. In fact, if you’re not doing it, your competitor more than likely has the jump on you. LinkedIn, for example, is an incredible way to gather contacts and expand your reach through secondary connections. Next up, we’ll talk about outreach. Hint: You’re nowhere near ready to craft that first post.

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installation was tendered to a group of pre-qualified contractors. Given the substantial scope of electrical work associated with the project, the successful electrical contractor would assume the role of the prime contractor and be responsible for coordinating other trades on the project, as well as procuring and installing the pre-selected equipment package. The project was awarded to Ontario Electrical Construction Co. Ltd. The preliminary enabling works were completed, and the temporary switchgear and rental generator were installed in Phase 1. With Sunnybrook’s critical loads supported by temporary infrastructure, half of the existing generator plant was decommissioned and existing equipment removed from the site. The existing floor slab was removed and a new one poured, complete with structurally reinforced bases for the new generator sets. The building’s structure was reinforced and structural steel installed for an air intake plenum expansion and exhaust plenum expansion. While construction was progressing on-site, major equipment items were being manufactured and undergoing rigorous factory acceptance testing procedures. The entire emergency power system lineup (generators, switchgear and control panels) was shipped to an off-site testing facility and assembled to undergo integrated system testing, which included testing automatic transfer functions, paralleling and system controls with portable load banks. This process helped identify operational issues before the equipment was shipped to the site. Once installed on-site, it was subjected to additional pre-service evaluation to test the site-specific installation. Final functional testing was successfully performed with Sunnybrook’s critical loads and the first phase of the installation was placed into service. The process was repeated for Phase 2 of the project.

4 regulations, lowering pollutants levels, such as nitrogen oxide, by as much as 95 per cent. DERS modules consist of a particulate filter, selective catalytic reduction system, sound attenuation system (deleting the requirement for a separate muffler) and a dosing system, whereby an external supply of urea, water and compressed air is injected into the exhaust stream to catalyze the nitrous oxide emissions. The new 4.16 kV switchgear and automatic transfer controls are equipped with closed-transition transfer logic, enabling the distribution system to momentarily parallel utility power with generator power. This mode of operation is important in reducing disruption to hospital operations during weekly generator tests (a requirement for healthcare facilities noted in CSA standards C282, Emergency Electrical Power Supply for Buildings, and Z32, Electrical Safety and Essential Electrical Systems in Health Care Facilities). By incorporating both of these innovative design features into the project, Sunnybrook has the capability to utilize its standby generators to offset electrical demand load from the utility grid during peak conditions and reduce its global adjustment costs (a utility charge that is levied to large facilities in Ontario, with a peak electrical demand load in excess of 5 MW during peak electrical demand conditions). Closed-transition transfer controls allow Sunnybrook to transfer hospital loads to generator power seamlessly, and emissions reduction technology enable Sunnybrook to power hospital loads from generator power during non-emergency conditions. By displacing hospital loads for approximately 60 hours or more during summer months, Sunnybrook’s plant operations group anticipates a significant reduction in utility costs.


Philip Chow, P.Eng., is a senior project manager at H.H. Angus & Associates Ltd. He specializes in electrical solutions for critical applications and was the lead electrical engineer on Sunnybrook’s generator plant renewal project. Michael McRitchie is director of plant operations, maintenance, security and biomedical engineering at Sunnybrook Health Sciences Centre. They can be reached at and, respectively.

Undertaking infrastructure renewal allowed for a number of innovative features to be included with the equipment upgrades. Each of the new diesel generators is equipped with a diesel emissions reduction system (DERS). This has reduced emissions from the standard U.S. Environmental Protection Agency Tier 2 levels to the more stringent Tier

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OPPORTUNITY KNOCKS Timing right for St. Boniface Hospital to improve central chiller plant By Steve Tiede


ocated at the fork of the Red and Assiniboine Rivers in downtown Winnipeg, St. Boniface Hospital is the second-largest healthcare facility in Manitoba. Two years ago, senior management was faced with the unenviable task of deciding what to do about the hospital’s chiller plant, which provides cooling to the 1.3 million-square-foot, seven building campus. With the Ozone Depleting Substances Act’s ban on the use of machines charged with CFC-11 to take effect Dec. 31, 2014, and two chillers from the original energy centre (built in 1986) still utilizing the chlorofluorocarbon, the choice was to either purchase and install new compliant chillers


or convert existing ones to HCFC-123 refrigerant. Through consultation with Southampton Trane of Winnipeg, the decision was made to convert the last two of the hospital’s four 1,000-tonne machines to compliant HCFC-123 refrigerant (the others were already in compliance). The conversion came with a downside, though. The chillers would go from a combined 2,000 tonnes of refrigerating capacity to 1,920 tonnes. But considering the cost of rebuilding the units to meet compliance would be a fraction of the cost of new replacement, this option far outweighed the negative impact of the slight reduction in capacity.


The conversion of a 1,000-tonne machine is not simply a matter of evacuating the old refrigerant and charging it with new fluid. Since the machines are operated at a lower design pressure and the refrigerant comes into contact with the hermetically sealed windings of the motor, they must be fully compatible with the HCFC-123 refrigerant. This means the motor must be completely remanufactured to meet or exceed OEM (original equipment manufacturer) tolerances. To complement the rebuilt motors, new medium voltage starters with surge and ground fault protection systems were installed.

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WHAT’S MOST EXCITING IS THE POTENTIAL FOR THE CHILLER-CONTROLLER TECHNOLOGY TO EASE THE OPERATION AND OVERALL EFFICIENCY OF THE CHILLED WATER SYSTEM AS A WHOLE. The compressor section was also completely disassembled and the impellors resized for optimized performance, providing the required capacity and maximum efficiency. HCFC-123 compatible orifice plates, gaskets and seals were replaced, too. The replacement of the purge system has provided a highly efficient separation system that removes air, moisture and noncondensables that rob a chiller of the ability to run efficiently. To be fully code compliant, a HCFC-123 leak detection and alarming system was installed. The device sounds an alarm when the slightest amount of refrigerant is released from the machine. It also activates the exhaust fan and shuts down any compressors that are running. OPTIMIZING EFFICIENCY

The chiller conversion project presented the opportunity to incorporate monitoring and

control advancements that were not available when the machines were originally installed 30 years ago. These system upgrades allow engineers to monitor outputs at the machine itself as well as control other functional yet vital parts of the hospital’s chilled water system (beyond the chillers from the energy centre control room). This includes the main chilled water distribution pumps, which are driven by 300 horsepower variable speed drive (VSD) motors, and four cooling towers comprised of a total of eight fans (two of which are VSD, with the remaining dual speed control). As well, now that all the machines ‘talk’ to one another, the hospital can consolidate operations, which will improve efficiency. But perhaps what’s most exciting is the potential for the chiller-controller technology to ease the operation and overall efficiency of the chilled water system as a whole. Future advancements will allow for the integration of

complex logarithms that take into account outside air conditions, hospital cooling load requirements as well as chiller and condenser loading. Also, with two chillers already capable of ‘free cooling’ — chilling water to a higher set point without utilizing the compressor — the controller will be able to tell the engineer when this mode should be initiated for greatest efficiency or when mechanical cooling needs to be started to maintain the quality of conditioned air in the hospital. Low-pressure centrifugal chillers operate most efficiently at 80 per cent load or above. The control system can also be programmed to start and stop machines based on this, thus avoiding having chillers operating virtually unloaded and inefficiently when not required. There is also the potential to put the chilled water system onto a virtual server alongside other building operating systems that control not just cooling, but also the heating system and its auxiliaries, as well as the various HVAC units situated around the hospital. Steve Tiede is a first class power engineer and currently the energy centre manager at St. Boniface Hospital in Winnipeg.

WISER WASHING UPDATE It’s been more than two years since a water recycling system was installed at the Nova Scotia Hospital central laundry facility to reduce the amount of water and steam required in the laundry process. The system was designed to filter and sterilize wastewater produced by a row of five washer-extractors during normal operation. The water is kept at a relatively high temperature throughout the laundry process to minimize the amount of steam needed to complete the cycle. Over the first six months of operation, a 77 per cent reduction in water use by the washer-extractors was reported, resulting in approximately $13,500 in monthly savings (for both steam and water). Unfortunately, at the time the Canadian Healthcare Facilities article on the capital project was published (Winter 2014/2015), it was difficult to project annual savings. Now, with the system in operation since spring 2014, more accurate cost and usage data is available. For the period May 2014 to December 2015 (20 months), total savings have been calculated as $351,000, or an average of $16,700 per month. Calculations were made using temperature and flow data from the system, and monthly natural gas and water prices from the respective utilities. Greater savings are attributed to the slightly increased water recycling rate of 79 per cent, and higher than expected natural gas prices over the reporting period. Overall, total water usage at the facility has been reduced by approximately 70 per cent since spring 2014, part of which is owing to reduced laundry throughput. With all the success, there has been a slight bump in the road. Operation of the system has been complicated by the high noise levels produced by the lint shaker and some minor leaks caused by thermal expansion and contraction in the piping. However, these issues have been addressed satisfactorily. —David Bligh, onsite energy manager, Efficiency Nova Scotia


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Objectives: Objectives: 1.

Understand 1. Understand in medical in medical terms terms the definition the definition of andofother and other areas areas wherewhere it is impractical it is impractical to move to move a a patientpatient in an emergency in an emergency as defined as defined by a specific by a specific CASECASE study study of BC of Childrens BC Childrens and Womens and Womens Hospital Hospital



Be 2. able Be to ableaccess to access the high-rise the high-rise hospital hospital code code requirements requirements for your for facilities your facilities i.e. horizontal i.e. horizontal relocations relocations areas.areas.

09:00-14:00 09:00-14:00 The Great The Great CHESCHES Golf Game Golf Game – Sponsored – Sponsored by Williams by Williams Engineering Engineering Canada Canada - (Bus- (Bus 3. time totime be determined) to be determined) 18:30-21:00 18:30-21:00 Opening Opening Reception Reception – Sponsored – Sponsored by Class by Class 1 Inc. 1 Inc. East Meeting East Meeting RoomsRooms 1-2, Foyer 1-2, Foyer s, Vancouver s, Vancouver Convention Convention CentreCentre Reception Reception Entertainment Entertainment - Sponsored - Sponsored by E.B.byHorsman E.B. Horsman and Son and Son

Understand 3. Understand high-rise high-rise smokesmoke controlcontrol requirements. requirements. Be able Be toable determine to determine systemsystem approaches approaches and and strategies strategies to successfully to successfully implementing implementing smokesmoke controlcontrol systems. systems.

12:00-13:00 12:00-13:00 2 CONCURRENT 2 CONCURRENT TRACKS TRACKS - 3A &- 3A 3B & 3B Track Track 3A: 3A: OPROPR TEAM TEAM – a presentation – a presentation by Fraserhealth by Fraserhealth Lower Lower Mainland Mainland Facilities Facilities Management Management - Sponsored - Sponsored by SNC-Lavalin by SNC-Lavalin


Maureen Maureen Haddock, Haddock, Capital Capital Project Project Planner, Planner, Fraser Fraser Health, Health, Vancouver Vancouver BC BC

07:00-08:30 07:00-08:30 Breakfast Breakfast – Sponsored – Sponsored by Thomson by Thomson PowerPower Technology Technology

Rob Rob Kolen, Kolen, Project Project Manager, Manager, Fraser Fraser Health, Health, Vancouver Vancouver BC BC

08:30-08:45 08:30-08:45 Opening Opening Ceremonies Ceremonies

Larry Larry Harder, Harder, Director, Director, Capital Capital Projects, Projects, Fraser Fraser Health, Health, Vancouver Vancouver BC BC

08:45-09:30 08:45-09:30 KEYNOTE KEYNOTE ADDRESS ADDRESS - Sponsored - Sponsored by Honeywell by Honeywell

Tony Tony Dagnone, Dagnone, C.M,C.M, RetiredRetired President President and CEO, and CEO, London London HealthHealth Sciences Sciences CentreCentre The Owners The Owners ProjectProject Requirements Requirements is a process is a process in which in which the owner the owner gathers gathers information information clarifying clarifying the the As a graduate As a graduate of both of University both University of Saskatchewan of Saskatchewan and University and University of Toronto, of Toronto, Tony Dagnone Tony Dagnone has more has morespecific specific functional functional characteristics characteristics of theofbuilt the environment built environment to support to support the clinical the clinical program program and building and building than 38 than years 38 years experience experience in the in Health the Health Care sector, Care sector, 25 of25 which of which have been have as been Chief as Chief Executive Executive OfficerOfficer of ofoperations. operations. The statements The statements are primarily are primarily performance performance basedbased ratherrather than prescriptive than prescriptive to inform to inform projectproject academic academic hospitals. hospitals. After spending After spending more more than two thandecades two decades at Royal at Royal University University Ho spital Ho spital in Saskatoon, in Saskatoon,consultants consultants responsible responsible for thefordesign the design and toand support to support innovation. innovation. Time lines Time can linesbecan optimized be optimized and multi and multi Saskatchewan, Saskatchewan, Mr. Dagnone Mr. Dagnone was appointed was appointed in 1992 in 1992 as theasPresident the President and CEO andofCEO University of University Hospital, Hospital,stakeholder stakeholder conversations conversations can result can result in conflict in conflict identification identification and resolution and resolution in a timely in a timely fashion. fashion. London London Ontario. Ontario. In 1995, In 1995, University University Hospital Hospital merged merged with Victoria with Victoria Hospital Hospital and became and became the London the LondonObjectives: Objectives: HealthHealth Sciences Sciences CentreCentre (LHSC) (LHSC) and Mr. andDagnone Mr. Dagnone was appointed was appointed President President and CEO. and CEO. 1. Understand 1. Understand the Owner’s the Owner’s ProjectProject Requirement Requirement process. process. His career His career achievements achievements include include the visioning, the visioning, planning planning and redevelopment and redevelopment of overof$500 over $500 millionmillion of newof new 2. Understand 2. Understand the deliverables the deliverables resulting resulting from the fromOPR theprocess. OPR process. healthcare healthcare facilities. facilities. In 2009, In 2009, he was he appointed was appointed as Independent as Independent Commissioner Commissioner by thebySaskatchewan the Saskatchewan government government to conduct to conduct a Province a Province wide Patient wide Patient First Review. First Review.


Identify 3. Identify how current how current gaps in gaps standard in standard projectproject delivery delivery models models are addressed. are addressed.

4. Describe advantages advantages to the tostakeholders the stakeholders (includi (includi ng FMO) ng FMO) and the andconsultants. the consultants. Over the Overyears the years he hasheheld has aheld number a number of leadership of leadership and Board and Board positions positions at the atprovincial, the provincial, national national and and4. Describe international international level. level. Mr. Dagnone Mr. Dagnone is pastis Chair past Chair of theofOntario the Ontario Hospital Hospital Association, Association, past Chair past Chair of theof the5. Describe 5. Describe the advantages the advantages when when used in used alternate in alternate procurement procurement strategies strategies such as such Design/Build, as Design/Build, P3 P3 Canadian Canadian College College of Health of Health Service Service Executives, Executives, past Chair past Chair of theofChange the Change Foundation. Foundation. Between Between 1985 1985 and IPD and(Integrated IPD (Integrated ProjectProject Development). Development). and 1989, and 1989, he served he served as Chair as Chair of the ofCanada the Canada GamesGames held inheld Saskatoon. in Saskatoon. Track Track 3B: 3B: Infrastructure Infrastructure Assessments Assessments - Navigating - Navigating the Risk the Risk In 1991, In 1991, he washegranted was granted the Order the Order of Canada of Canada for hisforwork his in work theincommunity the community and leadership and leadership in health in health Kevin Kevin Cassidy, Cassidy, BEng, BEng, PEng, PEng, Manager-Electrical Manager-Electrical Engineering, Engineering, care. care. In 2005, In 2005, Mr. Dagnone Mr. Dagnone was the wasrecipient the recipient of theofCanadian the Canadian College College of Heath of Heath Service Service Executives Executives Partner, Partner, MMM MMM Group Group Limited, Limited, Toronto Toronto ON ON (CCHSE) (CCHSE) Distinguished Distinguished Service Service AwardAward as a testament as a testament to histoextraordinary his extraordinary contributions contributions to health to health care care Ron Ron Saporta, Saporta, Executive Executive Director, Director, Redevelopment Redevelopment & Support & Support managei:nent. managei:nent. He is He a Fellow is a Fellow of theofCanadian the Canadian College College of Health of Health Service Service Executives Executives and a and Fellow a Fellow of theof the Services, Services, Baycrest Baycrest Centre, Centre, Toronto Toronto ON ON American American College College of Healthcare of Healthcare Executives. Executives. In 2009 In he 2009 washeawarded was awarded the Regents the Regents AwardAward by theby American the American our neglected hospital hospital infrastructure infrastructure continues continues to age, to we age,areweoften are often presented presented with awith needa need for for College College of Healthcare of Healthcare Executives. Executives. In London, In London, his community his community volunteer volunteer work has workincluded has included UnitedUnited Way WayAs ourAsneglected renewal that far thatoutweighs far outweighs our available our available resources. resources. This session This session will present will present a casea study case study of theof the Cabinet Cabinet for twoforcampaigns, two campaigns, Honorary Honorary Chair Chair 2001 2001 Canada Canada Games, Games, and Founding and Founding BoardBoard member member of theof therenewal strategies employed employed at Baycrest at Baycrest hospital hospital to prioritize to prioritize their approach their approach to infrastructure to infrastructure renewal renewal through through a a Canadian Canadian Medical Medical Hall ofHall Fame. of Fame. He frequently He frequently presides presides over Citizenship over Citizenship Court Court ceremonies ceremonies in Southwest in Southweststrategies comprehensive comprehensive risk management risk management framework. framework. Ontario. Ontario. 09:30-10:30 09:30-10:30 PLENARY PLENARY SESSION SESSION - TRACK - TRACK 1 1 Track Track 1: 1: Healthcare Healthcare Sustainability: Sustainability: Designing Designing for Wellness for Wellness Marco Marco Buccini, Buccini, Architect Architect AIBC, AIBC, President, President, MB Architecture MB Architecture Inc. Inc.

Objectives: Objectives: 1.

Analyze 1. Analyze existing existing building building infrastructure infrastructure and identify and identify renewal renewal needsneeds


Apply 2. Apply a risk amanagement risk management framework framework to prioritize to prioritize infrastructure infrastructure investments investments

3. Translate facilityfacility capitalcapital needsneeds into a into language a language that C-level that C-level and board and board members members understand understand This session This session will look will beyond look beyond designing designing green green and sustainable and sustainable buildings buildings and explore and explore how conscious how conscious3. Translate 13:00-14:00 Lunch Lunch in Exhibit in Exhibit Hall Hall - Sponsored - Sponsored by Klenzoid by Klenzoid Canada Canada Inc. Inc. designdesign decisions decisions can influence can influence the determinants the determinants of an individual’s of an individual’s and community’s and community’s health,health, whichwhich in turnin turn13:00-14:00 keepskeeps us healthier, us healthier, thus allowing thus allowing the universal the universal healthhealth systemsystem to sustain to sustain itself and itselfthrive and thrive with the with emphasis the emphasis13:00-15:00 13:00-15:00 Exhibit Exhibit Hall Hall Open Open on prevention, on prevention, not cure. not cure. 15:00-16:00 15:00-16:00 2 CONCURRENT 2 CONCURRENT TRACKS TRACKS - 4A &- 4A 4B & 4B 10:30-11:00 10:30-11:00 Refreshment Refreshment Break Break in Exhibit in Exhibit Hall Hall – Sponsored – Sponsored by Cullen by Cullen DieselDiesel PowerPower 11:00-12:00 11:00-12:00 2 CONCURRENT 2 CONCURRENT TRACKS TRACKS - 2A &- 2A 2B & 2B

Track Track 4A: 4A: Emergency Emergency Generators: Generators: Undertaking Undertaking critical critical power power upgrades upgrades without without compromising compromising back-up back-up power power

Track Track 2A: 2A: Bottoms Bottoms Up Planning: Up Planning: The The way way LEAN LEAN methodology methodology transforms transforms patient patient carecare – Sponsored – Sponsored by Fortis by Fortis BC BC

Philip Philip Chow, Chow, PEng, PEng, P.E.,P.E., Senior Senior Project Project Manager Manager and Electrical and Electrical Engineer, Engineer, H.H.H.H. Angus Angus & Associates & Associates Ltd., Ltd., Toronto Toronto ON ON

PaulPaul Blazer, Blazer, President, President, Principal Principal Architect, Architect, LEAN LEAN Integrated, Integrated, Saskatoon Saskatoon SK SK

Michael Michael McRitchie, McRitchie, CFM,CFM, CCHFM, CCHFM, CHPA, CHPA, Director Director of Plant of Plant Operations, Operations, Maintenance, Maintenance, Security Security & Biomedical & Biomedical Engineering, Engineering, Sunnybrook Sunnybrook Health Health Sciences Sciences Centre, Centre, Toronto Toronto ON ON

Cecile Cecile Hunt, Hunt, President President & CEO, & CEO, Prince Prince Albert Albert Parkland Parkland Health Health Region, Region, Prince Prince Albert Albert SK SK

With aWith centralized a centralized dieseldiesel generator generator plant dating plant dating back toback the to 1970s the 1970s and approaching and approaching end ofend life of conditions, life conditions, Sunnybrook Sunnybrook HealthHealth Sciences Sciences CentreCentre was faced was faced with the with challenge the challenge of undertaking of undertaking a project a project to replace to replace their their existing existing generating generating plant itplant its entirety. it its entirety. This presentation This presentation will discuss will discuss the challenges the challenges faced faced by thebyproject the project Since Since 2011,2011, Saskatchewan Saskatchewan has committed has committed to continuous to continuous Improvement Improvement through through the Saskatchewan the Saskatchewan team including: team including: creating creating a schedule a schedule to meet to provincial meet provincial funding funding requirements, requirements, managing managing risk throughout risk throughout Healthcare Healthcare Management Management System System using using LEAN LEAN Methodology. Methodology. Among Among the many the many storiesstories of improvement, of improvement, the the the project the project and building and building withinwithin the footprint the footprint of theofexisting the existing dieseldiesel plant, plant, while while ensuring ensuring criticalcritical powerpower to to planning planning of the ofnew theregional new regional hospital hospital for Prince for Prince AlbertAlbert standsstands out asout an as exemplary an exemplary modelmodel for integrating for integrating the campus the campus was not wasinterrupted. not interrupted. hospital hospital planning planning aroundaround real improvements real improvements to patient to patient care. Data care.isData collected, is collected, processes processes are planned, are planned, and and Objectives: the design the design of the of hospital the hospital emerges emerges aroundaround the new theway newtoway caretofor care patients. for patients. The process The process is fullyisintegrated, fully integrated,Objectives: MikeMike Weishaar, Weishaar, CEO,CEO, LEAN LEAN Integrated, Integrated, Saskatoon, Saskatoon, SK SK

with the withpatient the patient at the atcentre. the centre.


Understand 1. Understand how ahow complicated a complicated infrastructure infrastructure renewal renewal projectproject can becan undertaken. be undertaken.

Objectives: Objectives:


Identify 2. Identify planning planning opportunities opportunities for operational for operational savings savings when when undertaking undertaking a project. a project.


Learn 1. Learn how tohow bridge to bridge hospital hospital designdesign from planning from planning to operations to operations


Mitigate 3. Mitigate risk torisk operations to operations when when undertaking undertaking a critical a critical powerpower project. project.


Learn, 2. Learn, Innovate, Innovate, Test and TestAdapt and Adapt healthcare healthcare planning planning in an in iterative an iterative process process that keeps that keeps patientpatient care care4. Structure 4. Structure a project a project schedule schedule that meets that meets funding funding requirements. requirements. as theascore theoutcome core outcome Track Track 4B: 4B: RiskRisk Reduction Reduction - Collaborative - Collaborative Planning Planning and and Design Design


Prove 3. Prove planned planned innovations innovations in careinbefore care before the new thefacility new facility is builtis built

Track Track 2B: 2B: Addressing Addressing Various Various Clinical Clinical Patient Patient Safety Safety Needs Needs in High in High RiseRise Hospital Hospital Design Design - Sponsored - Sponsored by Reliance by Reliance Worldwide Worldwide Corporation Corporation

Tracey Tracey Graham, Graham, MN, MN, MBM, MBM, Senior Senior Associate, Associate, Stantec, Stantec, Winchester Winchester VA VA

PaulPaul Anseeuw, Anseeuw, BSc,BSc, PEng, PEng, Principal, Principal, AMEAME Group, Group, Vancouver Vancouver BC BC

Berry Berry Brunk, Brunk, Senior Senior Consultant-Information Consultant-Information Technology, Technology, Stantec, Stantec, Seattle Seattle WA WA

Kevin Kevin Zembik, Zembik, AScT, AScT, Project Project Manager, Manager, Construction, Construction, BC Childrens BC Childrens and and BC Womens BC Womens Redevelopment Redevelopment Project, Project, Vancouver Vancouver BC BC

JeanJean Molina, Molina, Business Business Sector Sector Leader Leader Engineering Engineering and Healthcare, and Healthcare, Stantec, Stantec, Longueuil, Longueuil, QC QC

Clinical Clinical PatientPatient needsneeds are identified are identified in the in CSA thestandards CSA standards but intent but intent is not isoften not understood often understood or addressed or addressed“Healthcare “Healthcare Sustainability Sustainability Best Practices Best Practices for theforFuture” the Future” describing describing opportunities opportunities for sustainability for sustainability in high-rise in high-rise hospital hospital design. design. The clinical The clinical definition definition of Patient of Patient Population Population Classification Classification for Mobility for Mobility is isthrough through client client support, support, operational operational planning planning and improvements and improvements in technology, in technology, infrastructure infrastructure upgrades upgrades and energy and energy management. management. the key. the key.

Objectives: Objectives:

Objectives: Objectives:


Offer 1. tools Offer / checklist tools / checklist for assessment, for assessment, continuity continuity planningplanning and ways and to ways mitigate to mitigate risk (building, risk (building, site, site, 1. IT and Operations) IT and Operations) 2.


Methodology 2. Methodology for assessing for assessing energy efficiency energy efficiency and creating and creating solutions solutions for the future for the future

Overview 1. Overview of the Design of the Guidelines Design Guidelines Putting 2. Putting the Guidelines the Guidelines to work to inside workand inside outside and outside

3. Putting 3. Putting the Guidelines the Guidelines to work to high work riskhigh areas, riskBehavioral/Mental areas, Behavioral/Mental Health Emergency Health Emergency Departments Departments 3. Review 3. technology Review technology system life system cycles lifeand cycles provide and provide ways to ways achieve to achieve a long-lived, a long-lived, flexible,flexible, scalablescalable set set 4. Consider 4. Consider healthcare healthcare facility design facility and design its impact and its on impact security on security and safety and safety of technology of technology systems,systems, including including equipment, equipment, and infrastructure. and infrastructure. TRACK TRACK 6B: 6B: Critical Critical Factors Factors in thein Design the Design & Maintenance & Maintenance of Enviromental of Enviromental 4. Assist 4. participants Assist participants in planning in planning for systems for systems and supporting and supporting structures structures which are which easily areapplied easily applied to to Rooms Rooms in Healthcare: in Healthcare: aka How akato How keep to cold keeprooms cold rooms cold cold future requirements, future requirements, technology technology demands, demands, structural structural additions additions and modification and modification with minimal with minimal “site- “siteJeff Mumford, Jeff Mumford, Vice President, Vice President, Labworks Labworks International International Inc., Vaughan Inc., Vaughan ON ON adapt”.(planned adapt”.(planned and unplanned). and unplanned). ModernModern Healthcare Healthcare Institutions Institutions have been havedesigned been designed to provide to provide continuous continuous operation operation in the event in theofevent of 16:00-17:00 16:00-17:00 “Happy “Happy Hour”Hour” in Exhibit in Exhibit Hall - Sponsored Hall - Sponsored by Traneby Trane emergencies, emergencies, disasters, disasters, and unexpected and unexpected interruptions. interruptions. Within Within Hospitals, Hospitals, Environmentally Environmentally controlled controlled 18:00-19:00 18:00-19:00 President’s President’s Reception Reception - Sponsored - Sponsored by Tremco by Tremco rooms represent rooms represent one of the onemost of the critical most areas criticalofareas concern, of concern, as in many as incases manythere cases is there no ability is notoability shut the to shut the area down, areaand down, the and product the product most often most requires often requires the cooling the cooling to be continuous. to be continuous. This presentation This presentation uncoversuncovers East Ballroom East Ballroom AB, Vancouver AB, Vancouver Convention Convention Centre Centre the mostthecommon most common ‘Achilles‘Achilles heals’ found heals’infound the operation in the operation of cold ofrooms cold and rooms provides and provides ‘best practice’ ‘best practice’ 19:00-23:00 19:00-23:00 Gala Banquet Gala Banquet - Sponsored - Sponsored by Johnson by Johnson ControlsControls solutions solutions to thosetochallenges those challenges in the event in theofevent a lossofofa service. loss of service. Banquet Banquet Entertainment Entertainment – Darcy – Darcy Michael Michael - Sponsored - Sponsored by ChembyAqua Chem Aqua Objectives: Objectives: Participants Participants will: will: East Ballroom East Ballroom AB, Vancouver AB, Vancouver Convention Convention Centre Centre 1. Be1.provided Be provided an assessment an assessment criteria to criteria determine to determine what areas whatofareas risk exist of risk in exist their facility. in their facility.



Understand 2. Understand the options the options that are that available are available to address to address areas ofareas concern, of concern, and resources and resources to do do so.

07:00-08:30 07:00-08:30 Breakfast Breakfast – Sponsored – Sponsored by Stantec by Stantec


Learn 3. from Learn previous from previous experiences experiences at other atinstitutions other institutions the pitfalls the and pitfalls opportunities and opportunities as they relate as theytorelate to critical environmental critical environmental rooms. rooms.


Understand 4. Understand what thewhat latesttheapproaches latest approaches are to addressing are to addressing these concerns these concerns in new installations. in new installations.

08:30-09:30 08:30-09:30 2 CONCURRENT 2 CONCURRENT TRACKS TRACKS - 5A & 5B - 5A & 5B TRACK TRACK 5A: 5A: Limiting Limiting Risk by Risk theby Decisions the Decisions You Make You Make DenisDenis Pellichero, Pellichero, PEng,PEng, PMP, CD, PMP,Manager, CD, Manager, Infrastructure Infrastructure Management, Management, Nova Scotia Nova Scotia Department Department of Transportation of Transportation and and Infrastructure Infrastructure Renewal, Renewal, HalifaxHalifax NS NS

14:15-15:15 14:15-15:15 2 CONCURRENT 2 CONCURRENT TRACKS TRACKS - 7A & 7B - 7A & 7B TRACK TRACK 7A: 7A: Sustainable Sustainable Healthcare Healthcare Design: Design: How adopting How adopting a hybrid a hybrid approach approach to LEAN to LEAN design design will benefit will benefit your project your project

DallasDallas Huard,Huard, MSAA,MSAA, MRAIC, MRAIC, A.T., Principal A.T., Principal Architect, Architect, aodbt aodbt With decisions With decisions comes risk. comes Therisk. human The mind humancan mind observe can observe and weigh andaweigh multitude a multitude of sensory of sensory information information architecture architecture + interior + interior design, design, Saskatoon Saskatoon SK SK and make anda make calculated a calculated “gut” decision “gut” decision in a fraction in a fraction of a second. of a second. It wouldIt take would hours, take day hours, or more day ortomore to have thathave person that explain person explain to stakeholders to stakeholders why theywhy made theythat made decision. that decision. This canThis be further can be complicated further complicated While aWhile full 3Pa Session full 3P Session allows for allows the most for theengagement, most engagement, the leanthe process lean process can be costly. can be By costly. adopting By adopting when a when team agathers team gathers to maketothe make same thesort same of decision sort of decision and theand riskthe is always risk is increasing. always increasing. What if What a ifaahybrida Lean hybridsession Lean session can be can morebeeconomically more economically efficientefficient in allocating in allocating resources resources and timeand fortime smallfor small scientificscientific model can model be used can be to used develop to develop guide that guide aidsthat a team aidstoa team maketoa decision. make a decision. A set of Aclear set of rules clear and rules and projectsprojects or projects or projects in smaller in smaller communities. communities. The success The success of the Lean of thesession Lean session should be should tailored be tailored to the to the objectives objectives that not that onlynot identifies only identifies the bestthe decision best decision but alsobut proves also it. proves it. specificspecific needs ofneeds the client. of the client. Objectives: Objectives:

Objectives: Objectives:


Understand 1. Understand the pit falls the pit of some falls ofcurrent some methods current methods of groupofdecision group decision making making


Learn 1. how Learn to make how toLean make Design Lean more Designefficient more efficient and sustainable. and sustainable.


Understand 2. Understand the concept the concept of evidence of evidence based decision based decision making making



Walk 3. away Walk with away an with understanding an understanding of how this of how canthis be implemented can be implemented in their organization in their organization

How 2. accelerated How accelerated version version of Lean of workshops Lean workshops can be tailored can be tailored to the project to the and project the and specific the specific needs ofneeds of the clienttheresulting client resulting in an increase in an increase in user group in userbuy-in group and buy-in a reduction and a reduction in wastein waste


How 3. money Howand money resources and resources can be used can be more used efficiently more efficiently throughthrough a hybridaversion hybrid version of the Lean of the session Lean session


The 4. importance The importance of keeping of keeping the staffthe doing staffwhat doingthey what need theytoneed do while to domaintaining while maintaining high quality high quality patient care. patient care.

TRACK TRACK 5B: 5B: Practical Practical Code Code IssuesIssues for Healthcare for Healthcare Facilities Facilities Gordon Gordon Richards, Richards, AIBC, AIBC, FRAIC, FRAIC, CP, Senior CP, Senior Consultant, Consultant, Gage Gage Babcock Babcock & Associates-a & Associates-a Jensen Jensen Hughes Hughes Consulting Consulting Canada Canada Company, Company, Vancouver Vancouver BC BC

5. Patient-Centred 5. Patient-Centred Lean Process Lean Process - How money - How can money be can savedbethrough saved through a hybrida version hybrid version of the Lean of the Lean sessionsession Randell Randell Kovacs, Kovacs, PEng,PEng, CP, FEC, CP, Senior FEC, Senior Consultant, Consultant, Gage Gage Babcock Babcock & Associates-a & Associates-a Jensen Jensen Hughes Hughes Consulting Consulting Canada Canada Company, Company, 6. Efficiency 6. Efficiency in schematic in schematic design can design savecan money save and money timeand in the timeoverall in the process. overall process. Vancouver Vancouver BC BC 7. Any 7. money Any that money canthat be saved can becan saved be put cantowards be put towards the actual theconstruction actual construction of the project. of the project. This session This session will cover willbasic coverbuilding basic building code provisions code provisions for health forcare health facilities, care facilities, updatedupdated to incorporate to incorporate 8. When 8. budget When budget cannot afford cannotaafford full Lean a fullDesign Lean Design process,process, a hybrida solution hybrid solution can be can an alternative be an alternative the 2015 the National 2015 National BuildingBuilding Code requirements. Code requirements. Topics Topics coveredcovered include include requirements requirements for firefor fire solutionsolution that willthat accomplish will accomplish the sametheresult. same result. compartmentation, compartmentation, fire alarm fireearly alarm warning early warning systemssystems and a discussion and a discussion about the about myths theofmyths pressurization of pressurization TRACK TRACK 7B: 7B: Medical Medical Air 2.0: AirManaging 2.0: Managing your risk yourasrisk a drug as a producer drug producer of compartments of compartments under fire under emergency fire emergency conditions. conditions. Sustainability Sustainability issues will issues be examined will be examined with respect with respect to to Paul Edwards, Paul Edwards, B. Com., B. Com., Vice-President-Medical Vice-President-Medical Gas, Air Gas, Liquide Air Liquide the fire and the fire life and safety lifemandatory safety mandatory requirements requirements and whatand canwhat be done can be to done incorporate to incorporate sustainable sustainable featuresfeatures Healthcare, Healthcare, Mississauga, Mississauga, ON ON of emergency of emergency Having Having spent the spent pastthe twopast years twointroducing years introducing Canadian Canadian facilitiesfacilities to the concept to the concept of Quality of Quality Control Control for for on-site on-site medicalmedical air production, air production, we nowwe have now data have to share data towith share facility with engineers, facility engineers, including including a growing a growing Understand 1. Understand basic code basic requirements code requirements governing governing patient areas patientinareas hospitals in hospitals and health andcare health facilities. care facilities. list of reported list of reported quality incidents. quality incidents. This presentation This presentation will clearly will outline clearly the outline riskstheand risks personal and personal liabilitiesliabilities 2. Understand 2. Understand and appreciate and appreciate the importance the importance of fire safety of fireplanning safety planning and staffand training. staff training. associated associated with producing with producing a therapeutic a therapeutic product,product, and provide and provide recommendations recommendations for risk mitigation. for risk mitigation. 3. Understand 3. Understand the correct the design correct issues designrelating issues relating to air movement to air movement Objectives: Objectives: 09:30-10:15 09:30-10:15 CHESCHES National National Annual Annual General General Meeting Meeting 1. Understand 1. Understand the therapeutic the therapeutic importance importance of the drug of the Medical drug Medical Air. Air. 10:15-10:45 10:15-10:45 Refreshment Refreshment BreakBreak in thein Exhibit the Exhibit Hall –Hall Sponsored – Sponsored by Daikin byApplied Daikin Applied 2. Understand 2. Understand certain physiological certain physiological consequences consequences of treating of treating patientspatients with off-spec with off-spec product.product. 10:15-10:45 10:15-10:45 CHESCHES BC Chapter BC Chapter AGM AGM 3. Understand 3. Understand the National the National and Provincial and Provincial regulations regulations pertaining pertaining to on-site to on-site production production of gaseous of gaseous 10:15-13:15 10:15-13:15 Exhibit Exhibit Hall Open Hall Open drugs. drugs. 12:15-13:15 12:15-13:15 LunchLunch in thein Exhibit the Exhibit Hall / Draw Hall / Draw PrizesPrizes - Sponsored - Sponsored by Thermogenics by Thermogenics 4. Learn 4. first Learn hand first of hand recentofmedical recent medical air quality air incidents quality incidents and howand to avoid how toexperiencing avoid experiencing the same. the same. Objectives: Objectives: Upon completion Upon completion of this seminar, of this seminar, attendersattenders will be able will be to: able . to: . 1.

13:15-14:15 13:15-14:15 2 CONCURRENT 2 CONCURRENT TRACKS TRACKS - 6A & 6B - 6A & 6B

15:15-15:45 15:15-15:45 Refreshment Refreshment BreakBreak TRACK TRACK 6A: 6A: Security Security Design Design Guidelines Guidelines for Healthcare for Healthcare Facilities: Facilities: Supporting Supporting 15:45-16:45 15:45-16:45 PLENARY PLENARY SESSION SESSION - TRACK- TRACK 8 8 a safe,a secure safe, secure and accessible and accessible environment environment of care of care TRACK TRACK 8: 8: Lessons Lessons Learned Learned During During the CHES the CHES Conference Conference Jeffery Jeffery Young, Young, Executive Executive Director, Director, LowerLower Mainland Mainland Integrated Integrated Gordon Gordon Burrill, Burrill, Fredericton Fredericton NB NB Protection Protection Services Services & 2016& President, 2016 President, IAHSS, IAHSS, FraserFraser Health,Health, SurreySurrey Richard Richard Dixon,Dixon, Vancouver Vancouver BC BC BC BC

This closing This closing sessionsession of the conference of the conference will bring willtogether bring together thoughtthought leaders leaders in the industry in the industry as well as as well as all conference all conference delegates delegates to sharetotheir share experiences their experiences and theirand “totheir do” “to lists. do”Converting lists. Converting learnings learnings at any at any conference conference into actions into actions back at back homeatwill home inevitably will inevitably move our move healthcare our healthcare system system in a positive in a positive direction. direction. This session This session will introduce will introduce the International the International Association Association for Healthcare for Healthcare SecuritySecurity & Safety& (IAHSS) Safety (IAHSS) SharingSharing those learning those learning on a national on a national basis significantly basis significantly increases increases the reachtheofreach the CHES of theconference. CHES conference. SecuritySecurity design design guidelines guidelines for healthcare for healthcare facilitiesfacilities in support in support of the provision of the provision of a safe, of asecure safe, and secure and Objectives: Objectives: Throughout Throughout the conference, the conference, attendees attendees will develop will develop their “totheir do” “to ideas. do”This ideas. session This session will helpwill help accessible accessible environment environment of care,ofallowing care, allowing our clinicians our clinicians to focustoon, focus andon, provide, and provide, exceptional exceptional care. care. consolidate consolidate those ideas thoseinto ideas actionable into actionable steps. steps. These guidelines, These guidelines, which are which noware integrated now integrated in to and in referenced to and referenced throughout throughout the 2014theFGI 2014 Guidelines FGI Guidelines 16:30-17:00 16:30-17:00 Closing Closing Ceremonies Ceremonies for Hospitals for Hospitals and Outpatient and Outpatient FacilitiesFacilities and being andexpanded being expanded in the 2018 in theFGI 2018 document, FGI document, were developed were developed by a multi-disciplinary by a multi-disciplinary team that teamincluded that included personspersons with extensive with extensive expertiseexpertise in design, in design, healthcare healthcare securitysecurity management, management, physicalphysical security,security, Crime Prevention Crime Prevention ThroughThrough Environmental Environmental Design,Design, regulatory regulatory agencies, agencies, emergency emergency management, management, healthcare healthcare physicalphysical plant management plant management and included and included international international representation representation to ensure to the ensure Design the Guidelines Design Guidelines will alsowill be also applicable be applicable outside outside the US. the US. KevinKevin Tuohey, Tuohey, Executive Executive Director, Director, Research Research Compliance, Compliance, BostonBoston University University & Boston & Boston Medical Medical Center, Center, BostonBoston MA MA


Participating Participating companies companies are are listed listed below. below. Participating companies are listed below.

4th4thUtility 4th Utility Inc. Inc. Utility Inc.

EIEISolutions EI Solutions Solutions

Megamation Megamation Systems Systems Inc. Inc. Megamation Systems Inc.

AAF AAF International International AAF International

Engineered Engineered AirAirAir Engineered

MIP MIP Inc. Inc. MIP Inc.

Abatement Abatement Technologies Technologies Ltd. Ltd. Abatement Technologies Ltd.

Envirosafety Envirosafety Inc. Inc. Envirosafety Inc.

Modern Modern Purair Purair Aeroseal Aeroseal Modern Purair Aeroseal

Acklands Acklands Grainger Grainger Acklands Grainger

Enviro-Vac Enviro-Vac Division Division ofofParagon of Paragon Remediation Remediation Group Group Enviro-Vac Division Paragon Remediation Group

Mondo Mondo America America Inc. Inc. Mondo America Inc.

AIC AIC Heat Heat Exchangers Exchangers AIC Heat Exchangers

Equipco Equipco Ltd. Ltd. Equipco Ltd.

NABCO NABCO Canada Canada Inc. Inc. NABCO Canada Inc.

AirAirLiquide Air Liquide Healthcare Healthcare Liquide Healthcare

ErvErvParent Erv Parent Co. Ltd. Ltd. Parent Co.Co. Ltd.

Neptronic Neptronic Neptronic

Allegion Allegion Canada Canada Inc. Inc. Allegion Canada Inc.

ESC ESC Automation Automation Inc. Inc. ESC Automation Inc.

Phoenix Phoenix Controls Controls Phoenix Controls

Aqua Aqua AirAirSystems Air Systems Ltd. Ltd. Aqua Systems Ltd.

Filterpro Filterpro Services Services Canada Canada Ltd. Ltd. Filterpro Services Canada Ltd.

Plan Plan Group Group Plan Group

Armstrong Armstrong Ceilings Ceilings Armstrong Ceilings

Finning Finning (Canada) (Canada) Finning (Canada)

Armstrong Armstrong Flooring Flooring Armstrong Flooring

Firestone Firestone Building Building Products Products Canada Canada Firestone Building Products Canada

Precise Precise Parklink Parklink Inc. Inc. Precise Parklink Inc.

Asco Asco Power Power Technologies Technologies Canada Canada Asco Power Technologies Canada

Follett Follett Corporation Corporation Follett Corporation

Atlas-Apex/Coast Atlas-Apex/Coast Hudson Hudson Roofing Roofing Atlas-Apex/Coast Hudson Roofing

Forbo Forbo Flooring Flooring Systems Systems Forbo Flooring Systems

Austco Austco (Canada) (Canada) Austco (Canada)

Fortis Fortis BCBCBC Fortis

Automated Automated Logic Logic Corporation Corporation Automated Logic Corporation

Franke Franke Kindred Kindred Canada Canada Inc. Inc. Franke Kindred Canada Inc.

Avigilon Avigilon Corporation Corporation Avigilon Corporation

Garland Garland Canada Canada Inc. Inc. Garland Canada Inc.

B.G.E. B.G.E. Service Service & &Supply & Supply Ltd. Ltd. (The (The Filter Filter Shop) Shop) B.G.E. Service Supply Ltd. (The Filter Shop)

Genesis Genesis Restoration Restoration Genesis Restoration

BCBCInsulators BC Insulators Insulators

Grundfos Grundfos Inc. Inc. Grundfos Inc.

Bender Bender Canada Canada Inc. Inc. Bender Canada Inc.

Hazmasters Hazmasters Inc. Inc. Hazmasters Inc.

C/S C/S Construction Construction Specialties Specialties C/S Construction Specialties

Honeywell Honeywell Honeywell

Camfil Camfil Farr Farr (Canada) (Canada) Camfil Farr (Canada)

Houle Houle Electric Electric Houle Electric

Canadian Canadian Coalition Coalition forforGreen for Green Health Health Care Care Canadian Coalition Green Health Care

IEM IEM Industrial Industrial Electrical Electrical Mfg. Mfg. (Canada) (Canada) Inc. Inc. IEM Industrial Electrical Mfg. (Canada) Inc.

Canadian Canadian Engineered Engineered Products Products & &Sales & Sales Ltd. Ltd. Canadian Engineered Products Sales Ltd.

International International Water Water Treatment Treatment NANALLC NA LLC International Water Treatment LLC

Canstar Canstar Restorations Restorations Canstar Restorations

IPAC IPAC Chemicals Chemicals Ltd. Ltd. IPAC Chemicals Ltd.

Cascadia Cascadia Energy Energy Ltd. Ltd. Cascadia Energy Ltd.


Castertown Castertown Ltd. Ltd. Castertown Ltd.

IRC IRC Building Building Sciences Sciences Group Group IRC Building Sciences Group

Centura Centura Tile Centura TileTile

Johnson Johnson Controls Controls Johnson Controls


Klenzoid Klenzoid Canada Canada Inc. Inc. Klenzoid Canada Inc.

CHEM-Aqua CHEM-Aqua Canada Canada CHEM-Aqua Canada


Chubb Chubb Edwards Edwards Chubb Edwards

Kontrol Kontrol Kube Kube bybyFiberlock by Fiberlock Kontrol Kube Fiberlock

Class Class 1 Inc. 1 Inc. Class 1 Inc.

Labor Labor Management Management Cooperative Cooperative Trust Trust (LMCT) (LMCT) Labor Management Cooperative Trust (LMCT)

Commercial Commercial Lighting Lighting Products Products Commercial Lighting Products

Lellyett Lellyett & &Rogers & Rogers Co. Lellyett Rogers Co.Co.

Tremco Tremco Canada Canada Tremco Canada

Cool Cool AirAirRentals Air Rentals Ltd. Ltd. Cool Rentals Ltd.

Levitt-Safety Levitt-Safety Levitt-Safety

Tyco Tyco integrated integrated Fire Fire & &Security & Security Tyco integrated Fire Security

CSA CSA Group Group CSA Group

Logical Logical Solutions Solutions Logical Solutions

Victaulic Victaulic Company Company ofofCanada of Canada Ltd. Ltd. Victaulic Company Canada Ltd.

Cullen Cullen Diesel Diesel Power Power Ltd. Ltd. Cullen Diesel Power Ltd.

Magna Magna IVIVEngineering IV Engineering Magna Engineering

Vidir Vidir Vertical Vertical Storage Storage Solutions Solutions Vidir Vertical Storage Solutions

Cura Cura FloFloof Flo of BC Ltd. Cura ofBC BCLtd. Ltd.

Masco Masco Canada Canada Ltd. Ltd. Masco Canada Ltd.

Viessmann Viessmann Manufacturing Manufacturing Company Company Viessmann Manufacturing Company

Door Door & &Hardware & Hardware Institute Institute Canada Canada Door Hardware Institute Canada

McGregor McGregor Hardware Hardware Distribution Distribution McGregor Hardware Distribution

Watertiger Watertiger Watertiger

E.B. E.B. Horsman Horsman & &Son & Son E.B. Horsman Son

MediaEdge MediaEdge MediaEdge

Weishaupt Weishaupt Corporation Corporation Weishaupt Corporation

Eaton Eaton Eaton

Medical Medical Gas Gas Innovations Innovations Medical Gas Innovations

Wesco Wesco Distribution Distribution Canada Canada Wesco Distribution Canada

ECNG ECNG Energy Energy L.P. ECNG Energy L.P.L.P.

Medical Medical Mart Mart Medical Mart

Willis Willis Willis

Primco Primco Limited Limited Primco Limited Primex Primex Wireless Wireless Primex Wireless Proactive Proactive Hazmat Hazmat & &Environmental & Environmental Ltd. Ltd. Proactive Hazmat Environmental Ltd. RaulandRaulandBorg Borg RaulandBorg Reliable Reliable Controls Controls Corp. Corp. Reliable Controls Corp. Reliance Reliance Worldwide Worldwide Corporation Corporation (Canada) (Canada) Inc. Inc. Reliance Worldwide Corporation (Canada) Inc. Roofing Roofing Contractors Contractors Association Association ofofBC of Roofing Contractors Association BCBC Safety Safety Express Express Safety Express Salto Salto Systems Systems Inc. Inc. Salto Systems Inc. Sansys Sansys Inc. Inc. Sansys Inc. Schneider Schneider Electric Electric Schneider Electric Specified Specified Technologies, Technologies, Inc. Inc. Specified Technologies, Inc. Steam Steam Specialty Specialty Sales Sales Steam Specialty Sales Steris Steris Canada Canada Inc. Inc. Steris Canada Inc. StonCor StonCor Group Group StonCor Group Swisslog Swisslog Healthcare Healthcare Solutions Solutions Swisslog Healthcare Solutions Thermal Thermal Insulation Insulation Association Association ofofCanada of Canada (TIAC) (TIAC) Thermal Insulation Association Canada (TIAC) Thermogenics Thermogenics Inc. Inc. Thermogenics Inc. Thomson Thomson Power Power Systems Systems Thomson Power Systems Trane Trane Trane


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Project SOIL unearths fruits of on-site food production


ncreasing interest in food’s backstory continues to fuel the local food movement. The number of farmers’ markets and farm-to-table restaurants is on the rise, and farming has even begun to move to the roof. Back on the ground, some hospitals, schools and other public institutions are examining the viability of on-site food production as part of Project SOIL (Shared Opportunities on Institutional Lands) — a three-year feasibility study funded by the New Directions Research Program of the Ontario Ministry of Agriculture, Food and Rural Affairs. 28 CANADIAN HEALTHCARE FACILITIES

Launched in Se ptember 2013, Project SOIL is led by Dr. Phil Mount, a postdoctoral researcher at Wilfred Laurier Univer sity and research associate at the Centre for Sustainable Food Systems, and his esteemed research team, which includes the Canadian Coalition for Green Health Care’s Linda Varangu. Here, the Coalition’s executive director discusses the organization’s involvement in Project SOIL, as well as the benefits and challenges of, and opportunities f o r, o n - s i t e f o o d p ro d u c t i o n a t healthcare facilities.

What is the Canadian Coalition for Green Health Care’s role in Project SOIL?

The Canadian Coalition for Green Health Care (CCGHC) is a team member and advisor regarding healthcare facility perspectives for Project SOIL. The Coalition helped identify prospective healthcare facility participants, and has provided advice related to healthcare facility needs and concerns throughout the project. The four healthcare participants (and their projects) are: Lakehead Psychiatric Hospital in Thunder Bay, Ont. (GreenWerks Garden); Glengarry Memorial Hospital in Alexandria, Ont. (Horticultural Therapy Garden);

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s Victorian-style vegetable garden at Homewood Health Centre in Guelph, Ont. Homewood Health Centre in Guelph, Ont. (Kitchen Garden); and KW Habilitation in Kitchener, Ont. (Our Farm). Why did the CCGHC get involved with the project?

The CCGHC wanted to explore this opportunity because it had just finished projects that researched opportunities to incorporate local food into long-term care facilities and hospitals in Ontario. The Coalition knew there were challenges to increased use of local foods in the health sector, but it was also aware of potential opportunities since some facilities had already taken the lead in exploring and growing food on their lands. The CCGHC wanted to find out more about what, how and why they were doing this, and share the results with others in the healthcare sector. What are the benefits of on-site food production?

The Intergovernmental Panel on Climate Change (IPCC) reports that agricultural land use represents 12 per cent of global greenhouse gas (GHG) emissions. Other impacts of agriculture on the environment include high water usage, water and air pollution, and the use of pesticides, antibiotics and synthetic fertilizers. On-site food production can reduce GHG emissions by controlling the practices to grow food and curtailing food-related transport. Growing food locally can also provide enhanced resiliency to a facility should its food sources and delivery be affected by the ever-increasing extreme weather events caused by climate change. The CCGHC knows from its previous work that a significant portion of food is currently imported from thousands of kilometres away. 30 CANADIAN HEALTHCARE FACILITIES

There is also increasing pressure on healthcare facilities to be leaders in better nutrition and local food procurement. On-site food production offers direct access to fresh produce, which has tremendous potential to improve nutrition for staff and patients; creates a healing space; provides the long-professed physical, mental and emotional benefits of gardening; better connects institutions with the communities in which theyâ&#x20AC;&#x2122;re located; and serves a public relations purpose, as it becomes a visible, explicit expression of the institutionâ&#x20AC;&#x2122;s dedication to improved food. Food gardens and greenhouses on institutional land can also be sites of food and nutrition education. There are also excellent examples of revenue generation through on-site food production. For instance, Greenwerks Garden at Lakehead Psychiatric Hospital sells 2,000 pounds of produce a year, both on-site and in the community. Additionally, the garden is a site of job creation and skills training for persons with mental health or addiction issues. Institutions that have implemented on-site food production also list a number of key opportunities and successes from their own experiences, including partnerships, strong institutional support and broader institutional initiatives that can embed food production into larger projects or strategic plans (for example, healthcare reform, sustainability plans and corporate social responsibility schemes) to ensure their growth and success. What are the potential barriers to on-site food production on institutional lands?

Although on-site food production is generally viewed positively, a number of barriers have been identified as limiting or prohibitive.

From project surveys, the most cited potential barriers are lack of administrative capacity, general lack of interest, concerns for liability, lack of land/limited space and general maintenance (staffing requirements and cost). Difficulty in quantitatively measuring the qualitatively documented benefits was also cited. Generally speaking, funding is the most frequently cited barrier. Almost all institutions hoping to start projects do not have (or are unwilling to divert) their own funds for on-site food production. The second major barrier for healthcare institutions is lack of staff or volunteer interest to both start and maintain projects. Existing staff are typically overworked, with little time to dedicate to a new project, regardless of willingness or interest. What are the opportunities for on-site food production?

The are many potential opportunities due to the co-benefits on-site food production offers: improved resiliency and risk reduction resulting from reduced reliance on food contracts from abroad that may be impacted by challenging weather-related growing conditions; development of social enterprises that can help bring in additional revenues to support patient care; greater institutional emphasis on nourishing patients and the planet; and improved ties with community partners (such as the agricultural community, which could provide the expertise and manpower). In ter ms of available lands, a Geographic Information Systems (GIS) study of Ontario healthcare facilities shows 217 have more than one acre of arable land available, and 54 with more than five acres.

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ON THE GREEN BRICK ROAD University Health Network’s energy and environment department paves way to sustainable savings

By Lisa Vanlint


ospitals are places of healing, filled with healthcare professionals that vow to do no harm. Yet they consume large amounts of resources, which impacts the planet. This is especially significant for one of Canada’s largest acute care teaching organizations, the University Health Network (UHN), comprised of four major Toronto hospitals as well as the Michener Institute for Applied Health Sciences. Enter UHN’s energy and environment department. Established in 1999, to lead the health network on a greener path, the department is accountable for all aspects of energy. Since its inception, the department has spearheaded a number of initiatives related to energy conservation, waste reduction, toxics stewardship, sustainable construction, environmentally preferable procurement, healing gardens and green commuting. Today, thanks to its efforts, UHN is considered a leader in not just patient but planet-centred care.


UHN’s commitment to sustainability and reducing its environmental impact has not gone unnoticed. It has received a string of 32 CANADIAN HEALTHCARE FACILITIES

green awards throughout the years. Most recently, the Toronto Rehabilitation Institute was named the 2015 Green Hospital of the Year. Toronto Rehab nudged out four other healthcare facilities to claim the esteemed award, presented at the Ontario Hospital Association’s (OHA) annual HealthAchieve — Canada’s largest healthcare conference and exhibition. It was nominated because of staff success (at both the front line and managerial level) in making the physical environment efficient and sustainable, resulting in impressive energy and cost savings. Notable ‘green’ accomplishments include: an annual savings of 24,200 gigajoules (GJ) of electricity and $420,000 in utility costs from a combination of efficiency projects (LED lighting replacement, installation of energy-efficient mechanical equipment and more); a reduction in paper consumption by 54,000 sheets annually with the creation of new paperless volunteer orientation packages and facilities work orders; and 2,365 cubic metres (m3) of water savings as a result of changing four fridges from once-through City water cooling to recirculating.


From the outset, the energy and environment department has worked with various other departments to make UHN an exceptionally green organization. However, ingrained staff behaviour can undo some of the bestlaid plans. To motivate people toward sustainability and encourage positive change, the department adopted a communications strategy that includes in-person training, e-Learning, ecofriendly events to engage all staff and an e-newsletter. In 2010, it added another tool to its communications arsenal with the launch of Talkin’ Trash with UHN, a blog about greening the hospital environment. Accessible inside and outside the organization’s (fire)walls, the blog provides a platform to share green hospital stories. The goal is to start a sustainability conversation that leads to engagement and action. In healthcare and beyond, the time to act is now. Lisa Vanlint is the University Health Network’s energy steward.

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Adoption of MES program provides Humber River Hospital with sustainable access to medical technology

By Barbara Collins


hen a hospital project starts w i t h a c l e a n s l at e, t h e opportunities to explore innovations on all fronts are almost limitless. Whether that innovation is applied to room design, tracking systems, robotics or imaging equipment, it is not often that a healthcare organization has the chance to build the hospital of the future from the ground up. Humber River Hospital has had the privilege of taking that journey. While much of the focus has been on creating Canadaâ&#x20AC;&#x2122;s first digital hospital, one area 34 CANADIAN HEALTHCARE FACILITIES

that has received little attention, but is having a significant impact on the hospitalâ&#x20AC;&#x2122;s ability to sustain its innovation agenda, is the financing model for imaging equipment. Among the many milestones Humber River Hospital has achieved, it is the first Canadian hospital to engage in a multi-vendor, managed equipment s e r v i c e ( M E S ) a p p ro a ch fo r i t s diagnostic imaging, surgical, cardiology and emergency departments. Under the terms of the 15-year agreement, GE Healthcare will manage the

ongoing acquisition, installation and replacement for most of the medical technology at the hospital, and provide technology maintenance services for the life of the agreement at a fixed monthly fee. The initial procurement of $50 million in equipment from 25 suppliers is now in operation at the new site, which opened in October 2015. An integral part of the MES program is a built-in refresh component, as well as ongoing maintenance and support over the term of the contract.

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Imaging equipment procurement, management and maintenance accounts for a significant portion of a hospital’s capital budget. Equipment replacement and maintenance may be subject to long and arduous approval processes, and significant capital outlay that may or may not be available. Even beyond the initial funding, design and procurement stages, the ongoing challenge for healthcare facilities is that despite their best efforts, technology continues to move forward unchecked. As a result, facilities quickly find they are working with older technologies and escalating maintenance costs until the next capital outlay can be approved. A much more effective and efficient alternative is the MES concept. While new to Canada, it has gained significant traction in Western Europe and Australia. Basically, it functions like a cellular phone service, in which a telecom company provides a phone and covers all services for a fixed monthly contract fee over a specified duration. Not only does MES alleviate the need to procure funding to acquire new equipment, but it also provides hospitals with sustainable access to medical technology for a predictable fee. Benefits of the program include accountability and predictability through a well-defined and transparent operational process, regular performance reviews and project management. MES is a program that is ideally suited to the Canadian healthcare system because of the constraints hospitals are facing in terms of acquiring equipment for patient needs. Other facilities worldwide have clearly shown MES can deliver significant cost savings while improving cash flow. Although in the early stages of the process, Humber River Hospital estimates savings over the term of the contract could reach $25 million through improved expenditure planning across multiple programs. The refresh component also means the hospital can further enhance its quality of care by offering continued access to the latest medical equipment at predictable costs. As a new hospital, senior management 36 CANADIAN HEALTHCARE FACILITIES


is acutely aware that capital outlays for diagnostic equipment can create a vicious fiscal cycle, as a majority of those systems would need replacing within a similar time frame. This can have a devastating impact on operations when that time comes. The alternative is to manage with what’s already in place, at the risk of rising maintenance costs and equipment downtimes. A MES program, on the other hand, offers predictable costs for a fixed fee, flattening out cash flow while any risks associated with the equipment are transferred to the provider. JOURNEY TO SUSTAINABLE INNOVATION

The decision to adopt a MES program was not an easy one. Looking back to the initial stages of the project, Humber River Hospital was faced with a unique challenge in 2008: How to build a technologically advanced environment that would continue to lead in the years to come. It started with an executive working session to review what was needed, benefits and outcomes. T hroughout the process, senior management looked at a variety of partners as well as conducted site tours of other facilities to determine the appropriate technologies that would support a digital hospital of the future. In working with industry experts, senior management asked several questions. Perhaps the most important was: How can the hospital ensure it is positioned to take advantage of those innovations when they come without depleting its capital budget? In other words, how could it build something groundbreaking today and sustain that financially in the years to come?

Part of the initial discussions revolved around how other hospitals and jurisdictions in the world buy their technology. Although the project team had heard of managed equipment services, it was essential to learn more about the model. Given MES had never been used in Canada, proof of concept was critical to gain approval from Infrastructure Ontario a n d t h e p rov i n c e ’s M i n i s t r y o f Health. Humber River Hospital’s decision to work with a MES model in partnership with GE Healthcare is one that could have significant impact on how facilities approach imaging technology acquisition in the future. Beyond medical equipment, managed services is a proven and widely accepted concept in many operational areas, from telecommunications services to IT infrastructures. Applying the same principles to imaging equipment acquisition, installation, maintenance and replacement is simply a logical extension of that. Ultimately, the decisions made as healthcare providers are squarely focused on optimizing the quality of care for patients. Whether it’s keeping p a c e w i t h i m a g i n g t e ch n o l o g y, streamlining registration processes within clinical environments, automating functions or improving staff access to patients, the key for the healthcare system moving forward is to understand the role of innovation in that equation and how it can be applied in a fiscally responsible way. Barbara Collins is president and CEO of Humber River Hospital.

CHES would like to congratulate the following successful CCHFM Certificate Holders. All 11 individuals have been awarded their designation in the past year following the launch of this CHES Certification.

Robert Barss – Bridgewater NS Gordon Burrill – Fredericton NB Irwin Campbell – O’Leary PE Randy Cull – St. Anthony NL Craig Doerksen - Winnipeg MB Roy Kirton - Vancouver BC John J. Knott – Simcoe ON Michael McRitchie – Toronto ON George Pankiw – Oakville ON Steve Schaub – Yellowknife NT Gary Stairs – Douglas NB




Dr William Rutala:


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EXPANDING THE TOOL BOX Planned preventive maintenance program well worth the investment By Neil Crane


he healthcare system is faced with many challenges these days, with the aging population and shrinking financial resources putting the greatest strain on it. There is enormous pressure on healthcare organizations to reduce operating costs of both clinical and noncore support services, including the maintenance and operation of the physical plant. 38 CANADIAN HEALTHCARE FACILITIES

While facilities departments have a mandate to comply with the maintenance of life safety systems, including fire alar m, emergency generation and uninterruptible power supply, they are not obliged to engage in other preventive maintenance activities. As a result, preventive maintenance has been more popular in principle than in practice throughout the years.

There are a number of reasons the concept of preventive maintenance â&#x20AC;&#x201D; keeping equipment well-maintained to extend its expected life and avoid future repair costs â&#x20AC;&#x201D; has not caught on, one being the inability to see the long-term benefits. Decision makers are often interested in the short-term and, in particular, the current fiscal year. The maintenance budget is focused on


providing an environment that supports the mission, vision and value statements of the organization. In other words, equipment is typically repaired on failure. The facilities department provides the necessary accommodation supports (for example, appropriate room temperature, lighting and other ergonomic features) to conduct business.


A preventive maintenance program requires leadership in terms of the d e s i g n , exe c u t i o n a n d o n g o i n g maintenance of the program, and communication with all members of the facilities department and stakeholders to ensure its success.

The budget for preventive maintenance should also be separated from that of corrective maintenance. This helps better define how resources are utilized. Neil Crane is managing director at Neil Crane & Associates Inc. He served as CHES National president from 1991-1995.


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Healthcare physical plants have much in common with the human body. There are processes and operating parameters that change over time, and wear and tear on the systems may cause them to become less efficient and effective. However, if equipment (or the body) is well-maintained, it will preserve and even extend the equipment’s (body’s) expected life. A properly designed and comprehensive preventive maintenance program is key to maximizing the longevity of either asset. There are additional benefits. In the case of an organization’s facilities department, this includes: prevention of equipment failure before it occurs; reduction in the need for equipment repair and replacement, resulting in a healthier bottom line; improved annual budgeting and long-range projection; discover y of important information and situations not necessarily related to preventive maintenance work orders (such as mould or wear and tear); improved annual insurance premiums; reduction in stakeholder complaints; promotion of concept of continuous improvement; and record-keeping, which is all-important in the event there is an audit or legal issues. Preventive maintenance and maintenance history records also play a key role in strong grant applications for capital upg rades, are important for future healthcare facility planning and development, provide valuable information for repair parts inventory control, and can be useful when making future decisions on equipment replacement and system modifications. Furthermore, a preventive maintenance program is a significant component of the accreditation process for a facilities department. It addresses the key issues of quality control and risk management as it deals with life safety, and health and safety.

SUMMER/ÉTÉ 2016 39



Best practices for cleaning, disinfection of environmental surfaces to control HAIs By Nicole Kenny


eeping an institution clean used to be a fairly straightforward process that was entrusted to the housekeeping department. Few were concerned with how it got done so long as it did. However, with the emergence of healthcare-associated infections (HAIs), tremendous pressure has been placed on healthcare organizations, particularly environmental services departments, to ensure their facilities are properly cleaned and disinfected. 40 CANADIAN HEALTHCARE FACILITIES


Disinfection of surfaces is a vital part of any facilityâ&#x20AC;&#x2122;s environmental hygiene program. Choosing the right disinfectant can support its overall success and have a dramatic impact on program costs. While there is a plethora of disinfectants available for use in Canada, it has been difficult to find a single product that kills all pathogens quickly and effectively without presenting a health hazard to humans or damaging equipment and other surfaces.


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What’s more, a disinfectant is only as good as the people who use it. Fortunately, recent breakthroughs in the development of safer disinfectants, the introduction of validation tools to assess cleaning effectiveness and the adoption of training methods to improve cleaning procedures have created new opportunities for facilities to achieve better outcomes. This includes a greater reduction in the incidence of HAIs, less injury resulting from disinfectant use and dramatic cost savings. STEPPING INTO ACTION

Developing a cleaning and disinfection prog ram to address current best practices can be a daunting task due to the reams of scientific studies and infection prevention and control guidelines. However, this information can be distilled into five key steps that every healthcare facility should follow. The first involves defining clear roles and responsibilities. This is imperative to ensuring the program’s success. The functional groups responsible for cleaning patient care environments and equipment need to work together to determine who is responsible for cleaning each surface and piece of equipment in a patient room as well as the cleaning frequency. If this division of responsibilities does not occur, surfaces or devices will be overlooked. Since environmental surfaces and shared patient care equipment have been linked to the transmission of HAIs, it’s necessary to ensure cleaning is done right each and every time. Once responsibilities have been assigned, it is then imperative that all staff be trained on how to use the disinfectant correctly. A 42 CANADIAN HEALTHCARE FACILITIES

2010 study published in the Journal of AOAC International illustrates the importance of using products in accordance with label instructions. Products that dried before the recommended contact time — the length of time the surface needs to stay wet in order to achieve the level of kill listed on the product label — did not achieve optimal disinfection. Before staff training can occur, the right disinfectant must be chosen. Germicidal efficacy, realistic contact (or dwell) time and surface compatibility should all be taken into consideration when making this decision. When it comes to the development of disinfectants, the safety profile of the product has generally been sacrificed to achieve the highest degree of kill, putting staff at risk. A 2010 study by the Centers for Disease Control and Prevention (CDC) identified more than 150 cases of acute occupational illness in a six-year period caused by surface disinfectants that used quater nary ammonium compound chemistries — a chemical found in commonly used disinfectants today. Another CDC study found a significant increase in the rate of occupational asthma among nursing staff, which was associated with the use of disinfectants. Thankfully, there are a number of safer disinfectant products available today that provide the desired level of kill and do not pose occupational health and safety concerns. Selecting the right disinfectant, however, is not enough to ensure the elimination of pathogens. In addition to staff training, the product must be made readily accessible. If it is locked in a housekeeping closet several feet from where it needs to be used, for example,

the area and shared patient care items are less likely to be properly disinfected. Finally, compliance monitoring is necessary to ensure cleaning and disinfection best practices are being met. This involves the use of a ultra-violet (UV) ref lectant product or adenosine triphosphate (ATP) bioluminescence. Both have their respective advantages and disadvantages. Implementation should be based on who will be conducting the validation, and how the results will be interpreted and presented. An area often misunderstood when looking at the use of ATP is that these devices are not intended to compare the effectiveness of disinfectant products. In a recent study that investigated the limitations of ATP and how different disinfectants either enhanced or quenched the tool’s readings, it was concluded that ATP meters should be used with caution when validating cleaning effectiveness. Compliance monitoring should be implemented not just for high-touch surfaces but also for shared patient care equipment. This objective measurement of cleanliness and disinfection allows the environmental services department manager to provide positive feedback when a job is done well. Perhaps more importantly, it allows for the opportunity to coach and improve cleaning practices if surfaces or shared patient care equipment were missed. Nicole Kenny is senior director of professional and technical services at Virox Technologies Inc. She has 20 years’ experience as a technical consultant, educator and author working in the field of environmental hygiene and chemical disinfection for infection prevention.

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Surroundings are an important part of reducing the risk of infection control in health care. Crowded rooms and poor design can spread infection, impede workflow, and lead to unnecessary spread of illness. This was part of the reason why CSA Z8000 Canadian Health Care Facilities was published, followed by Z8001 Commissioning of Health Care Facilities and Z8002 Operation and Maintenance of Health Care Facilities. Applicable to virtually every health care setting - in any location from coast to coast - these standards work together to ensure that health care facilities are design and maintained to support healthy environments & optimal patient care.

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TIME TO BREATHE EASY Next version of medical gas standard coming down pipeline By Roger Holliss


h e C SA Group’s technical subcommittee on medical gases is making its final set of changes to Z7396-12 — Medical Gas Pipeline Systems - Part 1: Pipelines for Medical Gases, Medical Vacuum, Medical Support Gases and Anesthetic Gas Scavenging Systems — in preparation for public review later this year. The goal is to release the next version of the standard in early 2017. 44 CANADIAN HEALTHCARE FACILITIES

Changes are significant and varied t o a d d re s s f i ve ye a r s ’ wo r t h o f medical gas incidents of no gas, bad gas or wrong gas. There is also a philosophical shift, with the standard moving from being predominantly prescriptive to more performancebased. Rather than stipulating requirements, the revised standard, when it makes sense, allows hospitals

to select from potential options, so long as all can provide a specific p e r fo r m a n c e l eve l . T h e re i s a n exception, though. The standard continues to be prescriptive for highrisk medical gas scenarios (for example, high probability and high consequence). This philosophical shift provides hospitals with more control; however, it comes with additional responsibility. Healthcare

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facilities have to verify, confirm and monitor performance and conformance to the standard. INSPECTION CERTIFICATE

The new standard ushers in two noteworthy amendments to the certification process. RCABC_CHF_Summer_2016.indd 1 2016-06-14 12:05 PM To begin, the building owner must verify it has a reliable medical gas management system. Specifically, the • Trust third party inspection agency requires proof of a functional preventive • Reliability maintenance program as well as an • Innovation accurate set of ‘as built’ drawings. This • Performance requirement is not new; it’s already within the standard. However, field experience indicates poor compliance. TENTE Canada, Inc. • ON 519.896.7500 • QC: 514.708.7000 By making these elements part of the TENTE Casters, Inc. • USA 859.586.5558 • certification process, it increases the facility’s incentive to comply. The building owner may also disagree with CHF Ad Aug 20162.indd 1 2016-07-15 9:33 AM the inspection agency on one or more specific compliance elements and still receive a certificate for new work, albeit a qualified one. In such instances, the healthcare facility and inspection agency can go on record that they disagree on a specific section. Then, upon completing a risk assessment as per BE A PART OF THE Z1002-13, Occupational Health and Safety: Hazard Identification and Elimination and Risk Assessment and Control, the two parties sign off on the building owner’s acceptance of the actual condition. With that done and IE M RE 15 documented, the inspection agency 20 D I U G E C R U RESO issues a qualified inspection certificate.

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The concept of ‘qualified persons’ is further advanced in the newest version of the standard. There is a national installation accreditation program in place to improve the quality and repeatability of medical gas installations. The program is stringent enough that it incorporates a revocable licence. As such, building owners are

required to document that their tradespeople are licensed to work on medical gas systems. In the 2012 edition of the standard, the concept of ‘qualified persons’ (pipeline installers) became mandatory. The newest version outlines their minimum training and experience requirements as well as responsibilities. Along that ‘qualified’ logic, the new edition introduces the concept of a ‘qualified technician and manufacturer.’ With these additions, the standard touches all individuals who come in contact with medical gas systems. It should be noted that the ‘qualified technician and manufacturer’ is not as well defined and managed as the ‘qualified installer.’ However, the inclusion of this concept serves as a starting point, with refinements and improvements likely to come in future standard updates. THE EXTRA MILE

Other changes to the standard include chart updates for pipe loops, pipe sizing and supply system sizing to address the inappropriate use of old charts; consideration and use of new technologies, such as wireless and remote control systems, albeit within an educational framework; and language that speaks to the impact medical gases, particularly oxygen, can have on a facility’s fire plan and appropriate emergency response tools (fire control valves, maps, among others). Overall, members of the technical subcommittee on medical gases agree the newest version of the standard is a substantial improvement over the 2012 edition. Upon publication, healthcare facilities will be able to develop and manage safer and more reliable medical gas systems. Roger Holliss is director of engineering and redevelopment at St. Mary’s General Hospital in Kitchener, Ont.

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Canadian HealthcareFacilities  

Summer 2016

Canadian HealthcareFacilities  

Summer 2016