Canadian Healthcare Facilities

Canadian

HealthcareFacilities JOURNAL OF CANADIAN HEALTHCARE ENGINEERING SOCIETY

Volume 38 Issue 3

Summer/Été 2018

A NEW FRONTIER

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CONTENTS

CANADIAN HEALTHCARE FACILITIES Volume 38

Issue 3

Patrick Savoy patricks@mediaedge.ca PUBLISHER/ÉDITEUR

14

EDITOR/RÉDACTRICE Clare Tattersall claret@mediaedge.ca PRESIDENT/PRÉSIDENT

Kevin Brown kevinb@mediaedge.ca

SENIOR DESIGNER/ CONCEPTEUR GRAPHIQUE SENIOR

Annette Carlucci annettec@mediaedge.ca

PRODUCTION MANAGER/ DIRECTEUR DE PRODUCTION

Rachel Selbie rachels@mediaedge.ca

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

DEPARTMENTS

MAINTENANCE & OPERATIONS

6

8

30 Computer Chronicles

CMMS systems improve biomedical equipment management at facility level

Editor’s Note President’s Message

10 Chapter Reports

FEATURE 14

Redesigning the Heart of the East Redessiner le coeur de l’Est

HEALTHCARE DEVELOPMENT 23 It’s Just a Phase

How to make renovation planning (relatively) painless 26 Emergent Readiness

Focus on five factors key to success in relocation of ED

32 Guiding the Way

PIDAC’s latest best practices for environmental cleaning sets minimum standards to prevent, control HAIs

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

CHES Canadian Healthcare Engineering Society

SCISS

Société canadienne d'ingénierie des services de santé

PRESIDENT VICE-PRESIDENT PAST PRESIDENT TREASURER

REGULATORY UPDATE 36 Don’t be Shocked by Change Keeping up-to-date with CSA Z462 37 A Study in Success Standard impacts healthcare facility design, helps prevent infection

SECRETARY EXECUTIVE DIRECTOR

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

CHAPTER CHAIRS

Newfoundland & Labrador: Colin Marsh Maritime: Helen Comeau Ontario: Jim McArthur Quebec: Bassam Ajam Manitoba: Tom Still Saskatchewan: Jim Allen Alberta: Peter Jarvis British Columbia: Steve McEwan FOUNDING MEMBERS

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

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EDITOR'S NOTE

NEW DEVELOPMENTS I’LL NEVER FORGET the first hospital groundbreaking ceremony I attended. It occurred more than a decade ago when I was working for a community newspaper in the west end of Toronto.

I was assigned to cover the revitalization of Runnymede Healthcare Centre, which at the time operated out of a converted public school. The day was filled with excitement, not just for staff, patients and their families, but the community, of which I was a member. The continuing care and rehabilitation hospital was once destined for closure but thanks to a major investment by the thenMcGuinty provincial government, it was given a new lease on life.

Ever since, I’ve enjoyed writing and reading about hospital projects, both new construction and renovations, perhaps even more so when they’re in my proverbial backyard. Just a 20-minute drive (in good traffic) from MediaEdge’s Toronto office, Michael Garron Hospital is currently undergoing a massive redevelopment, which is expected to achieve LEED (Leadership in Energy and Environmental Design) silver certification. The design-build-finance project involves construction of a new eight-storey patient care tower and three-story connection, as well as demolition of some existing space and renovations to the existing hospital. You can read more about this issue’s feature story beginning on pg. 14.

We then move on to steps to planning a successful renovation in It’s Just a Phase, followed by what was involved in the relocation of Aberdeen Hospital’s emergency department.

The remainder of this issue focuses on operations and maintenance issues, specifically how CMMS systems can improve biomedical equipment management at the facility level and PIDAC’s (Provincial Infectious Diseases Advisory Committee) latest version of its best practices for environmental cleaning, as well as regulatory updates. Don’t be Shocked by Change delves into the most noteworthy changes to CSA Z462, which is now in its fourth edition, while A Study in Success looks at how Z8000 has fared since it was developed seven years ago.

Clare Tattersall claret@mediaedge.ca

Reproduction or adoption of articles appearing in Canadian Healthcare Facilities is authorized subject to acknowledgement of the source. Opinions expressed in articles are those of the authors and are not necessarily those of the Canadian Healthcare Engineering Society. For information or permission to quote, reprint or translate articles contained in this publication, please write or contact the editor.

Canadian Healthcare Facilities Magazine Rate Extra Copies (members only) 25 per issue Canadian Healthcare Facilities (non members) 30 per issue Canadian Healthcare Facilities (non members) 80 for 4 issues A subscription to Canadian Healthcare Facilities is included in yearly CHES membership fees.

6 CANADIAN HEALTHCARE FACILITIES

La reproduction ou l’adaptation d’articles parus dans le Journal trimestriel de la Société canadienne d’ingénierie des services de santé est autorisée à la condition que la source soit indiquée. Les opinions exprimées dans les articles sont celles des auteurs, qui ne sont pas nécessairement celles de la Société canadienne d’ingénierie des services de santé. Pour information ou permission de citer, réimprimer ou traduire des articles contenus dans la présente publication, veuillez vous adresser à la rédactrice.

Prix d’achat du Journal trimestriel Exemplaires additionnels (membres seulement) 25 par numéro Journal trimestriel (non-membres) 30 par numéro Journal trimestriel (non-membres) 80 pour quatre numéros L’abonnement au Journal trimestriel est inclus dans la cotisation annuelle de la SCISS.

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PRESIDENT'S MESSAGE

GOING THE DISTANCE I HAVE DISCOVERED the two-year commitment as CHES president has made me better organized. Most recently, I successfully balanced my day-to-day workload with visiting five provincial chapter conferences and education sessions over the course of two months, starting with Alberta, followed by Manitoba, New Brunswick, Ontario and British Columbia.

Participating in these events has revealed the true meaning of partnership in healthcare and the professionalism that is demonstrated. Each chapter is proud of its efforts and achievements, and it is evident that we have a first-class organization.

Over the next several months, I will continue to represent CHES National while attending the ASHE conference (July), 2018 CHES National Conference (September), IFHE Congress (October), CHES Saskatchewan chapter conference (October) and ASHE leadership (November).

With the 2018 CHES National Conference just a couple months away now, I would like to thank everyone who submitted applications/nominations for consideration for the Hans Burgers Award for Outstanding Contribution to Healthcare Engineering, Wayne McLellan Award of Excellence in Healthcare Facilities Management and Young Professionals Grant. We have strict terms of reference for these submissions and our committee is in the process of reviewing and selecting the best submission for each recognition.

I’m very much looking forward to the upcoming CHES conference in St. John’s, Nfld., Sept.

16-18. It is a great opportunity to attend (at least) one of the many education sessions and catch up with fellow peers. CHES National will hold its annual general meeting Sept. 17, but before then we have a full day of strategic planning plus review of the action log for the committee on Sept. 15.

It’s going to be a busy but exciting few months!

Preston Kostura President, CHES National

EARN CONTINUING EDUCATION CREDITS FROM CHES Members of the Canadian Healthcare Engineering Society can earn free continuing education units (CEU) by reading the Summer 2018 issue of Canadian Healthcare Facilities and passing a quiz based on articles in the issue. Once you’ve read the issue from cover to cover, simply go online to www.surveymonkey.com/r/5HKPZL2 to take the quiz. CHES members who pass the quiz will be able to claim one contact hour (0.1 CEU) on their CanHCC or CCHFM certificate renewals.

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CHAPTER REPORTS

MANITOBA CHAPTER

MARITIME CHAPTER

Manitoba healthcare continues to see changes in how it does business. Shared Health officially became an operational entity on Apr. 3. Part of the province’s broader health system transformation, Shared Health is leading the development of Manitoba’s first clinical and preventive services plan, and will evolve over the coming months to deliver certain health services as well as support centralized administrative and business functions for the province’s health organizations.

The chapter’s spring education day was a success. While the final numbers are still forthcoming, it appears this year’s event may have been the biggest to date. Held Apr. 24, the theme was “A Safe Worker is a Happy Worker.” Seminar topics included pest control, hazmat in healthcare, electrical safety, and patient and resident ceiling track lifts.

There were nine presentations in total and from member/exhibitor feedback, information gleaned has been quite useful. We made some changes to this year’s event, most notably extending the invite to frontline facility management staff to attend the trade show at no cost.

The Manitoba chapter held its annual general meeting at the education day, during which the executive committee was introduced: Tom Still (chair), Reynold Peters (past chair and vice-chair), James Kim (treasurer) and Brent Kolton (secretary). A few small changes to the chapter bylaws were proposed and adopted. The updated bylaws can be found on the CHES website.

We will once again sponsor a session at the Manitoba Building Expo. This year’s event will take place Oct. 16, at the Victoria Inn Hotel and Convention Centre in Winnipeg. The session topic and speaker details will be confirmed soon. Cost of attendance to the sponsored session, luncheon and trade show will be covered by the chapter for all Manitoba CHES members. Registration information will be sent out via an e-mail blast.

The Manitoba chapter has started planning its 2019 education day.

If you would like to volunteer to assist with the event, take part in a committee or help out with the 2021 CHES National Conference in Winnipeg, please contact a member of the chapter executive. The time commitment is flexible.

—Tom Still, Manitoba chapter chair

The newest members of the chapter executive were welcomed at our annual general meeting, May 7. They include Mark McNeil (secretary) and Ken Morriscey (vice-chair Nova Scotia). Andrew Bradley will move into the position of vice-chair New Brunswick. A sincere thank you to outgoing vice-chairs Keith Fowler (New Brunswick) and Denis Pellichero (Nova Scotia) for their years of dedicated service.

The spring conference was a great success. Held in Moncton, N.B., May 6-8, we had more than 90 registered delegates. The theme was, “Efficiency: The Positive Effects on Patient and Familycentred Care.” Keynote speaker Mark Black kicked things off with an inspirational address on his experience as a heart and doublelung transplant recipient. The educational programming included a full slate of guest speakers and the trade show featured a number of new services, products and technologies. Pub night at the Old Triangle Irish Alehouse was well-attended by 100 delegates and exhibitors.

Following the conference, the two-day Canadian Healthcare Construction Course (CanHCC) was held at the city’s Delta hotel.

The unique educational sessions were geared to contractors and facility personnel who gained valuable information in key areas such as the planning, design and construction process; building and fire codes; infection control; mechanical and plumbing systems; medical gas systems; electrical systems; and emergency preparedness. The CanHCC was also successful, with 30 registrants from across the Maritimes. I’d like to thank CHES members Gordon Burrill and George Pankiw, as well as Tim Adams from the American Society of Healthcare Engineering (ASHE), for the exceptional program.

This year’s Per Paasche bursary recipient is Patrick Leblanc.

Patrick received a $1,000 cheque at the chapter conference in May. The grant is presented annually to a family member of a Maritime chapter member to assist with their post-secondary education.

The Maritime chapter’s fall education day will be held Nov. 20, at the Best Western Glengarry in Truro, N.S. —Helen Comeau, Maritime chapter chair

s The Ontario chapter's bid submission to host the 2022 International Federation of Hospital Engineering (IFHE) Congress in Toronto has been approved for presentation.

10 CANADIAN HEALTHCARE FACILITIES

CHAPTER REPORTS

ALBERTA CHAPTER Summer is upon us! We started the season on a high note as our local chapter conference and trade show was well-received. Attended by a record number of delegates and vendors, several changes contributed to its success: the planning committee saw the addition of new members who brought fresh ideas to the table; and lessons learned from last year’s conference resulted in a modified floor plan, delegate passport that vendors had to sign to be entered into prize draws and new food options. These additions brought an unanticipated improvement to the evening social.

For the second year in a row we gave away two trips to the CHES National Conference, a tradition we hope to continue for years to come.

A focus of the Alberta chapter has been to improve and promote our brand. Since creating a new chapter logo, you can find both executive and conference planning members wearing it proudly. The chapter partnered with some generous sponsors at our last two conferences and gave all delegates a CHES branded coffee cup in 2017, and water bottle in 2018. As chapter chair, I try to wear and promote our brand as much as possible and often find myself randomly discussing CHES with people I meet — attention I embrace as it makes them aware of the organization and its many benefits. As we continue to promote our brand, our aim will be to improve membership.

—Peter Jarvis, Alberta chapter chair

National Healthcare Facilities and Engineering Week October 14 - 20, 2018

Recognize yourself, your department and your staff during Healthcare Engineering Week. Make sure everybody knows the vital role played by CHES members in maintaining a safe, secure and functioning environment for your institution.

Visit the CHES Website www.ches.org/resources/ for downloadable material to help you with plans to celebrate!

ONTARIO CHAPTER The chapter’s spring conference was held June 3-5, at Blue Mountain Resort in Collingwood, Ont. The planning committee did an outstanding job organizing another excellent event. Nearly 130 delegates attended, and 87 exhibitor booths filled the trade show floor. Two post-secondary bursaries were presented at the gala banquet to Ontario chapter family members. Our annual general meeting was held on the last day of the conference, with approximately 40 members present.

Planning is already underway for next year’s conference in Hamilton, Ont. Several members of the chapter executive have attended awards ceremonies at various Ontario colleges. We currently award a small scholarship to students in engineering or technical programs at 10 colleges.

The Ontario chapter’s bid submission to host the 2022 International Federation of Hospital Engineering (IFHE) Congress in Toronto has been approved for presentation at this year’s event in Brisbane, Australia. Our competition is from the U.S. and South Africa. I’d like to thank everyone who worked on the bid submission. We feel very confident about our chances.

The Canadian Healthcare Construction Course (CanHCC) is scheduled Oct. 16-17, in Toronto. The chapter will host a fall education day Nov. 8, in Cambridge, Ont. Topics will cover CSA standards updates and new drone technology.

—Jim McArthur, Ontario chapter chair SUMMER/ÉTÉ 2018 11

CHAPTER REPORTS

BRITISH COLUMBIA CHAPTER

NEWFOUNDLAND & LABRADOR CHAPTER

The chapter enjoyed another successful conference and Canadian Healthcare Construction Course (CanHCC) in Whistler, B.C. The trade show sold-out with 99 booths, and so did the sponsorship categories thanks to the overwhelming support from all our vendors. The conference saw more than 170 delegates and a total of 447 attendees. The education forum featured 12 sessions, all of which were well-received. This year’s banquet was one of our best to date, with 370 guests and a waiting list to attend.

The theme, “Healthcare Emergency Planning: Are we Ready?”, was relevant given last year’s fires and recent flooding.

The keynote address by Trevor Murdock discussed climate change and the impact it should have on facility planning. Trevor’s work has focused on climate scenarios and online mapping tools, downscaling to high resolution, analysis of historical climate data and improvement of seasonal climate predictions. Climate change continues to impact our healthcare operations and therefore needs to be considered when planning for the future.

The B.C. chapter is still in good financial standing.

Conference venues have been secured in Penticton for 2019 and 2021, and Whistler for 2020. The education committee continues to top up the many college bursaries and fund the national webinars for our members.

2018 is an election year for the chapter executive. The positions of vice-chair, secretary and treasurer are up for election. The call for nominations has been rescheduled to meet our bylaw requirements.

I’d like to thank all executive committee members for their many years of service, dedication and support. It has been a pleasure to work with such a professional group of volunteers. A special thank you to Norbert Fischer (vice-chair), Mitch Weimer (past chair), Ken Van Aalst (treasurer), Sarah Thorn (secretary), Arthur Buse (membership director), Mark Swain (communications director), Rick Molnar (education director), Caroline Reid (education committee) and Linda Williams (conference coordinator).

—Steve McEwan, British Columbia chapter chair

As September draws ever closer, excitement around the 2018 CHES National Conference continues to intensify. We are looking forward to this year’s event in scenic St. John’s, Nfld. Our goal is to break even or do better than the last time the chapter hosted the conference in 2009. The theme, “Smarter Infrastructure for Enhanced Patient Outcomes,” was that of the chapter’s 2017 professional development day. It was such a success, boasting a record-breaking number of attendees, stellar lineup of presenters, engaging Q&A period and unbelievably well-received sessions, that we decided to carry the theme forward. Registration for the 2018 event of the year is now open.

The chapter is sitting in a solid financial position. We have committed to subsidizing some aspects of the national conference, with further talks to occur in the coming weeks to determine how we can support our membership. The chapter executive wishes to contribute as much as it fiscally can so the majority of members can attend the coveted event.

It’s been a rocky few years for Newfoundland and Labrador. The decline in oil price per barrel has drastically impacted the province, resulting in many changes. Tough fiscal times has resulted in job losses within the government sector, primarily healthcare since it’s the largest draw on the provincial purse. Many people now find themselves fulfilling roles that were once performed by two or three individuals. For this reason, it is challenging for people to find time to partake or participate in voluntary groups such as CHES. Nevertheless, we continue to move forward.

I’d like to thank those who have remained supportive and committed to the organization. For those that are currently task burdened, reach out to the chapter executive (if we don’t get to you first) when you resurface. The door is always open.

—Colin Marsh, Newfoundland & Labrador chapter chair

s The 2018 CHES National Conference will take place Sept. 16-18, in scenic St. John's, Nfld.

12 CANADIAN HEALTHCARE FACILITIES

SUMMER/ÉTÉ 2018 13

REDESIGNING THE HEART OF THE EAST Redessiner le coeur de l’Est By/Par Hannah Ward

I

t’s time to give east Toronto the healthcare facility it needs and deserves.

After a decade in the making, Michael Garron Hospital (MGH) marked a major milestone this spring when it broke ground on the new Ken and Marilyn Thomson Patient Care Centre and redevelopment of its 89-year-old hospital campus.

Part of the Toronto East Health Network, MGH is a vibrant community teaching hospital that serves more than 400,000 people in 22 distinct neighbourhoods. The hospital (formerly Toronto East General) has delivered high-quality, patient-centred healthcare services since 1929, to families along the continuum of care, from welcoming a new life to facing end-of-life.

Over the years, MGH has continually renewed its commitment to community by adapting its programs, services and campus to meet the evolving needs of the diverse population it serves. But the hospital now finds itself in a position where it can no longer rely on expansion.

“It’s exciting to transform the campus into a state-of-the-art facility that reflects the hospital’s excellence and provides an environment the east Toronto community deserves,” says MGH director of redevelopment Kirsten Martin.

In partnership with EllisDon Infrastructure Healthcare (EllisDon Design Build Inc., Diamond Schmitt Architects and B+H Architects in joint venture, and EllisDon Capital Inc.) and Infrastructure 14 CANADIAN HEALTHCARE FACILITIES

I

l est temps de donner à l’est de Toronto l’établissement de santé dont il a besoin et qu’il mérite.

Après une décennie de préparatifs, l’Hôpital Michael Garron (HMG) a franchi une étape importante au printemps dernier avec la première pelletée de terre du nouveau Centre de soins aux patients Ken et Marilyn Thomson et du réaménageant de son campus âgé de 89 ans.

Faisant partie du Toronto East Health Network, l’HMG est un hôpital universitaire communautaire dynamique qui dessert plus de 400,000 personnes dans 22 quartiers. Depuis 1929, et d’abord sous le nom de Toronto East General, il offre aux familles des services de soins axés sur les patients de grande qualité qui vont de l’accueil d’une nouvelle vie aux soins en fin de vie.

Au fil des ans, l’HMG a continuellement renouvelé son engagement envers la communauté en adaptant ses programmes, ses services et son campus pour répondre aux besoins changeants d’une population diversifiée. Or, l’hôpital ne peut plus simplement agrandir.

“C’est emballant de transformer le campus en quelque chose à la fine pointe de la technologie, qui reflète l’excellence de l’hôpital et qui offre à l’est de Toronto un bel environnement,” affirme Kirsten Martin, directrice du réaménagement de l’HMG.

FEATURE

Ce projet historique de $500 millions consiste en un partenariat entre EllisDon Infrastructure Healthcare (EllisDon Design Build Inc., Diamond Schmitt Architects et B + H Architects en coentreprise, plus EllisDon Capital Inc.) et Infrastructure Ontario. Il couvre la construction d’un nouveau centre de soins aux patients de huit étages comptant 215 lits et un bâtiment de trois étages pour se raccorder à l’hôpital existant. Certaines ailes désuètes seront démolies et on effectuera des rénovations dans divers secteurs du campus.

“La persévérance et le dévouement inlassables de tant de personnes et d’équipes, passées et présentes, ont permis au projet de réaménagement de l’HMG de se concrétiser,” déclare le vice-président du réaménagement de l’HMG, Robert Orr. La solidité du partenariat entre les deux architectes, Diamond Schmitt et B + H, a joué un rôle déterminant dans la conception du futur établissement: l’un possède une expertise en espaces publics et l’autre en espaces cliniques. Ensemble, ils ont transformé la vision d’avenir du MGH en un concept visionnaire proposant des espaces publics accueillants qui honorent la riche histoire de l’hôpital et autour desquels se greffent des aires cliniques adaptables qui favorisent les soins collaboratifs entre professionnels, patients et familles.

SERVIR LA COMMUNAUTÉ

Le hall actuel de l’HGM sur l’avenue Coxwell est central à l’expérience quotidienne à l’hôpital — il est accueillant, actif et dynamique. La réunion de personnes dans un cadre modeste et non institutionnel imprime un sentiment d’appartenance et affiche la culture communautaire de l’hôpital.

Afin de préserver l’essence de ce hall, les architectes ont conçu un espace de rassemblement fonctionnel baigné de lumière naturelle, avec de nouvelles installations alimentaires, des aires d’attente et des carrefours d’information. On y aura accès à des espaces flexibles et polyvalents, dont un grand auditorium et une salle de ressources pour accommoder les programmes communautaires. Patients et visiteurs trouveront leur chemin facilement grâce à une signalisation claire et intuitive faisant appel à des indicateurs spatiaux, comme des entrées et des sorties faciles à identifier, une disposition logique et des repères visuels, tactiles et auditifs.

Pour le carrefour communautaire, EllisDon Infrastructure Healthcare s’est penché, outre sur l’environnement intérieur, sur les possibilités qu’offre l’extérieur. L’équipe a élaboré un lieu de rassemblement avec une grande pelouse pour les activités, SERVING THE COMMUNITY une aire de jeux pour enfants et divers sièges et plantes. Ces MGH’s existing Coxwell Avenue lobby is a central part of the daily espaces extérieurs et l’aménagement paysager contribuent experience within the hospital — it’s a welcoming, active and largement à l’expérience en bonifiant l’accès à la nature et à la dynamic space. The congregation of people in a modest and non- lumière du jour.

Ontario, the historic $500-million project involves construction of a new eight-storey patient care centre with 215 acute care inpatient beds and a three-storey building to connect to the existing hospital.

The campus will see the demolition of outdated wings and undergo renovations in select areas.

“The tireless perseverance and dedication of so many individuals and teams, both past and present, finally brought MGH’s redevelopment project to fruition,” says MGH vice-president of redevelopment Robert Orr. The strong partnership between the two architects, Diamond Schmitt and B+H, has been instrumental in the design of the future facility, as their distinct skills in both public and clinical spaces have come together to create a perfect pairing. Together, the firms have taken MGH’s vision for the future and transformed it into a visionary design, providing inviting public spaces, honouring the hospital’s rich history and developing flexible clinical areas designed for collaborative care amongst care professionals, patients and families.

SUMMER/ÉTÉ 2018 15

FEATURE

institutional setting evokes a sense of belonging and displays the culture of community that is persistent throughout MGH. To maintain the essence of the main lobby, the architects designed a functional gathering space filled with natural light, new food and retail amenities, waiting areas and informational hubs. There will be access to flexible, multipurpose spaces, including a large auditorium and resource room to accommodate community programming.

Clear and intuitive wayfinding with spatial indicators such as easily identifiable entrances and exits, a logical building layout and visual, tactile and auditory cues will enable patients and visitors to naturally navigate the hospital.

To create a community hub, EllisDon Infrastructure Healthcare not only looked at the design of the indoor environment but also opportunities outside. Through the evolution of the design, the team has created a space for the community to gather, with a large event lawn, children’s play area and a variety of seating and ground plantings. These exterior spaces and the elaborate landscaping are an important part of the holistic hospital experience, increasing access to nature and daylight.

The hospital shared the designs of various public areas, including the landscaping and community resource room, with staff, physicians, patients and community members for feedback and discussion.

Based on these sessions, the vision and design of these spaces was refined and adjusted to better suit the needs and experiences of hospital users; the intent is to build a facility designed for the community, by the community.

L’hôpital a partagé les dessins de divers espaces publics, y compris l’aménagement paysager et la salle de ressources communautaires, avec son personnel, les médecins, les patients et la communauté pour obtenir leur opinion. Para suite, on a peaufiné ces espaces pour les adapter aux besoins des usagers; l’idée est de construire un édifice conçu pour et par la communauté.

HONORER L’HISTOIRE

Le campus de l’HMG possède une certaine diversité stylistique.

Conçu dans les années 1920, on y a ajouté des éléments chaque décennie ou presque. Pour son réaménagement, l’hôpital et EllisDon Infrastructure Healthcare ont entrepris de construire quelque chose qui rappelle l’hôpital existant, tant dans son environnement physique que dans son atmosphère accueillante.

Les architectes ont choisi la pierre naturelle, la brique et le bois pour refléter le style Art déco original. Ils ont aussi incorporé des reliques restaurées, comme les vitraux et les pierres angulaires, qui seront exposées dans le hall. L’aile la plus ancienne sera restaurée: elle disparaît actuellement parmi les ajouts qui ont été attachés à la façade de l’hôpital avant au fil du temps.

“On en fera le visage du nouvel Hôpital Michael Garron,” explique Matthew Smith, directeur de Diamond Schmitt. “Le bâtiment qui était un cadeau de la communauté restera au cœur du campus.” À l’extérieur, les matériaux retenus rappelleront les autres HONOURING HISTORY ailes et le revêtement de briques des résidences environnantes.

Designed and developed in the 1920s, and added to almost every Ainsi, la présence extérieure de l’hôpital se rattachera au decade since, there is a stylistic diversity to MGH’s campus. As campus et à la communauté élargie. part of the redevelopment project, the hospital and EllisDon Infrastructure Healthcare set out to build something reminiscent SURVEILLER L’AVENIR of the existing hospital, both in its physical environment in Comme alternative aux zones médicales hautement addition to its welcoming atmosphere. personnalisées, L’HGM bénéficiera d’espaces cliniques flexibles The architects selected natural stone, brick and wood to mirror the et uniformisés pour adapter ses activités et ses services à original art deco design, and have incorporated historic, restored l’évolution des besoins. Et la création d’espaces généreux, items such as the hospital’s stained glass windows and corner stones, simples et épurés, facilement modifiables et transformables, which will be featured as a display in the new lobby. permettra de répondre aux nécessités de la journée. Par MGH will keep the earliest hospital wing, which is currently buried exemple, en rapprochant cliniques thoraciques, rénales et amongst additions that were attached to the front hospital facade cardiaques, on aidera les patients atteints de maladies multiples over time. (comme une bronchopneumopathie chronique obstructive, une 16 CANADIAN HEALTHCARE FACILITIES

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FEATURE “The hospital’s original wing will be restored and prominently displayed as the face of the new Michael Garron Hospital,” says Diamond Schmitt principal Matthew Smith. “The building that was a gift from the community will remain at the heart of the campus.”

The materiality of the new building exterior will also mirror the construction of the remaining wings as well as the brick cladding on the surrounding residential homes. By doing this, the hospital’s outer presence will tie into the existing fabric of the campus and greater community.

EYING THE FUTURE

As an alternative to highly customized medical areas, flexible, standardized clinical spaces will enable MGH to adapt its workflows and services over time to suit the needs of the community. The creation of generous, simple and uncluttered spaces that can be easily modified and transformed will also help meet the needs of the day.

For instance, co-located chest, renal and cardiac clinics will support patients with multiple illnesses like chronic obstructive pulmonary disease, heart disease and diabetes, allowing them to easily navigate multiple appointments.

“Enhancing the accessibility and adaptability of spaces will position MGH for success well into the future” says B+H principal Chris McQuillan. “When spaces are overdesigned and highly customized for today’s function it constricts an organization’s ability to respond to changing healthcare needs.”

MGH worked closely with active users of the space to develop and validate the design of the facility. Using lean methodology and its seven flows of healthcare — patient, information, clinicians, medications, supplies, equipment and process engineering — hospital leaders, physicians and multidisciplinary staff engaged in examining drawings of future unit designs to determine if opportunities existed to improve proposed patient and clinician spaces.

Throughout these sessions, MGH stakeholders identified ways to optimize departmental layouts and improve the overall patient and staff experience. For example, the new patient care centre will include modernized inpatient mental health service units with 46 adult care beds and six for children and youth. The unit will offer home-like environments, bright private rooms, shared spaces to come together for meals and healing, and access to a secured outdoor terrace with seating and gardens.

MGH care stations of the future have been designed to facilitate the collaboration of integrated teams. The front and back of house have been clearly separated to improve efficiency, safety, infection control, patient confidentiality and dignity, and technology has been integrated to improve clinical workflows. These new design features will contribute to enhanced experiences for the MGH community.

“It’s critical to our success as an organization to design purposeful spaces that support today’s hospital operations across clinical, education and research activities,” says MGH’s Martin. “What’s most exciting is to plan spaces that can respond to future development and continue to position MGH as a leader in community medicine by building flexible and dynamic spaces for our staff and community.”

The hospital’s new Ken and Marilyn Thomson Patient Care Centre is scheduled for completion in late 2021, and the full hospital campus renewal in 2024.

maladie cardiaque et le diabète) à regrouper leurs rendez-vous.

“En améliorant l’accessibilité et l’adaptabilité des espaces, l’HMG pense à l’avenir,” avance Chris McQuillan, directeur de B + H. “Des espaces surspécialisés pour remplir leur fonction actuelle limitent la capacité de l’établissement à évoluer au rythme des besoins.”

L’HMG a collaboré étroitement avec les usagers pour développer et valider le concept de l’installation. En utilisant la méthodologie Lean et ses sept flux de soins — patients, information, cliniciens, médicaments, fournitures, équipement et ingénierie des procédés — les responsables hospitaliers, les médecins et le personnel multidisciplinaire ont examiné les dessins des futures unités afin de déterminer s’il existait des possibilités d’amélioration. À ces séances, les intervenants de l’hôpital ont identifié des façons d’optimiser la disposition des services et d’améliorer l’expérience globale des patients et du personnel. Par exemple, le nouveau centre de soins aux patients comprendra des unités modernisées de santé mentale avec 46 lits pour adultes et six pour enfants et jeunes. L’unité offrira des environnements comme à la maison, des salles privées lumineuses, des aires communes pour les repas et la guérison, ainsi qu’une terrasse extérieure sécurisée avec sièges et jardins.

Les postes de soins de l’HMG du futur sont conçus pour faciliter la collaboration d’équipes intégrées. Pour améliorer l’efficacité, la sécurité et le contrôle des infections et respecter l’intimité et la dignité des patients, on a mieux séparé les secteurs pour patients et les secteurs réservés au personnel. Ces nouvelles caractéristiques contribueront à améliorer l’expérience de chacun.

“Notre réussite repose sur la conception d’espaces utiles aux activités cliniques, pédagogiques et de recherche d’aujourd’hui,” précise M. Martin. “Le plus excitant, c’est de planifier des espaces flexibles et dynamiques qui pourront répondre au développement futur et positionner l’HMG comme un chef de file en médecine communautaire.”

L’ensemble du projet devrait être terminé en 2024, mais le nouveau Centre de soins aux patients Ken et Marilyn Thomson le sera à la fin de 2021.

Hannah Ward is the coordinator, corporate communications and redevelopment, at Michael Garron Hospital.

Hannah Ward est la coordinatrice des communications d’entreprise et du réaménagement à l’hôpital Michael Garron.

18 CANADIAN HEALTHCARE FACILITIES

“Smarter Infrastructure for Enhanced Patient Outcomes” 38TH ANNUAL CONFERENCE OF THE CANADIAN HEALTHCARE ENGINEERING SOCIETY SEPTEMBER 16-18, 2018 | ST. JOHN’S CONVENTION CENTRE, ST. JOHN’S NL

–––––––––– SPONSORS –––––––––– KEYNOTE

DIAMOND

PLATINUM

GOLD

SILVER Belimo Canada CORE Engineering Inc. CBCL Limited Forest Contractors H.H. Angus & Associates Limited Consulting

BRONZE IEM Industrial Electric (Mfg) Canada Inc. Newlab Engineering Limited Precise Parklink Primex Stantec Consulting

www.ches.org

Abatement Technologies Pinchin Ltd. Reliance Worldwide Corporation (Canada) Inc. Thermal Insulation Association of Canada

PROGRAM SUNDAY SEPTEMBER 16, 2018

options. As a result, UHN has invested in an upgrade utilizing Enwave’s deep lake district cooling system, entering into a 20-year agreement for chilled water services.

07:00-14:00

The Great CHES Golf Game Clovelly Golf Course (Bus time to be determined)

18:30-22:00

Opening Reception – Sponsored by Class 1 Inc. Reception Entertainment– Sponsored by Precise Parklink Reception Transportation - Sponsored by Newlab Engineering Limited The Rooms, St. John’s NL

Objectives: This session will help participants: 1. Step through the process of developing a rock solid business case (with sensitivity analysis) to communicate with senior leadership and key stakeholders.

2. Show how energy saving projects can provide more value to an organization than just operating cost reductions.

3. Communicate key steps in the chilled water investigation process and lessons learned in identifying issues.

4. Highlight how data is fundamental in identifying existing issues, creating a reliable business case, and in developing a well-functioning design.

MONDAY SEPTEMBER 17, 2018 07:00-08:30

Breakfast – Sponsored by Thomson Power Systems

08:30-08:45

Opening Ceremonies

08:45-09:30

KEYNOTE ADDRESS - Sponsored by Honeywell Team Broken Earth Dr. Andrew Furey Dr. Arthur Rideout

Team Broken Earth is a volunteer-driven relief effort made up of doctors, nurses and other healthcare professionals from across Canada. The first team started here in Newfoundland in response to the dire need for medical assistance in the wake of the 2010 earthquake that levelled Port-au-Prince, Haiti, killing over a quarter of a million people and injuring countless more. Seven years removed from that devastating earthquake, the team has grown to be a nationwide effort, and has expanded to include relief work and assistance in Nepal, Bangladesh, Nicaragua and Guatemala.

Team Broken Earth’s mission is threefold. First, we believe in providing a sustained medical relief effort to those who need it most. We’re there until we are no longer needed. Second, we believe that education creates sustainable, everlasting change. Finally, as our organization matures we look to continue our ongoing research activities measuring outcomes and deliverables that result from our efforts.

09:30-10:30 Track 1:

PLENARY SESSION - TRACK 1 Build it Right Now to Save Lives in the Future Bob Bedard, Senior Supervisor – Graham Construction, Edmonton AB Gordon D. Burrill, P.Eng., CCHFM, FASHE, CHFM, CHC – Teegor Consulting Inc., Fredericton NB

Healthcare-acquired infections (HAIs) have become a key focus for many healthcare organizations and regulatory authorities. Often, HAIs are due to pathogens deposited during construction from years or decades ago. These pathogens are raised during renovation and maintenance activities. By implementing innovative construction techniques during new construction, these legacy HAIs can be significantly reduced and potentially eliminated.

Objectives: 1. Attendees will gain practical knowledge of methods to create the culture of infection prevention at the earliest stages of construction.

2. Attendees will receive real numbers from real construction as to the costs associated with a major infection prevention program on greenfield construction sites.

3. Attendees will take away tools with which to “sell” a strong program to senior leaders in the construction industry or to their healthcare clients.

10:30-11:00

Refreshment Break in the Exhibit Hall – Sponsored by Belimo Canada

10:30-14:00

Exhibit Hall Open

11:00-12:00 Track 2A:

2 CONCURRENT TRACKS - 2A & 2B When Risk Becomes a Reality; Behind the Scenes of an Aspergillus Investigation - Sponsored by Pinchin Ltd. Jessica Fullerton, University Health Network, Toronto ON

For many working in healthcare design and construction, the link between construction and patient risk is an abstract, theoretical one. This presentation will provide a detailed look into the investigation of an increase of invasive Aspergillosis infections within an acute care institution in downtown Toronto. It will walk attendees through the enormous task of defining hospital-acquired cases, attempting to uncover the source, the significant cost and time dedicated to the investigation, and the negative impact to patient care. The importance of preventive measures in all maintenance and construction activities, whether they occur within the walls of the healthcare facility or outside, will be a main focus.

Objectives: This session will help participants: 1. Understand what is involved in the investigation of an outbreak of environmental importance.

2. Determine potential exposure risks for fungal elements.

3. Identify ways to mitigate this risk.

Track 2B:

Transforming Toronto General Hospital’s Chilled Water Supply Through Enwave Deep Lake Cooling – Sponsored by Thermal Insulation Association of Canada Chad Berndt, University Health Network, Toronto ON Nasreddine Guerfala, Enwave Energy Corporation

Toronto General Hospital’s 5,400 tonne chilled water plant has been reconfigured and modified over many years. This has led to an inefficient, poorly functioning and unreliable system, costing UHN $2.6 million a year in electricity. To develop solutions, a detailed engineering assessment was conducted. This included an hourly simulation, detailed business cases and a multivariable sensitivity analysis of several upgrade

12:00-14:00

Lunch in Exhibit Hall - Sponsored by Klenzoid Canada Inc.

14:00-15:00 Track 3A:

2 CONCURRENT TRACKS - 3A & 3B Upping the Game: How the New Edition of Z8000 is Shaping Healthcare Design for the Next Decade - Sponsored by Reliance Worldwide Corporation (Canada) Inc. Cliff Harvey, MSc(HQ), EDAC, FRAIC, OAA, MRAIC, Senior Architect and Advisor Michael Keen, P.Eng, MBA, Executive Director, Chief Planning & Redevelopment Officer, St. Michael’s / St. Joseph’s / Providence

Safe and effective service delivery needs safe, effective and well-designed healthcare facilities. The first edition of Z8000 did two things: it codified Canadian and international best practice to create a common design reference for healthcare, and it pushed the field to accept new ideas that would improve patient outcomes.

Presenters will describe how the new Z8000 edition addresses technological advances and changes to service delivery models while continuing to promote supportive environments where people can safely live, work and heal.

Objectives: This session will help participants: 1. Know the background of Z8000 and where it fits in the healthcare standards universe.

2. Understand how facility design and clinical operations need to work together for maximum safety and effectiveness — and why so often they don’t.

3. Learn about the changes and additions in Z8000-18, and how the new edition has evolved and expanded to deal with current trends, advances and needs in healthcare.

4. Get an update on recent research into the effect of specific design approaches used in the first edition of Z8000 in reducing healthcare-acquired infections.

Track 3B:

Impacting Patient Care by Optimizing Operations & Reducing Energy Usage Kate Butler, Energy Manager, Service New Brunswick Health Services Keith LaRose, Director of Business Development, CopperTree Analytics

The presentation will focus on optimization of the healthcare environment through building and energy analytics software, which aims to better serve patient and healthcare facility operations staff. The outcomes at New Brunswick healthcare facilities will be shared, as well as challenges and lessons learned.

Objectives: This session will help participants: 1. Identify the key components/resources of a successful building analytics continuous optimization approach that gives facilities the ability to make improved operating decisions, as well as showcasing the additional value added to exceptional patient care.

2. Demonstrate how to identify, collect, integrate, manage and understand building data — and how it can be turned into actionable information. Outcomes in a New Brunswick healthcare facility will be presented.

3. Understand how advanced building analytics can be used to enhance fault detection and system diagnostics, which will impact thermal and humidity levels as well as better service areas such as medical equipment requirements.

4. Describe the value of building analytics and the ability to improve an energy management program, including return on investment and project measurement and verification with respect to targets.

15:00-16:00 Track 4A:

2 CONCURRENT TRACKS - 4A & 4B Engineered Infection Prevention Barry Hunt, Coalition for Healthcare Infection Reduction, Cambridge ON

Engineered Infection Prevention (EIP) is a game-changer for hospitals. EIP includes automated technology and materials incorporated into healthcare infrastructure designed to eliminate air, water and surface transmission of disease. EIP was named a 2017 Top 10 World Patient Safety Innovation by the Patient Safety Movement, and is rapidly being adopted by leading hospitals and Ministries of Health across Canada. This presentation will provide an update on EIP research, technologies, implementation and standards.

Objectives: This session will help participants: 1. Identify opportunities and challenges to deploying EIP in existing facilities.

2. Assess the value of adding EIP to their facility.

3. Specify EIP materials and technologies when considering future projects.

NATIONAL CONFERENCE 2018 CONGRÈS NATIONAL | SEPTEMBER 16-18 2018 SEPTEMBRE | www.ches.org

Track 4B:

How Smart Robots Improve Logistics for Better Patient Outcomes Anthony Pugliese, SVP North American Sales, Swisslog Healthcare

Hospitals face many challenges in delivering outstanding patient care at a reasonable cost. Technology offers opportunities to improve healthcare efficiency and support patient-centred care. This session will provide an overview of how incorporating smart robotics into healthcare design provides engineers and their clients with solutions to logistics and workflow challenges.

Objectives: 1. Identify key healthcare trends and challenges impacting facility design and logistics.

2. Evaluate the value of smart robots in addressing challenges in healthcare design and the delivery of high-quality patient care.

3. Understand the opportunities for partnerships and how to select technologies that achieve engineering goals and objectives.

16:00-17:00

“Happy Hour” in Exhibit Hall - Sponsored by Trane

18:00-19:00

President’s Reception - Sponsored by Tremco President’s Reception Entertainment – Sponsored by Forest Contractors Avalon Ballroom Foyer, Delta St. John’s Hotel

19:00-23:00

Gala Banquet - Sponsored by Johnson Controls Banquet Entertainment – SPIRIT OF NEWFOUNDLAND - Sponsored by Chem-Aqua Avalon Ballroom Foyer, Delta St. John’s Hotel

TUESDAY SEPTEMBER 18, 2018 07:00-08:30

Breakfast – Sponsored by Stantec

08:30-09:30 TRACK 5A:

2 CONCURRENT TRACKS - 5A & 5B Maximizing Emergency Department Capacity by Design: New Workflow + Flexible Environments Jon Huddy, AIA, NCARB, March, BA Jerald D. Peters, Architect AAA AIBC MAA OAA SAA FRAIC LEED AP

Capacity is a challenge for nearly every emergency department (ED) across Canada. Reshaping operational flow, staffing patterns and the physical environment can elevate capacity and streamline care for patients, resulting in a high-performance ED. Sample projects from across Canada, as well as other ED projects around the world that impacted the design of recent Canadian ED projects, will be presented to document how rethinking flow and architecture can result in tremendous project success.

Objectives: This session will help participants: 1. Identify key operational and facility data points that need to be considered when approaching a comprehensive emergency department design solution.

2. Describe the process to incorporate hospital and ED clinical leaders and staff into a comprehensive design process that considers operational redesign and architectural planning.

3. Assess various operational and physical design alternatives to elevate ED capacity and reduce key length of stay metrics.

4. State the benefit of considering key operational data, new patient flow and flexible design concepts for any ED project.

TRACK 5B:

Primary Healthcare Infrastructure Design Guide: Patient-focused Design Supporting Collaborative Care Teams David LeBlanc, P.Eng, Project Manager, Nova Scotia Department of Transportation and Infrastructure Renewal, Engineering, Design and Construction Suzanne Rhodenzier Rose, RN, BScN, MHA, CIC, Provincial Director, Nova Scotia Health Authority, Medical Device Reprocessing

This presentation describes the development of a design guide for purpose-built infrastructure to support the emergence of collaborative care teams, called patient-focused primary healthcare. The presentation will provide a detailed description of the Design Guide for Infrastructure Supporting Collaborative Healthcare Teams, key outcomes for the specific detailed requirements and how they relate to the healthcare environment, care providers, quality, patient safety and the patient experience.

Objectives: 1. Provide evidence of how changing primary healthcare delivery models need purpose-built infrastructure to support their delivery.

2. Identify how the overarching principles of patient safety, quality, infection control and the patient experience are captured in the design guide.

3. Describe how the design guide is being implemented, the positive impact and the challenges with change.

09:30-10:15

CHES National Annual General Meeting

10:15-10:45

Refreshment Break in the Exhibit Hall – Sponsored by CORE Engineering Inc.

10:15-10:45

CHES CCHFM Prep Course - Targeting Challenges through Certification – Why CCHFM? Why me? And why now?

Gordon Burrill, P.Eng., CCHFM, FASHE, CHFM, CHC

explore why you should consider challenging the CCHFM exam to demonstrate your competence in the complex field of healthcare facilities management. We will spend some time discussing highlights as well as presenting the types of questions that you might expect when taking the exam.

Objectives: 1. Provide a basic overview of the requirement for those contemplating challenging the exam.

2. Attendees will leave the session with a better understanding of the competencies.

3. Attendees will be given insight into the structure and style of questions that may be asked on the exam.

10:15-13:15

Exhibit Hall Open

12:15-13:15

Lunch in the Exhibit Hall / Draw Prizes - Sponsored by Thermogenics

13:15-14:15 TRACK 6A:

2 CONCURRENT TRACKS - 6A & 6B Operating Room Relative Humidity Control using Liquid Desiccant Dehumidification Technology Patrick Leach, Alfa Laval-Kathabar Clean Air Mark Piegay, Global Sales Engineer, Alfa Laval-Kathabar Clean Air

This session addresses the issue of maintaining the required relative humidity (RH) level within an operating room (OR) setting in an academic health sciences centre with a 734-bed acute care hospital.

Problematic RH levels, and methods of dealing with and solving the RH control level will be discussed.

Attendees will learn how the application of liquid desiccant dehumidification technology resolved the unacceptable RH levels within the hospital OR suites.

Objectives: 1. Identify the acceptable relative humidity (RH) level within an operating room (OR).

2. Explain the inability of conventional HVAC to maintain OR RH level.

3. Explain how liquid desiccant dehumidification controls RH level in the OR. 4. Explain how to apply liquid desiccant dehumidification to an existing HVAC system.

TRACK 6B:

Five Steps to a Successful Hospital Construction Project – Sponsored by Abatement Technologies Martin Mielke, MTE Consultants Inc., Kitchener ON

Hospital construction projects are unique in their complexity and the success of any project, from a small-scale renovation to a capital renewal project, is not accidental. What are the steps to ensure minimal disruption to hospital services, consistency in care and, ultimately, protection of patient health regardless of the size of the project? It is our goal to outline five key steps that will aid you in planning a “successful” construction project for your facility.

Objectives: This session will help participants: 1. Identify the foundational elements for a successful construction project in their facility.

2. Assess the effectiveness of their current project process.

3. Identify opportunities to integrate a “patient-first” approach into their construction projects.

14:15-15:15 TRACK 7A:

2 CONCURRENT TRACKS - 7A & 7B Intelligent Drains: Addressing HAI with Hand Hygiene Sink Drainset Technology Christopher McLeod, OS&B, Oakville ON

The hand hygiene sink in the hospital room is a boon and a curse. The boon is to supply a dependable tool for Listerian hand hygiene, the curse is the provision of a local nexus for bacteria leading to nosocomial infection causing Hospital Acquired Infection (HAI), particularly in ICU and other rooms hosting immunocompromised patients. Research on the influence of design, materials and process regarding the drainsets of hand hygiene sinks in a major Toronto hospital over several years is discussed, ongoing research reviewed and other strategies considered. The cost of HAI is reviewed to inform budgetary choice of control strategies.

TRACK 7B:

St. Michael’s Hospital: The Application of Digital Healthcare Technology into an existing Healthcare Expansion Project Michael Keen, P.Eng, MBA, Executive Director, Chief Planning & Redevelopment Officer, St. Michael’s / St. Joseph’s / Providence Marco Ottavino, Honeywell

St. Michael’s Hospital had three challenges ahead of it in 2016: build a modern new wing to their hospital; fill it will modern technology to drive world-class patient experience and clinical outcomes; and integrate it within an existing healthcare ecosystem. This presentation will focus on the holistic approach implemented at St. Michael’s, and the successful outcomes achieved throughout 2017-2018 with the hospital expansion project and applied use of digital healthcare technologies.

15:15-15:45

Refreshment Break – Sponsored by CBCL Limited

15:45-16:45 TRACK 8:

PLENARY SESSION - TRACK 8 Relationship between Indoor Air Parameters and Occupant Health: Roles of the Microbiome of the Built Environment Dr. Stephanie Taylor, CEO Taylor Healthcare Commissioning Inc.

16:45-17:00

Closing Ceremonies

This presentation starts with an overview of the competencies with which an individual should be familiar in order to challenge the Canadian Certified Healthcare Facility Manager exam. Competencies such as compliance; planning, design and construction; maintenance and operations; finance; and administration will be explored to get a sense of exactly what is to be expected in a certified individual. The session will

NATIONAL CONFERENCE 2018 CONGRÈS NATIONAL | SEPTEMBER 16-18 2018 SEPTEMBRE | www.ches.org

TRADE SHOW

Sponsorship

Participating companies are listed below.

Masco Canada (DELTA Commercial) MediaEdge Communications Inc. Medical Design MegaMation Systems Inc. MIP Inc. Mondo Contract Flooring Morris Lee OS&B Pinchin Ltd. Precise Parklink Precision AirConvey Waste & Linen Conveying Group Primex Reliable Controls Rodan Energy Solutions Inc. RWC Setra Systems Smillie McAdams Summerlin Ltd. Specified Technologies Inc.

3M Window Film Products Abatement Technologies Air Liquide Healthcare Altro AMG Medical Amico Corporation Ascom Austco Communications Belfor Property Registration Belimo Canada Bender Canada Inc. Camfil Canada Inc. Canadian Coalition for Green Health Care CGC Inc. Chem-Aqua, div. of NCH Canada Inc. Class 1 Inc. Construction Specialties, Inc. DCM Inc.

DDC Dolphin Ltd. ECNG Energy Group Firestop Contractors International Association Follett LLC Franke Kindred Canada Limited Global Plasma Solutions Grundfos Health Care Relocations Ltd. Heritage Parts Canada Honeywell IEM Industrial Electric (Mfg) Canada Inc. IRC Building Sciences Group iSave Team Johnson Controls Klenzoid Labworks International Inc. Levitt-Safety Marathon Engineering Corporation

Conference App/Final Program . . . . . .

Companion Program. . . . . . . . . . . . . .

Student Program . . . . . . . . . . . . . . . . .

Mobile Recharge Station . . . . . . . . . .

Lanyards . . . . . . . . . . . . . . . . . . . . . .

Official Time . . . . . . . . . . . . . . . . . . . .

Sponsored by Medical Gas Innovations Sponsored by IEM Industrial Electric (Mfg) Canada Inc. Sponsored by H.H. Angus & Associates Limited Consulting Sponsored by Jewer Bailey Consultants Limited Sponsored by Stantec Consulting Sponsored by Primex

Steam Specialty Sales Ltd. Swisslog Healthcare Thermal Energy International Thermal Insulation Association of Canada Thermogenics Thomson Power Systems Time Trackers Ltd. Toromont CAT Trane Tremco Roofing and Building Maintenance Trimco Universal Power Solutions Vernacare Canada Inc. Victaulic Weishaupt Corporation Wilshire Works Solutions

NATIONAL CONFERENCE 2018 CONGRĂˆS NATIONAL | SEPTEMBER 16-18 2018 SEPTEMBRE | www.ches.org

HEALTHCARE DEVELOPMENT

IT’S JUST A PHASE How to make renovation planning (relatively) painless

By Kim Spencer & Jeff Vernon

W

hether planning a small departmental renovation, major redevelopment or infrastructure renewal, there are a number of important questions to ask at the outset.

Having clear answers will have a positive impact on the project outcome.

In particular, project phasing can be greatly informed by asking the right questions about existing and required mechanical, electrical and plumbing services in order to arrive at a successful design solution that supports the project objectives, continued operation of the healthcare facility and safety of its patients.

So, what makes a renovation project a success?

Some key markers are meeting the schedule, staying on budget, minimally disrupting operations and having no safety issues.

Since each facility and project is unique, however, there may be additional, more specific considerations that arise.

SCOPING IT OUT

One of the most important questions is, What is the project scope? At a higher level,

What problem/need will the project solve?

It may be an identified need for redevelopment of a particular area or a key piece of equipment has been failing regularly and funding is now available to address it.

Be aware that the scope may grow beyond the initial assessment based on the requirements of current codes and standards, and existing equipment capacities, among other factors. It is essential to fully understand these impacts and determine how to deal with them.

Conditions specific to the site may dictate changes to the planned scope. For example, there may be a need to run new services into the renovation area from a distribution shaft; replace existing services and equipment to accommodate a renovation, unless alternative approaches are feasible (such as rearranging or reworking equipment to facilitate the increase in load); or phase renovations in critical areas, such as the emergency department, so they can remain operational.

Realize, too, the quality of project work is constrained by three factors: budget, deadlines and scope. A trade-off between con-

straints is possible but changes in one will usually mean adjustments in the other two to compensate, otherwise the quality of work will suffer.

FACING THE UNKNOWN

It’s imperative to identify and mitigate risks in advance as much as possible. A good question to ask is whether there are plans and budgets for the unexpected, such as discovering ‘serviceable’ equipment is actually on its last legs or the capacity of a generator won’t permit additional load.

One form of technology that can help mitigate the risk of the unknown is 3-D scanning of systems infrastructure, which can greatly improve the reliability of ‘as-built’ information. Scanning is performed within a space to collect ‘as-built’ data and the resulting point cloud is reconstructed into a 3-D model. The model can accurately capture the scanned space and size of services and objects within. This approach works particularly well for plant spaces where services are exposed.

Another way to mitigate unknown risk is by pre-demolition of a space prior to SUMMER/ÉTÉ 2018 23

HEALTHCARE DEVELOPMENT

s LEFT TO RIGHT: Construction in progress at British Columbia's Penticton Regional Hospital. Data gathering panel at Royal Victoria Hospital (RVH) in Barrie, Ont. Information technology hub room at RVH.

finalizing the design. After demolition of walls and ceilings, the design team can physically view existing services, identify conditions that may not be observable prior to demolition and update documents accordingly. When this is possible, the schedule cost of approximately three to four weeks is often well worth it to alleviate the impact of the unexpected. Other ways to confirm the current condition and capacity of services include review of maintenance records, pipe thickness tests, drain scoping, air and water audits, and metering existing services.

Unknowns are always a risk to the budget, schedule and project scope. No matter how diligent the preparations, carrying an allowance as part of the project budget is recommended.

ACCORDING TO SCHEDULE

Questions around schedule are also critical: How quickly does the project need to be designed, constructed and in operation? Is there a fixed deadline (for example, driven by financing mechanisms such as the Health Infrastructure Renewal Fund (HIRF) or Hospital Energy Efficiency Program (HEEP))? How has the schedule been developed? Have representatives been engaged from across the hospital team? What about the design team? And, depending on how the project is being delivered, is construction team input required?

In building the schedule, it’s important to allow time for considerations such as long delivery equipment items, after-hours work, proper infection prevention and control, and construction phasing. If phasing includes multiple phased occupancies of various areas, time should also be allotted for testing, 24 CANADIAN HEALTHCARE FACILITIES

adjusting, balancing and approvals from authorities having jurisdiction at the conclusion of each stage.

Other scheduling-related questions include: Are plans in place to meet required procurement timelines and processes? Are requests for qualifications and/or proposals or tenders being released through a procurement department? Is the facility posting for competitive bids? If so, does the schedule account for the required bidder response times?

Engaging a design team experienced in healthcare renovation will greatly assist in arriving at reasonable and reliable answers to these questions. The team will also need to understand future plans for the facility. For example, if replacing boilers and the five to 10-year plan includes building an addition, consider whether reasonable allowances can be made in the boiler project to facilitate future expansion. Sometimes spending a few extra dollars now can save on future capital and operating costs.

A MATTER OF PRINCIPLES

Answers to the preceding questions will inform the establishment of the project’s key principles; in other words, the most important factors driving the project.

When faced with a difficult decision during the project, these principles will serve as a guide for making decisions.

The principles may be driven by budget, schedule, patient experience or a combination of these, plus other factors. Whatever is identified as key principles, share them with the team to assist in setting expectations and defining the scope.

When key principles are established, the sum of the parts may not lead to the outcome originally envisioned. For example, getting things done quickly does not always lend itself to the lowest cost; off-hours/overtime work may be required to meet a compressed schedule. A well-worn axiom sums up this challenge: All successful projects require sufficient time, money and quality. If one is missing, there better be lots of the other two.

PHASING IMPACT

Construction phasing — the general sequence in which the renovation work needs to be performed in order to meet project requirements — is a culmination of addressing all the foregoing issues.

Phasing is developed by considering factors such as schedule, departmental operations, hospital operations, infection prevention and control, and budget.

The earlier construction phasing is established, the better. For a departmental renovation, for example, the ideal situation is to shut down the entire area; however, this is often not possible due to operational constraints, so phasing becomes critical.

When establishing phasing, consider how different phases will affect existing mechanical, electrical, plumbing and information technology services. These services often do not respect a renovation project’s physical boundaries. For instance, ductwork supplying one area may continue through to a completely unrelated area but the renovation may impact both.

If the team includes multiple design disciplines and professionals, encourage the

HEALTHCARE DEVELOPMENT architect to engage the engineers early and often in the phasing planning to help mitigate some of these risks.

In the early stages of multi-phase projects, execute enabling works for later phases. For example, leave valved/capped connections for extension of medical gases; rough-in junction boxes/empty conduit; allow for proper raceways; and consider placement of any new equipment to permit easy access to expand in a future phase. These simple steps can help ease some of the challenges of building a project over multiple phases.

Minimizing disruption to operations is typically one of the most important factors in a healthcare renovation project. Some schedule-friendly approaches include seasonal replacement of infrastructure (for chiller replacement, schedule construction in non-cooling months; conversely, schedule boiler replacement in summer) and the use of pre-fabricated equipment to assist with overall schedule and phasing/turnover.

FUTURE OUTLOOK

If the initial project scope doesn’t include

infrastructure upgrades, it’s important to assess the equipment serving the renovation area and clearly understand its life expectancy and operating costs.

While the budget may not allow for it, investigate if spending a little more now (from the capital budget) can reduce future operating costs.

And while looking into the future and thinking about operating dollars, consider the facility’s master plan.

Can this current renovation reasonably accommodate parts of future planned renovations?

Those accommodations could include purchasing additional capacity for particular equipment, leaving space for future equipment in a location conducive to expansion or choosing modular equipment that can be readily expanded.

CODES OF PRACTICE

It’s essential to understand the impact of current codes and standards on the project. The design team can help sort through which activities and replacements should be undertaken

versus those that must be done.

Understanding how codes and standards relate to the project is critical as they can potentially have a major impact on the project scope and, accordingly, the budget and schedule as well.

GROUNDWORK FOR SUCCESS

For the best chances of delivering a successful project, it is important to ask the right questions. In particular, clarity around the project’s scope and problems it addresses is vital. Determine phasing and related impacts early. As much as possible, identify and mitigate risks in advance. Finally, engaging a design team with verified healthcare renovation exper ience is a va luable asset in achieving these goals.

Kim Spencer, P.Eng., is a mechanical engineer and principal, health division, at HH Angus and Associates Ltd. Jeff Vernon, P.Eng., is an electrical engineer and principal, health division, with the consulting engineering firm. They can be reached at kim.spencer@hhangus.com and jeff.vernon@hhangus.com, respectively.

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SUMMER/ÉTÉ 25 2018-02-26 2018 2:40 PM

EMERGENT READINESS Focus on five factors key to success in relocation of ED

By Benjie Nycum & Lori-Anne Jones

M

anaging change in healthcare is no easy feat. When that change occurs in an existing hospital (through an expansion or renovation project) where care must be seamlessly provided, it introduces an additional element of complexity and comes with disruption and stress. This is furthered when tasked with planning a move into a new space.

Staff is busy providing what’s most important — quality care — with little time to juggle an extra item on their already overladen ‘operational’ plate.

Aberdeen Hospital’s Jennifer Sutherland faced this when planning the move into the healthcare facility’s new emergency department (ED). Located on the south side of the hospital, the new ED is four times the size of the original, providing improved 26 CANADIAN HEALTHCARE FACILITIES

layout and workflow for healthcare providers.

But with no additional staff, the ED’s health services manager was apprehensive about the relocation.

“Honestly, I was unsure about how I was going to pull it off,” says Sutherland about the year-long change readiness process through which she led her team.

To successfully execute it, Sutherland focused on five key areas in the 12 months leading up to the move: time, relationships, accountability, structure and serious leadership.

TIME MATTERS

In any healthcare change initiative, particularly when construction is involved, ensuring sufficient time to both establish stakeholder buy-in and ownership, as

well as allowing for major construction milestones such as substantial completion and occupancy, are critical.

Substantial completion is an important milestone because once achieved, staff can enter the space and think through their workflows. Occupancy is an obvious essential milestone, when the work of tangible preparation can happen in situ.

However, these milestones are often moving targets. Change planning has to be well-structured yet sufficiently agile to make modifications on the fly to avoid stale-dating for team readiness.

“Three hundred days after the change management consultants were procured and started up felt adequate,” says Sutherland. “I wouldn’t recommend less time for a project of our scope and complexity.”

HEALTHCARE DEVELOPMENT

RELATIONSHIP STATUS

Well-managed relationships are crucial to achieve successful change. In the first 100 days, the change consultants should map internal and external relationships, and validate how they will impact one another as a result of the planned change.

In the case of Aberdeen Hospital, a detailed matrix for each of the 24 service areas provided the key reference for this enterprise relationship scaffolding, tracking such things as current and future state, risks and associated impacts as well as requirements and strategies. This deep (and sometimes frustrating and exhausting) exercise provided a vital integration tool going forward.

MAKING IT COUNT

At Aberdeen Hospital, the first 100 days were used to form the project structure and conduct deep assessments of each service area. The next 100 days were spent designing the change tools, with the final 100 spent actively implementing and testing change, primarily through simulations and standard operating procedure, or SOP, refinement.

“At the 21-day mark after we moved into the new space, we had every kink ironed out,” says Sutherland. “Our colleagues in a nearby hospital came to visit and said it took them a whole year to do what we did in three weeks. A lot of this can be attributed to taking the time and (making the) commitment to a change readiness planning process.”

Accountability anchors were leveraged at Aberdeen Hospital using tools such as terms of reference and decision process mapping, which were collaboratively developed and collectively owned across the service areas and key stakeholder groups. This created and clarified personal and broader service specific motivation by defining accountability to each individual, one another and, most importantly, patients and families. Once people realized participating in change planning was critical to their own as well as the entire team’s success, accountability was fortified.

SOUND STRUCTURE

Structure is essential to prevent the daily demands of regular work from interfering with critical change planning activities. For this, external consultants are beneficial because their primary task is to drive towards a successful outcome and they are less influenced by the day-to-day operations that would otherwise delay change planning.

The consulting team at Aberdeen Hospital created structure by developing

and implementing a range of tools, including: structural plans and diagrams that illuminated relationships, decision-making, leadership and integration; a detailed assessment matrix and a facilitated step-by-step plan for each of the 24 service areas; process and SOP mapping; leadership coaching; a concurrent ‘patients and families’ engagement plan; a stakeholder engagement plan; simulations; and validation and close out.

FOLLOW THE LEADER

Change is uncertain. With so many variables that have the potential to intervene and disrupt it, strong leadership is vital. Qualities that are found in successful leaders are authenticity, clarity, certainty, tenacity and hard work. A good leader also needs strong and steady back-up from superiors, co-workers and employees.

In Sutherland’s case, the leadership demands on her were overwhelming.

“It wasn’t just the work, making all the decisions and the mental and emotional energy,” she says. “It was also the fear that if this fails, it will be all my fault.”

To bring change to fruition at Aberdeen Hospital, it sometimes meant making decisions based on limited data and a lot of visceral reaction and exper i e n c e. A n u n d e n i a bl e a s s e t o f Sutherland’s leadership is that she always kept her word with her team.

She’s also skilled at authentic confrontation, which led to intelligent and meaningful resolution.

Benjie Nycum is CEO and strategic planner at Nycum & Associates, and an adjunct professor in the Faculty of Architecture and Planning at Dalhousie University. Lori-Anne Jones is president and chief change strategist at SHIFT StrategiesChange Consulting. SHIFT expertly creates the right space for leaders, teams and organizations to fully realize their transformational potential.

SUMMER/ÉTÉ 2018 27

SPONSORED CONTENT

POWER, STAT! It was a step towards sustainability that almost became a stumble. Shortly after a Canadian hospital invested in an energy-efficiency upgrade, the facility began experiencing significant issues with their critical equipment. System malfunctions and complete shut-downs began affecting treatments and dayto-day operations, causing delays, frustrations, and sizable headaches for both staff and patients alike.

After some investigation, they reached the conclusion that it was a power quality issue.

Soon after, the hospital reached out to Schneider Electric Services to do a thorough investigation.

DIAGNOSING THE DISTURBANCES Schneider Electric was no stranger to the facility, having worked with the hospital on several prior initiatives. As such, its Power Quality (PQ) team jumped in with an acute understanding of its electrical configuration.

The initial review and analysis of the site were completed using the existing Schneider Electric Power Management System (PMS). This helped immensely to review the site’s electrical grid parameters and narrow down the likely sources of the power quality issues. Ultimately, three PQ

disturbances were identified: voltage distortion (THD or VTHD), voltage sag, and zero crossover point distortion for voltage.

The cause of the voltage distortion and multiple zero cross-over points was determined to be tied to the lighting ballasts and variable frequency drives (VFDs) that were installed as part of an energy retrofit.

While the existing PMS provided Schneider Electric’s PQ team with a general direction of where to look, further analysis was required to determine the source and quantity of harmonic current being generated and to evaluate the cost and time required to implement the recommended solutions.

Soon after, Basillio Binghay, a Power Quality Specialist with Schneider Electric Power, arrived

to conduct a full power quality audit. He set up the appropriate tools at the various nodes within the electrical system and began logging the various parameters and disturbances such as sags, voltage spikes, voltage, and current distortion levels. Over a period of several months, the data was compiled and a report was drafted and delivered to the facility manager which indicated some of the substations had significant levels of voltage distortion.

Based on the data observed, the PQ team concluded that the main source of harmonic current was the variable frequency drive (VFD) loads. The harmonic current produced by the VFDs was significant and it was causing voltage distortion throughout the entire electrical distribution system. A Reactive Compensation and Harmonics Filtering Activity Simulation

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“ An electrical system is like a living organism. And, like in healthcare, each treatment is unique to the patient. First, we diagnose the symptoms and get to the root of the issue, identify the culprits, and only then can we tailor a solution for the grievance at hand.”

report was then prepared which summarized the findings, modeled the system and – more importantly – simulated the results of different filtering and compensation techniques.

By applying the various compensation remedies, the harmonic current was calculated to be greatly reduced and in turn, the Voltage Distortion at the main incoming feeders would be reduced to below 3%. This would meet or exceed guidelines as per IEEE 519-1992 guidelines.

TAKING ACTION Schneider Electric’s PQ study presented three specific actions to rectify the situation.

1. Install input line reactors (3% Imp) for the VFDs rated 10 HP and above. Additional input impedance on a VFD will reduce harmonic currents and add protection to the VFDs from external transients.

2. Install Active Harmonic Filters at four locations on the 600 V Main Incoming system. These filters monitor the status of the grid and actively compensate for variation in the distortion levels on the grid and will further reduce voltage distortion to acceptable levels as per IEEE-519-1992 guidelines.

3. Install an isolation transformer at each of the main feeder circuits for the critical equipment to provided additional impedance during high-frequency switching, etc.

A simplified line diagram was then produced along with detailed mapping of the various feeders, transformers, MCCs, and electrical panels. This allowed the team to visualize what was needed and where. A plan of attack began to form.

The second part of the project included installing, testing, and commissioning the needed equipment. Schneider Electric won the bid which included not just the installation, but also project management, equipment supply, commissioning, and testing.

Since the equipment was installed, ongoing monitoring has shown that the power quality has improved significantly and the sensitive equipment is no longer shutting down or causing issues with patient treatment. Throughout the project, the power management system was configured to ensure the facility manager can review the progress and the system at any time, monitoring levels of power quality and disturbances. It is set up to alarm the team if anything in the system gets out of hand (i.e., voltage distortion on a particular feeder).

NO COOKIE-CUTTER CURE An electrical system is like a living organism.

And, like in healthcare, each treatment is unique to the patient. First, it is necessary to diagnose the symptoms and get to the root of the issue. Then, identify the culprits, and only then can you tailor a solution for the grievance at hand.

It’s true that the cost of addressing issues such as these can be intimidating at first and it can be a challenge for organizations to receive funding for improvements. That’s why it’s critical to be armed with the best information available to enable success.

Power Quality issues can look daunting and it can manifest itself through strange and seemingly non-related occurrences like essential equipment shut-downs, electronic and electrical equipment failure, and the tripping of critical circuits. With the right tools and skillsets, however, these adversaries can be exposed, measured, and treated.

References: IEEE Std. 519-1992: Recommended Practices and Requirements for Harmonic Control in Electrical Systems

To contact a Power Quality specialist, visit us at www.schneider-electric.ca/pqs

MAINTENANCE & OPERATIONS

COMPUTER CHRONICLES CMMS systems improve biomedical equipment management at facility level

By Reena Sommer

A

t no other time than now has the healthcare delivery system been more challenged with the task of keeping pace with changes largely the result of medical and technological advances. Some of the most noteworthy advances in the past 15 years include genomic mapping and testing, targeted cancer therapies, combination drug therapies for HIV, laparoscopic surgeries and bionic limbs. Along with these developments, there have also been changes in industry standards centred on revising drug regulations and protocols, improving patient care safety and record privacy, and adopting smoke-free environments, just to name a few.

Healthcare facilities are also challenged to adapt and change in response to demands for equipment modifications or upgrades, compliance with stringent government regulations and 30 CANADIAN HEALTHCARE FACILITIES

performance audits. Because of the ongoing evolution in healthcare in general, facilities across the spectrum are now increasingly turning to computerized maintenance management software (CMMS) systems to monitor and execute preventive maintenance programs. For those new to maintenance management systems, CMMS is best described as a highly sophisticated program that utilizes thousands of data points, which, at any given time, can provide a user with an overview of a facility’s operations or, alternatively, the status of an individual piece of equipment. In terms of functionality, these systems offer organizations the ability to monitor inventory levels, track work orders, quickly generate accurate reports and instantly determine which of their assets require preventive maintenance.

THE PERFECT SCHEDULE

Unlike other facilities, most healthcare environments operate on a 24-7 basis.

Consequently, there is no defined time when operations cease in order to carry out unrestricted maintenance activities.

This poses an added scheduling challenge for maintenance managers to consider, especially in light of the potentially life-saving functions that biomedical equipment provides.

CMMS systems are able to assist in overcoming this obstacle by tracking equipment usage and identifying low usage times in order to schedule optimal times for maintenance activities to occur. As well, many CMMS systems include mobile device photo integration and architectural drawings that can highlight the exact locations of equipment. By grouping scheduled preventive maintenance tasks by location, this is another way to improve efficiency for health-

care facilities that often have thousands of pieces of equipment to manage.

software that reduces error and improves overall operations efficiency.

SEND IN THE TASK FORCE

IN THE LONG RUN

In the same way that architectural drawings and mobile photo accessibility identify the location of equipment and assist in preventive maintenance scheduling, CMMS systems can also be helpful in strategically deploying maintenance technicians to carry out tasks. By assigning technicians to particular areas of a facility in need of preventive maintenance on several pieces of equipment, time, energy and resources can be saved.

A logical corollary of preventing unforeseen equipment failure is ensuring its continued long-term use along with increased lifespans.

Given the high cost of biomedical equipment, it is imperative that replacement costs are minimized by directing efforts toward proper use and routine maintenance.

Scheduling regular preventive maintenance using CMMS systems, with their task checklists, notifications, reports and mobile device apps, is the best way to ensure all biomedical equipment will continue functioning optimally for as long as possible.

READY FOR INSPECTION

Biomedical equipment must adhere to strict and routine inspection requirements.

Keeping track of inspection dates on thousands of pieces can be an arduous task when using a spreadsheet alone. This important task is made easier by entering inspection dates into a CMMS system where notifications (and reminders, if needed) are delivered as inspection dates approach.

CMMS systems also have the capability of sending notifications via computer as well as mobile devices.

FAILURE NOT AN OPTION

In the past, equipment maintenance was primarily a reactive exercise. More to the point, preventive maintenance did not really previously exist because equipment was maintained on an as need basis only when a problem surfaced.

With CMMS systems, preventive maintenance is now a reality and benefits are noticeably apparent. For example, an important and critical benefit of conducting preventive maintenance on biomedical equipment is avoiding unforeseen equipment failure. Maintaining equipment on a routine basis ensures its function and ongoing operation. Through regular checks, major repairs can be minimized, if not completely eliminated.

CMMS systems provide maintenance managers with a checklist of all tasks involved in maintaining each piece of biomedical equipment in addition to creating routine schedules, sending notifications and reminders, and generating maintenance reports.

Additionally, when replacement parts are required, the CMMS’s integrated barcode scanning app ensures that the exact part is ordered. This is yet another benefit of the

help facility managers make informed decisions about allocating technicians, scheduling routine maintenance and ordering replacement parts as needed. These benefits suggest that conducting regularly scheduled preventive maintenance is the best way to avoid unforeseen equipment failure while also prolonging their lifespans. To ensure that all equipment is operating optimally, CMMS systems are able to accomplish this by using advanced features such as mobile device capabilities (for example, barcode scanning, camera integration and user access) and architectural drawings, as well as by providing checklists for all preventive maintenance tasks, notifications and reminders, and maintenance reports once preventive maintenance is completed.

THE BIG PICTURE

Preventive maintenance is a central function of efficient healthcare facility management.

Without routine scheduled preventive maintenance, unanticipated breakdowns, costly repairs and even equipment replacement may result. Poorly maintained biomedical equipment may also pose unnecessary risks to patients.

CMMS system analytical reports can

Reena Sommer graduated from the University of Manitoba in 1994, with a PhD in psychology, sociology and family studies. She has had a diverse career, working as a researcher in U of M’s community health sciences department, a mental health consultant to First Nations communities and a self-employed trial consultant. Now retired, Reena spends her time travelling and contributing content for Hippo CMMS.

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SUMMER/ÉTÉ 2018 31

MAINTENANCE & OPERATIONS

GUIDING THE WAY PIDAC’s latest best practices for environmental cleaning sets minimum standards to prevent, control HAIs

By Keith Sopha

H

ousekeeping staff continue to face cleaning and disinfecting challenges in healthcare facilities because many environmental surfaces don’t meet best practice recommendations under the Provincial Infectious Diseases Advisory Committee (PIDAC), a multidisciplinary scientific advisory body that advises Public Health Ontario on the prevention and control of healthcare-associated infections (HAIs).

However, PIDAC’s recently released third edition of Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings places more stringent guidelines on the selection of environmental surfaces in healthcare settings in the hopes of changing this.

EARLY EDITION

PIDAC first released its best practices document in 2009, to ensure the critical elements and methods of decontamination, disinfection and sterilization are incorporated into healthcare facility procedures.

Specifically, it addressed the healthcare environment and equipment cleaning.

32 CANADIAN HEALTHCARE FACILITIES

Citing numerous studies, the committee acknowledged the physical setting can harbour bacteria and viruses that may be transferred to patients and equipment via the hands of healthcare professionals, potentially causing infection in susceptible individuals. As a result, PIDAC affirmed that maintaining a clean and safe environment is essential to infection prevention and control, and integral to patient safety.

This was an important step forward in the selection process of environmental surfaces for healthcare settings but was not enough to make a huge difference in the type of surfaces entering such facilities.

DOCUMENT REVISITED

In 2012, the second edition of the best practices document was released, which addressed the selection of finishes and surfaces. PIDAC boldly stated, “If you can’t clean it, don’t buy it.”

At the time, the committee emphasized this point to ensure healthcare purchasing practices considered the importance of selecting finishes that are cleanable and

stand up to hospital-grade disinfectants. This applies to medical equipment and all finishes and surfaces, including materials for floors, ceilings, walls and furnishings.

Cleaning is the physical removal of foreign material; disinfection is the inactivation of disease-producing microorganisms. Surfaces must be cleaned thoroughly before effective disinfection can take place. If a surface can’t be cleaned, then it likely can’t be effectively disinfected.

The revised edition recommended clear purchasing policy statements and input from environmental services and occupational health and infection prevention professionals in the selection of finishes and surfaces. Combined, this would help ensure hard-to-clean items do not arrive in healthcare facilities.

The document also encouraged the implementation of a process to report and remove damaged items since fabrics that are torn and items that are cracked, chipped and scratched allow entry and accumulation of microorganisms, and are more difficult to clean and disinfect.

MAINTENANCE & OPERATIONS STATUS UPDATE

This past April, the third edition of the best practices document was released. Building on previous publications, it reflects increasing evidence that the environment plays a role in the transmission of microorganisms in a healthcare setting and uses the word ‘must’ to set a minimum standard based on current recommendations in medical literature.

PIDAC contends that all surfaces, items and equipment installed or used within a healthcare environment be cleanable and this must be a central consideration when facilities are designed, redesigned or renovated, and when new equipment is obtained.

Surfaces and equipment that are difficult or impossible to clean and disinfect should not be purchased, installed or used. The goal is to positively shift the supply industry. Once manufacturers realize they can’t sell certain products, they will move to develop those that meet PIDAC guidelines.

There is an additional statement of accountability regarding surface selection.

The administration of the healthcare setting is responsible for ensuring and verifying that any item used in the provision of care is

capable of being cleaned and disinfected according to current standards and guidelines. This includes purchased, borrowed or donated equipment, and equipment used for research purposes if such equipment will be used within the care environment.

Equipment that is used to clean and disinfect must also meet these standards.

A potential roadblock, however, is shared purchasing agreements, which often don’t include appropriate stakeholder input on surface selection. In the revised document, PIDAC stresses that infection prevention and control, occupational health and safety and environmental services personnel must be involved in the selection of environmental surfaces, equipment, furniture and finishes in healthcare settings.

With regard to repairs, the new document states that if equipment, furnishings, finishes or surfaces are damaged and cannot be effectively cleaned, they must be repaired, replaced or removed from use within clinical areas. In addition, healthcare settings must have a process in place to meet this provision.

There is also an increased requirement with regard to upholstered furnishings and carpeting.

Upholstered furniture and furnishings and other cloth items that cannot be cleaned should not be used in care areas, including nursing stations that support clinical activity.

Upholstered furniture that is used in care areas should be covered with fabrics that are fluid-resistant, nonporous and can withstand cleaning with hospital-grade disinfectants. Many healthcare facilities need to address this guideline as cloth-type seating is still often used in nursing stations.

Carpeting has been associated with an increased risk of HAIs in immunocompromised populations. Carpeted floors are more likely to become contaminated with C. difficile than their non-carpeted counterparts. PIDAC recommends that carpeting not be used in areas that house immunocompromised patients at risk of invasive fungal infections, such as transplantation and high-risk oncology units. It should also not be installed in clinical areas; if present, it should be removed, particularly within immunocompromised patient populations.

Keith Sopha is an environmental consultant and founder of CleanLearning.

• 200,000 people in Canada get an infection from a hospital each year • 5% (10,000) will die • Healthcare acquired infections cost us $4-5 billion EACH year Join the Coalition for Healthcare Acquired Infection Reduction (CHAIR)

@chaircanada info@chaircanada.org 34 CANADIAN HEALTHCARE FACILITIES

www.chaircanada.org

RELIABILITY

EcoStruxure for Healthcare brings

$119B to $188B is the estimated amount of losses due to power-quality phenomena in the U.S.* • Power quality is critical to the health of your electrical system.

• Learn how poor power quality can be identified and mitigated.

• Schneider Electric has the solutions to resolve any power-quality concerns.

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Learn more at

schneider-electric.ca/pqs *S. Bhattacharyya, S. Cobben, “Consequences of Poor Power-Quality — An Overview” ©2018 Schneider Electric. All Rights Reserved. Schneider Electric | Life Is On is a trademark and the property of Schneider Electric SE, its subsidiaries, and affiliated companies. 998-20329009_US

REGULATORY UPDATE

DON’T BE SHOCKED

BY CHANGE Keeping up-to-date with CSA Z462

By Terry Becker

T

his year heralded in the fourth edition of CSA Z462, Workplace Electrical Safety. It builds upon previous versions by including new definitions that harmonize with other safety standards, such as CSA Z1000 (Occupational Health and Safety Management) and CSA Z1002 (Occupational Health and Safety: Hazard Identification, Elimination, Risk Assessment and Control), and those dealing with arc flash and shock hazards. It also features additional requirements aimed at establishing more robust electrical safety programs.

Here are some of the most noteworthy changes to the standard, which aims to help workers install, operate and maintain electrical equipment safely, and provide additional safeguards to those who work in close proximity to energized electrical equipment.

SAFETY FIRST

Clause 4.1.6 contains several new electrical safety program requirements.

Newly installed or modified electrical equipment must be approved and inspected to ensure the basis for a ‘normal operating condition’ is fulfilled before contemplating condition of maintenance.

Human error must be considered and the hierarchy of risk control methods be applied to reduce risk to workers from electrical hazards. Methods include: elimination; substitution with other processes, systems or materials; engineering ‘safety by design;’ warning signs and barricading; administrative, training and procedures; and electrical specific personal protective equipment, tools and equipment, and proper care, use and maintenance.

A detailed job safety plan must be completed by a qualified electrical worker and documented. The plan should include a 36 CANADIAN HEALTHCARE FACILITIES

description of the job and individual energized electrical work tasks; identification of electrical hazards associated with each energized electrical work task; a shock risk assessment for energized electrical work tasks involving a shock hazard; an arc flash risk assessment for energized electrical work tasks involving an arc flash hazard; and work procedures, special precautions and energy source controls.

PURPOSEFUL TRAINING

Clause 4.1.7 outlines requirements for general electrical safety training for arc flash and shock hazards for qualified electrical workers and unqualified persons. They include: arc flash and shock hazard training with safety-related work practices; lockout procedure training; and emergency procedure training with specific instruction on contact release.

Clauses 4.1.10 and 4.1.11 provide guidance and protection to unqualified persons working with portable cord-andplug connected electric equipment and ground-fault circuit interrupters, or GFCIs. This is where the risk of shock to unqualified persons exists. Risk reduction is achieved by awareness training and instruction of proper care, use, testing and maintenance.

Clause 4.2 includes lockout procedure training requirements. Two new steps have also been added to the process for establishing and verifying an electrically safe work condition: release of stored energy; and release or blocking of stored mechanical energy. It’s important to follow the eight-step process specific to electrical equipment isolation and ‘test before touch’ every conductor and circuit, every time.

ENSHRINED PRACTICES

Clause 4.3.6 provides several requirements that have a direct impact on the likelihood of occurrence that, for example, an arcing

fault will occur or there will be exposure to a shock hazard. Precautions for personnel activities include being aware of potential hazards at all times (alertness), communicating changes in scope, not reaching blindly into equipment that could contain exposed energized conductors or circuit parts and anticipating failure, among others. Specific policies and practices should be documented in the electrical safety program to ensure these requirements can be enforced.

SOMETHING SPECIAL

Changes to Clause 6 relate to safety requirements for special equipment, including electrolytic cell lines, batteries, lasers and power electronic equipment, and work requirements for research and development laboratories.

NOT TO BE FORGOTTEN

The annexes contain a wealth of information related to clause content: how to apply the standard in a safety management system; limits of approach; an example of an energized electrical work permit; a detailed lockout program; electrical hazard explanations; compliant arc flash and shock hazard equipment labels; high voltage substations and related practices; and details on human performance.

Terry Becker, P.Eng., is senior vice-president, electrical safety, at Danatec Educational Services Ltd. He is first past vice-chair of the CSA Z462 standard technical committee and currently a voting member and working group 8 leader, annexes. Terry is also a voting member on the Institute of Electrical and Electronics Engineers (IEEE) 1584 technical committee and a voting member of the CSA Z463 standard (2018). He can be reached at 1-403-465-3777 or tbecker@danatec.com.

A STUDY IN SUCCESS

Standard impacts healthcare facility design, helps prevent infection

By Hélène Vaillancourt

E

ach year, approximately 220,000 Canadians are struck by healthcare-associated infections (HAIs), with 8,000 dying as a result, according to the Public Health Agency of Canada.

The high number of HAIs is why the Canadian Standards Association (operating as CSA Group) developed Z8000, Canadian Health Care Facilities, in 2011. It was designed to help ensure improved outcomes for those receiving care in a healthcare facility where design and construction play a role. Given planned capital spending increases on healthcare facilities, no universally-accepted national standard and growing public concerns over HAIs, the need for Z8000 was clear.

THE STANDARD’S IMPACT

With the standard now seven years old, a study was launched to gauge the effect Z8000 has had on the healthcare facility landscape until now. While the standard includes many clauses designed to improve outcomes at healthcare facilities, the study focused on three features to determine

whether facilities have experienced a decrease in HAI rates. The features investigated were: the requirement for single-patient rooms (and separate washrooms in exceptional cases where a room was shared); dedicated provisions for human waste disposal (equipment/technology and location); and the requirement for deeper and better designed hand hygiene sinks (and their location) and the placement of alcohol-based hand rub stations When Z8000 was released, each of these requirements posed challenges, notably because of the increased capital costs associated with single-patient rooms and the lack of commercially available sinks at the time.

The latter has since been addressed but the former has yet to see widespread acceptance.

While Z8000 was not in place when the study projects were being designed, the study was able to examine healthcare facilities that were early adopters of the advocated design features. As a result, it could assess the impact on hand hygiene compliance and infection rates.

The infection prevention indicators

employed in this study included HAI quarterly rates for MRSA and C. difficile infection, and hand hygiene compliance.

RESEARCH PROCESS

In the planning and development stage of the study, existing literature was reviewed to determine if previous studies had examined the same design elements and if so, what conclusions those authors had drawn regarding effects on HAI rates. Generally, the literature concluded that evidence suggested there were improvements in HAI rates when these design elements were employed but the overall sense was that the issue likely warranted further study.

Further, the study examined data from Canada’s surveillance and reporting systems with respect to both hand hygiene compliance and the incidence of HAIs in healthcare facilities.

The research phase involved recruiting (via a questionnaire) healthcare facilities across the country that had recently undergone new builds or major renovations.

Qualified facilities then participated in a survey. All the survey data was reviewed and SUMMER/ÉTÉ 2018 37

REGULATORY UPDATE

analyzed with a specific examination of the reported HAI and hand hygiene rates to assess their statistical significance.

Nine healthcare facilities participated in the study; the majority (seven) were newly constructed facilities. With just two completed surveys from renovated healthcare facilities, the sample was too small to extract meaningful relationships or trends, so only new construction data was presented in the report.

Given the multitude of factors that affect HAI rates, the ability to consider every factor was limited. For this reason, the study focused on the correlations between key design parameters and related patient safety metrics (comparing before and after the move into a new healthcare facility).

Another challenge was the difficulty in establishing the correlation between each design element independently and changes in HAI rates. So, for the purposes of the study, all design elements were considered together as a bundle.

Other study limitations included the lack of uniformity of case definitions for MRSA and C. difficile infection, and incomplete information due to issues in collecting before data from some sites (different collection methods that may have been used in the past).

The average percentage of singlepatient rooms in hospitals before the new design was 15 per cent; that figure rose to 71 per cent in the new healthcare facilities.

Similarly, compliance to Z8000 requirements related to hand hygiene sinks and alcohol-based hand rub stations increased dramatically after the change in hospital design. For intensive care units in those healthcare facilities, hand hygiene sink compliance rose from 31 per cent to 90 per cent, with alcoholbased hand rub station compliance increasing from 57 per cent to 85 per cent. For the medical/surgical units of those healthcare facilities, hand hygiene sink compliance increased from 40 per cent to 84 per cent, while alcohol-based hand rub station compliance increased from 66 per cent to 82 per cent.

Although differences in measurement methods and insufficient data points made it difficult to calculate statistical significance, hand hygiene compliance rates showed an increase from 83 per cent to 88 per cent after the implementation of hospital design changes.

It is worth noting not all healthcare facilities showed a correlation between hand hygiene sink and alcohol-based hand rub station availability and hand hygiene compliance rates, which suggests factors other than facility design are THE RESULTS ARE IN influencing the rates such as the design Biomedical_2_CHF_Winter_2017_FINAL.pdf 1 2018-01-03 AM In terms of hospital design features, the and9:30 location of sinks and alcohol-based survey results showed an increase in hand rub stations, staff education and a compliance to Z8000 requirements healthcare facility’s safety culture.

Biomedical_CHF_Winter_2017_FINAL.pdf 1 2017-10-23 4:45 PM related to both single-patient rooms, and The data collected on C. difficile the design and availability of hand infection surveillance revealed an infechygiene sinks and alcohol-based hand tion rate decrease in five of the seven rub stations. healthcare facilities, two of which

experienced statistically significant decreases. Overall, C. difficile infection rates per 1,000 patient days dropped from 0.52 before the changes in hospital design to 0.29 afterwards.

MRSA rates underwent a similar decrease. While data was only available from five of the healthcare facilities, each one experienced a general decrease, with two of the facilities reporting statistically significant reductions. On the whole, MRSA infection rates per 1,000 patient days dropped from 0.38 before hospital design changes to 0.18 afterwards.

While healthcare facility design is just one element in the arsenal for preventing HAIs, it is vital that design supports rather than undercuts good practices in patient management, hand hygiene and human waste disposal.

The data collected in the study — as supported by subsequent analysis for statistical significance — backs the evidence that implementing key design elements in line with those recommended in Z8000 helps drive overall improvements in C. difficile infection and MRSA rates.

As healthcare facilities continue to follow best practices in design and improve the monitoring of key patient safety metrics, hospitals will be able to demonstrate where efforts have increased patient safety and where they can be focused for continued improvements.

Hélène Vaillancourt is vice-president, standards research and planning, at CSA Group and a member of the Canadian Patient Safety Institute’s board of directors. The full research report is available at www.csagroup.org/article/infectionprevention-control-health-care-facility-design/.

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