CHF Summer 2022

Canadian

HealthcareFacilities JOURNAL OF CANADIAN HEALTHCARE ENGINEERING SOCIETY

Volume 42 Issue 3

Summer/Été 2022

CLIMATE CHANGE ACCOUNTABILITY

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Nova Scotia Health reaps environmental, financial rewards of smart recommissioning plan

Monolithic versus modular UPS Remediating pathogens in plumbing systems Photodynamic therapy for mask decontamination

SPONSORED CONTENT

HELPING CREATE SAFE ENVIRONMENTS FOR HEALTH CARE DELIVERY IN CANADA Canadian Institute for Health Information estimated that Canada would spend $308 billion on health in 2021, representing 12.7% of Canada’s gross domestic product (GDP)¹. With such investment, Canadians expect safe, efficient, and effective health care services. But even the best-trained medical professionals will struggle if their efforts are undercut by poorly-designed hospitals, unclean instruments, or inefficient support systems. That’s where standards can help.

THE ROLE OF STANDARDS IN THE HEALTH CARE SYSTEM Standards are an important part of the total quality framework supporting health care delivery. By outlining requirements and best practices for performance and process, standards can help patients, staff, and visitors avoid injury from medical devices or acquiring health care-associated infections.

Standards can also help build better health care facilities that last longer, operate more efficiently, and serve their users better, and promote innovation through the adoption of new processes into standardized procedures. Further, standards often complement government regulations and help support flexibility in how certain requirements are adopted by health care services.

CSA GROUP STANDARDS FOR HEALTH CARE FACILITIES CSA Group has led the development and maintenance of health care standards for over 50 years. About 800 volunteer exper ts representing government, professional groups, industry, patients, and other stakeholders contribute their time and knowledge to the development of standards that help deliver health care services in safe environments.

CSA Group standards for health care

facilities (HCF) address various crucial aspects of their design, mechanical systems installation, commissioning, operation, and technology integration.

These standards are highly relevant for day-to-day activities in any wellfunctioning facility.

DESIGNING AND BUILDING HEALTH CARE FACILITIES The flagship publication in the portfolio, CSA Z8000-18, Canadian health care f a c i l i t i e s , p rov i d e s re c o m m e n d e d requirements and guidance for the planning, design, and construction of all types of HCFs regardless of their size, location, or range of services. While the Standard contains some very clear-cut requirements, it also allows for certain flexibility, acknowledging that every facility has its unique set of challenges.

Many concepts set out in the Standard, such as isolating infected patients and

¹ Canadian Institute for Health Information website, https://www.cihi.ca/en/health-spending (accessed in March 2022)

SPONSORED CONTENT

CSA Group Standards for Health Care Facilities CSA Z8000-18

Canadian health care facilities

Commissioning of health care facilities CAN/CSAZ8001-13 (R2018)

CSA Z8002:19

Operation and maintenance of health care facilities

CSA Z8003:21

Health care facility design research and evaluation

CSA Z8005

Special requirements for digital infrastructure in health care facilities (in development )

CSA Z317.1:21

Special requirements for plumbing installations in health care facilities

CSA Z317.2:19

Special requirements for HVAC systems in health care facilities

CSA Z317.5-17

Illumination design in health care facilities

CSA Z317.10:21

Handling of health care waste materials

CSA Z317.11-17

Area measurement for health care facilities

CSA Z317.12:20

Cleaning and disinfection of health care facilities

CSA Z317.13:22

Infection control during construction, renovation, and maintenance of health care facilities

CSA Z317.14-17

Wayfinding for health care facilities

CSA Z10535.1:15 (R2021)

Hoists for the transfer of disabled persons - Requirements and test methods

CSA Z10535.2-17

Lifts for the transfer of persons - Installation, use, and maintenance

CSA PLUS 317

Guidelines for elementary assessments of building systems in health care projects

CSA Z32:21

Electrical safety and essential electrical systems in health care facilities

CSA Z7396.1-17

Medical gas pipeline systems – Part 1: pipelines for medical gases, medical vacuum, medical support gases, and anaesthetic gas scavenging systems

Medical Gas Pipeline Systems - Part 2: Anaesthetic gas scavenging CAN/CSAZ7396.2-02 (R2007) disposal systems

single-patient rooms, were informed by the SARS crisis of the early 2000s and challenged the accepted design practices at the time. Many subsequent Standard updates happened in a similar way – through learned experience, reflecting changes in the health care system.

The next edition of CSA Z8000 is anticipated in late 2023. The Technical Committee is considering various updates to address challenges HCFs faced during the Covid-19 pandemic, from better pandemic planning and more flexible building configurations to temporary facilities and field hospitals, surge capacity and resilience, operating room pressurization, and many other topics.

MECHANICAL SYSTEMS IN HEALTH CARE FACILITIES Installations of mechanical systems in health care facilities are far more complex

than in regular commercial buildings. For example, plumbing installations in hospitals involve specialized water supply systems for operating rooms, laboratories, dialysis units, and so on.

Similarly, hospital heating, ventilation, and air-conditioning systems must ensure adequate indoor air quality for patients and staff and reduce the risk of airborne transmission of harmful microorganisms. All these systems are critical for patient and staff safety.

CSA Group standards CSA Z317.1:21, Special requirements for plumbing installations in health care facilities, and CSA Z317.2:19, Special requirements for heating, ventilation, and air-conditioning (HVAC) systems in health care facilities, of fer requirements for the design, construction, operation, and maintenance of these systems. The new edition of CSA Z317.2 (in development) will reflect

insights gained during the Covid-19 pandemic. The updated requirements will address pandemic planning, operating room pressurization, and other topics.

INFECTION PREVENTION AND CONTROL IN HEALTH CARE FACILITIES Cleaning and disinfection of surfaces are essential components of ef fec tive infection prevention programs in HCFs. CSA Z317.12:20, Cleaning and disinfection of health care facilities, is one of the standards supporting this area, applying to both manual disinfection practices and automated disinfection systems. The Standard outlines requirements for cleaning and disinfection processes and their frequency and includes additional requirements for specialized areas, such a s o p e ra t i n g ro o m s , e m e rg e n c y departments, hemodialysis units, or food preparation areas. The Standard also provides guidance on personal protective equipment, cleaning agents, and technologies, and addresses quality management system, staff education, and training.

NEW GUIDANCE FOR HEALTH CARE FACILITY DIGITAL INFRASTRUCTURE E m e rg i n g t e c h n o l o g i e s p l a y a n increasingly important role in the health care sector. Digital systems can help improve collaboration, efficiency, health outcomes, and patient experience, and save costs. As hospitals become more connected, integrating different systems becomes increasingly complex and critical to their day-to-day operations. The new standard, CSA Z8005, Special requirements for digital infrastructure in health care facilities, aims to address specific needs of the health care sector in this area. The Standard will provide a framework for the planning, adoption, implementation, and management of digital health technologies and infrastructure used in HCFs, including inter-system communication within HCFs and across the continuum of care. CSA Z8005 is anticipated to be published later in 2023.

While CSA Group HCF Standards may not be easily visible, they are important to a well-functioning health care system and services and help enhance their safety and effectiveness across Canada.

To learn more about these Standards, visit csagroup.org/store.

CONTENTS

CANADIAN HEALTHCARE FACILITIES Volume 42

Issue 3

EDITOR/RÉDACTRICE

Clare Tattersall claret@mediaedge.ca

PUBLISHER/ÉDITEUR

Jason Krulicki jasonk@mediaedge.ca

PRESIDENT/PRÉSIDENT

Kevin Brown kevinb@mediaedge.ca

SENIOR DESIGNER/ CONCEPTEUR GRAPHIQUE SENIOR

Annette Carlucci annettec@mediaedge.ca

GRAPHIC DESIGNER/ GRAPHISTE

Thuy Huynh roxyh@mediaedge.ca

30

PRODUCTION MANAGER/ Rachel Selbie DIRECTEUR DE rachels@mediaedge.ca PRODUCTION CIRCULATION MANAGER/ Adrian Hollard DIRECTEUR DE LA circulation@mediaedge.ca DIFFUSION

DEPARTMENTS

BUILDING SYSTEMS

6

Editor’s Note

8

President’s Message

38 Choosing a UPS System Monolithic versus modular uninterruptible power supply

10

Chapter Reports

12

Announcements

40 What’s Lurking in the Water The impact of poorly managed, maintained plumbing systems and mitigating risks

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

INNOVATION & TECHNOLOGY

PAST PRESIDENT TREASURER SECRETARY

16 Enhancing the Sustainability of Existing Buildings Améliorer la durabilité des bâtiments 26 Harnessing the Power of Data Real-time machine learning for optimal operations of medical gas systems 30 32

Dyes, Light and Oxygen A novel method for mask decontamination Face Facts Empowering health IT with facial recognition

EXECUTIVE DIRECTOR

Roger Holliss Craig Doerksen Preston Kostura Kate Butler Reynold Peters Donna Dennison

CHAPTER CHAIRS

Newfoundland & Labrador: Colin Marsh Maritime: Robert Barss Ontario: Jim McArthur Quebec: Mohamed Merheb Manitoba: Reynold J. Peters Saskatchewan: Jim Allen Alberta: Mike Linn British Columbia: Sarah Thorn FOUNDING MEMBERS

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

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

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

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

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

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

EDITOR'S NOTE

RIDING THE WAVES OF CHANGE MORE THAN TWO YEARS into the pandemic and COVID-19 rages on, though few would know it these days. The virus no longer dominates the news cycle, government-imposed lockdowns have lifted along with public health measures like capacity limits and mandatory masking indoors, for the most part, and many people have returned to their pre-pandemic life. For those keeping up with COVID, which undoubtedly includes healthcare workers who are perhaps most affected, the country has entered its seventh wave, driven this time by the Omicron BA.5 subvariant.

Unsurprisingly, the virus has once again mutated to become even more transmissible, proving that people don’t decide when the pandemic is over. This isn’t to say we’re not moving into the endemic phase, as purported by reputable infectious disease specialists. Rather, as a society, we still need to take necessary precautions at times to mitigate the risk of disease transmission and severe outcomes. After all, if we haven’t learned from our past, then we’re sure to repeat it. (And goodness knows no one wants to replay the last two years again.)

Keeping with this topic is the article Harnessing the Power of Data, in which the author, Dr. Gaoyong Luo, addresses the extra demands COVID has placed on medical gas systems. He discusses the need for hospitals to optimize multiple aspects of operational performance by adopting technological innovations or, more specifically, real-time artificial intelligence in order to maintain a stable supply of medical gases and keep their systems operating efficiently.

Dyes, Light and Oxygen explores another COVID-related topic, mask decontamination. Author John Bjornson looks at photodynamic therapy, which has been employed clinically since the 1980s.

This treatment has recently proven to be effective in ‘cleansing’ N95 masks for reuse.

To begin this issue, long-time CHES member Robert Barss provides an overview of Nova Scotia Health’s efforts to reduce energy consumption and carbon emissions at its healthcare facilities to mitigate the effects of climate change. Enhancing the Sustainability of Existing Buildings is based off his seminar, Placing the Patient First: Innovative Infrastructure Renewal and Energy Efficiencies, at this year’s Maritime chapter conference.

Other topics covered in this issue include facial recognition technology, uninterruptible power supply systems and the potential hazards of healthcare plumbing systems. The latter may be familiar to some as it was the focus of a recent CHES webinar given by Jessica Fullerton of The Ottawa Hospital and Marianne Lee of consulting engineering firm H.H. Angus and Associates Ltd. As always, if you are interested in contributing an article to the publication or there’s a topic you’d like to see covered, please contact me.

Clare Tattersall claret@mediaedge.ca

6 CANADIAN HEALTHCARE FACILITIES

PRESIDENT'S MESSAGE

A LOOK BACK AT THE PAST “LEARNING WITHOUT reflection is a waste. Reflection without learning is dangerous.”

(Confucius) As this is my last president’s message, it seems appropriate to reflect on the last three years. At the risk of stating the obvious, the world has truly changed. Initial goals established in fall 2019 when I first took over the CHES reins were completely replaced by a new set of ‘adapt or perish’ challenges just months later. At the onset of COVID-19, we found out very quickly which organizations had strong foundations through their processes, resources and people to take on the pandemic and which were struggling. I am proud to say CHES weathered this difficult time better than most.

This isn’t to say we haven’t stumbled along the way. But we quickly learned what changes needed to be made to weather this storm. Some challenges faced included: Do we cancel the 2020 CHES National Conference in Halifax? Should we host a hybrid event, virtual conference or nothing at all? What is the difference between a hybrid and virtual conference? Having never planned a virtual conference, how do we pull-off this type of event? And how do we manage that legal term on page 17 in the ‘terms and conditions’ called force majeure?

We discovered that all of us at CHES are social animals that rely heavily on face-to-face interactions to learn and exchange ideas. Early in 2020 we weren’t aware of this — but we sure are now.

Not only has CHES navigated the pandemic but we have managed to accomplish a number of things that will serve the association well going forward. Our use of webinars (and the reception to these online learning sessions) continues to grow. We streamlined our governance process to be more efficient. While we transitioned many of our education offerings to a virtual format out of necessity, we can now leverage these to reach a larger range of members. And we have stronger working relationships with sister associations than ever before.

How have we achieved so much?

It comes down to having the right people within CHES that are committed to the goal of improving member expertise and the healthcare environment as a whole.

While the last three years weren’t what I anticipated in fall 2019, they ended up being the most memorable of my healthcare career. And they wouldn’t have gone anywhere as well without all of you. So, thank you for your patience, dedication and effort. It has been quite a ride.

I’m looking forward to seeing as many of you as possible at our big ‘coming out’ conference in Toronto this fall. Until then, have a safe and enjoyable summer.

Roger Holliss CHES National president

EARN CONTINUING EDUCATION CREDITS FROM CHES Members of the Canadian Healthcare Engineering Society can earn free continuing education units (CEU) by reading the Summer 2022 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/6VSWKW8 to take the quiz. CHES members who pass the quiz will be able to claim one contact hour (0.1 CEU) on their CanHCC or CCHFM certificate renewals.

8 CANADIAN HEALTHCARE FACILITIES

C

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MY

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the ART of Building Sustainability

HVAC

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INTEGRATED FAULT DETECTION & DIAGNOSTICS

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Ensure a strong level of interoperability by using open protocols which have third-party listing laboratories to verify adherence to your protocol’s form and function.

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Employ a single sign on (SSO) architecture with compliance to scalable credentialing architectures and secure tunneling methodologies such as BACnet virtual private networks (B/VPN).

Select lifecycle-centric manufacturers who minimize the negative impacts of waste with long-term warranty and repair services while adhering to WEEE, RoHS, R2, and LEED directives.

Specify integrated FDD (IFDD) that delivers real-time fault detection, step-by-step root-cause diagnostics while using all your existing cabling structures, including twisted-pair networks.

Enjoy the long-term benefits of suppliers who engineer a path forward to new technologies while remaining backward compatible without third-party gateways or hardware replacement.

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Stay on top of regular advances in technology with supplier-certified, multi-lingual online educational videos, technical documentation, software updates, and advanced leader lead training.

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CHAPTER REPORTS

BRITISH COLUMBIA CHAPTER

MARITIME CHAPTER

The past year was incredibly busy for CHES British Columbia. The chapter went through an election process, held an in-person conference and hosted the Canadian Healthcare Construction Course (CanHCC).

Executive positions that were up for election were treasurer, secretary and vice-chair. The new team includes myself (chair), Mitch Weimer (vice-chair), Rick Molnar (treasurer), Dawn Chan (secretary) and Norbert Fischer (past chair).

Our conference planning committee was excited to welcome everyone back to Whistler, and have a trade show for participants to meet with vendors, suppliers and industry partners. We had 99 exhibitors that shared information on new products, materials, services, equipment and systems, and more than 517 attendees, which included delegates, exhibitors, speakers and guests.

On June 13-14, the chapter hosted the CanHCC. We had full attendance with 50 participants. We partnered with the Vancouver Regional Construction Association this year to help market the course to the industry. I’d like to thank Reynold Peters and the Manitoba chapter for sharing this approach to promote the CanHCC. CHES B.C. awarded our new Healthcare Award for Outstanding Contribution to Healthcare Engineering. The first-ever annual recipient was Steve McTaggart.

The chapter executive is working on succession planning and mentorship. One of our goals is to invite members who may be interested in joining the executive team. It’s important to welcome them to the table and allow others to participate.

Throughout summer, CHES B.C. will promote the upcoming International Federation of Hospital Engineering Congress/CHES National Conference to our membership and industry partners. We are very excited to support and attend this incredible event in September.

After a significant slowdown due to COVID-19, CHES Saskatchewan is looking to resurrect operations. The chapter executive is planning a conference for Oct. 24-25 in Regina. We are working with the Saskatchewan Health Authority, as well as industry consultants and vendors, to put together a conference that will see representatives from across the province meet in-person for the first time since fall 2019. It is hoped that this conference will rekindle interest in the Saskatchewan chapter.

Recent meetings have resulted in great conversation about the value of being involved in CHES, and how rewarding it can be for both individuals and organizations. The current executive is comprised of a number of individuals who retired over the past few years. It is truly impressive to see their dedication given they no longer work in the industry. I have great confidence in the team and am certain their hard work and commitment will result in a successful chapter conference this fall.

Although the Maritimes enjoyed a relatively mild winter, COVID variants were still causing issues. After a fall season of low case numbers and eased restrictions, the chapter executive decided to attempt a spring faceto-face conference in Moncton, N.B. Unfortunately, with the advent of Omicron, cases increased and restrictions were put back in place.

The executive team made the tough decision to cancel the in-person conference and move forward with a virtual event instead. With assistance from Tanya Hutchison, Sarah Seward and Donna Dennison of the CHES National events management team, the chapter executive put together a successful program for May 2-3.

The conference, offered at no cost to any regular CHES member, opened with an enthusiastic keynote presentation by Bill Carr. Bill delved into the stresses of the current situation and offered solutions to ease the pressures of work and personal life. He also held a workshop on the art of communicating. Other education session topics covered were innovative infrastructure renewal and energy efficiencies for Nova Scotia Health; better performing facilities now and into the future; and managing virus threats with proper air filtration. Gordon Burrill finished the educational portion of the event with a session that explored the positives coming out of our COVID-19 pandemic journey. The conference closed with a grand prize draw of a trip to this year’s International Federation of Hospital Engineering Congress/CHES National Conference in Toronto. The winner was Andrew Crooks, an energy manager with the Nova Scotia Department of Health and Wellness. I’d like to thank the conference planning committee and CHES events management team for their hard work, as well as all sponsors who supported the program, both through financial contributions and hosting education sessions.

Our annual general meeting (AGM) was held May 3. Reports were presented by executive and committee representatives. The financial report showed no revenue increases due to the lack of fundraising opportunities during the pandemic. However, the chapter has retained a positive balance of $34,000. There has been a seven per cent decline in membership from the last fiscal year, again attributed to the pandemic.

The new chapter executive was sworn in during the AGM. Members include myself (chair), Steve Smith (executive vice-chair), Helen Comeau (past chair), Andrew Bradley (vice-chair, New Brunswick), Ken Morriscey (vice-chair, Nova Scotia), Dave Bligh (secretary), Gord Jackson (treasurer), Jason Turner (corporate associate), Pat Dunn (member-at-large) and Kate Butler (member-at-large and CHES National executive liaison). The position of vice-chair, Prince Edward Island, is presently vacant.

A free fall education day is being planned for November, to be held in Truro, N.S. Planning has started for the 2023 Maritime chapter conference in Moncton, N.B. It will take place at the Delta Beausejour, April 30-May 2.

The Maritime chapter will host the twice postponed CHES National Conference in Halifax, Sept. 6-10, 2024. Much of the planning has already been completed.

—Jim Allen, Saskatchewan chapter chair

—Robert Barss, Maritime chapter chair

—Sarah Thorn, British Columbia chapter chair

SASK ATCHEWAN CHAPTER

10 CANADIAN HEALTHCARE FACILITIES

CHAPTER REPORTS

MANITOBA CHAPTER

ONTARIO CHAPTER

The Manitoba chapter’s spring conference was a megahit. After waiting three years to hold it in person again, we had record attendance with more than 160 people present, representing both CHES members and vendors. I’d like to thank Preston Kostura (CHES National past president), Kate Butler (CHES National treasurer) and Jim McArthur (Ontario chapter chair) for attending and helping make it a huge success. A special thank you to Sarah Seward from the CHES National office who was key in keeping everything well-organized.

Congratulations to our Manitoba chapter award winners. Kevin Davis is the recipient of this year’s Project Management Award of Excellence, and Craig Doerksen received the Facilities Management Award of Excellence. Curran Neustaedter (Mitch), a power engineering student at Red River College, is the recipient of the CHES Manitoba student grant. Congratulations also go to CHES Manitoba members Brian MacKenzie and Sergio Cohen who both won a trip to this year’s International Federation of Hospital Engineering (IFHE) Congress/CHES National Conference in Toronto.

The Manitoba chapter, together with the Winnipeg Construction Association (WCA), held the Canadian Healthcare Construction Course (CanHCC) in May — the first time in the last three years.

With the help of the WCA, their fantastic facilities and our CanHCC faculty, we had a sold-out session. The next session, to be held in early October, is also sold out.

The Manitoba chapter is planning a session at the Manitoba Building Expo. The show is Oct. 18, at the Victoria Inn Hotel and Convention Centre in Winnipeg. CHES Manitoba will cover the cost of registration for chapter members.

CHES’s journal, Canadian Healthcare Facilities, is always looking for article submissions. If interested in contributing a written piece, please contact anyone on the chapter executive to assist in getting your article published.

I hope many of you are able to attend the IFHE Congress in Toronto in September. It is being held in conjunction with the CHES National Conference, so the added content and international flare will not disappoint. More information is on the CHES website.

We are now just months away from the 2022 International Federation of Hospital Engineering (IFHE) Congress/CHES National Conference. Online registration is now open. At the time of writing this report, more than 100 delegates have already registered. Booth space is 60 per cent sold out. Sponsorships are almost sold out. I’d like to thank the planning committee for their dedication, support and expertise with organizing this huge event.

There was great interest shown by visitors to our booth promoting the IFHE Congress at the ASHE Region 6 Conference in Rochester, Minn., in April, CHES Manitoba conference in Winnipeg in May, and the CHES B.C. conference in Whistler in early June. Thank you to the conference hosts for accommodating our participation. I, along with my CHES colleagues, will be attending the ASHE National Conference in Boston in July, to promote the upcoming IFHE Congress.

The chapter executive continues to meet quarterly via Zoom. We also continue to pursue new members through various outreach activities and to offer additional member benefits, including bursaries and the young professional education tuition grant.

At our annual general meeting (AGM) in September, I will move into the position of past chair and our vice-chair, John Marshman, will assume the role of chapter chair. Beth Hall will become vicechair, Ken Paradise will stay on as treasurer and we will welcome Chris Mackey into the role of secretary. Also remaining on the chapter executive are Ron Durocher (conference planning), Derek Lall (education), Jeff Weir (membership) and Larry Erwin (communications and public relations). Alex Sullo (partnerships and advocacy) will join the team, replacing Richard White. I’d like to thank Richard for his many years of service on the Ontario chapter executive, as well as Roger Holliss. Roger is our current past chair and his tenure on the chapter executive will end at the AGM. After more than two years of no in-person events, it has been wonderful to once again interact with colleagues face-to-face at conferences. I look forward to seeing many more of you in-person in Toronto, at this year’s IFHE Congress/CHES National Conference.

—Reynold J. Peters, Manitoba chapter chair

—Jim McArthur, Ontario chapter chair

The combined International Federation of Hospital Engineering Congress/CHES National Conference will be held in Toronto, Sept. 17-21.

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commits assault while at one of these meetings? Should the occupier or organizer of the board meeting be liable for failing to ensure the safety and security of those lawfully on the premises?

14 CONDOBUSINESS | Part of the REMI Network

In Omotayo v. Da Costa, 2018, the defendant occupier, Metro Toronto Condominium Corporation 1292 (MTCC 1292), was successful in dismissing the plaintiff’s claim and the assailant’s crossclaim when a member in attendance at a condominium board meeting struck another meeting attendee with a chair.

Justice Nishikawa found that the duty the condominium corporation owed to the plaintiff did not include preventing an assault that occurred during their condominium board meeting.

Facts of the case T he plaintif f, J ac queline O mot ayo, was a resident and former chair of the condominium corporation. The defendant, Jose Da Costa, was also a resident and former president of the condominium corporation. An emergency board meeting was held on Oct. 4, 2011, to discuss the future organization of the board as Ms. Omotayo had recently been removed from her position as chair and Mr. Da

Summary judgment motion MTCC took the position that its duty under the law is confined to the physical condition of the premises and foreseeable risks, not the unforeseeable conduct of individuals in attendance. Meanwhile, Mr. Da Costa argued that MTCC 1292’s duty extends to having rules of conduct for meetings, policies relating to abusive l an g u a g e, thre at s an d intimi d atin g behavior, and a duty to hire and supervise competent professionals to oversee its business (including, if appropriate, security personnel). Mr. Da Costa further argued that the assault was foreseeable given the quarrelsome nature of MTCC 1292’s board meetings and a prior unrelated incident involving the plaintiff and another member of MTCC 1292 wherein the police was called.

In reaching her decision, Justice Nishikawa looked to Coleiro v. Premier Fitness Clubs where summary judgment was granted in favour of the defendant

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Want to stand out on social media?

Don’t fake it

By Steven Chester Let’s face it, we all want our businesses to be social media rock stars, and we know it ain’t easy.

It’s becoming more prevalent that some of the most popular social media platforms have been infiltrated by those who game the system.

This includes those that buy fake followers and “likes” in order to create the illusion that their social media profile is more popular than it is.

These fake followers are predominantly bots – accounts run by software designed to look and act like real people.

New services are also popping up that allow authentic social media accounts to become part of the bot game. By signing up for the service, the user authorizes their account to automatically like, follow and randomly comment on other users’ posts, and in turn they trade that fake engagement with other users. Sound harmless enough? The thing is you have no say in in the message your account is spreading or where it ends up.

Ask yourself this: What’s more important, having 50,000 cosmetic followers, or having 500 followers who are in your target market that actually want to hear from you?

As a consumer, it’s even simpler, as deceptive tactics are easy to spot. If you’re using underhanded methods to promote your business, this can be viewed as a reflection of your product or service. Your integrity is at stake.

This is one of the more complex topics that can’t be fully covered in this space. As always, I invite you to stay social and continue the conversation on Twitter at @Chestergosocial where I’ll share a link to the full article.

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

www.REMInetwork.com | June 2018 15

REAL ESTATE MANAGEMENT INDUSTRY

12 CANADIAN HEALTHCARE FACILITIES

O F

T H E

P A R T

O F

T H E

t

LONG-TIME CHES supporter Guy Bourbonniere is the new chair of the Canadian chapter of American College of Healthcare Executives (ACHE).

Bourbonniere, who has also been an associate member of the Canadian Healthcare Engineering Society since 2007, was officially sworn in Jan. 1, for a two-year term.

Within just six months of taking office, ACHE Canada has upped its membership numbers (again). Not only have five new members joined the association (for a combined total of 32 added since 2020), but they reflect a group the association wants to attract to ensure continued growth and success.

“One of the struggles we have in Canada is an aging member base, so we need younger members who are energized to join and then take part in committee work,” says Bourbonniere.

This would also help fill vacant roles like that of treasurer, which the board has been without since the start of the year. Bourbonniere explains there is a general tiredness of returning board members who are senior level executives in the healthcare industry. This is not unlike what is being seen among frontline staff in hospitals. They are overworked, exhausted and some are battling burnout due to the work life and personal burdens of the COVID-19 pandemic.

To attract young professionals, the board is focused on delivering learning opportunities deemed of greatest value to members, says Bourbonniere.

New ACHE Canada board chair Guy Bourbonniere.

“The ability to receive lifelong education credits is important to them because it’s good for their ability to advance in healthcare,” he explains.

Networking opportunities are another major association draw for people of all ages, something Bourbonniere says the board has struggled with providing over the past two years. Like most organizations, ACHE Canada quickly adopted virtual tools like Zoom in spring 2020 to stay connected, but general membership participation was low. Now, with the removal of government mandated public health measures countrywide, face-to-face meetings and other in-person social interactions have gained a renewed importance that isn’t lost on Bourbonniere.

“Networking is a necessity to building lasting relationships,” he says.

Something Bourbonniere knows all too well, as he was approached by his ACHE Canada peers to get involved in (and stay on) the board not long after becoming a member and an active participant on the program committee. He has held several positions since then, first serving in the role of treasurer (2013-2015) and then vice-chair (2019-2021), before being elected chair in late 2021.

Bourbonniere’s involvement in the association dates back more than a decade to 2008, when he led Trane’s North American energy contracting business. He is now the company’s vicepresident, Eastern Canada region.

“I have a passion to serve others,” he says. “I enjoy utilizing my talents and skills to further an organization like ACHE Canada.”

In terms of goals, Bourbonniere would like see greater diversity on the association’s board and committees, specifically representation of Indigenous peoples. While all executive meetings begin with a land acknowledgement, he recognizes these words don’t go far enough.

“We need their actual voice at the right levels in ACHE in Canada,” he says. “This will empower them and the association, and only improve the board’s performance.”

And a better functioning board leads to improved outcomes for members.

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EXPLORING THE MANY USES FOR DIGITAL DIRECTORIES Are you making the most of your digital signage? While “digital directories” in a healthcare setting are most often used to help people find their way, wayfinding is just one of several ways they can benefit patients, visitors and staff.

“One screen can serve many useful purposes in a hospital,” says Scot Martin, President and CEO of youRhere. “Sure, they’re extremely helpful in letting people know how to get to a certain destination within the hospital but that’s only a fraction of their potential.”

From raising money to promoting events, reducing stress to offsetting staffing pressures, there are ample ways digital signage can enrich a healthcare space.

Consider the following.

• Fundraising: When not being used as an interactive map, digital directories can be programmed to display a scrolling “playlist” of posters informing viewers on a variety of topics, including a hospital’s fundraising initiatives.

For example, says Martin, “Say your hospital has launched a capital campaign to fund a new cancer research department or its encouraging donations for the hospital foundation; you can use your sign’s screen to rotate through posters talking about those initiatives and providing info on how viewers can contribute.”

• Promoting healthy and safety: There are many steps that hospital guests and staff can take to maintain a clean, hygienic environment. And for its part, a digital directory's screen can include messages that promote sanitary practices (e.g., hand washing, social distancing, etc.) or drive home important health and safety messages, such as the use of masks to mitigate ongoing pandemic risks.

“There are a lot of easy but important actions people can take to keep everyone safe. Sometimes, they just need a visual reminder,” adds Martin.

• A more welcoming space: Visiting a hospital can be stressful for patients and their visitors. Emotions are already running high the moment they step through the doors, and frustrations can mount if they feel lost or unable to access help. Here's where a digital directory can help make hospital information more accessible by including directions in multiple languages and ensuring visual supports are accessible to everyone, including those in wheelchairs.

Beyond making the search for key information more user-friendly, digital signage can provide instant information on where users can pick up vital supplies (e.g., medical items, gifts) or what shops and other amenities are nearby.

• Connecting commuters: Digital directories can be set up to provide real-time transit information that removes the stress of finding a way home.

For example, says Martin, "One of the things that we frequently do in our installations –is provide up-to-the-minute information on the local transit. For

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instance, our signs can show people when certain busses are due to arrive at the stops servicing the hospital, so they know exactly when to head to the bus stop instead of waiting around outside, particularly in inclement weather."

• Champion sustainability: Sustainability is a healthcare priority; yet it's not always top of mind in a medical faciliiy.

Here again, interactive and passive digital signage can display updates on a hospital's sustainability missions, be they recycling programs, energy and water conservation practices, or environmental awareness campaigns.

Moreover, digital signs can display the real-time impacts and results of these actions, such as the amount of energy being saved, how much waste has been diverted from landfills, and other encouraging stats.

"It's also about engaging visitors and guests to join with staff in those sustainability goals as well," adds Martin. "You can have pre-programmed messages cycle through that screen reminding people to toss their soda cans in recycling or help the hospital preserve energy where they can."

• Hospital team support: Staff shortages are a growing challenge in the Canadian healthcare sector. Digital signs

can help alleviate workforce pressures by answering many frequently asked questions otherwise directed to shortstaffed help desk teams or security personnel.

MORE THAN A MAP There is plenty of potential in a digital sign. More than a valuable source for directions, today's smart and connected solutions are being used to promote hospital programs, champion eco-forward practices, and relieve common stress points that may otherwise hurt the visitor experience.

Importantly, Martin adds, they can offer these benefits without breaking the bank, adding, With the option we provide to lease signs, there isn’t a big capital cost that needs to be absorbed up front. Facilities can pay for this extremely useful resource under their operating budget instead of having a large one time capital outlay.”

"There's a lot you can do on that screen," he continues, "and by tapping into that full potential, digital signage becomes an investment that pays off in many ways."

Scot Martin is CEO of youRhere, a leading provider of interactive digital signage solutions for commercial, retail, healthcare, and educational properties across Canada. For more information, visit www.youRhere.ca.

ENHANCING THE SUSTAINABILITY OF EXISTING BUILDINGS Améliorer la durabilité des bâtiments By/Par Robert Barss

16 CANADIAN HEALTHCARE FACILITIES

INNOVATION & TECHNOLOGY

T

he healthcare sector in Canada is one of the largest users of energy and emitters of greenhouse gases (GHG). As a result, healthcare facilities are taking proactive measures to deal with this growing environmental crisis. Energy management can also have health benefits for patients, employees and the community, while directly affecting a facility’s bottom line by reducing utilities and operational costs, and minimizing vulnerability to energy price increases.

A VISIONARY PROGRAM

The effects of climate change are becoming more obvious in the Maritimes. This is evidenced by coastline damage caused from rising sea water levels and increasing storm surge, and forest destruction due to sustained gale force winds.

Nova Scotia Health (NSH) is working to reduce energy consumption and carbon emissions to mitigate the effects of climate change. The health authority is comprised of 41 hospitals and 140 healthcare facilities, totalling 8 million square feet of physical space.

Approximately half of its maintenance and operations budget is dedicated to utilities, so environmental-related changes also have financial implications. If NSH continues ‘business as usual,’ utility costs will rise by $26 million by 2030, based on current rates. By developing a plan and looking for opportunities, NSH is on a path to lower utility costs by $12.5 million. Although wildly fluctuating fuel prices will affect the actual dollar figure, the goal is to reduce energy intensity to 47 equivalent kilowatt hours per square foot (ekWh/ft2) from 76 ekWh/ft2.

Energy audits of all regional, tertiary and some community hospitals have recently been completed, highlighting approximately $200 million in renewal and energy projects. An energy master plan has been developed with a roadmap for reducing energy consumption and GHG emissions, while addressing equipment renewal. The plan also addresses energy security, utility management, operations and maintenance options, facilities renewal, renewable energy systems, sustainable facilities planning and energy-efficient retrofits.

NSH has a history of commitment to sustainable healthcare.

Over the past five years, 140 energy efficiency projects have been implemented at a cost of $6.6 million, with a focus on reducing consumption of electricity, natural gas, fuel oil and water. This effort has resulted in an annual reduction of 26 equivalent gigawatt hours, a cost avoidance of $5 million and carbon emissions reduction of 30,000 tonnes. Projects undertaken include lighting retrofits, insulation repairs, inefficient/failed equipment replacement or upgrades, heat recovery, upgraded boiler control and installation of solar photovoltaic technology.

STEP-BY-STEP PROCESS

One of the most significant NSH undertakings has been the ongoing recommissioning and upgrade of building automation controls.

This program required a systematic process for investigating, analyzing, planning and implementing improvements to building systems and space.

L

e secteur des soins de santé au Canada est l’un des plus grands utilisateurs d’énergie et émetteurs de gaz à effet de serre (GES). Par conséquent, les établissements de santé prennent des mesures proactives pour faire face à cette crise environnementale croissante. La gestion de l’énergie peut également avoir des avantages pour la santé des patients, des employés et de la collectivité. Elle peut aussi avoir une incidence directe sur les résultats financiers d’une installation: réduction des coûts des services publics et des opérations, et réduction au minimum de la vulnérabilité aux prix de l’énergie.

UN PROGRAMME VISIONNAIRE

Les effets des changements climatiques sont de plus en plus évidents dans les Maritimes. Ces effets sont démontrés par l’élévation du niveau des eaux de mer et l’augmentation des ondes de tempête, ainsi que la destruction des forêts causée par les bourrasques.

Nova Scotia Health (NSH) travaille à réduire la consommation d’énergie et les émissions afin d’atténuer les effets des changements climatiques. Cette autorité sanitaire est composée de 41 hôpitaux et de 140 établissements de santé, totalisant 8 millions de pieds carrés d’espace physique. Environ la moitié de son budget d’entretien et d’exploitation est consacrée aux services publics, de sorte que les changements environnementaux ont également des répercussions financières. Si NHS maintient le ‘statu quo,’ les coûts des services publics augmenteront de 26 millions de dollars d’ici 2030. En élaborant un plan et en cherchant des possibilités, NSH est en voie de réduire les coûts des services publics de 12.5 millions de dollars. Bien que les fluctuations considérables des prix du carburant aient une incidence sur le montant réel, l’objectif est de réduire l’intensité énergétique à 47 kilowattheures équivalents par pied carré (ekWh/ pi2) à partir de 76 ekWh/pi2.

Des vérifications énergétiques de tous les hôpitaux régionaux, tertiaires et de certains hôpitaux communautaires ont permis de constater qu’environ 200 millions de dollars avaient été consacrés à des projets de rénovation et d’énergie. Un plan directeur de l’énergie a été élaboré avec une feuille de route pour réduire la consommation et les émissions de GES, tout en traitant du renouvellement de l’équipement. Le plan porte également sur la sécurité énergétique, la gestion des services publics, les options d’exploitation et d’entretien, le renouvellement des installations, les systèmes d’énergie renouvelable, la planification des installations durables et les rénovations écoénergétiques.

NSH a une longue tradition d’engagement en faveur de soins de santé durables. Au cours des cinq dernières années, 140 projets d’efficacité énergétique ont été mis en œuvre au coût de 6.6 millions de dollars, en mettant l’accent sur la réduction de la consommation d’électricité, de gaz naturel, de mazout et d’eau. Au cours des cinq dernières années, 140 projets d’efficacité énergétique ont été mis en oeuvre au coût de 6.6 millions de dollars, en mettant l’accent sur la réduction de la consommation d’électricité, de gaz naturel, de mazout et d’eau. Cet effort a entraîné une réduction annuelle de 26 gigawattheures équivalents, un évitement des coûts de 5 millions de dollars et une réduction des émissions de carbone SUMMER/ÉTÉ 2022 17

INNOVATION & TECHNOLOGY

Recommissioning building automation systems has its perks. Some benefits include greenhouse gas reductions; utility consumption reduction/ cost avoidance; equipment renewal and extended equipment life; and controlled comfort for occupants. La remise en service des systèmes d’automatisation des bâtiments a ses avantages. Parmi les avantages réduction des gaz à effet de serre; réduction de la consommation des services publics/évitement des coûts; renouvellement de l’équipement et prolongation de sa durée de vie; et confort contrôlé des occupants. t

The first step in the recommissioning process was assessment.

This provided insight of the building through utility data analysis, current facility requirements, an engineering review of the facility and systems, and conversations with stakeholders. The assessment process was typically a quick turnaround and assisted in gauging the required detail and expected benefits. As typical building automation systems are computer-driven and network integrated, much of the analysis was done remotely. The ability to work remotely was of great benefit as many sites had restricted access due to the pandemic.

Opportunities identified during the assessment moved forward to the investigation phase. During this phase, sensors, such as outdoor, supply and return air temperatures, humidity and pressures, were tested and calibrated. Functional operation was confirmed for items like dampers, actuators, valves and fans. The system programming was reviewed. Often, minor improvements were implemented and deficiencies corrected. Air balance reports were checked for changes from original design, and room controls and equipment were visually inspected. The building baseline was compared to similar facilities to gauge performance.

The investigation phase identified corrections or optimizations for potential implementation. The report that was produced pinpointed smaller low-cost and low labour measures that were often completed during the investigation. These were typically related to defective equipment programming changes. Examples include 18 CANADIAN HEALTHCARE FACILITIES

de 30,000 tonnes. Les projets entrepris comprennent la modernisation de l’éclairage, la réparation de l’isolation, le remplacement ou la mise à niveau de l’équipement inefficace ou défectueux, la récupération de chaleur, la modernisation du contrôle des chaudières et l’installation de la technologie photovoltaïque solaire.

UNE DÉMARCHE GRADUELLE

L’une des initiatives les plus importantes de NHS a été la remise en service et la mise à niveau continues des contrôles d’automatisation des bâtiments. Ce programme nécessitait un processus systématique d’enquête, d’analyse, de planification et d’améliorations aux systèmes et à l’espace des bâtiments.

La première étape du processus de remise en service était l’évaluation. Elle a permis de mieux comprendre le bâtiment grâce à l’analyse des données sur les services publics, aux exigences actuelles de l’installation, à un examen technique de l’installation et des systèmes, et à des conversations avec les intervenants. Le processus d’évaluation a généralement été rapide et a permis d’évaluer les détails requis et les avantages prévus. Une grande partie de l’analyse a été effectuée à distance grâce au fait que les systèmes typiques d’automatisation des bâtiments sont informatisés et intégrés au réseau. La possibilité de travailler à distance a été très avantageuse, de nombreux emplacements ayant un accès restreint en raison de la pandémie.

INNOVATION & TECHNOLOGY sensor calibrations, stuck or broken dampers or actuators, and points in operator override.

The implementation phase followed and corrective actions were implemented. The commissioning engineer reviewed the selected measures with the maintenance technicians. Maintenance personnel are key to process changes becoming a successful part of the future program. Staff need to understand the modifications and resulting benefits since they will be called upon to explain to end-users why changes have been made and how they positively affect them. The review also covered a list of facility improvement measures. These included items like conversion of constant volume pumping to variable volume flow; conversion of constant volume air systems to variable volume or demand-based ventilation; conversion of fresh air systems to mixed, isolation or operating room control modernization; occupancy-based control with time of day scheduling; and conversion from pneumatic to digital control.

A report was then developed that prioritizes all findings, includes an analysis of facility conditions and benchmarks utility use against similar facilities. Class B or C cost estimates were developed and recommendations listed with measures prioritized by expected financial benefits and estimated GHG reductions.

The report recommendations are being implemented as funding becomes available. Lower cost measures often have a shorter return on investment and can sometimes be funded through operational budgets. Higher cost measures require capital funding sources and are generally more challenging to finance. Regardless, the report is a resource for future energy projects.

The final phases of the recommissioning process involved handoff and persistence. During the hand-off, the commissioning engineer conducted measurement and validation of implemented changes to determine whether each measure met the intent and expected return. The final report showed the results, which were reviewed with stakeholders. Operators and technicians were educated on the measures implemented and how they affect facility operations. Users of affected spaces were informed of the changes, benefits to occupants and what action, if any, was required by them.

Persistence is the continuous improvement of the process. It includes ongoing education of staff, which may include on-site vendor training during service technician visits and formal in-class/online sessions. Understanding the data and trends and how to utilize the information to further enhance building conditions is part of the persistence process. Staff need to ensure the improvement measures are long-lasting and their analysis will identify future opportunities.

RECOMMISSIONING EFFORTS PAY OFF

Building automation upgrades and recommissioning is industry best practice. By confronting the challenges head on and developing viable solutions, NSH has acquired many of the benefits. The health authority continues to strive to develop performance solutions for the comfort, life safety, energy efficiency and operation of its hospitals.

Integrating sustainability into a healthcare facility's operations is never ending and often challenging, but with a committed team that creatively looks to the future, NSH can expect more successes.

Robert Barss is manager of environmental stewardship at Nova Scotia Health.

Les opportunités cernées pendant l’évaluation sont passées à l’étape de l’enquête. On a testé et étalonné, au cours de cette phase, des capteurs mesurant les températures de l’air extérieur, de l’air d’alimentation et de l’air de retour, de même que l’humidité et la pression barométrique. Le fonctionnement a été confirmé pour des éléments comme les registres, les actionneurs, les vannes et les ventilateurs. La programmation du système a été examinée. Souvent, des améliorations mineures ont été apportées et des lacunes ont été comblées. Les rapports de bilan aérodynamique ont été vérifiés pour voir s’il y avait des changements par rapport à la conception originale, et les commandes et l’équipement de la salle ont été inspectés visuellement. Les données de référence de l’immeuble ont été comparées à des installations semblables pour évaluer le rendement.

L’enquête a permis d’identifier des corrections ou des optimisations pour une mise en œuvre éventuelle. Le rapport a permis de cerner des mesures peu coûteuses qui ont souvent été effectuées pendant l’enquête. Ces problèmes étaient généralement liés à des changements de programmation d’équipement défectueux. Les exemples comprennent les étalonnages de capteurs, les registres ou actionneurs coincés ou brisés, et les points de contournement de l’opérateur.

La phase de mise en œuvre a suivi et des mesures correctives ont été prises. L’ingénieur de mise en service a examiné les mesures choisies avec les techniciens de maintenance. Le personnel de maintenance a joué un rôle clé dans la réussite des changements apportés aux processus. Le personnel doit comprendre les modifications et les avantages qui en découlent puisqu’il sera appelé à expliquer aux utilisateurs finals pourquoi des changements ont été apportés et comment ils les touchent positivement. L’examen a également porté sur une liste de mesures d’amélioration des installations. Il s’agit notamment de la conversion du pompage à volume constant en un débit à volume variable; de la conversion des systèmes d’air à volume constant en un système de ventilation à volume variable ou fondé sur la demande; de la conversion des systèmes d’air frais en un système mixte; de l’isolement ou de la modernisation des salles d’opération; du contrôle basé sur l’occupation avec horaire de jour; et de la conversion du contrôle pneumatique au contrôle numérique.

On a ensuite préparé un rapport qui établit l’ordre de priorité de toutes les constatations, qui comprend une analyse de l’état des installations et qui établit des points de repère pour l’utilisation des services publics par rapport à des installations semblables. Des estimations des coûts de catégorie B ou C ont été élaborées et des recommandations ont été formulées, les mesures étant classées par ordre de priorité en fonction des avantages financiers prévus et des réductions estimées des GES. Les recommandations du rapport sont mises en œuvre au fur et à mesure que des fonds sont disponibles. Les mesures à faible coût ont souvent un rendement du capital investi plus court et peuvent parfois être financées par des budgets de fonctionnement. Les mesures de coûts plus élevés exigent des sources de financement des immobilisations et sont généralement plus difficiles à financer.

Quoi qu’il en soit, le rapport est une ressource pour les projets énergétiques.

Les dernières phases du processus de remise en service comprenaient le transfert et la persistance. Au cours du transfert, l’ingénieur de mise en service a procédé à la mesure et à la validation des changements mis en œuvre afin de déterminer si chaque SUMMER/ÉTÉ 2022 19

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OVER THE PAST FIVE YEARS, 140 ENERGY EFFICIENCY PROJECTS HAVE BEEN IMPLEMENTED AT A COST OF $6.6 MILLION, WITH A FOCUS ON REDUCING CONSUMPTION OF ELECTRICITY, NATURAL GAS, FUEL OIL AND WATER. AU COURS DES CINQ DERNIÈRES ANNÉES, 140 PROJETS D’EFFICACITÉ ÉNERGÉTIQUE ONT ÉTÉ MIS EN OEUVRE AU COÛT DE 6.6 MILLIONS DE DOLLARS, EN METTANT L’ACCENT SUR LA RÉDUCTION DE LA CONSOMMATION D’ÉLECTRICITÉ, DE GAZ NATUREL, DE MAZOUT ET D’EAU. mesure respectait l’intention et le rendement prévu. Le rapport final présentait les résultats, qui sont examinés avec les intervenants. Les opérateurs et les techniciens ont été informés des mesures mises en œuvre et de leur incidence sur l’exploitation des installations. Les utilisateurs des espaces touchés ont été informés des changements, des avantages pour les occupants et des mesures, le cas échéant, qu’ils devaient prendre.

La persistance est l’amélioration continue du processus. Cela comprend la formation continue du personnel, qui peut aussi inclure la formation sur place des fournisseurs pendant les visites des techniciens d’entretien et les séances officielles en classe et en ligne. La compréhension des données et des tendances et la façon d’utiliser l’information pour améliorer davantage l’état des bâtiments font partie du processus de persistance. Le personnel doit veiller à ce que les mesures d’amélioration soient durables et leur analyse permettra de déterminer les possibilités futures.

LES EFFORTS DE REMISE EN SERVICE PORTENT LEURS FRUITS

La mise à niveau et la remise en service de l’automatisation des bâtiments sont des pratiques exemplaires de l’industrie. En affrontant les défis de front et en élaborant des solutions viables, NSH a acquis bon nombre des avantages. La régie de la santé continue de s’efforcer de mettre au point des solutions de rendement pour le confort, la sécurité des personnes, l’efficacité énergétique et l’exploitation de ses hôpitaux. L’intégration de la durabilité dans les activités d’un établissement de soins de santé n’en finit plus et représente souvent un défi, mais avec une équipe engagée qui regarde l’avenir avec créativité, NSH peut s’attendre à plus de succès.

Robert Barss est gestionnaire de la gérance de l’environnement au ministère de la Santé de la Nouvelle-Écosse.

unleashinG innoVaTion healThCare enGineerinG eXCellenCe

sePTeMber 17-21, 2022

The WesTin harbour CasTle, ToronTo, on

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SILVER Abatement Technologies Belimo Air Controls Camfil Canada Inc. Flynn Group of Companies Gerflor IEM Industrial Electric Mfg. (Canada) Inc.

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HH Angus & Associates

NICKEL Tektum

PROGRAM SUnDAY SEpTEMBEr 18, 2022 06:30-15:50

18:30-20:30

The Great CHES Golf Game – Sponsored by PCL Construction Lionhead Golf Club & Conference Centre (Bus time to be determined) opening reception – Sponsored by Bender Hockey Hall of Fame

Track 3B:

Aging in the Arctic: Long-Term Care Design in Canada’s north Jeff Penner, Verne Reimer Architecture Inc. Catherine Orzes, Blouin Orzes Architects

Track 3C:

Working Toward World-Class Energy-Efficient Hospitals Ian Jarvis, Enerlife Consulting Inc. Grace Pan, Humber River Hospital

12:00-12:30

TrACK 4: ConCUrrEnT SESSIonS 4A, 4B & 4C

Track 4A:

CSA Z8004 operation and Infection prevention and Control of Long-Term Care Homes Buvana Buvaneshwari, CSA Group Alex Mihailidis, CSA Group

Track 4B:

The Future of Hospitals: Harnessing Smart Buildings Technologies and Data to Improve patient Care and Facilities operations Akira Jones, HH Angus and Associates Ltd.

Track 4C:

ASHrAE Infectious Aerosols position Document Walter Vernon, Mazetti (USA)

12:30-13:00

TrACK 5: ConCUrrEnT SESSIonS 5A, 5B & 5C

MonDAY SEpTEMBEr 19, 2022 07:00-07:40

Breakfast – Sponsored by DuBois Chemicals Canada Inc.

07:40-08:45

Opening Ceremonies

08:45-09:30

KEYnoTE ADDrESS – Sponsored by Honeywell Change as a path to Greatness Hayley Wickenheiser

Hayley shares the importance of always looking for improvements or opportunities for change within your life.

09:30-10:30

TrACK 1: pLEnArY SESSIon – Sponsored by Thermogenics

Track 5A:

Track 1:

A Common Language of Design and planning for new Hospitals Peter Sellars, IHEEM Paul Fenton, IHEEM

We Are What We Breathe: The Historic Burden of Shared Air and the Future of Indoor Air Quality Andrew Brimble, Stantec Tariq Amlani, Stantec Patrick Chambers, Stantec

Track 5B:

Canadian Electrical Safety Systems (and Application of the International Electrical Code) Ark Tsisserev, AES Engineering

Track 5C:

Solidarity Architecture for Hospitals in Emergency Situations: planning for the Future Fábio Bitencourt, IFHE

10:30-11:00

refreshment Break in the Exhibit Hall – Sponsored by Gerflor & Precise Parklink

11:00-11:30

TrACK 2: ConCUrrEnT SESSIonS 2A, 2B & 2C

Track 2A:

oakville Hospital: Innovative Excellence in a Challenging Environment Martin Payne, General Manager, Facilities Services (EDFS), EllisDon

13:00-15:00

Lunch in Exhibit Hall - Sponsored by Johnson Controls

15:00-15:30

TrACK 6: ConCUrrEnT SESSIonS 6A, 6B & 6C

Determining the Correlation Between a Hospital’s Architecture and Medical and Hospital Equipment by Studying omid Hospital During Design, Construction and operation phases Samira Ramezani, Iran

Track 6A:

Ventilation System resiliency in Existing Hospitals Amandeep Deol, Enerlife Consulting Inc. Harry Vandermeer, Alberta Health Services

Track 6B:

A.I. and the Tool Guy: The Interaction Between Man and Machine Denton Smith, Head of Engineering and Health Care Technology, Western Cape Government Department of Health, South Africa

Track 6C:

Solutions for the Healthcare Environment in an Urban Hospital During the CoVID-19 pandemic Hiroshi Yasuhara, Tokyo Teishin Hospital

15:30-16:00

TrACK 7: ConCUrrEnT SESSIonS 7A, 7B & 7C

Track 7A:

Using Active IAQ and remote Sensors to Monitor the Continued Health of Buildings David Muise, Pinchin Ltd.

Track 2B:

Track 2C:

Designing Security for Healthcare Environments in Dangerous Times: The new 2020 IA SHH Security Guidelines Randy Atlas, Atlas Safety & Security Designs Inc.

11:30-12:00

TrACK 3: ConCUrrEnT SESSIonS 3A, 3B & 3C

Track 3A:

Hamilton Health Sciences’ response to CoVID-19 George Pankiw, P.Eng., CCHFM, SASHE, CHFM, Director Capital Development, Hamilton Health Sciences, McMaster University Medical Centre, Hamilton ON Dave Thompson, Walter-Fedy

NatIONaL CONfERENCE 2022 congrès national | September 17-21 2022 septembre | www.ches.org

Track 7B:

Track 7C:

new Frontiers for Healthcare Leadership and Innovation Dr. Jaason Geerts, Director of Research and Leadership Development, The Canadian College of Health Leaders Brenda Lammi, Vice-President, Professional and Leadership Development, The Canadian College of Health Leaders Chilean Healthcare research: Innovative Solutions in the Local Healthcare Environment

16:00-17:00

“Happy Hour” in Exhibit Hall – Sponsored by Trane & Tremco

18:00-19:00

president’s reception – Sponsored by Class 1 Inc. & Grainger Artifacts Room at the Liberty Grand

19:00-23:00

Gala Banquet – Sponsored by Siemens & Steris Banquet Entertainment – Dwayne Gretzky – Sponsored by Camfil Canada Inc. Governor’s Room at the Liberty Grand

TRACK 9A:

Design for Air Source Heat pumps in Cold Climates Kurt Monteiro, Smith + Andersen

TRACK 9B:

Creating Smart Hospitals: Enhancing patient Experiences, reducing Staff Workloads and Improving operating results Using IoT and other Technologies Jerry Folsom, Siemens

TRACK 9C:

Evidence-Informed Evaluation of Hospital Facilities’ Quality and Sustainability Andrea Brambilla, Politecnico di Milano

14:15-14:45

TrACK 10: ConCUrrEnT SESSIonS 10A, 10B & 10C

TRACK 10A:

retrofitting a Heat recovery System into an Existing Hospital: Sustainability Cutting Emissions and Costs Bjorn Richt, Vancouver Island Health Authority

TRACK 10B:

Born in a pandemic Marinelly Vásquez, [M] ARQ | Marinelly Arquitectura

TRACK 10C:

Electrifying Your Campus: Engineering Bottom Line Advances for Healthcare providers Jeff Urlaub, Salas O’Brien

14:45-15:15

TrACK 11: ConCUrrEnT SESSIonS 11A, 11B & 11C

TRACK 11A:

Excellence in Healthcare as a product of Comprehensive Innovation Maria Delicia Soria, Biomedical Engineer, Metodologia Lean Healthcare, Argentina

TRACK 11B:

How it Started vs. How it’s Going: Engineering for Canadian Healthcare pre- and post-CoVID-19 pandemic

TUESDAY SEpTEMBEr 20, 2022 07:00-08:30

Breakfast – Sponsored by Loue Froid/HVAC Rentals

08:30-09:30

KEYnoTE ADDrESS – Sponsored by Chem-Aqua Environmental Stewardship Dr. Dave Williams

09:30-10:15

CHES national Annual General Meeting

10:15-10:45

refreshment Break in the Exhibit Hall – Sponsored by Belimo Air Controls & TORMAX Canada Inc.

10:15-10:45

CHES Ontario Chapter Annual General Meeting

10:15-10:45

IFHE General Assembly

10:15-13:15

Exhibit Hall Open

12:15-13:15

Lunch in the Exhibit Hall/Draw Prizes

13:15-13:45

TrACK 8: ConCUrrEnT SESSIonS 8A, 8B & 8C

TRACK 8A:

new Techniques to realize Large-Scale Construction projects with Immense risks in a post-CoVID Era Ludo Vereecken, AZ Sint-Lucas

TRACK 8B:

Sustainable Hospital Design Case: Chemical Management and Logistics Design Anna-Ritta Kallinen, ARKCON

16:15-16:45

TRACK 8C:

placing the patient First: Innovative Infrastructure renewal and Energy Efficiencies for nova Scotia Health Robert Barss, CET, CCHFM, CHFM, Manager Environmental Stewardship, Building Infrastructure & Asset Management, Nova Scotia Health

16:45-17:00

13:45-14:15

Langdon Baker, Smith + Andersen Peter Kastelic, Smith + Andersen Brandon Hayes, Smith + Andersen TRACK 11C:

Augmented Healthcare Design of the Future Jan Buthke, LINK Arkitektur A/S

15:15-15:45

refreshment Break – Sponsored by MIP Inc.

15:45-16:15

TrACK 12: pLEnArY SESSIon – Sponsored by Cummins Sales and Service Global net Zero Future: risk or opportunity for Healthcare?

Ryan Duffy, Blackstone Energy Services Inc. TrACK 13: pLEnArY SESSIon Meet the Winners of the IFHE Global Healthcare Energy Awards Closing Ceremonies

TrACK 9: ConCUrrEnT SESSIonS 9A, 9B & 9C

NatIONaL CONfERENCE 2022 congrès national | September 17-21 2022 septembre | www.ches.org

TRADE SHOW COMPANIES Aatel Communications Inc. Abatement Technologies Actall Canada Air Liquide Healthcare Altro Canada, Inc. Amano McGann Canada Inc. Amico Corporation Amico Lights Armstrong World Indsutries Ascom Atlas-Apex Roofing (Saskatchewan) Inc. Belimo Aircontrols (CAN) Inc. Bender Canada Inc. Camfil Canada Inc. Canadian Coalition for Green Health Care Chem-Aqua C-INTECH Chicago Faucets Class 1 Inc. Construction Specialties, Inc. Convergint Technologies Cornerstone Medical Inc. Cummins Canada DDC Dolphin Ltd. Delta Controls Inc. DuBois Chemicals Canada Inc. ECNG Energy Group EllisDon ESC Automations Inc. an Ainsworth Company Evcor Solutions

Firestop Contractors International Association (FCIA) Filtration Group IAQ First Onsite Property Restoration FlexITy Flynn Group of Companies Franke Commercial Gerflor GlasCurtain Inc. Grainger GuardRFID Guldmann Care-Lift Solutions Honeywell IEM Industrial Electric Mfg (Canada) Inc. Interface Infection Control Training Group

Morris Lee Ltd. Nalco Water – An Ecolab Company Omega Industrial Supply Canada Omnilumen/GS Lighting Pinchin Ltd. Precise Parklink Inc. PULLMAN Primex, Inc. Reliance Worldwide Corporation (Canada) Inc. Rockfon Salto Systems Schneider Electric Siemens Specified Technologies Inc. Spirax Sarco

IFHE 2024 IRC Building Sciences Group, A Rimkus Company Johnson Controls Jutzi Water Technologies Kinetic GPO Labworks International Longhill Energy Loue Froid/HVAC Rentals Masco Canada Limited – Delta Commercial MediaEdge Communications Inc. Medical Design Megamation Systems Inc. MIP Inc. Mondo Contract Flooring

Stanley Security Canada ULC Steam Specialty Sales STERIS Canada Sales ULC Thermogenics TORMAX Canada Inc. Total Power Trane TransLogic – A Division of Swisslog Healthcare Tremco Tri-Tech Pinnacle Group Victaulic Viega LLC Willis Wilshire Works WSP

NatIONaL CONfERENCE 2022 congrès national | September 17-21 2022 septembre | www.ches.org

SPONSORED CONTENT

LIVES ON THE LINE:

PRIORITIES IN HEALTHCARE PROPERTY RESTORATIONS There’s zero room for error in healthcare facility restorations. When a fire, flood, or other disaster occurs, quick and comprehensive action is required to bring critical services back online, and with minimal impact on patients and staff. Here’s where calling on a restoration partner with specialized healthcare experience, equipment, and strategies counts.

“It is an understatement to say that healthcare environments are complex, so when an incident disrupts patient care, you need a contractor who knows what they’re walking into and what needs to be done to keep everyone safe,” says Jim Mandeville, senior project manager, large loss, North America, for First Onsite Property Restoration.

Healthcare-related restorations carry several priorities. For Mandeville and the First Onsite team, they include: • Infection control and prevention: The key to healthcare-related restorations is protecting all facility occupants from potential infections during the restoration and construction process. For First Onsite, doing so involves employing a

broad range of prevention measures, including HEPA air scrubbing and negative air pressurization, indoor air quality (IAQ) and airborne particulate control, biomass reduction (e.g., topdown cleaning, decontamination, and sterilization), proper waste and debris disposal, and ongoing project monitoring and documentation. Importantly, these actions adhere to all infection control policies and procedures.

• Ongoing biocontainment support: Care must be taken to mitigate the risk of biocontainment during a restoration and prevent biocontainment risks through ongoing risk assessments and the development of hazard mitigation response plans.

• HVAC: Fresh and hygienic indoor air quality (IAQ) is critical in a healthcare environment. Herein, says Mandeville, “Restoration efforts must focus on fostering and ensuring healthy IAQ, and we do that by following all national and provincial regulations for Infection Control and Prevention, in addition to industry standards for HVAC cleanliness.”

• Emergency planning and training: Part of healthcare-related restorations is mitigating future incidents. As such, First Onsite’s strategy includes helping healthcare staff prepare for the next incident by providing emergency preparedness planning and training, performing annual inspections and hazard surveys, and conducting facility assessments.

Experience matters Keeping patients and staff safe is job one during a hospital restoration. Doing so effectively means working with a restoration partner that recognizes the risks and understands the steps necessary to quickly and safely mitigate damage and minimize exposure to areas of the facility not affected by damage.

For First Onsite, that means in-depth training of staff and adherence to strict protocols that ensure restoration work meets the strict standards of a healthcare setting.

The company has structured its teams to help healthcare facilities across Canada bounce back from disasters.

“We’ve worked with healthcare clients across Canada over the years, and it’s given our teams the specific skills and insights they need to tackle these uniquely challenging situations,” adds Mandeville.

FIRST ONSITE is a leader in emergency response planning, disaster remediation, property restoration, and reconstruction services, helping North America restore, rebuild, and rise after catastrophic events of every kind. Learn more at www.firstonsite.ca.

HARNESSING THE POWER OF DATA Real-time machine learning for optimal operations of medical gas systems

By Gaoyong Luo

T

he global COVID-19 pandemic has posed unprecedented healthcare system challenges. One is it has largely increased the demands for oxygen supply from medical gas systems (MGSs). This has reinforced the need for smart hospitals to optimize multiple aspects of operational performance by adopting the technological innovations from Industry 4.0, known as the fourth industrial revolution. The objective is to make production processes and decision-making more efficient, autonomous and adaptive using artificial intelligence (AI), cyber-physical systems, big data and Internet of things (IoT). These processes, resource utilization and productivity can then be improved and maximized through qualitative and quantitative data analysis that provides descriptive, predictive and prescriptive inputs and feedback loops.

26 CANADIAN HEALTHCARE FACILITIES

This is why technology enabling big data capture (sensing), analysis (cloud computing), connectivity (IoT), intelligent monitoring and control (AI algorithm) is becoming the new baseline for building smart hospitals. By using mathematical algorithms and input-output models to enhance productivity and efficiency, and elevate decision-making and performance, AI and machine learning can create insights that provide visibility, predictability and automation of operations, and can be applied to produce technology innovations to power products and services that benefit from the digital transformation of Industry 4.0. Due to the availability of vast data sets over IoT networks, AI-based data-driven systems and products can now be delivered to help digitize the healthcare industry and to better serve this sector.

To maintain a stable supply of all medical gases and keep their systems operating with the best efficiency to create the safest possible environment and support remote working environments, it has become increasingly important to remotely monitor MGSs and intelligently control medical air plants where sensing, data processing, communication technology and AI can be integrated to enable the systems to make confident decisions, as well as optimize the operations and maintenance of processes of prediction and prevention. Remotely monitoring MGSs in real-time over IoT networks where all devices are connected also allows a global vision and to report any parameter/ anomaly so that hospitals can enhance usage of medical gases and reduce risk of failure. As well, using data collected from IoT networks for real-time inference can

INNOVATION & TECHNOLOGY

help create predictive maintenance programs based on machine condition monitoring, resulting in more uptime and higher efficiency. This would allow the hospital equipment maintenance provider to constantly verify that the system is operating safely and make reasonable adjustments to optimize performance. At the facility and system level, to meet the emerging challenge of the energy-efficient and optimal operation of medical air plants, a novel machine learning system is designed to perform intelligent plant control with respect to energy savings and reduced costs and carbon emissions, and to implement predictive maintenance. By building IoT networks to remotely collect data and developing deep wavelet neural networks (DWNNs) to process streaming data for optimal control, faults prediction and machines condition monitoring, real-time AI can now be applied to improve control strategy and optimize system performance and energy efficiency.

In the real-time machine learning system, printed circuit boards are designed as

machine controllers, signal collectors and transmitters, and the IoT communication networks are built for real-time monitoring, control and AI optimization for highly efficient operation of MGSs. With the IoT networks built, real-time fault prediction and detection based on multi-sensor measurements can be performed by deep learning, providing an eagle eye view of every event while or before it happens. With the data collected over IoT networks and streamed to a cloud server that can run more detailed data processing for, as an example, predictive control by the AI algorithm, the hybrid edge and cloud approach developed can now provide edge autonomy as well as support remote monitoring and intervention when required. It also enables real-time big data analytics to improve decision-making and performance with minimal energy usage and waste, creating an opportunity to apply deep learning for advanced control, management and maintenance by collecting data from all sources on the IoT networks. Through real-time processing of measurement data provided

by dedicated sensors installed, autonomous decision-making is enabled based on the online diagnosis of the system with right conditions, leading to increased reliability toward zero defects. By collecting, analyzing and making use of data, predictive maintenance based on real-time AI can be planned and scheduled, too.

As a machine learning algorithm, deep neural network has shown powerful performance in a variety of applications by processing large datasets. However, overparameterization, high computational complexity and hardware resources requirements remain as technical challenges in such a network, where the existence of overfitting in association with overparameterization and presence of noise can worsen the performance of a network and make real-time applications difficult to implement. To address these issues, DWNNs with the use of wavelet activation functions have been developed to achieve adaptive dropout and sparse connections to optimize network structure for better performance and faster computation with

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YOUR PATIENTS, STAFF, VISITORS & PROPERTY. To learn about SALTO Systems, visit saltosystems.ca SUMMER/ÉTÉ 2022 27

INNOVATION & TECHNOLOGY

Structure of real-time machine learning system.

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very low latency. Because of the properties, such as time frequency localization, admissibility and energy preservation, wavelet functions are advantageous in signal detection, feature selection and data decomposition. In the context of DWNNs, input data is decomposed into the time frequency domain by the wavelet activation functions in the neurons and connected by weights, which can be interpreted as wavelet coefficients. In the wavelet domain, small wavelet coefficients are normally considered as noise. So, small weights in the network can be set to zero to denoise and achieve sparse connections. The product of the output and weight of a neuron can be regarded as the contribution of this neuron to the network. When this value is below a certain threshold, it will be removed to achieve adaptive dropout. This allows the network structure to be simplified and optimized for real-time applications. Then Mexican hat wavelet as activation functions has been derived to construct DWNNs. It is the negative normalized second derivative of a Gaussian function, and has admissibility condition and a symmetric structure. And its derivative is also a Gaussian function.

Compared with commonly used deep neural networks, using nonlinear Gaussian (Mexican hat) wavelet with sparsity as activation functions in the DWNNs model can improve nonlinear f itting and convergence speed with adaptive learning 28 CANADIAN HEALTHCARE FACILITIES

rate so that the power and capabilities of machine learning can be raised. In addition to predicting faults, the real-time machine learning system will also be trained to learn and diagnose what causes the faults and the actions that can be taken to prevent the failure or reduce system damage.

In a case study, the presence of faults in the MGSs was verified in an unsupervised manner. The system could diagnose each fault and perform cause analysis based on importance ranking explained by the trained DWNNs model, where a fault can be related to a potential or unique type of component fault and even to more than one fault, and then a knowledge-based system can be established to perform the explanability, from which the cause is analyzed and solution is sought. For example, by data analysis, a fault detected causing oxygen generator shutdown was diagnosed and it can be attributed to very high demand of oxygen during the pandemic. When the flow rate sensor values increased at a very high level, the system could not generate enough output due to the limited capacity and that led to a system failure.

Experimental results have demonstrated that the DWNNs with Mexican hat wavelet as activation functions can adaptively adjust the network structure and sparsifying on weights as denoising to significantly simplify the model and reduce overfitting, leading to being less computationally expensive. By the trained DWNNs with

multi-sensor measurements over the IoT networks, the real-time machine learning system designed can give valuable insights, track everything that’s relevant to operations, and perform qualitative and quantitative data analysis to monitor machine conditions, detect faults, and predict and optimize system performance. Optimum performance of MGSs operations can be achieved by the real-time AI, where the sensing capabilities and the computational power are provided by the designed controller, transmitter and distributed cloud, such that by deep learning from big data analytics, both knowledge-based and data-driven AI techniques can be applied to correct errors, perform intelligent control and focused maintenance procedures to prevent the failure without unnecessary interruptions, improving energy efficiency and maximizing productivity.

Gaoyong Luo is a chair professor of electronics information and communication engineering, and currently leads research and development at SHJ Medical Gas Specialists, a leading supplier of medical gas pipeline systems and services and a market leader in remote monitoring and energy-saving technologies. He is a renowned expert in the field of wavelets, artificial intelligence and multicarrier spread spectrum communication, with expertise in control and modulation theory and applications to automation and communication systems.

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INNOVATION & TECHNOLOGY

DYES, LIGHT AND OXYGEN A novel method for mask decontamination

By John Bjornson

T

he use of light for treatment of health conditions, known as phototherapy, has been utilized since ancient times. Photodynamic therapy (PDT), the use of a photosensitizer and light, has been deployed clinically since the 1980s for treatment of skin, eye diseases and cancer, including skin, lung, brain, bladder, pancreas, bile duct, esophagus, and head and neck cancers. Neurosurgeon Dr. James Chen had been studying and practicing PDT for decades when the COVID-19 pandemic hit. As the virus spread, and mask and personal protective equipment (PPE) shortages became prevalent, Dr. Chen hypothesized that the same concepts of PDT he had used in cancer treatment could be applied to COVID-19, specifically to decontaminating infected masks.

PDT relies on photosensitizers, also known as protective dyes, and light. When exposed to light, certain protective dyes absorb light photons and transfer their energy to nearby oxygen molecules, thereby generating singlet oxygen. Singlet 30 CANADIAN HEALTHCARE FACILITIES

oxygen is well-known for killing pathogens, including inactivating viruses.

Singlet oxygen generated by methylene blue (a common protective dye) and light has been previously shown to inactivate Middle East respiratory syndrome (MERS), Ebola and severe acute respiratory syndrome (SARS) in blood plasma.

According to scientific researchers, singlet oxygen is thought to inactivate microbes and cause cell damage via three mechanisms: damage to the cell membrane or virus envelope; inactivation of essential enzymes and proteins; and/or damage to nucleic acids. This indiscriminate mode of inactivation makes singlet oxygen uniquely powerful. In 2012, science journalist Anthony King investigated then-current research on the combined ability of photosensitizers and light, calling the technology the “ultimate weapon in the battle against deadly superbugs.”

Fast forward to 2020, when a global research consortium comprised of 13 organizations, universities and laboratories, includ-

ing the World Health Organization and U.S. Centers for Disease Control and Prevention, embarked on a DeMaND study, short for Development of Methods for Mask and N95 Decontamination. Their goal was to determine if methylene blue and light could safely decontaminate masks infected with SARS-CoV-2 — the novel coronavirus that causes COVID-19 — thereby allowing for safe and affordable reuse or extended use of masks.

DeMaND researchers confirmed PDT as an effective decontamination method, thereby enabling masks to be safely reused during times of emergency or short supply.

Methylene blue and light robustly and consistently decontaminated coronavirus from medical masks and N95s without altering the filtration, breathability or fluid resistance properties of masks and respirators, even up through five decontamination cycles. Additionally, though many previous PDT studies had relied on red light specifically, DeMaND researchers found ambient light sufficient in dose and

time-dependent scenarios. What’s more, masks and respirators pretreated with methylene blue days before inoculation of virus were shown to offer ongoing inactivation of coronavirus. With the coronovirus able to remain infective on medical masks for up to seven days, healthcare workers are at increased risk when wearing, adjusting or doffing their masks. A pre-treatment option that provides ongoing decontamination while masks are being worn is the enhanced protection they deserve.

A recent research paper on mask filtration efficiency cited that if masks do not destroy viruses or microorganisms that have fallen on them, then they are essentially virus collectors, particularly when the masks’ outer surfaces are exposed to contaminated droplets.

According to lead author of the DeMaND study, Dr. Tom Lendvay, DeMaND data should inform future PPE development. He states, “Masks have historically served the purpose of shielding or trapping pathogens.

We have the opportunity now to create masks and PPE that quickly decontaminate present virus and actively protect against further contamination. Ultimately, this technology will make healthcare workers safer and that’s what matters.”

Research has continued on methylene blue and light treatment and ongoing decontamination, both by DeMaND2 researchers and in the private sector.

Several WHO-sponsored DeMaND2 follow-on studies are in pre-press or under review now. Methylene blue and light’s efficacy against the harder to kill murine norovirus, a surrogate for the cause of a common stomach bug, has already been pre-published. Methylene blue and light treatment of norovirus-infected masks resulted in reduced infectious viral titers over four orders of magnitude.

John Bjornson is the CEO of Singletto, a Seattlebased company. Singletto licenses its Oxafence Active Protection technology to healthcare-focused and general consumer brands and manufacturers. The technology can be embedded into products to provide ongoing decontamination and active protection. Oxafence technology is based on principles of photodynamic therapy and deploys proprietary combinations of protective dyes to create pathogen-destroying singlet oxygen solutions.

As the demand for constant sanitation of high traffic environments continues to rise, so does the need for efficiency and effectiveness in killing bacteria on surfaces.

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FACE FACTS Empowering health IT with facial recognition

By Gus Malezis

W

hether unlocking a smartphone or logging into an app, facial recognition has become a bigger part of how people access technology.

Breached credentials remain a common factor in cyberattacks. And the demand for advanced and secure authentication methods like biometrics has only grown as part of the solution, offering usable and effective options to combat cyber threats.

It is therefore no surprise that the global facial recognition market is projected to reach $10.2 billion US by 2028. For industries like healthcare, which require clinicians to enter multiple logins every day, facial biometric authentication could be a game-changer. A lot of time is spent logging in to various systems and applications and

32 CANADIAN HEALTHCARE FACILITIES

accessing data while caring for each patient.

The seamless and non-disruptive workflow of facial recognition could save valuable time, resulting in a better patient experience and staff job satisfaction.

Now, with the broad adoption of telehealth and virtual care, health systems are expected to do more even faster. There is a growing need for mobile and remote clinical workflows with fast authentication methods.

Although it is more common to use a laptop or desktop for authentication, this can be a clunky process and sometimes causes patient delays in receiving medication. Too often, the lack of mobile workf lows, namely smartphone and tablet devices, also creates patient safety issues,

increases dissatisfaction and adds greater stress to providers. To optimize patient care, innovation in technology is needed across all the various devices that doctors and nursing staff use.

Fortunately, facial biometric authentication options allow for a secure, fast and efficient workflow. Considering the time this can save clinicians from log-ins alone, facial recognition might lead to pivotal change for caregivers and patients alike.

REDUCING RISK

The opioid crisis has impacted many nations, with two of the hardest hit being Canada and the United States. While the U.S. has implemented nationwide legislation requiring electronic prescribing of

INNOVATION & TECHNOLOGY

controlled substances (EPCS), Canada has yet to enact any federal mandates.

Nonetheless, provinces are still responsible for ensuring ethical and safe prescribing, and many already have electronic prescribing programs in place.

Still, any sensitive information about prescriptions for controlled substances has the potential to be abused. For this reason, biometrics are not new to the healthcare sector. Two-factor authentication is required for EPCS in the U.S., and many hospitals have used fingerprint biometrics to make this process as smooth as possible.

But while fingerprint solutions are effective, they do not provide the same sleek workflow as facial biometrics. Clinicians are usually wearing personal protective equipment (PPE) like gloves, which creates obvious obstacles. In addition, when used as a second factor of authentication, fingerprints are often paired with entering manual credentials. This is still not an ideal workflow.

Using facial recognition now supports and can work with facial PPE, enabling a frictionless workflow for mobile devices.

AS BIOMETRIC TECHNOLOGY EVOLVES, FACIAL RECOGNITION WILL BECOME INTEGRAL TO HEALTHCARE SECURITY, HELPING KEEP VULNERABLE DATA SECURE WHILE IMPROVING BOTH CLINICIAN WORKFLOWS AND PATIENT IDENTIFICATION WITH SEAMLESS AND EFFICIENT ACCESS. Not only does this increase identity proofing and comprehensive reporting capabilities, but it also creates the potential to eliminate manually entered passwords as a factor of authentication, saving time spent with technology and directing more toward patient care.

ENHANCING DIGITAL IDENTITIES

Some of the biggest misconceptions around facial recognition relate to trust, privacy invasion and long-term practicality. However, biometrics are one of the strongest authentication factors and they could revolutionize the way organizations manage digital identities.

Over the last decade, breached credentials have remained a leading cause of cyberattacks due to how easily weak usernames and passwords can be guessed.

The three forms of authentication include something you know (password), something you have (push notification or identification badge) and something you are (biometrics). Considering the way in which many data breaches occur, a method that no one can guess, phish or steal is most reliable.

Ultimately, biometrics are one of the hardest factors to fake or replicate. Plus, facial recognition technology allows for machine learning — recognizing user patSUMMER/ÉTÉ 2022 33

INNOVATION & TECHNOLOGY terns and enhancing details over time — arguably leading to greater accuracy.

Healthcare organizations should consider this when building their digital identity strategy.

TRANSFORMING OPERATIONS

On average, clinicians can spend more than 45 minutes per shift logging into systems like virtual desktops and applications. This inefficiency and redundancy can lead to clinical burnout and disruption in effective patient care delivery. Facial recognition solutions could potentially reform this entire process by making mobile authentication a lot faster.

Many hospitals have implemented mobile devices into their workflow but the authentication process typically requires a slow, manual log-in via a touchscreen.

Clinicians with protective gear, such as gloves, might find this process cumbersome, slow and error-prone, especially when operating the device and entering credentials via a touchscreen.

Considering that most smartphones now have facial recognition technology, utilizing

this function would place usable technology in the hands of clinicians, offering significantly greater mobility when delivering care.

Even outside the clinical setting, facial recognition offers a simpler way to reduce time spent on mundane tasks. Integrating this workflow into the administrative side of the hospital would also enhance productivity levels and satisfaction. In turn, operational improvements affect the quality of patient care.

This technology, when implemented as part of a zero-trust architecture, can help healthcare networks monitor for ‘bad actors’ with enhanced reporting and tracking features. This provides a layer of security to ensure only the right people are appropriately accessing the proper applications and information.

GETTING STARTED

The evolution of facial recognition and biometric technology in healthcare settings is rapidly evolving to meet clinician and patient needs. In addition to securing access to medical data, it can help health delivery organizations improve cybersecu-

rity with a more holistic digital identity strategy.

As biometric technology evolves, facial recognition will become integral to healthcare security, helping keep vulnerable data secure while improving both clinician workflows and patient identification with seamless and efficient access.

The benefits of facial recognition impact all areas of healthcare enterprises and the potential for growth is practically endless.

Together, this boils down to delivering on the most important objective — keeping patients healthy and safe by focusing on care, not technology.

Gus Malezis is president and CEO of Imprivata, the digital identity company for mission and life-critical industries that is redefining how organizations solve complex workflow, security and compliance challenges with solutions that protect critical data and applications without workflow disruption. Gus is widely recognized as a visionary leader in the information technology security industry where he brings more than 30 years of experience driving innovation and growth while building market leading organizations.

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ENHANCING HEALTHCARE THROUGH SMARTER TECH The healthcare industry is in constant evolution. Every year brings new or advanced practices, techniques, and resources to the fold that improve both patient outcomes and the delivery of care. This unending transformation is crucial to public health, and today, it is largely driven by smarter, more secure, and connected technologies.

“Technology has transformed the healthcare industry in many different ways,” says Paul Cannon, healthcare industry leader with SALTO Systems. “For many, that transformation is most visible at the patient level, where integrated systems are making building controls and patient information more accessible to medical professionals.”

More importantly, he adds, modern advancements in healthcare technologies are today being designed with a “patient-centered” philosophy. This approach puts patients’ abilities, limitations, challenges, and preferences at the core of their design, leading to solutions that are more aligned with patients’ needs.

“You can introduce the latest, greatest technology into a healthcare facility, but if patients or staff can’t - or don’t want to - use them, you’re not going to get the full benefit from your investment,” says Cannon.

PATIENT PEACE OF MIND Digital innovations can be found throughout the hallways, patient rooms, and operating suites of healthcare. For Cannon and the SALTO Systems team, however, the focus is introducing next-gen building access and security solutions.

“Remote visitor management systems are an important part of building trust and a sense of security in the healthcare space,” he says. “What we’re focused on is bringing smarter, more mobile, and more integrated building security and access control solutions to the sector that do just that.”

Those solutions, he continues, provide building teams with a suite of building security controls they can access via mobile devices, as well as live video and audio feeds from connected cameras throughout the building. Moreover, these technologies enable authorized hospital staff to virtually manage various hospital activities, such as health screenings, emergency mustering, and attendance recording.

“Importantly, these solutions include mobile credentialing that can control how these security solutions are used, by whom, and to what extent,” Cannon adds. “The result is integrated building security and access control solutions that deliver more control and peace of mind.”

SPONSORED CONTENT MAKING PEACE WITH NEW TECH Whether securing facilities, enhancing communications, or revolutionizing care, the technology is only effective when it is embraced by actual people. Here again, part of implementing patient-centered technologies is taking measures to bring everyone on board.

“The first step to introducing any new piece of tech is educating users on the benefits they’ll get from using it,” advises Cannon. “There is always resistance with any new process, so a well thought educational program is critical in gaining the enduser’s trust.”

When adopting new technologies in any environment, it helps to have training programs and resources at the ready, gain “buyin” from the top, as well as enlist “tech champions” among the staff who can help guide others in its adoption.

Technology adoption is also an ongoing process, part of which involves ensuring the tech and associated systems are working as effectively as possible. For this reason, says Cannon, it’s important to make regular monitoring and updating part of one’s schedule: “Being proactive with a defined program allows for fixable problems ahead of time, rather than a potentially larger challenge that may take place once the issue occurs. A good software and hardware maintenance plan will ensure that the software is updated with the latest version and that the hardware is in good working condition.”

After all, he warns, “Failure to upgrade these systems can leave openings in the security layer that make it easier for hackers to find vulnerabilities.”

MOVING AHEAD The healthcare revolution is never over. And much like SALTO’s ongoing mission to rethink building security and access control, innovators in all corners of the industry are seeking ways to take the industry into the future.

“Ultimately, the future of healthcare includes mobile technologies that will integrate multiple systems, such as a patient’s medical history, real-time health updates, insurance coverages, and access control management,” Cannon adds.

“And as always, the end-user experience will continue to drive expansion into these newly digitized areas.”

Learn more about SALTO Systems’ healthcare access control solutions. Visit saltosystems.ca or call 514-616-2586.

CHOOSING A UPS SYSTEM Monolithic versus modular uninterruptible power supply

By Luke Eiland

I

ncreasing demand for reliable power, coupled with the growing use of essential electrical equipment and digitization, is driving up adoption of uninterruptible power supply (UPS) systems.

Considering the high stakes associated with energy failure, what are the most important factors to consider when choosing such a system?

UPS system design boils down to two main types: monolithic or modular. The original UPS design, the monolithic system, is a solution made of single subsystems, including a static switch, rectifier, inverter and so on, that have no intrinsic redundancy.

The later-developed modular UPS is, as the name suggests, comprised of several smaller components that can be added or removed to scale the solution up or down.

Here are the benefits of each in relation to three main decision criteria: cost, reliability and simplicity.

COST

With any investment, cost is always the primary consideration. When it comes to UPS 38 CANADIAN HEALTHCARE FACILITIES

systems, and if comparing systems of a similar power requirement, the traditional monolithic solution has the lower initial price tag.

This is why, traditionally, it has been the solution of choice for organizations with smaller power requirements, especially if their needs are unlikely to change in the near future. However, for those with larger power requirements or where increased flexibility is needed, there is more to consider.

While there are different model sizes of monolithic systems, there is less flexibility in terms of power capacity than with modular UPS. Subsequently, monolithic UPS users often end up paying more for a system that is larger than they need to reach their power requirements. Additionally, should their power requirements change, a whole new monolithic system is often required due to a lack of design flexibility.

This is one of the strengths of modular UPS. To increase the capacity of a modular system, it is as simple as buying additional power modules and slotting them into the existing rack. What’s more, should a facility have multiple modular UPS solu-

tions, modules can be swapped from system to system to address changing load profiles. This increases efficiency savings and mitigates risk.

RELIABILITY

Designed to ensure a facility’s power supply is reliable and uninterrupted, a UPS system must be extremely robust. Obviously, this is critical when powering life-saving medical equipment or other essential electrical devices.

Traditional monolithic systems feature a simple design. Consisting of fewer individual components, this means there are less failure points in the system. Alternatively, modular UPS solutions spread the load over many more components, which could be argued provides greater potential failure points.

However, in a monolithic system, failure of one component could mean failure of the system as a whole. But in true modular units, if one module fails, it is separated from the rest of the system and the other modules pick up the slack to ensure continued operation/ power. However, not all modular solutions

BUILDING SYSTEMS are the same and only ‘true modular’ UPS provide this functionality.

Like many things in life, being handmade is generally better, though this is not the case with UPS systems. While large monolithic solutions are manufactured manually with the resulting risk of human error, smaller power modules for modular UPS systems are manufactured and tested utilizing automated solutions. This approach adds to reliability, with each of these smaller modules also being machine tested before shipping — something that’s not undertaken within the monolithic manufacturing process.

SIMPLICITY

Failure of a UPS system is uncommon but replacing individual components as part of regular system maintenance is both expected and planned. Ensuring the system remains operational or that there is backup power during service intervals can be a big issue with considerable consequences for a facility’s operation.

For this, modular UPS systems are relatively easy to maintain. In a true modular solution, each essential part is hot swappable

and can be removed for maintenance or replaced while the system continues to run.

Conversely, a monolithic system will likely need to be shut down for maintenance of core components, which means either the loss of the facility’s backup power during this period or having to switch to another system. In other words, essentially two units are needed to provide the same service, with all the associated costs of purchasing, installing and maintaining two UPS devices. Now, some users also install two modular UPS systems for ultimate peace of mind, but this trend is beginning to change as, depending on the load’s criticality, it’s often not necessary.

Crucially, and unlike the modular approach, if certain individual parts fail in a monolithic environment, the process of replacing them is often complex and time-consuming, requiring a specialist UPS engineer. This represents additional downtime and cost.

COMPARATIVE OUTCOME

Both monolithic and modular UPS systems are reliable but they employ totally different

designs to provide distinct levels of flexibility and autonomy.

For organizations with lower critical power application requirements, a monolithic solution will be both cheap to install and generally fit the purpose. But this system may be larger and more expensive than what’s needed, as well as more costly to maintain in the long-run. Plus, should the facility’s power requirements change and greater capacity is required, a monolithic solution doesn’t have the system flexibility to support this.

A modular UPS system is very appealing to organizations that desire ultimate reliability and no downtime. On the face of it, they do look more expensive. But when the total cost of ownership is calculated, which takes into account ease of maintenance, a smaller floorspace footprint and overall system flexibility, the modular argument becomes very compelling.

Luke Eiland is the service manager of SolarEdge’s critical power division, which delivers innovative products and solutions that powers critical computers, storage and machines in a broad range of sectors.

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INNOVATION BUILDING SYSTEMS & TECHNOLOGY

WHAT’S HIDING IN THE WATER The impact of poorly managed, maintained plumbing systems and mitigating risks

By Jessica Fullerton & Marianne Lee

H

ealthcare facilities are places of healing, with a burden of responsibility on architects, designers, engineers, contractors and operators to design, maintain and operate them as safe buildings to support patient care and minimize the transmission risk of healthcare-associated infections (HAIs).

Plumbing systems can contribute to the proliferation of pathogens in a facility’s water supply system and facilitate water-toair transmission of pathogens through

40 CANADIAN HEALTHCARE FACILITIES

water fixtures, contaminated traps and aerosolization of toilet bowl contents.

Special considerations impact the selection of fixtures for healthcare facilities, including cleanability, hands-free activation and laminar flow faucets, and suitable physical dimensions to facilitate proper handwashing. Designers must also balance sustainability and water conservation efforts with infection prevention and control concerns, which impact fixture flow rates, recycled or grey water reuse.

PLUMBING SYSTEM PATHOGENS

Microorganisms present in healthcare facility plumbing systems include gram-negative pathogens of medical importance, such as Escherichia coli, Klebsiella, Serratia, Pseudomonas aeruginosa and Legionella pneumophilia. Legionella replication within protozoa provides the pathogens with protection from biocides and heat used to disinfect water systems, making it very difficult to eradicate once established.

Major risk factors within the plumbing sys-

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tem include stagnation, reduced disinfectant levels and inadequate hot water temperatures. Factors that increase the risk further are the presence of scale and sediment, biofilm and pH fluctuations. Actions known to release resident bacteria are construction activities, watermain breaks, water shutdowns and changes in water pressure.

CSAstandardZ317.1,SpecialRequirements for Plumbing Installations in Health Care Facilities, includes specific design and maintenance requirements for plumbing systems that minimize the development and proliferation of pathogens in them.

Water conservation is a significant concern given the growing push to preserve resources and for buildings to achieve LEED accreditation involving water use reduction credits.

Unfortunately, water conservation measures have been associated with an increase in bacterial contamination. To address this, Z317.1 prohibits the use of aerators and mandates a minimum flow rate of 1.5 gallons per minute for lavatory and hand hygiene sink faucets.

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BUILDING SYSTEMS Another factor is energy conservation targeting domestic hot water systems through the lowering of generation and distribution temperatures, and the introduction of energy conservation devices.

Z317.1 mandates hot water system temperatures and specifically addresses water preheating as part of an energy recovery strategy, prohibiting it unless the healthcare facility has performed a documented risk management exercise.

In terms of maintenance requirements, the latest edition of Z317.1 contains a new clause requiring healthcare facilities to develop a documented water management plan to manage and mitigate risks to their water systems. This clause references ASHRAE standard 188 and establishes minimum legionellosis risk management requirements for building water systems.

These are described in Annex E in Z317.1, and include building water systems analysis; control locations; control limits; monitoring; corrective actions; implementation; and documentation.

REMEDIAL MEASURES

When microbial contamination is identified in a healthcare facility, prompt remedial action is required. This typically involves system decontamination, either by chemical shock treatment through hyperchlorination or thermal shock treatment (superheating). Z317.1 requires that hyperchlorination be implemented for new or significantly altered systems, or following the reactivation of a plumbing system that has been inactive or that was drained for an extended period. Annex D1 Biomedical_CHF_Winter_2017_FINAL.pdf in the standard includes guidance on both superheating and hyperchlorination, describing the method and precautions for both.

Flushing can also be implemented as a remedial measure and as part of routine maintenance to prevent water stagnation.

Flushing begins at the building service line and works systematically through the building systems to avoid introducing or moving contaminants from one location to another.

The latest edition of Z317.1 includes updates regarding unused portions of a water system and requires a risk assessment be performed prior to its shutdown. For any time frame of two weeks or more, the water system must be disinfected prior to being drained or put into an out-of-use state, or must be flushed thoroughly for a minimum of 10 minutes at least twice a week.

When a single case of healthcare-associated Legionnaires disease is detected, immediate investigation and control measures should be initiated. If contamination is identified, disinfection of the water distribution system may be necessary. If hyperchlorination is performed, chlorine should be introduced into the potable water system to maintain a minimum target chlorine contact time value of 4,000 ppm-min per litre at every outlet for a minimum of three hours, but not exceeding 24 hours. Showerheads and aerators/laminar flow devices should be removed prior to system disinfection and either disinfected or replaced before reinstallation. Every outlet must then be flushed until chlorine residual returns to normal municipal water levels. It is important to prevent aerosolization of water during this work. A risk assessment should be performed to determine the need to relocate respiratory fragile patients, such as neonatal intensive care infants, due 4:45 to chlorine off-gassing during 2017-10-23 PM disinfection.

After disinfection, approximately 10 per cent of fixtures should be resampled with measures in place to protect at-risk popula-

tions until results are received. Further testing should take place every two weeks for the following three months and then at three-month intervals.

FINAL TAKEAWAYS

Plumbing systems can contribute to injury and the spread of infectious diseases due to hazards created by improper temperatures, stagnation, leaks and inadequate drainage, and adverse conditions created by failure or improper operation.

A detailed water management/water safety plan is imperative and must take into account patient populations and services provided, as well as the age, complexity and limitations of the plumbing infrastructure for each building. Z317.1 can assist by providing guidance on design and maintenance requirements that minimize the development and proliferation of pathogens, and ultimately reduce the risk of HAIs. Healthcare facilities should consider various situations when developing their water management plan, such as how to perform a system-wide disinfection if required, how to deal with a loss of water, the potential to run a mock code grey and acceptable legionella concentrations.

Jessica Fullerton is the infection prevention and control lead for The Ottawa Hospital planning and redevelopment department. She is also chair of CSA standard Z317.13, Infection Control During Construction, Renovation and Maintenance of Health Care Facilities. Marianne Lee is a principal and senior mechanical engineer at H.H. Angus and Associates. She is chair of CSA standard technical subcommittee Z317.1, Special Requirements for Plumbing Installations in Health Care Facilities. Jessica and Marianne can be reached at jfullerton@toh.ca and marianne.lee@hhangus.com, respectively.

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