CHF Summer 2024

JOURNAL OF CANADIAN HEALTHCARE ENGINEERING SOCIETY

CULTURAL CONNECTIONS HealthcareFacilities Canadian

Design of new Cowichan District Hospital demonstrates respect, inclusion for Indigenous populations

Hospital lighting retrofit a shining example Wayfinding for a better patient experience A novel solution to the sink P-trap problem

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40 A Fine Balance

Preserving cultural heritage in Indigenous long-term care facilities with infection control

42 Just Breathe Ventilation resilience in age of COVID, climate crisis

16 Wayfinding: Guiding a Better User Experience Signalétique: Rehausser l'expérience des utilisateurs

26 Form Flows from Function

Misericordia Community Hospital emergency department project illustrates innovative approach to space planning

32 Brightening the Future

Lighting retrofit at Perley Health leads to significant cost savings, other sustainable initiatives

36 A Hospital for All

Inclusivity drives design of new healthcare facility on Vancouver Island

44 A Reservoir of Bacteria

Novel solution aims to rid hospital sinks of pathogenic potential

EDITOR/RÉDACTRICE Clare Tattersall claret@mediaedge.ca

GROUP PUBLISHER/ Sean Foley ÉDITEUR DU GROUPE seanf@mediaedge.ca

PRESIDENT/PRÉSIDENT Kevin Brown kevinb@mediaedge.ca

SENIOR DESIGNER/ Annette Carlucci CONCEPTEUR annettec@mediaedge.ca GRAPHIQUE SENIOR

GRAPHIC DESIGNER/ Thuy Huynh-Guinane GRAPHISTE roxyh@mediaedge.ca

PRODUCTION Ines Louis COORDINATOR/ inesl@mediaedge.ca COORDINATEUR DE DE PRODUCTION

CIRCULATION MANAGER/ Adrian Holland DIRECTEUR DE LA circulation@mediaedge.ca DIFFUSION

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 SCISS

PRESIDENT Craig B. Doerksen

VICE-PRESIDENT Jim McArthur

PAST PRESIDENT Roger Holliss

TREASURER Reynold J. Peters

SECRETARY Beth Hall

EXECUTIVE DIRECTOR Tanya Hutchison

CHAPTER CHAIRS

Newfoundland & Labrador: Colin Marsh

Maritime: Robert Barss

Ontario: John Marshman

Quebec: Mohamed Merheb

Manitoba: Stephen R. Cumpsty

Saskatchewan: Melodie Young

Alberta: James Prince British Columbia: Mitch Weimer

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

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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.

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FINDING THE WAY

THERE IS A SENSE of unease when going to hospital, whether as a patient or visitor. Generally, the trip is for an ailment that requires treatment, which is anxiety-inducing in and of itself. Coupled with the fact these healthcare spaces can be extremely challenging and time-consuming to navigate, as they’re often large, consisting of multiple wings, departments and services, and in a constant state of flux, it’s no wonder people are stressed before they even walk through the doors. Wayfinding is key to helping solve these pain points and improve overall satisfaction within healthcare facilities. Assam Michel Daoud of Arium Design delves into its importance and how wayfinding can guide a better user experience, including for hospital staff, in the first of a number of articles based around the theme of the 2024 CHES National Conference — Enriching Patient Experiences by Optimizing the Environment. Others in the feature series focus on specific hospital projects: the newly opened emergency department at Misericordia Community Hospital in Edmonton; a lighting retrofit at Perley Health in Ottawa; and the Cowichan District Hospital replacement in Duncan, British Columbia.

Infection prevention and control is this issue’s second theme. Topics covered include how to balance infection control and cultural issues in long-term care facilities within Indigenous communities; Alberta Health Services’ approach to ventilation resilience; and a novel idea to the sink P-trap problem.

Looking forward to fall, the annual CHES awards will be presented at the society’s national conference, Sept. 8-10, in Halifax. Recipients will be celebrated in the next issue of Canadian Healthcare Facilities, which will also include special focuses on sustainable healthcare and facility management and design. If you would like to submit an article on either topic, please contact me.

Clare Tattersall claret@mediaedge.ca

WORKING TOGETHER

REFLECTIONS AND LOOKING FORWARD

SEPTEMBER WAS A BUSY month with three events: the 2023 CHES National Conference, Saskatchewan chapter conference and trade show, and Quebec chapter souper-conférence (dinner conference). As I wrote in my last message, CHES members see these conferences as a reunion of sorts. They provide an opportunity for those in the healthcare industry to come together, learn, share and investigate how to make our healthcare system more efficient and effective, with the goal of improving the patient experience and healthcare outcomes.

IT’S HARD TO BELIEVE my term as CHES National president is coming to an end. As I reflect on my past seven messages, amongst the themes I have to reiterate is the ‘family’ aspect of CHES.

This past spring, Manitoba, Ontario and British Columbia held their annual chapter conferences, and the Maritimes chapter hosted an education event. Saskatchewan, Alberta, and Newfoundland and Labrador will hold their chapter conferences in fall. However, as CHES, we are celebrating our newest family addition, the Quebec chapter, which held its first all-day conference May 15, at Hotel Universel in Montreal. More than 90 delegates were in attendance, supported by eight vendors. The chapter executive, chaired by Mohamed Merheb, has strived for many years since their formation in 2018, to get to this point. After hosting several education dinners, we are excited for our Quebec family, now and in the future.

Throughout my more than 10 years on the CHES board, including the past eight years serving on the executive, acting strategically has been a strident goal. Building upon past work to guide and direct the organization around our mission, vision and values, the board and committee chairs have recently completed a new strategic planning document. This document interconnects the ‘who’ of CHES, that is, our mission, vision and values, with ‘what’ we do, pillared around the three cores of our vision — education, innovation and partnership — and then answers ‘how’ we do these three cores, ‘how’ we work as a society and ‘how’ we function through committees, the board, executive and national office.

While at the national conference in Winnipeg, the entire CHES board and four committee chairs gathered over two days for strategic planning sessions and meetings. I’ve had the honour of serving on the CHES National board under three previous presidents. We have built on this legacy of leadership and planning, and again this year we spent time reflecting on the organization that CHES has become and where it is going. We discussed how to make CHES more effective, which included an assessment of our leadership model, promote the value of CHES membership, and shape the future of our flagship Canadian Healthcare Construction Course (CanHCC). Time was also spent discussing goals and aspirations. To meet the ever-changing healthcare landscape, CHES must continue to grow, mature and expand. This requires the involvement and engagement of CHES members in national and chapter leadership roles and on committees. Look for ongoing dialogue, information and plans as CHES moves forward — together with you, its members.

We then laid the groundwork for ‘what’ we are going to do — turning this into a strategic plan for the society and the committees (membership, communications, corporate advisory, partnership and advocacy, and professional development) and executive’s highest-level actions. The strategic plan will be presented at the upcoming national conference and other forums.

From this, committees and the executive will develop specific goals and objectives. These will guide CHES activities, budgeting and national office, executive and committee work plans.

Why is this important?

This year’s national conference is now ‘in the books’ but there are still plenty of activities taking place. I attended the International Federation of Healthcare Engineering (IFHE) Congress in Mexico City Nov. 4-6, chaired by current IFHE president and former CHES president Steve Rees. Chapters across the country are planning next year’s conferences, and the CHES National conference planning committee, under the leadership of Robert Barss, is preparing the Maritime chapter to host the 2024 CHES National Conference in Halifax, Sept. 8-10. CHES’s webinar series, CanHCC sessions, social media platforms and regular e-blasts of timely news articles, as well as other partner organizations’ events promoted to CHES members, are significant value-added benefits.

An ever growing, changing and nationally focused Canadian society needs to clearly communicate this to its members (owners) and customers (Canadian healthcare), and create consistency in focus to achieve the multi-year vision.

And let’s not forget the enormous value found in our quarterly journal, Canadian Healthcare Facilities. It’s a forum to share your successes, learnings and challenges with design professionals and vendor teams, and internally with infection prevention and control, environmental services, laboratory and/or security teams at your facility. Reach out to the journal’s editor, Clare Tattersall, at claret@mediaedge.ca to relay your ideas to help impact Canada’s healthcare system.

Craig B. Doerksen CHES National president

CHES recently completed its national election process. The results are the acclamation to all three positions. Elected executive positions are vice-president, Kate Butler (Maritimes chapter); treasurer, Reynold Peters (Manitoba chapter); and secretary, Paul Perchon (Alberta chapter). As per the bylaws, Jim McArthur moves into the role of president and I will become immediate past president. Tanya Hutchinson remains appointed as executive director. These six people comprise the CHES National executive for 2024-2026. I’d like to thank Beth Hall, who served as CHES National secretary for the past two years and will return in spring 2025 to the national board as Ontario chapter chair. Roger Holliss now moves into being past president, after having served on CHES National as Ontario chapter chair, and then a pandemic-extended seven-year term in the presidential series. I know Roger will continue to contribute to CHES in many national and chapter roles.

It has been a pleasure to serve the membership of CHES and those relatives (patients, residents and clients) that we serve. While my term comes to an end, the work of CHES and my involvement will not. I look forward to continuing to serve alongside my CHES family.

Craig B. Doerksen CHES National president

EARN CONTINUING EDUCATION CREDITS FROM CHES

EARN CONTINUING EDUCATION CREDITS FROM CHES

Members of the Canadian Healthcare Engineering Society can earn free continuing education units (CEU) by reading the Fall 2023 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/6QDKXP8 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.

Members of the Canadian Healthcare Engineering Society can earn free continuing education units (CEU) by reading the Summer 2024 issue of Canadian Healthcare Facilities and passing a quiz based on articles in the issue. Once you’ve read the issue from cover to cover, simply go online to https://www.surveymonkey.com/r/BFSM55B 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.

PRIORITIZING PATIENT CARE:

The Unique Demands of Restoring Medical Facilities

In the event of a loss, the immediate goal of a restoration company is to provide post-event damage mitigation services and begin restoration. In healthcare environments, the ability to work around medical functions without impacting service is crucial to the success of the project and the continuing care of patients. During a healthcare restoration project, a specialized approach is required to prioritize work areas based on the criticality of their functions.

SPECIALIZED CARE FOR CRITICAL ENVIRONMENTS

Last year, First Onsite responded to a water loss at a hospital where a six-inch sprinkler main had burst creating a catastrophic failure. Over a 4-hour period, hundreds of gallons of water were lost, flooding vital areas of the hospital.

“We had to pull all our forces together, focusing on mitigating the loss by using extraction pumps to remove three feet of water from the basement,” explains Luis Soares, a construction manager with First Onsite who oversees healthcare projects across the East Coast. “It’s a complicated task just to get rid of the water.”

medical equipment within the hospital. “By understanding the function of each specific department, we were able to prioritize which areas needed attention first.”

First Onsite’s approach emphasizes readiness and proficiency. Each of their supervisors and project managers are Infection Prevention and Control (IPAC) certified, meaning that no matter what time a call comes in, whomever responds has the basic understanding of how to function within a healthcare environment, and brings in the appropriate specialization as needed.

The loss affected multiple vital areas of the hospital, including the basement, laundry services, and vital functioning of the hospital.

“We were dealing with areas of the hospital where patients had appointments and surgeries booked, and where it involved critical care.” The water loss had also affected the clinical engineering department, which deals with implementing and commissioning

COLLABORATION AND CLIENT ENGAGEMENT

For a healthcare restoration project to be successful, collaboration is crucial. “We engage heavily with end users, holding roundtable discussions and meetings to understand their needs and work around schedules,” Soares says.

MINIMIZING DISRUPTION IN CRITICAL ENVIRONMENTS

Infection Control and Prevention, and Biocontainment Support all play into the unique needs of a healthcare property. First Onsite will utilize HEPA air scrubbing and negative pressurization to reduce the risk of airborne contaminants and work diligently to contain biohazardous materials and associated risks. In some cases, work will be phased to allow healthcare procedures to continue.

Soares’ dedication to healthcare restoration is personal. “I consider if one of my family members needed this care. As a company, we prioritize healthcare restoration. Rain or shine, our personnel are there, ensuring hospitals get back up and running as soon as possible.”

Healthcare restoration requires a blend of specialized knowledge, readiness, and empathy. First Onsite not only brings technical know-how but also a deep understanding of the critical nature of the work. Faced with challenges and with the right support, healthcare facilities can continue to provide essential services with as little interruption as possible.

“When working with operating rooms, we will often phase the work by restoring a quarter of the area, mitigating that loss, and then turn that area back over for use. We will then work on the next quarter and phase the work accordingly so that the hospital continues to function.” To minimize disruption, First Onsite uses advanced techniques and materials including modular hoarding systems that can be set up quickly to delineate damaged areas.

For more information, contact Kevin Spiers, Vice President, National Accounts at 416-272-5919.

HCONVENIENT, SECURE, HYGIENIC:

ADVANCED ACCESS SOLUTIONS IN HEALTHCARE

ospitals employ a staggering number of workers, each of whom has unique access needs. These facilities contain a broad range of rooms and spaces ranging from ERs, ICUs and Operating Rooms, to reception, waiting rooms, administrative o ces and many others. The people who need to access each of these spaces varies, as do those who need to be restricted. Each has specific security requirements; each needs to be monitored consistently and some require an available audit trail. With a rotating user base including sta , patients and visitors, as well as maintenance personnel, deliveries and other vendors, access management has traditionally been a considerable challenge.

Providing sta with convenient, keyless access is a modern solution to streamlining healthcare safety and security—as well as hygiene practices. Recent innovations in prop-tech systems now allow healthcare facilities to set specific requirements of access control to oversee each employee and ensure security of their assets. Understanding the advanced access control needs in healthcare settings, Salto has developed innovative solutions to meet these complex challenges.

SMART CONTROL SOLUTIONS

Salto’s proprietary SVN (Salto Virtual Network) technology allows locks to communicate through user credentials such as ID badges, key cards, key fobs, and smartphones. By linking user profiles and working calendars to specific areas or practice zones, healthcare facilities can instantly set and modify user

access privileges. This not only enhances security but also streamlines the workflow, reducing administrative burdens associated with traditional key management. Once scanned on one of the main connected access points throughout the hospital, the information stored on the access credential reports back to the network providing an audited trail of all access points and locations the card holder has visited. The SVN allows the natural movements of people to create an audit trail that helps to monitor access to hospital assets and workflow. Sensitive areas such as birthing centres and intensive care units are safeguarded by restricting access to authorized personnel only, protecting assets, data, and medical supplies. In the context of infectious diseases, a modern access control system can be used to audit patient movement flows and for contact tracing, thus aiding in contagion control and microbe protection.

STAND-ALONE LOCKS NEED NO INTERNET CONNECTION

Using Salto’s “Data-on-Card” technology means individual locks do not need internet connectivity. Throughout the day, information from each access credential is transferred back to the network. Each time users’ credentials interact with an o ine lock, a “read/write” exchange of information occurs. This instantaneous data swap updates the lock with the latest user information for the entire network and simultaneously updates the credential with information about every user who has accessed that lock.

In high-touch healthcare environments, hospital lockers equipped with keyless access systems not only o er convenience but also play a vital role in maintaining security and hygiene standards. These keyless locker systems eliminate the need for physical keys, reducing the chances of crosscontamination—a critical factor in sterile environments. This ease of use not only benefits sta but also enhances the overall hygiene within the facility. Implementing advanced locker solutions like those o ered by Salto, can significantly enhance a hospital’s operational capabilities, making it a safer place for both sta and patients.

Designed to optimize the control and monitoring of lockers in healthcare environments, Relaxx by Gantner—part of the Salto Wecosystem—is a cutting-edge locker management software. O ering a centralized platform to manage locker use assignments, usage data, and access rights, the software allows real time updates to access rights and 24/7 monitoring. The Relaxx software user-friendly interface allows administrators to easily assign lockers to individuals or groups, set access permissions, and monitor locker status. This functionality enhances operational e ciency and improves user experience by minimizing wait times and ensuring secure, hassle-free access.

ADVANCED TRACKING AND AUDITING

Advanced locker systems o er secure locking, encrypted communication and alarm function to prevent tampering,

a digital audit trail tracks and verifies all access attempts. This ensures that only authorized personnel can open specific lockers, helping safeguard personal items and sensitive materials, significantly reducing the risk of theft or unauthorized access.

Smart lockers allow hospitals to:

• Quickly Add or Modify Access: As sta members join, leave, or change roles, the system can easily update access permissions, ensuring that only authorized people have access to specific areas.

• Facilitate Emergency Situations: In case of an emergency, locating a sta member becomes easier with digital records of locker access, which can provide crucial information quickly.

• Flexible Use Cases: For pharmaceutical lockers, utilizing RFID technology and mobile access credentials ensures that only authorized personnel can access medication storage. This helps meet regulatory compliance and also prevents unauthorized access and potential theft. By providing secure and e cient personal storage, secure lockers can be integrated into the hospital’s overall security network.

Advanced locker systems integrate with existing hospital security infrastructure, including video surveillance and alarm systems. Hospitals can easily expand their security infrastructure to include additional properties thanks to the adaptable Salto design. By implementing smart locker systems, hospitals can better manage contagion risks. Limiting and controlling access to areas with contagious diseases helps manage patient movement flows and track potential contagion chains, significantly enhancing infection control measures.

Hospital lockers play a crucial role in ensuring the safety and e ciency of healthcare environments. By providing convenient, keyless access and robust security features, smart lockers help protect belongings and sensitive or controlled materials, providing peace of mind for hospital workers, their patients and medical facility management. Their integration into the broader hospital security infrastructure provides daily support to critical healthcare professionals.

Implementing Salto solutions can eliminate the cost of replacing keys and maintaining outdated access systems. Easy and economical to deploy, Salto’s solutions o er a path to upgrading facility safety and security and retrofitting modern access control into existing infrastructure.

Salto continues to champion innovative-thinking and is a leader in access control technology, o ering unparalleled convenience and security. The future is ready to unlock. To learn how your facility can benefit, visit saltosystems.ca

BRITISH COLUMBIA CHAPTER

We held our spring conference June 2-4, in Whistler, around the theme, Surviving and Thriving: Stories of Hope Amidst Disaster. There were excellent education sessions and sponsorship was fully sold-out. We are already preparing for our next provincial conference.

The education committee is exploring increased marketing for members to take advantage of our educational support, such as the bursary program and CHES webinar series. We are also considering targeted funding for each health authority to send a resource for CSA medical gas technical training. More information to come in fall or early winter.

Chapter executives and members remain actively engaged in various committee work, including support for CHES partnership and advocacy, professional development, membership and social committee, CSA standards and the Canadian Healthcare Construction Course.

The B.C. chapter held an election this year, as part of our annual general meeting during the spring conference. We received several nominations from members interested in volunteering. The new executive is chaired by Mitch Weimer. Other members include Doug Davis (vice-chair), Dawn Chan (treasurer), Steve McEwan (secretary) and myself (past chair).

This is my last report as chair (written in May). It has been an honour to lead the B.C. chapter and represent our membership. Thank you for all your support. I’d also like to express my gratitude for the dedication and hard work of our executive team, directors, volunteers and members.

—Sarah Thorn, British Columbia chapter chair

SASKATCHEWAN CHAPTER

The Saskatchewan chapter has held several meetings with great conversation around membership and growing our presence within the province and healthcare sector. There are a number of healthcare or construction-related organizations that we essentially contend with for membership. As we plan for our fall conference, we will be promoting and further expanding our invite list to local consultants, contractors, suppliers and various Saskatchewan Health Authority teams, including infection control, clinical departments, environmental services, building maintenance trades and major capital project teams. Our plan is to showcase CHES, with the hope of garnering new and lasting memberships.

One of our chapter goals is to increase our presence within CHES on a national level. Three committee members will attend the 2024 CHES National Conference in Halifax, in September. This will provide a great opportunity to network and have conversations with our national partners.

The Saskatchewan chapter is looking to host the Canadian Healthcare Construction Course in spring 2025. In preparation, we will send out communications for interest, as well as course details and description.

MANITOBA CHAPTER

We held our annual education day April 16, at the Victoria Inn Convention Centre, around the theme, Transformative Healthcare Infrastructure. Although it was only a one-day event this year, it was well-attended, with 33 sponsors and 190 delegates, and considered a huge success. Planning has already started for next year’s event.

Unfortunately, due to low nominations, chapter awards in project management and facility management were not given out at our education day. We will try again in 2025.

As well, attendance for May’s Canadian Healthcare Construction Course was lower than anticipated. Consequently, it was cancelled. The course will be offered again Nov. 28-29, and held in conjunction with the Winnipeg Construction Association. The Manitoba chapter will be advertising the event to improve session attendance.

CHES Manitoba held an election this year, as part of the education day. The chapter executive is now led my myself (chair) and Kevin Shmon (vice-chair). Reynold Peters has moved into the role of past chair, but I doubt he will be far away, if needed. Treasurer and secretary positions remain unchanged, held by James Kim and Jeremy Kehler, respectively. There is some interest from others in helping out, so the executive is making every effort to grow the chapter.

After several tries to give away the grand prize trip to the CHES National conference in September, it was finally claimed by Mike Reader, director of capital management at the Northern Regional Health Authority. In addition to Mike, there will be a strong contingent of Manitoba chapter executives at the conference. I will be attending as chapter chair, along with Kevin, Jeremy, who also serves as CHES National professional development subcommittee chair, and Reynold (CHES National treasurer). There, current CHES National president and Manitoba chapter member-at-large Craig Doerksen will move into the role of past president for the next two years.

—Stephen R. Cumpsty, Manitoba chapter chair

The Manitoba chapter pared back its spring conference to a single day this year, holding it at the Victoria Inn Convention Centre in Winnipeg.

—Melodie Young, Saskatchewan chapter chair

Much of the planning has been completed and most events have been confirmed for the 2024 CHES National Conference in Halifax, Sept. 8-10. The opening reception will be held at Pier 21, the gateway to this country for one in five Canadians. Delegates are invited to visit the Pier 21 website to find out if they have family connections and are encouraged to sign-up for one of the free tours to be held during the reception. Conference educational sessions have been reviewed and approved. Thank you to Gordon Burrill and the abstract review team for putting forth the effort to develop a fantastic line-up of speakers and topics. CHES members from across Canada are encouraged to join us for some homegrown Maritime hospitality and what will be an event to remember.

Post-conference, the chapter will host the Canadian Healthcare Construction Course (CanHCC), Sept. 11-12, at the Prince George hotel in Halifax. We have been meeting with various groups, including construction associations from all three Maritime provinces, to promote the CanHCC. If planning to attend the CHES National conference and you would like to complement your healthcare facility education, consider signing up for this twoday training program. Information can be found on the CHES website.

Kate Butler and Helen Comeau are part of the team developing Women in CHES. Look for activities from the group to be highlighted at this year’s CHES National conference.

A spring education session was held May 14, at the Four Points by Sheraton in Moncton, N.B. This free program was open to hospital and long-term care maintenance staff. Approximately 70 people attended. There were seven presentations on a variety of topics, including water damage in healthcare facilities, using the right filtration, computerized maintenance management system software, roof and chiller maintenance, power quality and water management plans. Thank you to all presenters and sponsoring companies for helping make this day a success.

The Maritime chapter continues to foster a strong relationship with the Nova Scotia Department of Seniors and Long-term Care and is pleased to announce the department has committed to a long-term membership obligation for approximately 138 of their facility managers. We are excited to have this opportunity to further the relationship between CHES and the seniors and long-term care sector and look forward to their participation and support.

Several CHES Maritime members supported CHES National past president Roger Holliss at the Canadian College of Health Leaders conference in Halifax, June 1-3. Roger presented a seminar titled, Your Healthcare Facility, Your Health Teams and Your Patients: What Keeps You Up at Night?, as well as hosted an exhibit lounge. This was a great opportunity to promote the benefits of CHES membership and its programs to healthcare leaders from across the country.

The Maritime chapter continues to offer several financial incentives to members, such as the Per Paasche bursary, contributions to Canadian Certified Healthcare Facility Manager exam fees, and spring and fall education days, among other membership benefits.

—Robert Barss, Maritime chapter chair

ALBERTA CHAPTER

As we navigate the challenges posed by Alberta Health Services and its partners’ expenditure restrictions, I am pleased to share updates regarding our annual Clarence White conference and related events.

In response to budget constraints, we have transformed our traditional multi-day conference into a single-day event. The 2024 Clarence White Conference will take place Sept. 16, at the Red Deer Resort and Casino. Buses will be arranged for convenient, complimentary transportation to and from the event, connecting delegates from Edmonton and Calgary. Our focus remains on delivering high-quality content and fostering meaningful connections among healthcare engineering professionals.

Recognizing the limited support currently received from conference attendance, we have reduced delegate fees. This adjustment ensures our event remains accessible to all interested participants without the obligation of a hotel night expenditure. We encourage early registration to secure a spot at this valuable networking and learning opportunity.

On Sept. 15, we will host a round of golf at the Spirit Creek Golf Course. This informal gathering provides a relaxed setting for networking and camaraderie. Golf enthusiasts are invited to join for a day of friendly competition and scenic views.

Regrettably, due to current limitations, we have decided to cancel the planned Canadian Healthcare Construction Course for this year. Rest assured, we remain committed to providing educational opportunities in the future.

As always, we appreciate the unwavering support of our vendors. Their contributions enhance the conference experience and allow us to offer valuable resources to attendees.

—James Prince, Alberta chapter chair

The opening reception of the 2024 CHES National Conference will be held at Pier 21, home to the Canadian Museum of Immigration.

QUEBEC CHAPTER

The Quebec chapter’s inaugural conference in Montreal was a great success. With more than 90 delegates and seven vendors in attendance, it is evident CHES is establishing a strong presence in the province. There were four technical sessions, all of which received positive feedback from participants. CHES National president Craig Doerksen was present, showcasing the collaboration among all chapters. I am pleased to announce the chapter conference will return in 2025. Many participants and vendors have already reserved spots.

Following the conference, the Quebec chapter hosted the Canadian Healthcare Construction Course, June 5-6, for the first time. The Montreal event was made possible through collaboration with the Quebec Construction Association.

The Quebec chapter aims to participate in the CHES National conference, Sept. 8-10, in Halifax. Numerous members have expressed interest in attending and learning more about our society.

We expect a rise in membership over the summer months. Our goal is to reach 100 members by 2025. We are actively leveraging social media platforms like LinkedIn and Instagram to build a robust communication network. I encourage you to follow us on these channels to stay informed about the latest events and initiatives. Your continued support and active engagement are invaluable as we collectively strive to advance healthcare engineering in Canada.

—Mohamed Merheb, Quebec chapter chair

ONTARIO CHAPTER

The Ontario chapter executive continues to meet quarterly via virtual means, focused on membership development, education events and member benefits, including bursaries and the Young Professionals Grant.

From the silver linings playbook of the pandemic, we held a virtual education session earlier this year, which brought together vendors and members around the important topic of decarbonization. The session was well-organized and well-attended. We will continue to balance virtual and in-person engagement opportunities going forward to maximize member benefit.

Our conference planning committee under Ron Durocher’s leadership pulled off another successful spring conference, May 2628, at Blue Mountain, in Collingwood. The CHES Ontario family gathered around the theme, Embracing Change and Transformation.

We continue to engage in networking and advocacy opportunities. In March, I attended the ASHE PDC Summit in San Diego, as well as the HIMSS Global Health Conference and Exhibition in Orlando.

The Ontario chapter continues to work to further partnerships with our long-term care colleagues at Advantage Ontario, and participated in their conference this past April.

—John Marshman, Ontario chapter chair

CHAPITRE DU QUEBEC

Notre conference inaugurale du chapitre à Montréal a été un grande succès. Avec plus de 90 délégués et sept fournisseurs presents, il est evident que la SCISS établit une forte presence dans la province. Nous avons organisé quatre sessions techniques, toutes ayant reçu des retours positifs de la part des participants. De plus, notre president national de la SCISS, Craig Doerksen, était présent, démontrant la collaboration entre tout les chapitres. Nous sommes heureux d’annoncer que la conference du chapitre reviendra en 2025, avec de nombreux pariticipants et fournisseurs ayant déjà reserve leurs places.

À la suite de la conférence, la section québécoise a accueilli pour la première fois, les 5 et 6 juin, le Cours canadien sur la construction d’établissements de santé. Cette séance a été rendue possible grâce à la collaboration de l’Association de la construction du Québec.

Nous visons à participer à la conference nationale de la SCISS à Halifax. De nombreux members de la SCISS Québec ont exprimé leur intérêt à assister et à en apprendre davantage sur notre société. Nous prévoyons une augmentation des adhésions pendant l'été 2024. Notre objectif reste d’atteindre 100 membres d’ici 2025. Nous exploitons activement les plateformes de medias sociaux telles que LinkedIn et Instagram pour créer un réseau de communication solide. Nous vous encourageons à nous suivre sure ces canaux pour rester informés de nos derniers événements et initiatives. Votre soutien continu et votre engagement actif sont inestimables alors que nous nous efforçons collectivement de faire progresser l'ingénierie de la santé au Canada.

—Mohamed Merheb, chef du conseil d’administration du Québec

The Ontario chapter's spring conference in Collingwood was well-received, providing an educational and enjoyable time for all who attended. Photos courtesy Kent Waddington.

A TESTAMENT TO RESILIENCE: FACILITIES

MANAGEMENT IN HOSPITALS

DURING THE WILDFIRES IN BRITISH COLUMBIA

Last year, as more than 2,000 raging fires engulfed over 1.5 million hectares, British Columbia faced a daunting challenge: how to keep its healthcare facilities running smoothly and safely amid the smoke and ash. The Kelowna fires of 2023 presented significant challenges for the city’s healthcare sector.

For Black & McDonald, this meant ensuring that the Kelowna General Hospital and Vernon Jubilee Hospital, remained functional, comfortable, efficient, and resilient. David Frost, B&M’s Division Manager overseeing operations at both hospitals, shared the strategies his team employed to cope with the unprecedented situation.

“Right from the onset, air quality became a pivotal focus,” he said. “It was hard to breathe with the outside air deteriorating to hazardous levels as smoke and particles from the fires drifted into the city.”

To maintain healthy indoor air quality, the B&M team managed the HVAC systems, ensuring that the filters were changed as needed, that the airflows throughout the buildings were adjusted, and that the outdoor air drawn into the building was minimized, thereby reducing the smoky smell within the facilities.

Another challenge for the team involved removing the accumulation of ash and debris on the roofs of the hospitals, which posed a fire hazard. The team regularly patrolled the roofs and hosed off any ash or debris that may have landed there. They also ensured that any loose flashing or potentially flammable material was removed promptly.

“We had to be meticulous and proactive,” he said. “It required

constant monitoring and adaptation, given the uncertainty of the situation and the fact that everything could change hour by hour.”

The B&M team communicated regularly through incident command centres set up to address any questions or concerns and to keep everyone updated on the progress in managing the fire’s impact.

Given the intensity of wildfires is increasing, especially in areas like the Okanagan Valley, Frost said his team

items like air filters, which now form part of the standard preparedness for wildfire threats.

Another was the need for extra planning and coordination to ensure staff availability and mobility, as the fire was so severe in Kelowna, it closed down major access roads between Kelowna and Vernon hospitals, affecting the staff’s ability to reach their workplaces or homes. “We had to find workarounds to ensure that health-care services were not disrupted,” he said.

“We had to be meticulous and proactive. It required constant monitoring and adaptation, given the uncertainty of the situation and the fact that everything could change hour by hour.”

David Frost, Division Manager

learned some valuable lessons from their experience in 2023. One of them was the importance of regular supply inventory checks, especially of critical

As we look toward the future, the experience of the fires in British Columbia serves as a crucial lesson in disaster management for health care facilities. Our resilience and adaptability helped keep the lights on in the hospitals, while the city smoldered around them. In a warming world, an effective facilities management team can help navigate the path to recovery.

For more information on Black & McDonald’s Facilities Management services, please visit www.blackandmcdonald.com

WAYFINDING:

GUIDING A BETTER USER EXPERIENCE

Signalétique: Rehausser l'expérience des utilisateurs

By/Par Assam Michel Daoud

Afacility manager’s primary objectives are to provide the best healthcare services, enhance the user experience, streamline operations, manage wait times, reduce user stress and anxiety, and ensure smooth operations and satisfaction with services provided. At the same time, it is critical to create a healthy work environment for employees while minimizing operational costs.

In reality, this is a daily struggle for managers. They are faced with stressed and anxious users, over-solicited employees, complaint management, rising budgetary costs and the constant search for last-minute solutions. Consequently, managers often find themselves in reactive mode, like firefighters putting out fires, rather than

Le gestionnaire d’établissement de santé vise l’excellence. Son ambition: offrir des soins de qualité, améliorer l’expérience des usagers et optimiser les opérations. Il s’efforce de réduire l’attente, d’apaiser les patients et d’assurer leur satisfaction. En parallèle, il doit créer un environnement de travail sain tout en maîtrisant les coûts.

La réalité sur le terrain s’avère plus ardue. Le gestionnaire affronte chaque jour des usagers anxieux, du personnel débordé et des plaintes incessantes. Il jongle avec des budgets serrés et cherche constamment des solutions de dernière minute. Résultat: il se retrouve souvent en mode réactif, tel un pompier éteignant des feux,

LE DÉVELOPPEMENT D’UNE STRATÉGIE DE SIGNALÉTIQUE INTÉGRANT PSYCHOLOGIE ENVIRONNEMENTALE ET ACCESSIBILITÉ UNIVERSELLE GARANTIT INCLUSIVITÉ ET CONCENTRATION SUR L’USAGER.

focusing on planning and management. Caught off guard, this leads to improvisation and last-minute interventions, resulting in trial and error approaches that divert efforts to crisis management rather than service improvement.

When it comes to user experience, welcoming hospital patients and guests, and customer service, wayfinding is one of the critical interventions that can better equip facilities to interact and communicate with users. However, it is more than just the systematic placement of signs and arrows. Wayfinding is a holistic approach that integrates various communication methods to improve spatial understanding and guide users through a facility. These include the architectural environment, colours, textures, lighting, landmarks, orientation, imagery, inclusivity and more.

A user-centred approach considers environmental psychology and universal accessibility. Users respond differently to environmental contexts based on their physical and psychological states, which vary for each individual. Multiculturalism introduces an additional dimension of environmental perception related to each person’s cultural background, a reality that is particularly evident in healthcare settings. Environmental psychology helps to understand the interaction between users and their environment. It involves the impact of the environment on the individual, both physically and psychologically, and defines this relationship in terms of perceptions, emotions, attitudes or behaviours. Understanding these issues is critical to developing user-centred wayfinding strategies.

Unfortunately, planners and designers often consider wayfinding at the end of a project, prioritizing architectural design and assuming it will satisfy most navigational needs. However, wayfinding is directly related to architectural design, space planning, navigation, room numbering and naming, and the placement of environmental visuals, textures and artwork as landmarks.

The significance of wayfinding is often underestimated. Studies have shown poor wayfinding programs cause anxiety and stress among users, leading to frequent employee interruptions, appointment delays, additional operational management and frustration for both users and staff. This can have a significant financial impact on cost management.

To address these issues proactively and avoid constant reactivity, effective management of the environment, as well as welcoming and user guidance, are essential to achieve customer service, satisfaction, better operational management and cost reduction goals. Involving

au lieu de planifier et gérer sereinement. Pris au dépourvu, il improvise des interventions hâtives, multipliant les essais et erreurs. Pour optimiser l’expérience des usagers et l’accueil des patients, la signalétique joue un rôle crucial. Mais attention: il ne s’agit pas simplement de placer des panneaux et des flèches au hasard. La signalétique ou ‘wayfinding’ adopte une approche holistique intégrant divers modes de communication pour faciliter l’orientation spatiale. Elle englobe l’architecture, les couleurs, les textures, l’éclairage, les points de repère et bien plus encore.

Une approche centrée sur l’usager tient compte de la psychologie environnementale et de l’accessibilité universelle. Chaque personne réagit différemment à son environnement selon son état physique et psychologique. Le multiculturalisme ajoute une dimension supplémentaire liée au bagage culturel de chacun, particulièrement en milieu hospitalier. La psychologie environnementale étudie cette interaction complexe entre l’usager et son cadre. Elle analyse l’impact du milieu sur la personne, tant physiquement que psychologiquement. Malheureusement, les concepteurs et planificateurs négligent souvent la signalétique, la reléguant en fin de projet. Ils privilégient le design architectural, supposant qu’il répondra à la plupart des besoins de navigation. Erreur! La signalétique est intimement liée à la conception des espaces, des parcours, à la numérotation des salles et au positionnement des éléments visuels servant de repères. L’importance de la signalétique reste sous-estimée. Pourtant, les études le prouvent: un programme déficient engendre anxiété et stress chez les usagers. Il entraîne des interruptions fréquentes du personnel, des retards aux rendez-vous et une gestion opérationnelle accrue. Frustration garantie, tant pour les usagers que pour le personnel. Sans parler de l’impact financier considérable. Pour éviter cette réactivité constante, une gestion proactive de l’environnement et de l’orientation des usagers s’impose. Elle permet d’atteindre les objectifs de service, de satisfaction et d’optimisation des coûts. L’implication d’experts dès le début du projet est cruciale. Elle favorise une approche multidisciplinaire où architectes, designers et spécialistes de la signalétique collaborent étroitement. Ensemble, ils définissent les espaces, les parcours et les liens entre l’environnement bâti et les usagers. Une stratégie de signalétique élaborée en amont s’intègre mieux aux interventions architecturales. Bénéfique pour les usagers, elle minimise aussi les coûts.

t DEVELOPING A WAYFINDING STRATEGY THAT INCORPORATES ENVIRONMENTAL PSYCHOLOGY AND UNIVERSAL ACCESSIBILITY ENSURES INCLUSIVITY AND USERCENTREDNESS.

The signage program at the Centre hospitalier de l’Université de Montréal was developed and implemented over a 10-year period by Arium Design in collaboration with several stakeholders to meet the requirements and the highest performance criteria. Le programme signalétique du Centre hospitalier de l’Université de Montréal a été développé et implanté sur une période de 10 ans par Arium Design en collaboration avec plusieurs intervenants pour répondre aux exigences et aux plus hauts critères de performances.

La réalisation collaborative de projets gagne en popularité. Elle produit de meilleurs résultats en termes de design et d’intégration. Cette approche s’applique aisément aux nouvelles constructions. Pour les rénovations partielles ou les mises à jour, un processus d’analyse, de consultation et d’étude s’impose. Il permet de définir les problèmes et d’élaborer une stratégie de signalétique pérenne, centrée sur l’usager.

Une fois la stratégie développée, un plan directeur et un guide de normes deviennent essentiels. Ils définissent les outils de mise en œuvre et d’entretien. Sans ces principes et guides de référence, un programme de signalétique peut se détériorer rapidement après son implantation. La rigueur dans l’application des principes établis est cruciale. Cependant, flexibilité ne signifie pas rigidité. Un plan directeur doit s’adapter à l’évolution des besoins environnementaux et des usagers. Avec des principes solides basés sur l’utilisateur, les mises à jour seront facilitées.

La consultation, les tests et l’expérimentation jouent un rôle clé dans l’élaboration de la stratégie et du plan directeur. Ils permettent une validation continue tout au long du processus. Rien ne doit être tenu pour acquis. Une réévaluation constante s’impose.

Une démarche intégrée et collaborative s’avère essentielle pour un design environnemental et expérientiel efficace. L’implication d’experts en signalétique et en expérience utilisateur au sein d’une équipe multidisciplinaire dès le début du projet est vitale. Le développement d’une stratégie de signalétique intégrant psychologie

experts from the outset of a project is critical, fostering a multidisciplinary approach in which architects, designers, wayfinding experts and others work closely together to define the spaces, paths and connections between the built environment and users. A wayfinding strategy developed at the beginning of a project allows for better integration into architectural interventions, benefitting users while minimizing costs. Collaborative project delivery is increasingly preferred, leading to better design and integration results. This approach is easily applied to new construction projects. However, for partial renovations or updates, it is necessary to initiate an analysis, consultation, study and problemdefinition process to develop a user-centred wayfinding strategy that will endure over time.

Once the strategy is developed, it is essential to have a master plan and standards guidelines that outlines the tools for implementation and maintenance. It is not uncommon for a wayfinding program to deteriorate a year after implementation due to lack of principles and reference guides. It is essential to be rigorous in the application of established principles. However, this does not mean being inflexible. A master plan must be adaptable to changing environmental and user needs. With solid user-based principles in place, updates will be easier. Consultation, testing and experimentation are essential to developing the wayfinding strategy and master plan. They allow for validation throughout the development process. Nothing should be taken for granted and constant re-evaluation is necessary.

An integrated and collaborative approach is essential for effective environmental and experience design. Involving wayfinding and user experience experts on a multidisciplinary team from a project’s outset is vital. Developing a wayfinding strategy that incorporates environmental psychology and universal accessibility ensures inclusivity and user-centredness. In healthcare, where reducing stress and anxiety and improving the experience are paramount, creating friendly, intuitive, gentle and less institutional environments catalyzes user psychology. The development of solutions must be holistic and not focused solely on signage. Audits, meetings with user groups and testing are necessary to understand problems and validate solutions. Implementing a master plan and standards guidelines will ensure a structured approach, enabling the longevity and effectiveness of interventions from a global perspective.

Healthcare wayfinding is a multifaceted challenge that when approached with early expert involvement, continuous re-evaluation and a user-centred viewpoint, holds immense potential for improving user experience, operational efficiency and overall satisfaction. By focusing on these principles while reducing costs, facility managers can pave the way for a more streamlined and user-friendly healthcare environment. The path to success lies in understanding the intricate relationship between the environment and its users and implementing a cohesive wayfinding strategy that effectively addresses these complexities.

Assam Michel Daoud is CEO of Arium Design, a multidisciplinary firm specializing in wayfinding and experiential graphic design, industrial design and lighting for 20 years. Assam Michel can be reached at 514-861-7771 ext. 200 or assam@ariumdesign.com.

tThe signage for the healthcare and research centres is a tangible example of the ways in which environmental design can improve quality of life for users. Le projet de signalisation est un exemple concret de la façon dont la conception de l’environnement peut améliorer la qualité de vie des utilisateurs.

environnementale et accessibilité universelle garantit inclusivité et concentration sur l’usager. En santé, où la réduction du stress et l’amélioration de l’expérience sont primordiales, la création d’environnements conviviaux, intuitifs et moins institutionnels catalyse la psychologie des usagers. Les solutions doivent être holistiques, au-delà de la simple signalétique. Audits, rencontres avec les groupes d’usagers et tests s’imposent pour comprendre les problèmes et valider les solutions. La mise en place d’un plan directeur et de lignes directrices assurera une approche structurée, permettant la pérennité et l’efficacité des interventions dans une perspective globale.

La signalétique en santé représente un défi multidimensionnel. Abordée avec l’implication précoce d’experts, une réévaluation continue et une perspective centrée sur l’usager, elle recèle un immense potentiel d’amélioration de l’expérience, de l’efficacité opérationnelle et de la satisfaction globale. En se concentrant sur ces principes tout en réduisant les coûts, les gestionnaires d’établissements peuvent ouvrir la voie à un environnement de soins plus fluide et convivial. La clé du succès réside dans la compréhension de la relation complexe entre l’environnement et ses usagers, et dans la mise en œuvre d’une stratégie de signalétique cohérente qui répond efficacement à ces enjeux.

Assam Michel Daoud fondateur d’Arium Design, une entreprise multidisciplinaire spécialisée depuis 20 ans dans la signalétique directionnelle, le design graphique expérientiel, le design industriel et l’éclairage. Vous pouvez contacter Assam Michel au 514-861-7771 poste 200 ou par courriel à assam@ariumdesign.com.

PROGRAM

SUNDAY SEPTEMBER 8,

2024

09:00-15:00

18:30-22:00

The Great CHES Golf Game

Osprey Ridge Golf Course

Opening Reception – Sponsored by Class 1 Inc.

Reception Entertainment – Sponsored by Precise Parklink

Canadian Museum of Immigration at Pier 21

MONDAY SEPTEMBER 9, 2024

07:00-08:30

08:30-08:45

08:45-09:30

12:00-1:00

Island Health Authority recently developed and launched an internal continuous optimization program as a pilot project supported by BC Hydro and Fortis. We have internalized the function of identifying, implementing, and verifying energy conservation projects rather than leveraging external consultants for these important services. Our program results speak for themselves. We have achieved greater impact much faster and cheaper than the conventional consultant-led model. There are many other values gained, which will also be discussed.

Objectives:

• Report the results of our program.

• List the values associated with internalizing continuous optimization.

• Describe why internalizing this function leads to these improved results.

• Identify how others can develop and launch their own programs.

2 CONCURRENT TRACKS – 3A & 3B

From Plan to Product: Navigating the Nuances of Delivering a Master Facilities Plan

Jeff Stewart, Principal, Colliers Project Leaders

Craig Doerksen, Executive Director, Shared Health-Soins Communs, Winnipeg

Wayne Walker, Executive Director, Mental Health and Addictions Capital Planning, Department of Health and Wellness, Government of PEI

David Benoit President & CEO, Build Nova Scotia

09:30-10:30

Breakfast – Sponsored by Falkbuilt Opening Ceremonies

KEYNOTE ADDRESS – Sponsored by Honeywell

Reaching New Heights Through Agile Leadership

Alan Mallory, CSP MA (Psych), BSc, PE, Peng, PMP

This engaging keynote is a visual and educational experience packed with tools, strategies and actionable ideas that can be put into practice to make positive changes in our professional and personal lives. It focuses on agile leadership strategies in adapting and working through volatility, as well as making timely adjustments based on immediate feedback and lessons learned. The presentation is built around the two years of planning and two months of climbing that went into making the goal of reaching the summit of Mount Everest a reality for Alan and three members of his immediate family. Considered one of humanity’s greatest feats of physical, mental and emotional endurance, the exciting expedition to the top of the world’s highest peak is a journey filled with unparalleled challenges through some of the roughest, most extreme conditions imaginable.

PLENARY SESSION – TRACK 1

At Home in Hospital - Sponsored by Victaulic

Barry Hunt, Prescientx

Hospital patients miss the comfort and convenience of home. They also miss the control they have over their environment. Empowering patients and giving them convenience and control over comfort, privacy, communication and entertainment is important. Building trust and giving patients peace of mind is critical to improving the patient experience. Patients need to feel safe and be safe. And they need to feel cared for starting with their environment.

Objectives:

• Identify opportunities to improve patient control of their environment (e.g., lighting, temperature, privacy).

• Assess the best strategy for building in ease of use and protection from obsolescence for communication and environmental controls from a patient’s perspective.

• List the “must-haves” every hospital should provide for patients in the future.

10:30-11:00

11:00-12:00

Refreshment Break in the Exhibit Hall – Sponsored by Belimo Air Controls Inc.

2 CONCURRENT TRACKS – 2A & 2B

Pressurization and HVAC Configuration of Hospital Operating Rooms to Reduce Infectious Disease Transmission

Reza Daneshazarian, University of Toronto

Jeffrey Siegel University of Toronto

Typical hospital operating rooms (OR) are positive-pressure, which can increase the risk of disease transmission within the OR and to adjacent areas. This work focuses on reducing airborne infectious disease transmission by evaluating OR design, including HVAC configuration and the inclusion of an anteroom. The results showed that a negativepressure OR or an adjacent anteroom can prevent the migration of the particles from the OR into clean corridors, reducing healthcare worker exposure to respiratory aerosol.

Objectives:

• List key factors in the HVAC configuration of hospital operating rooms that contribute to reducing the risk of surgical-site infections.

• Identify the impact of positive pressure in hospital operating rooms on the risk of disease transmission to adjacent areas.

• Assess the effectiveness of negative pressure configurations in operating rooms and anterooms in preventing the migration of infectious particles.

• Describe the role of anteroom presence in reducing the risk of disease transmission in hospital operating rooms.

Lessons from Internalizing Continuous Optimization

Pierre Iachetti RPP, MCIP, PAq, LEED Green Associate, Director of Energy, Environment & Climate Change, Facilities Management, Island Health

1:00-3:00 1:00-2:00 2:00-3:00

This session will be a panel discussion about master facility planning – where to start, common challenges that arise, and how challenges evolve during each stage of the project life cycle. Attendees will hear first-hand perspectives and lessons learned from Build Nova Scotia, the Government of PEI, and Shared Health Winnipeg.

Objectives:

• Describe essential prerequisites and the critical initial steps that lay the foundation for a successful master facility plan.

• Share the various nuances of master facilities planning and common pitfalls teams experience when developing and implementing a master plan.

• Describe how challenges vary at different stages of the planning process, how some might be interrelated and how to spot warning signs that indicate potential issues.

• Identify guidelines to support teams navigating a master facility planning process and best practices on how to overcome challenges at any stage.

Electrifying Hospitals - Is the Medicine Worse than the Disease?

Tariq Amlani Stantec

Carl Shilling, Stantec

Bernard Ropson, Stantec

Buildings are major contributors to global emissions. New laws, regulations, and tariffs are accelerating the embrace of decarbonization. Across North America and Europe, governments are pushing for emissions reductions to meet 2050 goals. Naturally, the health sector is looking to electrification in its next generation and existing facilities. That’s good news. BUT electrifying hospitals is not a simple matter, and is it really green? Explore these questions and more as we discuss sensible approaches to electrification.

Objectives:

• Assess if electrification is really green based on regional impacts and timelines for grid capacity.

• Describe the duration curve and how loads follow an exponential growth.

• Understand the ‘sharknado’ event.

• Identify the tradeoffs between patient care and energy improvement.

• Identify design optimization and solutions that go beyond 2050.

EXHIBIT HALL

Green Park Area - Sponsored by WSP Canada Inc.

Lunch in Exhibit Hall - Sponsored by DuBois Chemicals

Free Time in Exhibits

2 CONCURRENT TRACKS – 4A & 4B

Approaching Long-Term Care Builds through Collaboration, Innovation and Lessons Learned (BC Health Authorities Unite)

Sarah Thorn, Manager, Planning and Projects, Facilities Management, Fraser Health

Rick Buksa, Senior Manager, Major Capital Projects – St. Vincent’s Heather, Providence Health

Drew Hart, Project Director, Major Capital Projects – St. Vincent’s Heather, Providence Health

David Neufeld, Director, Facilities Design & Construction and LTC Major Capital Projects, Island Health

The Facilities Management and Major Capital project teams in the province of BC are working toward the delivery of numerous new long-term care builds in British Columbia. These capital investments provide an opportunity to reflect on our lessons learned, consider innovative ideas, collaborate on procurement methods and share critical information on building systems that support better buildings with consideration for climate resilience.

Objectives:

• Encourage frequent information sharing through collaboration.

• Demonstrate United Collaboration with Health Leaders and Project Teams.

• Describe and Discuss New Innovations, Systems or Technologies.

• Promote Climate Resiliency and Planetary Health.

4:00-5:00

6:00-7:00

7:00-11:00

Rethinking Healthcare Facilities Management - Implementing Technology in the Right Way

Colin Flock P.Eng., CPA, CMA, Senior Vice President, EllisDon Facilities Services

Pranjal De, P.Eng. VP, Integrated Building Technology Development, Modern Niagara

Healthcare FM teams are charged with continuously optimizing patient experience, whole-life asset condition, and energy performance against cost and resource constraints. Technology, and a data/condition-based approach to asset management, is changing the way we enable clinical excellence.

Objectives:

• Understand challenges faced by the healthcare sector in creating a safe, functional, and comfortable space for patients and staff within resource, and cost output constraints.

• Learn how to effectively leverage a combination of facilities management methodologies and technology tools to optimize the environment, preserve assets, and enhance patient experiences. (e..g,. Fault Detection Diagnostics tools)

• Understand the potential of big data and automated diagnostics on the long-term energy performance and facility condition index (FCI) rating.

“Happy Hour” in Exhibit Hall - Sponsored by Trane

President’s Reception - Sponsored by On Side Restoration

President’s Reception Entertainment – Sponsored by Thermogenics Inc.

Gala Banquet - Sponsored by Chem Aqua Banquet Entertainment – Ian Stewart - Sponsored by SDI Canada

TUESDAY SEPTEMBER 10, 2024

7:00-8:30

8:30-9:30

TRACK 5A:

Breakfast – Sponsored by Revizto

2 CONCURRENT TRACKS – 5A & 5B

Alberta Health’s Facility Maintenance and Engineering CSA Z8002.19 Journey from Assessment to Implementation

Paul Perschon Alberta Health Services

This session is focused on how Canada’s largest health authority has implemented this standard into the facilities operations across the province of Alberta at both at a provincial level and at a site level (HCF Health Care Facility).

Objectives:

• Value of CSA standard for operations.

• Evaluation of current state: Assessment vs Audit - What’s the difference?

• Engagement Strategy: How to involve both frontline and management.

• Operationalization of Plan System: Areas of focus (COMP, SOPs’, Inventory Management, Training, and Safety). Implementation of CSA at a HCF (Pincher Creek, AB).

• Challenges, benefits and opportunities of work done to date. An overview of the lessons learned along this 5-year journey.

TRACK 6B:

TRACK 5B:

2:15-3:15

TRACK 7A:

Objectives:

• Identify potential impacts of the changes.

• Prepare the listeners for the different approaches to HVAC that will be required in the future.

A Robust Framework for Effective Project Delivery in Operating Hospitals

Rudy Dahdal, North York General Hospital

Alket Cuni Director, Facilities and Support Services, North York General Hospital

The recent completion of several capital projects at North York General Hospital, and the imminent approval of several others have triggered the need to formalize project management processes that capitalize on lessons learned to improve project delivery. This session presents lessons learned in implementation of capital projects while maintaining full hospital operations and introduces a framework that provides project teams, including facilities management, with tools for effective and efficient project delivery.

Objectives:

• Discuss challenges and opportunities in delivering projects in aging hospital facilities while maintaining full operations.

• Review challenges in balancing competing priorities amongst project stakeholders, including facilities, project management team, funders, clinical user groups, and contractors.

• Present a robust and dynamic framework for effective and efficient delivery of facilities redevelopment projects in complex healthcare environments.

• Discuss processes and tools to manage, monitor and report on project performance.

2 CONCURRENT TRACKS –

7A & 7B

CSA Z8005: A New Standard for Digital Infrastructure and Digital Healthcare Technologies in Healthcare Facilities

Taimur Qasim, CSA Group

CSA Z8005 is a new standard published to provide guidance on the topic of digital infrastructure and digital healthcare technologies. This presentation will cover the core concepts and tools included in the standard that should help HCFs around Canada plan and manage their digital infrastructure and digital healthcare technology projects.

Objectives:

• Describe the core concepts of CSA Z8005.

• Explore how CSA Z8005 can support HCFs.

• Share the various tools presented in CSA Z8005.

9:30-10:15

10:15-10:45

10:15-10:45

10:15-14:15

12:15-13:15

1:25-2:15

TRACK 6A:

The Role of Mechanical, Electrical and Information Technology (MEIT) Design in the Patient Experience

Julie Lawson, HH Angus & Associates Ltd

Robyn Munro, HH Angus & Associates Ltd

In this presentation, we will walk through a ‘day-in-the-life’ of an inpatient journey characterized by a prolonged medical stay, highlighting both challenges and opportunities where improvement could be achieved through the application of technology systems and management of the environment.

Objectives:

• Patient Care Experiences – focusing on patient care departments and patient rooms

• Managing Patient Movement and Overflow.

• A Day-in-the-Life Journey: from admission through to surgery and inpatient care.

• Solutions covered: Automated Guided Vehicles, Pneumatic Tubes, Real-time locating system, bedside controls, patient washrooms, environmental comfort/feedback and infection control.

CHES National Annual General Meeting

Refreshment Break in the Exhibit Hall - Sponsored by Abatement Technologies

CHES Maritime Chapter Annual General Meeting

Exhibit Hall Open

Lunch in the Exhibit Hall

2 CONCURRENT TRACKS – 6A & 6B

The 2024 CSA HVAC Standard - What You Need to Know

Nick Stark, HH Angus & Associates Ltd.

The Canadian Standards Association published the new edition of CSA Z317.2 Special Requirements for HVAC Systems in Health Care Facilities in June of 2024. There are a considerable number of new and revised clauses that will impact the requirements for design, construction and operation of healthcare facilities across Canada.

TRACK 7B: 3:15-3:45 3:45-4:45 4:45-5:00

Sight and Light | Design Beyond the Patient Room

Rachel Vair, DIALOG

Josh Bornia, DIALOG

Jill Robertson, DIALOG

Raul Dominguez, DIALOG

A focused conversation on key challenges, opportunities, and tradeoffs necessary to bring light and nature not only in patient rooms but in waiting areas, courtyards, staff areas, and all spaces of a healthcare facility. Leveraging tools like energy and daylight modelling, presenters will share an integrated, analysis-based approach to prioritize natural light and views of nature while optimizing building energy performance.

Objectives:

• Identify strategies to overcome potential barriers to providing daylight and views throughout a healthcare facility.

• Incorporate lessons learned and feedback from hospital administrators that incorporate expansive daylight and views into future design.

• Balance potentially competing sustainability goals, including daylight and views, thermal comfort, visual comfort, and energy efficiency.

Refreshment Break - Sponsored by Camfil Canada Inc. and MMP

Architects

TRACK 8-Plenary

Reconciliation and a Net-Zero Carbon Future: The New Cowichan District Hospital Aims to Give Back to the People and the Land It Will Serve

Meagan Webb, P.Eng., Principal, H.H. Angus & Associates Ltd.

Kyle Basilius, AIA, ACHA, EDAC, NCARB, Principal, Parkin Architects Calvin Winquist Director of Design and Construction, Island Health Ryan Kennedy, P.Eng., LEED AP BD+C, Principal, H.H. Angus & Associates Ltd.

A spotlight on the Cowichan District Hospital project in Duncan being delivered through the Alliance Procurement Model. The presentation will focus on the project goals of reconciliation, a net-zero carbon future, and healing environment and how they are being delivered with the goal of giving back to the people and lands the project will serve as well as how the Alliance Procurement Model has been leveraged to achieve these objectives.

Objectives:

• Describe how the Alliance Procurement Model process and how the project delivery method has been leveraged to maximize the key result areas tied to staff wellness, healing environment, and Indigenous representation and inclusion.

• Learn about how patient-centred design and reconciliation was approached.

• Assess how sustainability and resiliency can support the needs of patients, their external support networks and healthcare workers, including highlights of specific approaches, while balancing energy and sustainability goals.

Closing Ceremonies

TRADE SHOW COMPANIES

AAF+A3:A80 Canada

Abatement Technologies

Ainsworth Inc.

Air Liquide Healthcare

Amico Corporation

Armstrong Fluid Technology

Ascom

Belimo Air Controls, Canada

Belden Inc.

Blade Air

Bray Controls Canada

Bruce Sutherland Associates Limited

Camfil Canada, Inc.

Canadian Coalition for Green Health Care

Canature WaterGroup

Carmichael Engineering Ltd.

Carrier Enterprise Canada

Chem-Aqua

Class 1 Inc.

Construction Specialties, Inc.

Cornerstone Medical

CP Distributors

Delco Security

Delta Commercial-Masco Canada Ltd.

Delta Controls

Distech Controls

Dormakaba

DuBois Chemicals Canada Inc.

EcoPilot Canada | USA

ECNG Energy Group

EMCO Applied

Falkbuilt

First Onsite Property Restoration

Flynn

Franke

Genetec Inc.

Grainger

Grundfos

GuardRFID - part of HID Global

Guldmann Care-Lif Solutions

Hanwha Vision

Haws Corporation

HMTX Commercial

Honeywell

Infection Control Training Group

Interface FLOR Canada Inc.

IPAC Consulting

Johnson Controls Canada L.P.

JCI Security Products

Labworks International Inc.

LOC Medical

Delta Commercial-Masco Canada Ltd.

MediaEdge

MegaMation Systems Inc.

Miura Canada

Mondo Contract Flooring

Motorola Solutions

National Floor Covering Association

Noventa Energy Partners

On Side Restoration

Pa-Co Lighting Inc.

Pinchin Ltd

Power Air Cleaning Ltd.

Precise ParkLink Inc.

Px Solutions

Reliable Controls

Revizto

Schneider Electric Canada Inc

SDI Canada

SGP Purchasing Partner Network

Siemens Canada Limited

Steris Canada Sales ULC

Superteck Roof and Building Consultants

Thermenex

Thermogenics

Time Trackers Ltd.

Trane

TransLogic, a Swisslog Healthcare Company

Tremco Roofing & Building Maintenance

Umano Medical

Unicel Architectural Corp.

Verge Technologies

Vernacare

Victaulic

Viscor

Weishaupt Coporation

Wimar Property Restoration Specialists

Wood4Heating Canada Inc.

THE BUILDINGS SHOW

Dec 4 - 6, 2024

Metro Toronto Convention Centre

FORM FLOWS FROM FUNCTION

Misericordia Community Hospital emergency department project illustrates innovative approach to space planning

By Jan Kroman

Built in 1969, Misericordia Community Hospital is one of four major acute care hospitals currently serving Edmonton, central and northern Alberta, and the Northwest Territories. Owned by Alberta Health Services (AHS) and operated by Covenant Health, the campus has been redeveloped and expanded to better suit community needs over its half century of operation. The hospital’s emergency department had outgrown its current space, facing overcrowding, substandard conditions, ever-increasing mechanical system challenges and, in some cases, infrastructure failures. In late 2017, a major capital project was initiated by Alberta Infrastructure, AHS and Covenant Health to create a new emergency

department adjacent and connected to the main hospital on the campus. More than a simple addition, this project challenged industry norms in several key ways.

RETHINKING PROCUREMENT

The project’s innovation started from its inception, with the consultant team chosen via a qualification-based selection process. The methodology prioritizes the merits of each proponent, with fees not considered in the overall adjudication. This allows for key considerations, such as firm and individual consultant experience, team availability and fit to drive procurement. Via this process, Rockliff Pierzchajlo Kroman (RPK) Architects was

named prime consultant and lead design architect.

Upon preliminary selection, the consultant team had a limited window to further negotiate fees, scope and the team composition (sub-consultants) with the client, Alberta Infrastructure. Due to abundant experience on both sides, the RAIC 6 contract along with schedule of services became a framework around which potential scenarios were reviewed, with the document being amended to suit both parties. The process was effective in kick-starting a collaborative relationship between the consultant team and client, successfully setting the stage for the planned five-year project.

Alberta Infrastructure subsequently elected to deliver the project using a construction manager, with the contract awarded to PCL Construction. This methodology, in contrast to stipulated sum or public-private partnership, was effective in staging the work through multiple tender packages issued at strategic milestones during the project, giving the construction team flexibility in effectively scheduling the work over different parts of the campus. PCL was also able to collaborate and work with RPK’s team in a detailed, design-assist capacity. This included splitting out long lead items, reviewing scope items needing accommodation due to performance specification and providing campus-specific insight from past project experience on the Misericordia site. Further, PCL incorporated these elements to prepare a highly calibrated and articulated construction and execution plan, implementing it early in the pre-construction phase. The plan clearly defined how the project would be managed with final measures of success in mind. This approach allowed work on-site to be completed safely and on time while complying with the quality and service expectations of Alberta Infrastructure, AHS and Covenant Health.

Throughout the planning process, PCL engaged with trade contractors during pre-construction to solicit their input and unique expertise pertaining to the review of construction documents, constructability of key elements, durations of critical path activities, labour and equipment resources, material and equipment supply chain risks, and overall expectations and common goals. As a result, when each sequential tender package was completed and ready for public tender, an increased number of trade partners bid on the work. Sharing an accurate and realistic procurement and construction plan with the client, hospital and potential trade partners not only set everyone up for success, but also removed costly and time-consuming barriers, mitigated risk and recognized opportunities with work execution to benefit the client and end-users. Overall, through these means, the project was successfully delivered on time while also allowing for a planned and effective facility turnover to AHS and Covenant Health.

PUTTING PATIENTS FIRST

The existing emergency department was cramped, with a single overcrowded waiting

room — a space patients and their families would often enter multiple times (triage, registration, waiting) throughout their visit. The need to streamline and avoid this type of patient cycling became a guiding principle in the new department’s design. Working with the user group and functional programmer Resources Management Consultants (Alberta) Ltd., RPK’s design team developed a model that promoted constant flow. Amalgamating lean ideology and clinical service delivery best practices, and considering a patient-centred care philosophy, the department was designed so patients are constantly progressing in their convalescence. The goal was patients should always feel as though they are moving forward toward the next step, both physically and in terms of their recovery.

This philosophy manifested itself, in part, through the formalization of five pods — intake and assessment, general treatment, mental health, clinical decision unit, acute — responding to varying levels of patient acuity. Further, internal waiting areas were developed within each area. Fundamentally, this

organization allows for patients to potentially touch down only once (if at all, depending on acuity) at the arrival/triage area and move into a corresponding pod where, at an internal waiting area, they can start to receive care prior to proceeding into an exam or procedure space. From the exam room, patients progress forward, either leaving the emergency department or being admitted to an applicable hospital department. In the case of the largest department with the least acute cases (intake and assessment), there is another lounge for patients that may be waiting on diagnostic results prior to discharge. Of additional note is the incorporation of emergency medical services (EMS) stretcher bays on the perimeter of the intake and assessment waiting room, connecting EMS teams and their patients directly into the flow of the department.

As part of the constant flow philosophy, the patient arrival area was carefully designed, restructuring all requisite elements. Like other emergency departments, the space contains triage, registration, volunteer welcome station,

THOUGH THE SYMBOLISM MAY NOT BE OBVIOUS FOR ALL VISITORS, IT WEAVES A STORY AND SENSE OF PRIDE FOR STAFF, REINFORCING THEIR MISSION OF CARING FOR THE WHOLE PERSON — BODY, MIND AND SOUL.

security and seating, and is the initial touchpoint for all patients and visitors. The welcome desk, staffed by volunteers, has been located so that it has a prominent role, while security is tactfully obscured via a tiled feature wall and mirrored glass. Universal stations have been designed to facilitate both triage and registration functions so staff, rather than patients and families, can move from station to station to accommodate processing. Though well-appointed, the waiting area itself is smaller than might be expected, as it is

anticipated that patients will move quickly into smaller individual waiting areas within each pod. It is believed these changes will improve patient outcomes and aid in the throughput of the department, although this will need to be proven by studies of the operational department. Current anecdotal feedback from staff has been positive.

BLENDING HISTORY WITH PROGRESS

As part of the design process, a narrative structure was developed by RPK to engage with stakeholders in the

development of qualitative attributes. Initial discussions led to the synthesis of a distinct mission for the emergency department to be a space that is efficient, welcoming, warm and safe. This vision was then further augmented, with the building’s design elements reflecting several key aspects of the site’s and Covenant Health’s history, both overtly and in subtle ways.

The building was designed to blend into the remainder of the existing campus rather than standout. Its vertically-oriented white metal cladding organized in horizontal bands, together with the white brickwork on the front facade, reflect the materials and geometries of the original hospital building, with the large ‘emergency’ sign and arrival area glass delineating the entrance.

An additional layer of meaning has been created through the courtyards that are carved into the building’s footprint, each associated with an internal patient waiting area or other specific programmatic element (mental health courtyard and family room). The exterior walls that form the courtyards

Opened in November 2023, the expanded emergency department at Misericordia Community Hospital is three times the size of the original department, which was beset by maintenance issues in recent years. It features 60 treatment spaces, up from 26, boosting the facility's capacity to help reduce wait times and improve the patient experience.

are clad in copper, an acknowledgment of the chapel that was demolished to accommodate the department. These copper-clad walls have been left to patina, transitioning from bright orange to brown and finally to green, a reminder of what once stood on the site. As a naturally oxidizing material, theses walls lend further interest to the courtyards that serve to provide visual respite and connection to the outdoors in the patient waiting areas.

In addition to reflecting the immediate history of the site via the copper cladding, the design team incorporated symbolism relating to Covenant Health’s history. Realizing lanterns represent hope for the organization, they were reinterpreted as a design motif for the department’s wayfinding indicators. Each pod entrance is identified with a backlit wall, subtle colour and rectilinear lantern motif. Though the symbolism may not be obvious for all visitors, it weaves a story and sense of pride for staff, reinforcing their mission of caring for the whole person — body, mind and soul.

AN UPLIFTING EXPERIENCE

Opened in November 2023, the Misericordia Community Hospital emergency department renovation is exemplary of how novelty in procurement methodology, functional planning approach, thoughtful design and quality construction can create a project that truly elevates apatient’s experience. Alberta Infrastructure’s approach to the initial procurement process created a groundwork of trust from the very beginning. The subsequent development of a philosophy of flow became a focal point for a physical manifestation of a clinical plan that will likely see improved patient outcomes. And the weaving of organizational and site-specific details into the interior and exterior design elements has created a rich tapestry of meaning that serves to elevate the building’s purpose. Indeed, it seems that to go with the flow is a good thing.

Jan Kroman is a principal with Rockliff Pierzchajlo Kroman (RPK) Architects, which has been creating diverse architectural projects throughout Western Canada and its territories for the past 55 years, with a focus on civic projects, healthcare, long-term care and socially responsible housing. Jan has extensive international and local experience, having worked for renowned design firms in Holland, Japan, Toronto and Calgary. He excels in balancing design intent with scheduling and fiscal constraints throughout all project phases. Jan can be reached at 780.426.7415 or jkroman@rpkarchitects.com.

INNOVATIVE ANTIMICROBIAL SURFACE COATING:

AN ADDED LAYER of PROTECTION

n healthcare settings, routine cleaning and disinfection of surfaces, accessories and machinery is critical to protect people and patients. The cycle of clients and residents sees surfaces and equipment continually contaminated with potentially hazardous microorganisms. Once compromised, the risk of infection transmission increases, further burdening the healthcare system. Strict hygiene and disinfection routines are vital to reduce the risk of contamination and enforced more stringently in medical practices than in non-health care, commercial or public

vital reduce

All medical facilities include a variety of surfaces touched by patients, their visitors, and patient care providers. This includes equipment, medical devices, furniture and belongings, all of which can carry and transmit infectious microorganisms. In environments like hospitals, surface bacteria can accumulate rapidly between cleanings.

To combat this, Elimagen Technologies has introduced an added layer of protection—a cutting-edge solution aimed at revolutionizing cleanliness and hygiene across various industries, especially healthcare. Elimagen is a durable, clear coating with integrated anti-fingerprint and antimicrobial technologies which complements regular cleaning and serves as a barrier, reducing bacterial buildup on high-touch surfaces.

Requiring a one-time application with a lifespan of years, not weeks or months, it includes a UV-cured, durable finish that dries to the touch in about 30 seconds. This minimizes disruption in busy environments, a feature which is particularly beneficial for high-traffic areas like hospitals, where reducing downtime is crucial.

VERSATILE APPLICATIONS

Designed with different formulas tailored for various substrate surfaces such as plastic and stainless steel, its adaptability makes Elimagen suitable for a wide range of hightouch surfaces.

“We can cover everything from door handles, elevator buttons, and light switches to computer keyboards,” explains Paul Svendsen, CEO of Elimagen Technologies. “Each type of surface can benefit from a slight adjustment in the formula for optimal adhesion, and once applied, our coating works 24/7 to knock down bacteria between cleanings.”

slight adjustment in the formula for our coating works 24/7 to knock down bacteria between cleanings.”

HOW IT WORKS

Microban® antimicrobial additives are supplied in powder, polymer pellet or liquid forms, depending on the product to be treated and the manufacturing process employed. Microban® antimicrobial technology works at a cellular level, continually disrupting the growth and reproduction of microorganisms. It operates a multi-modal attack, damaging the protein, cell membrane, DNA and internal systems of a microbe. Once infused into a product, Microban® antimicrobial technology starts to work as soon as a microorganism comes into contact with the protected surface.

Besides healthcare settings, the commercial and hospitality industries also stand to benefit from this technology. High-touch surfaces, such as shopping cart handles and electronic switches, can harbour significant bacteria. By applying the coating, businesses can enhance their cleanliness protocols and provide peace of mind to their customers.

The Elimagen application process involves a limited spray with HEPA filtration to ensure safety and minimal odour. Cured using UV technology, the coating dries rapidly and can be ready for use within minutes. This

infection control specialists, and healthcare authorities. The company has also seen inquiries from the commercial sector, particularly for electronic switches and other high-touch surfaces.

PRICING AND IMPLEMENTATION

Pricing for the coating application varies depending on the specific needs and scale of the project. The application must be performed by trained technicians using specialized equipment, ensuring proper adhesion and curing. This approach ensures the highest efficacy and durability of the coating. “We look at high-traffic zones and high-touch surfaces, then provide a tailored estimate,” Svendsen clarifies.

The demand for antimicrobial solutions has surged, especially in the wake of the COVID-19 pandemic. While the coating was developed prior to the pandemic, the heightened awareness of hygiene has accelerated interest in such technologies. “COVID highlighted the need for clean surfaces, but our work started before that. The pandemic just underscored the importance of what we’re doing,” he observes.

Looking ahead, Elimagen Technologies aims to expand the application

efficient application process ensures there is little downtime for a facility.

The coating not only provides antimicrobial protection but also enhances the appearance of surfaces. It creates a smooth, easy-to-clean finish that resists fingerprints, further simplifying maintenance. The CEO notes, “The finish is beautiful and glass-like, making surfaces easier to clean and more visually appealing.”

DOES MICROBAN ® PROTECTION WORK IMMEDIATELY?

Microban® protection begins to work as soon as a microorganism comes into contact with the product surface. It then works continuously to maintain a consistently lower bio-burden than would be expected on a product without Microban® antimicrobial protection. While the coating offers continuous protection, it is not a replacement for regular cleaning. Instead, it serves as a bridge between cleanings, reducing the bacterial load on surfaces. “We’re not trying to replace cleaning,” emphasizes Svendsen. “There’s a gap between cleanings, and our coating helps fill that gap.”

This approach is especially critical in healthcare settings, where hightouch surfaces can be vectors for bacteria transmission.

MARKET POTENTIAL AND INTEREST

Since launching the product officially a few weeks ago, the response has been promising. Initial interest has come from facilities managers,

of their coating across various industries. The company sees significant potential in both new builds and retrofitting existing facilities. “The possibilities are endless. We’re starting with healthcare, but we see applications in commercial, hospitality, and beyond,” the CEO envisions.

Elimagen Technologies’ innovative antimicrobial coating represents a significant advancement in maintaining cleanliness and hygiene. By providing continuous protection between cleanings, it addresses a critical need in high-traffic environments, particularly in healthcare settings. With its versatility and ease of application, this coating has the potential to become a standard solution across multiple industries, enhancing both safety and peace of mind.

To learn more about this exciting technology, visit www.elimagentechnologies.com

BRIGHTENING

THE FUTURE

Lighting retrofit at Perley Health leads to significant cost savings, other sustainable initiatives

By Lorie Stuckless

With roots going back to 1897, Perley Health is one of the largest and most progressive longterm care communities in Ontario. Located in south-central Ottawa, the campus is home to more than 600 seniors and veterans in long-term care and independent apartments. It also includes an on-site living classroom where future caregivers study, acquire hands-on skills and invaluable experience to deliver the clinical, therapeutic and recreational services to residents, tenants, clients and people from across the Champlain region.

Perley Health’s mandate is brought to life each day by more than 800 employees and approximately 400 volunteers. Despite that support, significant challenges are on the horizon. Public demand for better quality care for

residents and improved working conditions for healthcare workers will drive costs higher. Ideally, this deficit should be met by public funding but it may not be sufficient. Additionally, Perley Health will face largely invisible costs from the impacts of climate change, as well as regulatory pressures from governmental environment policies.

In response to these challenges and in preparation for the doubling of Canadian seniors over the age of 70 by 2035, Perley Health has developed a comprehensive strategy to address sustainability. Already, an environmental audit, conducted before the onset of the COVID-19 pandemic, has spawned the implementation of more than 100 energy-saving and eco-friendly retrofits across the seven buildings situated on the 25-acre campus.

Recently, Perley Health’s 25-year-old light-

ing system was upgraded to LED. This refurbishment has improved illumination and safety for residents while significantly reducing energy costs. The project, which included lamps, kits, controls and 9,000 fixtures, has a projected annual savings of $450,000 in energy, $39,000 in heating, ventilation and air conditioning (HVAC), and $202,000 in maintenance. Further, the post-project cost-benefit analysis has revealed a monthly savings of $57,000, which has been redirected back into the facility’s operational requirements. Reducing energy use is the quickest, safest and most cost-effective way to lower greenhouse gas emissions from electricity generation. The LED upgrade alone, a rebate and tax incentive-based initiative responsible for a reduction of 3,004,756 kilowatt hours (kWh) per year, is a testament to that reality.

The LED upgrade is predicated on the incorporation of new technology: a wireless lighting management system utilizing Bluetooth smart life gateway mesh protocol. This Internet of Things-based technological advancement offers high visibility and security while being low-cost and power-conscious. It links smart devices to cloud-based mobile app and web-based software platforms.

The system is loaded with additional functions. These include scene control to set the lighting scenario; occupancy sensing, facilitating the adjustment of lighting according to the presence or absence of people in a designated space; continuous dimming, allowing for changes in resolution in accordance with shifts in light level; group control, which focuses light on a specific gathering of subjects; high-end trim, a setting that allows for the maximum output of light; and scheduling, wherein an automatic response can be scheduled based on time of day or astronomical events. There is also a colour changing/tuning function, offering different choices of colour, including varying shades of white, via a dedicated control interface(s). These devices are also capable of adjustments to area dimensions, such as floors and rooms.

Any of these features can function or be disabled at the same time. In addition, there is a real-time device fault notification feature. This serves as a reliable replacement system for underperforming devices, negating user frustration and minimizing disruptions of use.

Other retrofits at Perley Health have included the introduction of a high-efficiency heating and cooling system. With four boilers operating on an as-needed basis, this saves the facility more than $300,000 annually. Further, the installation of 1,250 rooftop solar panels, generating 250,000 kWh of electricity per year, allows Perley Health to sell excess energy back to the grid, earning $239,000 yearly through the province’s feed-in tariff program.

Perley Health has also automated all HVAC controls for better energy management, installed high-efficiency toilets to conserve water and expanded hot water sources to ensure uninterrupted service. Collectively, this has created a self-sustaining ‘circular economy,’ with an 11-year payback period and ongoing annual savings of $560,000. These initiatives also reduce Perley Health’s carbon footprint by more than 320 tonnes of carbon dioxide equivalent per year, analogous to the removal of 53 medium-sized cars from the road.

Perley Health’s commitment to sustainability and welcome embrace of the corresponding technology demonstrates a proactive approach to environmental stewardship. The organization continues to explore new opportunities to refine its facilities and services, a commitment driven by incentives, investment and innovative thinking, ensuring a sustainable future for both the community and the planet.

Lorie Stuckless is director of support services at Perley Health, where she leads food and nutrition services, housekeeping, laundry, materials management, property management, property services, information technology, analytics and informatics, infection prevention and control, and security and on-site contract services. Lorie has been with Perley Health for more than 26 years. She is dedicated to delivering a high-level of service for the seniors living at Perley Health, and is passionate about improving the quality of service experienced by residents and tenants.

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Relief is on the horizon for the lengthy delays caused by hospital renovations and expansion. Frustrated by downtime, lengthening waiting lists and the negative impact on patients, some hospitals are moving away from traditional construction to a faster way of mobilizing.

Take Brockville General, for instance. The need for an MRI suite was obvious. Up until early 2024, patients needing a scan were forced to travel to either Kingston or Smiths Falls, almost an hour’s drive away. The hospital needed construction completed quickly so they could begin scanning a growing waiting list of patients.

One innovative opportunity stood out. Instead of using traditional construction methods, SDI Canada could build Brockville General’s MRI suite o -site in a controlled,

Fast Forwarding Hospital Construction:

HOW PREFABRICATED CASSETTES SHAPE

MEDICAL INFRASTRUCTURE

sterile environment and deliver it to the hospital where the site would be prepped and ready for its installation. The facility could be built faster, the project would be less expensive, and there would be less disruption for the hospital in general.

of SDI Canada explains that the latest innovation in medical infrastructure plays o several variables traditionally known as the ‘construction triangle.’

In March 2024, two super-loads of modular Cassette ® MRI scanning room were carefully transported from a factory in north GTA to Brockville. After a journey that took 7 days, the prefabricated buildings— each weighing 110,000 lbs—were lifted by crane and placed like puzzle pieces in their new location.

Brockville General Hospital is now training hospital personnel and patients are already scheduling appointments. It is expected that the hospital will begin scanning patients within 14 months of contract signature, a goal which would not have been achievable had this been built using regular construction.

Toufic Abiad, President and Founder

“Now we can deliver something at a controlled and lesser cost, with a higher quality, and it’s going to be ready faster,” he says. “We’ve broken the famous construction triangle. Cost vs quality vs time”.

The initial project

at Brockville was slated to take around two and a half years to complete using traditional construction methods. SDI Canada delivered the prefabricated Cassette ® modules in one year. “This year of extra scanning will help save countless lives by pushing forward their diagnosis and allowing earlier treatment for more patients,” Abiad stresses. “Not only does this mean more people are being treated, but the resultant waiting lists are shortened as the pressure on hospitals is reduced. It improves a hospital’s e ciency and ability to provide for the community. Everyone’s a winner.”

as the pressure on hospitals is reduced. It improves a hospital’s

INNOVATION OF HOW

“We’ve learned from the innovation of things, but it’s time to recognize the innovation of how,” says Abiad. “The point is not to take a hospital hostage through construction, the point is to deliver care. ‘How’ we’re doing this has a huge impact.”

point is to deliver care. ‘How’ we’re doing this has a prefabricated modular cassette structures making up

For hospitals with room to spare on-site, prefabricated Cassettes® are a commonsense and easy-to-initiate solution. The two prefabricated modular cassette structures making up Brockville’s MRI suite were the first in Ontario and come with impressive credentials:

• The Cassette® structure is designed and engineered and complies with Institutional Type II-B and Seismic “D” requirements.

• Ability to withstand 150 MPH hurricane force winds, heavy snow loads and influences known to create imaging artifacts.

• Meets strict criteria requirements for medical equipment installation and operation.

• The Cassette® can be installed either vertically or horizontally and used as an extension of existing facilities or as a standalone unit.

• Complies to Building Codes, Fully CSA Certified, CSA A277 Building, Post disaster, CWB Certified.

The Cassette® prefabricated building solutions meet a variety of needs for healthcare facilities and can be used for MRI, CT, PET/CT, critical, primary and respiratory isolation units. It is completely customizable to the hospital’s needs and can even serve non-critical applications.

The standard size for a Cassette® is 16 x 60 x 12 ft / unit and can be added on to as needed. A variety of finishes are o ered, from standard stucco, partial or full brick wall, curtain wall or metal siding. Depending on the parameters of the project, estimated time for delivery is between 12 to 18 months.

NOW MANUFACTURING IN CANADA

NOW MANUFACTURING IN CANADA

Understanding the strength in partnerships, SDI Canada has partnered with PDC, a US company specializing in prefabricated buildings, to be their exclusive Canadian distributor and their licensed manufacturer for Cassettes in Canada. SDI Canada has always been committed to local content and as of 2024 will be manufacturing Cassettes in Canada.

“We would talk to American manufacturers, and they wouldn’t give us the time of day. My idea was to combine many projects and act as the manufacturer’s bridge to Canada. That’s what we did with the Cassettes,” Abiad says. “I also wanted an agreement to say that if volume reaches a certain level, I can manufacture in Canada. Now, we’ve reached that level.”

Founded in 2003, SDI Canada is the Canadian leader in the implementation of MRI and biomedical equipment, the design and construction of medical infrastructures and the distribution of specialized accessories. To learn more, visit www.sdicanada.ca or email info@sdicanada.ca

A HOSPITAL FOR ALL

Inclusivity drives design of new healthcare facility on Vancouver Island

By Shane Czypyha

Hospitals are meant to be places of healing. But when the place itself is intimidating or feels restrictive, health outcomes of patients are affected. This impacts Indigenous communities disproportionately.

The design of a hospital plays a vital role in addressing the challenges of the communities it serves. The $1.45 billion Cowichan District Hospital replacement project in Duncan, British Columbia, was designed to not just meet but surpass the needs of Indigenous patients and their families.

At the heart of the culturally-inclusive design are the 185 patient rooms that are equipped with provisions for healing customs that involve burning (shqw’uqw- wiils in the Hul’q’umi’num people’s native language, something used to spiritually cleanse). The initial requirement called for just one such room to be included in the hospital design; however, architects on the project worked collaboratively with clinical staff and mechanical engineers, as part of the project’s Nuts’a’maat Alliance, to equip every room with individually-controlled smoke systems

— each can be easily activated by staff for 59 minutes at a time.

The design brings healing practices directly into patient rooms, rather than moving patients to perform traditions that are vital to their recovery.

PATIENT-CENTRED FOCUS AT ITS CORE

Through the 2020 In Plain Sight report and conversations with Indigenous community members, designers understood Indigenous peoples experience racism and discrimination when accessing the health system. This

prevents them from seeking care in a timely manner and ultimately impacts their health outcomes.

The patient-centric approach to the new Cowichan District Hospital’s design meant the architecture design teams worked closely with Indigenous Nations to ensure the facility was culturally sensitive and significant to the local communities. Fostering a sense of belonging was paramount. The emergency department triage desk became a primary focus.

The project’s Nuts’a’maat Alliance thoughtfully designed a culturally safe and inclusive triage desk area by tucking the security room to a less prominent location, while maintaining safe sightlines. Through Indigenous patient journey mapping sessions, community members shared how incorporating Hul’q’umi’num language can contribute to more welcoming care experiences. As a result, the area will include the name Ts’uwtun, which means greeter, so patients seeking care are met with a welcoming and trusting impression as they enter the emergency department.

Out of the 204 patient rooms, 80 per cent are single-occupancy. Recognizing the fundamental role of family in the healing process for Indigenous patients, the rooms have space to accommodate sleeping sofas. There are also larger labour and delivery rooms for families to stay. A dedicated, culturally-inclusive kitchen allows use of

traditional food sources for meal preparations and a teaching kitchen provides the opportunity for leaders to demonstrate how to cook healthy Indigenous foods.

The 607,601-square-foot, seven-storey hospital is comprised of two buildings that are being constructed using mass timber structures, including the Reach Out building, which houses the Indigenous health program. Natural elements and views from the surrounding environment were incorporated to promote connection with nature and support the healing process. The use of wood materials, large, operating windows for access to fresh air and natural light, and dedicated outdoor spaces all contribute to proven benefits in recovery and healing time.

THE SITE OF MANY FIRSTS

To celebrate the diverse community and support inclusivity and equality, the new Cowichan District Hospital will be fully accessible to people with diverse abilities when it opens in approximately three years’ time. Eight-hundred parking spaces will include accessibility stalls with electric vehicle chargers, seating nodes through the parking areas to support people needing to take breaks, and tactile road edging to cue people with various visual abilities to know when they are crossing higher risk areas. Parking will remain free of charge.

Sustainability-wise, the healthcare facility is on track to become the first Canada

Green Building Council net-zero carbon hospital in Canada. It is designed to meet LEED gold standards and will be the province’s first fully-electric hospital.

Cowichan District Hospital is also the premier vertical alliance project delivery model in the country, making the owner, contractor and designer all equal partners. The collaborative model allows for ‘best for project’ decisions to be made over its course and supports innovation.

The Nuts’a’maat Alliance includes Island Health, EllisDon, Parkin Architects, B.C. Infrastructure Benefits and Infrastructure B.C. Parkin Architects in association with ZGF Architects spearheaded the design of the replacement project, working collaboratively as part of the alliance.

Construction of the new Cowichan District Hospital is expected to be completed by 2026, with patients welcomed in 2027.

Shane Czypyha is a principal, hands-on project manager and architect at Parkin Architects, who takes pride in seeing projects come to life. With extensive experience in healthcare, he enjoys working closely with clients, contractors and design teams to develop innovative solutions that respond to users’ needs. Shane’s collaborative team-first approach has proven valuable in leading high-performance teams to deliver facilities that make their communities proud. He draws on his wealth of public-private partnerships and design-build experience to deliver projects from kickoff to handover.

ABOVE:

Low-Carbon HVAC Reimagined:

THE INNOVATIVE THERMALIZATION APPROACH

Conventional HVAC design uses separate systems for heating and cooling, each optimized for performance during peak seasonal weather conditions. Typically, heating and cooling are considered as separate entities that are opposite of each other, but according to Je Weston, this methodology is fundamentally flawed.

“You can’t heat something without cooling something else, meaning all heating or cooling is simultaneously heating and cooling.” says Weston. In 2005, this insight led Weston, through his company, Thermenex, to develop a patented system called a Thermal Gradient Header (TGH), a single pipe to integrate all thermal systems together. The continuous pipe is filled with water or glycol and has a hot and a cold end with multiple variable-temperature zones in between.

“Many HVAC design professionals are starting to develop ‘integrated designs’ that use chillers for both hot and cold temperatures and are reclaiming heat instead of expelling thermal energy as waste. What many are learning the hard way is that many of the old standards and rules of thumb no longer apply and need to be unlearned. If not, they will unknowingly design systems that struggle.”

Systems which are too complex, use too much electric energy or o er poor control of energy flow, often miss performance targets and create dissatisfied clients. Traditional HVAC thinking of hot and cold as opposites, misses the benefits of reclaiming energy by using the same components for both heating and cooling systems.

“The amount of infrastructure required is reduced because most major components are used for both heating and cooling. Not only that, but the purchased energy consumption is also significantly reduced because we can now optimize the utilization of the free thermal energy already in the building.”

At the core of the Thermenex system is the principle that every chiller is also a heater. A refrigerator, for example, cools food by transferring thermal energy to its surroundings, e ectively heating the kitchen.

The Thermal Gradient Header approach involves lowering heating temperatures to use for cooling and raising cooling temperatures to use for

Providence Health Care, with major facilities in Vancouver, and Island Health, which oversees all hospitals on Vancouver Island, have become staunch supporters of Thermenex’s system.

OVERCOMING SKEPTICISM

Despite the proven success, encouraging the broader HVAC industry to adopt this novel approach

“PHC’s government mandated target is a 50% reduction in GHG emissions by 2030, but due to the promise shown by the Thermenex system, we decided to set ourselves a stretch goal of reaching 80% by 2023 for the majority of our buildings. Three of these facilities are successfully achieving over 80% reduction in annual GHG emissions, with two over 90%, which is very impressive performance indeed. The remaining TGH system will come online later in 2024, and I expect to see similar results in energy efficiency and emissions reduction.”

Tony Munster, Providence Health Care

heating. This overlap allows for a single system to handle both heating and cooling needs. The result is an elegant, e cient solution that dramatically reduces gas and energy usage.

“Thermenex has proven results, with some buildings achieving over 90% reduction in gas usage and up to 75% reduction in total purchased energy. Our innovative system has been successfully implemented in numerous projects, especially in healthcare facilities across British Columbia,” Weston says.

Thermenex is now working with owners and engineers to design, build and operate reliable HVAC systems that minimize resource waste and create truly sustainable buildings.

“We’ve completed five projects for one health authority and are working on six for another,” says Weston. “Our clients have seen significant benefits from our system. Healthcare facilities are not only reducing their carbon footprint but also cutting their energy consumption and reducing their operating costs.”

THE FUTURE OF HVAC: THERMALIZATION BEFORE ELECTRIFICATION

has been challenging. Which is not surprising given the human tendency to resist paradigm shifts.

“Our industry has trained designers to think of heating and cooling as separate processes,” explains Weston. “It took me 20

In the push towards sustainability, many in the building industry are advocating for full electrification. Weston believes that thermalization, the process of switching from purchased energy resources to free thermal energy resources, should come first.

Thermenex’s belief, “Thermalization before electrification,” encapsulates this philosophy. By prioritizing the e cient use of thermal energy inherent in our environment, buildings can achieve near-zero carbon emissions with less electricity usage which makes getting to zero carbon much easier.

With a track record of success in healthcare facilities and the potential to revolutionize the way we think about energy e ciency, what’s next? As a continuous innovator, Westons says, “We developed a way to incorporate free cooling at peak summer. Future clients will not only

“I have worked at decarbonizing healthcare facilities for 10 years. None of the other heat recovery solutions have come close to the achieving results like the TGH technology. Recently I have worked with Thermenex on five projects and the solutions being developed are saving millions in capital cost with operational cost savings to come.”

Ryan Galloway, Island Health

years to realize there was a different way, and another 15 years to change my knowledge enough to perfect it. This change doesn’t make sense using traditional HVAC knowledge, but many owners are starting to see the benefits and are pushing for this innovative solution.”

be able to get energy savings with a reduced carbon footprint, but also get through heat dome events without adding more chillers.”

A FINE BALANCE

Preserving cultural heritage in Indigenous long-term care facilities with infection control

By Stephanie Cini

The Nunavut government has long grappled with providing adequate long-term care (LTC) facilities for its Indigenous communities. Due to a shortage of beds and the absence of secure wards within the territory, many seniors requiring round-the-clock care have been transferred to facilities outside the region, leading to separation of families and a foundational shake in cultural ties.

Nunavut’s struggle extends beyond just the number of beds available. It’s about preserving cultural identity and promoting community well-being. The government is taking steps to address this issue, exemplified by the Working Together Agreement, which aims to open new LTC facilities in major communities like Cambridge Bay, Rankin Inlet and Iqaluit.

With the government’s commitment to building LTC homes in the region, it is crucial to consider not only the healthcare needs of the population but also the preser-

vation of Indigenous traditions and values. Fostering collaboration and cultural sensitivity throughout the design, construction and operation of these facilities will result in spaces that truly serve the holistic needs of Indigenous communities for generations to come.

TAKING ACTION ON HEALTHCARE

The construction of LTC facilities in Indigenous communities involves preserving cultural heritage and ensuring infection control. By prioritizing cultural preservation while implementing innovative solutions, environments can be created that honour residents’ identity and support their health and well-being.

The integration of cultural elements into facility design is crucial for cultural preservation within these communities. Using traditional materials reflects commitment to preserving Indigenous heritage, fostering a sense of cultural pride among residents and

honouring the traditions and values passed down through generations.

In addition to preserving cultural heritage, it is vital within these communities to incorporate spaces for communal activities, such as drumming and sewing circles, storytelling sessions and social teas, into the design of LTC facilities. These spaces serve as essential hubs for community connection and cultural revitalization. Infection control measures often limit large gatherings, posing a challenge to integrating these spaces. To address this, partnership between the community, healthcare providers and builders is crucial. By working together, these spaces can be designed with safety in mind, implementing measures like proper ventilation, physical distancing protocols and flexible layouts that allow for adaptable use according to public health guidelines.

Cultural preservation in LTC facilities goes beyond just the physical environment; it encompasses the provision of culturally com-

petent care and the promotion of Indigenous languages, traditions and spirituality. Staff training programs should incorporate cultural competency training to ensure healthcare providers understand and respect the cultural beliefs and values of Indigenous residents. Involving Indigenous elders and community members in decision-making processes regarding facility design and care practices ensures cultural preservation remains a priority.

Balancing these cultural elements with infection control requirements often presents unique challenges. Incorporating traditional materials into the facility requires ensuring they meet infection control standards through proper cleaning and maintenance protocols. Collaborating closely with Indigenous elders and community members helps identify culturally significant elements that can be seamlessly integrated into the design without compromising safety or hygiene. For example, a seal skin bench in a current long-term care home in Nunavut undergoes thorough risk assessment to ensure it can be safely incorporated without compromising infection control.

Infection control measures during the construction and design process, including the selection of materials and layout planning, are crucial to preventing the spread of infectious diseases within LTC facilities. Choosing construction materials that are easy to clean and disinfect, such as non-porous surfaces for countertops and flooring, minimizes the risk of microbial contamination. Proper ventilation systems should be installed to ensure adequate air circulation and reduce the buildup of airborne pathogens. However, these measures must be implemented in a way that respects and preserves Indigenous cultural practices.

THE PAST INFORMS THE FUTURE

In the course of pandemics, Indigenous peoples suffer increased infection rates, more severe symptoms and higher mortality rates than the general population due to the

powerful forces of social and cultural determinants of health and lack of political power. During the 1918 Spanish influenza pandemic, Māori in New Zealand died at a rate seven times that of the European population. First Nations people in Canada were eight times more likely to die compared with non-First Nations. In more recent times, Indigenous peoples in Canada were three times more likely to be hospitalized and six and a half times more likely to be admitted to an intensive care unit during the H1N1 pandemic.

Indigenous peoples in colonized nations share similar histories of invasion, displacement from traditional lands, relocation onto missions or reservations, forced assimilation and decimation from introduced infectious diseases. These historical traumas have con-

tributed to current health disparities, making the need for culturally sensitive healthcare infrastructure all the more pressing.

By recognizing and addressing these historical and ongoing challenges, healthcare facilities can be built to not only meet the highest standards of infection control but also honour and preserve the rich cultural heritage of Indigenous communities.

Stephanie Cini is director of consulting services at IPAC Consulting, which offers infection control expertise to various sectors, including travel, film productions, dental, long-term care and the construction of healthcare facilities. Stephanie brings more than a decade of management experience and three years of specialized consulting expertise in construction and film to her leadership role at IPAC Consulting.

CHES SCISS

National Healthcare Facilities and Engineering Week October

13 - 19, 2024

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

*2024 Challenge*

CHES members are challenged to celebrate NHFEW by creating a short video and posting it on LinkedIn or Twitter using #NHFEW. CHES will then like and share it on LinkedIn (@CHES National Office) and Twitter (@CHES_SCISS).

Visit the CHES website https://ches.org/resources/national-healthcare-facilities-engineering/ for downloadable material to help you with plans to celebrate!

JUST BREATHE

Ventilation resilience in age of COVID, climate crisis

By Amandeep Deol

Hospital ventilation systems are primary contributors to the health, safety and comfort of patients and staff. Since 2020, hospitals have attempted to curb the spread of COVID-19 by increasing outside air per cent setpoints, filtration standards and ventilation operating periods. Then, beginning in March 2023, and with increased intensity starting in June, Canada experienced record-setting wildfires, with all provinces and territories affected. Last year’s wildfire season surpassed 1989, 1995 and 2014 fire seasons, and was the worst in recorded North American history, eclipsing the 2020’s wildfire season in the United States. Severe smoke conditions were seen across Canada and in the U.S., and Toronto recorded an air quality health index of 10-plus, briefly the worst in the world. The country has yet to come to grips with filtra-

tion and ventilation requirements when outdoor air is so polluted. With the likelihood of continuing internal and external airborne threats to human health, ventilation systems will be increasingly required to closely monitor and manage the quantity and quality of air supply.

Ventilation systems are also responsible for the largest share of energy use, utility costs and greenhouse gas emissions in hospitals, contributing directly to the climate crisis that is increasing pressure on healthcare systems globally. Public health effects of disruptions to physical, biological and ecological systems include increased respiratory and cardiovascular disease; injuries and premature deaths related to extreme weather events; changes in the prevalence and geographical distribution of air, food and water-borne illnesses and

other infectious diseases; and threats to mental health. Hospitals are one of the most energy intensive building types and disproportionate carbon emitters. Effective energy management of ventilation systems has the greatest potential to reduce healthcare facilities’ carbon footprint.

Alberta Health Services (AHS) takes a systematic approach to ventilation resilience, with testing, rebalancing and control of its hospital ventilation systems helping ensure health and safety while delivering large energy and emissions savings. The work begins with energy benchmarking, system testing and documentation of the areas served by each air handling system. Energy benchmarking and targets quantify electricity and thermal savings potential, focusing attention on the hospitals with the biggest opportunities.

Testing uncovers a myriad of issues that limit resilience: airflow imbalances and variances from CSA standards; damper malfunctions; excessive static pressures; underperforming fans; and airflow leakage and losses. Inspection establishes and accurately documents the departments and rooms supplied by each air handling system and amount of outdoor and total air change rates.

This foundational information sets the stage for making necessary improvements to achieve and sustain resilience over time. These include scheduling operating/setback periods of each ventilation system to match current occupancy, in accordance with CSA guidance; installation of additional variable frequency drives (VFDs), sensors and volume control devices where needed; rebalancing supply and return airflows to individual spaces, based on current use and occupancy, to CSA 317.2; rebalancing central airflows, including exhaust fans, to maintain pressure differentials between departments and overall pressurization; connection

of additional equipment to the building automation system where needed; reprogramming with smart control sequences, including resets, for VFDs, heat/enthalpy recovery wheels, dampers, heating, cooling and humidification; and upgrading user interfaces and trend log capability for monitoring and verifying performance.

The latest AHS project is upgrading ventilation systems in six city and rural acute care hospitals totalling approximately two million square feet. Weather normalized electricity and thermal savings recorded from July 2022 to June 2023 totalled $1,056,000. Emissions reductions to date are close to 20,000 tonnes of carbon dioxide equivalent greenhouse gas emissions. Subsequent completion of the work is forecast to double the annual savings. The project took 18 months from initial testing and investigation to implementation, with a simple payback of less than four years.

Equally important to the financial and environmental benefits is the ventilation systems at these six hospitals are now truly resilient. Testing, documentation, upgraded

equipment, rebalancing, refurbishment and monitoring provide assurance that all areas of the hospitals are always receiving the right quantities and quality of ventilation. Engagement of AHS corporate and site staff alongside consultants and contractors has embedded a shared understanding and commitment to resilient ventilation. The project provides a replicable and scalable model that can deliver the material benefits of resilient ventilation systems to all 8,500 hospitals across North America.

Amandeep Deol is director of engineering at Enerlife Consulting, where he heads the healthcare division, focusing on using a data-driven recommissioning approach to enhance energy efficiency and lower emissions. Amandeep provides technical expertise on new healthcare hospital designs to set energy targets and project specifications that deliver high-performance facilities. He also leads many technical research projects addressing market gaps in decarbonization of healthcare facilities and is a regular speaker at CHES and ASHRAE conferences.

Features of Resilient Ventilation Systems

Capable of withstanding normal wear and tear as well as unexpected shocks or stressors.

If one component fails, the redundant system can take over, ensuring continuous operation.

Ability to adjust operating parameters, switch to alternative power sources or incorporate new technologies to cope with evolving challenges.

Proactive maintenance helps identify and address potential issues before they become critical, reducing the risk of unexpected failures.

Automatic restart procedures, failover mechanisms or manual interventions that minimize downtime.

Identify potential threats to equipment, such as power outages, extreme weather events or equipment failures, and develop plans to mitigate these risks.

Resilient systems often prioritize energy efficiency to reduce operational costs and environmental impact.

Easier integration of backup systems and the sharing of resources in case of failures.

Can help detect anomalies or failures early, allowing for timely intervention.

RESERVOIR OF BACTERIA

Novel solution aims to rid hospital sinks of pathogenic potential

By Richard Dixon & David Koenig

In the complex landscape of healthcare, fostering a culture of empowerment, building trust and implementing robust incident command structures are essential to ensure patient safety and resilience in the face of unforeseen events. A poignant example of this unfolded in October 2022, at Mayo Clinic Health System in Menomonie, Wis. An incident in the operating room tested the organization’s commitment to these principles and underscored the need for comprehensive evaluation of such significant events.

Antimicrobial resistance (AMR) is among the World Health Organization’s (WHO) top

10 threats to global health. Initially driven by the misuse of antimicrobials in livestock, crops and humans, the rise in AMR has reduced or eliminated the effectiveness of many antibiotics used to treat infections. With limited alternatives, lack of treatment is predicted to lead to a tenfold increase in AMR-associated deaths by 2050. AMR microbes and associated health impacts are expected to become a burden on the global economy leading to a rise in poverty.

It is well-known the environment plays a pivotal role in the development and transmission of AMR microbes. It is also key for active prevention of AMR. In hospitals,

the hand hygiene sink has been shown to contribute to the rise of AMR. Not only is the sink a source of hospital-acquired infections (HAIs) but it is also a reservoir for dispersal of AMR microbes into the community. So, eliminating the sink as a source of HAIs and AMR microbes will greatly help in the quest to control AMR globally.

SINKS AND DRAINS

Researchers worldwide have been investigating sinks and drains as a source of HAI microorganisms, especially carbapenem-resistant Enterobacteriaceae (CRE). CRE infections are of particular concern because of their abil-

ity to transfer their AMR genetic elements from one bacterial species to another. Reports that suspected sinks and drains could be the source of CRE-causing HAIs began to emerge in 2003. In a 2017, 17 studies identified sinks as a potential source of microorganisms causing HAI outbreaks, often in the intensive care unit. Additionally, AMR microbes can colonize sinks and associated plumbing allowing for the transmission of AMR genes to non-AMR microbes, increasing the AMR problem exponentially. Given the waste stream from a sink ultimately reaches municipal wastewater facilities, AMR microbes and other pathogens can be released into the community.

Sink design directly drives the environmental conditions that favour microbial growth on plumbing line surfaces and ultimately AMR development. To prevent sewer gases being released into the room, sinks use water traps, specifically the P-bend trap that adds a 90-degree fitting on the outlet side of a U-bend. By design, the P-trap allows for the sink lines to remain wet; however, these conditions are conducive to the rapid growth of biofilms that will harbour pathogens and AMR microbes.

AMR microbes can spread along waste lines connecting sinks and colonize the P-trap. Once there, they form a biofilm that

INFECTION PREVENTION &

can grow upwards to reach the sink strainer at a rate of up to 2.5 centimetres a day. When the water from the faucet hits the sink strainer there is splashing that carries pathogens (HAIs) and AMR microbes in droplets onto surrounding counters and the floor up to one metre away. Patient care and personal items left around the sink can become contaminated, increasing the chance of transmission of pathogens to patients. Additionally, superbugs contained in sink biofilms can be flushed out of the sink into the municipal water treatment system, contaminating the outside world and leading to community AMR infections.

Healthcare facilities have tried a wide range of interventions to stop outbreaks associated with sinks; however, most have not proven successful. Some interventions have resulted in the end of outbreaks but didn’t fully eliminate CRE from the P-trap or drain and the potential of a CRE infection occurring. Others have failed to eliminate outbreak altogether. Given this, it’s time to change the plumbing system design introduced more than 140 years ago.

EASYFLOW CONCEPT

All interventions to date have missed the obvious: the P-trap contains the water

conditions that are hard to treat and remove. Further, the water in the P-trap provides the necessary water activity conditions in the waste lines from the P-trap to the sink strainer that allows growth of biofilm on all surfaces and, ultimately, enables the source of microbes to be splashed into the hospital-built environment. Removal of the P-trap allows for reducing the water activity in the sink lines so biofilms will not form, significantly lessening the risk of splashing microbes into the hospital-built environment.

A new approach, called EasyFlow, eliminates the P-trap. To do this, an offset sink drain line is routed straight down or at any angle equal or less than 45 degrees from the bottom of the sink, after which the drain line is routed 90 degrees or less to the discharge line. Sewage odours are mitigated by installing a negative pressure fan on the vent pipe to pull the air gases continually out of the entire system. Negative pressure fans will have the ability to adapt flow rate to ensure appropriate operation in concert with room fluctuations of the heating, ventilation and air conditioning (HVAC) system’s airflow and pressures. All fans are connected via a low voltage control wire to the healthcare facility building automation system so that if a fan fails, the engineering department can receive

TYPICAL STRATEGIES TO MITIGATE DISEASE OUTBREAK ASSOCIATED WITH SINKS

• Replacing the entire contaminated sink or the downpipes and p-traps. Problem reoccurs soon after replacement as P-trap plumbing is still employed.

• Correcting defective conditions in water systems, such as dead ends, low water use areas, temperature and pressure fluctuations. Helpful in simplifying water flow but the P-trap is still there, maintaining the primary driver for biofilm development.

• Placing of an offset sink drain in hand hygiene sinks. Reduces splashing from the sink strainer but, again, the P-trap is still in place allowing for biofilm growth.

• Changing to deeper sink basins to prevent cross-contamination of hands and adjacent surfaces. Does not eliminate splashing or biofilm growth.

• Regularly pouring disinfectants, such as sodium hypochlorite, hypochlorous acid, hydrogen peroxide, acetic acid, octanoic acid or peroxyacetic acid, down the sink. Significantly decreases bioburden but regrowth happens within a few days.

• Blocking the drain line and allowing the disinfectant to sit in the P-trap. More successful than just pouring disinfectant down the drain but regrowth still occurs within a few days.

• Using a device that heats and/or subjects the downpipe to ultrasound to kill and remove the biofilm. The device requires a power source near the sink and there’s still biofilm regrowth after treatment.

• Adding a sink that generates ozonated water via the faucet to disinfect the P-trap and drain at each use. Shown to be effective at decreasing Pseudomonas aeruginosa and Candida auris contamination. However, a power source near the sink is needed and ozone generators require controls in the sink engineering to ensure no release of ozone into occupied spaces.

the failure signal and repair or replace the fan/ motor immediately. A ceiling hatch is required for access by engineering. The advantage of this system is it will substantially reduce the moisture in the waste system lines thereby minimizing dangerous wet biofilms, unlike the P-trap design. Dry biofilms are still expected to persist but will be treated using disinfectant applications. A horizontal drain line will be installed at an applicable distance away from the sink or varying number of sinks on the front end of the drain system. These lines will have a closure gate or ball valve that will isolate the drain for short periods of time. This allows for the complete filling of the system with an appropriate disinfectant for a sufficient dwell time to be as effective as possible. The goal of this procedure is to remove any dry biofilm that may propagate in the waste lines. The valve should be placed so there is an easy to locate access hatch, which is appropriately marked. Conversely, a remote-control valve can be used to allow for energization of the circuit without manual interventions. A remotely controlled ice plug device can also be installed at the point required for fluid restriction as a redundant feature. Additionally, it’s possible to use these valves to close off the drain line in the case of a negative pressure fan failure, stopping sewer gas escaping into the room during fan repair.

Regular auditing of the drain lines via ATP tests, protein tests or microbial culture is recommended to ensure appropriate function of the system and that there is no or very little dry biofilm in the section of the drain line closest to the sink(s). Remember, dead biofilm that is still on the surfaces will enhance the regrowth of new biofilm.

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Richard Dixon is a board member and co-founder of the Coalition for Community and Healthcare Acquired Infection Reduction (CHAIR), whose members are working on introducing engineered solutions to reduce healthcare-acquired infections to create a safe healthcare environment for Canadian patients, staff and visitors. He is also a former standards writer for the Canadian Standards Association. David Koenig, PhD, is chief technology officer at DKMicrobios, which provides consulting microbiology and skin biology services. Richard and David can be reached at dixonconsulting@gmail.com and dkmicrobios@gmail.

The purpose of this article is to stimulate a discussion on an innovative new concept to clean and disinfect healthcare sink drains that are a common source of pathogens and healthcare associated infections and deaths. It is not intended to claim any outcomes.