HealthcareFacilities JOURNAL OF CANADIAN HEALTHCARE ENGINEERING SOCIETY
Volume 39 Issue 1
ULTIMATE CHAMPION Specialized centre for people with autism recognized with award but patients, families come out on top
Working Safely with Asbestos The Day Edmonton Went Dark Mass Notification Systems Explained
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CANADIAN HEALTHCARE FACILITIES Volume 39
Clare Tattersall firstname.lastname@example.org EDITOR/RÉDACTRICE
PUBLISHER/ÉDITEUR Kelly Nicholls email@example.com PRESIDENT/PRÉSIDENT
Kevin Brown firstname.lastname@example.org
SENIOR DESIGNER/ CONCEPTEUR GRAPHIQUE SENIOR
Annette Carlucci email@example.com
PRODUCTION MANAGER/ DIRECTEUR DE PRODUCTION
Rachel Selbie firstname.lastname@example.org
CIRCULATION MANAGER/ Anthony Campbell DIRECTEUR DE LA email@example.com DIFFUSION
SECURITY & LIFE SAFETY
24 The Ready for Anything Network Improving healthcare facility responsiveness with passive optical LAN
Editor’s Note President’s Message
10 Chapter Reports 13 Engineering Week
26 Safety Matters Personal protective equipment for working with asbestos
CANADIAN HEALTHCARE FACILITIES IS PUBLISHED BY UNDER THE PATRONAGE OF THE CANADIAN HEALTHCARE ENGINEERING SOCIETY. SCISS JOURNAL TRIMESTRIEL PUBLIE PAR SOUS LE PATRONAGE DE LA SOCIETE CANADIENNE D'INGENIERIE DES SERVICES DE SANTE.
CHES Canadian Healthcare Engineering Society
Société canadienne d'ingénierie des services de santé
PRESIDENT VICE-PRESIDENT PAST PRESIDENT
HEALTHCARE DEVELOPMENT 14 Building Capacity for Care Renforcer la capacité de soins 18 Nature is Nurture West Park’s new hospital to redefine how the outdoors can be effectively integrated into rehabilitative care 20 A Sustainable Vision for Wellness Selkirk Regional Health Centre doubles the size of former hospital, increasing opportunities for holistic patient care
EMERGENCY PREPAREDNESS & RESPONSE 28 This is Not a Test Mass notification systems designed to alert, protect and inform people when disaster strikes 30 Edmonton’s Dark Day Wildfire smoke clouds Alberta’s capital, triggering carbon monoxide, dioxide alarms and putting medical air at risk
TREASURER SECRETARY EXECUTIVE DIRECTOR
Preston Kostura Roger Holliss Mitch Weimer Craig B. Doerksen Kate Butler Donna Dennison
Newfoundland & Labrador: Colin Marsh Maritime: Helen Comeau Ontario: Jim McArthur Quebec: Mohamed Merheb Manitoba: Tom Still Saskatchewan: Greg Woitas Alberta: Dan Ballantine British Columbia: Steve McEwan FOUNDING MEMBERS
H. Callan, G.S. Corbeil, J. Cyr, S.T. Morawski CHES
4 Cataraqui St., Suite 310, Kingston, Ont. K7K 1Z7 Telephone: (613) 531-2661 Fax: (866) 303-0626 E-mail: firstname.lastname@example.org www.ches.org
22 A Hub of Innovation Specialized centre for people with autism first of its kind in North America
Canada Post Sales Product Agreement No. 40063056 ISSN # 1486-2530
South Health Campus | Calgary
Committed to service excellence and designing better performing buildings. Structural Engineering Building Science Parking Facility Design Structural Restoration rjc.ca 4 CANADIAN HEALTHCARE FACILITIES
A TOUR LIKE NO OTHER IN RECENT YEARS, Canada has seen a shift of care outside the hospital and into the community. This doesn’t mean these bricks and mortar buildings are any less important. Rather, by moving specialist services closer to ‘home,’ it’s expected to ease pressure on hospitals so they can improve responsiveness, provide better care to patients and, potentially, reduce costs in the process. The number of hospital projects that were announced, broke ground and completed in recent years is an indication of their continued significance within Canada’s healthcare system. In this issue, we ‘tour’ four, starting with Alberta’s Medicine Hat Regional Hospital, which opened its new emergency department doors Jan. 8. The occasion officially marked the completion of Phase 2 in a three-phase emergency department renovation and expansion, which adds more than 6,450 square feet of floor space to the hospital. Phase 2 also features three new treatment spaces, bringing the total to 27. You can read more about the first major renovation to the emergency department since its 1984 opening in Building Capacity for Care. We then head east to Toronto, where West Park Healthcare Centre is preparing to undertake the largest redevelopment in its history with construction of a new six-storey, approximately 730,000-square-foot hospital that will create an accessible and green environment to deliver more enhanced and integrated rehabilitative services. From here we return west, stopping in Manitoba along the way. A Sustainable Vision for Wellness explores the new Selkirk Regional Health Centre, which, at 184,000 square feet, is not only double the size of the Interlake-Eastern Regional Health Authority’s obsolete 1970s hospital but is designed to support future expansions that may be required. We conclude our hospital ‘tour’ in Richmond, B.C., home to the Goodlife Fitness Family Autism Hub. While the oldest of the four projects, having opened three years ago, the specialized centre for people with autism — the first of its kind in North America — was honoured in 2018 with a Wood Design Award for its stunning showcase of innovation and ingenuity in wood building and design.
Clare Tattersall email@example.com
Reproduction or adoption of articles appearing in Canadian Healthcare Facilities is authorized subject to acknowledgement of the source. Opinions expressed in articles are those of the authors and are not necessarily those of the Canadian Healthcare Engineering Society. For information or permission to quote, reprint or translate articles contained in this publication, please write or contact the editor. Canadian Healthcare Facilities Magazine Rate Extra Copies (members only) 25 per issue Canadian Healthcare Facilities (non members) 30 per issue Canadian Healthcare Facilities (non members) 80 for 4 issues A subscription to Canadian Healthcare Facilities is included in yearly CHES membership fees.
6 CANADIAN HEALTHCARE FACILITIES
La reproduction ou l’adaptation d’articles parus dans le Journal trimestriel de la Société canadienne d’ingénierie des services de santé est autorisée à la condition que la source soit indiquée. Les opinions exprimées dans les articles sont celles des auteurs, qui ne sont pas nécessairement celles de la Société canadienne d’ingénierie des services de santé. Pour information ou permission de citer, réimprimer ou traduire des articles contenus dans la présente publication, veuillez vous adresser à la rédactrice. Prix d’achat du Journal trimestriel Exemplaires additionnels (membres seulement) 25 par numéro Journal trimestriel (non-membres) 30 par numéro Journal trimestriel (non-membres) 80 pour quatre numéros L’abonnement au Journal trimestriel est inclus dans la cotisation annuelle de la SCISS.
NATIONAL CONFERENCE | 2019 | SEPTEMBER 22-24 | SASKATOON ARTS & CONVENTION CENTRE, TCU PLACE | SASKATOON, SK
SAVE THE DATE! The CHES 2019 National Conference will be held in Saskatoon, Sask., at the Saskatoon Arts & Convention Centre, TCU Place, September 22-24, 2019. The Saskatoon Arts & Convention Centre, TCU Place, is conveniently located near downtown and local amenities. A block of rooms has been reserved at both the Hilton Garden Inn Saskatoon Downtown, starting at $199 plus applicable taxes single/double occupancy, and the Holiday Inn Saskatoon Downtown, starting at $167 plus applicable taxes single/double occupancy. The theme of the 2019 conference is The “HUB” that enables resiliency in healthcare The CHES 2019 Education Program is still under development but will once again feature dual tracks with talks on relevant industry topics from high-profile experts in the field. We are investigating Mark Black as our Keynote Speaker. Mark is a Resilience Expert, Heart and Double-Lung Transplant Recipient and 4-Time Marathon Runner born with a congenital heart defect. Mark has beaten all the odds and uses his new gift of life to inspire people to “live life with passion and purpose.” The Great CHES Golf Tournament will be on Sunday, September 22, 2019. Join us for the CHES President’s Reception and Gala Banquet again in 2019! The banquet will celebrate the accomplishments of our peers with the 2019 Awards presentations, while enjoying great food and entertainment with friends.
See you in 2019 in Saskatoon! For more info visit our website at www.ches.org Follow us on Twitter!
GIVING THANKS GREETINGS TO all my colleagues across our great country. As we go about our lives in a merry way, we have come to discover the world is ever-changing — disasters occur, people get injured or fall ill. It is during these times that we realize the importance of our role in Canada’s healthcare facilities. We may not be physicians or nurses that tend to patients but we, along with our skilled staff, are responsible for keeping these buildings up-and-running and maintaining best practices so that clinicians can do their job and help heal those in hospital. We sometimes forget the ‘boots on the ground’ — our frontline employees who go above and beyond their regular duties for the betterment of our facilities. I would like to thank this group of remarkable individuals. The Saskatchewan chapter is busy preparing for the 2019 CHES National Conference, which will be held Sept. 22-24, in Saskatoon. Mark your calendar as it’s no doubt going to be another great event. Ontario chapter chair Jim McArthur and his team are already preparing for the 2022 International Federation of Hospital Engineering (IFHE) conference. They started early to meet the logistics required for this grand event, which will be held in Toronto, Sept. 18-20, 2022. CHES continues to offer educational opportunities through webinars and courses. I encourage you to check the CHES website or your local chapter for session dates. On behalf of the CHES National executive, I would like to wish everybody a happy and prosperous 2019!
Preston Kostura President, CHES National
EARN CONTINUING EDUCATION CREDITS FROM CHES Members of the Canadian Healthcare Engineering Society can earn free continuing education units (CEU) by reading the Winter 2018/2019 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/86NL67D to take the quiz. CHES members who pass the quiz will be able to claim one contact hour (0.1 CEU) on their CanHCC or CCHFM certificate renewals.
8 CANADIAN HEALTHCARE FACILITIES
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NEWFOUNDLAND & LABRADOR CHAPTER
Planning continues for the 2019 Manitoba Education Day. To be held April 23, the theme is, ‘Innovation and Technology.’ If you have any questions about the event or you would like to volunteer your time, please contact any member of the executive team. The Manitoba chapter sponsored a session at the 2018 Manitoba Building Expo. George Harrison of Crosier, Kilgour and Partners Ltd., and Health Sciences Centre Winnipeg’s Gerry Berard gave a presentation on ‘Roofing: Standards and Inspections.’ The cost of attendance to the session, luncheon and trade show was covered by the chapter for all CHES Manitoba members. The turnout was excellent. To encourage members to excel in their field, the Manitoba chapter will cover the cost of the Canadian Certified Healthcare Facility Manager (CCHFM) practice/self-assessment exam for those attempting it for the first time. Details are on the Manitoba chapter section of the CHES website. —Tom Still, Manitoba chapter chair
While the excitement surrounding the 2018 CHES National Conference has come and gone, attendees are still reaping the benefits of the successful event. Hats off to all those who made it possible. The executive team is currently planning the chapter’s next professional development day. As always, it will offer a diversity of educational opportunities. Many vendors are already looking to take part. The Newfoundland and Labrador chapter will seek nominations in early 2019 to fill the roles of vice-chair and secretary. Both seats have been vacant for some time now. Chapter membership has been relatively constant, with a slight increase leading into the 2018 CHES National Conference. There are currently more than 45 active members and the chapter is actively pursuing new membership. The Newfoundland and Labrador chapter is sitting in a solid financial position. All expenses incurred as a result of the 2018 conference have been paid. The executive team is in the process of determining what types of rebates it can offer the membership next year. —Colin Marsh, Newfoundland & Labrador chapter chair
MARITIME CHAPTER After an extremely warm and beautiful fall, winter arrived (too) early in the Maritimes. The latest edition of the Canadian Farmer’s Almanac is predicting a long winter lasting in many locations through April, with cooler weather even stretching into May. Let’s hope that’s not the case given the chapter’s annual conference will be held May 5-7. Regardless, it will be a great event. Like last year, the 2019 spring conference will take place at the Delta hotel in Moncton, N.B. The theme is, ‘Healthcare Infrastructure: Understanding the Risks.’ Registration information and the floor plan will soon be posted on the Maritime chapter section of the CHES website. The chapter’s fall 2018 education day was well-attended by approximately 80 participants. Held Nov. 20, at the Best Western Glengarry in Truro, N.S., education sessions covered computerized maintenance management systems and work orders; water quality as it relates to boiler efficiency; energysaving measures; mould, asbestos and duct cleaning; HVAC and fire systems maintenance; and floor material comparisons. I’d like to thank the sponsors that supported the event. Planning is well underway for the 2020 CHES National Conference in Halifax, Sept. 20-22. While still almost two years away, I’m already excited. The chapter continues to balance its books while offering several financial incentives to its members in the way of student bursaries, contribution to Canadian Certified Healthcare Facility Manager (CCHFM) exam fees, webinars, the fall education day and other rebates. On behalf of the Maritime chapter, I hope everyone had a safe, happy and healthy holiday season, and 2019 is off to a great start. —Helen Comeau, Maritime chapter chair 10 CANADIAN HEALTHCARE FACILITIES
BRITISH COLUMBIA CHAPTER I would like to congratulate the Newfoundland and Labrador chapter on the 2018 CHES National Conference. A big thank you to Colin Marsh and his team for all their hard work. Planning for the 2019 B.C. chapter conference is well underway. To be held in Penticton, May 26-28, the theme is, ‘Safety First: Our Mandate for Responsible Healthcare.’ The Penticton Lakeside Resort is our host hotel. Call for abstracts has been posted. Check out the B.C. chapter page on the CHES website. The Canadian Healthcare Construction Course (CanHCC) will follow the conference, May 29-30. The executive team continues to support the chapter’s college bursaries, as well as members with education grants. We had the opportunity to sponsor and attend the 2018 Lieutenant Governor Safety Awards hosted by Technical Safety BC. The awards recognize individuals and organizations that demonstrate exceptional leadership, achievement, innovation or contribution in the safety of technical systems in the province. The B.C. chapter has a new executive team: Norbert Fischer (chair), Sarah Thorn (vice-chair), Rick Molnar (treasurer), Ken Van Aalst (secretary), Steve McEwan (education and past chair), Arthur Buse (membership), Mitch Weimer (public relations), Mark Swain (communications) and Caroline Reid (education). As I move into my role as past chair, I want to acknowledge the dedicated group of professionals I’ve had the pleasure to work with on the chapter executive. It’s truly been an honour. —Steve McEwan, British Columbia chapter chair
SASK ATCHEWAN CHAPTER
The chapter’s fall 2018 education day was a success, with more than 25 delegates in attendance. Held Nov. 8, in Cambridge, Ont., morning sessions covered drone technology and updates to CSA standards. A very productive roundtable discussion was the highlight of the afternoon. I’d like to thank Rick Anderson and Ron Durocher for organizing the event. Planning continues for our 2019 spring conference in Hamilton, Ont. It will be held June 2-4, at the Hamilton Convention Centre. The keynote speaker, Bill Carr, and conference theme, ‘Breaking Down Barriers to Improving our Healthcare Facilities,’ have been confirmed. The planning committee is busy working to select session speakers and locations for the great CHES golf game and companion program. Vendor space is filling up quickly. I’d like to once again thank conference planning chair Ron Durocher and the entire team for their hard work thus far. Windsor, Ont., has been selected to host the chapter’s 2020 spring conference, May 31- June 2. The executive team is looking at locations for the 2021 conference and the following year we will host the 2022 CHES National Conference along with the International Federation of Hospital Engineering (IFHE) Congress in Toronto. —Jim McArthur, Ontario chapter chair
It was a busy fall. In September, three executive team members attended the 2018 CHES National Conference in St. John’s, Nfld. We gleaned much from the event, which will help guide us as we prepare to host the 2019 CHES National Conference. About a month afterwards, from Oct. 22-23, the Saskatchewan chapter held its annual conference and trade show at TCU Place in Saskatoon. The conference planning committee did an excellent job organizing the two-day event, which saw a record number of 69 delegates in attendance. The 35 vendor booths that filled the trade show floor also contributed to its success. The chapter’s annual general meeting was held on the last day of the conference with approximately 35 members present. The Member of the Year award went to Jim Allen who has led constant change and development within the province’s everchanging healthcare environment. Preparations are well underway for the 2019 CHES National Conference. The venue has been booked and various committees have been put into place. Planning for the chapter’s 2020 conference and trade show, to be held in Regina, will begin shortly. The transition to a single provincial health authority (from 12 regional health authorities) is complete. Representatives from the Saskatchewan Health Authority participated in a session at the chapter’s fall 2018 conference, detailing interesting facts, figures and plans for the future. Some of the health authority’s strategic priorities are sustaining operations, delivering existing capital projects, and implementing standardized in-take and prioritization processes for capital equipment and infrastructure projects. Long-term priorities include ensuring the health authority’s asset plan is aligned with care requirements, population needs and the province’s workforce, and that patient-focused equipment and facility maintenance services are grounded in a proactive preventative maintenance program. —Greg Woitas, Saskatchewan chapter chair
Winter is upon us in Alberta. On the bright side, most areas see more than 300 days of sun each year, making the province one of the sunniest in the country. There is nothing more exhilarating than venturing outside to enjoy the scenery and many activities that Alberta has to offer. I had the good fortune to attend the 2018 CHES National Conference. I’d like to congratulate the Newfoundland and Labrador chapter on hosting such a hugely successful event. If you’ve never been to St John’s, Nfld., you should put it on your bucket list. Settled in the 1600s, the province’s capital is one of the oldest cities in Canada, rich in scenery, culture and history. The 2019 Clarence White Conference and Trade Show will take place April 16-17. The annual event has grown and improved since its inception. I would like to thank the conference planning committee’s efforts year after year, which have contributed to its continued success. It seems as though it’s almost inevitable that every year some executive committee seats become vacant as chapter members’ roles migrate to other responsibilities. Currently, we are looking for nominations and expressions of interest for the vice-chair, secretary and treasurer positions. If you know someone who might like to join the executive team or you want to put your own name forward, please let me know. Elections will be held in January. The Alberta chapter will host the Canadian Healthcare Construction Course (CanHCC) in Calgary, Oct. 16-17. This is a great way to further prepare to challenge the Canadian Certified Healthcare Facility Manager (CCHFM) exam. —Dan Ballantine, Alberta chapter vice-chair
The 2019 CHES National Conference will be held Sept. 22-24, in Saskatoon. WINTER/HIVER 2018/2019 11
CHAPITRE DU QUÉBEC
The Quebec chapter was created in 2017, making it the last province to join CHES. With Quebec’s health sector undergoing great change due to the many policies introduced by different political parties, the chapter will play an important role in sharing with its membership information related to healthcare facilities’ daily operations. Since its formation, the Quebec chapter has held two conferences. The subject of the first, in 2017, was medical gases, with Busch Vacuum Technics’ René Nadeau giving a presentation on the topic. Nearly 40 attended the event. The second conference, held April 2018, saw an increase in attendance to approximately 60 people, confirming the growing interest in the chapter. The theme was, ‘Infection Control: New Engineered Infection Prevention Approaches.’ Class 1’s Barry Hunt hosted a session on the subject. 2018 saw changes to the chapter’s executive team, which is now comprised of Mohamed Merheb (president), Maxime Demeule (vicepresident), Bruno Rajotte (treasurer) and Alexandre Blain (secretary). The chapter executive is committed to raising awareness in healthcare facilities on the value of its technical presentations and networking at the CHES National level. Three conferences are currently planned for 2019. Topics and dates will be published soon on the CHES website. —Mohamed Merheb, Quebec chapter president
Le chapitre du Québec a été créé en 2017, ce qui en fait la dernière province à se joindre à la CHES. Étant donné que le secteur de la santé du Québec subit de grands changements en raison des nombreuses politiques adoptées par les différents partis politiques, le chapitre jouera un rôle important en partageant avec ses membres l’information sur les activités quotidiennes des établissements de soins de santé. Depuis sa création, le chapitre québécois a tenu deux conférences. La première, en 2017, portait sur les gaz médicaux. René Nadeau, de Busch Vacuum Technics, a alors fait une présentation sur le sujet. Près de 40 personnes ont assisté à l’événement. La deuxième conférence, qui a eu lieu en Avril 2018, a attiré une soixantaine de personnes, ce qui confirme l’intérêt croissant envers le chapitre. Le thème était, ‘Lutte Contre les Infections: Nouvelles Approches de Prévention.’ Barry Hunt de Class 1 a animé une séance sur le sujet. En 2018, des changements ont été apportés à l’équipe de direction du chapitre, qui est maintenant composée de Mohamed Merheb (président), Maxime Demeule (vice-président), Bruno Rajotte (trésorier) et Alexandre Blain (secrétaire). Le responsable du chapitre s’est engagé à sensibiliser les établissements de soins de santé à la valeur des présentations techniques et du réseautage national dans le cadre de la CHES. Trois conférences sont actuellement prévues pour 2019. Les sujets et les dates seront publiés sous peu sur le site Web de CHES. —Mohamed Merheb, président du chapitre du Québec
CHES Canadian Healthcare Engineering Society
Société canadienne d'ingénierie des services de santé
CALL FOR NOMINATIONS FOR AWARDS
CALL FOR NOMINATIONS FOR AWARDS 2016 2016 Hans Burgers Award
For Outstanding Contribution to 2019 Hans Burgers Award Healthcare Engineering
Wayne McLellan Award of Excellence In Healthcare Facilities Management
for Outstanding Contribution to Healthcare Engineering DEADLINE: April 2019 DEADLINE: April 30, 30, 2016
2019 Wayne McLellan Award of Excellence In Healthcare Facilities Management April 30, 2019 DEADLINE: DEADLINE: April 30, 2016
Tonominate: nominate:Please use the nomination form posted on theTo nominate: To nominate: Please use the nomination form posted on the To Please use the nomination form posted on use theand nomination form posted on Please CHES website refer to the Terms CHES website refer to the Terms of Reference. the CHES website andand refer to the Terms of of Reference. the CHES website and refer to the Terms of Reference. Reference. Purpose: To recognize hospitals or long-term care facilities that Purpose: The award shall be presented to a resident of Canada Purpose have demonstrated outstanding success in completion of a major asPurpose a mark of recognition of outstanding achievement in the field To recognize hospitals or long-term The award shall of behealthcare presentedengineering. to a resident of capital project, energy efficiencycare program, environmental facilities that have demonstrated outstanding Canada as a mark of recognition of outstanding stewardship program or team building exercise. success in completion of a major capital achievement in the field of healthcare Award sponsored by project, energy efficiency program, engineering. Award sponsored environmental stewardship program, or by team building exercise. Award sponsored by Award sponsored by
For Nomination Forms, Terms of Reference, criteria, and past winners www.ches.org / About CHES / Awards For Nomination Forms, TermsNational of Reference, and past winners Send nominations to: CHES Officecriteria, firstname.lastname@example.org Fax: 866-303-0626 www.ches.org / About CHES / Awards
12 CANADIAN HEALTHCARE FACILITIES
Send nominations to; CHES National Office email@example.com
WINDSOR HOSPITAL STAFF SHOW COLLEAGUES ‘HIDDEN’ WORLD
Hôtel-Dieu Grace Healthcare’s plant operations and maintenance team. BACK ROW: Pat Quinlan, Jules St. Martin and Chris Ard. FRONT ROW: Iovan Marin, Steve Walach, John Pritchard, Paul Baggio and Richard White. ABSENT: Mark Ranson, Dave Russo and Karen Wills.
THE PAST FEW YEARS at Hôtel-Dieu Grace Healthcare have been, at times, chaotic. Just as the finishing touches were being put on a six-year, $100 million redevelopment, the community’s need for a new hospital drove the respective administrations of Hôtel-Dieu Grace Hospital and Windsor Regional Hospital to ‘trade’ sites in order to ensure the success of a local initiative to build a new acute care healthcare facility in the Windsor-Essex region of Ontario. Such an enormous endeavour brought a sea change to the facilities staff at the new Hôtel-Dieu Grace campus, where they had to become acquainted with the buildings, equipment, technology and oversight. Since the ‘trade’ more than five years ago, the plant operations and maintenance team has overcome many unique obstacles in its quest to provide the highest level of service to hospital patients, visitors and staff. It was with this backstory in mind that Hôtel-Dieu Grace’s skilled trades staff held its first-ever ‘open house’ Oct. 17, 2018, to celebrate National Healthcare Facilities and Engineering Week. Carpenters, painters, electricians, power engineers and the plant operations and maintenance team welcomed their colleagues into the facilities space for light refreshments, an opportunity to chat with ‘back of house’ experts and to glean what goes on ‘behind the scenes’ via a personal guided tour of the inner workings of the hospital. For most, if not all, participants, the power plant with its vast array of pipes and
major equipment provided an eye-opening experience. Many commented on the sheer complexity and size of the operations and were thankful for the chance to see it first-hand. The plant operations and maintenance team not only enjoyed enlightening their guests but are looking forward to making this a regular event. —Richard White, director of facilities and support, Hôtel-Dieu Grace Healthcare
• • • • • • •
Ozonated water Laminar flow Self-flushing Motion activated Programmable Wheelchair accessible Prevents bacterial growth and biofilm • Drain & trap free of CPOs and other pathogens • Future data integration with hand hygiene monitoring programs • Exceeds CSA Z8000 and Z317.1-16
Proud to be a founding member chaircanada.org
WINTER/HIVER 2018/2019 13 2018-02-26 2:40 PM
Photo courtesy Ed White Photographics
BUILDING CAPACITY FOR CARE Renforcer la capacité de soins By/Par Michelle Ervin
onsider what a patient who is about to begin dialysis or chemotherapy might be going through, both emotionally and physically. Then add to that the prospect of having to drive three or more hours to access those treatments. The more than 100,000 residents served by Medicine Hat Regional Hospital are less likely to face this with the completion of a 245,000-square-foot expansion. The six-storey addition, which opened in summer 2018, has increased the capacity of the healthcare facility’s renal program and cancer clinic, among other ambulatory care areas. The addition has also introduced a rooftop helipad, enlarged the central utility plant and replaced the hospital’s medical devices reprocessing and surgery departments, as well as its labour and delivery suites and neonatal intensive care unit. Michael Stanford, executive director of capital management at Alberta Health Services, says the province has expanded both of its south regional hospitals — the other is located in Lethbridge, Alta. — to alleviate pressure on inpatient beds and speed up access to important outpatient services. “Adding those outpatient treatment spaces to these programs allowed us to expand that capacity for care within the community,” says Stanford. Without access to local treatment, patients might otherwise have to travel to tertiary hospitals in Calgary and Edmonton, he adds. 14 CANADIAN HEALTHCARE FACILITIES
ongez à ce qu’un patient sur le point de commencer une dialyse ou une chimiothérapie pourrait vivre, tant sur le plan émotionnel que physique. Ajoutez à cela la possibilité de devoir conduire trois heures ou plus pour avoir accès à ces traitements. Les plus de 100 000 résidents desservis par l’Hôpital régional de Medicine Hat sont moins susceptibles d’y faire face avec l’achèvement de l’agrandissement de 245 000 pieds carrés. L’annexe de six étages, officiellement ouverte cet été, a augmenté la capacité du programme rénal et de la clinique de cancérologie de l’établissement de soins de santé, entre autres domaines de soins ambulatoires. L’annexe a également introduit une hélisurface sur le toit. Elle a agrandi la centrale et remplacé les services de chirurgie et de retraitement des appareils médicaux de l’hôpital, ainsi que ses salles de travail et d’accouchement et son unité de soins intensifs néonatals. Michael Stanford, directeur général de la gestion des immobilisations d’Alberta Health Services, dit que la province a élargi ses deux hôpitaux régionaux du Sud — l’autre est situé à Lethbridge, en Alberta — pour réduire la pression sur les lits pour patients hospitalisés et accélérer l’accès à d’importants services externes.
The $274 million redevelopment of Medicine Hat Regional Hospital, which includes an ongoing emergency department renovation, will help ensure residents can access ambulatory and acute care close to home. REDUCING THE HAZARDS OF HAIs
The hospital expansion project also focused on accounting for changes in infection prevention and control standards. Greg Colucci, principal at Diamond Schmitt Architects, says current infection prevention and control standards prescribe greater square footage per program area. “Any space where patients are going to be present has generally increased in area, relative to space allocated in the existing hospital, because evidence has shown that one of the best ways to prevent hospital-acquired infections is simply to segregate or give more space between patients and isolate patients from soiled equipment,” says Colucci. These principles have been applied in private labour and delivery suites, reception areas that control access to clinical areas and dedicated service elevators for clean and soiled supplies.
“L’ajout de ces places de traitement en consultation externe à ces programmes nous a permis d’accroître la capacité de soins au sein de la collectivité,” affirme Stanford. Sans accès au traitement local, les patients pourraient autrement devoir se rendre dans des hôpitaux tertiaires de Calgary et d’Edmonton, ajoute-t-il. Le réaménagement de l’Hôpital régional de Medicine Hat, d’une valeur de $274 millions, qui comprend la rénovation en cours du service des urgences, permettra aux résidents d’avoir accès à des soins ambulatoires et actifs près de chez eux. RÉDUIRE LES RISQUES D’INFECTIONS NOSOCOMIALES
Le projet d’agrandissement de l’hôpital visait également à tenir compte des changements dans les normes de prévention et de contrôle des infections. Greg Colucci, directeur chez Diamond Schmitt Architects, affirme que les normes actuelles prescrivent une superficie plus grande par secteur de programme. “Tout espace où les patients seront présents a généralement augmenté en surface. C’est parce que les données probantes ont démontré que l’une des meilleures façons de prévenir les infections nosocomiales était simplement de donner plus d’espace entre les patients et d’isoler ces derniers de l’équipement souillé,” déclare Colucci. Ces principes ont été appliqués aux suites de travail et d’accouchement, aux aires d’accueil qui contrôlent l’accès aux zones cliniques et aux ascenseurs de service dédiés pour les fournitures propres et souillées. DONNER LA PRIORITÉ AUX PATIENTS
Photo courtesy Ed White Photographics
Bien que la conformité aux normes de prévention et de contrôle des infections ait été un élément important du projet, les soins ont vraiment été au cœur de la conception. Celle-ci a été entreprise en collaboration par Diamond Schmitt Architects et Gibbs Gage Architects. La notion de ce qu’un hôpital devrait être a beaucoup changé au cours des dernières décennies. Bien plus que des lieux de traitement des maladies et des blessures, conçus autour du travail des médecins et des infirmières, les établissements de soins de santé sont désormais considérés en général comme des lieux de guérison et de bien-être, explique Colucci. “Il ne s’agit pas de compromettre ou de diminuer l’importance de l’efficacité opérationnelle, mais plutôt de l’accroître en reconnaissant la place du patient, des membres de sa famille, de ses amis et de la collectivité,”dit‑il. La considération pour ces groupes a commencé à la porte d’entrée. L’annexe a élargi l’empreinte de l’installation de soins de santé vers le sud et vers l’est, ce qui a permis de créer une WINTER/HIVER 2018/2019 15
PUTTING PATIENTS FIRST
While conforming with infection control and prevention standards was an important part of the project, patient care really drove the design, which was undertaken in joint venture by Diamond Schmitt Architects and Gibbs Gage Architects. The notion of what a hospital should be has changed considerably in the last few decades. Much more than clinical places to treat disease, illness and injury, and designed around the work of doctors and nurses, healthcare facilities are now seen broadly as places of healing and well-being, explains Colucci. “(This) is not to compromise or diminish the importance of operational efficiency but rather augment it by recognizing the place of the patient, (their) family members, friends and the community,” he says. Consideration for these groups started at the front door. The addition expanded the footprint of the healthcare facility southward and eastward, providing an opportunity to create a new entrance that shelters visitors from the harsh elements during winter. The main entry rises one-and-a-half storeys, mediating the difference in grade between the addition and existing building, which share a spine. Masonry was used on the building exterior to acknowledge the brick-making that occurred in Medicine Hat, Alta., for so long and serve as a point of continuity with the existing hospital. Other materials, namely curtain wall and metal panel systems, were used to segment the sizeable addition in order to prevent it from imposing upon its lowrise residential surrounds. Inside, small doses of green and orange — colours Colucci says were drawn from southern Alberta’s landscape — identify the east and west wings of the hospital, fading with each floor ascended. The only other hue, yellow, was used to highlight nursing stations in the otherwise bright, white interiors. Natural light filters into the facility through clerestory windows, not only illuminating the series of atria but also reaching into some of the procedure rooms, where ceramic frit protects against solar gain and provides privacy. “When the medical staff come out of surgery spaces they actually have opportunities to see outside,” says Stephen Mahler, a partner at Gibbs Gage Architects. “Often, you’re really thinking a lot about the patients and the families but the caregivers are under a lot of stress, (too).” Recognizing this, the addition introduced a wellappointed outdoor space that’s configured to offer a connection to nature and views to the river valley beyond, providing staff the perfect place to go to escape. Visitors can similarly get some fresh air thanks to the provision of a neighbouring outdoor space that is open to the public.
nouvelle entrée qui protège les visiteurs des intempéries en hiver. L’entrée principale s’élève d’un étage et demi, ce qui atténue la différence de niveau entre l’annexe et l’immeuble existant. L’immeuble a été paré de maçonnerie pour faire écho la fabrication de briques qui a eu lieu à Medicine Hat, en Alberta, pendant si longtemps et servir de point de continuité avec l’hôpital existant. D’autres matériaux, notamment des mursrideaux et des panneaux métalliques, ont été utilisés pour segmenter l’annexe afin d’éviter qu’elle en impose trop par rapport aux résidences environnantes. À l’intérieur, de petites doses de vert et d’orange — des couleurs qui, selon Colucci, proviennent du paysage du sud de l’Alberta — identifient les ailes est et ouest de l’hôpital. Ces couleurs s’estompent à mesure que l’on monte d’Étage. La seule autre teinte, jaune, a été utilisée pour mettre en évidence les postes de soins infirmiers dans les intérieurs blancs. La lumière naturelle entre dans l’installation par des clairesvoies, éclairant non seulement la série d’atriums, mais aussi atteignant certaines des salles de procédures, où la céramique frittée protège contre l’apport solaire et procure une intimité. “Lorsque le personnel médical sort des salles de chirurgie, il a l’occasion de voir à l’extérieur,” déclare Stephen Mahler, un associé de Gibbs Gage Architects. “Souvent, on pense beaucoup aux patients et aux familles, mais les soignants vivent beaucoup de stress.” Conscient de ce fait, l’annexe a introduit un espace extérieur bien aménagé qui est configuré pour offrir un lien avec la nature et une vue sur la vallée, offrant au personnel l’endroit parfait pour s’échapper. De même, les visiteurs peuvent profiter d’un peu d’air frais grâce à un espace extérieur voisin ouvert au public.
This article is an edited version of the one that originally appeared in the October/November 2018 issue of Canadian Facility Management & Design.
Cet article est une version révisée de celui qui a paru à l’origine dans le numéro d’octobre-novembre 2018 de Canadian Facility Management & Design.
16 CANADIAN HEALTHCARE FACILITIES
Photo courtesy Tom Arban Photography
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NATURE IS NURTURE West Park’s new hospital to redefine how the outdoors can be effectively integrated into rehabilitative care By Lijeanne Lee
est Park Healthcare Centre is set to become one of the first hospitals in Canada to redefine how nature can effectively be integrated into rehabilitation to improve complex health outcomes, and support the psychological and emotional wellbeing of patients and their families. Originally established in 1904, as the Toronto Free Hospital for Consumptive Poor, West Park was one of the first centres in the country devoted to treating patients with advanced cases of tuberculosis (TB). Back then, TB patients would often sit outside to take in the fresh air as part of their treatment. Today, West Park has evolved into a leading provider of specialized rehabilitation and complex care, helping patients get their 18 CANADIAN HEALTHCARE FACILITIES
lives back after a life-altering illness or affliction, such as lung disease, amputation, stroke, neurological trauma and severe musculoskeletal injuries. Demand for West Park’s services has significantly increased due to an aging population and people living longer with chronic conditions, outstripping its ability to keep up with patient demand in its current facilities. Preparing to undergo the largest redevelopment in its history, West Park will uphold its roots of integrating nature into therapy. Located in a park-like corner of Toronto’s cityscape, West Park is boldly transforming its 27-acre property into an integrated campus of care, offering patients easy access to a continuum of healthcare services in one location. At the heart of the transformation is West Park’s new six-storey
hospital. Approximately 730,000 square feet, it will incorporate the best and latest in architectural design, enabling technologies, and the highest standard of accessible and senior-friendly features to meet Ontario’s future healthcare needs. But the design signature for West Park’s new hospital will be its success in bringing elements of nature indoors and extending the therapeutic environment to the outdoors, ultimately intersecting nature and healing, inside and out. Tasked with this challenge is EllisDon Infrastructure Healthcare, a consortium that includes EllisDon Design Build Inc., and lead architectural firms CannonDesign Ltd. and Montgomery Sisam Architects. Together with its partners, West Park will create a powerful new vision for healthcare architecture.
Evidenced-based planning drove the need for every patient to have a connection to nature. This starts in the patient rooms where views to the surrounding landscape, like the Humber River ravine, will be optimized with expansive, operable windows. This is especially important in supporting the therapeutic healing of patients who must remain in bed. The architectural plan will bring the outdoors closer to patients who are challenged to get outside on the ground floor, allowing them to connect to nature on every level. Each floor will be equipped with terraces large enough to support therapeutic rehabilitation, family gatherings or silent reflection. The terraces will also boast natural elements, such as flowers and greenery. Outdoor therapeutic spaces and views will be shared with other key indoor social spaces, such as dining rooms, cafeteria, activity rooms and outpatient rehabilitation gyms — all of which will be outfitted with large windows allowing for light-filled spaces and expansive views to motivate and inspire. The outdoor motif will also be reflected in the design and finishes of the interiors via motivational images and elements of nature.
emotional and spiritual aspects of healing within the architectural plan. Therapy courtyards will allow patients to have structured rehabilitation therapy outside. For example, patients re-learning to walk will be able to practice on steps, curbs and uneven surfaces, such as gravel, turf, rubberized pavement and wood chips. The therapy courtyards will also connect to walking trails enabling patients to wander supervised or unsupervised, giving them the opportunity to explore their personal connection to nature. The walking trails will have distance markers to encourage physical activity and socialization. Respiratory patients, especially, will be able to utilize the trails to strengthen and improve lung capacity in an environment that distracts them from pain and discomfort. The trail will also feature 10 self-directed exercise stations for use by West Park patients, staff and the community. In addition, sensory gardens will form an integral part of the rehabilitation process, particularly for seniors and neurological patients, as they can trigger patients’ memories and re-orient them to date, time and place. Other gardens include a recreational space to support gardening for patients, and two spiritual gardens to promote therapeutic outcomes for individuals and small groups.
DESIGN THAT CARES
Of course, the vision goes beyond the views. With more than 10,000 square feet of outdoor space, West Park will create an assortment of more than a dozen outdoor destinations that will integrate the physical, psychological, social,
Since West Park’s patients are not acute care patients but rather those living with complex and often debilitating medical conditions that can make them feel segregated from society, nature will be leveraged to promote their sense of
belonging to the neighborhood and community. The healthcare centre aims to break down the barriers both physically a n d e m o t i o n a l l y by s u p p o r t i n g community re-integration of its patients. The planned expansive west lawn, which will include the majority of outdoor spaces, will welcome the public into the grounds, providing social and engagement opportunities for people receiving care at West Park with those living in the area. Other unique elements include a planned labyrinth, tables for chess and other board games, shuffleboard and bocce courts, ping pong tables, basketball wall and a putting green, enabling patients to interact with these spaces on their own, with a therapist, other patients, visiting family or members of the local community. AN EYE ON VISION
Throughout the years, West Park has worked to create an oasis of care within Canada’s most populous city. The healthcare centre’s natural park-like setting and nurturing environment has enabled it to provide a bright world of restorative care to help patients achieve their highest potential. Its unique campus has a rich history that stretches back more than a century but it is the future that holds the most promise. West Park sees a time when nature plays a vital role in nurturing care. That vision will be fully realized when its new facility opens in 2023, and extensive landscaping is complete in 2024. Lijeanne Lee is the communications coordinator at West Park Healthcare Centre.
WINTER/HIVER 2018/2019 19
A SUSTAINABLE VISION FOR WELLNESS Selkirk Regional Health Centre doubles the size of former hospital, improving opportunities for holistic patient care By James G. Orlikow
ike any city that is reaching a higher level of livability, Selkirk, Man., has grown to need significant health services for the more than 100,000 people that call the region home. The new Selkirk Regional Health Centre (SRHC), an expanded replacement facility for the Interlake-Eastern Regional Health Authority’s obsolete 1970s hospital, is a two-storey, state-of-the-art, 184,000-square-foot healthcare hub that offers everything from dialysis, surgery, cancer care, MRI diagnostics and day hospital to outpatient programs. Strategically positioned on the edge of downtown, SRHC is one of the largest greenfield healthcare campuses in the province. It transforms 30 acres of vacant commercial lands into 15 acres of naturalized parklands, and five acres of xeriscaped plazas and courtyards. The landscape and building connect seamlessly through passive and active exterior spaces and public courtyards. SRHC features an interior contemplation courtyard, three accessible roof terraces, sun decks, an
20 CANADIAN HEALTHCARE FACILITIES
outdoor kitchen and a green roof overlooked by patient bedrooms. PLANNING FOR THE FUTURE
The initial aspirations that stakeholders held for SRHC were significant to achieving the future for healthcare in the Interlake region. Key project objectives included creating a centre that promotes well-being for patients, their families, staff and the community; providing a safe environment for all; designing a high performing, sustainable site and building; creating lean planning that optimizes the flow of people, information, materials and services; and working with the community to create a campus that responds to context, history and culture. The project objectives for the 65-bed health centre were then pursued through a rigorous, collaborative, integrated planning process. CULTIVATING A HEALING ENVIRONMENT
The design process commenced in 2007, with the evaluation of the site — how it could respond to the program, connect to
context and integrate environmental factors (wind, sun, water, soil, topography, vegetation and energy). The analysis was synthesized in the preliminary architectural planning concepts. At each subsequent stage, the design was evaluated for both mandatory and optional sustainable design features, concepts and systems. Leadership in Energy and Environmental Design (LEED) status reviews, in parallel with the site, and architectural, structural, mechanical and electrical design complied with the project’s objectives as a healing environment while reducing its environmental impact. Access to the outdoors was a design driver from the outset. The park-like site is planned with extensive native grasslands and more than 200 native trees. Three kilometres of accessible pathways connect SHRC to surrounding neighbourhoods, while the main entrance courts serve as community gathering spaces. Exposure to natural sunlight was another driver. Glazed curtain walls are located in all public areas, starting at the front entrance
Photos courtesy Gerry Kopelow Photography
and completely surrounding the interior contemplation courtyard, serving as a wayfinding amenity. The courtyard gives people a ‘sun-filled’ central reference point within the 90,000-square-foot floor area. Building forms and spaces ‘fitting in’ the regional context was important to the design, too. The interior architecture is shaped to reflect the history and geography of the Interlake region. This area is rich in aspen forests, inland lakes, grasslands and wetlands. The spirit of these environments is captured in the interior using (in excess of 10 per cent) locally quarried limestone, wood and natural materials that add warmth, texture and a sense of well-being to all spaces. The colours and finishes echo the water, sky and earth. Shades of aqua and warm terra cotta balance the golden buff stone of the walls and durable terrazzo floors. The first and last impression at every threshold is that this is much more than a hospital — it is a sustainable, holistic centre for wellness. Energy conservation was also key to the design. SRHC is a highly efficient building
with the largest horizontal loop geothermal system of any hospital in the province. Situated below the parking lots, the 550,000-square-foot ‘double decker’ geothermal field uses the earth’s energy to drive 16 heat pumps for 100 per cent of the cooling and 60 to 70 per cent of the heating required by the hospital. The electrical systems for SRHC are extensive and run over a dedicated medical IT network. The facility is designed for true redundancy, with emergency power generators that can run the entire facility. Efficient LED lighting ensures the health centre is accessible, bright, welcoming and sustainable. Exterior lighting minimizes light pollution; strategically locating fixtures with shielded luminaires reduces the impact on the nocturnal ecosystem. Other notable sustainable features include: a 43 per cent reduction in water use compared to the baseline hospital standard, which was achieved using low-flow technologies.; 44 per cent energy savings (compared to the 1997 Model National Energy Code for Buildings), achieved with a
high-performance envelope, ventilation air heat recovery, the geothermal system, variable speed drives on pumps and supply fans, efficient lighting and condensing boilers; a renewable energy certificate that offsets 100 per cent of the building’s regulated electricity; and exemplary indoor air quality, with no off-gassing from materials and a facility-wide scent-free policy. In pursuit of its project objectives, SRHC received LEED gold certification. Achieving this standard for a typology as programmatically and technically complex as a regional hospital speaks not only to vision and commitment, but also to the aspirations for quality and sustainability within the context of affordability that serves the Interlake region today, tomorrow and in future years and decades to come. James G. Orlikow was LM Architectural Group’s principal-in-charge and team leader responsible for the planning and design of the Selkirk Regional Health Centre project. He can be reached at 204-942-0681 or email@example.com. WINTER/HIVER 2018/2019 21
A HUB OF INNOVATION
Specialized centre for people with autism first of its kind in North America By Larry Adams & Dawn McKenna
ach year, Wood WORKS! BC honours excellence in wood building and design, and leadership and innovation in wood use at its Wood Design Awards event. In 2018, the Goodlife Fitness Family Autism Hub, commonly referred to as the Hub, was the victor in the western red cedar category for its outstanding architectural and structural achievement using wood. Noteworthy design elements include the exterior materials, which are primarily stained cedar siding and metal panels. The western red cedar is finished with a clear sealer to maintain the natural warmth of the wood and provide visual richness. Most of the exterior site structures are also clad in western red cedar. Beyond the expressed wood structure, 22 CANADIAN HEALTHCARE FACILITIES
interior finishes include linear wood ceilings, wood acoustic wall panels and extensive millwork. These are all designed and detailed to create a modern expressive architecture and nurturing place for people living with autism spectrum disorder (ASD). Opened in late 2016, the groundbreaking, 58,000-square-foot provincial knowledge centre incorporates state-of-the-art resources for research, information dissemination and learning opportunities, as well as assessment, treatment and support for the lifespan needs of individuals and their families living with ASD in British Columbia. ASD is a complex condition that impacts brain development and affects a person’s social relationships, com-
munication, interests and behaviour. It’s estimated that 69,000 people are living with ASD in the province. When the Pacific Autism Family Network embarked on the project, the primary goal was to develop a nurturing, supportive and sustainable environment for the physical and emotional well-being of the building’s occupants. While there were few precedents and very little research on the effects of the built environment on people living with ASD, early design research and consultation with autism experts stressed that the building should be warm, approachable and inviting. The need to reduce overstimulation was a constant theme in the existing literature and research.
â€œPROGRAM SPACES FREQUENTED BY CHILDREN (WITH AUTISM SPECTRUM DISORDER) AND THEIR FAMILIES RECEIVED CAREFUL ATTENTION TO ENSURE COMFORT AND ASSIST WITH POSITIVE BEHAVIOURAL REINFORCEMENT.â€?
Upon walking into the Hub, located in Richmond, B.C., patrons immediately feel welcome and at ease. The design of the modern, bright building, with its wide spaces, soothing colours and comfortable furniture that often faces the outdoors, allows individuals to immediately settle themselves. The post and beam structure allowed the interior layout to be clear and simple, providing ease of identification, location and direction. The acoustic design minimizes external noises from the nearby airport and busy street, making the interior quiet and peaceful.
Private and semi-private calm rooms can be found on the first and second floors of the three-storey building. Designed with flexibility in mind, these spaces can be adapted to suit the sensory needs of a range of occupants. Program spaces frequented by children and their families received careful attention to ensure comfort and assist with positive behavioural reinforcement. Most areas have access to daylight and outdoor views, reducing the need for artificial light and assisting with orientation. Major activity spaces
within the building are oriented toward outdoor spaces. There are areas that encourage play and creativity with toys, with millwork storage and built-in furniture that is comfortable, enveloping (for sensory calming) and have soft or rounded corners for safety. Playful elements of colour and texture animate these spaces. All materials for the project were selected based on their durability, functionality, aesthetics and low environmental footprint with a high-priority placed on materials containing recycled content and sourced locally. Larry Adams is a principal at Vancouverbased NSDA Architects. A critical aspect of his work is his commitment to designing projects that reflect both the client's goals and the objectives, needs and values of the community. Dawn McKenna is executive director of the Pacific Autism Family Network. Her leadership and expertise will build on the innovative vision and mandate of the Goodlife Fitness Family Autism Hub.
WINTER/HIVER 2018/2019 23
THE READY FOR ANYTHING NETWORK Improving healthcare facility responsiveness with passive optical LAN By Phillip Gardner
he d e s i g n o f n e t wo rk s fo r healthcare facilities has a direct impact on the reliability of mission-critical services and the quality of care provided. At best, when the network goes down, well-prepared teams can implement contingency plans and carry on. At worst, teams are unable to function without the tools and information they need, resulting in potentially serious consequences. For most hospitals, the network is so important that the loss of communications alone is an emergency that can cripple facilities’ effectiveness. Fortunately, new technologies are delivering on the promise of high-security, high-performance networks that are simpler to manage, and more reliable and secure to use. These networks are also less expensive, take up less space, use less power and have a longer lifespan, thereby producing less e-waste. 24 CANADIAN HEALTHCARE FACILITIES
In a healthcare facility, the most important network is the local area network (LAN). There are other networks for specialized tasks but the LAN is where most of the real healthcare work happens and dependence on the LAN is dramatically increasing. Until recently, buildings had separate networks for each service provided (computer data, voice, video, security, building controls and so on). Advancements in technology have enabled the convergence of these separate services onto the computer’s active Ethernet network, the original LAN. Driven by economics and enabled by technology, healthcare facilities are relentlessly adding more and more services and functions to the existing LAN. However, today’s copper-based active Ethernet LAN, built with copper cabling and Ethernet switches, is not well-suited to increasing complexity. The problem
lies in the fundamental nature of a network with distributed switching. An Ethernet switch is a device with a lot of processing ability, its own software, memory, provisioning and administrative functions. A small network can be built with just one switch. As switches are added and connected together to grow the network, there comes a point where switches must be connected to switches just to connect to other switches. In a medium to large network, this results in several layers of aggregation switches. As the network gets larger, it becomes more complex and difficult to manage resulting in less reliability and the potential for failure, security breach or human error. This can be addressed somewhat by adding redundancy but it also increases complexity and potential for problems leading to diminishing return on investment. What’s more, the active Ethernet LAN upgrade plan is to replace
SECURITY & LIFE SAFETY everything every three to five years. Tossing out 100 per cent of the previous investment creates a huge negative environmental impact that could be avoided with better planning and a different design. Passive optical networking (PON) is a relatively new technology that enables a fibrebased optical LAN to address the complexity and reliability issues faced by the active Ethernet LAN. A single optical line terminal (OLT) is at the core of the optical LAN. The OLT is made up of a redundant set of high-capacity, high-performance switches with optical interfaces. The optical signals are transmitted via single mode fibre up to 30 kilometres. Along the way, passive optical splitters are used to split the signal to numerous optical networking terminals (ONTs), typically 64 per optical port. The ONTs are relatively simple, low power devices that take their instructions from the OLT. They don’t have their own software, administrative login or user information. They consume much less power than an Ethernet switch, so they can be installed without cooling in ceiling or wall boxes, in single gang wall boxes, under desks, outside or mounted anywhere con-
venient. ONTs support all the features of an Ethernet switch, including PoE+. The basic idea is to build a network with electronic devices, OLTs and ONTs only at the edges, with all passive components in the middle for distribution and aggregation. There is now the installation flexibility to build a network that requires zero building floor space. The OLT provides a single point of control with ports on ONTs distributed across the network. Logically, the entire system is a single network. Provisioning is centralized and automated using templates and profiles to minimize human error and enable simplified computing of complex services. Even greater reliability is achieved by deploying OLTs as redundant nodes. One or both OLTs could even be located off-site at secure locations. The entire optical LAN is managed as one device with a single software licence, a single database to backup/recover and a unified security and management plan. OLTs come in different shapes and sizes with the largest supporting more than 28,000 Ethernet ports. This allows a
single optical LAN to support an entire campus or multiple facilities across a city without any additional networking equipment. Optical LAN has been built specifically to support multiple PON standards and advanced networking technologies like software-defined networking. This forward-thinking design enables the incremental addition of new capabilities without replacing the installed equipment, which gives optical LAN a lifespan measured in decades, eliminating huge amounts of e-waste when compared to active Ethernet over the same time period. Phillip Gardner is a sales agent at Tellabs, a global network technology provider. He has been helping governments, service providers and major enterprises build mission-critical networks for more than 30 years. Today, with Tellabs, Phillip is focused on using passive optical networking (PON) technologies to increase reliability and security, while reducing the environmental and economic cost of networks. He can be reached at firstname.lastname@example.org.
• 200,000 people in Canada get an infection from a hospital each year • 5% (10,000) will die • Healthcare acquired infections cost us $4-5 billion EACH year Join the Coalition for Healthcare Acquired Infection Reduction (CHAIR)
www.chaircanada.org WINTER/HIVER 2018/2019 25
SECURITY & LIFE SAFETY
SAFETY MATTERS Personal protective equipment for working with asbestos By Martin Kun
orking in the presence of hazards always calls for personal protective equipment (PPE) specific to
the task. When it comes to asbestos testing and abatement, and when this hazard is located in close proximity to electrical cables, workers need to take precautions that protect them from both the harmful health effects of this fibrous material as well as the potential risks of working in an electrically charged environment. It is imperative that they are provided with the right type of PPE and they understand the proper care and maintenance of the equipment to ensure their safety. To determine the right PPE for working in the presence of hazards, there are three main areas of consideration: protective suits, protection ratings and flame-resistant protective garments. There are three primary types of protective suits. Selection will depend on the level of protection required, combined with known hazard and exposure levels. Category 1 suits cover non-hazardous liquids and particulate, providing protection from dust and splashes. Category 2 suits provide protection from hazardous particulate and light chemical splashes. Category 3 suits provide protection from chemical, biological and thermal hazards. Once the level of protection needed is determined, the next step is to consider the type of work and application of the protective garments. There are a variety of brands that offer different materials, stitching and sealing methods. There are also many different fabric technologies that provide different levels of protection. High density polyethylene, used in some products, provides inherent protection and durability with no fillers or thin films that could wear away. This option is ideal in environments where workers come into contact with equipment, as the suit is more likely to withstand everyday wear and tear. Spunbond-meltblown-spunbond, commonly known as SMS, provides two 26 CANADIAN HEALTHCARE FACILITIES
The Tychem 2000 SFR series provides the required protection for working with asbestos and has the added protection of secondary flame resistance.
spunbond layers with a middle meltblown layer that offers strength. This fabric is less prone to tearing and filters fine particulates. Microporous films, which are made up of laminate fabric with thin microporous film and non-woven spunbonded polypropylene, provide more limited durability and protection and are best used in situations where work requires minimal movement or there is little risk of abrasions or cuts to the material. When working with asbestos in an energized electrical environment, select a suit that provides protection from chemical, biological and thermal hazards (Category 3). It’s important to follow the manufacturer’s recommended procedures for sealing around the face mask respirator, boots and gloves. In addition to ensuring the material choice can withstand abrasions or cuts to protect workers from asbestos, another key consideration is flame-resistant protection. This is especially important when there are live electrical lines involved, so materials with the added protection of secondary flame resistance should be considered. Keep in mind, flame-resistant garments can behave differently in flash or arc flash scenarios. Some will self-extinguish, while others will melt and continue to burn. There
are lightweight, disposable overgarments designed to help protect and preserve primary flame-resistant garments. The material is treated to provide fire retardancy and liquid repellant characteristics. The fabric will not ignite or continue to burn after a flame source is removed. Applications for use include maintenance work, welding, steel mills, laboratories, utilities and hazardous maintenance operations. When working with asbestos in electrically charged environments, select a protective suit that provides a primary chemical-resistant barrier to protect against environmental hazards and one that offers secondary flame-resistant performance in flame/fire exposure. Other features that are beneficial are a respirator fit hood, chin flap with double-sided adhesive tape, single-flap closure over zipper with double-sided adhesive tape and taped seams to ensure maximum protection. Martin Kun is a sales specialist with AcklandsGrainger, Canada’s largest distributor of industrial supplies. The company offers the broadest selection of in-stock, brand-name products from the world’s top manufacturers and serves customers from a Canada-wide distribution network.
2019 WEBINAR SERIES Time: 0900 BC/1000 AB & SK*/1100 MB/1200 ON & QC/1300 NS & NB/1330 NL One hour in length *SK â€“ 1000 during Daylight Savings time; otherwise 1100 Wednesday January 16, 2019 High Performance Building Envelope in Hospitals Speaker: Steven Tratt, BPI, Construction Management degree from NAIT Wednesday February 21, 2019 CHU in QC - A Case Study of their Journey Speaker: Servanne Fowlds, MBA, LEED AP Wednesday March 13, 2019 Refrigerant Update: The New Transition has Begun Speaker: Mike Thompson, P. Eng Wednesday April 17, 2019 Simple and Permanent Reduction in Steam Line Losses Speakers: Guy Bonneau, B.A. Sc. Elec. Eng. Rob Triebe, N.A. Sc. Chem. Eng. Wednesday May 15, 2019 Infection Prevention and Control During Construction Training Speakers: Michael Houston, CCLP, C Log Craig Doerksen, MFM, P.Eng, CCHFM, CEM, CFM Wednesday June 12, 2019 NAPRA Compliant Pharmacy Cleanrooms Speaker: Jeff Mumford P. Eng. Wednesday October 16, 2019 New CSA Z8000: Designing for Improved Patient Outcomes Speakers: Michael Keen, P. Eng., MBA Gordon Burrill, P.Eng, CCHFM, FASHE, CHFM, CHC Wednesday November 13, 2019 Pros & Cons of Different Construction Procurement Models Speaker: TBD
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THIS IS NOT A TEST Mass notification systems designed to alert, protect and inform people when disaster strikes By Andrew Dodsworth
oday’s healthcare facility professionals are not only concerned with providing high-quality health services to patients but also ensuring a safe and secure environment for staff, visitors and the public at large. From catastrophic natural disasters, such as earthquakes, flooding and forest fires, to domestic terrorism, the complexity and diversity of present day threats has heightened the need for mass notification systems (MNS) to effectively communicate what to do in an emergency. Also known as emergency communication systems, MNS are designed to protect, alert and inform an organization’s most critical resources — its employees — by providing the right message to the right people at the right time. Distributing concise, accurate and well-directed voice, audible and/or visual instructions that communicate how to 28 CANADIAN HEALTHCARE FACILITIES
respond to an emergency inside and/or outside a facility is critical to mitigating the effects of a disaster. Emergencies include terrorist activities, hazardous chemical releases, severe weather, fire, Amber alert and other situations that may endanger the safety of building occupants. SETTING THE STANDARD
Man-made or natural, the magnitude of today’s threats has influenced Canadian gover ning agencies, inter national councils and other organizations to create regulatory codes for MNS. Although the National Building Code of Canada (NBC) does not include requirements for MNS just yet, the Underwriters Laboratories of Canada (ULC) has released CAN/ULC-S576, Standard for Mass Notification System Equipment and Accessories.
On the global front, the International Fire Code (IFC) and International Building Code (IBC) require voice communications in K-12 buildings, assembly occupancies of more than 1,000 people and highrise buildings. Recently, the IFC and IBC added the requirement that risk assessments be conducted for certain occupancies to determine if a MNS is required. Other sectors, such as military and higher education, have also established codes for MNS. A LESSON IN LAYERS
Key technology trends that are critical to the design and implementation of effective MNS are redundancy, interoperability and intelligibility. There are four MNS layers that can be deployed to provide a robust and redundant solution, as outlined in CAN/ULCS576. Layer one involves notifying
EMERGENCY PREPAREDNESS & RESPONSE
RELYING ON JUST ONE LAYER IN AN EMERGENCY COULD RESULT IN A RELATIVELY LARGE PORTION OF THE TARGETED POPULATION NOT RECEIVING THE MESSAGE. people inside a building through an emergency voice/alarm communications system, fire alarm speakers and visible notification equipment. In layer two, wide area MNS (high power speaker arrays) provide communications to occupants outside the building. With layer three, distributed recipient MNS alerts personnel through individual measures like text messaging, automated voice calls, computer pop-ups and e-mails. Finally, layer four notifies personnel through public means, such as broadcast, radio, television and social networks. Relying on just one layer in an emergency could result in a relatively large portion of the targeted population not receiving the message. The overall solution is to deploy the first method with one or more layers to produce a reliable and robust design. Interoperability is also important to system design. Integrating MNS with other building systems improves emergency response time and increases situational awareness. With limited staff and multiple systems to launch, organizations need an integrated MNS with a simplified, single interface to launch all the different applications. This ease-of-use allows healthcare facility managers and emergency response personnel to focus on the emergency at hand without being slowed down trying to activate numerous systems.
Due to today’s sophisticated threats, there has been an increasing trend for MNS to provide clear, concise and intelligible voice messages that communicate specific actions to be taken in an emergency (for example, building lockdown or evacuation), which is not the case with a tone only system. But what about a public address (PA) system? While a PA system can serve a healthcare facility well, key performance requirements (outlined in the CAN/ ULC-S576 standard) ensure MNS work in an actual emergency. Some performance requirements include system supervision and monitoring, survivability of the system, minimum power supply and battery life, security and data protection, and system redundancy. MNS also use speakers that meet CAN/ ULC-S525, Standard for Audible Signaling Devices for Fire Alarm and Signaling Systems, Including Accessories, and visual signal devices that meet CAN/ ULC-S541. Additionally, one MNS can interface with another, like an outdoor wide area MNS, or other building systems, such as HVAC and access control systems. GETTING STARTED
To determine which MNS best fits the needs of a healthcare organization, a
detailed risk assessment or vulnerability analysis should be completed of each location. This provides healthcare administrators with an overview of the organization’s current situation and allows them to develop a master plan to address the needs of each facility. The risk analysis also helps determine the layer or layers of MNS needed to meet the organization’s emergency communication objectives. Once the layers are determined, it is essential to conduct an audit of existing life safety and communication systems to determine if any can be leveraged. For example, a building’s fire alarm system may be upgraded to a voice evacuation system by integrating an in-building MNS and adding fire alarm speakers. Organizations can build their MNS one layer at a time, depending on budget, starting with an in-building emergency communications system or an outdoor giant voice speaker system, adding and integrating the different layers as funds become available. Andrew Dodsworth is the engineering and sales leader at Eaton. From the battlefield to college campuses, Eaton’s mass notification solutions Biomedical_CHF_Winter_2017_FINAL.pdf 1 are helping emergency managers around the globe deliver critical alerts when it matters most. Andrew can be reached at 403-808-1174 or email@example.com.
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EMERGENCY PREPAREDNESS & RESPONSE
EDMONTON’S DARK DAY Wildfire smoke clouds Alberta’s capital triggering carbon monoxide, dioxide alarms and putting medical air at risk By Alex Sagatov & Sheldon Ferguson
ugust is an excellent time to explore Edmonton, where the average daytime high temperature is 23 C and sunshine is often abundant. However, on Aug. 17, 2018, the city grew dark and not from an impending rainstorm. The culprit was smoke blown in from wildfires raging in British Columbia, resulting in a very poor air quality rating for Alberta’s capital. In fact, among the thousands of urban areas (with populations of more than 250,000 people) in 85 countries around the world, Edmonton had the worst air quality, beating out cities in India, China and the Middle East, which usually top the list. When outdoor air is bad, health a u t h o r i t i e s re c o m m e n d l i m i t i n g exposure. High levels of fine particulate matter (PM 2.5) and gaseous pollutants can be har mful to people when breathed in, especially if suffering from a respiratory disease. Most Canadian hospitals use external ambient air to make medical air on-site to treat patients. CSA compliant and well-maintained medical air systems do a great job of filtering fine particles. However, they do little to remove or even monitor gaseous chemical contaminants associated with smoke, namely carbon monoxide and carbon dioxide. So, what happened with carbon monoxide and carbon dioxide in medical air during the week long stretch of bad quality air in Edmonton? At least one healthcare facility reported multiple carbon monoxide alarms, which occurs when the carbon monoxide level is greater than the USP limit of 10 parts per million (ppm). After reaching levels of 16 ppm, the facility suspended production of medical air and used medical oxygen as an alternative in order to protect patients. 30 CANADIAN HEALTHCARE FACILITIES
Beautiful summer days are aplenty in Edmonton, but on Aug. 17, 2018, the city woke up to a cloak of smoke caused by wildfires raging in B.C.
At another site, the hospital’s Patient Protect Purge Control (P3C) dryer system worked overtime to prevent excessive levels of carbon dioxide from being delivered to patients. The dryer was developed in Canada specifically to address the carbon dioxide catch and release effect common to all desiccant air dryers. In addition to forcing a tower purge on measured humidity, the dryer measures carbon dioxide and forces a purge before it surpasses the USP formula limit of 500 ppm. But what about the main active ingredient in medical air, oxygen? Could the sudden release of carbon dioxide impact oxygen content at bedside by displacing it from the air? Theoretically, this is quite possible. Typical desiccants used in medical air dryers could potentially capture and release up to 28.5 litres of carbon dioxide per kilogram (kg). So, a dryer containing 8 kg of desiccant (typical for a large hospital) could produce a carbon dioxide bolus that lasts 45.6 seconds at five litres per minute patient flow. What does this mean for facility managers? It’s recommended to include on-site production of medical air within the hospital’s code grey (air exclusion code in Alberta) preparedness plan.
To ensure accuracy, medical air system chemical sensors (such as carbon monoxide) should be calibrated after every alarm or prolonged exposure to the element they measure. A procedure should be in place to restart the medical air system after a quality related shutdown. It should include means to ensure that quality condition has normalized. Facility managers should consider installing/calibrating oxygen monitors on equipment that uses wall medical air, such as neonatal intensive care unit incubators. Finally, a medical air quality risk analysis, as required by CSA standard Z7396.1-2017, should be completed. Facility managers should then decide what, if any, additional quality control measures are needed, such as a realtime medical air quality control system or P3C dryer. Alex Sagatov is sales director of medical gases, Western Canada, at Air Liquide Healthcare. Sheldon Ferguson is the company’s technical sales representative in Alberta and Saskatchewan. They can be reached at email@example.com and firstname.lastname@example.org, respectively.
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