Canadian Healthcare Facilities * Winter 2019/20

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Volume 40 Issue 1

Winter/Hiver 2019/2020

A NEW PHASE PM#40063056

SickKids' Patient Support Centre to set precedent for healthcare workplace design Video surveillance solutions Equal access to quality care Tools for on-the-job violence

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Issue 1




Kevin Brown


Annette Carlucci




6 8

22 Seeing is Believing Network cameras take video surveillance to next level

Editor’s Note President’s Message



10 Chapter Reports 12 Announcements

24 Do No Harm De-escalation training stops trouble before it starts

Canadian Healthcare Engineering Society


Société canadienne d'ingénierie des services de santé


HEALTHCARE DEVELOPMENT 14 A New Horizon SickKids takes holistic approach to healthcare workplace design 18 Dare to Dream Saskatchewan welcomes new era of care for moms, kids

25 Breaking the Silence Southwestern Ontario hospital leads the way in workplace violence prevention

HEALTH & SAFETY 26 A Study in Confidence Researchers question reliability of surface ATP tests to achieve optimal cleaning effectiveness 28 A Dirty Secret Government agency cannot guarantee efficacy of registered disinfectants

REGULATORY UPDATE 29 Overcoming Barriers New legislation renews impetus to improve healthcare access for people with disabilities


Roger Holliss Craig Doerksen Preston Kostura Kate Butler Reynold Peters 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: Norbert Fisher FOUNDING MEMBERS

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

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

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THIS ONE’S FOR THE KIDS SINCE HAVING CHILDREN, I’ve become well-acquainted with the hospital ER. Two trips involved stitches/staples and one was for a misdiagnosed case of necrotizing fasciitis. (Can you say, scary?). However, most were to treat high fevers and other minor ailments. Regardless of severity of illness, I always felt at ease entering the doors of the Hospital for Sick Children (SickKids), likely given its esteemed reputation as one of the top healthcare institutions globally. This past fall marked a momentous occasion for the Toronto hospital. After eight months of demolition, SickKids broke ground on its new Patient Support Centre — a 22-storey education, training and administrative hub that’s expected to be complete in 2022. The building is the first of three phases in SickKids’ campus redevelopment, known as Project Horizon, and one of two children’s hospitals featured in this issue. The other is located in Saskatchewan’s largest city, Saskatoon. Jim Pattison Children’s Hospital opened its doors to the public in late September — a dream almost two decades in the making. The 176-bed building was designed in consultation with families to provide state-of-the-art maternal and pediatric care in the province. We then turn to security matters, specifically the benefits of network cameras and measures hospital staff can take to minimize violence in the workplace, as demonstrated by Runnymede Healthcare Centre in Toronto, and Hôtel-Dieu Grace Healthcare in Windsor, Ont. Rounding out this issue, we explore the reliability of ATP testing, the efficacy of registered disinfectants and whether the new Accessible Canada Act will actually improve access to healthcare for people with disabilities. Clare Tattersall

Reproduction or adoption of articles appearing in Canadian Healthcare Facilities is authorized subject to acknowledgement of the source. Opinions expressed in articles are those of the authors and are not necessarily those of the Canadian Healthcare Engineering Society. For information or permission to quote, reprint or translate articles contained in this publication, please write or contact the editor. Canadian Healthcare Facilities Magazine Rate Extra Copies (members only) 25 per issue Canadian Healthcare Facilities (non members) 30 per issue Canadian Healthcare Facilities (non members) 80 for 4 issues A subscription to Canadian Healthcare Facilities is included in yearly CHES membership fees.


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


SAVE THE DATE! The 2020 CHES National Conference will be held in Halifax, Nova Scotia, at the Halifax Convention Centre, September 20-22, 2020. The Halifax Convention Centre is conveniently located in the downtown core and close to local amenities. A block of rooms has been reserved at both the Cambridge Suite Hotel, starting at $199 plus applicable taxes for single/double occupancy, and the Prince George Hotel, starting at $239 plus applicable taxes for single/double occupancy. The theme of the 2020 conference is “Enriching Patient Experiences by Optimizing the Environment” The 2020 CHES Education Program is well underway and will once again feature dual tracks with talks on relevant industry topics from high-profile experts in the field. We have booked Alan Mallory as our Keynote Speaker. Alan is a dynamic keynote whose talk 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. Alan will discuss focusing on results rather than tasks, being agile so we can adapt to change, overcoming adversity through resilience, building trust in professional relationships and adopting an iterative approach. The Great CHES Golf Tournament will be held at Glen Arbor Golf Course on Sunday, September 20, 2020. Join us for the CHES President’s Reception and Gala Banquet at Pier 21. The banquet will celebrate the accomplishments of our peers with the 2020 Awards presentations, while enjoying great food and entertainment with friends.

See you in 2020 in Halifax! For more info visit our website at Follow us on Twitter!



OVER THE HORIZON NOW THAT I’M A grizzled CHES president veteran of four months, I often find myself thinking about what awaits our organization in 2020. My awkwardness of being the CHES National ‘rookie’ is slowly giving way to the anticipation of completing initiatives currently underway and new ones yet to be started. Among the 2020 highlights is our national conference in Halifax. Robert Barss’s conference planning team is well on its way to pulling off another great event. The companion program includes a cruise on the Bluenose II, a replica of the original Bluenose schooner that raced undefeated in international competition for 17 years, beginning in 1921. Be sure to mark the conference dates, Sept. 20-22, on your calendar. On the education front, 2020 has a full slate of offerings for members. CHES’s webinar series will again cover a broad range of topics, from smoke control systems to isolation room design. Webinars are probably one of the easiest, most concise ways to bring everyone up to speed on what’s happening in the industry without leaving your healthcare facility. CHES’s newest offering will be the overdue updated medical gas training sessions, co-developed with the CSA Group. Both the revamped introductory online course and the brand new ‘qualified operator’s’ course are due to be released in 2020. Jim McArthur and his international conference planning team continue to flesh out details of the 2022 International Federation of Healthcare Engineering (IFHE) Congress. I will be travelling with Jim and Steve Rees to Rome in May, to promote the event at the 2020 IFHE Congress. Even at this relatively early stage, the 2022 IFHE conference planning committee has generated buzz. In November, CHES was recognized at the Leaders Circle gala in Toronto, for its bid win to host the 2022 IFHE Congress. Toronto Tourism made a short video about this, which aired at the gala. Even today, when watching it, I feel great pride about what we’re doing. Even though we’ve always had a formal working agreement with the Canadian College of Health Leaders (CCHL), with the current contract due to expire, we are looking to develop a more impactful, symbiotic relationship between CCHL and CHES. I recently met with CCHL’s president and we both agreed that our associations can better help each other to further the common goal of improving healthcare in Canada. 2020 is going to be an exciting year. I look forward to seeing and experiencing everything it has to offer. Roger Holliss CHES National president

EARN CONTINUING EDUCATION CREDITS FROM CHES Members of the Canadian Healthcare Engineering Society can earn free continuing education units (CEU) by reading the Winter 2019/2020 issue of Canadian Healthcare Facilities and passing a quiz based on articles in the issue. Once you’ve read the issue from cover to cover, simply go online to to take the quiz. CHES members who pass the quiz will be able to claim one contact hour (0.1 CEU) on their CanHCC or CCHFM certificate renewals.


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As 2019 drew to a close, I found myself leaping months ahead into 2020. Are there going to be challenges? Yes, of course. There will be budgets to meet, political influence, natural threats like flooding and fires, the work-life balance struggle and for some of us, the added responsibility of volunteering for CHES. The key is to persevere. I can write with confidence that the chapter executive is committed to promoting CHES province-wide. We recently added two new members to the executive team: Daniel Parsons (vice-chair) and Sandra Evans (secretary). CHES Newfoundland and Labrador is sitting in a solid financial position. We will continue to sponsor and support members’ travel and accommodations to attend the chapter’s spring professional development day. The executive team is discussing what we can offer membership in terms of sponsorship for local conferences and the 2020 CHES National Conference in Halifax. We will work harder to promote educational opportunities and partner with local bodies to spread CHES news. As we get deeper into winter, I’d like to remind everyone to think about contingency plans for power outages, extremely cold temperatures and heavy snowfalls. —Colin Marsh, Newfoundland & Labrador chapter chair

The cold winter weather has arrived; however, that hasn’t dampened spirits. The Quebec chapter executive team is gearing up for a number of 2020 activities. We are focused on offering informative sessions for healthcare facilities users and increasing membership. 2019 was a busy year with many planned conference-dinners where the daily operations of healthcare facilities were discussed. The last event took place in November, and was a success. Many engineers, consultants and suppliers attended. There were heated discussions about the new CSA standard for medical gas pipeline systems. CHES, through its Quebec chapter, offers the best forum for such dialogue. I attended the 2019 CHES National Conference in Saskatoon, Sept. 22-24. It was a great opportunity to become more involved in CHES. It also exposed me to new ideas that can help further develop the Quebec chapter. We hope to have a big leap in the coming year. —Mohamed Merheb, Quebec chapter president

ONTARIO CHAPTER The Canadian Healthcare Construction Course (CanHCC) hosted by Trane in Markham, Oct. 31Nov. 1, was well attended with 30 registrants, as was our chapter education day Nov. 6, in Cambridge, which drew 34 attendees. The one-day event also provided the opportunity for the chapter executive to meet face-to-face following the education sessions. On Nov. 7, Roger Holliss, John Marshman and I attended the Leaders Circle gala in Toronto, where CHES was recognized for its bid win to host the 2022 International Federation of Healthcare Engineering (IFHE) Congress. Many CHES members from across the country are now involved in planning this event. The chapter’s past chair Roger Holliss and current vice-chair John Marshman were session presenters at The Buildings Show Dec. 4-6, in Toronto. During the session, Unique Facets of Construction and Renovation in Healthcare, Roger and John covered the elements and considerations that can increase the ability to be successful in this area of construction. Beginning in 2020, the Ontario chapter will recognize the long-term dedication of past education chair Rick Anderson by naming the family bursary in his honour. The award will now be known as the Rick Anderson Family Bursary. Rick has been invited to our next chapter conference to make the initial presentation under his name. Ron Durocher and the conference planning committee are well on their way to organizing CHES Ontario’s 2020 conference, which will take place May 31-June 2, in Windsor. —Jim McArthur, Ontario chapter chair 10 CANADIAN HEALTHCARE FACILITIES

CHAPITRE DU QUEBEC L'hiver est arrivé avec son temps froid. Toutefois, l'exécutif de la section du Québec ne fait que commencer à se préparer pour les activités à venir de l’année 2020. Nous avons terminé l’année en cours avec de nombreux dîners-conférences portant sur des sujets importants des activités quotidiennes des établissements de santé. Le dernier événement a eu lieu en novembre 2019 et ce fut un succès. De nombreux ingénieurs, consultants et fournisseurs étaient présents et des discussions animées ont eu lieu au sujet de l'application du nouvel norme CSA des gaz médicaux au Québec. La SCISS à travers son chapitre au Québec est le meilleur forum pour un tel dialogue. On parle de plus en plus de la société et nous espérons faire un grand saut l’année prochaine. J'ai eu la chance de participer à la conférence nationale à Saskatoon, et ce fut une excellente occasion pour nous et une inspiration pour plus d'activités à venir. Nous sommes en train de planifier notre prochaine année avec un focus particulier sur l'augmentation du nombre de membres et la proposition des conférences dédiés aux utilisateurs des établissements de santé. —Mohamed Merheb, président du chapitre du Québec

SASK ATCHEWAN CHAPTER The Saskatchewan chapter was proud to host the 2019 CHES National Conference Sept. 22-24, at TCU Place in Saskatoon. I’d like to thank everyone who volunteered to make the conference a success, particularly Steve Kemp, Jim Allen and Carol Cole. Plans are underway for the 2020 chapter conference. It will be held Oct. 19-20, at the Delta Hotel in Regina. The event features two days of speakers and a one-day trade show (Oct. 19). More details to come. —Greg Woitas, Saskatchewan chapter chair




Planning for the Alberta chapter’s spring conference is well underway. Geri Sklenar is the conference planning chair. Geri brings a wealth of enthusiasm and new ideas to the committee. I’m looking forward to attending the event May 11-12. I wish I had the opportunity to go to all CHES chapter conferences but time will not permit. I am, however, able to attend the Ontario chapter’s conference in Windsor, May 31June 2, which also gives me a chance to visit home. I will be going to the 2020 CHES National Conference in Halifax, too. It will be my first visit to Canada’s east coast. Currently, the main focus at Alberta Health Services (AHS) is Connect Care. The new electronic health system will give healthcare providers at AHS and its partners a central access point for more complete, up-to-date patient information and best practices. Patients will have better access to their own information and it will be easier for healthcare providers to communicate with patients and each other. Several acute care sites in Edmonton are currently being rolled out and are online. Other parts of the province are still seeing construction activities to support a variety of wireless devices, printers, barcode readers, workstations on wheels and desktop workstations that will be linked through one common database. I finally got a chance to attend the Canadian Healthcare Construction Course (CanHCC) in October, in Calgary. A big thank you to CanHCC faculty Gordon Burrill, George Pankiw and Jeff Smith, who shared a wealth of information. I was pleased to see the course was attended by a number of general contractors and consultants from the Calgary area. This shows a dedication to learning the special considerations of healthcare construction. —Dan Ballantine, Alberta chapter chair

I would like to congratulate the Saskatchewan chapter on a great national conference in Saskatoon. Thank you to conference planning co-chairs Jim Allen and Steve Kemp, and the entire committee for all your hard work. The chapter executive continues to support college bursaries and members with education grants. We had the opportunity to sponsor the delegate gifts for the 2019 CHES National Conference. Planning for the B.C. chapter’s spring conference is well underway. It will be held June 7-9, at the Delta Whistler. The theme is, The Physical Environment: Creating Patient Focused Facilities. The deadline for education abstracts was Dec. 20. The chapter will host the Canadian Healthcare Construction Course (CanHCC) following the conference June 10-11, at the Delta Whistler. 2020 is an election year. The first call for nominations has been posted. Positions up for election include vice-chair, treasurer and secretary. —Norbert Fisher, British Columbia chapter chair

The Maritime chapter’s fall education day was a great success with approximately 80 attendees. Held Nov. 19, in Truro, N.S., at the Best Western Glengarry, education session topics included: supporting patient well-being and hospital staff efficiency through electrical systems; effective installation of pre-fabricated containment systems and key elements/components; water remediation; preventive maintenance of life safety and isolation rooms; and roof, HVAC and fire systems maintenance. I’d like to extend a special thank you to the sponsors that supported this event. Planning is well underway for the 2020 CHES National Conference. It will be held Sept. 20-22, at the Halifax Conference Centre. The theme is, Enriching Patient Experiences by Optimizing the Environment. The call for abstracts is now closed. Delegate registration is open and can be accessed on the CHES website. The chapter is able to balance its books while offering several financial incentives to its members in the way of student bursaries, contributions to Canadian Certified Healthcare Facility Manager (CCHFM) exam fees, webinars, the fall education day and other rebates. —Helen Comeau, Maritime chapter chair

CHES Manitoba’s spring conference and trade show will be held April 20-21. The two-day event will include a banquet with entertainment. The theme is, Construction and Renovations in Healthcare Facilities. Dr. David G. Barber is our keynote speaker, presenting on climate change in the Arctic and its effect on lower latitudes. The chapter has introduced two new annual awards that recognize excellence in facilities management and project management, respectively, by regular CHES Manitoba members. Terms of reference were recently circulated. Nominations for the 2020 awards are to be submitted by March 1. The awards will be presented at the spring conference banquet April 20. 2020 is an election year for the CHES Manitoba executive. Call for nominations went out in December. The chapter is planning student events in cooperation with Red River College, which is home to the province’s most comprehensive skilled trades and technology programs. This includes a new student award, and a presentation on trades and technologies careers in healthcare at the college. —Tom Still, Manitoba chapter chair




The 2020 CHES National Conference will be held Sept. 20-22, in Halifax. WINTER/HIVER 2019/2020 11


REFLECTING BACK, LOOKING FORWARD ON CHES’S 40TH ANNIVERSARY AT A 1978 MEETING OF THE International Federation of Hospital Engineering in Lisbon, a seed was planted to start a Canadian engineering society. In spring 1980, two Ottawa engineers and two consulting engineers met to discuss the need for national representation for those involved in hospital engineering, as well as the structure and objectives of such an organization. Over the course of seven subsequent meetings, the group expanded to include four more for a total of eight who established the Canadian Healthcare Engineering Society (CHES). On Oct. 21, CHES was officially incorporated. The first national organizing committee convened in Ottawa, in January 1981, with representation from all 10 provinces. Three months later, on April 13, the inaugural CHES National executive committee was elected by acclamation: Harry Callan (president), Steve Morawski (vice-president), Ted Aubin (secretary), John D. Cyr (treasurer), J. Sosnowski (membership and public relations), Peter Hanley (education), Lakis Ellinas (publication) and R.T. Rawlings (conference). The society’s vision was to help members further develop their professional abilities and to provide opportunities for the exchange of ideas and information through newsletters, educational programs, conferences and interprofessional consultations. Seven goals were set, which became part of the bylaws. The objectives were (and continue to be) to: promote, develop and disseminate healthcare engineering technology; compare and exchange national experience; promote the principle of integrated design by improved collaboration between the professions (team approach); promote more efficient management of operation, maintenance, fire protection and safety of healthcare facilities, and their engineering systems, equipment and buildings; collaborate with other national and international organizations; provide educational opportunities to increase knowledge and competence in the field of healthcare systems; and formulate and communicate ideas and advice to governments and the public on issues and policy related to all aspects of engineering in Canadian healthcare facilities. CHES established a membership fee of $20 per year ($4 for students), plus $15 for registration and a membership certificate. On June 9-11, 1981, the society hosted its first national convention. Originally a biannual event, it was attended by approximately one-quarter of CHES’s 300-plus members at the time. The program covered a variety of topics to 12 CANADIAN HEALTHCARE FACILITIES

EN 1978, LORS D’UNE RÉUNION de la Fédération internationale des ingénieurs hospitaliers à Lisbonne, une graine a été plantée pour créer une société Canadienne d’ingénierie. Au printemps 1980, deux ingénieurs d’Ottawa et deux ingénieurs-conseils se sont rencontrés pour discuter de la nécessité d’une représentation nationale des ingénieurs hospitaliers. Le groupe s’est ensuite élargi pour inclure quatre autres personnes qui ont fondé la Société Canadienne d'Ingénierie des Services de Santé (SCISS), constituée le 21 Octobre 1980. Le premier comité organisateur national s’est réuni à Ottawa, en Janvier 1981, avec des représentants des 10 provinces. Trois mois plus tard, le 13 Avril, le premier comité exécutif a été élu par acclamation: Harry Callan (président), Steve Morawski (vice-président), Ted Aubin (secrétaire), John D. Cyr (trésorier), J. Sosnowski (adhésions et relations publiques), Peter Hanley (éducation), Lakis Ellinas (édition) et R.T. Rawlings (conférence). La vision de la société était d’aider ses membres à parfaire leurs compétences et de leur fournir des occasions d’échanger au moyen de bulletins, de programmes éducatifs, de conférences et de consultations. Sept objectifs ont été f ixés, qui sont devenus partie intégrante des règlements administratifs: promouvoir, développer et diffuser la technologie du génie de la santé; comparer et échanger l’expérience nationale; promouvoir le principe de la conception intégrée par une meilleure collaboration entre les professions (approche d’équipe); promouvoir une gestion plus eff icace du fonctionnement, de l’entretien, de la protection incendie et de la sécurité des établissements de santé, de leurs systèmes, équipements et bâtiments techniques; collaborer avec les autres organisations nationales et internationales; offrir des possibilités de formation pour accroître le savoir et les compétences dans le domaine des systèmes de santé ; formuler et communiquer aux gouvernements et au public des idées et conseils concernant des questions et politiques liées aux aspects du génie dans les établissements Canadiens. La SCISS a établi des cotisations de $20 par année ($4 pour les étudiants), plus $15 pour l’inscription et un certif icat d’adhésion. Du 9-11 Juin, 1981, la société a tenu son premier congrès national. À l’origine, il s’agissait d’un événement bisannuel auquel assistait environ un quart des 300 membres. Le programme couvrait une variété de sujets dans les domaines de la planif ication, de la conception et de l’exploitation des établissements de soins de santé,


address the challenges of changing technology in the fields of planning, design and operation of healthcare facilities, including energy conservation, construction and commissioning issues, plant maintenance and factors related to fire safety and fire control. That same year, CHES published its first journal in October. Like today, there was an assortment of both English and French articles. The cost for members was $5 per issue ($8 for non-members). As CHES approaches its 40th anniversary, much has changed and, at the same time, stayed the same. Membership has grown in excess of 1,000 and the society has expanded to include chapters representing every province. The national conference themes have evolved with the times; however, the educational program structure has remained relatively constant. Similarly, the vision to ensure “excellence in the patient carefocused environment through education, innovation and partnerships” is still at the core of CHES’s endeavours. Founder Callan’s hope was that “we will all dedicate ourselves to the achievement of (CHES’s) objectives and work together towards their successful accomplishment.” Almost 40 years later, I can proudly say we have. —Norbert Fischer, British Columbia chapter chair

CHES Canadian Healthcare Engineering Society

y compris les questions de conservation de l’énergie, de construction et de mise en service, d’entretien des installations et de facteurs liés à la sécurité incendie. La même année, en Octobre, paraissait la première revue de la SCISS. Comme aujourd’hui, il y avait un assortiment d’articles en Anglais et en Français. Le coût pour les membres était de $5 par numéro ($8 pour les non-membres). À l’approche du 40 anniversaire de la SCISS, beaucoup de choses ont changé et, en même temps, sont restées les mêmes. Le nombre de membres a augmenté de plus de 1,000 et la société s’est élargie pour inclure des sections représentant chaque province. Les thèmes de la conférence nationale ont évolué avec le temps, mais la structure du programme éducatif est demeurée relativement constante. De même, la vision d’assurer “l’excellence dans l’environnement axé sur les soins aux patients par l’éducation, l’innovation et les partenariats” est toujours au cœur des efforts de la SCISS. L’espoir du fondateur Callan était que “nous nous consacrerons tous à la réalisation des objectifs (de la SCISS).” Presque 40 ans plus tard, je peux dire avec f ierté que nous l’avons fait. —Norbert Fischer, Présidente de la section de Colombie Britanique


Société canadienne d'ingénierie des services de santé

CALL FOR NOMINATIONS FOR AWARDS 2020 Hans Burgers Award for Outstanding Contribution to Healthcare Engineering DEADLINE: April 30, 2020

2020 Wayne McLellan Award of Excellence in Healthcare Facilities Management DEADLINE: April 30, 2020

To nominate: Please use the nomination form posted on the CHES website and refer to the Terms of Reference.

To nominate: Please use the nomination form posted on the CHES website and refer to the Terms of Reference.

Purpose: The award shall be presented to a resident of Canada as a mark of recognition of outstanding achievement in the field of healthcare engineering.

Purpose: To recognize hospitals or long-term care facilities that have demonstrated outstanding success in completion of a major capital project, energy efficiency program environmental stewardship program or team building exercise.

Award sponsored by

Award sponsored by

For Nomination Forms, Terms of Reference, criteria, and past winners / About CHES / Awards Send nominations to: CHES National Office Fax: 613-531-0626 WINTER/HIVER 2019/2020 13



SickKids takes holistic approach to healthcare workplace design By Patrick Fejér


he healthcare design landscape is constantly evolving, extending far beyond the walls of the patient room and into the workplace setting. In many ways, today’s healthcare institutions are responding to the same challenges as commercial facilities: staff burnout, employee health and well-being, siloed teams, lack of collaboration space and the impact of technology on the workplace. The conversation around design is shifting to a more holistic lens, bringing staff ’s space needs to the forefront. 14 CANADIAN HEALTHCARE FACILITIES

There is much to be learned from the innovative workplace design strategies utilized in other sectors where traditional role-based spaces are eschewed for collaborative, team-based environments that support cross-disciplinary interaction and spontaneous innovation. In a hyperconnected world dominated by disruptive change, and a labour pool with different expectations of their work area than previous generations’, new ways of working continue to emerge. Designers are responding through the creation of future flexible spaces to address today’s

modern realities while bridging multigenerational needs. For the first time in history, there are four age groups in the workforce — baby boomers, gen X, millennials and the first of generation Z. Contextualizing this within healthcare workplace design means shifting the focus to the specific needs of staff to uncover operational efficiencies and improve workflow. Transforming the workplace into a smart, flexible, adaptable, integrated and operationally efficient support system is increasingly becoming a focal point in the conversation.

Renderings courtesy B+H Architects.

As a world-leading hospital for pediatric health sciences, the Hospital for Sick Children (SickKids) is setting a precedent in healthcare workplace design with the construction of the new Patient Support Centre (PSC). Anchored firmly in the centre of the hospital campus in downtown Toronto, the 22-storey PSC will house education, simulation and core administrative services in a modern, technology-enabled and sustainable building. It will establish a critical link between clinical care, learning and discovery across SickKids

for more than 3,000 medical professionals, management and support staff. The PSC goes beyond traditional healthcare workplace design by bringing together medical expertise and support staff currently dispersed across offices within Toronto’s Discovery District into a central campus hub for c o nve rg e n c e a n d c o l l a b o r at i o n . Co-locating workspaces for staff from different disciplines under one roof will make it easier for colleagues to meet for planned and spontaneous knowledge sharing and problem solving.

Leveraging the latest thinking in efficient and healthy workplace design, the PSC will provide a variety of inspiring spaces to meet. The new tower will also be home to hospital administration, including (but not limited to) legal services, financial services, human resources and information technology, fostering a strong sense of community for the organization’s culture. To help bring the project concept to life, a series of collaborative visioning and planning sessions were held with the SickKids team, engaging all levels WINTER/HIVER 2019/2020 15


THE INNER WORKINGS OF THE BUILDING ARE EXPOSED THROUGH AN INTERCONNECTED, MULTI-COLOURED STAIRCASE, CHANNELLING INTUITIVE WAYFINDING AND RECOGNIZABLE BRANDING WHILE REVEALING A PUBLIC GLIMPSE OF THE FACILITY IN ACTION. of hospital staff through facilitated workshops and tailored tools to generate insight and help inform how to best translate spatial solutions that support the healthcare facility’s desired culture. The PSC’s first floor lobby will blur the boundary between indoors and out. A 16 CANADIAN HEALTHCARE FACILITIES

playful yet purpose-built facade will provide a necessary transparent exterior to foster increased connectivity with hospital staff and SickKids patients, who will be able to see into the building’s interior from some inpatient rooms in the neighbouring atrium building. The

inner workings of the building are exposed through an interconnected, multi-coloured staircase, channelling intuitive wayfinding and recognizable branding while revealing a public glimpse of the facility in action. A series of coloured horizontal fins further animates the viewer’s experience, and at the same time provides shading and optimizes thermal performance on the interior. The lower publicly accessible floors will include a learning concourse that will feature a simulation centre for hands-on teaching, as well as a library and conference centre. An enclosed pedestrian bridge will connect the hospital’s main atrium to the PSC and Peter Gilgan Centre for Research and Learning, emphasizing the critical relationship between clinical care, learning and research across the campus. T h e P S C i s t a rg e t i n g L E E D (Leadership in Energy and Environmental Design) gold certification. The building will also comply with the Toronto Green Standard, a two-tier set of mandatory and volunteer performance standards for new development projects, while exploring the option of compliance with WELL, an architectural benchmark focused exclusively on human health and wellness to improve sustainability. The PSC officially broke ground in October 2019, and is the first phase of SickKids’ campus redevelopment plan, Project Horizon, which aims to build an inspired hospital of the future, transform care delivery, and empower patients and families to be partners in their care. Patrick Fejér is a senior design principal at B+H Architects, the design architect and prime consultant for the Hospital for Sick Children’s new Patient Support Centre. Patrick has more than 20 years’ experience in mixed-use building, office and hospitality design for a diverse range of high-profile urban developments in Toronto and around the world.

2020 Webinar Series Time: 0900 BC/1000 AB & SK*/1100 MB/1200 ON & QC/1300 NS & NB/1330 NL One hour in length *SK – 1000 during Daylight Savings time; otherwise 1100 Wednesday January 22, 2020

The Impact on Incident Energy as Switching Devices Age Speaker: Verma Vikrant, P. Eng; Virginia Balitski, CET, NETA, Level IV Wednesday February 19, 2020

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Isolation Room Design

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Commissioning in a Health Care Facility Speakers: Wayne Stokes, CET Arch, FMA, RPA Wednesday May 20, 2020

An Overview of Smoke / Fire Doors and the 2015 NBC Speakers: Ben Coles, M.Sc.E., MBA, P.Eng., PE Wednesday June 17, 2020

Optimizing Design with Virtual and Mixed Reality (AR/VR) Speaker: Daniel Doherty, BTech, C.E.T., CM BIM Wednesday October 21, 2020

CSA Z317.13-17 Role of the Multi-Disciplinary Team – Pros and Cons Speakers: Wayne Stokes, CET Arch, FMA, RPA Wednesday November 18, 2020

Awareness / Update on Med Gas Qualified Operators Speaker: Roger Holliss

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Saskatchewan welcomes new era of care for moms, kids

By Rebekah Lesko


askatchewan is no longer one of two Canadian provinces without a dedicated maternal and children’s hospital. The new Jim Pattison Children’s Hospital opened in September 2019, in Saskatoon. The 176-bed healthcare facility is dedicated to family-centred care, offering neonatal and pediatric intensive care, acute inpatient pediatric care, a children’s emergency department, pediatric surgery and outpatient care. Maternal services include outpatient care, a maternal-fetal medicine unit, labour and delivery (including three dedicated maternal operating rooms), antepartum and postpartum care. A BELIEF IN A BETTER FUTURE

In 1992, the beginnings of Jim Pattison Children’s Hospital Foundation were laid by two passionate doctors who knew children had unique needs and required specialized equipment and research. Seventeen years later, the provincial government announced a $200 million commitment to the building of a new maternal and children’s hospital, and the planning of the healthcare facility got 18 CANADIAN HEALTHCARE FACILITIES

underway. Ground was officially broken in fall 2014, and construction started on the Children’s Hospital of Saskatchewan. In May 2017, the name of the 400,000-square-foot hospital and its foundation was changed in honour of businessman and philanthropist, Jim Pattison, who gave an unprecedented $50 million gift to the people of Saskatchewan. The $286 million facility was substantially complete by spring 2019. More than 77,000 pieces of equipment and furniture were moved in and more than 2,400 staff, in addition to physicians, received orientation and training before the building’s operational opening. On that day, the patient move for maternal and pediatric services was completed in approximately four hours. One hundred and twelve maternal and pediatric patients were transferred from the previous facility, Royal University Hospital, to the new hospital by a connecting corridor. FAMILY-FOCUSED DESIGN

The voices of hundreds of patients, families, staff and physicians from across the province shaped the hospital design. An extensive

engagement process resulted in a healthcare facility made for and by Saskatchewan families, with the main theme consistently being the hospital needed to feel like home, no matter where that was. For ease of navigation, colourful graphics and images line the walls to assist with wayfinding, while also bringing different regions of the province to life. There are five graphical themes within the hospital, one for each floor: the lake, forest, north, Prairies and seasons. All patient rooms are private, each with a dedicated sleep space for family members or support partners. Large, bright windows offer a view of the South Saskatchewan River’s serene surroundings and provide a natural light source proven to elevate moods, regulate sleep and decrease stress. Admiration of the northern lights in Saskatchewan was noted during design development. This led to the incorporation of special LED lighting elements in pediatric patient rooms, as well as recovery and induction areas in pediatric surgery. The colours can be easily changed with a remote based on the child’s wishes, providing a sense of comfort, distraction and control.

HEALTHCARE DEVELOPMENT There are approximately 50 designated family spaces located throughout the facility. Spots for sleeping, nourishment rooms, quiet areas and laundry spaces help provide a sense of normalcy and comfort to families. An outdoor play area creates a sanctuary for patients and their families to wander, explore and play, while an indoor playroom helps young children escape the everyday redundancies of a hospital environment. A Saskatchewan Roughrider teen lounge was designed specifically with youth in mind. There’s also a family theatre to host movies and special events. SASKATCHEWAN FIRSTS

The hospital opening marks the introduction of many firsts for the province. Families now have access to a dedicated pediatric cardiac catheterization lab, sleep lab and surgical suites. The surgical suites include both an operative area and an induction room, allowing parents to be with their child while anesthesia is administered. The facility also houses Saskatchewan’s only 24-hour children’s emergency department, with the capacity to treat more than 21,000 children and teenagers each year. Jim Pattison Children’s Hospital is home to one of Canada’s largest single room maternal care centres. The innovative new model of care lets women remain in one room for their entire stay, allowing continuity of care during labour, birth and postpartum. With 65 private maternal patient rooms located on one floor, the centre is approximately the size of two football fields with space to care for more than 6,000 pregnant women a year. The Teammates for Kids Child Life Zone is a state-of-the-art environment for pediatric patients and their families. The Child Life Zone joins 11 other zones across North America, including New York, Phoenix and Dallas, but Saskatchewan’s is Canada’s first. The unique space is for young patients to laugh and relax, while using medical play to learn about their treatment and find fun ways to share their fears and experience. This 2,800-square-foot therapeutic play area was generously supported by Garth Brooks and the Teammates for Kids Foundation in partnership with Jim Pattison Children’s Hospital Foundation.


Rebekah Lesko is a content marketing specialist on behalf of Jim Pattison Children’s Hospital Foundation.

TOP TO BOTTOM: Jim Pattison Children's Hospital opened Sept. 29, 2019. A state-of-the-art play space provides a sanctuary for patients. The 176-bed facility is dedicated to family-centred care. WINTER/HIVER 2019/2020 19


Plan to prevent. Process compliance for optimal protection against healthcare-associated infections. Maintaining a safe, clean and hygienic environment, and minimizing microbial contamination of surfaces, items and equipment within the healthcare environment are increasingly recognized as an essential approach to reducing the risk of healthcare-associated infections.1,2 Pathogens can spread easily in high-traffic facilities. Cleaning and disinfection of equipment (medical, clinical) are important components of preventing the spread of microorganisms that can cause infections; however, such equipment is often composed of many different materials, each of which may respond differently to disinfectants used in healthcare and fitness facilities. 3 Pathogens such as Clostridium difficile, vancomycin-resistant enterococci (VRE) or methicillin-resistant Staphylococcus aureus (MRSA) can persist on surfaces and items for prolonged periods of time, sometimes up to several months.4 Healthcare providers who come in contact with surfaces in the room of a patient colonized with MRSA or VRE have a 42% to 52% risk of subsequent hand or glove contamination with the same organism; this risk is similar to the risk seen following direct contact with the patient. 5,6 After contact with a VRE-contaminated surface, healthcare providers transmit VRE to the next clean surface or skin site they come in contact with approximately 10% of the time.7 Studies show that up to 85% of wheelchairs in hospitals are contaminated with pathogens such as MRSA. 8 A newly released Canadian report suggests that antibiotic resistance is expected to have a stark impact over the next three decades, with superbugs estimated to lead to 400,000 deaths, resulting in $120 billion in hospital costs by 2050. 9

Know your high-risk surfaces. High-touch surfaces and items require more frequent cleaning and disinfection than low-touch surfaces and items, for example, patient beds and surrounding equipment, light switches, blood pressure and ECG carts, nursing stations, call bells, door handles, washrooms, etc.11 Additionally, to prevent the transfer of pathogens from the previous room occupant to a new patient, the room or bed space must be cleaned and disinfected thoroughly.11 Only about 50% of surfaces in hospital operating or patient rooms are effectively disinfected.12

Optimize your disinfection strategy.  The cornerstone of efforts to reduce the risk of transmission of microorganisms from the environment is the cleaning and disinfection of all surfaces, items and equipment in the healthcare setting on a regular and systematic basis.10 In its recent report, Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings, the Provincial Infectious Diseases Advisory Committee (PIDAC) suggests the following should be considerations when deciding upon an effective cleaning and disinfection strategy:11 • Frequency of cleaning

• Surface compatibility

• Cleaning method

• Alcohol-free

• Types of cleaning solutions

• Odour

• Kill claims

• Ease of use and aesthetics

• Contact and drying times of cleaning solutions

• Cost and environmental impact

CloroxPro™ can help. Clorox Professional is continually developing advanced and comprehensive solutions that help eliminate healthcare-associated infections wherever they are.

1. Dancer SJ. Eur J Clin Microbiol Infect Dis 2011;30(12):1473-81. 2. Weber DJ, Rutala WA. Infect Control Hosp Epidemiol 2013;34(5):449-52. 3. Lankford MG, et al . Limiting the spread of infection in the health care environment. Assessment of materials commonly utilized in healthcare: Implications for bacterial survival and transmission. Concord, CA: Coalition for Health Environments Research (CHER) and The Center for Health Design; 2007. Accessed November 20, 2019. 4. Kramer A, et al . BMC Infect Dis 2006;6:130. 5. Hayden MK, et al . Infect Control Hosp Epidemiol 2008;29(2):149-54. 6. Boyce JM, et al . Infect Control Hosp Epidemiol 1997;18(9):622-7. 7. Duckro AN, et al . Arch Intern Med 2005;165(3):302-7. 8. Hakuno H, et al . J Hosp Admin 2013;2(2):55-60. 9. Council of Canadian Academies, 2019. When antibiotics fail. Ottawa (ON): The Expert Panel on the Potential Socio-Economic Impacts of Antimicrobial Resistance in Canada, Council of Canadian Academies. 10. Donskey CJ. Am J Infect Control 2013;41(5 Suppl):S12-9. 11. Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee. Best practices for environmental cleaning for prevention and control of infections in all health care settings, 3 rd edition. Toronto, ON: Queen’s Printer for Ontario; 2018. 12. Bhalla A, et al . Infect Control Hosp Epidemiol 2004;25(2):164-7.

For more information, or to try CloroxPro™ products at your facility, visit: |

© 2019 The Clorox Company

Protect her. She has a spelling bee tomorrow. CloroxPro™ offers 3 chemistries for triple protection from hospital-acquired infections.

Your patients trust you to create a clean healing environment, so trust CloroxPro™ to stand behind you to help protect them. With multiple Health Canada registered disinfectants, based on 3 chemistries in a variety of ready-to-use formats, you have more choices to meet your unique cleaning and disinfection needs. Because we believe that supporting you every step of the way means protecting them. | © 2019 The Clorox Company


SEEING IS BELIEVING Network cameras take video surveillance to next level

By Paul Baratta


new technological era is enabling better care and security in hospitals. Central to it are net work cameras, which combine video surveillance with access control and audio systems. Their advanced video analytics can process captured images and analyze large volumes of data with surgical precision to produce act ionable infor mat ion t hat healthcare managers can use to assess risks, enhance patient care, streamline processes, and save energy and labour costs.

can be sent automatically to a control room, central monitoring station or to a care team member’s mobile phone, along with a video showing the situation in real-time. Similar type cameras pointed at a patient bed can generate automatic alerts when someone crosses a digital line like the boundaries of a bed. If a patient is leaning out of bed, for ex a m p l e, t h e e m b e d d e d c a m e r a intelligence will detect this and send an alert with corresponding video to the nurses’ station.



Falls are the second leading cause of accidental injury deaths worldwide. Early detection is key to ensuring the best patient outcome. The first few minutes after a fall occurs are critical. Cameras with embedded video analytics signal when a person remains on the floor for a pre-defined period of time. This is especially useful when a person falls in a secluded room. The alert message

Healt hc a re worker s c a n be ea s y targets for patients or family members’ rage, confusion or anx iet y. They experience a fourfold higher rate of workplace violence than any other profession. Workplace violence results in staff shortages due to injuries, high rates of burnout and stress. A greater patient-tohealthcare provider ratio impacts delivery of care.


An intelligent surveillance system can create the safest environment for staff and patients. Access control combined with network cameras ensure only authorized personnel enter a facility; tailgating incidents are detected and averted at entry points. Cameras with anti-loitering analytics can deploy audio warnings to deter people attempting to enter a restricted area. In emergency departments, cameras with aggression detector analytics can notify security staff of potentially dangerous interactions well in advance of phone calls or panic button activations, so that they arrive on scene faster. AVERTING THEFT

Medical instrument and supply theft is common in hospitals. Installing highresolution cameras with a wide viewing angle in critical locations is one of the most effective preventive measures. Some cameras are also capable of generating an automatic alarm if someone covers the lens. By combining an access control system with event-triggered video recording,

hospitals have a reliable record of all persons who enter or exit a specific area, allowing for easy investigations. A manager simply enters the name of an employee or patient into the system to bring up video of all movement of that individual. Equipped with motion detection capabilities, cameras recognize when there is movement in the area and automatically start recording. This avoids overburdening the network with the data traffic of images that do not contain relevant information, such as an empty rehabilitation room, thus reducing the need for data storage. Moreover, the motion detection analytic makes it possible to quickly search camera video feeds to obtain a summary of the event that happened, eliminating periods of time when the room was empty. PROTECTING RESTRICTED AREAS

The same solution can also be used in restricted areas like hospital pharmacies where visits may be infrequent and there are high-value goods to protect. In such installations, the pharmacy door opens

only if the person has permission to enter. Once inside, the lights automatically turn on and the motion sensing camera begins recording. Video captured is of such high quality that viewers can compare the dosage being entered on a computer to the actual amount being dispensed, providing another safeguard against theft. With efficient compression technology, the hospital is capable of storing three to four weeks of video typically needed for internal narcotics theft investigations. SECURING PARKING LOTS

Generally speaking, hospital parking lots are monitored to produce video evidence in litigation cases if car owners attempt to hold the hospital liable for damages to their vehicle. However, cameras can also be used to track suspicious individuals walking from hospital buildings to their vehicles and vice versa. This can be helpful when a critically wounded patient, such as a knife or gunshot victim, is left outside an emergency room entrance by someone who does not want

to be questioned by law enforcement. Having forensic quality, high definition video recordings can provide vital clues that help police identify and apprehend potential suspects. ADDRESSING PRIVACY CONCERNS

There are instances where non-visual surveillance technologies are required for privacy protection. For instance, thermal cameras are often used in sensitive healthcare environments, a l low ing pat ients to be obser ved remotely without capturing personal details. This is something that is mandated by the Personal Information Protection and Electronic Documents Act (PIPEDA) in Canada. Paul Baratta is a security professional with more than 34 years’ experience in law enforcement, security and security sales. His sales experience includes national security specialist at GE Security, vice-president at Niscayah and vicepresident, healthcare, at Stanley. In 2016, Paul joined Axis Communications as business development manager, healthcare. WINTER/HIVER 2019/2020 23

DO NO HARM De-escalation training stops trouble before it starts By Michael Oreskovich


nruly behaviour needs to be carefully managed in a healthcare setting. It poses a danger to patients, families and staff, and interferes with care delivery. By recognizing when people are at risk of aggressive behaviour and understanding its root causes, hospital staff, are empowered with strategies to safely resolve potentially harmful situations. During a hospital stay, stress, anxiety and certain medical conditions may trigger some patients and visitors to use physical force or make threats against others. In 2005, more than one-third of Ontario’s nurses reported being physically assaulted by a patient over the year, according to the Workplace Safety and Insurance Board. Healthcare workers have the second highest rate of lost time due to injury from workplace violence among all labour sectors in the province. Runnymede Healthcare Centre has a zero-tolerance approach to violence in the workplace. To complement safety measures already in place, hospital-wide violence de-escalation training was introduced in


May 2019. This preventive measure provides staff with knowledge and techniques to safely resolve potential conflicts before they escalate. The training also helps staff recognize and address warning signs from people who are at risk of violent behaviour. These include nonverbal cues like pacing and verbal cues such as changes in tone of voice. An important de-escalation technique taught is rational detachment, which helps staff control how they react to others’ aggressive behaviour and stay calm. Key to the practice is understanding that hostility from others should not be taken personally. This keeps staff members’ response to an aggressive person measured and allows them to focus on resolving the situation in a rational way. Staff are also trained to be more aware of what are known as precipitating factors — stressors in a person’s life that can trigger violent behaviour. Recognizing these factors and being empathetic are key to improving communication with patients or visitors before they become aggressive. It helps people feel understood and that

their concerns are validated, so they’ll be more likely to cooperate with staff in a productive way. Runnymede’s training consists of an online learning module followed by an in-person workshop. Facilitated by a violence de-escalation expert, the in-person workshop provides staff the opportunity to role play their responses to potentially violent scenarios. This includes using a collaborative, team-based approach to resolving tense situations. There have been many benefits to rolling out violence de-escalation training. It has ensured Runnymede continues to provide safe, high-quality care by proactively reducing the risk of harm to patients, family members and staff. The training has also refined staff’s ability to be sensitive to others’ needs, which is another example of how Runnymede puts patients and families at the centre of their care experience. Michael Oreskovich is a communications specialist with Runnymede Healthcare Centre.


BREAKING THE SILENCE Southwestern Ontario hospital leads the way in workplace violence prevention By Nicole Crozier


ôtel-Dieu Grace Healthcare (HDGH) strongly believes that excellence in patient and client care starts with employees who feel safe at work. This precipitated the development of a workplace violence prevention program (WVPP), and the goal of becoming the safest hospital in Ontario. The WVPP is led by an inter-disciplinary team with representation from management, frontline staff and a variety of unions. The multi-faceted program includes a full-time safe workplace advocate and threshold case review policy. It is updated annually and improved with involvement from union partners, in particular the Ontario Nurses Association. HDGH’s commitment to creating a safe work environment is clearly evident to staff, physicians and visitors. The hospital has a sign stretching three-storeys on the outside of its Prince Road campus with the message, ‘Respect our healthcare workers, we have zero tolerance for violence.’ This means each and every incident of violence and aggression at HDGH will be addressed to ensure the behaviour stops. Inside, there are elevator wraps and signs, as well as ‘It hurts to be quiet” posters hung in all staff rooms to remind everyone Biomedical_CHF_Winter_2017_FINAL.pdf 1 that violence in any form is not condoned. The hospital strongly encourages staff to use its safety reporting system if they witness verbal or physical abuse, or any other form of disrespectful conduct.

HDGH is also working on a four-part video series titled, Awareness Keeps You Safe. The f irst video educates viewers on what to do in the event the hospital calls a code lockdown for a v iole nt p er s on w it h a we a p on . Subsequent videos, all to be filmed on 2017-10-23 4:45 PM campus, will focus on patient and family violence, domestic violence and worker-to-worker violence. All will provide HDGH staff, volunteers and physicians with tools to prepare them

should they find themselves in similar situations. The remaining videos in the series are scheduled to be completed in early 2020. Nicole Crozier is the communications manager at Hôtel-Dieu Grace Healthcare, a hospital that offers a unique blend of community and home-based services in mental health and addiction, rehabilitative care, complex medical and palliative care, and children and youth mental health.

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WINTER/HIVER 2019/2020 25 Untitled-1 1

2016-11-22 10:48 AM

A STUDY IN CONFIDENCE Researchers question reliability of surface ATP tests to achieve optimal cleaning effectiveness By Brad Evans


hen ATP rapid monitoring systems first hit the market, many people were exuberant that science had finally made headway into the professional cleaning industry. Before ATP, which stands for adenosine triphosphate, the only way a cleaning contractor or facility manager could determine if a surface was clean was to swab it and then place the swab findings in a Petri dish. If contaminants were 26 CANADIAN HEALTHCARE FACILITIES

present, they would make themselves known within a few days. This was not only a slow process but it required costly and time-consuming work with a laboratory. The other option was visible observation, which is not reliable. Just because a surface looks clean does not mean it is sanitary, at least as far as germs, bacteria and pathogens are concerned. While the introduction of ATP was a big step forward, the testing procedure

may, unfortunately, not be as effective as once believed. According to a 2014 study, which looked at the reliability of AT P b i o l u m i n e s c e n c e m e t e r s i n decontaminating environmental surfaces in healthcare settings, ATP measurements can vary depending on the soil load on the surface, chemistry of the cleaning solution or disinfectant used to clean the surface, and ATP system.




Before discussing the study’s findings, it’s important to understand how ATP rapid monitoring systems work. ATP tests measure the concentration of light units generated by organic material of living or dead cells on a surface. A specially designed swab is rubbed on a surface and then placed into the reader. Within seconds, a digital evaluation appears. A high number indicates that a large volume of organic material or living cells are present and surface contamination is likely. A low reading signifies the opposite. ATP systems do not specify the types of pathogens that may be present or if there is microbial contamination, which is a concern in all types of facilities but particularly worrisome in hospitals because of the high number of nosocomial infections. Microbial contamination is the introduction of microbes on a surface and can include germs, mould, fungi, bacteria or viruses. If the surface is touched, these microbes can be passed onto fingers and hands, potentially spreading disease.

ers. Further, some disinfectant ingredients had either a quenching or enhancing impact on the ATP readings. In other words, the different meters might show higher or lower ATP readings based on the disinfectants used to clean the surface. IMAGE IS EVERYTHING

The big concern, based on these findings, is that ATP test results will create a false confidence on surface disinfection. A Brad Evans is general manager of Optisolve, surface may be believed to be clean when an assessment service that uses surface it is not, which can jeopardize public imaging technology to enhance and advance health and increase infection control costs cleaning procedures. This allows administraat healthcare facilities. tors to validate investments made in cleaning Fortunately, imaging technologies are activities and resources. Brad can be reached 1 2016-06-23 10:16 AM addressing McGregorAllsop_GTA_June_2016_FINAL.pdf this issue. These systems at

Expertise. Insight. Trust.


In conducting the study, researchers created pure concentrations of ATP in varying amounts. Dilutions of Staphylococcus aureus, a known nosocomial pathogen, were added to the ATP ‘broth.’ To avoid variability in the recovery, the ‘broth’ was applied directly to the swabs. Four ATP meters were used (all from respected manufacturers) and experiments were comp l e t e d i n c o n t ro l l e d l a b o r at o r y conditions. The researchers found that ATP monitoring systems were not a reliable disinfection validation tool. More specifically, the testing devices’ limitations prevented them from confir ming proper removal of disease-causing agents. What this means is the ATP monitors reported different findings. In some cases, the researchers found that one set of swabs was more effective at collecting ATP than others, leading to varying results. The researchers also reported that some meters were more effective at detecting pathogens than oth-

create a map, indicating where pathogens are located on a wider area of a surface and in what amounts. (ATP typically focuses on a small area, such as the front of a door handle.) Imaging technologies also provide the advantage of pinpointing more precisely where contamination exists. The result is a much clearer picture of the cleanliness of a surface.

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WINTER/HIVER 2019/2020 27


A DIRTY SECRET Government agency cannot guarantee efficacy of registered disinfectants By John C. Moore


here are laws that safeguard patient confidentiality on the one hand, and then those that force hospitals to clean solely with government registered cleaners that have not been tested against deadly pathogens. PUBLIC HEALTH PROBLEM

A new study based on a survey of Canadian hospitals has revealed that cases of healthcare associated infections, or HAIs, have continued to rise, and infection prevention and control programs have continued to fall short of experts’ recommendations. Targeting acute care hospitals over a seven-year period from 1999 to 2005, the study found significant increases in the rates of major communicable bacterial infections, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) and Clostridium difficile (C. difficile). The empirical results, recently published in the American Journal of Infection Control, demonstrate the rates of MRSA more than doubled during that period. A CLEANING CONCERN

In another study, this one by the Royal College of Medicine, it was found that the residual effects from chemical cleaners accumulate in the human body in everincreasing amounts over the life course. These have health consequences that are rarely attributed to them. Further, although most of the compounds in these cleaners have been tested for toxicity, it is uncertain how dangerous they are when mixed with other substances. MORE THAN A HEADACHE

Chemical-only cleaners are formulated with caustic and environmentally harmful 28 CANADIAN HEALTHCARE FACILITIES

agents. These are often mixtures of hazardous chemicals, such as quaternary ammonium compounds, 2-butoxyethanol, boron, ethanolamines, phosphate, surfactants and detergents. With sufficient exposure, they can result in negative health outcomes, including contact dermatitis, respiratory disorders, poisoning, bacterial resistance and death. There are also environmental consequences that impact the anatomy and physiology of terrestrial and aquatic organisms, soil and aquatic habitats. Beyond this, the potential induction of antibiotic resistance represents a highly undesirable side effect of chemical cleaning because it allows reinfection within 30 minutes.

Nonetheless, as currently designed and implemented, the EPA’s testing procedure does not assure that disinfectant products continue to be effective after they are registered. Specifically, once a product has been tested by the EPA and passes, it is listed as ‘agency confirmed efficacy’ on the EPA’s website and is typically not tested again, which means the long-term efficacy of the product cannot be assured. Also, the current testing design does not consider the risk factors when prioritizing and selecting what antimicrobial products to test. As a result, some of the pathogens of greatest concern do not fall within the current scope of testing.


John C. Moore is an American lawyer/entrepreneur and developer of Professor Microbe, a 100 per cent organic, food-safe, earth-friendly, people and pet-safe, all-purpose, chemical-free, fragrance-free cleaner. John can be reached at

In September 2016, the U.S. Environmental Protection Agency’s (EPA) office of the inspector general warned that the EPA needs a risk-based strategy to assure the continued effectiveness of disinfectants.


OVERCOMING BARRIERS New legislation renews impetus to improve healthcare access for people with disabilities By Steve Dering & Jennifer Camulli


n estimated 20 per cent of Canadians aged 15 or over has one or more disabilities that affect their daily life. This equates to more than six million people. While some disability conditions result in poor health and extensive healthcare needs, others do not. These disabled people have the same general health-related needs as every other Canadian. Yet they can find it difficult to access healthcare facilities. Poor signage, narrow doorway s, i nter na l steps, i nadequate restrooms, not enough parking spaces and inaccessible medical equipment pose challenges. Disability advocates therefore welcomed the long-awaited new Accessible Canada Act, which the federal government passed in June 2019. But will it fill the gaps that currently exist to create accessible healthcare in Canada? The new Accessible Canada Act has still to develop standards and regulations. Even when this is achieved, they w i l l only govern accessibi lit y for Government of Canada departments,

the federally regulated private sector, Canadian Armed Forces and RCMP. Although Health Canada is a federal institution, the current Canada Health Act does not address accessibility in medical facilities, hospitals or doctors’ offices. That’s covered under provincial legislation, that is, if the province has an accessibility or disability act. Provincial governments that have passed legislation have not yet mandated assistive equipment be in place to ensure those with disabilities, as well as pregnant women, injured persons and the obese, can be examined with dignity. Currently, only Ontario, Manitoba and Nova Scot ia have passed an accessibility act. Full enactment is slated for 2025, 2023 and 2030, respectively. Ontario was the first province to initiate measures to improve accessibility under the Accessibility for Ontarians with Disabilities Act (AODA); however, healthcare accessibility issues persist, according to a 2012 Toronto-based study by the Canadian Disability Policy Alliance. Thirty-two per cent of disabled

people experience physical barriers to healthcare facilities. Others exist as well: attitudinal, level of expertise and systemic lack of provision. It is expected all provinces will eventually follow suit with an accessibility act. Some may opt to wait for the federal government to outline what the standards should be and then simply adopt those at the provincial level. Others like British Columbia, which just passed its first reading of the British Columbia Accessibility Act, will develop their own standards. However, this approach of provincial autonomy may create additional challenges for people with disabilities. Consistency in standards and regulations is vitally important to disabled people; if standards differ from province to province, this could cause confusion and result in delays in treatment or the delivery of inadequate care. Another challenge is that private family practice doctors and walk-in clinics are expected to cover the cost of building adaptations, which can be complicated by restrictive billing practices imposed by provincial regulations. Discrepancies WINTER/HIVER 2019/2020 29

REGULATORY UPDATE already exist between provinces; some allow doctors to bill for more than one ailment per visit while others do not, compelling physicians to increase their patient load by reducing time spent with pat ient s, wh ich ca n comprom i se comprehensive care for complex needs. This constraint has contributed to a shortage of family practice doctors in B.C., as many have opted to leave the province and even Canada for more lucrative positions. Those who have remained often feel disenfranchised by primary care networks. Provincial governments need to address the financial barriers doctors will face to retrofit and equip their offices and clinics to make them fully accessible. ASSESSING DEFICIENCIES

All healthcare facilities have obligations under national and provincial building codes to remove barriers to access. Various standards can also be referenced, including the Canadian Standards Association’s Accessible Design for the Built Environment, which can be used in lieu of Canada’s

nationa l build ing code. However, these codes only address basic access provisions, such as accessible ingress/ egress, disabled park ing and restrooms, targeted largely at those with mobility impairments. To better understand the level of access for people with disabilities, an access audit should be carried out and findings recorded. The audit should identify features and services that may affect or impose physical, sensory, psychological and intellectual barriers on staff, volunteers, patients and their families, and visitors. While a checklist can be found online as a starting point, a disability access consultant who understands healthcare settings is the best person to select the most appropriate guide or standard to use. What may be relevant for an emergency room may not, for example, be suitable for a neurology ward or department. The consultant will take detailed measurements, generate a report and create an action list to meet compliance.

An accessibility audit is generally a two-stage process. The first involves a walkthrough inspection of the site. The surveyor will examine a number of items, including external and internal ramps, entrances, reception areas, platform lifts, lighting, acoustics and means of escape, among others, in order to identify any issues or barriers. Next, the sur veyor will recommend site improvements, from small adjustments to major structural alterations. The audit will provide a list of priorities and, most importantly, how to address issues identif ied. This will be in the form of an action plan that demon st r ates to st a keholder s a n understanding of existing barriers and a planned route to resolv ing them. Steve Dering is head of engagement and Jennifer Camulli, PhD, is senior access consultant at Direct Access, a disability accessibility consultancy with healthcare experience from home care to acute frontline services in Europe.

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