Issuu

Canadian

HealthcareFacilities JOURNAL OF CANADIAN HEALTHCARE ENGINEERING SOCIETY

Volume 41 Issue 1

Winter/Hiver 2020/2021

A TOWERING OPPORTUNITY

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The potential of prefab A ‘laundry’ list of savings Clean energy management software

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E M E R S O N . C O N S I D E R I T S O L V E D.

™

CONTENTS

CANADIAN HEALTHCARE FACILITIES Volume 41

Issue 1

EDITOR/RÉDACTRICE

Clare Tattersall claret@mediaedge.ca

PUBLISHER/ÉDITEUR

Kelly Nicholls kellyn@mediaedge.ca

PRESIDENT/PRÉSIDENT

Kevin Brown kevinb@mediaedge.ca

SENIOR DESIGNER/ CONCEPTEUR GRAPHIQUE SENIOR

Annette Carlucci annettec@mediaedge.ca

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

DEPARTMENTS

SUSTAINABLE HEALTHCARE

Editor’s Note

President’s Message

Chapter Reports

22 A Laundry List of Benefits Modernization of Saint John plant improves production capacity, efficiency of SNB’s linen services

HEALTHCARE DEVELOPMENT 14 Virus Hastens Completion of New Hospital Tower Le virus accélère l’achèvement de la nouvelle tour de l'hôpital

SCISS JOURNAL TRIMESTRIEL PUBLIE PAR SOUS LE PATRONAGE DE LA SOCIETE CANADIENNE D'INGENIERIE DES SERVICES DE SANTE.

CHES Canadian Healthcare Engineering Society

SCISS

Société canadienne d'ingénierie des services de santé

PRESIDENT

24 The Peak of Performance Energy management software platform exactly what doctor ordered at Hamilton hospital

Education

CANADIAN HEALTHCARE FACILITIES IS PUBLISHED BY UNDER THE PATRONAGE OF THE CANADIAN HEALTHCARE ENGINEERING SOCIETY.

VICE-PRESIDENT PAST PRESIDENT TREASURER SECRETARY EXECUTIVE DIRECTOR

INNOVATION & TECHNOLOGY 26 Prefab Construction for Emergency Response Modular healthcare spaces respond to changes in client, quality care needs 28 Human Perception in a Digital World Virtual, augmented reality applications help users better understand the built environment

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

CHAPTER CHAIRS

Newfoundland & Labrador: Colin Marsh Maritime: Helen Comeau Ontario: Jim McArthur Quebec: Mohamed Merheb Manitoba: Reynold J. Peters Saskatchewan: Jim Allen Alberta: Dan Ballantine British Columbia: Norbert Fischer 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: ches@eventsmgt.com www.ches.org Canada Post Sales Product Agreement No. 40063056 ISSN # 1486-2530

Chinook Regional Hospital Redevelopment and Expansion | Lethbridge

Committed to better performing buildings. Structural Engineering Structural Restoration Building Science Parking Facility Design Structural Glass Engineering Building Energy Modelling

rjc.ca

EDITOR'S NOTE

DEFINING WORDS HURRY UP and slow down. These are the words I would use to describe 2020 — the year our lives revolved around the global health crisis of COVID-19. There was the rush to stock up on ‘essentials’ ahead of each lockdown, the scramble to return home before the border closed, the urgency to reopen schools prior to safe practices being effectively put in place, and the need to speedily develop and deliver a virus vaccine. At the same time, Canada’s economic growth grounded to a halt amid painstaking efforts to decelerate virus spread. The pandemic also forced many people into remote work, resulting in the realization that there’s a need to ease up to achieve a more balanced life. In healthcare, it has been operation warp speed. Hospital ICUs were rapidly transformed to care for COVID-19 patients and temporary alternate care sites set up for expanded capacity. In Toronto, construction of the Peter Gilgan Patient Care Tower at St. Michael’s Hospital was fasttracked to keep pace with the pandemic. You can read all about it beginning on pg. 14. Also in this issue are success stories of sustainable healthcare facility projects. The first, A Laundry List of Benefits, highlights the consolidation and modernization of laundry sites in New Brunswick. This is followed by The Peak of Performance, which delves into the adoption of an energy management software program at St. Joseph’s Healthcare Hamilton. To close, we look at two innovative solutions, modular construction and virtual/augmented reality, that help build and better understand healthcare environments, respectively. Clare Tattersall claret@mediaedge.ca

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

4 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.

HEALTHCARE HEALTHCARE VENTILATION SYSTEMS VENTILATION SYSTEMS What’s really in yours ? What’s really in yours ?

We are pleased to announce that Ventcare now monitors hospitals the We are pleased50toplus announce thatinVentcare Ontario region. now monitors 100 plus hospitals in the

The location and inspection of the hospital

Ontario region. Labour Canada has fully “acknowledged” scopefully of Labour Canadathehas work provided inthethescope semi“acknowledged” of annual inspection program. work provided in the semiIn addition, the program. written annual inspection documentation contributes In addition, the written greatly to thecontributes hospital documentation accreditation greatly to programs. the hospital accreditation programs. Further we are always pooling the knowledge resources Further we are always poolingof Infection Control and Engineering the knowledge resources of Groups like CHES, the ventilation Infection Control and Engineering inspection is in a constant Groups likeprogram CHES, the ventilation evolution meet future needs for inspectiontoprogram is healthcare in a constant patients evolutionand to staff. meet future healthcare needs for patients and staff.

The location and inspection the Some hospital your building audit thisofyear. of ventilation fire dampers may be part of you have already taken advantage yourofbuilding auditsoftware this year. program Some of our new youwhich have already taken advantage in conjunction with our of patented our newrobotics, softwareallows program us which in conjunction with our to minimize ceiling access patented robotics, allows us requirements. to minimize ceiling access requirements. To date, of the thousands of fire doors inspected To date, of the thousands approximately 30% are of fire dampersaccessible inspected not humanly approximately are from traditional30% ceiling not humanly accessible access points. Our from traditional ceiling patented robot overcomes points.allowing Our thisaccess obstacle, patented robot overcomes complete documentation of all obstacle, allowing fire this doors within the ventilation documentation all complete system. Further, of the total,of7% fire dampers within the ventilation have been found defective, blocked system. Further, of simply the total,closed 15% with wood, wired up, or have been found defective, blocked shutting off airflow. with wood, wired up, or simply closed shutting off airflow.

“Setting the Standard for Commercial Ventilation Care” “Setting the Standard for Commercial Ventilation Care”

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PRESIDENT'S MESSAGE

MAKING IT THROUGH THE MIDDLE WHAT A YEAR! Just as a frame of reference, I reread my president’s message from the journal’s Winter 2019/2020 issue. From then to now, we went from looking forward to numerous opportunities and growth to the uncertainty and challenges of making it through COVID-19. Yet here we are and we’re doing okay. We’ve got a very tough winter ahead of us before we can begin to work our way out of this pandemic in spring. To quote Johnny Uzan, “Anyone can start something. No one quits right before the prize. The middle sets people apart.” I find this particularly relevant for our association and membership. The middle part of the pandemic is going to be as hard on healthcare as any of us are likely to experience in our lives. But if you have the right people with the right ‘stuff,’ you can make it through the “middle” to better days. We are those people. For now, I want to thank everyone for their efforts and perseverance. I hope you come up with creative ways to spend time with loved ones. A good friend of mine shared that her family plays Family Feud virtually over the Internet. Whatever it takes — it’s all food for the soul. 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 2020/2021 issue of Canadian Healthcare Facilities and passing a quiz based on articles in the issue. Once you’ve read the issue from cover to cover, simply go online to https://www.surveymonkey.com/r/BDWXW5D 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.

6 CANADIAN HEALTHCARE FACILITIES

the ARTT of Building Sustainability

HVAC

SECURE DATA

INTEGRATED FAULT DETECTION & DIAGNOSTICS

OWNERSHIP OF ANALYTICS

SINGLE-APP EXPERIENCE

CERTIFIED OPEN STANDARDS

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

Lighting

B UIL

LIT Y

ART o

S U S TA I N

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

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

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

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

Insist on timely analytics for all stakeholders with complete control of formatting and scheduling while retaining full ownership of your data and the reports generated.

Stay on top of regular advances in technology with supplier-certified, multi-lingual online educational videos, technical documentation, software updates, and advanced face-to-face classroom courses.

Create better-connected spaces with real-time access to occupancy, lighting, ventilation, and thermal comfort levels, using a holistic single app on the occupant’s mobile device.

Choose from a global network of factory-certified service partners who are passionate about long term, consistent, local support for you and your buildings.

Security

MINIMAL WASTE

BACKWARD COMPATIBLE

OPERATOR TRAINING

FACTORYCERTIFIED SERVICE

Sustainability requires a high level of integration between HVAC, lighting, and security systems. The art of building sustainability skillfully combines this integration with other technological and supporting elements that must endure over the long term. When these additional elements are maintained over the life of your building, true building sustainability emerges. To learn more about the ART of Building Sustainability please visit reliablecontrols.com/TABS3H20

CHAPTER REPORTS

QUEBEC CHAPTER

CHAPITRE DU QUEBEC

Winter is here and all hands are on deck as the fight against COVID-19 is not finished yet. Many countries were initially taken by surprise with the coronavirus spread. A public health emergency was declared in March in Quebec, and the province was subsequently shutdown to protect the healthcare system, which was under a lot of stress. Many modifications were made without haste to accommodate a new type of patient and safeguard the workforce. Facility managers had to be innovative, relying on internal resources and their own knowledge. The Quebec chapter held its first event of 2020 in February, at McGill University Health Centre’s Glen site. It included a tour of the mechanical rooms, followed by a conference on legionella in the hospital water network. The event was a huge success with more than 70 people in attendance, including Ontario chapter chair Jim McArthur whose presence was valued. We’d like to increase interactions with other chapters on a national level, as well as bring local healthcare facility communities together. CHES Quebec hosted its first-ever webinar this past September. It focused on different HVAC technologies and solutions to help fight COVID-19. The online offering reached many hospital operators across the province. Given how well the webinar was received, I am pleased to announce the 2021 webinar series. It will cover specific healthcare facility issues, providing the opportunity for no more than 15 participants at a time to engage in a constructive way, as well as share their experiences and solutions. A variety of sessions will be offered at different times throughout the year. Be sure to regularly check the Quebec chapter page on the CHES website and follow us on social media to stay up-to-date. —Mohamed Merheb, Quebec chapter president

L’hiver est arrivé. Tout le monde est sur le pont car la lutte contre la COVID-19 n’est pas encore terminée. De nombreux pays ont d’abord été pris par surprise avec la propagation du coronavirus. Une urgence de santé publique a été déclarée en mars au Québec, et la province a ensuite été fermée pour protéger le système de santé, qui était soumis à un stress important. De nombreuses modifications ont été apportées en un rien de temps pour accueillir un nouveau type de patients et protéger les effectifs. Les gestionnaires des établissements ont dû faire preuve d’innovation, en s’appuyant sur les ressources internes et leurs propres connaissances. La section québécoise a tenu sa première activité de 2020 en février, sur le site Glen du Centre universitaire de santé McGill. Elle consistait en une visite des salles mécaniques, suivie d’une conférence sur la legionella dans le réseau d’eau de l’hôpital. Ce fut un énorme succès : plus de 70 personnes y ont participé, dont le président de la section ontarienne, Jim McArthur. Sa présence a été appréciée. D’ailleurs, nous aimerions accroître nos interactions avec les autres sections et rassembler les communautés régionales des installations en soins de santé. SCISS Québec a organisé son tout premier webinaire en septembre dernier. Il s’est concentré sur les différentes technologies et solutions de CVC pour aider à lutter contre la COVID-19. L’offre en ligne a permis de toucher de nombreux responsables d’hôpitaux dans toute la province. Compte tenu de l’accueil réservé à ce webinaire, je suis heureux d’annoncer la série de 2021. Elle couvrira des questions spécifiques aux établissements de santé, offrant la possibilité à un maximum de 15 participants à la fois de s’engager de manière constructive, ainsi que de partager leurs expériences et leurs solutions. Diverses sessions seront proposées à différents moments de l’année. N’oubliez pas de consulter régulièrement la page du chapitre québécois sur le site web de la SCISS et suivez-nous sur les médias sociaux pour rester à jour. —Mohamed Merheb, président du chapitre du Québec

MARITIME CHAPTER Unfortunately, the 2020 fall education day that was scheduled for November in Truro, N.S., had to be postponed due to COVID-19. The CHES National planning committee and board of directors have had to make a difficult decision about the 2021 CHES National Conference in Halifax, Oct. 17-19. It is now going to be a virtual event but we are confident it will still be a great success. The chapter started working on the conference back in 2015. A program was developed that we felt was going to result in the best CHES National conference to date. The effort the planning committee put into creating a first-class program is to be commended and will not be forgotten. Robert Barss and I want to thank everyone for their contribution and encourage you to continue to be a part of the development of the organization. The national conference will return to Halifax Sept. 6-10, 2024. The work completed to date will serve as building blocks for the event. I am hopeful many will still be able to take part in planning the conference when the time arrives. For a second year in a row, the Maritime chapter was the recipient of the President’s Award. The executive committee met in Moncton, N.B., this past September to receive the honour. —Helen Comeau, Maritime chapter chair 8 CANADIAN HEALTHCARE FACILITIES

ALBERTA CHAPTER Winter is usually when the chapter is busiest planning the Clarence White Conference and Trade Show; however, due to COVID-19, the chapter has decided to forego the conference in 2021. We will hold our annual general meeting virtually on April 19. One thing the pandemic has taught us at CHES Alberta is the importance of remaining connected. Many people are working remotely and social distancing but this does not mean being less engaged. I encourage everyone to set some time aside, reach out and make that connection. Strong relationships keep people healthy and provide great opportunities for support. On behalf of the Alberta chapter, I would like to thank all healthcare staff and volunteers that are working tirelessly during these unusual times. Your work does not go unnoticed and we’re all eternally grateful for what you do. I’d also like to thank Dan Ballantine for his time as chapter chair. Dan will be missed but not forgotten as once a chair, always a chair. —Mike Linn, Alberta chapter vice-chair

CHAPTER REPORTS

ONTARIO CHAPTER

MANITOBA CHAPTER

As we continue through this second wave of COVID-19, I am reminded of how fortunate we are to be associated with CHES. Although most in-person events have been cancelled, we have managed to stay connected through Zoom meetings, webinars and other virtual events. I think back to my first involvement with CHES in the mid-90s, when none of these platforms were available. I can’t imagine going through this pandemic 20 years ago. The chapter executive was fortunate to have the opportunity to meet face-to-face this past September in London, Ont. The meeting was held in conjunction with the presentation of the 2020 Hans Burgers Award for Outstanding Contribution to Healthcare Engineering to Ron Durocher, our conference planning chair. Anyone who has attended the Ontario chapter conference in recent years understands the success of this event is largely due to Ron’s leadership. On behalf of CHES Ontario, I’d like to congratulate Ron. At this time, the Ontario chapter conference is scheduled to take place in Niagara Falls in mid-May. The executive team will meet virtually in January, to determine whether to go forward with the in-person event or move to a digital format. Planning continues for the International Federation of Healthcare Engineering (IFHE) Congress in Toronto in September 2022. Gordon Burrill has agreed to chair the program committee. The first meeting will be held in January, with members from Canada, as well as the U.S., Japan, Australia and the U.K. Coordinating meeting times will be challenging given the many different time zones worldwide. Ron Durocher has agreed to chair the sponsorship committee with members from across the country. Many thanks to all who are volunteering their time on these committees. —Jim McArthur, Ontario chapter chair

The Manitoba chapter has decided to host a webinarbased series over a number of days at the end of April and beginning of May in lieu of our typical chapter conference, due to current and possible future COVID-19 restrictions. The theme will still be, Construction and Renovations in Healthcare Facilities. The 2021 CHES National Conference has also been moved to a virtual format. This will provide all CHES members with the opportunity to take part in the sessions. With this change, the chapter will now host the national conference in Winnipeg in 2023. CHES Manitoba introduced two new awards in 2020, one for facilities management and the other for project management, to recognize individuals who have excelled in their line of work. An e-mail will soon be sent to members calling for nominations for these two awards for 2021. The chapter will again sponsor the Award for Power Engineering Technology at Red River College. A $1,000 bursary will be given to a power engineering technology student who has completed their first term of the program with a minimum 3.0 GPA. Just a reminder, the Manitoba chapter will cover the cost of the Canadian Certified Healthcare Facility Manager (CCHFM) self-assessment exam for those attempting it for the first time. If successful, the chapter will then pay for you to take the certification exam. The designation demonstrates you have the necessary education and experience, confirmed by an outside body, to qualify as an elite professional in the healthcare facilities field. —Reynold J. Peters, Manitoba chapter chair

NEWFOUNDLAND & LABRADOR CHAPTER Before I write my chapter report, I always reread the one from the same quarter of the previous year. As I reviewed what I wrote for the Winter 2019/2020 issue, one particular line jumped out: Will there be challenges. (I was referring to 2020.) No one at the time could have predicted this pandemic that has essentially crippled the world? It certainly has been a difficult year to say the least. As we weave through this second wave, my heart goes out to the frontline staff and their families, as well as the senior population, particularly those who live alone or away from loved ones. Let’s not forget them this season. Reach out and reminisce about times past. This may be the best gift you can give (and receive). The chapter incurred no expenditures in 2020. Not much is expected to change in 2021, with respect to travel and hosting face-toface events, so I anticipate there will be little spend. The chapter’s biggest task going forward is to improve communication with its members. We aim to better deliver on virtual educational opportunities and look to host an online professional development session in spring. A component of this will be roundtable discussions. —Colin Marsh, Newfoundland & Labrador chapter chair

BRITISH COLUMBIA CHAPTER The second wave of COVID-19 is having a greater impact on the province’s healthcare system than anticipated. On behalf of the B.C. chapter, I would like to thank all healthcare workers for their effort, dedication and ongoing commitment during these very difficult times. I would also like to congratulate the Maritime chapter on winning the President’s Award for the third time, as well as Ron Durocher and the Selkirk Regional Health Centre who received the Hans Burgers Award for Outstanding Contribution to Healthcare Engineering and Wayne McLellan Award of Excellence in Healthcare Facilities Management, respectively. B.C. has elected a new majority NDP government, resulting in a new direction for capital investment in healthcare. Government policy has now stopped using the public-private partnership model for building new healthcare facilities and future major expansions in favour of a design-build approach. The chapter’s conference planning committee is reviewing a number of options for education sessions in 2021, and possible opportunities to engage exhibitors and sponsors. The committee has agreed to carry forward the 2020 conference theme, The Physical Environment: Creating Patient Focused Facilities. CHES B.C. is in a financially sound position, so we will continue to support our member education bursary, national webinars and various provincial college bursaries. —Norbert Fischer, British Columbia chapter chair WINTER/HIVER 2020/2021 9

EDUCATION

ENSURING EFFECTIVE HEALTHCARE FACILITIES MANAGEMENT LEADERS EVER WONDER WHY MEDICAL gases always flow toward electrical outlets? Why generators function when supposed to? Or why equipment is repaired quickly if there is a breakdown and backup plans are put in place? A lot is due to effective leadership of a hospital’s facilities management department. The best way to ensure such leadership is for the team to be certified. “It’s important our facilities management leadership understand the importance of working in healthcare and all the associated codes and standards that go with it,” says Chuck Donohue, director of facilities management at Hamilton Health Sciences. “Certification ensures the knowledge and experience is available to the organization on a daily basis.” Facilities management encompasses multiple disciplines to ensure functionality, comfort, safety and efficiency of the built environment by integrating people, places, processes and technology. In a healthcare setting, the profession is concerned with the built environment for the well-being of patients, visitors and staff. According to CSA standard Z8002-19, Operations and Maintenance of Health Care Facilities, organizations should make sure healthcare facilities are managed by competent, qualified individuals who have acquired

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knowledge, skill and judgment through experience and education. It further notes that knowledge, skill and judgment will enable the integration of planning principles, operations and business management with engineering and medical services to create and preserve a safe and effective healthcare environment. The standard also states healthcare facility managers should obtain recognized industry certification in Canadian healthcare facilities management and continue professional development to remain current in the field and retain those certifications. The Canadian Certified Healthcare Facility Manager (CCHFM) program is designed to test a well-defined body of knowledge representative of professional practice in healthcare facilities management. Developed by the Canadian Healthcare Engineering Society (CHES), it has evolved since its inception in 2015, when the first four CHES members obtained the designation. The goal now is to make the CCHFM program the standard for healthcare facilities leadership in Canada. I was one of the original recipients of the CCHFM designation and have since encouraged my supervisory team at Hamilton General Hospital to become certified along with all facilities managers with Hamilton Health Sciences. It is an important step in establishing a level of competency across the health network, which is comprised of five hospitals and a cancer centre. “Since we are a multi-site organization, we rely on our facilities management leadership to be independent critical thinkers who can resolve problems at their site quickly and efficiently,” says Kelly Campbell, vice-president of corporate services and capital planning at Hamilton Health Sciences. “Having certified facilities managers would only enhance these qualities.” George Pankiw, P.Eng., is a member of the Canadian Certified Healthcare Facility Manger (CCHFM) advisory panel. He is the site manager, facilities management, at Hamilton General Hospital, part of Hamilton Health Sciences. In addition to having obtained the CCHFM designation, George is a Certified Healthcare Facility Manager (CHFM) and holds the senior status (SASHE) as an American Society for Health Care Engineering active member.

10 CANADIAN HEALTHCARE FACILITIES

EDUCATION

GARANTIR L’EFFICACITÉ DES RESPONSABLES DE LA GESTION DES ÉTABLISSEMENTS DE SOINS DE SANTÉ NE VOUS ÊTES-VOUS jamais demandé pourquoi les gaz médicaux s’écoulent toujours vers les prises électriques? Pourquoi les générateurs fonctionnent quand ils sont censés fonctionner? Ou pourquoi, en cas de panne, le matériel est réparé rapidement et des plans de secours sont mis en place? C’est en grande partie grâce à l’efficacité de la direction d’un département de gestion des installations hospitalières. Et la meilleure manière de garantir une telle efficacité est de s’assurer que l’équipe est certifiée. “Il est important que la direction responsable de nos installations comprenne la portée de travailler dans le domaine des soins de santé, ainsi que toutes les normes et tous les codes relatifs à cet exercice,” explique Chuck Donohue, directeur responsable des installations du complexe Hamilton Health Sciences. “La certification garantit que les connaissances et l’expérience nécessaires soient mises au service de notre organisation au quotidien.” La gestion des installations comprend de multiples disciplines, qui garantissent le fonctionnement, le confort, la sécurité et l’efficience de l’environnement bâti en intégrant les personnes, les lieux, les processus et les technologies. Dans un établissement de soins de santé, les professionnels se préoccupent de l’environnement bâti dans une perspective de bien-être des patients, des visiteurs et du personnel. Selon la norme CSA Z8002-19, Exploitation et entretien des établissements de santé, les organisations devraient s’assurer que les établissements de santé sont dirigés par des personnes compétentes et qualifiées, qui ont acquis des connaissances, des aptitudes et du jugement lors de leurs études et par leur expérience. La norme précise par ailleurs que les connaissances, les aptitudes et le jugement permettent l’intégration des principes de planification, de l’exploitation et de la gestion des affaires avec les services d’ingénierie et de médecine, de manière à créer et à protéger un environnement des soins de santé qui soit à la fois sécuritaire et efficace. La norme précise également que les responsables d’établissements de santé devaient obtenir une certification de l’industrie qui soit reconnue en matière de gestion des établissements canadiens de soins de santé, et poursuivre leur perfectionnement professionnel pour rester informés dans leur domaine et conserver leur certification. Le programme Certification des responsables d’établissements canadiens de soins de santé (CCHFM) est conçu pour assurer un ensemble bien défini de connaissances reflétant les pratiques professionnelles de gestion des établissements de soins de santé. Élaboré par la Société canadienne d’ingénierie des services de santé (SCISS), ce programme a évolué depuis son lancement en 2015, année où les quatre premiers membres de la SCISS en ont obtenu la désignation. L’objectif est maintenant de faire du programme CCHFM la norme pour la direction des établissements de soins de santé au Canada. J’étais l’un des récipiendaires originaux de la désignation du CCHFM et j’ai, depuis lors, encouragé mon équipe de supervision à l’hôpital général d’Hamilton à être certifiée,

ainsi que tous les responsables d’établissements du complexe Hamilton Health Sciences. C’est une étape importante dans l’établissement d’un niveau de compétence sur l’ensemble de ce complexe de santé, qui comprend cinq hôpitaux et un centre anticancéreux. “Du fait que notre organisation comprend plusieurs sites, nous comptons sur nos responsables de la gestion des établissements pour avoir une pensée critique propre leur permettant de résoudre de manière rapide et efficiente les problèmes qui surviennent sur leur site,” explique Kathy Campbell, viceprésidente des services aux entreprises et de la planification des immobilisations du complexe Hamilton Health Sciences. “La certification des responsables d’établissements ne ferait que potentialiser cette qualité.” George Pankiw, P.Ing., est un membre du groupe consultatif du programme Certification des responsables d’établissements canadiens de soins de santé (CCHFM). Il est responsable de site, dans le département de la gestion des établissements, à l’hôpital général d’Hamilton, entité du complexe Hamilton Health Sciences. Outre l’obtention de la désignation CCHFM, George est un Responsable certifié d’établissements de soins de santé (CHFM) et a le statut senior (SASHE) en tant que membre actif de l’American Society for Health Care Engineering.

WINTER/HIVER 2020/2021 11

VIRUS HASTENS COMPLET OF NEW HOSPITAL TOW Le virus accélère l’achèvement de la nouvelle tour de l'hôpital By/Par Rebecca Melnyk

much-anticipated addition to St. Michael’s Hospital in downtown Toronto was fast-tracked to keep pace with the pandemic. The Peter Gilgan Patient Care Tower was still in design mode in mid-March, with patients expected to arrive in July — the tower itself slated for completion by summer’s end. A potential surge of coronavirus cases hung on the minds of hospital staff and contractors who rushed to ready the fourth and seventh floors within weeks, making space for 33 single-patient critical care rooms about three months ahead of schedule. Replacing an old three-storey parking and storage structure, the 17-storey glass facade building eases into the existing facility, linking two older wings that were constructed at different stages in the hospital’s life. Since the new floors were designed for infection control purposes, accelerating them came with opportunities to create capacity as well as challenges to meet deadlines. 14 CANADIAN HEALTHCARE FACILITIES

n ajout très attendu à l’hôpital St. Michael’s au centre-ville de Toronto a été accéléré pour suivre le rythme de la pandémie. La Peter Gilgan Patient Care Tower était toujours en mode conception à la mi-mars, et les patients devaient arriver en juillet — la tour elle-même devait être terminée d’ici la fin de l’été. Une vague potentielle de coronavirus a retenu l’attention du personnel hospitalier et des entrepreneurs qui se sont empressés de préparer les quatrième et septième étages en quelques semaines, ce qui a laissé de la place pour 33 salles de soins intensifs pour un seul patient environ trois mois plus tôt que prévu. Remplaçant une ancienne structure de stationnement et de stockage de trois étages, le bâtiment de 17 étages à façade de verre s’intègre dans l’installation existante, reliant deux ailes plus anciennes qui ont été construites à différentes étapes de la vie de l’hôpital. Comme les nouveaux étages ont été conçus à des fins de

HEALTHCARE DEVELOPMENT

TION WER Urgent timelines coupled with a lack of extra equipment and supplies to fit the units equated to long waits for items like oxygen flowmeters and critical care monitors. Equipment and supplies were scouted and harvested from existing units, says Margaret Moy Lum-Kwong, senior director of operational readiness at Unity Health Toronto. There was also little time to train staff and physicians on new technology, fire safety and emergency egress in the new tower. “This required a compressed orientation and training agenda offered at multiple times during each day over a five-day period, including the weekend, prior to opening,” she says. “Sessions beginning at 8 a.m. with the last (one) ending at 10 p.m. meant long days for the core groups conducting them.” To commission the floors in one week, contractors socially distanced as they activated the mechanical and electrical

Images courtesy NORR Architects & Engineers Ltd.

contrôle des infections, leur accélération s’est accompagnée d’opportunités de création de capacités ainsi que de défis pour respecter les délais. Les délais urgents et le manque d’équipement et de fournitures supplémentaires pour équiper les unités ont entraîné de longues attentes pour des articles tels que les débitmètres d’oxygène et les moniteurs de soins intensifs. Les équipements et les fournitures ont été repérés et recueillis dans les unités existantes, explique Margaret Moy Lum-Kwong, directrice principale de la préparation opérationnelle de Unity Health Toronto. Il y avait peu de temps aussi pour former le personnel et les médecins sur les nouvelles technologies, la sécurité incendie et l’évacuation d’urgence dans la nouvelle tour. “Cela exigeait une orientation et un programme de formation comprimés offerts à plusieurs reprises au cours de chaque journée sur une période de cinq jours, y compris la fin de semaine, avant la WINTER/HIVER 2020/2021 15

HEALTHCARE DEVELOPMENT

infrastructure and built life safety elements to code, says Frank Panici, vice-president of NORR Architects and Engineers Ltd. Everything was a go by the second week of April. The wide corridors on the new floors now hold a series of private inpatient rooms, including three negative pressure isolation rooms, each with sliding glass doors that offer direct vantage points from a decentralized nurses’ station. Staff can visually monitor patients without disrupting their rest, while reducing the risk of exposure. Large windows in every room amplify the amount of natural light. Rubber flooring reduces noise levels and worker fatigue, and ceiling-mounted patient lifts avert falls and injury. Upon entering any room, one will immediately find a hand hygiene sink; a washroom and shower are located at the head of the bed, so patients have little distance to travel. The tower is the second and largest phase of an ongoing $300-million multi-phase redevelopment that will also see 150,000 square feet of clinical renovations, including the expanded Slaight Family Emergency Department, and more than two million square feet of infrastructure upgrades. It is intended to transform patient care in Canada in a way likely unimaginable in 1892, when the hospital first opened with 26 beds, six doctors and four nurses. A new main entrance to St. Michael’s Hospital opened at the bottom of the Peter Gilgan Patient Care Tower in late September. Before this, patients accessed the new floors safely and horizontally, from an adjacent building isolated from the rest of the facility. 16 CANADIAN HEALTHCARE FACILITIES

journée d’ouverture,” dit-elle. “Les séances qui commencent à 8 h et qui se terminent à 22 h signifient de longues journées pour les groupes principaux qui les animent.” Pour poser les planchers en service en une semaine, les entrepreneurs se sont distancés en activant l’infrastructure mécanique et électrique et en construisant des éléments de sécurité des personnes conformément aux normes, explique Frank Panici, vice-président de NORR Architects & Engineers Ltd. Tous les feux verts ont été obtenus la deuxième semaine d’avril. Les larges couloirs des nouveaux étages abritent maintenant une série de chambres individuelles pour patients hospitalisés, y compris trois salles d’isolement à pression négative, chacune dotée de portes coulissantes en verre qui offrent un point de vue direct à partir d’un poste d’infirmières décentralisé. Le personnel peut surveiller visuellement les patients sans perturber leur repos, tout en réduisant le risque d’exposition. De grandes fenêtres dans chaque pièce amplifient la quantité de lumière naturelle. Le revêtement de sol en caoutchouc réduit le niveau de bruit et la fatigue des travailleurs, et les lève-patients fixés au plafond évitent les chutes et les blessures. En entrant dans une chambre, on trouve immédiatement un lavabo pour l’hygiène des mains; une salle de bain et une douche sont situées en tête de lit, de sorte que les patients ont peu de distance à parcourir. La tour est la deuxième et la plus grande phase d’un réaménagement en plusieurs étapes de 300 millions de dollars qui permettra également de rénover 150,000 pieds carrés d’installations cliniques, y compris l’agrandissement du

HEALTHCARE DEVELOPMENT Service des urgences de la famille Slaight, et plus de deux millions de pieds carrés de modernisation de l’infrastructure. Il vise à transformer les soins aux patients au Canada d’une façon probablement inimaginable en 1892, lorsque l’hôpital a ouvert ses portes avec 26 lits, six médecins et quatre infirmières. Une nouvelle entrée principale de l’Hôpital St. Michael’s a ouvert ses portes au bas de la Peter Gilgan Patient Care Tower à la fin de septembre. Auparavant, les patients accédaient aux nouveaux étages de façon sécuritaire et horizontale, à partir d’un bâtiment adjacent isolé du reste de l’installation. “C’est une autre caractéristique intégrée dans la conception et un avantage dans les situations de pandémie où l’on peut en fait séparer les étages,” dit Panici. Son équipe a conçu une grille de neuf mètres, avec une structure d’étage à étage pour permettre toute modification future de l’espace. De grands conduits mécaniques ont été déplacés dans un atrium, de sorte que les besoins de l’étage peuvent être reconfigurés à l’avenir sans affecter le reste de l’hôpital. NORMES ÉLEVÉES

“That’s another feature built into the design and a benefit to pandemic situations where you can actually separate the floors,” says Panici. His team designed for a nine-metre grid, with a floor-tofloor structure to accommodate any future alterations to the space. Large mechanical duct shafts were moved to an atrium location, so floor needs can be re-configured in the future without affecting the rest of the hospital. HIGH STANDARDS

The pandemic both validates design features of the current CSA standard, which embraces learnings from previous epidemics such as SARS and H1N1, as well as reveals gaps and areas for improvement. All inpatient rooms in the tower are single-use only, a feature the standard applauds as a means to appropriately distance infected patients. “This provides more privacy, reduced noise levels and better infection control, with space for families, leading to better comfort, recovery and outcomes for patients,” says Moy Lum-Kwong. Such a design, however, is mostly seen in newer hospitals, says Michael Keen, vice-president and chief planning officer at Unity Health Toronto, and chair of CSA Group’s strategic steering committee for health and well-being. Only 10 to 20 per cent of single-patient rooms are found in older facilities, with the rest being semi-private, two-patient rooms or three to four beds in a ward-like environment.

La pandémie valide les caractéristiques de conception de la norme CSA actuelle, qui tient compte des enseignements tirés des épidémies précédentes telles que le SRAS et le H1N1, et révèle les lacunes et les domaines à améliorer. Toutes les chambres sont individuelles, une caractéristique que la norme préconise comme un moyen de distancer de façon appropriée les patients infectés. “Cela offre plus d’intimité, un niveau de bruit réduit, un meilleur contrôle des infections et de l’espace pour les familles, ce qui entraîne un meilleur confort, un meilleur rétablissement et de meilleurs résultats pour les patients,” déclare Moy Lum-Kwong. Un tel concept est surtout observé dans les nouveaux hôpitaux, déclare Michael Keen, vice-président et chef de la planification à Unity Health Toronto et président du comité directeur stratégique du Groupe CSA pour la santé et le bien-être. Seulement 10 à 20% des chambres individuelles se trouvent dans des établissements plus anciens, les autres étant des chambres à deux, trois ou quatre lits dans un environnement semblable à une salle commune. “C’est vraiment un défi,” lance-t-il. “Au fur et à mesure que nous réaménageons nos installations, le fait de passer à un plus grand nombre de chambres pour un seul patient sera le plus important moyen de nous aider à faire face aux futures pandémies. La capacité de séparer les patients est peut-être la plus importante pour réduire la transmission.” Un espace d’enfilage et de retrait approprié pour l’équipement de protection individuelle et les lavabos pour le lavage des mains sont d’autres aspects importants, de pair avec la flexibilité — un point d’articulation clé pour les pratiques de conception exemplaires à l’avenir. Les chambres adaptables aux soins aigus — la possibilité de transformer facilement une chambre de soins aigus en une chambre de soins intensifs — permettent une plus grande adaptabilité en cas de crise et moins de mouvements de patients. Comme l’équipe de l’Hôpital St. Michael’s WINTER/HIVER 2020/2021 17

HEALTHCARE DEVELOPMENT

“That really is a challenge,” he says. “As we redevelop facilities, moving to a more single-patient room environment will be the biggest thing to help us in future pandemics. The ability to separate patients is perhaps most important for reducing transmission.” Appropriate donning and doffing space for personal protective equipment and hand-washing sinks are other important touch points, along with flexibility — a key focus for best design practices moving forward. Acuity adaptable rooms — the ability to switch an acute care room into a critical care room with ease — allows for greater flexibility in a crisis and less movement of patients. As the team at St. Michael’s Hospital anticipated a surge, this became an important tool for deciphering where best to place patients with COVID-19. Air system flexibility is another factor, says Keen. Twenty years ago, most hospitals in Ontario didn’t have any proper negative pressure airborne isolation rooms, which are particularly vital when intubating patients. Through SARS and tuberculosis, facilities began retrofitting to build these rooms. The standard now requires one per floor; the new tower houses three per floor. Negative pressure rooms are not always possible in some spaces, though. Keen says in a typical patient room it’s more of a balance of air moving in and out. Monitoring the pressure and being able to adjust the supply of air inward to the room is a key area of adaptability to enhance safety. “That flexibility with your HVAC system is an important piece that I think we will be looking at in the standards a lot closer,” he says. Since all rooms are grouped in a common air system, another element is ensuring air isn’t recirculated from one room to the other. Being able to adjust systems on “100 per cent outdoor air in and 100 per cent air exhausted out” is an important feature. “Most systems aren’t designed for that because in the cold of winter or heat of summer that’s when it can be most difficult bringing the outdoor air in,” says Keen. “As we moved into the summer, we found there was a burden of that heat on the system. Luckily, ours have that flexibility, but that’s definitely something that needs to be considered for situations in the future.” Specifying materials might also need a look-over. With input from the hospital’s infection prevention and control (IPAC) department, the design team was able to procure ceilings, flooring and furnishings that are easily cleanable, says Panici. He suspects industry will need to reexamine chemicals used to sanitize and whether such materials ‘hold up.’ “I think this will spur another conversation about how we are using these materials and are they IPAC controlled,” Panici said in a recent webinar. “We’re trying to balance that with the patient experience and make sure we provide exceptional spaces that can deliver care.” Rebecca Melnyk is editor of Canadian Facility Management & Design. 18 CANADIAN HEALTHCARE FACILITIES

s’attendait à une augmentation subite, cet outil est devenu un outil important pour déchiffrer où il est préférable de placer les patients atteints de la COVID-19. La f lexibilité du système d’aération est un autre facteur, déclare Keen. Il y a 20 ans, la plupart des hôpitaux de l’Ontario n’avaient pas de salles d’isolement à pression négative, qui sont particulièrement vitales pour l’intubation des patients. À cause du SRAS et de la tuberculose, les installations ont commencé à être réaménagées pour construire ces salles. La norme en prescrit maintenant une par étage ; la nouvelle tour en accueille trois. Toutefois, les chambres à pression négative ne sont pas toujours possibles dans certains endroits. Selon lui, dans une chambre de patient typique, il s’agit plutôt d’un équilibre entre l’air qui entre et celui qui sort. La surveillance de la pression et la capacité d’ajuster l’alimentation en air vers l’intérieur de la pièce sont des éléments clés de l’adaptabilité pour améliorer la sécurité. “Cette souplesse avec votre système de CVC est un élément important que nous examinerons de plus près dans les normes,” dit-il. Comme toutes les chambres sont regroupées dans un système d’aération commun, un autre élément consiste à s’assurer que l’air n’est pas recirculé d’une pièce à l’autre. Il est important de pouvoir régler les systèmes sur “100% d’air extérieur à l’entrée et 100% d’air vicié à la sortie.” “La plupart des systèmes ne sont pas conçus pour cela parce que dans le froid de l’hiver ou la chaleur de l’été, il peut être plus difficile d’admettre l’air extérieur,” dit Keen. “À l’approche de l’été, nous avons constaté que cette chaleur accablait le système. Heureusement, nous avons cette souplesse, mais c’est certainement quelque chose dont il faut tenir compte à l’avenir.” Il faudra peut-être aussi jeter un coup d’œil à la spécification des matériaux. Grâce à la contribution du service de prévention et de contrôle des infections (PCI) de l’hôpital, l’équipe de conception a pu se procurer des plafonds, des revêtements de sol et des meubles faciles à nettoyer, explique Panici. Il soupçonne que l’industrie devra réexaminer les produits chimiques utilisés pour désinfecter et déterminer si ces matériaux ‘tiennent le coup.’ “Je pense que cela suscitera une autre conversation sur la façon dont nous utilisons ces documents et sur la façon dont ils sont contrôlés par l’IAPC,” a déclaré Panici lors d’un récent webinaire. “Nous essayons d’équilibrer cela avec l’expérience des patients et de nous assurer que nous fournissons des espaces exceptionnels qui peuvent fournir des soins.” Rebecca Melnyk est rédactrice en chef de Canadian Facility Management & Design

2021 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 27, 2021

Update to CSA Z317.2 (HVAC)

Speakers: Gordon D. Burrill, P.Eng., CCHFM, FASHE, CHFM, CHC Nick Stark, P. Eng., CED, LEED AP, ICD.D

Wednesday February 24, 2021

Refrigeration Retrofits to Low GWP Refrigerants & How the Choices Effect Capacity and Operation Speakers: Jeff French Steve McTaggart

Wednesday March 24, 2021

Building Science 101: Understanding Building Air Leakage and the Effects on Your Building Envelope Speakers: Steven Tratt

Wednesday April 21, 2021

Understanding and Preventing Floor Covering Failure Speaker: Chris Maskell

Wednesday May 12, 2021

Infection Prevention Through Design & Innovation Speaker: Vicky Diab, BA

Wednesday June 16, 2021

Operating Rooms - Isolated power systems and Class A GFCIs in Operating Rooms Speakers: Amir Mojtahed, B.Eng, M.Eng Sonny Solanki, B.Eng

Wednesday September 22, 2021

Resilient Building Design for Hospitals in the face of Climate Change Speaker: Gord Rajewski, R.E.T.

Wednesday November 17, 2021

Roof Maintenance

Speaker: Ted Katsoris, B.Tech, BSS, CCCA

CHES Member: Single: $30 (per webinar) Series: $150 (per series)

Registration

www.ches.org

Professional Development

Non-Member: Single: $40 (per webinar) Series: $180 (per series)

SPONSORED CONTENT

Don’t Delegate the choice of directory supplier: Digital directories need to be maintained and supported throughout their lifespans. That's why it pays to choose a qualified partner who will work seamlessly with the hospital well past the initial installation. Conversely, when hospital teams let their general contractor or designer select a directory supplier, they risk being "locked-in" with a supplier who either can't handle the job or may not be around in future when needed. One size (doesn't always) fit all: Digital displays can come in many sizes depending on their intended use. Navigational signs, for examples, are typically larger and more noticeable than registration kiosks, which are usually smaller to protect patient privacy. Before you issue an RFP, consult with a digital signage vendor to discuss your objectives and find a digital sign to match. Considering the lifetime costs: The true cost of digital signage extends beyond the initial installation. Make sure to budget for ongoing maintenance, including software support and hardware replacement down the road. After all, every piece of technology has a useful lifespan and you'll want to keep those future costs in mind.

Content is king: Your digital signage RFP may spell out your hardware needs, but what about software? Make sure to clarify what you're looking for in terms of software features (e.g., accessibility options, languages, functionality, etc.), software services, support plans, and maintenance or repair response times. Digital signage, including directories, are an investment. They need to be done right in order to pay off in terms of creating a more appealing, supportive, and stress-reducing environment. “Digital signage can make a signiﬁcant difference in a healthcare facility, but only if you take the time to determine what you need and work with your chosen vendor to make it happen,” adds Martin.

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

SUSTAINABLE HEALTHCARE

A LAUNDRY LIST OF BENEFITS Modernization of Saint John plant improves production capacity, efficiency of SNB’s linen services By James Belliveau, David Dumont & Kate Butler

eliable laundry service is essential to the operation and delivery of healthcare and an integral component in the management of infection control. It includes the preparation and processing of items like isolation and patient gowns, surgical linen, bed sheets, towels and environmental products, among others. In 2012, faced with aging laundry infrastructure and rising costs, Service New Brunswick (SNB) implemented a strategy to improve laundry and linen services to the province’s healthcare system. The result is three efficient laundry sites, consolidated from the original eight. As laundry facilities reached their end of life usefulness in reg ional hospitals in southern New Brunswick, laundry was transferred to the more eff icient Saint John laundry plant. Production increased to more than 15.5 million pounds of laundry in 2020, from six million pounds in 2013. The consolidation yielded a net greenhouse gas emission reduction in facilities of 886 tonnes. It also allowed 22 CANADIAN HEALTHCARE FACILITIES

for valuable square footage inside facilities to be returned to the hospitals for healthcare purposes. For instance, the former laundry facility at Dr. Everett Chalmers Regional Hospital is now being renovated to add surgical suites, while other facilities have renovated their former laundry sites for much needed patient care areas, such as clinics and medical offices. The strategy required a complete renovation of the existing 50,000-square-foot, 1979-built Saint John laundry plant, including the heating plant, HVAC equipment and laundry production equipment, as well as a 23,000-squarefoot expansion. HVAC equipment such as the steam generator, air handling system units, unit heaters, exhaust fans and heat recovery systems, and laundry equipment like the presses, tunnel washers and dryers were all ranging from very poor to poor condition. The process took more than two and a half years while maintaining regular operations, from picking up soiled linen to delivering clean items throughout New Brunswick’s many healthcare facilities and nursing homes.

P h a s e 1 c onc e nt r a t e d on t he expansion, which included the addition of receiving bays, new soiled linen section (soil sort, soil wash), dryers, mechanical room and heating plant. Coordination to manage power and natural gas interruptions involved weekend and/or overnight shutdowns to ensure consistent service to the healthcare facilities. Other challenges included modified logistics for truck deliveries and pick up. Once the commissioning of the addition was completed, operations began in the new soiled linen section and the next phase began. Phase 2, the new clean linen section, involved a complete gut and renovation to the ex isting side of the plant, including the chemical room. This resulted in the temporary loss of a clean section. The solution was to move the clean finishing and retail operations to a temporary warehouse 1.5 kilometres away. The soiled linen was received, sorted, washed and dried at the recently added new addition and then shuttled to the temporary finishing site, where it

SUSTAINABLE HEALTHCARE

was folded and prepared for distribution to healthcare facilities. Having a temporary warehouse was unheard of in healthcare laundry services. Patient care requires consistent laundry and linen services that meet high infection prevention standards. Once this out-of-thebox approach was deemed viable, challenges included finding an appropriate space, engaging staff and operations to embrace the change, relocating existing equipment to the interim site, constructing a temporary loading bay and travel logistics. Shuttling temporarily required more trucks and drivers to drop-off and pick up between the warehouse and plant every 22 to 24 minutes. To execute the transition, operations at the existing plant stopped at 2 p.m. on a Friday. Existing equipment, such as blanket blasters, folders and electronic scales, was moved and commissioned to the temporary site over the weekend. Maintenance staff had set up required electrical and compressed air systems, as well as the loading bay, weeks prior. Operations began at the new temporary site on the Monday at 7 a.m. Once the renovation of the existing plant was commissioned, the f inal phase involved moving the temporary operations back to the newly renovated plant and implementing the new process. The completed major capital renewal and expansion that modernized the Saint John laundry plant has increased production capacity and improved overall efficiency. It is also aligned with SNB’s commitment to environmental stewardship, while maintaining the high standards of service and quality delivered to the healthcare sector. The new steam boilers in the heating plant are low water volume and quick load turndown, which provides the ability to shutdown during unoccupied and nonproduction periods. Boilers supply steam to the heating system as well as the washers and hot water storage tanks. Economizers in each boiler stack preheat the makeup water. A water softener system was also installed. The air handling units are equipped with heat recovery. The incoming fresh air is preheated from the glycol loop, which is warmed from the exhaust air. A wastewater reclamation system has been included in the process system that reuses water by treating and

TOP TO BOTTOM: Sixteen efficient 120 kilogram dryers. Three new tunnel washers with 60 kilogram batch capacity.

filtering the laundry wastewater. The goal is to have a final recycling range between 50 and 75 per cent. The system not only decreases water consumption by reusing water but also reduces energy as the recycled water is already preheated. Variable speed systems are included with all air compressors and pumping systems so that operations can meet variable loads rather than operate at full load constantly. The new tunnel washers are not only efficient but consume less water. The dryers and ironers are now direct natural gas-fired. The dryers are more efficient, too, and reduce energy and drying time. The need for hot oil heating for dryers and ironers was eliminated from the plant. Since the start of the project, there has been an increase in production from an average of 550,000 to 1.3 million pounds

a month. Energy consumed per 1,000 pounds of laundry has been reduced by 35 per cent. The next phase is to make the new plant work even better by focusing on the process, maximizing capacity, and bringing the plant and its operations to its highest production eff iciency. With proper maintenance, it should function for the next 25 years with reliable and quality service to the New Brunswick healthcare system. James Belliveau is executive director of laundry and linen services at Service New Brunswick (SNB), a crown corporation that provides non-critical services to the province’s health authorities. David Dumont is vice-president of health services at SNB. Kate Butler is executive director of energy management at SNB. James and David can be reached at james.belliveau@snb.ca and david.dumont@snb.ca, respectively. WINTER/HIVER 2020/2021 23

THE PEAK OF PERFORMANCE Energy management software platform exactly what doctor ordered at Hamilton hospital

By Kent Waddington

pproximating 830,000 square feet, St. Joseph’s Healthcare Hamilton consumes a great amount of electricity, natural gas and water. Management of these resources falls to Mike McKnight, who is responsible for monitoring and analyzing utility consumption, as well as planning and implementing initiatives to maximize utility conservation, minimize budgetary expenses and support senior leadership in forecasting energy needs. 24 CANADIAN HEALTHCARE FACILITIES

Thanks to RETScreen, McKnight’s job is now a lot easier. The energy management software platform package developed by the Government of Canada enables users to identify and assess the viability of energy efficiency, renewable energy and cogeneration projects. It assists with the verification of actual and ongoing energy performance of buildings, such as hospitals, long-term care facilities and energy plants, to uncover additional energy savings possibilities.

“RETScreen helps to highlight our energ y per for mance, par t icu larly when something such as air handlers, boilers or chillers are not operating at peak efficiency,” says St. Joe’s energy manager, McKnight. “As well, it’s very useful if working on a behavioural shift in energy consumption — the software can identify savings that can accrue by adopting conservation measures.”

SUSTAINABLE HEALTHCARE

RETScreen can a lso a id users in identifying, assessing and optimizing the technical and financial viability of energy projects, while they improve their climate change impact resilience. “By using RETScreen, an energy manager or team can quickly analyze cost savings, feasibility and emissions reductions related to proposed energy conservation measures,” says HealthCare Energy Leaders Canada (HELC) program lead, John J. Knott, who is simply known as J.J. “It can help prioritize future projects based on net present value analysis, return on investment, cost to benefit analysis and future cash f lows. Further, it enables healthcare organizations to monitor and track energy savings, and report on cumulative savings resulting from completed projects, with adjusted baselines based on project completion dates.” CALCULATED RESULTS

Months after a number of energy conservation measures were implemented at St. Joe’s, it was

time to look at a regression analysis of the hospital to determine the savings being realized and to visualize the measures’ impact on utility bills. McKnight created and populated a spreadsheet but quickly discovered it would not be easy to maintain. He found it took a lot of thought and manipulative effort to get results that energy management software could provide both quickly and easily. Canvassing his energy manager community for a better way, he learned R ETScreen was the platform of choice. He downloaded a trial version and after inputting data, McKnight qu ic k l y r e a l i z e d how i nt u it ive RETScreen is, as well as how easily he could populate graphs that could be used to share a variety of energy conservation success stories. For instance, a cumulative sum control chart (CUSUM) provides a visual representation of energy savings. This is a great tool to use to promote a project and roll it out campus-wide. “A tremendous benefit is I can quickly generate easy to read graphs that I can s h a r e w it h m a n a g ement ,” s ay s McKnight. “These graphs highlight the positive changes that have been occurring at the hospital and provide a clear indication of the value of our energy management initiatives.” The simplicity of initializing and using RETScreen is to be applauded, he adds. All users have to do is download their energy data, ensure it has the proper headings to comply with RETScreen’s formatting and then bulk upload. However, McKnight does caution on too much data granularity. Using data from hourly meter readings for analysis can slowdown the software. Instead, he suggests aggregating data to daily or weekly values. “Keep it simple,” says McKnight. “Even if you have a very low power

weekend, an analysis at the weekly level will still provide a very accurate image of your weekly energy consumption, which can then be used to predict annual values.” Now having mastered the basics of RETScreen, McKnight is aiming to learn how to update the regression analysis with as little effort as possible. He hopes to soon venture into the financial portion of the software to help his team with project scoping, as well as be able to update his spreadsheet and have RETScreen automatically pick up the changes. In the meantime, McKnight is sold on t he soft ware plat for m as an invaluable energy management tool. It has allowed him to continue to focus on future energy projects at St. Joe’s and not have to worry about spending an inordinate amount of time analyzing the results from past projects. “The only thing I need to think about is keeping a log of the changes I’ve made, so that I can add those annotations to the CUSUM,” he says. Moving forward, he plans to continue updating his software model and watching the CUSUM grow in the direction of favourable energy savings. “RETScreen has become my greatest advocate for showing the tangible benefits of energy management and maintaining a position within the hospital,” he explains. “Also, when it’s time to budget for the upcoming fiscal years, it will be a simple and calculated approach — even with the ever-changing political landscape trickling into the cost of energy.” Kent Waddington is the communications director and co-founder of the Canadian Coalition for Green Health Care. He can be reached at kent@greenhealthcare.ca. WINTER/HIVER 2020/2021 25

PREFAB CONSTRUCTION FOR EMERGENCY RESPONSE

Photo courtesy NMG Workspace Solutions

Modular healthcare spaces respond to changes in client, quality care needs By Chelsea Barlow

hysical footprints in the healthcare industry tend to be large and permanent. The experience in the space is functional, safe and practical. But as client expectations have evolved (perhaps more than ever in 2020) and technology impacts how care is delivered, spaces must change. Historically, rapid change of healthcare spaces has been a challenge as they’re built to last for decades. The cost uncertainty of healthcare construction, hassle of unpredictable completion schedules, and misaligned vision and output have also contributed to outdated spaces that are less functional and pose barriers to modern, quality patient care. This is no longer the case. Spaces that can quickly change with circumstances

26 CANADIAN HEALTHCARE FACILITIES

and precision are increasingly in demand. Modular, off-site construction offers a solution. The method provides maximum flexibility, adaptability to client needs and relevance. Modular interiors are made to be added to and integrated with current designs, built around the people that use them, to budget and on time. The COVID-19 pandemic has forced the construction industry to shift from healthcare’s conventional approach of making small, iterative space adjustments over multiple years to one where spaces are not meant to stay the same but consistently change. With modular interiors, it’s possible to update internal spaces on a continuous basis without making structural changes to facilities,

and to do so with minimal disruption. An added benefit is a reduction in waste through the reuse of existing materials. PRE-MANUFACTURED VERSUS TRADITIONAL

Conventional off-site methods only manage two components of a build: schedule and budget. Even if those criteria are met (and often they are not), the client receives a building with no flexibility to manage change or control costs. This limits growth, adaptability and potentially revenue generation and management, and does not address ongoing expenses, replacement capital and human resources costs. Modular construction is the opposite. It’s a process driven by technology and designed for disassembly and repurposing for maximum flexibility to manage pro-

INNOVATION & TECHNOLOGY

Photo courtesy Nicholas Swan Photography

OPPOSITE PAGE: King Fahad Medical City in Riyadh, Saudi Arabia. ABOVE: Summerlin Hospital Medical Center in Las Vegas.

grammatic, systems and control, technology and workflow changes, while reducing replacement capital, ongoing expenses and maintenance costs in a sustainable manner. Multi-trade off-site modular construction addresses the full spectrum of construction challenges and provides practical solutions to labour, schedule, cost, quality and sustainability requirements. For example, during the construction process, fewer people are required on-site and they spend less time there. This limits the risk of infection and contamination that can cause expensive and timely delays and disruptions. Modular construction can also respond to care provider styles and technology needs. In a healthcare environment, an electrical outlet can be moved in under an hour on-site, in a less intrusive manner for patients and for a more ergonomic solution for practitioners. A modern and relevant space even affects employee retention, attraction and productivity. People now demand a workplace that is designed to keep them safe while helping them do their job effectively and with ease. This goes beyond functionality to also include how the space makes them feel. Modular construction facilities can change quickly to create the conditions needed to respect and reflect employee values without necessitating a physical move or expensive and time-consuming internal teardown Biomedical_CHF_Winter_2017_FINAL.pdf 1 and build up.

about the interior space at the onset and how to access floor and integrated vertical support in the walls before teardown keeps costs, disruption and scheduling contained. Modular construction is about working in partnership, not isolation. The client’s architect retains responsibility for the design. Drawings are fed into an intelligent software platform. Clients can then explore their design in 3-D and make next-step decisions as they simultaneously experience the space. In many instances, the purveyor of modular construction acts as a mul2017-10-23 4:45 PM ti-trade subtrade under the client’s general contractor. A project manager will A SIMPLE PROCESS assist the general contractor and other An effective off-site modular construction trades to deliver appropriate bids, process begins with planning. Thinking reflecting fewer hours and less material.

Most of the interior walls, power, networks, millwork, integrated medical gas and doors are built off-site. The trades put in the mechanical, lighting, ceiling and flooring work in a wide-open space with little material waste and fewer journeyman hours. Trades are on and off the project faster than ever before. This means clients are back in business sooner. Chelsea Barlow is market segment strategist, healthcare, at DIRTT Environmental Solutions Ltd., an interior construction company that uses technology for client-driven design and manufacturing on interior spaces. Before joining DIRTT, Chelsea worked in a hospital setting for more than 10 years. She can be reached at cbarlow@dirtt.com.

MEDICAL GAS INSPECTION & CERTIFICATION MEDICAL EQUIPMENT REPAIR & INSPECTION SCC Accredited third party Inspection Body with 38 years in business inspecting and certifying medical gas systems. Also, specialized in medical equipment preventative maintenance, calibration and repair. Contact us today to book an appointment for your certification or annual inspections. MW Biomedical Inspection Services Ltd. British Columbia – Alberta – Saskatchewan info@mwbiomed.ca | www.mwbiomed.ca P: 780 463 3877

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INNOVATION & TECHNOLOGY

HUMAN PERCEPTION IN A DIGITAL WORLD Virtual, augmented reality applications help users better understand the built environment By Robert Manna

hough often used together, there are fundamental differences between virtual reality and augmented or mixed reality. Virtual reality gives users, through a headset with built-in screens, the experience of inhabiting an artificial physical space that is entirely rendered by a computer. Aug mented or m i xed rea l it y is intended to blend the virtual (computer-driven) with actual reality via a headset or mobile device that allows the user to see the physical space while computer generated renderings of objects are overlaid and contextualized with it. Each has its merits and applicability to the design, management and maintenance of facilities, as well as varying 28 CANADIAN HEALTHCARE FACILITIES

degrees of complexity to meet specific needs or expectations. VIRTUAL ENCOUNTERS

The simplest approach to virtual reality is the use of a smartphone and a specific type of rendered image called a stereoscopic panorama — a 360-degree image rendered twice (slightly different viewpoint for each eye); they are often rendered from the computer models used to develop the design. The image is displayed on-screen and smartphone movement mimics the behaviour of standing in one spot and looking all around. If the smartphone is put into a harness like a Google Cardboard, the feeling will be like the user is standing in the space.

The smartphone and Google Cardboard approach are great for very quick turnaround and ease of sharing; however, the experience is quite limiting, particularly in terms of navigation. This approach is popular for broader use like fundraising and capital campaigns because it can be widely distributed, including posting on a website. The same models used to generate stereoscopic panoramas can often be employed (with relative) ease to create a full walkthrough experience where the participant can navigate the whole model. Materiality and geometry of objects may not be 100 per cent picture perfect; however, the intent is to convey an experience. Models can be dressed up to improve fidelity but at the cost of more time and effort since that is not the

INNOVATION & TECHNOLOGY

Images courtesy Stantec

OPPOSITE PAGE: Various examples of virtual and augmented reality headsets. ABOVE: Users interacting in a virtual environment.

level of detail required to provide a set of drawings. Full walk-throughs require some type of dedicated virtual reality headset. This could be a tethered headset that is connected to a computer capable of high-end graphic output (similar to what a ‘gamer’ requires) and provides the highest fidelity, or a stand-alone headset, which only requires a WiFi connection and the Internet. The full walk-through experience allows the user to ‘feel’ the virtual space. This level of virtual reality can be used to replace physical mock-ups, so users begin to intuitively understand how they would move around in the space and reach for or move objects. The drawback is the quickest way to produce walk-throughs does not typically offer any type of interaction with the space and its virtual objects. For example, maintenance personnel may be able to simulate reaching for a valve or replacing a filter, but they can’t grasp or manipulate the environment. If there is a need to more fully simulate the environment and provide a richer interactive experience, the same source models can be used as the basis to develop a more robust

simulation with greater interactivity and multiple users. The effort now becomes a dedicated process to allow users to evaluate specific scenarios or perhaps rooms or systems for which the cost and expense of ‘not

CHES Canadian Healthcare Engineering Society

getting it right’ far outweighs the cost of setting up the virtual reality experience. This additional work might consist of richer materials and lighting effects; interactivity with a variety of objects in the space (doors,

SCISS

Société canadienne d'ingénierie des services de santé

CALL FOR NOMINATIONS FOR AWARDS 2021 Hans Burgers Award for Outstanding Contribution to Healthcare Engineering DEADLINE: April 30, 2021

2021 Wayne McLellan Award of Excellence in Healthcare Facilities Management DEADLINE: April 30, 2021

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

For Nomination Forms, Terms of Reference, criteria, and past winners www.ches.org / About CHES / Awards Send nominations to: CHES National Office ches@eventsmgt.com Fax: 613-531-0626 WINTER/HIVER 2020/2021 29

furniture, equipment, controls); or setting it up in such a way that multiple users can co-inhabit the same virtual space simultaneously and interact with each other. WORLDS COMBINED

Advancing beyond virtual reality is augmented reality. While virtual reality puts the participant in an entirely synthetic space, augmented reality’s intent is to combine the actual physical experience with the digital. Several manufacturers have released devices in the last five years that allow the user to see all their surroundings while being immersed in a digital experience. (Microsoft has made this a point of focus with its HoloLens.) Augmented reality’s strength is the combination of real and virtual. It can be used to envision an intervention in an existing space before construction begins. For example, in a complex mechanical room, the technology could show maintenance personnel what new pipes and equipment will look like and allow them to confirm accessibility for routine maintenance and up-keep. This information can have enormous benefits by ensuring the finished product can be properly used and maintained. Augmented reality also has the potential to provide access to relevant digital data. This could be metrics coming from embedded sensors and systems (flow rates, temperatures) or the ability for an employee to call up the appropriate maintenance manual for a piece of equipment. It can be used to visualize concealed systems, pipes and conduit in walls, and air equipment above ceilings. Use of this technology during occupancy assumes the necessary 3-D models and data for the facility are available and/or systems and accompanying sensors have been implemented that would allow the data to feed to the device. Also, while the more popular augmented reality devices are headsets, much of what the technology offers could be implemented on a smartphone or tablet device that has a camera. The user would ‘view’ through the device screen, which would superimpose the digital over the camera image. REAL COSTS

Science fiction has long envisioned a future with this ‘reality.’ That future is now. Technology continues to evolve at a rapid pace and design teams can easily deliver stereoscopic images or simple walkthroughs. More complicated efforts like interactivity or augmented reality may require specialists or more advanced technology. So how much is this going to cost? The easiest way to answer this question is to seek opportunities to try various experiences and determine the value not only to users but all stakeholders. Clients can measure and assign a value to the potential savings through reduced physical mock-ups, cost impact of poor maintenance access or an environment that doesn’t meet the end user’s needs. Also, in lieu of billing based on hours, firms should be remunerated based on a percentage of overall return on investment that the client expects from the technology and services. Robert Manna is an associate, digital practice specialist, at Stantec. The international professional services company specializes in engineering, architecture, interior design, landscape architecture, surveying, environmental sciences, project management and project economics. Robert can be reached at robert.manna@stantec.com. 30 CANADIAN HEALTHCARE FACILITIES

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