By Nick Duncan

The IHEA’s Healthcare Facilities Management Conference last month was a fantastic three days and we were delighted to support the ongoing innovation in the healthcare facilities management industry as the Platinum sponsors of this event.

As promised, here’s a run-down of some of the key presentations you may have missed if you were unable to attend this year.

Vision for the future

Keynote speaker and Director-General of Queensland Health, Ian Maynard shared with us his vision for the future of Queensland Health, focusing on four key areas for development:

• Becoming even more patient-centred;
• Empowering the community and workforce;
• Driving value; and
• Investments, innovation, and planning.

From specifically a facilities management point of view, Ian highlighted the need for constant innovation to combat rising operational costs. Surprisingly, Ian stated that new hospitals are more expensive to run than existing hospitals. This obviously bears relevance given the number of construction and upgrade projects that have recently been completed in Queensland.

Ian called on the stakeholders within the industry (including suppliers) to provide as much innovation and insight as possible to assist with delivering the goals of Queensland Health.

Ian also shared the examples of Lady Cilentro Children&r’s Hospital and Gold Coast University Hospital as successful models of operation. We are very pleased with this reference as the water treatment for both hospitals are conducted by HydroChem!

The theme was compliance

The theme for this year’s conference was Compliance: Governance in Healthcare, resulting in an agenda that focused on a range of critical, confronting, and significant issues faced by the industry today.

It is what is it is! What have we learned?

Kim Bruton, Chief Engineer, Northeast Health Wangaratta

Kim related his experiences and history of significant projects / incidents at Northeast Health Wangaratta over the past 15 years. He shared the lessons he’s learnt as a result, with his key insight being that good governance is about the inclusion of every person at all levels throughout the process – from initial concept discussion through to the receiving of congratulations from the local Member of Parliament. Kim provided a number of examples where management at Northeast Health Wangaratta have made sure that such inclusiveness is part of the everyday.

Managing Legionella: achieving best practice

Stuart Lloyd, Senior Hydraulic Designer, Sinclair Knight Merz Pty Ltd (Jacobs SKM)

Stuart started by looking at the operating temperatures of a range of water systems that commonly exist within hospitals. As you may be aware, Legionella grows at 37 degrees, which means that a number of these systems can potentially harbour the bacteria. Warm Water Systems are particularly susceptible as they are within the ideal temperature range and rarely vary in temperature

He then referred to the different regulations in play throughout Australia including SA, NSW, and Queensland which mostly provide guidance on risk management strategies. In comparison, the regulation in the UK, HSE L8 (Health & Safety Executive), provides a mandatory code of compliance. The UK also has BSRIA which provides guidelines including the testing and cleaning of systems during installation and commissioning.

Stuart suggested that you should be able rely upon your water treatment service providers to provide:

• Advice – use their experience with similar situations to aid you in resolving any concerns or issues;
• Training – they will be able to train you and your people on the best way to manage the risks from an operational perspective; and
• Quality of service

All risk assessments should cover communications, testing, and disinfection of water systems

Stuart also provided examples of mains water tanks that had been poorly designed. When designing tanks, he advised, keep the following basics in mind:

• The header should be balanced so that all tanks maintain flow,
• The inlet an outlet should be diagonally opposed; and
• The tanks should be closed so they don’t gather dust and/or pests.

In Stuart’s experience, it is most important to keep hot water hot and cold water cold. This should assist in the overall goal of maintaining cleanliness.

Control of Legionella in potable water

Vyt Garnys, Managing Director & Principal Consulant, CETEC

Vyt has learned from his experience ranging from assisting with the response at the Melbourne Aquarium in 2000 through to the Wesley Hospital in 2013. In addition to assisting with the organisational response, Vyt has been involved with the development of state and federal guidelines.

Vyt advised that Legionella was far more ubiquitous than previously thought.

State guidelines to this point have been mostly cooling tower focused. In 2013 Queensland introduced the Guidelines for Managing Microbial Water Quality in Health Facilities. New national guidelines for warm water systems are to be released soon.

The features of the approach are the development of a site holistic risk management plan. Often the greatest challenge is in knowing the plumbing of existing water systems.

In terms of disinfecting water systems, traditional cleaning methods are limited. At Wesley, thermal disinfection was not effective. The recommended cleaning method involves repeated alkaline cleaning and hyper chlorination. This needs to be undertaken on a repeated bases (3 times is normal) until results indicate that Legionella is no longer present.

Vyt reiterated that the biggest challenge is getting to know the plumbing system.

Meeting Queensland microbial water quality guidelines

Alex Mofidi, Australian/New Zealand Water Treatment Practice Leader, AECOM

Alex presented statistics to show that Queensland has a relatively low rainfall and long water storage times. There is also evidence to show that there are only low levels of chlorine at distribution points. The other important point he shared was that Queensland is a warm state, so the distribution networks operate at high temperatures compared to other states.

As a consequence of the above, bacteria will grow within the pipework and reticulation systems. Therefore, it is possible that bacteria will be introduced into your systems via the mains water.

Alex then reviewed the HACCP (Hazard Analysis and Critical Control Points) approach that is utilised in the food industry to minimise the risk of biological, chemical, and physical hazards. A similar approach can be followed in relation to the water systems within hospitals – but we’re not making food.

There is a need to variable and flexible as to how you apply the risk management approach within hospitals. You should focus on:

• Knowing your water systems; and
• Creating risk management plans for your systems.

A practical approach to facility regulatory compliance

Frederic Jeunet, General Manager, AMEC Australia

Frederic has been involved in designing the Victorian Comprehensive Cancer Hospital. He reviewed some of the Codes for compliance such as the Therapeutic Goods Administration, Dept of Health and State Pharmacy Authorities.

In his presentation, he shared that it is important to use a Verification Approach during design. That is, each stage of design needs a corresponding stage of verification during the commissioning phase.

To achieve this Verification Approach, your team must understand regulatory requirements. Therefore, it is best to use well-trained, experienced staff and a robust framework with full traceability.

Keynote Address: Winning the Battle for Relevance

Michael McQueen, Social Researcher

Renowned commentator, Michael McQueen presented on the morning after the IHEA cocktail party. His blend of stand-up humour, insightful observations, and anecdotes grabbed the attention of the audience.

The presentation began with him sharing a list of organisations that failed to recognise shifts in their respective markets and change accordingly. As a result, organisations such as Kodak and Atari who were once market leaders, were forced to file for bankruptcy.

Changes in demographics, technology, and legislation were all factors that impacted the shifts these organisations experienced.

Michael’s presentation shared examples of how a hospital engineer could anticipate change, and prepare for its impact by:

• recalibrating,
• reengineering
• reframing and
• repositioning

The delivery was both entertaining and thought provoking, with valuable suggestions applicable to all professionals working in a rapidly changing marketplace.

Keynote Address: Mao’s last dancer

Li Cunxin, Best Selling Author and Public Speaker

Thursday’s keynote address was given by Li Cunxin, the world-famous ballet dancer and choreographer. At first glance it may seem odd for a man of his talents to be presenting at a hospital engineers’ conference, but his talk was less about dancing and more about the determination and attitude that was required for him to rise to the top of his profession – in that there were some valuable insights for the audience.

Li told in emotive and graphic terms how he was born into abject poverty in rural China, always hungry and bitterly cold in winter. His many brothers and sisters huddled together in their village shack with only his father’s fables to cling to in hope. His life seemed mapped out; he was a frog in one of the fables, trapped at “the bottom of the well” who would have to be content to see just a small patch of sky. Then at the age of 11, he was pointed out at random by his school teacher to some visiting government officials, and as a result was selected to train as a ballet dancer in Madam Mao’s Beijing Dance Academy.

Listening, we all assumed that the story then ran its natural course; that he worked hard and became a success. But no, it was not that easy. Initially he was homesick (despite having the luxuries of food, clean clothes, and shelter), hated ballet and was at the bottom of the class on the verge of being kicked out of the school. It took years for him to value his privileged position, to accept responsibility for his life, and make the most of the opportunity that he had been given to both himself and his family, and to actually realise what was possible to achieve. Once he had done so however he became utterly single minded in his study and training, with an unquenchable thirst for learning – an approach which he has kept for the rest of his life.

Li also told of his experience when exposed to western culture and of his difficulty reconciling the demonising Maoist state propaganda that he had been brought up to believe, with the freedoms and affluence he witnessed on his first trip to America. Needless to say he worked it out and eventually defected, but the shock was profound and was the second lasting impact on his attitude to life, which he has refined down to:

• Always be a student, never stop looking to learn; and
• Always question, never assume that the current truths are absolute.

Whether running a hospital or more generally living a life, it would be hard to argue against the merit of these values.

Technical tours

The IHEA had organised two technical tours around the facilities of Lady Cilento Children’s Hospital and Brisbane Town Hall. By happy coincidence, HydroChem provides water treatment services to both the Hospital and the Town Hall.

Lady Cliento Children’s Hospital

The project covers around 80,000 square meters of floor space and was expected to cost around $1.4 billion. The site is in the final stages of construction, with the majority of works associated with the central energy plant being complete. We were able to walk-through the site and see firsthand the scale and innovation that has been applied.

The cooling tower systems have self-cleaning automatic screen filters supplied by HydroChem. The system utilises a special “pop-up” distribution nozzles within the cooling tower basis to provide maximum water turbulence. This turbulence minimises the settling of dirt and other solids that can contribute to biological fouling.

We also had a tour of some other innovative technologies such as the trigeneration system, designed to cut energy costs while improving efficiency. Within the hospital itself, day lighting, natural ventilation, and water harvesting have all contributed to the project’s sustainability credentials.

What struck me the most

Personally, I took something from each of the presentations I attended. There was great variety – from tales about recovering from catastrophic incidents to international ballet careers starting in communist China.

Overall, the message that struck me the most was the importance of learning. For many of us, the learning process was deemed to have concluded at the end of school, university or TAFE. However, the process continues in a less structured way throughout our lives. The important thing is that we realise that we’re still learning – that we keep our minds open and accepting of new ideas.

We attended IHEA this year to learn about innovations in compliance – whether through new ways of thinking, new products and services, or innovations brought about by others’ experiences in times when things haven’t gone to plan.

We presented too

Both Les Szabo and I also deeply appreciated the IHEA’s invitation to present. While we looked at it from two different angles, both our presentations focused on providing you with a framework for driving downs the risks and operational costs associated with water treatment at your hospital, which aligns very closely to our promise to you as HydroChem.

Download the conference papers and presentations

To help you kick start the process of optimising your water treatment operations, we’re sharing the conference papers our presentations are based upon and the presentations themselves with you, so that you can leverage the recommendations in your operations. Please download them below.

Please share your thoughts on my blog or the conference below.

If you’d value a discussion around any of topics I’ve discussed above or would like to learn more about whether you are exposed to avoidable risks or operational costs as a result of the water treatment processes at your hospital, please contact me on 1300 558 788 or leave me a message here.

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