HH Angus is a proud sponsor and presenter at the Canadian Healthcare Engineering Society (CHES) Conference on September 17-21, 2022 in Toronto. Two members of our firm will be presenting two different topics at the conference this year.

Akira Jones, Director of our Digital Services group, will be presenting on “The Future of Hospitals: Harnessing Smart Buildings Technologies and Data to Improve Patient Care and Facilities Operations” (September 19, 12:00 – 12:30PM, Track 4B).

This discussion will explore an approach to smart hospital solutions that implement purpose-built small-scale systems on a scalable platform to address specific challenges typically faced by an existing healthcare facility. Akira will use a real-world example to illustrate the opportunities and key considerations focused on updating existing infrastructure.

Marianne Lee will be co-presenting with Jessica Fullerton (The Ottawa Hospital) on “There is Something in the Water. Do you Know What it is and How it Can Hurt You?” (September 20, 13:15 – 13:45, Track 8B).

Plumbing systems in Canadian health care facilities (HCFs) are being recognized for the critical role they play in the day-to-day operations of the HCF. They can be sources of various infectious disease transmission such as CPE and legionella. As such, they must be designed, operated and maintained to contribute to patient and worker safety. This presentation will provide an overview to better understand which various pathogens are present within the plumbing system, the signs and symptoms of an outbreak, and how proper design and on-going maintenance can mitigate the risk in existing, new and renovated HCFs.

Click on the link below to learn more about the conference program and how to register.

https://ches.org/conferences-and-events/2022-ifhe-ches-conference/2022-program.html

Infrastructure Ontario (IO) and Children’s Hospital of Eastern Ontario (CHEO) have announced the shortlisted teams to design, build and finance the 1Door4Care: CHEO Integrated Treatment Centre project in Ottawa.

HH Angus is providing Mechanical Engineering consulting services as part of the EllisDon Infrastructure Healthcare team which was named as one of the three teams moving on to the RFP stage for this project. The new facility will merge seven care locations into a single, state-of-the-art, purpose-built site on CHEO’s main campus and will include multi-use clinic space, a physiotherapy rehab gym, expanded mental health clinics, indoor and outdoor space where teachers and therapists combine education and therapy, secure space for children who have been abused, modern treatment rooms for kids with behavioural needs, advanced technology to enable virtual care, a physical link to the main building on campus, family support spaces, a new parking structure, and more.

A request for proposals (RFP) is expected to be issued in fall 2022.

Source link: Teams Shortlisted for 1Door4Care: CHEO Integrated Treatment Centre project

The impact of poorly managed, maintained plumbing systems and mitigating risks

Healthcare facilities are places of healing, with a burden of responsibility on architects, designers, engineers, contractors and operators to design, maintain and operate them as safe buildings to support patient care and minimize the transmission risk of healthcare-associated infections (HAIs). 

Plumbing systems can contribute to the proliferation of pathogens in a facility’s water supply system and facilitate water-toair transmission of pathogens through water fixtures, contaminated traps and aerosolization of toilet bowl contents. Special considerations impact the selection of fixtures for healthcare facilities, including cleanability, hands-free activation and laminar flow faucets, and suitable physical dimensions to facilitate proper handwashing. Designers must also balance sustainability and water conservation efforts with infection prevention and control concerns, which impact fixture flow rates, recycled or grey water reuse.

PLUMBING SYSTEM PATHOGENS
Microorganisms present in healthcare facility plumbing systems include gram-negative pathogens of medical importance, such as Escherichia coli, Klebsiella, Serratia, Pseudomonas aeruginosa and Legionella pneumophilia. Legionella replication within protozoa provides the pathogens with protection from biocides and heat used to disinfect water systems, making it very difficult to eradicate once established. Major risk factors within the plumbing system include stagnation, reduced disinfectant levels and inadequate hot water temperatures. Factors that increase the risk further are the presence of scale and sediment, biofilm and pH fluctuations. Actions known to release resident bacteria are construction activities, watermain breaks, water shutdowns and changes in water pressure. 

CSAstandardZ317.1, SpecialRequirements for Plumbing Installations in Health Care Facilities, includes specific design and maintenance requirements for plumbing systems that minimize the development and proliferation of pathogens in them. 

Water conservation is a significant concern given the growing push to preserve resources and for buildings to achieve LEED accreditation involving water use reduction credits. Unfortunately, water conservation measures have been associated with an increase in bacterial contamination. To address this, Z317.1 prohibits the use of aerators and mandates a minimum flow rate of 1.5 gallons per minute for lavatory and hand hygiene sink faucets.

Another factor is energy conservation targeting domestic hot water systems through the lowering of generation and distribution temperatures, and the introduction of energy conservation devices. Z317.1 mandates hot water system temperatures and specifically addresses water preheating as part of an energy recovery strategy, prohibiting it unless the healthcare facility has performed a documented risk management exercise. 

In terms of maintenance requirements, the latest edition of Z317.1 contains a new clause requiring healthcare facilities to develop a documented water management plan to manage and mitigate risks to their water systems. This clause references ASHRAE standard 188 and establishes minimum legionellosis risk management requirements for building water systems. These are described in Annex E in Z317.1, and include building water systems analysis; control locations; control limits; monitoring; corrective actions; implementation; and documentation.

REMEDIAL MEASURES
When microbial contamination is identified in a healthcare facility, prompt remedial action is required. This typically involves system decontamination, either by chemical shock treatment through hyperchlorination or thermal shock treatment (superheating). Z317.1 requires that hyperchlorination be implemented for new or significantly altered systems, or following the reactivation of a plumbing system that has been inactive or that was drained for an extended period. Annex D in the standard includes guidance on both superheating and hyperchlorination, describing the method and precautions for both.

Flushing can also be implemented as a remedial measure and as part of routine maintenance to prevent water stagnation. Flushing begins at the building service line and works systematically through the building systems to avoid introducing or moving contaminants from one location to another. The latest edition of Z317.1 includes updates regarding unused portions of a water system and requires a risk assessment be performed prior to its shutdown. For any time frame of two weeks or more, the water system must be disinfected prior to being drained or put into an out-of-use state, or must be flushed thoroughly for a minimum of 10 minutes at least twice a week. 

When a single case of healthcare-associated Legionnaires disease is detected, immediate investigation and control measures should be initiated. If contamination is identified, disinfection of the water distribution system may be necessary. If hyperchlorination is performed, chlorine should be introduced into the potable water system to maintain a minimum target chlorine contact time value of 4,000 ppm-min per litre at every outlet for a minimum of three hours, but not exceeding 24 hours. Showerheads and aerators/laminar flow devices should be removed prior to system disinfection and either disinfected or replaced before reinstallation. Every outlet must then be flushed until chlorine residual returns to normal municipal water levels. It is important to prevent aerosolization of water during this work. A risk assessment should be performed to determine the need to relocate respiratory fragile patients, such as neonatal intensive care infants, due to chlorine off-gassing during disinfection.

After disinfection, approximately 10 per cent of fixtures should be resampled with measures in place to protect at-risk populations until results are received. Further testing should take place every two weeks for the following three months and then at three-month intervals.

FINAL TAKEAWAYS
Plumbing systems can contribute to injury and the spread of infectious diseases due to hazards created by improper temperatures, stagnation, leaks and inadequate drainage, and adverse conditions created by failure or improper operation.

A detailed water management/water safety plan is imperative and must take into account patient populations and services provided, as well as the age, complexity and limitations of the plumbing infrastructure for each building. Z317.1 can assist by providing guidance on design and maintenance requirements that minimize the development and proliferation of pathogens, and ultimately reduce the risk of HAIs. Healthcare facilities should consider various situations when developing their water management plan, such as how to perform a system-wide disinfection if required, how to deal with a loss of water, the potential to run a mock code grey and acceptable legionella concentrations.

 

Marianne Lee is a principal and senior mechanical engineer at HH Angus and Associates. She is chair of the CSA standard Z317.1, Special requirements for plumbing installations in health care facilities. Jessica and Marianne can be reached at jfullerton@toh.ca and marianne.lee@hhangus.com, respectively.

 

 

 

Jessica Fullerton is the infection prevention and control lead for The Ottawa Hospital planning and redevelopment department. She is also chair of CSA standard Z317.13, Infection control during construction, renovation and maintenance of health care facilities. 

Congratulations to Tim Zhu on being chosen as one of the ‘Top 10 Under 40’ on Canadian Consulting Engineers’ annual list of outstanding young engineers.

Tim is a senior mechanical engineer and project manager in HH Angus’ fast-paced Commercial Division. Since joining the firm in 2013, he has consistently demonstrated strong technical abilities and a dedicated work ethic, often putting in extra hours to ensure clients’ work is completed with the utmost quality and care. He has also been instrumental in developing calculation tools for HH Angus, including HVAC piping and ductwork sizing tools, ASHRAE 62.1 calculation tools and more. Tim is also member of ASHRAE and enjoys the distinction of being the first HH Angus WELL APTM-accredited staff member.

Tim expresses his passion for engineering by developing standards and protocols through his work. He is a member of the HH Angus sustainability committee, the standards committee, and the calculation tools committee. Tim is currently working on overhauling HH Angus’ drafting standards to be implemented in the REVIT platform. He is also developing template control sequences and diagrams based on the ASHRAE 36 High performance Sequences of Operation for HVAC Systems. Tim regularly provides instruction and training for colleagues, including both new and experienced engineers and designers, and volunteers in University of Toronto’s Engineering & Strategies Practice course, working with students to provide real-world context to their studies.

We warmly congratulate Tim on this significant honour that publicly recognizes his outstanding efforts and qualities – well done!

To read more about this year’s Top 10 Under 40, please click here.

“Azure’s International AZ Awards recognize excellence and innovation in architecture and design, and celebrate the world’s best projects, products and ideas.”

This international design competition annually selects winners in the categories of design, architecture, landscape architecture, urban design, experiential graphic design, interiors, concepts, student work and social good/environmental leadership. The 2022 awards saw Toronto’s Mirvish Village redevelopment project winning in the Urban Design Vision category. Click here to read more about the Mirvish Village AZ Award.

Award-winning Redevelopment

Mirvish Village is rising on the site of ‘Honest Ed’s,’ a much-loved discount store that was at the heart of Toronto’s Mirvish Village neighbourhood for almost 70 years. The redevelopment is currently under construction and spans 4.5 acres, creating nearly 1 million ft2 of purpose-built rental housing and retail space.

Mirvish Village has a focus on sustainability and affordability. To achieve this, the redevelopment is incorporating a district energy system and micro-grid that will offer a resilient means of thermal energy, power, and emergency power, enabling the project to meet LEED platinum and the City of Toronto’s Tier 2 Toronto Green Standard requirements. 

HH Angus’ Role

Our Energy Division team worked closely with Creative Energy Developments to provide mechanical and electrical engineering services for the Village’s central utility plant, which includes a combined heat and power plant (CHP), a boiler plant, and a cooling plant. The CHP plant includes an 800 KW generator set with auxiliaries and heat recovery system. The generator is expected to run continuously to provide power to the complex.

Heat recovery consists of two systems: high temperature to provide heat to buildings, and low temperature to provide additional heating for a winter snow melting system and swimming pool heating. The boiler plant includes four condensing hot water boilers, with the option for two additional boilers in future. All boilers have an output of 3.1 MW.

The cooling plant includes two water-cooled chillers, operating at 1200 tons each. One is a magnetic bearing chiller with variable frequency drive (VFD), and the other is a centrifugal chiller with VFD. As well, two rooftop cooling towers at 1200 tons each have been installed. 

Central distribution piping from the plant will provide hot water and chilled water to multiple energy transfer stations, with heating, cooling, and domestic hot water heat exchanges for each building within the complex.

A photo-voltaic solar system will have a capacity of 103KW, 480V. HH Angus provided direction for locating the installation, coordinated with the PV supplier for modeling the panel direction and angle for optimal PV output, developed technical connection requirements with Toronto Hydro, and identified requirements for parallel generation with the central utility plant. Our scope also included developing thermal and electrical metering strategies within a microgrid system, and design of operation for gas-fired emergency generators in electrical peak shaving mode.

Rendering courtesy of Westbank Corp

 

Mirvish Village - AZ Awards | AZ Awards (azuremagazine.com)