The First Facility Management Blog

Healthcare facilities can benefit from the services offered by Trane, a business of Ingersoll Rand, through its Environment of Care (EoC) program. The company has found a strong tie between the physical environment of care and patient outcomes, patient and staff satisfaction, and financial performance of a healthcare organization. As such, the EoC program is focused on working with healthcare facility managers to identify conditions in their physical facilities that are taking away from the effectiveness of patient care.

In internal research conducted by Trane, 93% of the healthcare executives asked said the physical environment is “Important” or “Very Important” to the patient experience. Carolyn Clancy, MD, U.S. Director, Agency for Health Research and Quality, has stated, “As hospital leaders continue to seek ways to improve quality and reduce errors, it is critical that they look around their own physical environment with the goal of ensuring the hospital contributes to, rather than impedes, the process of healing.”

Laura Rygielski Preston, FACHE, Director of Healthcare for Trane, says, “We feel it is best to understand the culture of the healthcare organization in developing organizational recommendations. This is done through interviewing key stakeholders, building assessments, and collaborative discussions. A comprehensive solution is developed through analyzing many factors.”

When Trane conducts an EoC assessment for a facility, broad focus areas include:

• enhancing patient safety by reducing infection, risk, injuries from falls, and medical errors
• eliminating environmental stressors, such as noise, that negatively affect outcomes and staff performance
• reducing stress and promoting healing by making healthcare facilities more pleasant, comfortable, and supportive for patients and staff alike.

Trane has the expertise to optimize indoor environments with its broad portfolio of energy efficient heating, ventilating and air conditioning systems, building and contracting services, parts support, and advanced controls for buildings.

While some changes to facility operations may involve no- or low-cost strategies, improvements to a hospital’s physical environment are often candidates for performance contracting, a funding mechanism that is available through Trane. Examples of action that might be taken to improve a healthcare facility through the EoC program are:

• Installing more energy efficient lighting and electrical systems
• Optimizing central chilled water and steam boiler systems for improved operation, efficiency, and water conservation
• Upgrading heating, ventilation, and air conditioning (HVAC) systems and controls
• Increasing energy efficiency, effectiveness, and throughput of laundry operations

(Photos courtesy of Trane Commercial Systems)

With cold and flu season upon us, spending time reviewing your HVAC system, its major components, and air and water distribution is time well spent to help mitigate the spread of type A (H1N1) and other types of Influenza. Some of the precautions may be based on adopting simple common sense measures, while others are related to proper maintenance protocols. In addition, there are system upgrades that can be performed to help mitigate risks. Below is a list of tips to consider during cold and flu season:

• Monitor facilities to ensure that no warm, stagnant water is present (which can provide an environment conducive to the growth of problematic microbes such as Legionella, the cause of Legionnaire’s Disease).
• Monitor areas including cooling towers, pooled water on roofs, or clogged drains that can harbor unhealthy contaminants that can be introduced into the building and circulated by the air distribution systems into occupied spaces.
• One simple change facilities can implement is to upgrade the efficiency of the air filters. As filter efficiency increases, typically their resistance to air flow also increases. Always check to be sure the fan system can handle the resistance being imposed by the filters and other components in the system. Also, select replacement filters based on the specific particles you intend to collect. Viral droplets or droplet nuclei of influenza, for instance, are very small but are typically surrounded by a mucus shell making them larger and easier to remove.
• It is necessary to re-evaluate how and when filters should be changed. Rather than set a simple schedule, it may be more prudent to measure the pressure drop through filter banks and set up basic performance metrics to determine the best model for filter changes.
• Simple measures are the first line of defense. Technicians should wear cut-resistant gloves when performing filter changes or basic maintenance to air dampers and commonly exposed system components. Also, properly fit respirators may help to ensure that the risk of exposure while working above the ceiling or in poorly ventilated areas is minimized.
• A common service and maintenance procedure is to verify correct outside air intake dampers settings and operation. Most commercial spaces should operate at a slightly positive pressure relative to the outdoors to reduce the likelihood of contaminants infiltrating into the occupied areas.
• Check and validate restroom and other critical area exhaust fans to assure they are removing contaminants from the building before they become mixed with the indoor air. Perform preventive maintenance on small exhaust fans to ensure they have not accumulated dirt, reducing their effectiveness.
• Provide staff with basic training and increase overall awareness about the risks of influenza exposure and the likely ways to contract the virus. Also, conduct formal training of staff technicians and subcontract workers in how to work with your building systems to reduce risk and increase health and safety as well as reducing exposure to other harmful airborne particles.
• Direct contact is the most common pathway for the spread of disease. Communicate influenza safety tips and precautions to all building departments – especially those whose primary function includes occupancy of guests, visitors, and the general public.
• Encourage hand washing among all staff. If possible, add hand cleaner and hand sanitizer supplies at air handler locations, equipment controls, railings and access doors.

There are many resources to provide details and more complete planning recommendations including:

• · IFMA Foundation’s Pandemic Preparedness Manual
• · The Center for Disease Control and Prevention
• · The Federal Emergency Management Agency

These tips have been provided by Trane (although the image at the beginning of the article was supplied by Cathy Aste).

Every cooling season, accident rates rise among facility staff and contractors. This is due to heavy cooling season workloads and the rush to respond to unscheduled maintenance. Summer brings more on site accidents of all types, and it’s critical that facility managers (fms) are prepared.

“Even under the pressure of a cooling emergency, take time to plan ahead, especially for safety,” says Bob Murphy, Trane safety leader. “No one goes to work expecting to get hurt. Safety is good for individual business and for practicing at customer sites. One of the most proactive things you could do before starting equipment repair or replacement is to ensure you have the right tools and personal safety equipment.”

Murphy recommends:

• Wearing the proper head protection for all conditions. MSA Hard Hats offer protection for the most stringent requirements of Class E Electrical Rating which is tested to withstand 20,000 volts.
• Conducting a job site audit for every new project to insure you will work in safe conditions.
• Using a strong glove when working with metals—lacerations and scrapes are the number one injuries. The Terminator Glove, made of Dyneema the world’s strongest fiber, can protect hands against injury and can be laundered for repeated use and a long life.
• Having what you need before starting a new project including: tools, equipment, approach boundaries, guards, barriers, PPE, knowledge, training or personnel.
• Wearing proper eye protection. Nearly 70% of eye injuries occur from flying particles and can be prevented by wearing the right safety glasses. Nemysis Eye Protection and AO Safety Eyewear provide wrap around styles to insure flying particles don’t reach the eyes.
• Training your 5 + 1 senses to recognize hazards including: sight, hearing, smell, touch, taste, and common.
• Keeping cool. Heat illness is indicated by: fatigue, confusion, nausea, fainting, clammy skin, and low blood pressure. When these signs of heat stress are present, stop exerting, move to a cooler place, and drink plenty of fluids with electrolytes. Electrolytes are crucial to maintaining healthy muscles and a productive energy level. To help stay cool, use a MiraCool Bandana—which helps keep the body cool and comfortable for up to 48 hours.
• Notify others when you observe unsafe actions. Use the S.T.A.R. (Stop, Talk, Agree, Recognize) method to help correct it.