Facility management of Healthcare facilities

STAT CONSULTANCYPVT. LTD. CONSULTANCYSERVICES PROPOSAL 1
HEALTHCARECONSULTANTS
STAT Consultancy
2018
mail@statconsultants.com +91 94460 01295/ 91/ 92www.statconsultants.com
FACILITY MANAGEMENT FOR HEALTHCARE
FACILITIES
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FACILITY MANAGEMENT
IN HEALTHCARE FACILITIES

CompanyProfile
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STAT is an experienced Healthcare Consulting firm which
kicked-offin2007.Wehaverendered50+projectsandstill
counting. We are a network of highly experienced
healthcare professionals with expertise in all the areas of
services offered. The services offered are delivered
through a well established system based methodology
developed andestablishedoveryearsofexperience.
We believe in a symbiotic method where Design and
Project Management become interdependent and
compliments each other. STAT adopts a unique
mechanism in perfecting our work through a “Design
Forum” where the Project Management feeds inputs to
theDesignDepartmentandviceversa.
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Our
Verticals
HealthcareProject
Management
Healthcare
Design
Commissioning&
PostOccupancyEngagement
Design&BuildofCriticalcareandSurgicalAreas
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HTM AP(UK) certified professionals
ASHRAEcertified HVACprofessionals
ASHE(American Society ofHealthcareEngineering) certified commissioningprofessionals
ProfessionalstrainedinSwedenfor pneumatictubedesign
andinstallation
Postoccupancyengagement in hospitals
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FacilityManagement
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OUR APPROACH• GAP analysis for facility management in infrastructure
• Conduct Energy Audit for the facility
• System analysis for value measurement and their interpretations
• Development of Infrastructure Upgradation Plan
• Development of Energy management plan
• Applying LEAN methodologies
• Development of SOP for Facility management
• Training staff and personnel based on the plans developed
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UtilityManagementPlan
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To establish, maintain, and continually provide a reliable utility systems management program to
promote a safe, controlled and comfortable environment of care for patients, visitors, and personnel
of the facility by the assessment and minimization of risks of utility failures and to ensure the
operational reliability of the utility systems.
• Ensures operational reliability of utility systems.
• Reduces the potential for organization-acquired illness to be transmitted through the utility
systems.
• Addresses the reliability and minimizes potential risks of utility system failures
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• The management plan specify maintenance strategies for all utility system equipment in the
inventory and define intervals for inspecting, testing, and maintaining each item of equipment.
• Performance under the management plan must be monitored on a continuing basis, typically
using performance measures similar to those used in medical equipment management plans, and
the management plan must be evaluated annually.
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The objectives of the Utility Systems Management Plan include:
• Comply with all relevant safety standards and regulations.
• Provide a safe, controlled, and comfortable environment for patients, staff, students and visitors.
• Ensure the operational reliability of the utility systems:
 Direct Life Support systems
 Infection Control systems
 Non-Life Support utility support systems
• Reduce the potential for hospital-acquired illness.
• Assess special risks of the utility systems.
• Provide a plan for response to utility systems failures.
• Effect essential coordination for scheduled utility systems interruptions.
• Establish and maintain a program of policies and procedures consistent with the organization’s
mission, vision, and values.
• Enhance of maintenance of the utility systems to reduce and minimize system failures and/or
interruptions.
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KeyPerformance
IndicatorsFACILITY MANAGEMENT FOR HEALTHCARE
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• Age coefficient (ACy) is defined as a coefficient for the adjustment of maintenance needs for each
particular year with respect to the mean annual expenditure along the designed life cycle (DLC) of
the facility.
• Annual maintenance expenditure (AME) reflects the scope of expenditure per m2 built (excluding
cleaning, energy, and security expenditures). From an organizational viewpoint, this parameter
determines the annual expenditure on maintenance of a clinic/hospital; and provides a means to
assess the overall expenditure on built assets with reference to the organization’s turnover.
• Building performance indicator (BPI) enables the evaluation of the overall state of a hospital building,
according to the physical performance of its components and systems. This enables us
• (1) to evaluate the overall state of a facility;
• (2) to evaluate the state of the facility’s systems;
• (3) to benchmark the asset’s performance in relation to other facilities (inter-organizational
benchmarking); and
• (4) to benchmark the systems of the clinic or hospital in order to compare the efficiency of the
various maintenance crews (intra-organizational benchmarking).
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Maintenance efficiency indicator (MEI) This indicator examines the allocation of resource for maintenance
in relation to the facility’s performance. This indicator expresses the expenditure on maintenance per
hospital/clinic performance unit, adjusted to prevailing conditions.
Ranges for the MEI in hospital facilities
Three ranges for MEI were established for hospital facilities:
– MEI < 0.37 reflecting high maintenance resource utilization efficiency, and/or lack of resources;
– 0.52 ≤ MEI ≥ 0.37 indicating normative use of maintenance resources; and
– MEI > 0.52 indicating high input in comparison with the actual performance, and/or surplus of
resources.
The coefficient enables delineation of the resources required for replacement and maintenance
activities; based on this outline, an annual maintenance plan can be drawn up. In addition, this
coefficient is used to evaluate the actual efficiency with which maintenance activities are implemented
and enable us to develop the SOP and UMP based on the same
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MEP SYSTEMS
TO BE OVERLOOKED
• HEATING VENTILATION AND AIR-
CONDITIONING
• ELECTRICAL SYSTEM
• MEDICAL GAS PIPELINE SYSTEM
• FIRE PROTECTION SYSTEM
• PUBLIC HEALTH ENGINEERING
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HVACSystems
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• The primary objective of HVAC systems in any facility is to provide appropriate levels of
temperature, humidity, and ventilation. HVAC systems in healthcare facilities have an
important additional role in infection control.
• HVAC is designed, installed, and maintained to provide appropriate pressure relationships, air-
exchange rates, and filtration efficiencies for ventilation systems serving areas specially
designed to control air-borne contaminants (such as biological agents, gases, fumes, and dust).
• The schedule of regular inspection of filter performance monitoring equipment, air pressure
sensing equipment, and airflow rate sensors is to be managed
• We are engaged to verify volume flow rates (air exchange rates, and positive or negative
pressure rates) and pressure relationships as part of the commissioning of all new building
projects and major space renovations. In addition, the air volume flow rates and pressure
relationships are tested periodically throughout the hospital including investigation of
complaints related to indoor air quality. The results of testing are used to adjust the
performance of air handling systems by changing control software parameters and mechanical
or electrical controls.
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STAT CONSULTANCY
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ElectricalSystems
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Emergency Distribution: Include emergency power for equipment that could cause patient harm when
it fails including life support, blood, bone, and tissue storage; air compressors; and vacuum systems,
operating rooms, recovery rooms, obstetrical delivery rooms, nurseries, and urgent care areas;
The electrical power distribution system includes a variety of components that generally operate at
high voltage and current levels. Inspection and maintenance of these components requires
knowledgeable personnel and extensive safety precautions to insure that electrical systems
undergoing maintenance remain de-energized until all personnel have completed their work. And, as
is the case for most utility systems in healthcare facilities, careful planning of inspection and
maintenance work is required to mitigate the effect of utility interruptions on patient care.
A program of inspection, maintenance, and testing of the essential electrical system is to be maintained.
Each system motor/generator set is tested under connected load conditions as per SOP. Appropriate
notice of each test run is forwarded to departments throughout the hospital. Tests will be delayed if a
critical medical procedure is underway and unanticipated failure of the essential electrical system
would result in immediate life threatening conditions, but testing is conducted within the defined time
frames.
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We adopt a risk management approach for enhancing the safety of the electrical installation. In this
approach, clinical locations are classified into three groups based on the level of criticality of the
treatment and whether any loss of power will compromise patient safety.
For instance, Group 0 and Group 1 locations are low and intermediate risk areas respectively, where
the contact of any medical equipment would only occur with patient’s external body parts. In these
two types of locations any loss of power for more than 15 seconds is not acceptable though it may not
always compromise patient safety and will not endanger life.
Group 2 locations are high risk locations where prolonged contact is needed between medical
equipment and patient’s internal body parts and loss of power can be life threatening. Therefore, use
of Isolated Power Systems is mandatory for minimising the electric shock hazard. Furthermore, loss of
power for more than 0.5 seconds cannot be tolerated and hence, use of external Uninterrupted Power
Supplies or internal batteries is considered essential.
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MGPSSystems
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A medical gas pipeline system (MGPS) is installed to
provide a safe, convenient and cost-effective system
for the provision of medical gases to the clinical and
nursing staff at the point-of-use.
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Medical Gas Pipeline System
in Healthcare Facility
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MGPS – Critical law
Patient safety is paramount in the design, installation, commissioning and operation of medical gas
pipeline systems. The basic principles of safety are achieved by ensuring quantity of supply,
identity of supply, continuity of supply and quality of supply.
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 The safe operation of a medical gas pipeline system relies on skilled staff who understand the
system and who can liaise with clinical users to ensure continuing patient safety.
 The pipeline systems contain gas under pressure, which can present a hazard to staff.
 The key to safe operational management is the availability of comprehensive installation data and
maintenance manuals.
 In addition, to ensure continued patient safety, permit to-work procedures are essential to
manage any intended or possible interruption of a supply
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MGPS in Operation

• Many of the difficulties arising from failure of medical gas supplies can be avoided if operational
protocols are in place before emergencies arise.
• Operational policy will be prepared. This should be based on a fully documented compliance
survey in which the MGPS is examined in the light of current requirements
• Any deficiencies are highlighted and become the subject of risk assessments where current risks
are analysed and solutions recommended along with re-assessed risk levels.
• Each risk is then attributed a priority level, and high-priority risks are summarised and used to
develop a remedial action plan.
• The operational policy will be based on the system at the time of the survey. Many of the
procedures it contains will be aimed at minimising identified risks. Some of these risks will
disappear as the system is brought up to specification.
• For this reason the operational policy must not be seen as a “static” document; rather, it will
change to reflect the needs of staff managing and using the MGPS.
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FireProtection
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Why Fire Protection ?
Fires can be devastating, especially in a hospital where a large
number of people who need to be evacuated may be vulnerable –
immuno-compromised, on life support, and incapable of moving on
their own. There are special requirements that must be met with
while evacuating such people in case of fire emergencies. But before
that – “fires must be prevented”.
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LACK OF FIRE SAFETY MAY LEAD TO …

Reports
“In December 9, 2011, a massive fire broke out at annex building of AMRI Hospital Dhakuria,
Kolkata in the early hours of the morning. The fire was first noticed by local residents at around
3.30a.m. Fire Control Room, Kolkata was informed about the incident at 4.10 am. Immediate
response from the fire services was arrived at the site within 20min. Though the fire was primarily
initiated and restricted within the basement of the hospital but poisonous smoke was sucked by air
conditioning ducts that carried it through the rooms and the corridors of the seven-story centrally air
conditioned hospital. Entire hospital building was filled with thick pile of smoke, caused
tremendous suffocation for all the indoor patients. Ninety people choked to death, many of them
are in their sleep or were not in condition to even escape. Among the list of dead persons, there
are persons from other Countries and States too. There are victims from Bangladesh, Bihar, Tripura
and two nurses from Kerala.”
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• NEED OF FIRE PROTECTION
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PRESENT
DAY

Fire Safety Plan
A Fire Safety Plan is designed by the building owner to identify
the actions that should be taken by the occupants and
building management in the event of a fire or
similar emergency situation. The Fire Safety Plan therefore
covers fire prevention, evacuation and emergency response.
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FIRE SAFETY THROUGH SYSTEMS
• Fire protection system
• Safety precautions
• Smoke extractors
• Compartmentalization
• Egress
• Evacuation
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• Bed ridden / mechanically life supported
patients
• Storage of reagents and hazardous materials
• Commercial kitchen within the system
• Use of alcohol based handrubs
• Liquid Oxygen tanks
• Large volume of backup fuel for DG
• Large number of electrical and electronic
equipment connected
• Presence of large volume of pressurised
oxidising agents(Medical oxygen)
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TYPE OF RISKS IN HEALTHCARE
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STAFF RESPONSIBILITIES
• At least 40 % of the staff to be trained in fire safety
• Evacuation as well as fire safety plan to relocate patients to care areas
• Transmission of appropriate alarm to the concerned
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ValueEngineering
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Strategies for
sustainability
Hospitals are highly complex facilities, and many of the functions
that take place within them consume a lot of energy. Together
that combination creates a significant opportunity to reduce
energy consumption.
There are several broad strategies hospitals and health systems
can use to achieve greater energy efficiency.
 Benchmarking
 Energy audits
 Re-commissioning & retro-commissioning
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Benchmarking
Benchmarking the facility against its peers is the first step in a strong energy-management
program. Through benchmarking, facilities can gain an understanding of how they are performing.
Often, a hospital will benchmark to find itself to be performing in the lower tier of its peers.
Managers can track energy use over time. Continually tracking energy has proven to be an
essential component in managing a building’s energy.

Energy audits
An important best practice regarding energy savings is to conduct a periodic and thorough
energy audit of a hospital.
Three levels of audits to assess energy use:
 walk-through analysis
 energy survey and analysis
 detailed analysis of capital-intensive modifications
A thorough audit includes a review of how the facility is consuming energy and how the
facility procures the energy it consumes, and also examines both low-cost/no-cost
opportunities and capital improvement measures in an effort to become more efficient.

Re-commissioning & retro-commissioning
 Recommissioning and retrocommissioning are two common approaches to comprehensive
evaluation and implementation for performance improvements.
 Recommissioning is when a building seeks to test system operational performance to support
energy efficiency and system reliability.
 A thorough recommissioning effort will bring the systems back to optimal performance levels
and identify any needs to replace aging systems. If space uses and facility requirements have
changed significantly from the original design, retrocommissioning may be more appropriate.
 Retrocommissioning starts by documenting current facility requirements (CFRs), which replace
or amend the original owner’s project requirements used for commissioning. Then, the
retrocommissioning team seeks opportunities to optimize the existing building systems to
meet the CFRs.

Existing Buildings
Existing health care facilities abound with opportunities to achieve greater
energy savings, including the following measures
• Control thermostats
• Adjust variable air volume
• Reduce airflows as possible
• Use occupancy sensors
• Optimize chillers
• Add heat-recovery elements
• Use variable-frequency drives (VFDs)
• Use fault-detection diagnostics (FDD)
• Create a sustainability program and culture
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Optimize chillers
 Many chillers run virtually continuously regardless of conditions. This doesn’t need to be the
case; upgraded chillers run much more efficiently.
 An algorithm takes data on temperature, humidity and other factors and calculates the most
efficient temperature.
 A more dramatic upgrade took place at a major hospital where the traditional
primary/secondary chiller loop was replaced with a variable primary system.
 Variable primary system dispatches water as needed to meet the cooling load rather than
continuously circulating water.
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Use Fault-Detection Diagnostics (FDD)
• All hospitals have some vintage of a building automation system (BAS) that controls the HVAC
system. The BAS keeps systems running according to operating schedules, setpoints and
fundamental sequences of operation.
• The programming coordinates the operation of thousands of components, including everything
from boilers and chillers, air handlers and exhaust fans, dampers and valves. However, the
programming in the BAS typically prioritizes the indoor environment (i.e., temperature, humidity or
air changes per hour) over energy efficiency.
• Continual retuning to maintain energy-efficient operations over time requires diligent monitoring at
the BAS by a trained operator. Alternatively, FDD uses analytics software to continuously collect
performance data from the BAS and identify potential faults.
• Faults are identified by evaluating a set of algorithms that are applied based on the system
configuration.
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Use FDD
While the BAS generates alarms, these alarms are typically simple notices that indicate a single sensor
is reading outside of allowed setpoints.
• FDD algorithms are more sophisticated, capable of evaluating multiple variables to conclude that a
fault may exist in the current operation.
• Once established, building systems are still controlled by the BAS, but the FDD service provides
the operator with a real-time list of prioritized faults, visualization tools for analyzing trend data
and a roll-up summary to track the status and resolution of identified faults.
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SustainabilityProgram
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Sustainability program
• As health systems are under continual pressure to reduce costs, the prospect of embracing
efficient and sustainable operations has become increasingly popular.
• However, a health care organization needs to analyze its current state of sustainability before
implementing any corrective measures.
• After completing a self-assessment and identifying potential areas of operational waste, STAT can
help to develop a strategy to measure and track usage.
• Once we have assessed the facility’s needs and established a baseline of consumption and waste,
STAT can create an interdepartmental team to help develop action plans and implement changes.
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SUMMARY
Often neglected, engineering systems and its vulnerability in creating potential hazards can cause
serious damage to the facility as well as the customers which can be prevented through a
systematic safety approach and planning.
Continually tracking energy has proven to be an essential component in managing a building’s
energy. The effective processes for identifying savings opportunities in existing equipment by
optimizing resources and controlling operating costs must be adopted.
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HeadOffice : 5Th Floor, PTCGrandeur,
YMR Jn., Kowdiar P.O.
Thiruvananthapuram,
Kerala , India. PIN695003
Br. Office: First Floor, 32/1932B,
Near Oberon Mall, Kochi, Kerala , India.
PIN682024
Registered Office:TC 5/432(1), Kailas,
Alathara, Sreekaryam P.O.
Thiruvananthapuram, Kerala, India.
PIN695017
ContactUs
www.statconsultants.com
Email : info@statconsultants.com
Phone : +91 471 2722229
+91 944 600 1291(2)
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Facility management of Healthcare facilities

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