Instrumentation for critical healthcare environments

Today’s hospitals contain many critical environments where building services play an important role in the wellbeing of patients, staff and visitors. Even the best-designed and built facility will need initial commissioning and constant monitoring to ensure peak performance throughout its lifecycle.  Accurate, fit-for-purpose fixed and portable measurement instruments are required in most departments of a hospital, from the boiler room to the pharmacy to ensure that all areas are functioning correctly.

In the wards and operating theatres it is imperative there can be no spread of infections or exposure to potentially hazardous materials.  Providing this effectively in terms of equipment ease of use and efficiently both in terms of the cost of instruments and the cost of staff presents challenges to the building services engineer, laboratory or medical personnel.  In an isolation facility, for example, staff need to monitor the pressure between rooms (positive or negative) to stop the spread of infections either to or from the patient, the temperature within the protected space, supply or extract ventilation rates, the quality of the air in terms of particulate concentration, as well as the flow-rates of medical gasses. Where, all of theses parameters can be measured with fixed (built-in) devices or portable (hand held) instruments.  Measurements of surface contamination may also need to be ascertained for infection control, but these are normally undertaken using standard laboratory techniques.

A number of medical facilities have incinerators on site to dispose of locally generated clinical waste; many different types of fixed measurement instrumentation are used on every aspect of the incineration process from the temperature thermocouples within the primary incinerator, through to the gas and particulate emissions measurement at the end of the process.  To compliment the fixed instrumentation, a selection of portable instruments are also often maintained to crosscheck and temporarily replace the fixed range of measurement equipment should a problem occur.

The boilers that supply steam to the hospital require various types of instrumentation to run correctly, hydrometers for example are used to measure the total dissolved solids (TDS) within the boiler water.  If the TDS level rises too high then this can cause foaming and carryover to the steam main leading to contamination of control valves, heat exchangers and steam traps.

There are also water supplies that have to be considered, and the need to combat the possibility of Legionnaires’ disease by chlorine dosing the systems to ensure all of the water pipes are disinfected.  The water quality then has to be sampled periodically with the appropriate instrumentation to ensure the water is fit for use.

BSRIA has been working on solving building services design, installation, commissioning and operating problems in hospitals for many years and is only too well aware of the importance of correct measurement. Most of the published work however concerns the facilities themselves rather than the instrumentation used for measuring performance.  A well designed facility that has been built and commissioned correctly should be a safe environment to work or visit from day one of its operation.  But, if the wrong instruments are used during commissioning or routine monitoring it could have life and death consequences, as there is the risk of spreading potentially infectious or hazardous agents.  In the field of pressure measurement there is a large array of instruments that measure this physical parameter, but if an instrument is used with an accuracy based on its full scale deflection, not on the indicated value, at low pressures it is impossible to establish if a system is operating correctly.  In a surgical suite it may be required to operate at a pressure differential between rooms of 10 Pa.  If an instrument with a range of 2000 Pa is used with a manufacturer’s claimed accuracy of ± 0.5% fsd (full scale deflection), there can be an error of some ±10 Pa. This errors being almost double the required measurement.  Similarly, when measuring air flow rates in a biological flow cabinet, instruments with a typical accuracy of ± 1.5% mv, +0.2 m/s (measured value) can be used.  But if the target measurement value is only 0.5 m/s, this accuracy equates to a possible reading as low as 0.29 m/s being accepted which could be very problematic in a critical environment and potentially expose an operator to hazardous materials.

Understanding manufacturers’ claimed instrument accuracies is only part of the problem in the correct selection of pieces of instrumentation; the correct calibration of the equipment is equally vital to ensuring reliable data.  For measuring pressures as low as 10 Pa in the surgical suite, the hospital engineer or laboratory staff needs calibrations with an uncertainty of no more than 0.1Pa, which often exceeds what manufacturers are offering.  The building services engineer must look beyond the simple requirement of measuring pressure, and understand the details of the complete process.  Understanding the real technical merit of an instrument therefore must have a greater significance in the future as services in healthcare facilities become more critical.

When buying, or hiring, instruments the engineer now has a global choice as to which product will meet today’s challenging testing environments.  Calibration of this instrumentation is, and always will be, of paramount importance to users, but keeping up-to-date of what is available especially in changes of technology and the scope of instrumentation available must also be considered during the selection process.  Tests that often took hours to conduct can now be undertaken easier, faster, and more accurately than those taken years ago.  For example there are pieces of instrumentation that can fit test N95 respirators and masks to protect workers against airborne biohazards such as TB or even SARS.  Likewise there are new types of ultrafine particle counters that can be used to trace air pollutants in operating theatres, as well as being used for the checking of the integrity of filter seals within laboratory fume cabinets.

With such a wide range of instruments available to today’s healthcare professionals they need to look beyond any procurement source that is tied to an individual manufacturer to obtain the best pieces of instrumentation within the marketplace.   Equally staff at the suppliers have to understand the finer points of the instruments they offering including calibrations at the ranges to be used.  Equipment can, where applicable, include data damping, backlit displays, self calibration check tools, data logging, keypad lock out to unauthorised users and long life battery operation to name just a few options that can also influence a final purchasing decision. BSRIA Instrument Solutions is a leading supplier of specialist test and measurement instruments to Industry since 1990. It has built its reputation by providing the most reliable and advanced test equipment from leading manufacturers supporting it with a high level of customer service and technical support to meet with its client’s requirements and expectations.  They are able to offer a choice of test equipment solutions with products from many leading instrument manufacturers.

Face fit testing a nurse to ensure the correct fitting face mask is used.

Simple to use fume hood controller.

Hospital isolation suite room pressure monitor

Particle counting in a clean room facility

Calibration of an anemometer in the BSRIA laboratory.

The  Smart Building in the Smart City – The Ultimate Convergence?

Some Thoughts from Qingdao

If smart cities are to meet the needs of the people living and working in them then they will benefit from expanding on the experience gained in managing complex buildings – and then up their game further…  

Qingdao, China – a Vibrant and Growing City focussing Minds on Smart Buildings and Smart Cities

In September I had the chance to speak at the 5th Annual Global Congress of Knowledge Economy-2018,  held in Qingdao, China.

As well as giving me the chance to set out BSRIA’s vision of smart homes and their wider impact on smart buildings, I was able to enjoy the opinions and insights of a wide range of fellow conference speakers drawn from more than a dozen countries, spread across Asia, Europe and North America.

The central focus of the conference was on the state of the smart city and its future.  For an organisation like BSRIA, whose expertise lies above all in buildings, the relationship between the smart building and the smart city is an interesting, subtle and increasingly strategic  one.

On the one hand, buildings are the most obvious and important elements making up any town or city. Think of a town or city and you probably think of prominent buildings and how they relate to each other and the landscape. In developed societies, buildings account for the largest share of energy use, ahead of industrial production or transport. Urban humans also spend most of our lives within the confines of buildings. In that sense they dominate our world.

Buildings and Cities – From a Technical Challenge to a Social One

Until recently, building services have been directly predominantly at addressing tangible technical challenges, such as how to reduce energy consumption while maintaining physically acceptable temperatures, ventilation, lighting levels and physical safety and security. Recently the emphasis has started to include more intangible, social and human objectives such as comfort, wellbeing and social cohesion. Such “humanistic” values are increasingly seen as being both valuable in themselves and having an economic value. A building where people feel happy is likely to be more profitable.

Such goals and outcomes are of course much harder to measure, but advances in the collection and analysis of data make it increasingly possible to measure human emotions and outputs, to the point where the question increasingly moves from “Can we do this?” to one of “Is it socially or ethically acceptable to be collecting and analysing such sensitive information about people’s inner states and information?”

This development in turn strengthens the links between the smart building and the smart city. Cities have always been close to the very essence of what it is to be human. It is no accident that the word civilisation is related to the Latin ‘civitas’ or town.  One of the strongest messages to come out of the conference is that some early smart city ‘solutions’ suffer from the fact that they purport to offer a ‘technical’ answer without considering all of the very human social needs of a city.

We heard from mayors, city managers and academics from cities ranging from around 5,000 inhabitants to ones with several million. Clearly there were big issues and divergencies with resources and with priorities. A larger city is likely to experience greater challenges in areas such as transportation. In a small city with more limited resources, focussing of effort needs to be more precise, concentrating on issues that will bring a quick and noticeable return.

Towards “City Management Systems”

As with standards in general, there is a natural tension between the benefits of experimentation and adopting a tailored approach which is focussed on a particular community’s needs on the one hand, and having solutions that can be adapted and rolled out by a wide range of different cities on the other, ensuring that systems can communicate and avoiding the temptation to “reinvent the wheel” every time. Two cities may have different detailed needs when it comes to tackling crime, or transport or urban places, but it doesn’t usually make sense to invent something completely different.

One possible answer to this dilemma is to produce smart city “platforms” which accommodate the key aspects likely to be found in a smart city project, including education, transport, security, energy management, health, governance etc. but which can then be configured to meet the different needs of different communities. This could be seen as something almost akin to a Building Automation System (or BACS).

If you think Building management is Complex, Try Cities..

At present there are obviously limits to how far this coordinated approach can advance. Even within a building, there are big challenges to resolve when integrating services such as HVAC, lighting, room booking, security or fire protection. For a start, these may well be the responsibility of different departments.

In a city, these divisions are likely to be multiplied many times. Most cities will have numerous ‘stakeholders’. Even where there is an enthusiastic, well informed and pro-active Mayor – like the people I met in Qingdao, they will need to accommodate political colleagues and rivals, public officials, services, utilities and businesses and media. In many cities, such as London, the Mayor has limited political power and budgeting resources and needs to cooperate not just with a council representing numerous parties, but with more than 30 London Borough’s each with their own powers and agenda, not to mention the UK national government.

Issues such as cyber security and data protection, which already loom large for building managers, are substantially more complex at a city level, and with much more potentially at stake.

Beyond city leaders in democratic countries have to court public opinion to secure re-election, and this opinion can be fickle if smart city initiatives are seen as ineffective, representing poor value, or are simply misunderstood.

Projects can easily go wrong, particularly where technology is used to plug a gap in a poorly thought out policy. To take an example related to buildings and energy, if policy encourages buildings to generate energy, store it and return it to the grid, then the investments will only work if there is an adequate infrastructure and pricing system in place to remunerate contributors and make efficient use of the energy.

Similarly, while district energy schemes can be extremely efficient, and can benefit from smart technology such as monitoring and analytics, the basic design needs to be properly balanced and they need to be supported with appropriate expertise.

This may encourage excess caution. While there are ample opportunities to spread risks and benefit from the expertise of the private sector, this is unlikely to be effective if the city managers lack the necessary knowledge and understanding.

The Way Forward

So what can the building services community specifically take away from this? Firstly, a confirmation that the boundaries between the building on the one hand, and what goes on both inside and outside of it are becoming increasingly blurred. Both building systems and city-wide systems need to be able to communicate and exchange information in a controlled and appropriate way.

Most obviously, buildings can contribute both positively and negatively towards the immediate environment, and via their consumption and production of greenhouse gasses, to the wider global environment. The conference heard of some interesting examples of projects for buildings forming “vertical cities”, including not just social amenities but also “sky gardens”.

In highly dense cities such as Hong Kong this approach could yet take off. And even in European cities like London, buildings meeting environmental and social needs look set to become a key element in the smart city of the future.

Open standards will also be essential for the world of the smart building and the smart city. ISO standards such as ISO 37106:2018 Sustainable cities and communities — Guidance on establishing smart city operating models for sustainable communities and ISO/IEC 30182:2017 Smart city concept model — Guidance for establishing a model for data interoperability will play an important role.

However, there is a real opportunity for companies which already have solutions for the management of complex buildings and campuses, including everything from services to physical and cyber security, to extend their offering in a way that allows for the integration, analysis and management of wider smart city services.

Beyond the Immediate Future, a More Unexpected Twist?

I came away from the conference convinced that smart technology is quite likely to change the whole structure of cities, and even, to some extent challenge the need for mega-conurbations. Large cities have arisen in the past 150 years mainly because industrial production and then service delivery required the concentration of large “armies” of people in a limited and accessible area.

If most routine production and most services come to be provided mainly by a combination robotics and by AI as now looks increasingly feasible, and humans are needed mainly the more specialised and abstract roles that sit above this, then is there really a need for millions of humans to be concentrated in a limited area?

It would be ironic if the same processes that usher in the smart city were to lead eventually to a kind of “post urbanised” world reversing the trend seen in modern history.

But that is a much bigger question for another article. For now, the opportunity lies with companies who can help meld the elements of the smart city – with buildings as a key component – into a robust and workable system.

Author: Henry Lawson, BSRIA