Healthcare Resources

November 2016

Is your Facilities Management team helping to pass a Joint Commission survey?

​Is your Facilities Management team helping your efforts to pass a Joint Commission survey? The bad news is that the odds are that it is not. The Joint Commission published a summary of the most frequent problems in all surveys done from January 1 to June 30, 2016. The third most common area of
non-compliance was EC.02.5.01 (The hospital manages risks associated with its utility systems) with 56% of hospitals non-compliant.

Bear in mind that the term Utility System covers much of your hospital’s physical plant. The HAP Glossary defines a Utility System as:

“Building systems that provide support to the environment of care, including electrical distribution and emergency power; vertical and horizontal transport; heating, ventilating, and air conditioning (HVAC); plumbing, boiler, and steam; refrigeration; piped gases; vacuum systems; and fire alarm and suppression systems; and communication systems, including data exchange systems.”

The Joint commission focuses on your Utility Systems because they play an important role in patient safety. Because your hospital’s heating, ventilation, and air conditioning (HVAC) system controls temperature, humidity, airflow (pressurization), and filtration, it plays an essential role in minimizing the spread of contaminants and infection. The Joint Commission addresses how the HVAC system controls airborne contaminants in standard EC.02.05.01, element of performance (EP) 15:

“In areas designed to control airborne contaminants (such as biological agents, gases, fumes, dust), the ventilation system provides appropriate pressure relationships, air-exchange rates, and filtration efficiencies.”

The EP lists the areas that must be designed for control of airborne contaminants, including operating rooms, special procedure rooms, delivery rooms, laboratories, and so on.

In the health care setting, a primary function of the HVAC system is to keep the air free of airborne contaminants, such as viruses, bacteria, and spores, which may exacerbate a patient’s current condition, cause illness, or even lead to death in highly vulnerable patients, such as an immunocompromised individual. Thus, the HVAC system plays an essential role in minimizing the spread of contaminants and infection.

A Joint Commission survey can be a challenging process for any hospital. You must ensure that your processes, policies and procedures meet the standards or remediate any that are not currently in compliance. The hospital must be in compliance with the standards for at least four months prior to the initial survey. The hospital should also be in compliance with applicable standards during the entire period of accreditation, which means that surveyors will look for a full three years of implementation for all standards.

Given the non-compliance rate around Utility Systems, your hospital’s Facility Management team should be regularly monitoring critical areas; checking HVAC equipment, proper temperature, humidity, airflow and filtering; and respond to any potential patient safety hazards.

Many hospitals design the controls for their HVAC systems to dynamically respond to facility demand while still providing a comfortable and safe environment for patients and staff. This has tangible benefits in reducing energy consumption but this can introduce risk if not monitored closely. Consider the issue ofoutside air.In conventional space, minimizing outside air keeps energy costs low because the HVAC system doesn’t have to work as hard. In healthcare, the percentage of outside air allowed in different spaces is mandated guidelines and codes from the Centers for Disease Control and Prevention (CDC) and ASHRAE. Depending on the space, a combination of outside air and reconditioned internal air is often required. Outside air may be contaminated (dirt, allergens, bugs, spores, viruses, and so on) that can cause problems for your vulnerable patients.

Outside air has to be conditioned before it can be introduced into a health care facility, which involves filtration, heating, or cooling, and possibly humidification or dehumidification, depending on outside conditions. This can be costly because the HVAC system has to work harder and use more energy than it does when conditioning inside air or a combination of recycled and outside air. Given the complexity of the HVAC system it is very easy for the balance of outside air to get out of balance and this can be very difficult to identify. It is common for the HVAC system to maintain occupancy comfort even though the amount of outside air is excessive. This wastes energy which wastes money while putting your hospital at risk for non-compliance.

Ideally, your Facility Management team can use technology to address this issue.Advanced analytics can monitor your complex systems and ensure that the various components are correctly configured.This will ensure optimal energy savings while ensuring compliance.The alarming features can alert you team to issues so they can be addressed promptly.The databases built in to these systems track all of this information so it is easy to show how you have maintained compliance over time. These systems can pay for themselves with both hard dollar savings from reduced energy usage and improved operations, as well as ensuring your hospital passes the survey with flying colors.

Utility Rebates Topped $7 Billion Last Year

​Rebates are critical when facility managers think of working with their utilities to cut energy use and costs. Utilities across the United States invested approximately $7.7 billion in energy efficiency over the past year, according to the ACEEE report, The 2016 State Energy Efficiency Scorecard.

The structure and delivery of customer-funded electric energy efficiency program have changed as the electric industry restructured.Restructuring resulted in a decline in funding for customer-funded electricity energy efficiency programs in the late 1990s, primarily due to regulatory uncertainty and the expected loss of cost-recovery mechanisms for those programs.

Subsequently, utility commissions placed renewed focus and importance on energy efficiency programs. From its low point in 1998, spending for electricity programs increased more than fourfold by 2010, from approximately $900 million to $3.9 billion. In 2015, total spending for electricity efficiency programs reached roughly $6.3 billion. Adding natural gas program spending of $1.4 billion brings the total to the $7.7 billion in 2015.

The report credits the growth in these programs to state policies. In Minnesota, for instance, utilities are expected to save 1.5 percent of their annual sales volume each year. Utilities also find that these programs are valuable customer service tools. The programs allow utilities to help address customers’ concerns about their use and cost of energy.

Some utilities also offer energy efficiency programs that focus on the ways in which the equipment within a facility operates. For example, a utility may offer some financial support for commissioning, including support for monitoring based commissioning. For instance, an HVAC system that isn’t performing as designed to maintain desired temperatures generally will use more energy than necessary. If the commissioning process reveals the need for major investments in new equipment, the utility may develop custom rebates or other incentives.

Do these incentives work? The Industrial Strategic Energy Management Initiative, at the Center for Energy Efficiency, examined the results of strategic energy management (SEM) programs. SEM programs emerged from the continuous improvement approaches used in many production operations, and focus on reducing energy intensity over time. Rather than focus on equipment change, they look at changing business practices, operations, and individual behavior.

Researchers tallied the results of the programs, and found they reduced overall electric energy intensity by 5.4 percent during the one-year implementation period. While this study focused on industrial users, it provides evidence that concerted efforts to reduce energy consumption can pay off.