Inside Look at Healthcare System Malfunctions: How to Best Protect Your Systems


Why do the best-planned and coordinated renovation projects (too often) not yield a positive impact? Too many times I’ve stood with the architect and engineer on record, scratching our heads at an unexpected anomaly. The math adds up, the installation appears to match the documents–so why is the resulting outcome a system malfunction?

Question to consider for renovation and system upgrade projects: Is the Facility Team, who operates the building, participants in the discussion? These operators have an incredible amount of knowledge on the systems quirks and reactions with other associated systems in the building. The inclusion of this team in an integrated upgrade /renovation team is incredibly important to the success of this type of project.

Similarly, equipment replacements should always be vetted through the facility department! How many times has an internal department purchased an “in-kind” replacement and it’s not; the replacement is installed by the vendor’s team, and something does not work.

Specific situations to consider (NOTE: The following is from my own firsthand experiences.

Replacement Sterilizers in the Surgical Suites

This was a simple equipment replacement, in-kind project completed by the operating room (OR) staff and the vendor. Everyone was thrilled with the project’s low impact on the operation of the OR’s. After the completion of each group of sterilizers, the OR staff was trained on the new equipment. This was deemed a successful installation… or so they thought.

The next day, maintenance started receiving calls regarding these units. They were “banging and jumping” during their cycle. Fortunately the facility team members investigating the complaint were able to enter an unoccupied OR and test the equipment per the complaint. Discovery made: The sterilizers were new units!

During the cycle, the unit’s water control valve was causing the banging vibration through the unit and into the water-piping infrastructure. Not a good situation to discover!

The system appeared safe to continue operating while research was conducted. The units were not an exact replacement in-kind. Problem: The replacement units operate at a substantially lower water pressure than the original units.

First Solution: Replace the water hammer arrestors with a larger alternative that would absorb the force from the closing valve. Preparations took place, replacement occurred, units restarted, and the water hammer maintained the force radiating through the system. The solution failed.

Back to the drawing board…

Final Solution: Keep all plumbing intact in the surgical suites and install the pressure reducing valves in the associated surgical penthouse where they could be monitored and maintained.

Outpatient Suite Next to the Hospital Lobby

Renovation project: Add an outpatient suite conveniently located off the lobby of the hospital. This sounds great in form and function, but what does that mean for your air handling system (AHU)?

The system is manipulated to allow the protective negative pressure for construction. Construction work begins and in time, is completed. In order for proper testing, the associated AHU is returned to normal operation, and the new suite is brought up on line, one box at a time.

The last few boxes come on line, but the design flow required more air in the system. This decrease in flow resulted in pressure relationship issues between the suite and the adjacent spaces. Balance dampers within the system were “tweaked.” Proper air flow was achieved, pressure relationships restored, and occupancy granted.

Facilities started receiving warm temperature complaints from other areas served by the AHU. Investigation identified a reduced air flow to these areas which started an engineering inquiry. The AHU could provide the cubic feet per minute (CFM) needed for the spaces but was already running at full speed all the time. Problem: Why was the air not getting to the areas where it was needed?

The ductwork was traced for a blow out, none were found; smoke dampers were verified open and operational, and still no sign of why there was not sufficient air. Tracing the ductwork unveiled a few discoveries—the turning vanes were not installed, elbows were mitered and not sweeping as drawings indicated, and too many turns and diversions to avoid other obstructions. This created a large amount of pressure drop in the system, not anticipated for the renovation project.

Option One: Completely replace the unit. For most facilities, this is not a feasible option (due to cost and location of the unit).

Option Two: The in-depth look at the AHU performance allowed for a sheave and belt change, to increase the pressure on the system. We revisited the coils to ensure appropriate heat transfer could be achieved to meet the system requirements. We ran a new model of the old unit to ensure it met the needs of the spaces served and pressure classification for the housing. The new model proved to be viable for the unit and system; appropriate changes to the sheave and belts were made. The water flows did not need to be modified to achieve the appropriate heat transfer. These corrections resulted in success for the system.

As a facility manager, reassuming control of a system following a renovation project can be stressful, especially when the unforeseen occurs. Early Facility Team participation in renovation projects can help alleviate preventable, future system malfunctions. However, in the event of necessary system correction, viable corrective solutions are often the right solution. Stay tuned for further root cause analysis with positive solutions.


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