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‎Chapter 5 -Electro-Mechanical Evaluation 126

CHAPTER FIVE

Electro-Mechanical Evaluation of the

Basrah Children’s Hospital


Chapter 5 - Electro-Mechanical Evaluation

5.1 Evaluation Standards

5.1.1 Mechanical standards

BSS: British Standards Specifications

BSI: British Standards Institute

CP: Code of Practice

ASHRAE: American Society of Heating, Refrigerating and Air Conditioning

Engineers

LPC: Loss Prevention Council

NFPA: National Fire Protection Association

CIBSE: The Chartered Institution of Building Services Engineers - U.K

DHSS: Department of Health and Social Security, Technical Memoranda and Design

Guide

ICBO: International Conference of Building Officials

Plumbing Code

EPD requirements for air, noise and water pollution control

British HVAC Specifications: DW142, DW151 and DW143

HTM: Health Technical Memorandum (NHS Estates)

General and specific requirements of the local water and drainage authority, local

public health officer and the regulations of the local Civil Defense Department

5.1.2 Electrical Standards

The general and specific requirements of the Local Authorities (Power Supply, Civil

Defense,‎Civil‎Aviation,‎telecommunication,‎etc…)

The Regulations for the Electrical Installations of Buildings issued by the Institution

of Electrical Engineers (IEE)

American Standard as issued in the National Electric Code (NEC)

Code for Interior Lighting: The Chartered Institution of Building Services Engineers

(CIBSE)

Hospitals and Health Care Facilities Lighting Guide as issued by the Illuminated

Engineers Society of North America (IES)

Life Safety Code (NFPA 101)

National Fire Alarm Code (NFPA 72)

Health Care Facilities (NFPA 99)

Protection of structures against lightning: BS 6651 and EN 62305


5.2 Mechanical Systems

5.2.1 Medical Gases Systems

5.2.2 Air Conditioning and Ventilation System

5.2.3 Building Management System

5.2.4 Water Supply System

5.2.5 Fire Fighting System

5.2.6 Drainage System

5.2.7 LPG System

5.2.1 Medical Gases Systems

Oxygen

N2O

Medical compressed air - 4 bars

Surgical compressed air - 7 bars

Vacuum

Anesthetic gas scavenging system (AGSS)

5.2.1.1 Oxygen System

The oxygen system consists of the following:

Two oxygen concentrator units

Two cylinders banks (left and right) with automatic changeover

Comments:

The two oxygen concentrator units are out of service due to lack of maintenance, no

back up support by the supplier and unavailability of spare parts.

Plant room oxygen concentrator is narrow and there is no space for routine

maintenance. Temperature built up can cause the system to shut down.

None of the maintenance personnel knows the plant maintenance date. There are no

documented maintenance procedures and standards.

The plant room does not comply partially with international related standards.

According to the international standards and Health Technical Memorandum (HTM)

02-01, all electrical installations within the medical gases areas are preferably

explosion proof; the lighting fixtures are explosion proof but switches are normal (not

explosion proof), and this also applies on air conditioning units, which is extremely

dangerous.

Although the system was designed according to HTM 2022 and although the HTM

02-01 is not retrospective, we recommend further testing according to HTM 02-01 for

areas that might compromise patient safety


Figure ‎5-1: Lighting fixture - the only item explosion proof

Figure ‎5-2: Air conditioning unit – not explosion proof

Figure ‎5-3: Oxygen Concentrator room with trench inside




Figure ‎5-6: Oxygen manifold room with floor drain inside




5.2.1.2 Nitrous Oxide System

The nitrous oxide system is out of service without any obvious reason; it was never

completed.

There is a manifold with two banks (left and right) without any nitrous oxide

cylinders.

Site engineers informed us that this was done according to medical staff requirements;

we find this justification illogical and against any known medical practices.

Comments:

The manifold room does not comply with any standard.

According to the international standards (HTM), all electrical installations in the

manifold room should be explosion proof. We have noticed that only lamps are

explosion proof while the air conditioning indoor unit is normal (not explosion proof);

which is very dangerous.

International standards require no trenches or manholes or floor drains in the plant

room or surrounding area; there is a floor drain in the manifold and plant room.

Figure ‎5-9: Nitrous Oxide Manifold Room

5.2.1.3 Compressed Air System

The compressed air system consists of the following:

Two compressors

Compressed air tank

Air filter (air treatment unit)

The compressed air system in the hospital was found to have a probably not connected

automatic manifold on the roof. There is no emergency standby cylinders (not required by


HTM2022). There are two systems of medical air, preferably to be installed although not

required by HTM 2022

5.2.1.4 Vacuum System

The vacuum system consists of the following:

Two vacuum pumps which are installed.

The exhaust pipe outlet installed at 3m height above finish floor level below the plant

room of air handling units where air intake is located, i.e. the extracted polluted

vacuum will be sucked by the air intake of the air handling unit and supply back to the

hospital‎while‎the‎standard‎requires‎that:‎“The‎position‎of‎the‎termination‎point‎should‎

be carefully chosen to be clear of windows and ventilation‎ intakes”.‎Accordingly‎ it‎

was instructed to the site engineers to run the exhaust terminal 3m above the roof

level.

We could not know if the isolation rooms have a separate vacuum line or not; most

likely they do not have any.

Vacuum system was found in the patient rooms. The installation was executed

according to DIN standard, which is a compressed air outlet with venturi apparatus

suction.

Figure ‎5-10: Vacuum plant room

Figure ‎5-11: Nitrous Oxide Manifold Room


5.2.1.5 Anesthetic Gas Scavenging Disposal

“Anesthetic‎gases‎are‎considered‎to‎be‎substances‎hazardous‎to‎health,‎for‎the‎purposes‎of‎the‎

Control of Substances Hazardous to Health Regulation 2002 (COSHH), except where they

are‎administered‎to‎a‎patient‎in‎the‎course‎of‎medical‎treatment”,‎HTM.

After a thorough site inspection and investigation, we could not see any AGSS extract

pumps on the roof.

No disposal system pumps on the roof. The standard requirement is to have the

number of disposal pumps equal to the number of air handling units serving the area,

i.e. if we have one air handling unit for each operating room then we have to install

one disposal AGSS system for one operating room.

But if we have one air handling unit for two operating rooms, accordingly one AGSS

disposal system will be installed for the two operating rooms (preferable in this case

to be duplex with automatic changer).

Discharge outlets.

Careful consideration should be given to the location of discharge for the disposal

system. It should preferably be placed at roof level, away from ventilation inlets,

opening or widows in order to prevent pollution re-entering the building.

5.2.1.6 Signage:

Signage is very important and highly recommended, but there is no signage on many

installations, some of which are mentioned in the table hereunder, which shows

samples of required signage:

Location Wording Notes

Pla

nt

roo

m

Medical Gas Plant Room – No unauthorized entry Adjacent to or on external door

Fire action On door / wall

External or internal

Keep locked On door(s)

Noise Hazard (+ ear defender symbol)

Electric Shock Hazard

Permit – to work must be used

Adjacent to or on the external door

Danger Rotating Machines

Warning: These machines stop and start automatically without warning

Guards Must be in Position

Do Not Isolate Without a Permit

Posted Adjacent to Plant

Medical Air Intake Do Not Obstruct On external intakes only

Emergency Tel. No.

Gas Supplier

Estates

Pharmacy

Porters

External wall

Ma

nif

old

roo

m

Medical Gases Manifold Room – No Unauthorized Entry Adjacent to or on external door

No Parking Adjacent to or on external door

Valve Open On line valves/ ERM cylinders

Danger No Smoking External (on door or wall)

Warning Oxidizing Agent External (on door or wall)

Danger Oxygen External (on door or wall)

M ai n

cy lin

de r st or e

Medical Gases Cylinder Store – No Unauthorized Entry Adjacent to or on external door

No Parking Adjacent to or on external door


Area valve service units in the wards are not locked and open, i.e. anybody can close

any system during patient consumption, which is very dangerous.

Figure ‎5-12: Area valves service unit should be locked

According to the HTM standard, critical care area bed head units such as ICU and

NICU should have medical gases supply from two different area valve service units at

the same time; and this is not the case here.

We asked for the testing and commissioning documents but the site staff answered

that they were delivered to the Ministry of Health.

General Comments:

Medical gases system does not function properly and it is far below the minimum

standards requirements.

No management for medical gases system.

Oxygen concentrator should be maintained immediately with no delays.

Recommendations:

The Medical gases system requires immediate re-habilitation by a specialized

contractor and supervision by a specialized consultant.

Keep loading by/doors clear Adjacent to or on external door

Approved Personal Protective Equipment Must be Worn Adjacent to or on external door

Make Sure Cylinders are Secure at All Times Adjacent to cylinders

Full Cylinders On bays

Empty Cylinders On bays

Emergency Exit Keep Clear May be already fitted

Danger No Smoking On door

Emergency Tel. No.

Gas Suppliers

Estates

Pharmacy

Porters

External wall

Push Bar to Open Emergency exit and main door(s)


Figure ‎5-13: Medical gas alarm unit

Figure ‎5-14: Medical gas alarm unit

Figure ‎5-15: Bed head unit using compressed air for vacuum system





5.2.2 Air Conditioning and Ventilation System

The air conditioning and ventilation system consists of the following:

Air-cooling chillers

Chilled water pumps

Chilled water pipe network

Air handling units

Supply and extract fans

Air ducts

5.2.2.1 Air Handling Unit's Plant Rooms

We inspected the air handling unit's plant rooms on the roof and we found the following:

Plant rooms (including plant room for operating rooms): dirty and full of rubbish.

No signage, i.e. nobody can know exactly which air handling unit serves which area.

In normal conditions, things should be as follows:

Air handling unit NO. X serves area operating room No Y.


Indication‎ (supply,‎ return,‎ fresh‎ air‎ intake,‎extract,‎ etc…)‎should‎be‎ clearly‎ labeled.‎‎

The site engineers could not provide any answers due to the lack of labeling.

Water side lacks any signage such as supply or return, with no labeled flow arrows.

Air handling units are even dirty from inside.

Humidifier is out of service, but at the same time it is connected to the water supply

(R.O. water stagnant). This creates the perfect condition for growth of bacteria inside

the humidifier, which is a public hazard. (The engineers were instructed to

immediately disconnect the humidifiers to be washed and disinfected by steam)

The absence of standard signage is dangerous for the following reasons:

If the maintenance department had been informed that there is a malfunction in the air

conditioning system at the operating room NO 1, it would be impossible for the

technician not to know which air handling unit he has to check.

Another more dangerous example: if according to the preventive maintenance

program (which does not exist), the engineer asks any technician to maintain the air

handling unit serving the ICU area for example, the technician might end up

maintaining the air handling unit serving the operating room while it is functioning.

During our visit to the operating block, we found a mobile fan in the operating room,

i.e. the air conditioning system does not function properly.

Also the engineers informed us that above the false ceiling in the clean area (operating

block), there is a fan and HEPA filters. This is not recommended by good engineering

practice since this area should be maintenance free.

The air conditioning system in the clean and critical care areas (specifically in the

operating room) does not comply with health standards and HTM requirements for

operating rooms function. They are working with open doors, i.e. no pressurization,

which is against the standard.

The most important factor in the ventilation of health care facilities‎is‎“How‎to‎control‎

air‎ movement‎ to‎ avoid‎ any‎ cross‎ contaminations.”‎ This‎ could‎ be‎ done‎ only‎ by‎

pressurization cascade.

For example:

- Preparation or (lay up) room in the operating suite pressure 35pa

- In the operating and scrub up rooms 25pa

- Anesthesia room 14pa

- Clean‎corridor‎3pa,‎etc…

This was not applied in this hospital.

Over and above, the clean area via the clean corridor is open to an electrical room which has

an open service shaft, i.e. no wall; it means it is connected directly to a dirty area.

It was instructed to the site engineers to close it immediately with gypsum board or any other

solution.


Figure ‎5-19: Electrical room with vertical shaft

Figure ‎5-20: Electrical shaft not ceiled in the clean area

Laboratories ventilation system is functioning in a wrong way: The Laboratories area

should be negative pressure. The way the system is functioning make it produce a

positive pressure.

The ventilation system in the kitchen does not function properly because the ON/OFF

switch of the hood exhaust fan is installed on the roof and not in the kitchen area; it

should be installed directly on the hood.

Conclusion

Air conditioning system:

Water‎related‎components,‎i.e.‎chillers‎pumps,‎etc…,‎‎may‎be‎OK.

Air related components, i.e. air handling units and air distribution duct work, are

public hazard.


Air side HVAC requires immediate re-habilitation, i.e. general maintenance,

inspection, testing, balancing and commissioning by a specialized company.

It was instructed to the site engineers to assign technicians on permanent duty (24

hours) on the roof to follow-up on the operating of the air handling units.

Figures ‎5-21-22-23-24-25: Non-Functional Feeding Operating Rooms Air Handling Units

Figure ‎5-26: Hose Reel


Figures ‎5-27-28-29: AHU's condensate drain connected to the drainage without any siphon while two siphons are required


Figures ‎5-30-31-32-33: Air handling unit plant room

Figure ‎5-34: HEPA filter and fan installed above false ceiling in clean area

Figure ‎5-35: Operating room ceiling

Figure ‎5-36: Return air from operating room


Figure ‎5-37: Return air from operating room behind hidden

Figures ‎5-38-39-40-41 : Air handling unit plant room

Figure ‎5-42: Air outlet in clean area


5.2.3 Building Management System

The building management system (BMS) is installed at the wrong place, in the

security room, while it should be installed in the maintenance department.

BMS system is not used, i.e. nobody knows what is going on in the hospital services.

For example, when we asked for the temperature in the operating room or what is the

humidity in the same room we received no or wrong data.

No data or drawings are available that show the data points connected to the BMS,

accordingly the BMS system should be checked in terms of what kind of information

was included.

5.2.4 Water Supply System

Water supply system consists of the following:

Domestic cold water supply system

Domestic hot water supply system

5.2.4.1 Cold Water Supply System

Cold water supply system consists of the following:

Three raw water tanks

Water softener system

Water softened storage tank

R.O. system

R.O storage tanks

Water softener: out of service and no salt in the regeneration tank (brine tank)

Site engineers informed us that there is a leak in the softener, accordingly the R.O. system is

currently fed with raw water 580ppm. This has destroyed the R.O membrane.

The outflow of the R.O. water is at 86ppm as measured by the maintenance engineer. Of

course the situation looks good, but in reality it is catastrophic since the whole hospital

(except for the W.C.) is supplied by R.O. water, with no preservative additives after the R.O.

system and no recirculation of water to avoid any water stagnation.

Since there are no preservative additives, the growth of bacteria and legionella might be

dramatic especially in a hot weather.

Recommendation

Immediate and urgent sterilization of the whole water system is required.

Also we suggest canceling the drinking water fountain in the hospital.


We recommend providing cold water outlet in each mechanical and air handling plant

rooms for cleaning. Currently they use fire hose reel.

5.2.5 Fighting System

The firefighting system consists of the following:

One system for the hospital.

Pumps set: fire hydrants and hose reel cabinets. No sprinklers system, while the

NFPA standard 101 Life Safety recommends to have a sprinklers system in the whole

hospital.

Another system serves the warehouse with a pumps set and sprinklers system.

Clean agent fire extinguishing system for electrical rooms.

During our visit to the operating block we noticed that the fire exit door is locked with

a key.

5.2.6 Drainage System

This is the only normal functioning system in the hospital, but the location of the submersible

pumps is near the oxygen concentrator room which is not a good practice.


Figure ‎5-43 : Floor drain against health standards

Figure ‎5-44 : Floor drain against health standards

5.2.7 LPG System

The LPG system is out of service due to the leak in the pipes network as declared by the site

engineers. The kitchen uses mobile gas cylinders.

Figures ‎5-45-46-47 : Wrong Location (Oxygen concentrator room, sewage submersible pumps and LPG are too close to each other)


Conclusion:

During our visit to Basrah Children's Hospital, the management, medical staff,

engineers and technical staff provided us with full support and demonstrated a high

level of cooperation.

We noticed that the site engineers and technicians are willing to work but they badly

need help in the health care facilities knowledge and expertise. As a matter of fact,

they do not have any idea on health care facilities standards and requirements.

We recommend upgrading their technical level by specialized courses. Then we

recommend sending a good technical group for a minimum of three months to work

with them on the site.

(Please refer to Appendix No. 1 of this report)

5.3 Electrical System

5.3.1 Main Electrical Service

The hospital is currently fed by electricity from the main local electrical company grid

through four (HV/LV) indoor transformers with a total capacity of 6MVA (1,5MVA for

each).

Figure ‎5-48 : Hospital Transformers

5.3.2 Stand-by Power Generation System

Diesel engine driven alternators, estimated at 7.5M KVA to provide a standby power system

as full load, are arranged to automatically feed the electrical loads in the event of a main

power failure. Four generating sets are placed indoor and the fifth (which was installed later)

is housed in a canopy to ensure that the noise level at the hospital building is kept at an

acceptable level.


The 5 diesel engine generating units are fully synchronized and use load sharing facility. Also

they are equipped with automatic transfer switches (ATS) in addition to manual transfer

switches (MTS) to be used in case of (ATS) failure or maintenance.

The diesel storage for the standby generators is sufficient in case of power failure.

The 5 diesel engine generating units are controlled by the building management system

(BMS) which is located in the hospital. Also they are controlled by digital management

control (DMC) which governs and controls the sequence of operation of the 5 units.

During our visit to the hospital the DMC was not working.

Figure ‎5-49 :Hospital Generators

Recommendation

Maintenance should be done to the BMS in order to enable the maintenance department to

control and monitor the situation of the generator sets.

Generator room is full of rubbish and should be immediately cleaned since it poses a

potential fire hazard.

Figure ‎5-50: Generator room full of rubbish


5.3.3 Earthing and Bonding

Earthing protection in the hospital is achieved through a powerful earthing system that

consists of many earth electrodes (ground rods) provided in ground pit adjacent to the power

plant room and the main building of the hospital and all other buildings related to the

hospital.

The earthing system is working and effective.

Recommendation

Continuous maintenance should be done for the earthing system.

5.3.4 Distribution System

Power distribution system is executed through cascading distribution boards.

(Form 4) type was used in the main electrical room and the sub-main distribution

boards in the hospital building.

All (Form 4) main and sub main boards are equipped with the following protection:

o Under voltage

o Phase failure

o Earth fault

o Space heater

Also the main low voltage distribution boards are equipped with power factor

correction.

During our visit we noticed that two of the power correction factors were out of

service (one due to a defect in its screen while the other is due to burn in its input

cables because of loose connection).

Recommendation

Continuous maintenance and check should be done for the distribution system

especially for the power factor correction.

Figure ‎5-51: Hospital Main Distribution Boards


5.3.5 Uninterrupted Power Supply (UPS)

The hospital is equipped with various capacities of uninterruptible power supply as

the following:

o Two (100KVA) on line UPS for ICU, NICU and operation room

o One (30KVA) on line UPS for radio logy department

o One (20 KVA) on line UPS for computer system

o One (6KVA) for PABX

o One (6 KVA) for endoscope

o One (10 KVA) for lab

In addition to the above, there are various small UPS located in assigned areas.

During our visit we noticed that (30KVA) UPS was out of service because there is a

defect in the power supply card.

Recommendation

Continuous maintenance and check should be done for the UPS (especially the

batteries).

Some rooms of the UPS, such as for computer system, are very crowded and need

new arrangement to allow sufficient cooling and ventilation.

5.3.6 Small Power System

We noticed that there were two panels in each department, one for the lighting system

and the other for the power system.

Also we noticed that the power cables are LSF except for the earthling cables.

Figure ‎5-52: Sample of the Hospital Electrical Distribution Boards


Figure ‎5-53: Sample of the Electrical Cables (LSF)

Recommendation:

Continuous maintenance and cleaning should be done for the electrical distribution

boards since there is some DB's full of dust.

Figure ‎5-54: Sample of the Electrical Distribution Board that needs to be cleaned

5.3.7 Lighting System

Lighting system consists of the following:

Internal lighting (different types of lighting fixtures according to the location and

function)

External lighting (decorative, single arm pole and double arm pole)

The problems we noticed are as follows:

The lighting fixtures installed in the medical gas plant room are not an explosion

proof type.


The lack of local agencies to supply the required spare parts.

The timers for the external lighting are mostly out of order especially in case of power

failure.

Recommendation:

Back up battery should be installed for the timers of the external lighting system to

avoid malfunction of those timers.

The lighting fixtures in the medical plant room should be changed to explosion proof

type.

5.3.8 Telephone and Data Systems

The telephone and data systems in the hospital are over IP. During our visit we noticed that

the PABX is not operating well. Also we noticed that the PABX has no ability to be

extended.

Recommendation:

Continuous maintenance and checkup should be done for the PABX and the patch

panels.

5.3.9 Fire Alarm System

The fire alarm system in the hospital is addressable and consists of master fire alarm control

panel located in the hospital and slave panels in the external building.

5.3.10 Clock System

The clock system installed in the hospital is wireless and consists of a master clock and slave

clocks located in different areas of the hospital.

5.3.11 Paging and Public Address System

The paging and public address system that was installed in the hospital is not working

because it needs programming.

Recommendation:

Maintenance should be done for the public address rack.

5.3.12 Nurse Call System

The nurse call system that was installed in the hospital is not working because it needs new

programming.


Recommendation

Maintenance should be done for the main nurse call panel and other nurse call panels

located at nurse station.

5.3.13 Satellite and Master Antenna TV System

The SMATV system is working but cannot be extended.

5.3.14 Closed Circuit and TV System

The CCTV system in the hospital is working and in a good condition.

5.3.15 Vertical Transportation System

The lifts in the hospital are hydraulic type elevators (passenger, bed and

dumbwaiters).

During our visit we noticed that one of the bed elevators is not working.

Recommendation

Continuous maintenance should be done for the lifts.

5.3.16 Lightning Protection System

Lightning protection system is installed in the hospital.

5.3.17 Access Door System

The access control system in the hospital is working and in a good condition.

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