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Introduction: The coronavirus disease 2019 (COVID-19) pandemic led to increased demand nationwide for dialysis equipment, including supplies and machines. To meet the demand in our institution, our surge plan included rapid mobilization of a novel continuous renal replacement treatment (CRRT) machine named SAMI. The SAMI is a push-pull filtration enhanced dialysis machine that can conjugate extremely high single-pass solute removal efficiency with very precise fluid balance control., Material and Methods: Machine assembly was conducted on-site by local biomedical engineers with remote assistance by the vendor. One 3-h virtual training session of 3 dialysis nurses was conducted before SAMI deployment. The SAMI was deployed in prolonged intermittent replacement therapy (PIRRT) mode to maximize patients covered per machine per day. Live on-demand vendor support was provided to troubleshoot any issues for the first few cases. After 4 weeks of the SAMI implementation, data on treatments with the SAMI were collected, and a questionnaire was provided to the nurse trainees to assess device usability., Results: On-site installation of the SAMI was accomplished with remote assistance. Delivery of remote training was successfully achieved. 23 PIRRT treatments were conducted in 10 patients. 7/10 of patients had CO-VID-19. The median PIRRT dose was 50 mL/kg/h (IQR [interquartile range] 44 - 62 mL/kg/h), and duration of the treatment was 8 h (IQR 6.3 - 8 h). Solute control was adequate. The user response was favorable to the set of usability questions involving user interface, on-screen instructions, machine setup, troubleshooting, and the ease of moving the machine., Conclusion: Assembly of the SAMI and training of nurses remotely are possible when access to vendor employees is restricted during states of emergency. The successful deployment of the SAMI in our institution during the pandemic with only 3-h virtual training supports that operating the SAMI is simple and safe., (© 2020 S. Karger AG, Basel.)

Objective: To describe an integral system of notification and management of incidents, created by the Primary Care Team of Guineueta, as well as the main results after 18 months of implementation., Material and Method: Using a simple online form, health professionals notified any type of, already categorised, incident. Each of them were distributed to an improvement team that assessed and performed the necessary actions. In addition, the Quality Committee immediately assessed the ones that affected patient safety, as well as the most relevant or repetitive ones every 6 months., Results: During the first 18 months of operation of the system, the health professionals reported 1,267 incidents, most notably informatics, maintenance/technical assistance, and errors in scheduling, in internal circuits and protocols. Eight of them were considered to significantly affect patient safety., Conclusions: The implementation of the described system has been consolidated into our team, facilitating the detection of problems, the accomplishment of improvement actions and involving the professionals in the improvement of the quality., (Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Claire Hennessy, head of Operational Estates and Facilities Oxford University Hospitals NHS Foundation Trust (HEJ - May 2016), describes a major infrastructure project currently ongoing at Oxford's John Radcliffe and Churchill Hospitals to upgrade and modernize heating and energy systems - one of the most challenging aspects of which has been the installation of a 1.4 km district heating system (Energy Link) between the two sites, involving laying of a variety of pipework and cabling under local roads. Without the heating and energy project, she explains, not only would the Trust have struggled to get through another winter, but it could also not have contemplated the redevelopment of the Churchill site, or met the expected needs of the John Radcliffe Hospital now and into the future.

In an article that first appeared in The Australian Hospital Engineer, Jeremy Stamkos, principal indoor environment consultant for Eronmor, a specialist indoor air quality consultancy, advises on some of the key steps that hospitals and other healthcare facilities should take following 'water ingress events'--to both protect property from damage, and safeguard the health of patients, visitors, and staff. The key, he stresses, is to act quickly and, where necessary, to harness specialist external expertise.

Paul Briars, North West regional director for independent engineering, IT, and facilities services business, NG Bailey (pictured), discusses the company's part in a major redevelopment at one of the UK's top orthopaedic hospitals, Wrightington Hospital in Lancashire --famous as the site, in the early 1960s, of first ever hip replacement operations, by pioneering surgeon, Professor Sir John Charnley (HEJ --April 2013).

Building usage is the phase in the building life cycle that is most time-consuming, most functional, most significant due to building purpose and often systematically ignored. Maintenance is the set of activities that ensure the planned duration of facility exploitation phase in accordance with the requirements for quality maintenance of a large number of important building features as well as other elements immanent to the nature of facilities' life. The aim of the study is to show the analysis of the current state of organized, planned and comprehensive managerial approach in hospital utilization and maintenance in the Republic of Croatia, given on the case study of Clinical hospital center in Rijeka. The methodology used consists of relevant literature section of theory of facility utilization, maintenance and management in general, hospital buildings especially, display of practice on case study, and comparison of key performance indicators values obtained through interview with those that author Igal M. Shohet defined in his study by field surveys and statistical analyses. Despite many positive indicators of Clinical hospital center Rijeka maintenance, an additional research is needed in order to define a more complete national hospital maintenance strategy.

Electrical engineering and estates personnel at Sodexo--which manages a wide range of soft and hard facilities management services for five hospitals under a PFI contract at the Manchester Royal Infirmary--have successfully planned, managed, and co-ordinated, a complex electrical engineering project which saw high voltage (HV) switchgear in the site's main intake sub-station dismantled by the supplier to repair a potential earthing mechanism fault which would have prevented individual switchgear panels being shut down, to, for example, cater for renovation of electrical cabling or components cross the site's high voltage network. With detailed planning, including provision for bringing onto site temporary bulk generators, and the formulation of a 600-step switching programme, the replacement of potential faulty driver components in the disconnect mechanism for 20 HV switchgear panels was completed in just four weeks, with minimal interruption to the vast complex's power supply.

With the NHS having committed to reduce its carbon footprint by 10% by 2015, Alan Newman, a partner at building services engineers, Troup Bywaters + Anders (TB+A), describes how, with the company's expertise and help, customer, the East and North Hertfordshire NHS Trust, 'surpassed the targets two years in advance'. As he explains, the key element of an ambitious carbon reduction scheme that won the 2013 IHEEM Healthcare Estates Sustainability Award (HEJ - November 2013) was a new combined heat and power-based energy centre at the Trust's Lister Hospital in Stevenage.

In an article in the April 2013 issue of Health Estate Journal, Geoff Dillow, a former head of training at the forerunner to Eastwood Park, the Hospital Engineering Centre, addressed the roles and responsibilities of personnel involved in the operation and management of medical gas pipeline systems (MGPS). In this second article, he introduces the prime tool in the day-to-day management of medical gas pipeline systems - the MGPS Permit to Work System.

A UPS system is the central building block of a Power Continuity Plan in medical facilities, but such equipment requires careful maintenance to continue fulfilling its vital role in delivering power resilience, and avoid catastrophic downtime, and potentially tens of thousands of pounds in costs to rectify the issues caused by poor maintenance. In our latest technical guidance article, Steve Mason, MD at Bender UK, one of the leading providers of isolated power supplies, theatre control panels, UPS systems, and Steris surgical products, and a turnkey provider of solutions for safe handling of electrical power and advanced provision of critical care products, examines some of the issue surrounding UPS maintenance.

The environmental impact of a hospital waste incineration plant in Krakow was investigated. The objective of this study was to assess the degree of environmental effect of the secondary solid waste generated during the incineration process of medical waste. The analysis of pollution of the air emissions and leaching test of ashes and slag were carried out. The obtained results allowed us to conclude that (i) the hospital waste incineration plant significantly solves the problems of medical waste treatment in Krakow; (ii) the detected contaminant concentrations were generally lower than the permissible values; (iii) the generated ashes and slag contained considerable concentrations of heavy metals, mainly zinc, and chloride and sulfate anions. Ashes and slag constituted 10-15% of the mass of incinerated wastes; they are more harmful for the environment when compared with untreated waste, and after solidification they can be deposited in the hazardous waste disposal.

Regular communication between the clinical engineering department and the wider hospital community not only keeps other departments informed about CE activities, but also conveys the value that CE brings to the institution. We provide a list of topics and information that CE should consider conveying to various groups within the hospital.

While the UK has an enviable safety record in the management of medical gas systems, it is only via strict adherence to the four tenets - 'continuity, adequacy, identity, and quality' - embodied within Health Technical Memorandum 02-01: 2006 - 'Medical Gas Pipeline Systems' (MGPS) that we can be certain that patients will not be harmed by these systems. So says Geoff Dillow, a former training head at the forerunner to today's Eastwood Park, the National Centre for Hospital Engineering, and co-author of the HTM, who has over 35 years' professional experience in assessing medical gas systems for compliance. In the first of four HEJ guidance articles on 'Managing Medical Gas Pipeline Systems' planned for coming months, he examines the critical role of the MGPS Permit to Work System (PTWS), and describes the parts played by those involved in its implementation and day-to-day management.

The Department of Health (DH) has released a revised and updated version of its NHS Premises Assurance Model (NHS PAM), a software-based tool originally launched in 2010 to enable estates and facilities managers to more easily gauge the overall 'condition' of their built estate, provide premises assurance to their management Boards using a nationally consistent technique, assure commissioners that healthcare is being delivered from high quality, 'clean, safe, and suitable' premises, and identify the priority areas for improving premises infrastructure efficiency and quality. While the DH estimates that the 'original' Model has been used by only 30% of the overall potential audience, the new, 'streamlined and easier-to-use' version, which IHEEM peer reviewed and endorsed last month (see page 29,) is designed to encourage much wider take-up, as HEJ editor, Jonathan Baillie, reports.