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phase of a project. Proposed savings to me- chanical and electrical systems should be thoroughly vetted with all stakeholders to understand the potential impacts on future operations and related costs. One person will not be able to address all aspects of future operations for a given project and an uninformed decision can drastically impact patient care. Closely monitor performance to control infection Once a building is operational, facility managers must monitor hospital environ- ments on a regular basis and keep building systems code compliant. They must also en- sure preventive maintenance programs are up-to-date and are being executed per plan. Using a commissioning plan and report protocol to ensure all building systems are running at optimal performance is critical. Implementing this approach can highlight systems not functioning properly, so that timely corrective actions can be taken. All air changes, pressure relationships, fi ltration and other HVAC features must function as designed. Improper pressure relationships can lead to the spread of infection, contamination, or other environ- mental situations detrimental to patient care. For example, fi lters in a facility's air handling system may seem insignifi cant, but play a vital role in keeping patient care areas code compliant. Facility managers should know where all fi lters reside system- wide. Neglecting fi lter sites could not only require future maintenance and equipment replacement costs, but could also result in breakdowns in infection control in patient care areas. Additionally, certain challenges can be avoided if proper commissioning docu- mentation for routine systems maintenance and operation is being followed. During the commissioning process, settings for one system's manufacturer-recommended settings might be changed in order to ac- commodate another system. If a facility manager is relying solely on the manufac- turer's operation and maintenance data for these systems and ignoring settings set forth in the commissioning process, then the building will have issues. Using integrated technologies to track and contain infection Certain integrated technologies can be critical to a hospital's comprehensive defense plan. Technologies that include real-time locating systems, building man- agement system controls and environmen- tal disinfection systems are valuable tools in controlling infection. If implemented properly, these technologies can help con- trol increased operating costs by creating "situational awareness" in patient envi- ronments. This awareness can help staf respond to patient needs more quickly and ef ciently, allow the optimization of HVAC system operations, pinpoint system failures for faster response and mitigation, help re- duce the concentration of microorganisms and help reduce energy usage. RTLS technologies allow for rules and algorithms to be set for all scenarios so staf is alerted when a process or procedure has been compromised. These technologies create situational awareness by enabling staf to monitor the location of tagged as- sets — both people and devices — in the hospital in real-time to ensure these assets are located within predetermined safe areas. They can alert staf to potential com- pliance breaches, such as instances where hand-washing protocols have not been fol- lowed or when an infected patient has left a safe location. RTLS also allows equipment such as an IV pump to be tagged, tracked and locked so it cannot be reassigned to another patient until it has been properly cleaned. Building systems controls, such as elevators, can be bypassed using RTLS so infected patients are delivered to destina- tions before stopping for hall calls. Digital waste stream tracking is another ef ective tool for infection control. Rooms with patients diagnosed as infection risks can be monitored via radio frequency identifi cation or bar-coding systems for waste removal. They can track who removes trash from the room, when the trash is removed and where trash travels on its way to fi nal disposal. Real-time alerts are triggered when infection control protocols are violated. Digital room signs integrated into the hospital data systems can be automated to display various caution messages and warnings based on patient diagnoses and events. Other information can also be displayed such as fall risks, privacy requests, in-room exam notifi cations, risk level indications, warning messages and isolation precautions. Implementing additional layers of infection-prevention technologies, such as ultraviolet light room disinfection and HVAC ultraviolet germicidal irradiation, along with emerging new technologies, can also play a role in a comprehensive approach to infection control. In order to prevent the spread of disease, and maintain public health, healthcare organizations should consider taking the above actions to prepare facilities for bet- ter infection control. Integrating building systems with cutting-edge technologies and monitoring hospital environments through preventive-maintenance programs are ef ective strategies to track and contain disease. Taking these actions can also ensure that costs, as well as infection, are controlled over the long term. Montie Garrison, associate principal for Rider Levett Bucknall, has 18 years of acute healthcare design, construction, transition, activation, occupancy and move planning experience. Von Lambert, senior project manager for Rider Levett Bucknall, has more than 30 years of healthcare design and operation experience. Dave Powers, senior project manager for Rider Levett Bucknall, has more than 20 years of project manage- ment experience, specializing in healthcare. Once a building is operational, facility managers must monitor hospital environments on a regular basis and keep building systems code compliant. They must also ensure pre- ventive maintenance programs are up-to-date and are being executed per plan. INFECTION CONTROL ISSUE FOCUS 26 Medical Construction & Design | JA N UA RY/ F EBRUA RY 2015 | MCDM AG.COM