ABSTRACT
Over 700 fire cases were investigated, which occurred in German hospitals during a period of 10 years. Their features and impact were evaluated. Conclusions shall support planners and operators in improving fire protection and shall contribute to lower exorbitant follow-up costs on account of fire fighting.

The majority of fires do not occur during night – as generally accepted and published – but during daytime. So does the presumption that small fires increasingly occur during daytime and fires during night cause larger damages, as a correlation between fire size and its occurance disproves.
Hospital fires have three major causes: The main cause is the electrical fault (27,9%). More detailed investigations of devices and facilities in individual hospital sites show that faulty manufacturing and installation and partly missing maintenance support fires. Further carelessness, like inadequate circumspection during welding, cooking or application of heat sources during works were detected as fire causes (25,2%). Peculiarly high compared to other causes is the evidence of fire raising (22,5%).

Valuable for risk reduction is the insight that fire raising essentially occurs in corridors and storages in the basement. Here, direct technical safety measures proved to be most effective. A correlation between fire increase and waste segregation since its legal introduction was evaluated in hospitals. A similar correlation was located in industry and office buildings.
The evaluation provides a huge number of valuable advices,on how to improve fire safety effectively and economically.

ABSTRACT

The hospital is not a risk-free building for its users
If the first subject of risk is constituted by the medical and health assistance activities, there are other subjects and places where it is possible a risk occurrence, like technical installations, logistics, and environment. In some cases their impact on the patient is not direct, but in fact they are normally at the origin of a decrease of Quality, Reliability and Safety in the healthcare activity, as well as of the conditions of hotel services and reception .

In order to avoid problems in the Health Centres, at the economic and legal levels , it becomes essential to determine the respective domains and sub-domains of responsibility and the associated risks with their effect, the probable causes and the solutions recommended to avoid or reduce them. It is the “ a priori “ analysis of risks

The best solution to control the risk is to have on place a team of supervisors in each domain, associated to medical supervisors . They perform an analysis of risks “ a priori “ and “ a posteriori “. Each team will actualize “ a priori “ the information at a regular pace and will apply the organization instruments and devices to fight against them “ a posteriori “

The paper analyzes this organization and the available information, and proposes the creation of a common Centre where all information on risks could converge , as well as all the strategies implemented with the correspondent results. This solution has in addition advantages of cost and of professionalism of the personnel involved in the program.

ABSTRACT

CORROSION PROBLEMS IN WATER FACILITIES IN HOSPITALS

Autor: Fco. Javier Serrano Santamaría
Ingeniero Técnico Industrial

- The bacterium Legionella pneumophila has existed, exists and will exist. It can not be fully eradicated since it enters into the caverns formed by the imbedded fouling to protect itself and develop, so regular disinfection processes are not capable of destroying it 100%.
Iron oxide is the caviar of the bacteria since it is involved the process of its development
The layers of biofilms are bacteria that use iron in their development process and help the Legionella bacteria to grow.

Many of our facilities are old, with iron oxidated pipes, fouling, galvanic pairs (steel - galvanized steel - copper), The Standards require metallic materials resistant to corrosion facing disinfections by thermal shock and chemical treatments .¿ What do we do with them? ¿Change?. Few opportunities remain to us, water treatment (electrolyte) and cathodic protection (sacrificial anodes),

But the plastic materials could be an alternative of choice since they cover most of the applications in our piping facilities.

ENGINEERED ACTION PURSUING CURATIVE GUIDELINES
Author: Cristoph Hartung. Hemmingen - Germany
ABSTRACT
Engineering and technical performance in hospitals must convince by safety, availability, economy and ecology within the scope of the selected curative profile on the basis of calculated risk. Technical risks can be controlled by defining and observing risk qualities. These can be derived from curative issues. Engineering pursuing curative guidelines operates on the basis of calculated risk within accepted risk margins

Title : ORION risk management method- Application at Epinal General Hospital
Authors : Franck Debrouck – Air France/ Anne Roubinet – Epinal General Hospital

In addition to ex ante risk management, any undesirable event must be traced, assessed and minimized.
The ORION method, already applied within civil aviation services has been successfully implemented at Epinal General Hospital.

The Experience Feedback Committee (or unit) – CREX – is an internal safety steering and management tool, a dynamic approach to sharing feedback within a continuous quality improvement process.

Observations in the field have demonstrated the importance of minor events that highlight organisational failures. Type of situations analysed: minor event leading to organisational failure without necessarily having an effect on patients. Such events often carry risks and are qualified as precursors.

The CREX meets once a month. This decision meeting in which corrective action is followed up, is non-hierarchy dependent and is necessarily multidisciplinary.

Meetings are organised according to simple, but strict, rules.

Management’s commitment, the modesty of the approach, the ability to listen, recording of events, and relevance of the analysis and the ability of the organisation to implement corrective action are the assertion of an efficient and enduring CREX.

The level 1 systemic analysis tool proposed (ORION©) enables the analysis director – selected from the professionals within the unit – to analyse the exemplary event. Identification of the principle technical, organisational, human or environmental contributing factors and influencing factors make it possible to propose corrective action accepted by the protagonists.

This ex ante risk management approach (CREX on the basis of precursors) must confer robustness and tolerance to the organisation with respect to human failures.

The CREX prospective safety improvement approach makes it possible to implement corrective action on the basis of analysis of precursor events.

Annexe

Epinal General Hospital was eager to structure the analysis bodies within the various entities of the establishment. The event feedback process was prompted by a participative approach taking into account the human factor in the occurrence of an event, whether the event is a precursor or an undesirable event. Systemic analysis was selected as principle analysis tool for identification of contributing factors ex post facto.