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Improving Mechanical Services in Healthcare Building Projects
Improving Mechanical Services in Healthcare Building Projects
Improving Mechanical Services in Healthcare Building Projects
MEKANIKAL
1.0 OBJECTIVE
The objective of this paper is to present the experiences and lessons learnt by the
Unit Kejuruteraan Mekanikal, Cawangan Kerja Kesihatan in the implementation
of healthcare building projects. The paper will capture on-site experiences and
discuss the improvements introduced via the Mechanical Brief of Design and
Build / Turnkey projects.
2.0 INTRODUCTION
Many hospitals built under the 8th Malaysia Plan (RMK8) were constructed
using the Design and Build / Turnkey (D&B/T) concept. Under this concept,
consultants are employed by Contractors to design and supervise the works, thus
performing most of what JKR would otherwise be doing. However in reality,
systems may not be designed and installed as they should and works not
properly supervised and coordinated, resulting in problems at a later stage. It is
not uncommon to find that after handing over, ie, during Defect Liability Period
(DLP), defects and maintenance issues cropped up. Thus the hospitals that have
been ‘completed’ become sources of complains.
a. Consultant’s Team
The consultants should have their own teams supervising work at site. However
at site they often have to depend on the Contractor’s teams. This can result in a
conflict of interest and occurrences of inaccuracies in evaluation and
endorsement. Contractors argue that since the consultants are employed by
them, they should not have to employ another team to supervise the works. This
argument is unacceptable because the Contractor’s men should be doing the
execution while the consultant’s people do the supervision.
This issue is not unique to JKR projects only as it has been mentioned in the
Board of Engineers ‘A Guide to Engineering Practice for M&E Engineers’. It is
recommended that consultants have their own site supervisor and site team.
There has also been disagreement about the responsibility of the consultants
during DLP and their role in the supervision of maintenance. The BEM
‘Conditions of Engagement’ Clause 2.7 states that,
“Unless terminated under Clause 2.3, Clause 2.4 or Clause 2.5 above
the Consulting Engineer's appointment under this Agreement shall
terminate when the Consulting Engineer shall make and issue the
certificate authorising the final payment to the Contractor. The
certificate authorising the final payment means the certificate to release
the retention sum by the Client at the completion of the defects liability
period/period of maintenance.”
A new clause is now added to the Mechanical brief to highlight requirements for
the consultant’s appointment, team at site, and their responsibilities.
It is not specified here the exact number of members in the team as this would
depend on the complexity and size of a project. For smaller projects this clause
may need to be amended accordingly.
b. JKR’s Team
On the part of JKR, the need for an experienced team to audit the works is
important. The JKR team must have sufficient numbers and experience to detect
potential installation problems before processing payment. Training is important
before an engineer is tasked to handle work at site. The team must have
knowledge of the relevant requirements of a D&B/T contract and standards.
The present Mechanical unit in CKK basically comprises engineers and staff
who started from scratch when the unit was formed, with minimum exposure on
hospital design and works. They have progressed far from then, though.
The Mechanical team needs to put on written record and bring to the attention of
the head of project team the critical services not completed. The project team as
a whole must also be made aware of this as in many cases there is simply not
sufficient Mechanical staff to be on the ground for all the projects at one time.
4.0 MAINTENANCE
a) Monitoring
For some projects, maintenance during DLP is monitored from Contractors’
monthly reports and clients’ feedback during meetings. Site visits would be
made for more serious situations. This arrangement seems satisfactory for minor
installations.
However, for hospital projects, due to the critical services mentioned earlier, a
more regular and closer monitoring system is required. A faster response to
failure and defect is necessary and the time taken for corrective action needs to
be monitored. It must be ensured that the Contractor’s maintenance team is
available at site. In the contract, it is now stated that the Mechanical
maintenance team shall be headed by an experienced mechanical engineer
resident at site.
However it must be noted that closer and regular monitoring would require
additional and dedicated JKR staff. It may not be always necessary to have
dedicated staff for every particular installation; instead a team can be
responsible for a number of facilities.
Some repair and replacement works may fall outside this definition. Damages
may be due to vandalism, neglect and other causes (abuse, environment etc).
Determining the exact cause and responsibility is not a straight and quick
process. For such situations, and where it involves critical services and safety,
the repairs must be done immediately. This requirement is now catered by a new
clause, as follow: (The list of items included however is not rigid and can be
changed as the need arises)
The availability of the above spares also provides some time for the hospital
authorities to put safety and security measures in place while educating the users
on the use of public facilities.
Testing and commissioning (T&C) are among the last items to be done before
handing over a project. Often not enough time is allocated for these activities. At
times, T & C of some components are also pushed into the DLP. Such practices
should not occur especially for critical and safety related services.
For hospitals that start operations immediately, getting work done during DLP is
a nuisance to the patients, hospital staff and visitors. It is also a safety hazard
and much more demanding.
To make sure sufficient time is allocated for T&C and due care is taken, it is
now required that the Contractor’s detail programme ‘shall include a T&C
period of not less than four (4) weeks for each Mechanical service’ and ‘For
special places/areas/rooms or mechanical systems such as the O.T, clean room
and medical gas system … the Contractor shall also furnish a report by an
independent third party specialist’.
With the above provision, JKR’s team can ensure that the Contractor allocates
time for T&C. For critical areas and systems, the report from third party
specialist may help to eliminate or at least reduce the concerns on T&C.
These reports could be due to the training not being properly planned and
contents poorly prepared. It could also be due to the wrong person being sent to
attend the tuition or the staff originally trained being transferred elsewhere.
The Mechanical Brief now requires the instruction to ‘ include classroom type
tuition on theories, hands- on training and the contents shall contain the
requirements of Clause 5.4.2 b) BEM/RD/PPC/11’.
Clients from time to time request for retraining sessions on operation and
maintenance. Request for retraining could be because of staff turnover or
because of time lapsed between training and actual use of equipment. Though
Contractors do conduct the retraining required, this activity involves cost and
should be well organised.
It ought to be noted that training must be attended by the right people. The
Consultants being designer of the system should advise the Client to appoint the
right operation and maintenance staff early. They can then familiarise
themselves with the system before being trained to do the job.
During the initial period after handing over, the hospital building is often under-
use with few patients and staff. The air conditioning heat load is low. This
results in the air conditioning system operating below the intended capacity.
Certain areas are even unused and with poor ventilation. The combination of
such factors, poor design and installation, idle system, lackadaisical
maintenance and environmental factors can contribute to condensation and
growth of fungus.
This issue will not be elaborated in this paper as it is easily a subject by itself.
The JKR team however must be alert to the more common causes such as poor
coordination, installation and operation.
The number of equipment able to operate on essential supply will affect the size
of the generator set, but all chiller sets (chiller, cooling towers and pumpsets)
should be connected to this supply. When required during emergency any
combination can then be switched on. However to control the number of chillers
that will operate and thus limit the demand on the gen-set, the number of
AHU/FCU that can be run shall only include those serving essential areas.
“the items to be wired for operation on essential power shall include but
not limited to the following:-
b) Standby Requirement
For in-house JKR design, standby chiller is provided and for ease of
maintenance, the chillers are configured such that they are identical and provide
the most economical service.
Installations in current and completed D&B/T projects however show that this is
not the case. The percentage of actual standby could be as low as only 25 %.
This arrangement is not maintenance friendly as the chiller load could be split
up to numerous very small units. This happens because formerly the
requirement only states that there shall be one identical standby unit installed
without being specific about the percentage of standby capacity.
In many areas in the hospital, the air conditioning system is an essential service.
For the operating theaters (OT) air conditioning supply is critical. It is noted that
most hospitals do not have back-up for the air handling units (AHU) even for
OTs.
To provide extra AHUs may be costly and there is also a constraint on space. As
a solution, AHUs for OT shall be installed with standby motors ready to be
connected when the duty blower motor fails.
If there is any mechanical system that could be said to be directly affecting the
patient than it must be the medical gas system. Its installation is specified to
comply with standards such as the HTM 2022.
Functionality need to be clarified during interaction with the client in the case of
usage of terminal units and attachments. Some of the issues that need to be
addressed are: Number of outlets (gas and electrical), and ease of use when
handling the terminal units.
Supply of gas cylinders was not a problem when JKR did the purchasing
through NSC tender. With D&B/T package contracts, cylinders of dubious
standards have been received. Problems arise when gas refilling contractor
refuses to refill the cylinders. Safety has been stated as one of the reasons to
decline. Requirement to have markings on the cylinders have proven to be
inadequate as cylinders can have all the ‘dubious’ marks and it is difficult to
ascertain authenticity. Hence, in addition to requiring cylinders to be new,
unused and complying to standards, it is now specified that cylinders must also
It is difficult to determine the quality of pipe work for medical gas once it has
been installed. Pipes, valves and fittings must be factory degreased and
delivered to site suitably packed and marked as medical gas items. These items
must be checked when delivered to site before installation.
b) Lifts
Lifts are another ‘front line’ services in a building and are very much used (and
abused) by the users. Generally there is not much complaining about this
system. However damage to lift buttons and display/indicator panels do occur. A
clause formerly specified for high rise quarters lifts have now been included to
tackle this problem. The car operating buttons, indicators and accessories must
now be anti-vandalism type and suitably protected.
Door hold function buttons has also been incorporated to avoid the crude
method of blocking the car doors with whatever is handy.
The other change made to the brief for this system is to take into account the use
of third party service for the link to the nearest Bomba station. Though the cost
may not be very high but it has been raised by Contractors. The costs shall now
be borne by the Contractor for the duration of the contract i.e till the end of the
DLP.
a) Settling disputes
Keeping proper and up-to-date records is important, especially in settlement of
disputes. Records on training, on who received manuals, drawings, tests results
and such documents will avoid pointing of fingers.
One mode that has been employed is by keeping an index list of the above
which can than be easily referred to.
b) Setting norms
Perhaps the major fault of the Contractor during DLP is their slow response to
complains. Repairs are said to take ‘forever’ or only done at the last minute.
However what is a reasonable response time ? For a simple repair a week may
be too long, but for a service that requires imported parts and specialised skill
that period may not be sufficient.
With records and by analysing the data, important information can be obtained
and norms established. Criteria such as response time, Mean Time To Repair
(MTTR), and availability can be determined and fixed. JKR will thus be able to
set with credibility the speed and duration of repair attendance by a Contractor.
12.0 CONCLUSION
There is a need to balance between having a very detail Mechanical Brief, like
our specification for in-house designed works, and the need to allow innovation
and avoid interferering with the Contractor / Consultant’s design. A rigid
specification will also probably put the responsibility heavily on JKR and not on
the design and build Contractor as it should be. However for critical, safety
related system and installations with repeated problems, there is a need for the
specification to be clear and complete.
Systematic records must be kept and maintained. With it problematic areas can
be identified and rectified.
Common solutions can be shared, training and awareness sessions for our staff
can then be held to avoid repeating the mistakes and to enhance the quality of
delivery of our projects.
The issues raised above are only some of the lessons learnt and improvements
that have been made and need to be continuously addressed.
The suggestions earlier and the improved Mechanical Brief should not be used
as a standard document for all projects. Changes and refinement may need to be
From time to time a committee can be formed to review the Mechanical Brief.
The members can look into changes introduced by individuals, adding new
standards and clauses to cater for current practice and situation.
//PaperMechCKK 011106.doc
The authors would like to thank all those who have directly and indirectly contributed
to the preparation of this paper. They include all mechanical engineers and staff of
Cawangan Kerja Kesihatan, who generously shared their experiences in handling
healthcare building projects.
A special note of appreciation to Ir. Mamat Rohizan Bin Abdullah, Ramli Bin Mohd.
Yusof and Ahmad Apandi Bin Larkin of Unit Kerja Kesihatan, Cawangan
Kejuruteraan Mekanikal for their invaluable knowledge and suggestion.
Last but not least to Pengarah Cawangan Kejuruteraan Mekanikal for his guidance
and for giving us this opportunity to present this paper.
Thank you.
5. JKR Malaysia, 2002, ‘Standard Form of Design & Build / Turnkey Contract.
(PWD FORM DB/T), 2002 Edition’.
ATTACHMENTS
1. Extracts from ‘Standard Form of Design & Build / Turnkey Contract. (PWD
FORM DB/T), 2002 Edition.’
ARTICLES OF AGREEMENT
FIRST RECITAL
2. Contractor's Obligations
2.9.1 The Contractor shall only employ local consultants for the design and
supervision of the Works and the management of the Project. Under no
circumstances will the Contractor be permitted to employ foreign consultants
except where there are no local consultants with the required expertise and
special exemption had been obtained from the Government, prior to the
execution of the Contract.
2.9.2 The Contractor shall submit a complete list of consultants to be employed for
the Works stating their job category and their obligations. The Consultants shall
be suitably qualified and competent and shall be registered with their respective
professional Boards.
2.9.3 The Contractor shall not employ any other professionals (other than those
named in his proposal) without the prior consent of the P.D.. The Contractor's
attention is also drawn to the fact that the said consultants shall be retained
throughout the Contract Period for the supervision of the Works and they shall
not be discharged without the consent of the P.D. All as-built drawings required
for the Works shall be certified by the relevant consultant.
48.1 At any time during the Defects Liability Period as stated in Appendix 1 hereto
(or if none stated the period is twenty-four (24) months from the date of
practical completion of the Works), any defect, imperfection, shrinkage or any
other fault whatsoever which may appear and which are due to design,
materials, goods, workmanship or equipment not in accordance with this
48.3 If the Contractor shall fail to comply with either sub-clause 48.1 or 48.2 or both
within the time so specified, the materials or works so affected may be made
good in such manner as the P.D. may think fit, in which case the costs incurred
including on-cost charges (calculated by applying the Percentage of On-cost
Charges stated in Appendix 1 to the costs incurred), shall be deducted from any
money due or to become due to the Contractor under this Contract and failing
which such costs shall be recovered from the Performance Bond or as a debt due
from the Contractor.
48.4 If any defect, imperfection, shrinkage or any other fault whatsoever be such that,
in the opinion of the P.D., it shall be impracticable or inconvenient to the
Government to have the Contractor to remedy the same, the P.D. shall ascertain
the diminution in the value of the Works due to the existence of such defects,
imperfections, shrinkages or any other fault whatsoever and deduct the amount
of such diminution from any money due or to become due to the Contractor
under this Contract, and failing which such diminution shall be recovered from
the Performance Bond or as a debt due from the Contractor.
48.5 When in the opinion of the P.D. the Contractor has made good the defects,
imperfections, shrinkages or any other fault whatsoever which he is required to
make good under sub-clauses 48.1 or 48.2, or both, the P.D. shall issue a
certificate to that effect, and the date stated in such certificate shall be the date
on which the Contractor has completed making good such defects,
imperfections, shrinkages or any other fault whatsoever. The said Certificate
shall be referred to as the 'Certificate of Completion of Making Good Defects'.
59.1 The Contractor shall maintain the whole of the Works and Services as listed in
the scope of maintenance of works contained in the Government's Requirements
for a period of twenty-four (24) months from the date of the Practical
Completion of the Works (hereinafter referred to as the "Maintenance Period")
and guarantee the same to be in good working conditions at all times. This
maintenance shall include services and equipment provided by the manufacturer
of the equipment installed and all materials and workmanship supplied by the
Contractor.
59.2 The Contractor hereby expressly undertake to remedy and supply/replace all
defective parts or items caused by normal wear and tear, inclusive of all
consumable items at his own cost. during the said twenty-four (24) months so
that the whole of the Works and Services is maintained in the best efficient
working order. This maintenance shall include regular and systematic checking,
cleaning, servicing, testing, calibration and services as recommended by the
manufacturer/supplier as required by the relevant authorities and necessary
adjustment to the equipment. The Contractor shall also provide
alternativeltemporary substitutes to the equipment and services as required in
the event of a breakdown of the plant. Any spare parts required for replacement
shall be made readily available during the Maintenance Period.
59.3 Replacement made or required to be made during the Maintenance Period shall
be subjected to a similar Maintenance Period from the date of replacement,
provided that such Maintenance Period shall not exceed 24 months from the
expiry date of the first Maintenance Period as aforesaid.
59.4 When in the opinion of the P.D. the Contractor has satisfactorily completed the
maintenance of the Works and Services as required under this Clause, the P.D.
shall issue a certificate to that effect, and the date named in such certificate shall
be the date on which the Contractor has completed the same. The said
Certificate shall be referred to as the "Certificate of Completion of
Maintenance".
CONDITIONS OF ENGAGEMENT
2. DURATION OF ENGAGEMENT
2.7 Unless terminated under Clause 2.3, Clause 2.4 or Clause 2.5 above the
Consulting Engineer's appointment under this Agreement shall terminate when
the Consulting Engineer shall make and issue the certificate authorising the final
payment to the Contractor. The certificate authorising the final payment means
the certificate to release the retention sum by the Client at the completion of the
defects liability period/period of maintenance.
2.7 (i) The Contractor shall appoint a Mechanical Consultant registered with the
Kementerian Kewangan Malaysia, the Board of Engineers Malaysia and
experienced in the specific area as required by the government.
(ii) The subcontractor for Mechanical Works shall be PKK, CIDB registered
and experienced in the specific area as required by the government.
2.18 The following sets / nos of items / components, whichever is larger, shall be
supplied to the P.D before handing over of the project :
Price for the above is deemed to be included by the Contractor in his offer.
The above parts shall not be used by the Contractor as spares or replacement
for the maintenance and guarantee works but shall be installed by the
Contractor at no additional costs as directed by the P.D. during the Defects
Liability Period.
The Contractor shall have in his direct employment at all times an adequate
and qualified team of supervisory and executive staff including a experienced
Mechanical Engineer to execute the works. The Contractor’s team shall be
different than the Consultant’s Mechanical team. All works shall be of good
current engineering practices and shall be carried out and supervised by
qualified, competent and skilled personnel whose quality shall be certified by
the Consultant’s Registered Professional Mechanical Engineer and agreed by
the P.D.
3.11.1 After completing the installation and before handing it over the Contractor
shall arrange to instruct one or more client operators, in all aspects of correct
operation and maintenance of the installation, including checking and fault
finding in case of breakdown during normal working hours. The instruction
shall include classroom type tuition on theories and hands on training. The
Contractor shall submit in advance for the P.D’s approval a detail and
complete schedule of the training to be conducted. This period of instruction
shall extend to a minimum of four (4) weeks or as specified by P.D. with the
plant in continuous normal operation.
3.11.2 During the Defect Liability Period the Contractor shall arrange for the
retraining of one or more of the government staff as directed by the P.D.
3.13.2 All the testing and commissioning shall be carried out and certified by the
Consultant’s Registered Professional Mechanical Engineer.
For the O.T, Clean room and Medical gas system, the Contractor shall also
furnish a report by a independent third party specialist.
3.17.9 Consumables
Fuels such as diesel, petrol and LPG, medical gases and vehicle tyres are not
included as consumables.
Sufficient nos. of chiller sets (chiller, water pumps, cooling towers etc)
to serve all essential areas, rooms etc.
AHUs/FCUs serving essential areas/rooms/department.
All exhaust fans serving essential areas and serving internalised toilets.
All areas with humidity controls.
4.5.1 Chillers.
The configuration of the chillers shall include identical standby unit/s to cater
for a minimum of 50 % hospital load.
All OT’s and laboratories shall have dedicated AHU. All OT’s AHU shall be
designed complete with standby motor.
5.3.15 The car operating panel buttons, indicators and accessories shall be anti-
vandalism type and suitably protected e.g with 10mm clear perspex with
countersunk screws.
5.3.16 All passengers lifts shall also cater for handicapped users e.g. Braille buttons
and markings, Synthesized voice, Handrails, Wheelchair level COP, Position
and travel direction indicators etc.
6.1 General.
6.1.3 Supply or rental of gas cylinders shall be decided during interaction meeting.
Gas cylinders shall be new, unused, from reputable factory and complete with
cylinder certificate issued by a reputable body. Should the gas cylinders be
rented, rental costs shall be borne by the Contractor for the duration of the
Contract i.e. till the end of the defect liability period.
6.3.8 All terminal units and accessories for pendants shall be approved by the
pendant supplier. The height of the pendants shall be determined during the
interaction meeting.
6.3.9 All works shall be pressure tested and certified by the Consultant’s Registered
Professional Mechanical Engineer.
7.3.7.3 A master switch to actuate all alarm bells and flashing lights shall be provided.
The panel shall be linked to the nearest Fire Brigade Station. For link through
third party authorities, the costs shall be borne by the Contractor for the
duration of the contract i.e. till the end of the defect liability period.