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2 THE ORGANISATION MAINTAINS A SAFE ENVIRONMENT

FOR EMPLOYEES, CONSUMERS / PATIENTS AND VISITORS

Criterion 3.2.2 Buildings, signage, plant, medical devices, equipment, supplies, utilities and
consumables are managed safely and used efficiently and effectively.

Intent

The intent of this criterion is to ensure that all buildings, signage, plant, medical devices, equipment,
supplies, utilities and consumables owned or used by the organisation are managed in a way that will
support the creation and maintenance of a safe healthcare environment.

Relationships of 3.2.2 with other criteria

The organisation‟s management of its buildings, signage, plant, medical devices, equipment, utilities,
supplies and consumables is an aspect of its responsibility to ensure the safety of consumers /
patients, staff, visitors and contractors (Criterion 3.2.1) and to manage risk (Criterion 2.1.2). It must
reflect the organisation‟s commitment to safe practice and a safe environment, as per its emergency
and disaster management policies (Criterion 3.2.4), while also providing for those consumers /
patients and carers with diverse needs and from diverse backgrounds (Criterion 1.6.3). The
implementation of efficient cleaning practices, as well as water usage and the choice of electrical
goods, will fall under the organisation‟s responsibility for providing a safe and sustainable environment
(Criterion 3.2.3) and may be influenced by its management of infection control (Criterion1.5.2). A
failure in the efficiency and/or effectiveness of management of its buildings, signage, plant, medical
devices, equipment, supplies, utilities and consumables may lead to incidents and complaints (Criteria
2.1.3 and 2.1.4).

Planning and development

The term building is held to include one building, a group of buildings, a part of a building or additions
1
to a building. A building usually has walls and a roof; while any fixtures are to be considered a part of
the building. For the purposes of this criterion, a building is assumed to be occupied by people; the
term workplace may be substituted. A healthcare building or workplace is usually a building where
the occupants or consumers / patients are undergoing medical treatment, and in the event of an
2
emergency would require physical assistance in order to evacuate. Under Occupational Health &
Safety legislation, if a vehicle is driven in the course of employment it may also be regarded as a
workplace, where health and safety policies must be complied with by those in possession of the
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vehicle. Alternatively, when the vehicle is not in use it may be regarded as plant, which is defined as
4
“machinery, equipment or tool, and any component thereof".

The organisation‟s management of its buildings, plant and equipment requires the development of
policy and procedures drawn from relevant legislation, codes of practice and Australian standards,
and which address how the organisation will maximise the safety and comfort, and supply the needs,
of the community it serves. The Australasian Health Infrastructure Alliance (formerly the Health
Capital Asset Managers‟ Consortium of Australia and New Zealand) has developed the Australasian
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Health Facilities Guideline (AusHFG) , a comprehensive guide to the planning, design, building and
refurbishment of healthcare facilities. It also covers the planning, selection and installation of plant
and equipment, aspects of sustainability, access features for those with special needs, and workplace
design and ergonomics. The AusHFG is intended to promote a best-practice approach to health
facility planning, and is subjected to a continuous review process to ensure that the content reflects
contemporary models of care and health planning practice. It also lists all appropriate jurisdictional

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Criterion 3.2.2 Buildings, signage, plant, medical devices, equipment, supplies, utilities and
consumables are managed safely and used efficiently and effectively.
legislation, including Occupational Health & Safety legislation, and relevant Australian standards. In
November 2007, the AusHFG was officially endorsed for use by Australian States / Territories and by
the Ministry of Health, New Zealand. Using this document as its guide, organisations should develop
policy and procedures that will provide an effective managerial framework.

In existing facilities, or where an area is designated for a new purpose, it can be difficult to redesign
workspaces without major renovation. If the organisation intends to adapt an existing space for a new
purpose, it should plan the changes and manage the area so as to ensure compliance with relevant
Occupational Health & Safety legislation.

The organisation‟s planning and development should also strive for continual improvements to the
environment and for a reduction in risk, by evaluating the workplace and making changes as
necessary. As part of its system of planning, organisations should recognise that over time, buildings,
plant, medical devices and other equipment may require maintenance and/or repair, or to be
replaced. Events such as these should be expected, prioritised and budgeted for, in order to ensure
that safety is not compromised. Success or the need for improvement in the area of workplace
planning/design may be gauged by surveying consumers / patients, visitors and staff.

To assist facility managers to improve their facility management services, the Institute of Hospital
Engineering Australia (IHEA) has developed a hospital facility benchmarking process, called
AssetMark. Further information can be found at: http://www.ihea.org.au/technical_resources
/performance.

Prompt points
 Was the workplace purpose-built, or was an existing facility adapted?
 If an existing facility was adapted, what measures were taken to ensure that the environment
was appropriate to the work?
 What legislation / guidelines were consulted when planning for disabled access to the facility?
 If dangerous goods and/or hazardous substances are stored onsite, what legislation / codes
of practice were consulted in planning for their storage?
 How did considerations of ergonomics influence the design and layout of the workplace?
 Highlight some improvements made to the workplace after it was re-evaluated?
 How does the organisation prioritise maintenance, repairs and/or replacement of buildings,
plant, medical devices and other equipment?

Plant, equipment, vehicles, supplies and consumables

Plant, equipment, vehicles, supplies and consumables purchased by the organisation should
support the provision of care and services, and protect the health and safety of consumers / patients,
staff and others within the organisation. Effective planning and assessment of equipment may include
reviewing the community‟s needs, involving staff who use the equipment, and seeking opinions of
those consumers / patients who use the equipment. The process for assessment of new plant,
equipment, supplies and vehicles should include:
compliance with relevant legislative requirements, codes of practice, Australian standards and
guidelines
intended use and user and consumer / patient needs
cost benefits

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Criterion 3.2.2 Buildings, signage, plant, medical devices, equipment, supplies, utilities and
consumables are managed safely and used efficiently and effectively.
safety, including manual handling / task issues
infection control, including waste management issues
energy efficiency and environmental sustainability
training needs
storage and distribution.

Installation of plant and equipment should be in accordance with the manufacturers‟ specifications,
with the plant / equipment appropriately tested and commissioned and all necessary licences
obtained. Current information and scientific data from manufacturers relating to their products‟
requirements should be available for reference and guidance for both the operation and maintenance
of plant and equipment.

Plant logs and maintenance processes should ensure that plant / equipment is maintained and
serviced by people trained in maintenance of that equipment and in accordance with manufacturer
specifications and relevant standards, including maintenance on high-risk plant such as cooling
towers and pressure vessels. Documented processes for procurement, upgrading and replacing
equipment and supplies should be in place. The organisation may address issues of planning,
purchasing and provision through a comprehensive asset management system. A program to address
breakdown or any planned, deferred and/or outstanding maintenance requirements should be
developed.

The safe operation of electrically operated equipment used in health care should be monitored in
regard to electrical shock, thermal, radiant and mechanical hazards. Organisations should refer to
State / Territory legislation, Australian standards, and any other relevant guidelines. Specialised
equipment should only be operated by trained staff to minimise the likelihood of injury and to obtain
the best results.

Vehicles, according to their use and/or location, may be considered as either a workplace or as plant.
It is the responsibility of the organisation to maintain all owned, operated and leased vehicles. Issues
to consider in the maintenance and operation of vehicles include:
details of the vehicles
documented processes for maintenance / service
vehicle operators‟ (including volunteers) position descriptions that specify appropriate training and
licence(s)
enforcement of workplace non-smoking policy
safe transport of consumers / patients
secure transport of equipment / supplies
OH&S issues associated with vehicles, including appropriate seating, boot access, storage, and
manual handling / task
that any accident is reported as an incident.

Efficient management of supplies and consumables requires that systems of ordering, storage,
distribution, and control of inventory be implemented by the organisation. Items designed for single
use should not be reused unless the organisation has specific policies and guidelines for safe reuse
incorporating relevant statutory requirements, codes of practice and Australian standards. There
should also be a system to manage the recall of any supply or consumable, as per bulletins from the
Therapeutic Goods Administration.

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Criterion 3.2.2 Buildings, signage, plant, medical devices, equipment, supplies, utilities and
consumables are managed safely and used efficiently and effectively.

Prompt points
 For what plant / equipment / vehicles are logs kept? Who updates the logs?
 How did considerations of efficiency and environmental sustainability influence the purchase
of plant / equipment / vehicles?
 What plant / equipment / vehicles within the organisation require the operator(s) to be
licensed? How is correct licensing of operators, including drivers of vehicles, monitored?
 Who carries out maintenance on the organisation‟s plant / equipment / vehicles? How often is
it carried out? What records are kept?
 In the event of the recall of a consumable by the Therapeutic Goods Administration, what is
the organisation‟s procedure?

Medical devices

A medical device is “any instrument, apparatus or appliance, including software, whether used alone
or in combination, together with any accessories necessary for correct operation, which makes
physical or electrical contact with the patient, or transfers energy to or from the patient, or detects
6
such energy transfer to or from the patient, or is intended to diagnose, treat or monitor a patient”.

The term „medical device‟ applies to all equipment used in treatment, diagnostic activities, monitoring,
and direct consumer / patient care. This includes, but is not limited to, devices used for:
life support: anaesthesia machines, ventilators, heart-lung machines, etc.
monitoring: bedside monitors, telemetry monitors, etc.
treatment: lasers, electrosurgery, diathermy, etc.
diagnostics: pathology laboratory analysers, radiology equipment, endoscopes, etc.
patient support: hospital beds, specialty beds, etc.

An organisation should have documented management strategies for all medical devices used within
its facilities including:
medical devices owned, leased or rented by the organisation
medical devices on short, medium or long term loan to the organisation
medical devices being trialled by the organisation
medical devices prescribed by the organisation‟s staff to consumers / patients.

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AS/NZS 3551:2004 Technical management programs for medical devices details for the
organisation‟s board, executives and managers the minimum requirements of an effective strategy for
the management of medical devices.

The planning for and procurement of medical devices should support the provision of clinical services
and quality care, reflect the organisation‟s commitment to the health, wellbeing and safety of
consumers / patients, and meet the community‟s expectations. The process for assessment of new
medical devices should include consideration of their clinical efficacy and effectiveness, human
factors, Occupational Health & Safety, infection control, cost of ownership and clinical life, and should
be undertaken in consultation with all relevant staff. However, ultimately the health, wellbeing and
safety of the consumer / patient must be the overriding consideration in the selection and
procurement of any medical device. The introduction of a new information system intended for clinical

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Criterion 3.2.2 Buildings, signage, plant, medical devices, equipment, supplies, utilities and
consumables are managed safely and used efficiently and effectively.
applications should be reviewed in a similar way to any other medical technology; there should be
clinical input to this process.

Many medical devices require specific training and some require licensing of the individuals who will
operate the device. The organisation must ensure that all those involved in the operation of medical
devices have undergone all necessary training, are competent, and that where required, all correct
licences have been obtained.

Increasingly, medical devices are utilising elements of information and communications technology
(I&CT). A growing number of medical devices are in essence a desktop computer, notebook or
network server running dedicated medical software, or a system incorporating a desktop(s),
notebook(s) or server(s). However, the organisation should manage all such devices as medical
devices, not as I&CT. The management of medical devices may therefore present a significant
challenge to the organisation, since training in IT does not qualify an individual to undertake or direct
the management and maintenance of medical devices or medical networks, nor does the ability to
operate a software-driven medical device imply the necessary knowledge and skills required to
manage and maintain it. Medical devices, whether networked or not, and medical networks should be
managed and maintained, including the software component, by competent biomedical engineers or
biomedical technicians. This task may be assigned to the manufacturer or the manufacturer‟s agent.
Only applications software (including antivirus software) and software updates, patches and service
packs authorised by the device manufacturer should be loaded onto a medical device, a networked
medical device or any device attached (including wirelessly) to a medical network. The National E-
Health Transition Authority (NEHTA) provides specifications for IT applications with which vendors
should comply.

Installation, calibration, maintenance and, finally, decommissioning and disposal of medical devices
should be carried out by registered and/or appropriately qualified, trained and competent individuals.
Records should be kept of all medical device maintenance.

Responsibility should also be assigned for the cleaning, sterilisation and/or recommissioning of each
individual device, as this is a specialised task that does not fall within the province of the
7
organisation‟s general cleaning staff.

Prompt points
 What processes exist within the organisation to ensure broad consultation during medical
device procurement?
 In managing medical devices within the organisation, how does the biomedical engineering
department ensure appropriate engagement on I&CT issues?
 What processes and approval mechanisms can the organisation demonstrate with respect
to the management of medical devices, including record keeping, risk evaluation, scope of
routine testing programs, contract management and resource availability?
 In the event of a recall of a medical device by the Therapeutic Goods Administration, what is
the organisation‟s procedure?

Signage and special needs

Clear signage is an important aspect of any healthcare organisation. In an emergency, an

individual‟s ability to determine quickly the location of the organisation and/or how to access the

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Criterion 3.2.2 Buildings, signage, plant, medical devices, equipment, supplies, utilities and
consumables are managed safely and used efficiently and effectively.
required department can be critical, while at any time clear signage will ensure that the consumer /
patient and the visitor alike can find their way around easily, and that a visit to the organisation is not
attended by confusion, stress or unnecessary loss of time. Installation of signage upon the roads
surrounding the healthcare organisation will need to be organised in consultation with local councils
and the appropriate roads authority.

The organisation‟s external signage should provide the following information:

appropriate routes of access
hours of access
after-hours access (where applicable)
telephone numbers
details of other healthcare organisations in the area, particularly the nearest accident / emergency
facility.

External signage may also relate to such management issues as designated parking / non-parking
zones, ambulance bays, and the enforcement of a non-smoking policy.

Internal signage must provide clear directions to specific areas of the organisation, as well as
providing health and safety information including non-smoking areas, restricted mobile phone usage
and the presence of any hazards. All exits must be clearly marked.

Signage within a healthcare organisation must consider the needs of the community in general and of
those with special needs. Colour-coding and symbols may be used in addition to word-based signage,
as literacy levels will vary greatly within the community; however, colour-coding should consider the
needs of those with colour-vision impairment. Word-based signage should use clear, simple and
concise language. The organisation may wish to provide multilingual signage. In doing so, it should
consider carefully the demographic being served. Moreover, as demographics can shift over time,
there should be regular reassessment of the signage provided, and changes made as appropriate.

The conditions of access of persons with a disability to the organisation will be governed by State /
Territory legislation. Designated routes of access and facilities should be clearly indicated. With an
aging population, an increasing number of consumers / patients and visitors may have impaired
eyesight, and this should be taken into consideration when the organisation is designing and
positioning signage: bright colours, good contrast and large lettering are appropriate choices; lighting
is also an important concern. The organisation may also wish to provide Braille and tactile signs; such
signage is governed by the Building Code of Australia.

Clear, effective, well-positioned signage is an important aspect of the efficient operation of any
healthcare organisation, and one that should be monitored and reassessed according to changes in
the community being serviced and the level of satisfaction expressed by consumers / patients and
visitors. Surveys may be used to assess satisfaction levels.

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Criterion 3.2.2 Buildings, signage, plant, medical devices, equipment, supplies, utilities and
consumables are managed safely and used efficiently and effectively.

Prompt points
 Is the organisation‟s signage language-based or symbol-based? What factors influenced
this choice?
 Does the organisation provide signage in languages other than English? How were the other
languages chosen?
 What special needs signage is found within this organisation?
 How often are the organisation‟s signage arrangements reassessed? On what basis are
changes to the signage made?

Utilities

Utilities are the basic services that the organisation uses to function, including water, power, ventilation,
medical gases and suction systems, and communications systems. Supplies and consumables are
generally commodities with a shorter life while in use than items that would remain in inventory after
distribution or assignment for use, such as dressings, syringes, disposable gloves, catheters, etc. The
effective management of utilities is required to minimise risk of failure, or of internal or external
emergencies.

As their supply, storage and use has a direct impact upon the consumer / patient, the organisation
may prefer to classify and manage medical gases as „a medical device‟. The regulators and
flowmeters with which medical gases are operated are, however, medical devices by definition, and
should be managed as such.

In an environment where there is extensive use of IT, redundancy systems, such as immediate
printing of core information on consumers / patients at a specific printer using battery back-up, should
be in place in the event of a power failure. IT systems should themselves have an external back-up
system, to guard against the consequences of IT failure.

Policies governing the use of utilities should cover emergency and disaster management. The organisation
should also have procedures to ensure that the use of energy and water is efficient and sustainable. These
should address considerations such as purchasing electrical equipment with a high energy rating, and
programs to conserve energy and water (switching off equipment, good plumbing maintenance, etc.). The
organisation‟s energy and water use should be assessed annually, and efforts made to improve efficiency.

Prompt points
 How has the organisation improved the efficiency of its energy and water usage?

Cleaning, maintenance and hazard management

In order to be efficient and effective, the organisation‟s management of its buildings, signage, plant,
equipment, utilities, supplies and consumables should be supported by a well-planned and well-
resourced system of cleaning, maintenance and hazard control.

In order to ensure thorough cleaning, there should be a schedule that clearly describes all areas to be
cleaned, as well as the specific surfaces / objects to be cleaned (e.g. floors, toilets, desk tops,
computer screens). This schedule should also specify which surfaces / objects are not to be touched

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Criterion 3.2.2 Buildings, signage, plant, medical devices, equipment, supplies, utilities and
consumables are managed safely and used efficiently and effectively.
(e.g. medical devices). Cleaning is not only crucial in its own right but a vital component of the
organisation‟s infection control and waste management systems. It is the organisation‟s responsibility
to ensure that cleaning is sufficiently staffed and resourced, and that cleaning products are stored and
used as per manufacturer‟s instructions and relevant OH&S policies. The frequency of cleaning of
specific areas should be related to a risk assessment.

Maintenance is also an essential aspect of the organisation‟s management of its buildings, plant,
equipment and vehicles. However, maintenance should not merely be reactive: the organisation
should implement a planned and coordinated system of preventive maintenance, in order to retain all
assets in good working order, to extend the working life of critical and expensive equipment, and to
reduce the risk associated with poorly operating equipment. All stages of preventive maintenance,
from planning to completion, should be documented. Any instances of deferred maintenance, that is,
maintenance that should be performed, but is not, for reasons ranging from budgetary constraints to
staffing limitations, should also be recorded and an explanation provided.

Within the organisation‟s integrated risk management framework, there must be a system for
identifying, documenting, evaluating and reducing the risk associated with its buildings, signage,
plant, equipment, utilities, supplies and consumables. This should encompass the reporting of all
relevant incidents, identified hazards and near misses, by all individuals within the organisation. A
culture of near miss reporting is especially to be encouraged, as near misses are a vital indicator of
developing problems, and are sometimes underreported due to the perception that no „actual‟ incident
occurred.

Well-implemented systems of cleaning, preventive maintenance and hazard reduction are

fundamental to the organisation‟s efficient and effective management of its buildings, signage, plant,
equipment, utilities, supplies and consumables, and the quality and efficacy of the systems should be
regularly evaluated, and improvements made as required.

Prompt points
 How does the organisation ensure that its cleaning requirements are sufficiently resourced?
 How and by whom is the organisation‟s program of preventive maintenance planned?
 How does the organisation encourage the reporting of near-misses within its management of
its buildings, signage, plant, equipment, utilities, supplies and consumables?
 What improvements have been made to the organisation‟s cleaning, maintenance and hazard
reduction systems, and why were they made?

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Criterion 3.2.2 Buildings, signage, plant, medical devices, equipment, supplies, utilities and
consumables are managed safely and used efficiently and effectively.

Evidence commonly presented

Consider whether the following will help to address criterion 3.2.2

• Risk ratings / assessments

• Preventive maintenance plan, including deferred maintenance records
• Preventive maintenance plan review
• Systems for handling recalled goods or devices
• Incident reports, including near misses
• Evidence of disability and cultural needs identification
• Policies on:
o purchase and supply
o buildings, signage, plant, equipment, utilities, supplies and consumables
o workplace design
• Asset register
• Contracts, including biomedical and IT contracts
• Results of mandatory plant / equipment testing

Performance measurement

This criterion states that: “Buildings, signage, plant, medical devices, equipment, supplies, utilities and
consumables are managed safely and used efficiently and effectively”. The organisation should be
able to demonstrate that it has policies and procedures for the safe and efficient use of its assets, that
it proactively maintains them, and replaces them as needed; and that it meets all standard and
jurisdictional requirements for the procurement, operation and maintenance of its medical devices.

Some common suggested performance measures are as follows:

Number of incidents resulting in loss of critical services

Total number of incidents

Number of injuries sustained by staff relating to the use of equipment or medical devices
Total number of injuries sustained by staff

Number of incidents, including complaints, relating to building defects (trip hazards, lighting problems,
insufficient or incorrect signage, etc.)
Total number of incidents and complaints

Number of scheduled preventative maintenance services completed on time

Total number of scheduled preventative maintenance services

Number of vehicle accidents / breakdowns

Total number of vehicles

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Criterion 3.2.2 Buildings, signage, plant, medical devices, equipment, supplies, utilities and
consumables are managed safely and used efficiently and effectively.
Number of Root Cause Analysis recommendations implemented
Total number of Root Cause analysis recommendations

Number of consumers / patients satisfied with the organisation‟s signage

Total number of consumers / patients surveyed

Number of staff and consumers / patients who are satisfied with the design / layout of the organisation
Total number of staff and consumers / patients surveyed

References

1. Australian Taxation Office. School Building Funds. Canberra ACT; Australian Government; 2008.
2. AS 4083:1997 Planning for emergencies - health care facilities.
3. Haworth N, Tingval Claes and Kowadlo N. Review of Best Practice Road Safety Initiatives in the Corporate
and/or Business Environment. Melbourne VIC; Monash University; 2000.
4. Comcare. The Definition of Plant. Canberra ACT; Australian Government. Accessed from
http://www.comcare.gov.au/forms__and__publications/fact_sheets/?a=39161 on 26 May 2010.
5. Australasian Health Infrastructure Alliance. Australasian health facility guidelines (AusHFG). Sydney NSW;
Centre for Health Assets Australasia, UNSW; 2009.
6. AS/NZS 3551:2004 Technical management programs for medical devices.
7. AS/NZS 4187:2003 Cleaning, disinfecting and sterilizing reusable medical and surgical instruments and
equipment, and maintenance of associated environments in health care facilities

Standards

ISO 7001:2007 Graphical symbols--Public information symbols.

AS/NZS 2500:2004 Guide to the safe use of electricity in patient care.
AS 2342:1992 Development, testing and implementation of information and safety symbols and symbolic signs.

Guidelines

Australian Building Codes Board (ABCB). Building Code of Australia. Canberra ACT; ABCB. Accessed from
http://www.abcb.gov.au/index.cfm?objectid=039FB520-2D52-11DE-9FC7001B2FB900AA on 2 June 2010.

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