Technology Transfusion

By Raj Gupta, P.E., LEED AP, President, and David Marshall, P.E., ASHE, Senior Vice President, Environmental Systems Design, Inc., Chicago July 1, 2005

Whether it’s allocating space for new technology, contending for U.S. Green Building Council LEED certification or weighing in on a project budget, today’s engineers are being asked to get more involved in facility design—and involved from the beginning.

For years architects were the ones who estimated the amount of space for mechanical and electrical equipment. Mechanical and electrical infrastructure were viewed almost as if they were necessary evils.

Today, however, owners, designers and building managers have a much different view; they’re putting more emphasis on the function of M/E/P systems within their facilities—and rightfully so.

Communicating early with other team members allows the engineer to design systems that work for all parties, from the facility’s administration, care-giving staff and operating engineers to its patients. Early involvement allows us to gather building criteria and get a real feel for operational issues, resulting in the ability to build more flexibility and adaptability into each and every facility.

Take, for example, Northwestern University’s Galter-Feinberg replacement hospital, which opened its doors in Chicago in May 1999. As one of the first hospitals in the United States to boast HEPA filters on all fan systems, the facility was primed for controlling airborne bacterial infection—and for dealing with the inevitable in health-care design: future renovation.

To be more precise, Galter-Feinberg’s HEPA filters supply rooms with air, preventing bacteria from recirculating through the hospital’s HVAC system and mitigating the spread of infection. But an added benefit is that the hospital can be easily modified, because each area contains identical filters. And it’s primarily because systems engineers were involved in the design from day one.

As the project’s engineers, our firm was brought onboard at the building’s inception. Because of the tremendous space considerations and financial impact of the HEPA filters, we presented them as an option to the hospital owners early in the project’s design phase.

From the beginning, the facility’s HVAC system was engineered to handle the filters, while architectural designers were also able to allocate for the additional space they required.

Since it first opened six years ago, Galter-Feinberg has already seen changes. For example, a space that was originally administrative offices has been converted to surgical beds—without major changes to the facility’s infrastructure.

Flexibility and adaptability

The rising cost of health care in the United States has inevitably created a push for competition, and hospitals and doctors must vie for business by improving patient experience. Revenue is at stake, a shortage of which can leave many of these health-care facilities with no other recourse than budget cuts and staff reductions.

The result? For one, less time and fewer maintenance personnel are allocated for the maintenance of mechanical and electrical equipment. And this leaves engineers with the challenge of designing systems that are easy to operate and maintain.

But meeting tight budgets isn’t the only challenge for engineers. Additionally, no other building type has been more affected by technological innovations than the health-care facility. Its infrastructure is expected to last 25 to 30 years, and yet, technology changes more rapidly—in 18-month cycles. A hospital can become obsolete in the wink of an owner’s eye.

So, how can health-care facilities stay up-to-date and still keep their costs down? One answer has been to ask engineers to design infrastructures in such a way that each area of a hospital can be isolated in the event of future expansion. In this way, sections of a facility can be shut down one at a time, helping to maintain patient care and maximize revenue throughout facility upgrades and retrofits.

Working with architects from the beginning and designing with flexibility and adaptability helps engineers contribute to these goals and saves clients time and money. Flexible design gives owners the ability to upgrade any M/E/P equipment necessary throughout the life of the facility, without having to change the building’s core infrastructure.

In a modularly designed building, it’s easiest to plan for additional physical space and piping so that future systems upgrades can be made without having to reconfigure the space. An empty area can serve different functions for the time being until the facility needs additional equipment.

Adaptable design builds on this idea. It gives a hospital the capacity to change the function of any area within, creating an entirely different purpose for the same space. For example, the Galter-Feinberg facility was able to change administrative offices to surgical beds.

Technology takes over

In the last 15 years, medical technology has changed so much that M/E/P and IT systems expenditure is now sometimes close to half of a hospital’s total construction cost, up from about 30% a generation ago. For one, the condition of today’s in-hospital patients is generally more acute than ever before. Patients are therefore more dependent on the reliable operation of hospital equipment and systems.

Additionally, an estimated 100,000 deaths a year are caused by infections patients receive during their hospital stays—with 5,000 of these attributed to the building’s mechanical systems. From this perspective, engineers figure into a significant portion of each health-care project.

One of the newest trends is interventional imaging, where digital, heat-producing equipment such as MRI and CT scan machines are being brought into the operating room (OR), requiring the space to be physically larger and creating the need for additional cooling, while also posing an infection-control challenge.

Designing IT rooms adjacent to the OR is one solution. A technician or consulting doctor has equipment control and visibility into the OR without having to enter the sterile area itself. This simplifies infection control within the OR, while eliminating additional cooling demands and giving surgeons the ability to transfer data quickly and work without interruptions.

Another infection control technique currently employed is supplying OR equipment from the ceiling, which keeps its floors clear of fixed equipment. While this is successful from an infection control standpoint, it introduces more congestion into the ceiling space where the M/E/P systems are housed and laminar-flow supply air is delivered. This is another issue we contend with in the early design phase to insure our systems are both constructible and maintainable.

Patient rooms are also filling up with IT-dependent equipment. New digital charts and bedside check-ins are just two ways they’re getting more crowded.

Remote IT rooms (IDFs) are now exceeding 120 to 150 sq. ft. just to accommodate the electronic equipment, servers, cooling and tight humidity controls required. In a lot of cases, an uninterruptible power supply is also needed so the systems can continue to function during a power outage before generators come up.

Prentice Women’s Hospital, which like Galter-Feinberg is part of the Northwestern Memorial Medical Center Campus, is a case in point.

Going state-of-the-art

When its doors open in 2007, the new Prentice facility will be a totally digital hospital from its ORs and imaging facilities to its patient rooms and building control systems. Bedside check-in, wireless communications and touch-screens for ordering room service are among the options the hospital is currently considering. Enhanced television, video, lighting and thermostat control are also on the hospital’s shopping list.

Designers are making provisions so the infrastructure is ready to handle it all. Each floor will have at least one dedicated IDF that is large enough to consolidate servers. All the building’s hardware will be looped together, so in the event of technical failure, there are redundant resources.

This gives the owners the ability to defer their decision on exactly which technologies will be implemented. We won’t know which systems will be used until 18 months before the hospital’s opening, assuring the most state-of-the-art equipment available. At that time we will assist the hospital with their final evaluation and equipment selections. Once those have been made, we’ll revisit the systems and make the necessary changes for a new generation of equipment.

Another way in which ESD is creating flexible health-care facilities is through the HVAC system. Another Chicago facility, Rush University Medical Center (RUMC), is in the early design stages of an expansion and renovation. In order to keep RUMC’s existing facilities running throughout the construction, and yet allow for future expansion, ESD was challenged to find a way to maintain the building’s HVAC systems, which will be isolated from their current outside air supply and exhaust sources by the expansion.

The final design will maintain two existing risers in all towers, each containing chilled water, steam and air systems. The existing fan systems will be replaced with two large central systems that will not only connect to the existing duct risers, but will also add operational redundancy and energy efficiency.

The systems will split the building vertically in two places. Looped together with valving/dampers, the dual risers will allow for individual rooms or small areas to be isolated, minimizing the amount of the building that is off-line during construction. This will not only benefit the current renovation effort, but will also anticipate changes that will come over the life of the facility.

Another upgrade for a different client involved replacing six-year-old imaging equipment with state-of-the-art CT and first-generation MRI/IR equipment. Because of the large magnets within the machinery, the equipment requires an external chilled-water source to keep it from overheating. In just six years, cooling demands have doubled from the original design, which was state-of-the-art in 1999. The existing chilled-water system has a higher water pressure than the new equipment requires. It also develops colder water than allowed by the manufacturer of the new system. As part of the design, our goal was to bring the hospital to a place where they could not only support the loads required today, but also anticipate future changes.

This was accomplished by adding dedicated heat exchangers and pumping systems to not only feed the new equipment, but also provide the capacity for future load growth. By using variable-frequency drives on the pumps and isolating the chilled water, we created a system that supplies only needed chilled water on a real-time basis and allows building engineers to take advantage of “free cooling” during Chicago’s cold winters without having to operate the electric chillers.

Our greatest goal as health-care designers is to build hospitals that won’t be obsolete in 20 or 30 years. The most effective way to do this is to be involved with the project from its concept phase; to gather building criteria and understand the facility’s operational issues; and ultimately, to build more flexibility and adaptability into each hospital we touch.

Health-Care Design 101

Hospital design is guided by two concepts: trends and drivers. Trends are specific to the hospital’s surrounding area and the demographics of its clientele, including how hospitals are reimbursed for their services. For example, in an area highly populated by young families, the hospital may create a large number of maternity and OB rooms, whereas a hospital in an area highly populated by assisted living homes may put more of an emphasis on geriatrics.

Drivers are the basics of a hospital design. It could be what the competition is doing or what a hospital needs for accreditation. Examples include a more flexible emergency room with check-in booths, a separate ambulance entrance or an expanded elevator system with options to skip floors for quicker patient relocation.

Every hospital incorporates both trends and drivers into its wish list of design features, creating unique and community-specific infrastructures that serve local patients just what the doctor ordered.

Controlling Threats

Since September 11, airborne chemical, biological and radiological hazard controls have appeared on the hospital design scene.

There are two possible scenarios in which a hospital can be affected: 1) a direct facility attack; and 2) victims arriving at the hospital, either by ambulance or on foot, from a CBR event at a remote location.

Either way, the hospital’s mechanical and electrical systems must be designed to contain the threat. This can be achieved by compartmentalizing HVAC systems, either with dedicated systems for separate areas or with central systems by using dampers, actuators, sensors, pressurization or electronic controls; using a combination of .03 micron HEPA filters and UV germicidal irradiation to provide contamination removal in selected areas; considering pathways from public entrances to potential treatment areas; and using IT to monitor or maintain isolation.

Consequently, engineers have become a major component of hospital security, which is something no one could have imagined even 10 years ago.

Threat Control, Part 2: Guidelines:

It is crucial that all new and renovated hospitals consider security threats in their initial design phases. Standards set by the Centers for Disease Control and Prevention and NIOSH help engineers by providing various types of guidelines:

Prevent access to outdoor air intakes.

Prevent public access to mechanical areas.

Prevent public access to building roofs.

Implement security measures, such as guards, alarms and cameras to protect vulnerable areas.

Isolate lobbies, mailrooms, loading docks and storage areas.

Secure return air grilles.

Restrict access to building operation systems by outside personnel.

Restrict access to building information.

Consider general building physical security upgrades.

Ventilation & Filtration:

Evaluate HVAC control options.

Increase filter efficiency.

Use ducted and non-ducted return air systems.

Utilize low-leakage, fast-acting dampers.

Keep the building airtight.

From “Guidance for Protecting Building Environments from Airborne Chemical, Biological, or Radiological Attacks”

By the National Institute for Occupational Safety and Health (NIOSH)

Health Care: The Market is OK—for Now

For the New York-based Syska Hennessy Group, the health-care market has been very good to the consulting engineering firm, with major activity on both coasts.

“Everything we see, hear and feel suggests that the health-care market will continue strong,” says Bill Scrantom, the firm’s national health-care director. “The end is not in sight. The only thing that might slow it down is an increase in interest rates.”

That being said, Scrantom adds, they have heard some economists suggest that the health-care market might begin to taper off in the coming year. But as things stand today, the firm is plenty busy.

“The East Coast continues to offer a lot of opportunities for designing acute-care facilities,” he says. “And on the West Coast, there’s also lots going on.”

One driving force in the California market is SB-1953, which mandates that all hospitals in the Golden State—new and existing—meet seismic codes. There are exceptions and extensions for hospitals in lesser seismic zones—but only through 2006, says Scrantom.

Another major driver that’s keepping health-care work steady is the fact that technology in specific health-care fields continues to develop. Combined with changing population demographics, this more advanced medical equipment has led to a market for specific types of outpatient care clinics.

“On both coasts, we’re seeing a big interest in specialized cancer treatment centers and ambulatory care centers,” says Scrantom.

Actually, to hear Scrantom tell it, the picture has changed little since last year. In CSE’s 2004 overview of the hospital market, the trend was a strong and robust market with new facilities being built on greenfield sites with good-sized budgets to support this construction. Since then, little has changed, but health-care facility owners, according to Scrantom, are a little tighter with their budgets.

“Any talk of budgets usually elicits discussion of what is a revenue generator,” he says. “For instance, a chiller is not a revenue generator.”

That means designers of basic building infrastructure have to more carefully scrutinize their designs. Offsetting a turn toward value engineering, however, is the need for reliability, particularly in retrofit projects, where the ongoing operation of a health-care facility can’t be compromised. “If you shut the facility down, the ROI doesn’t pencil out,” said Scrantom.

And not all infrastructure-related improvements are a hard sell. “Cogen is a no-brainer for hospitals,” says Scrantom, “because they generate so much heat.”

Elsewhere on the technology front, Syska is looking at microturbines, especially for health-care systems in California, where local government rebates support their installation and use.

Regardless of the the type of technology engineers experiment with, Scrantom adds, there is a universal mandate affecting the health-care design industry: the need for facility flexibility.

“That’s the real buzzword in health-care design these days,” says Scrantom, “no matter what you’re talking about. Future adaptivity is the key. And that’s all about modularity and plug-and-play.”

Seemingly good advice for all for consulting engineers working any market these days.