Sustainable Healthcare

Sponsored by:

The Corporate Realty, Design & Management Institute

CENTER FOR MAXIMUM POTENTIAL BUILDING SYSTEMS

The GGHC builds on LEED™ by

addressing the particular structural, usage, and regulatory challenges of healthcare buildings and by emphasizing the environmental and public health issues that comprise an important part of what it means for a healthcare institution to address sustainable construction. Unlike LEED™,the GGHC is structured as a self-certifying system.

GGHC

What are Green Healthcare Facilities?“…buildings that are environmentally responsible, profitable, and healthy places to live, work and heal.”

GGHC

sustainable

The Green Guidelines for Healthcare Construction seek to reward organizations that strive to engage in environmental stewardship, and that lead the healthcare industry toward high performance healing environments

GGHC

Section PreReqs - Points

1 – Integrated Design and Operations 4 - 0

2 – Sustainable Sites 1 - 20

3 – Water Efficiency 1 - 12

4 – Energy & Atmosphere 3 - 22

5 – Materials & Resources 2 - 25

6 – Indoor Environmental Quality 4 - 23

7 – Innovation 0 - 4

LEED for Healthcare Application Guide

Volunteer committee at work to develop application guide that will support healthcare facilities registered under LEED-New Construction.

Green Guidelinesfor Healthcare Construction

www.gghc.org

Download the draft nowRegister for version 1.0 Pilot - September, 04

GGHC

US Population by Broad Age Groups

20

40

60

80

100

120

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050

Mill

ion

s

<15 15-24 25-44 45-64 65+

Source: US Census Bureau

Demographics Drive Demand

Acute Care Admissions To Increase 41%

18.8 20.0 21.0 21.6 21.8 21.8

12.6 13.114.5 16.5 19.2 22.4

0.0

10.0

20.0

30.0

40.0

50.0

2002 2007 2012 2017 2022 2027

Ad

mis

sio

ns

(00

0,0

00

)

0-64 65+65+ account for40% Admissions49% Beds

65+ account for51% Admissions59% Beds

Source: Solucient

Demographics Drive Demand

46% More Hospital Beds Are Needed

519550

591639

694756

2002 2007 2012 2017 2022 2027

Acu

te C

are

Be

ds

(,0

00

)

Source: Solucient

Demographics Drive Demand

Yet Capital Spending Is Not Keeping Up

Between 1997 and 2001– Inpatient Admissions Rose

7.7%

– Outpatient Visits Increased 19.6%

– Capital Spending Increased Only 5%

41% of Medical Institutions Are Not Spending Enough to Keep Ahead of Asset Depreciation

When Was Infrastructure Built?

39%35%

55%

46%

1995 to2003

1980 to1994

1960 to1979

Before 1960

Source: IFMA HCC & CRD&MI SurveySource: Hospital Financial Managers Association

Demographics Drive Demand

Healthcare Impact on Energy

Energy Intensity kWh/SF

5.6

11.5

3.3

8.2

Thermal Lighting

Healthcare Office

The Big Numbers

3% - Buildings

4% - Floor Space

8% - Energy Consumption

Energy Consumption/SF

Inpatient 179,400 Btu

Outpatient 79,000 Btu

Energy Intensity/SF

Thermal 5.6 kWh

Lighting 11.5 kWh

Data Source: DOE

Environmental Impact

Medical Waste

• Hospitals produce 2 million tons of solid waste a year

15 pounds per patient daily• 85% is paper, plastic, food and other

materials$57 Ton Disposal Fee

• 15% has infectious potential$450 Ton Disposal Fee

• 4th largest source of mercury discharge into environment

• Mercury is highly toxic• Medical waste incineration is a

major source from mercury-containing devices and histopathological wastes

• Lamps are another source

Environmental Impact

Saving Energy Equals Millions in Revenue

$2.50

$1.67

$1.25$1.00

$0.83$0.71 $0.63

2% 3% 4% 5% 6% 7% 8%

Net Margin

Eq

uiv

ale

nt

Re

ve

nu

e -

mill

ion

s

Equivalent revenue of $50,000 in annual energy savings (annual savings divided by net margin)

Sustainable Economics

Which Earned More Money?

$0

$80,000

$160,000

$240,000

$320,000

US Treasury 5 yr. Wilshire 5000 S&P 500 Energy Savings

1/97 to 12/01 1/97 to 12/02 1/97 to 12/03

$100,000 Invested 1/’97 - Amounts shown exclude return of initial investment

Sustainable Economics

Lighting For Sustainability

• 75% of healthcare floor space is illuminated 100% of time

• Design lighting to occupant & task - IESNA suggestions:

Nurse Station 53 FCPatient Room 30 FCTask Lighting 50 FCAmbient Lighting 25 FC- Offices with Computers

• Maximize fixture, lamp and ballast efficiency

• Use automatic controls

• Optimize maintenance and disposal practices

Environmentally Responsible Lighting

197

99111

65

35

1 2 3 4 5

1 - 1970’s2’ x 4’ Fixture, (4) T1234 Lamp8’ x 8’ Layout, 24,656 Lamps, 2.9 W/sf

2 - Mid 1980’s2’ x 4’ Fixture, (2) T1234 Lamp8’ x 8’ Layout, 12,328 Lamps, 1.7 W/sf

3 - Mid 1990’s2’ x 4’ Fixture, (3) T8 Lamp8’ x 8’ Layout, 18,492 Lamps, 1.4 W/sf

4 - Low Mercury Alternative2’ x 4’ Fixture, (3) T8PLC Lamp8’ x 8’ Layout, 18,492 Lamps, 1.4 W/sf

5 - Save Energy & Low Mercury2’ x 4’ Fixture, (2) T8PLC Lamp8’ x 10’ Layout, 9,862 Lamps, 0.8 W/sf

355,000 SF. Building

Total Grams of Mercury

Change Lamps At Right Time And Save

0%

25%

50%

75%

100%

0% 20% 40% 60% 80% 100% 120% 140% 160%

Percent of Rated Life

Lam

ps S

urvi

ving

Group Relamp at 70% LifeSave 26% in Relamping Cost

Light Output @ 70% Life T - 5 95%T - 8 85%T -12 66%

Typical Hospital Building Envelope

Building Era <1980 >1980

Percent Glass 25 25

Shading Coefficient .71 .66

Window U-Value 0.57 0.51

Window R-Value 1.79 1.96

Wall R-Value 0.3 6.9

Roof R-Value 12.3 11.5

Roof Material Built Up• On a Sunny Day 95° F

Dark Roof 180° F

Window 120° F

Interior Space 75° F

Source: DOE - ORNL

White Roofs Are Cool

• Nearly half of US population lives or works in a heat island

Dark roofs cause 38% of heat island effect

• On a Sunny Day 95° F

Dark Roof 180° F

White Roof 110° F

• Energy Star Roof Criteria

65% Initial Reflectance

50% Reflectivity after 3-yrs.

• Roofs are 5-10% of building cost, yet account for 60-80% of litigation

White Roofs Are Cool Money Makers

Office/Lab Building - 34,000 Sq. Ft. CoolingSavings - Yr.

IncreasedBldg. Value

Valueper Sq. Ft.

Atlanta, GA $4,250 $56,667 $1.67Baltimore, MD $3,320 $44,267 $1.30Boston, MA $2,074 $27,653 $0.81Charlotte, NC $4,046 $53,947 $1.59Chicago, IL $2,312 $30,827 $0.91Columbus, OH $2,346 $31,280 $0.92Detroit, MI $1,802 $24,027 $0.71Las Vegas, NV $6,052 $80,693 $2.37Long Beach, CA $3,264 $43,520 $1.28Sacramento, CA $3,672 $48,960 $1.44

Source: DOE - ORNL

Auditing Operations & Maintenance

Things to Look At:

Lighting

Building Envelope

Controls

Testing, Adjusting & Balancing

Air Handlers, Fan Coils, Baseboard Units

Heating & Cooling System

Security Systems & Procedures

Housekeeping

Roads & Grounds

Typical Savings 5-15% & Better Performance

Be Healthy, Clean Safely, Save Money

• Clean for health first and appearance second

• Evaluate products and buy least toxic product available

• Selected disinfectants based on purpose and efficacy

Clean, then disinfect

• Educate workers on proper cleaning methods and use of hazardous cleaning products

• Take advantage janitorial pollution prevention projects

Is This Your Healthcare Facility?

Dust & Microbial Contamination

– 70% Airborne, 63% Not Visible

– 100 Microns of Dust on Coil Cuts Cooling Capacity 10%

– 20-30% increase in annual energy costs

Sick Building Syndrome

– Productivity & Absenteeism

Legionnaires’ Disease

– 50,000 to 100,000 Cases/Year 15% Death Rate - CDC

Indoor Air Quality

Ultraviolet Germicidal Irradiation - UVGI

• The germicidal wavelengths are located around 254 nanometers in the UV-C band

• Controls fungi in HVAC systems to reduce or eliminate mold-related allergies

• Prevents the development of Legionella and other bacteria … provides a recognized control strategy for tuberculosis

• Predictably reduces the spread of cold and flu viruses and other airborne-transmitted diseases

Indoor Air Quality

Children’s Hospital - SUNY Buffalo

Neonatal Intensive Care Unit

• Serial bacterial and fungal cultures on HVAC system and tracheal aspirate (TA) from intubated infants

• Microbes isolated from HVAC system were identical to those in NICU and TA

Pseudomonas, Klebsiella,

Bacillus and Serratia

• After UVGI was installed “total microbial load markedly decreased”

Source: Dr. C. Leach, Dr. R. Ryan

Indoor Air Quality

Economics of UVGI

Energy Reduction 112,075 kWh/yr.

Cost of Electricity $0.1168 kWh

Energy Cost Savings $13,090

Maintenance Cost Savings $500

Total Annual Cost Savings $13,590

UVGI System Installed Cost $10,000

UVGI Lamp Annual Replacement $1,350

• Simple Payback .74 Years

• Return on Investment 136%

Indoor Air Quality

How Much Water Do Hospitals Use?

42%

23%

14%

9%7%

5%

SanitaryHVACMedicalProcess

Food ServiceMisc.Laundry

200 Bed Hospital - 18,200,000 Gallons per Year300 Bed Hospital - 33,500,000 Gallons per Year

Water Efficiency

Where To Save Water and Money Too

• Toilets, sinks, showers

• Film Processors

• Sterilizers - Tempering

• Reverse Osmosis Filter (RO)

• Medical Air/Vacuum

• Lab Equipment Cooling

• Kitchen Equipment

• Water Cooled Ice Machines

• Laundry

• Landscaping

• Cooling Tower Blowdown

• Boiler Blowdown - Tempering

Water$2.15 per

1000 Gallons

Sewer$3.19 per

1000 Gallons

Water Efficiency

Thanks to Our Sponsors:

The Corporate Realty, Design & Management Institute

CENTER FOR MAXIMUM POTENTIAL BUILDING SYSTEMS