41th Annual Conference and Technology Exhibition
July 25-29, 2004
Presented By:
Tom Muratore, Executive Vice President,
H2O Applied Technologies
Bob Loranger, Director, Facilities,
TUFTS-New England Medical Center
Water, Water, Everywhere
Source Assessment
Treatment
Distribution
Conservation – Reduce Requirements
Source Assessment
Clean – know where your supply comes from
Quality – know the chemistry of the water
Reliable
– city based
- non-potable well
Treatment
Potable: Chlorine, Chlorine Dioxide, Softener
Plant
– Boiler
– Cooling Tower
Hi-Purity – DI/Reverse Osmosis
- Central Sterile, OR, Research, Dialysis
Distribution
Emergency – Are Plans in Place?
Disaster Preparation – Alternate supply,
domestic support, 18-24 hr backup
Mitigation
Recovery – know how systems will react when
water supply comes back
Water Conservation
Facility Type Assessment
Benchmark Facility
Mass Balance
Conservation Plan
Water Balance: Hospitals & Research Facilities
Sinks
Showers
Toilets/Urinals
Typical Water Saving Opportunity = A 25% Reduction
Cooling TowersBoilers/ChillersFood Services (Kitchen)Operating Room Sterile Processing (Autoclaves) Radiology (Film Proc) Analytical LabsPure Water Systems (RO/Stills)Medical Air/VacuumIrrigation
Domestic: 25%
(10 million gals/yr)
Non-Domestic: 75%(30 million gals/yr)
Why Water Conservation?
Wide range of water-using equipment in hospitals
Relatively easy to improve equipment efficiency
Excellent savings
What Water Conservation Is NOT
“Black Box”
Off-the-shelf solution
Limited to bathrooms
What Is Water Conservation?
Reduce, Reuse, Recycle, Replace– Reduce flow or frequency
– Replace with water-efficient models
– Reuse once-through water
Proven method to reduce operating expenses– Most solutions based on:
• Simple engineering principles
• Existing equipment specs/plumbing code
• Off-the-shelf retrofits
Engineered Products & SystemsNon-Domestic Water Reduction
Central Sterile Equipment
Vacuum Pumps/Air Compressors
Radiology Equipment
Radiation Oncology
Operating Room Equipment
Ambulatory Surgery
Food Service Area
Refrigeration Equipment
Bio Reactors
Analytical/Lab Equipment
Instrument Washers
Cage/Cart Washers
Laundry
Boiler Blowdown
Water Reuse
Reverse Osmosis Units
Stills
Water for Injection
Air Handling Unit Condensate
Domestic Water Reduction
Toilets/Urinals
Sinks
Showers
Water Supply/System Use Analysis
Cooling Towers
Condenser Water
Chilled Water
Non-Potable Supply
Irrigation
Steam System
Ways to Reduce Water Usage
Reduce
Reuse
Recycle
Replace
Benchmarking
• H2O Applied Technologies has conducted engineering audits at hundreds of Healthcare facilities, resulting in a comprehensive Benchmarking study
• The study with data from over 250 hospitals was presented at the 39th Annual ASHE Conference & Technology Exhibition, July 2002
• This standard is used to show facilities where their water use should be, based on size and shape, and what opportunities exists to bring them in line with ‘best practices’ in water conservation.
• This study is available upon request from H2O Applied Technologies
Water Use Profile Impact on Best Practice Factors
Type of Facility ( Specialty)
- Major Teaching with Research
- Major Teaching Hospital
- City Based General Hospital
- Community Based General
Regional Weather Impact
Local Steam, Chilled Water
Demographics
Benchmarking Data - Water Usage Analysis- H 2 O Applied TechnologiesActual Data - On-site Engineering Evaluations Revised : April 29, 2002Major Teaching General Hospitals
Facility AV AW AX AY AZBED SORT AVERAGE
City / State Nashville, TN Burlington, VT Ft. Worth, TX Hartford, CT Phoenix, AZ
Number of Beds 510 510 508 504 475 501
Staff FTEs 2,962 3,784 3,009 2,567 3,500 3,164
Outpatient Visits 321,460 397,613 209,341 260,454 285,000 294,774
Medical Research x
Water Usage (Gals/yr) 100,000,000 105,000,000 140,000,000 115,750,000 130,000,000 118,150,000
Year-round Cooling x x x x
Seasonal Cooling x
Number of Sterilizers 15 14 13 13 22 15
Water - Cooled Vac/Air #skids 4 4 4 4 0 3
Potential Audit Savings Gals/yr 18,400,000 42,000,000 18,800,000
Percent of Potential Audit Savings 18% 30% 14%
Best Practice Achieved Savings Gals/yr 19,100,000 28,333,240
Percent of Achieved Savings 18% 24%
Water Usage - Gals. Per Bed/yr. 196,078 205,882 275,591 229,663 273,684 236,180
*percents rounded to the nearest whole
Benchmarking Data - Water Usage Analysis- H 2 O Applied TechnologiesActual Data - On-site Engineering Evaluations Revised : April 29, 2002Major Teaching General Hospitals
Facility BF BG BH BI BJBED SORT AVERAGE
City / State Bay Pines, FL Crozer, PA New Brunswick, NJ Portland, ME Pittsburgh, PA
Number of Beds 453 450 445 435 420 441
Staff FTEs 2,130 2,345 2,918 3,200 4,780 3,075
Outpatient Visits 498,071 321,675 246,756 174,560 377,656 323,744
Medical Research
Water Usage (Gals/yr) 135,000,000 96,000,000 58,000,000 83,000,000 75,000,000 89,400,000
Year-round Cooling x
Seasonal Cooling x x x x
Number of Sterilizers 7 10 12 18 22 14
Water - Cooled Vac/Air #skids 0 4 1 2 4 2
Potential Audit Savings Gals/yr 21,000,000 8,700,000
Percent of Potential Audit Savings 22% 15%
Best Practice Achieved Savings Gals/yr 19,100,000 14,790,000 22,000,000
Percent of Achieved Savings 14% 18% 29%
Water Usage - Gals. Per Bed/yr. 298,013 213,333 130,337 190,805 178,571 202,212
*percents rounded to the nearest whole
Benchmarking Data - Water Usage Analysis- H 2 O Applied TechnologiesActual Data - On-site Engineering Evaluations Revised : April 29, 2002GENERAL HOSPITALS COMMUNITY BASED
Facility FP FQ FR FS FTBED SORT AVERAGE
City / State Stamford, CT Lakewood, NJ Pittsburgh, PA Atlanta, GA St. Petersburg, FL
Number of Beds 300 293 292 291 288 293
Staff FTEs 1,416 1,106 1,280 1,888 986 1,335
Outpatient Visits 167,528 171,126 152,626 389,187 98,752 195,844
Medical Research
Water Usage (Gals/yr) 34,750,000 30,000,000 30,000,000 82,500,000 19,800,000 39,410,000
Year-round Cooling x x
Seasonal Cooling x x
Number of Sterilizers 4 6 5 15 5 7
Water - Cooled Vac/Air #skids 2 0 0 2 0 1
Potential Audit Savings Gals/yr 5,100,000 21,470,000 8,900,000
Percent of Potential Audit Savings 17% 26% 44%
Best Practice Achieved Savings Gals/yr 7,177,000 8,000,000
Percent of Achieved Savings 21% 27%
Water Usage - Gals. Per Bed/yr. 115,833 102,389 102,740 283,505 68,750 134,643
*percents rounded to the nearest whole
Benchmarking Data - Water Usage Analysis- H 2 O Applied TechnologiesActual Data - On-site Engineering Evaluations Revised : April 29, 2002GENERAL HOSPITALS COMMUNITY BASED
Facility GY GZ HA HB HCBED SORT AVERAGE
City / State Cleveland, OH Providence, RI Hyannis, MA Cape Coral, FL Kittanning, PA
Number of Beds 219 216 214 212 210 214
Staff FTEs 987 1,271 1,339 1,057 793 1,089
Outpatient Visits 123,670 60,229 281,883 189,540 150,202 161,105
Medical Research
Water Usage (Gals/yr) 30,000,000 41,540,000 43,450,000 26,900,000 18,700,000 32,118,000
Year-round Cooling x
Seasonal Cooling x x x x
Number of Sterilizers 7 10 6 5 4 6
Water - Cooled Vac/Air #skids 2 2 0 1 2 1
Potential Audit Savings Gals/yr 8,900,000 5,670,000 3,800,000
Percent of Potential Audit Savings 30% 21% 20%
Best Practice Achieved Savings Gals/yr 8,796,880 12,100,000
Percent of Achieved Savings 21% 28%
Water Usage - Gals. Per Bed/yr. 136,986 192,315 203,037 126,887 89,048 149,655
*percents rounded to the nearest whole
Benchmarking Data - Water Usage Analysis- H 2 O Applied TechnologiesActual Data - On-site Engineering Evaluations Revised : April 29, 2002GENERAL HOSPITALS COMMUNITY BASED
Facility IK IL IM IN IOBED SORT AVERAGE
City / State Everett, MA Atlanta, GA Middlesex, CT Melrose, MA Laurel, MD
Number of Beds 145 140 136 135 133 138
Staff FTEs 856 283 1,362 1,011 606 824
Outpatient Visits 88,754 21,157 983,000 102,467 45,992 248,274
Medical Research
Water Usage (Gals/yr) 29,000,000 24,900,000 34,000,000 27,800,000 28,750,000 28,890,000
Year-round Cooling x
Seasonal Cooling x x x x
Number of Sterilizers 3 4 5 5 5 4
Water - Cooled Vac/Air #skids 1 2 0 1 1 1
Potential Audit Savings Gals/yr 3,750,000 6,000,000
Percent of Potential Audit Savings 15% 18%
Best Practice Achieved Savings Gals/yr 5,800,000 6,300,000 6,100,000
Percent of Achieved Savings 20% 23% 21%
Water Usage - Gals. Per Bed/yr. 200,000 177,857 250,000 205,926 216,165 209,990
*percents rounded to the nearest whole
Conservation Opportunities
Domestic– Replace 3.5 gpf with 1.6 gpf in HT Areas– Reduce sink flow – Repair leaky fixtures– Waterless Urinals– Replace old shower heads
Process Equipment– Replace water cooled equipment– Use alternate source of water for cooling– Recover waste water and reuse– Make water using equipment more efficient
Conservation Opportunities
Plant Operations– Install non-potable well– Reuse CT/Boiler Blowdown– Zero Landscaping– Recover condensate and reuse– Eliminate water-cooled equipment
Reduce Consumption by 30%– Benchmark– Set Goal– Develop WCM Plan– Implement Plan
Why Water Conservation?
Wide range of water-using equipment in hospitals
Relatively easy to improve equipment efficiency
Excellent savings
Facility Manager’s Perspective
Motivation -- what is our incentive?
Understanding -- where is water used?
Who cares?
Who has the time?
Where do we get the funds to implement?
Facility Manager’s Perspective: Motivation
A painless way to reduce usage and costs-- no staff reductions-- no reduction in material/service
Sustainable Savings
Third party can do the work – Facility Manager can take the credit
No need to divert staff from more important things
Facility Manager’s Perspective: Understanding:
Where is the Opportunity? The “no brainers” showers, toilets, faucets - been
there, done that Toilets, etc don’t excite the CFO Process equipment
Who controls the equipment?
How can we effect change?
No matter what your location, water rates are increasing and supplies becoming an issue
Facility Manager’s Perspective: Who Cares?
Answer: No one.
New Question: How do we get the CFO to care?
New Answer: 40% ROI oroperating expense reduction without a capital investment
Facility Manager’s Perspective: Who has the Time?
My staff is too busy complying with the new Environment of Care standards and continuing operations.
Exactly.
Let someone else do the work(corollary: it’s ok to let other people make money if your facility benefits, too)
Facility Manager’s Perspective: Where Do We Get the Funds?
Capital Dollars are scarce and must compete against program
Operating budgets are getting cut
Off-balance sheet financing (i.e. pay back installed conservation measures from savings)
Creative NEW Funding Approach
Utility Expense Reduction Program Requires NO Capital Treated as an Operating Expense 5-Year Program Savings Fund Program M&V Every Year
Questions and Answers
Call Tom Muratore, 617-574-1192
E-mail [email protected]
Benchmarking Study on “Water Usage”
available upon request