Sustainable Healthcare Sponsored by CENTER FOR MAXIMUM POTENTIAL

Sustainable Healthcare

Sponsored by: CENTER FOR MAXIMUM POTENTIAL BUILDING SYSTEMS The Corporate Realty, Design & Management Institute

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

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 Pre. Reqs - 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 GGHC

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

Green Guidelines for Healthcare Construction www. gghc. org Download the draft now Register for version 1. 0 Pilot - September, 04 GGHC

US Population by Broad Age Groups Source: US Census Bureau Demographics Drive Demand

Acute Care Admissions To Increase 41% 65+ account for 40% Admissions 49% Beds 65+ account for 51% Admissions 59% Beds Source: Solucient Demographics Drive Demand

46% More Hospital Beds Are Needed 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 Source: Hospital Financial Managers Association Source: IFMA HCC & CRD&MI Survey Demographics Drive Demand

Healthcare Impact on Energy The Big Numbers 3% - Buildings 4% - Floor Space 8% - Energy Consumption/SF Inpatient 179, 400 Btu Outpatient 79, 000 Btu Energy Intensity/SF Thermal 5. 6 k. Wh Lighting 11. 5 k. Wh 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 • 4 th largest source of mercury discharge into environment • Mercury is highly toxic • Medical waste incineration is a major source from mercurycontaining devices and histopathological wastes • Lamps are another source Environmental Impact

Saving Energy Equals Millions in Revenue Sustainable Economics Equivalent revenue of $50, 000 in annual energy savings (annual savings divided by net margin)

Which Earned More Money? Sustainable Economics $100, 000 Invested 1/’ 97 - Amounts shown exclude return of initial investment

Lighting For Sustainability • 75% of healthcare floor space is illuminated 100% of time • Design lighting to occupant & task - IESNA suggestions: Nurse Station 53 FC Patient Room 30 FC Task Lighting 50 FC Ambient Lighting 25 FC - Offices with Computers • Maximize fixture, lamp and ballast efficiency • Use automatic controls • Optimize maintenance and disposal practices

Environmentally Responsible Lighting 1 - 1970’s 2’ x 4’ Fixture, (4) T 1234 Lamp 8’ x 8’ Layout, 24, 656 Lamps, 2. 9 W/sf 2 - Mid 1980’s 2’ x 4’ Fixture, (2) T 1234 Lamp 8’ x 8’ Layout, 12, 328 Lamps, 1. 7 W/sf 3 - Mid 1990’s 2’ x 4’ Fixture, (3) T 8 Lamp 8’ x 8’ Layout, 18, 492 Lamps, 1. 4 W/sf 4 - Low Mercury Alternative 2’ x 4’ Fixture, (3) T 8 PLC Lamp 8’ x 8’ Layout, 18, 492 Lamps, 1. 4 W/sf 5 - Save Energy & Low Mercury 2’ x 4’ Fixture, (2) T 8 PLC Lamp 8’ 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 Group Relamp at 70% Life Save 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 Source: DOE - ORNL 75° F

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 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 k. Wh/yr. Cost of Electricity $0. 1168 k. Wh 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? 200 Bed Hospital - 18, 200, 000 Gallons per Year 300 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 Water Efficiency Sewer $3. 19 per 1000 Gallons

Thanks to Our Sponsors: CENTER FOR MAXIMUM POTENTIAL BUILDING SYSTEMS The Corporate Realty, Design & Management Institute