Innovations to reduce energy and resource consumption in health care

It is a widely held belief that the healthcare sector is uniquely placed to lead a series of environmental, economic and social initiatives to keep the general population healthy; and to deliver high quality medical care through facilities that meet the diverse needs of patients, staff and visitors alike. 

The paradox is, the healthcare sector, by its own admission is the most conspicuous consumer of energy on the planet and their contribution to carbon emissions is significant, thereby contributing to the environmental crisis we are in today. In England alone, it is estimated the National Health Service (NHS) carbon footprint, amounts to 18 million tonnes of carbon dioxide each year representing approximately three per cent of England’s total emissions. 

The positive news is that the healthcare sector is getting its house in order as evidenced by a series of initiatives around the world.

Leading by example

Hospitals by their very nature are energy hungry and resource intensive enterprises and contribute substantially to carbon emissions leading to climate change issues. Lighting, heating, hot water, and electricity for energy intensive technologies all contribute to an environment ripe for managing energy consumption strategically.

Hospitals in the US spend an average of $1.67 on electricity and 48 cents on natural gas per square foot annually. In a typical hospital, lighting, heating and hot water represent between 61 and 79 per cent of total energy use depending on the climate, making those systems the best targets for energy savings.¹

The American Society for Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) will soon be re-publishing their HVAC Design Manual for Hospitals and Clinics as part of its Advanced Energy Design Guide series.  The manual provides detailed guidelines and innovative design approaches to increase energy savings within healthcare facilities. 

In the United Kingdom, (UK) the National Health Service (NHS) employs five per cent of the working population and runs the largest estate in Europe.  They produce more carbon emissions than any other public sector organisation in Europe with a carbon footprint of 18 million tonnes of CO₂ per year.  The energy component makes up 22 per cent of their total emissions.²

Over recent years there has been a growing recognition that they have a pivotal role to play in reducing their energy consumption and contributing towards the UK Government’s national and European Union (EU) emission reduction targets.

The director of their Sustainability Development Unit, Dr David Pencheon, recently stated,

“The NHS is an internationally renowned health service, Europe’s largest employer and a lead in local communities across the country. By leading by example the NHS can help to mitigate climate change and improve the health of the people it serves.”  ³

The introduction of the Carbon Reduction Commitment (CRC) in 2010 strengthens the financial case to reduce carbon emissions as it will place a requirement on organisations including hospitals to buy carbon credits for energy use.

Saving Carbon, Improving Health

The NHS “Saving Carbon, Improving Health”, initiative aims to make a difference by introducing new approaches to the design, build and upgrading of healthcare facilities. ⁴

Specifically, the strategy promotes energy efficiency and resilience and more positively it is envisaged that all the savings will in effect be reinvested in patient care.

The recommendations in the report encourage more thought around increasing energy provided from renewable sources and increasing natural, rather than mechanical ventilation and air conditioning whenever possible.

Climate friendly building technology

Government strategies are excellent starting points to create the stimulus and focus; however as professionals supporting the healthcare sector we can do more.

There is an increasing awareness that innovations in healthcare building design can offer a practical opportunity to reduce energy and resource demands.  Design and project management professionals developing healing environments need to ask what the project’s positive legacy is and develop a solution where we understand the project’s impact from an environmental, economic and social perspective?

The design community is uniquely placed to take up responsibility to propose technologies that are climate friendly and will deliver cost benefits for the project owners and an improved level of comfort for patients, visitors and health sector workers.

Climate friendly building/design technologies might include, but are not limited to: Less dependency on air conditioning and more use of natural ventilation. The – evidence supports the use of natural ventilation in infection control management as well as increasing the general well being of the patients, visitors and health workers. The use of natural daylight should be considered. More than an energy saving factor since it is now acknowledged that there is a link between lighting quality and a range of health issues. Findings show that the presence or absence of daylight in buildings and the design of artificial light can have a huge impact on human performance, health and psychological well being - perhaps even promoting speedier patient recovery rates. Combined Heat and Power (CHP) to generate on-site electricity, heat and cool in Tri-generation systems. The use of heat recovery within all mechanical ventilation systems to minimise energy usage. The provision of automated lighting control to minimise energy wastage. Capitalising on renewable energy sources through wind turbines and solar panel technology. Rainwater harvesting, grey water recycling, water capture. Reduced volume in water cisterns to minimise water consumption. Heating and cooling controlled by adjustable thermostats and area-zoning. Selection of materials for their sustainability properties, fit for purpose and longevity. Biomass technology. Thermal Storage including use of Phase Charge Material.

Evidence based design

Across the world many healthcare facilities are now exploring and incorporating these principles into the early stages of the design process.  Sometimes referred to as, evidence based design, healthcare leadership understand the connection between better design and improved energy performance. This adds up to an improved working environment and a superior patient healing environment.

The compelling case for natural ventilation

An often overlooked technology, natural ventilation can provide significant dividends.  It is an effective solution to ventilating and cooling a building economically and environmentally and as such should be considered a viable technology for all new healthcare facilities and upgrades.

Airborne infections such as tuberculosis continue to be a public health concern and there is new evidence to indicate that natural ventilation may offer a low cost alternative to managing the spread of the disease. ⁵  So as well as providing quantifiable energy reduction, natural ventilation may also stop the spread of infections and help to improve air quality in healthcare environments.

SKM recently carried out research for the UK Department of Health into, “Low Energy Ventilation and Cooling in Hospitals.” The report identified major energy savings and capital cost savings through the use of natural ventilation in particular zones.  The research considered the basic principles including zoning, microbiological contamination pathways, infection control issues, indoor environmental quality, acoustics, patient and staff comfort and energy consumption and cost management.

The study showed that many spaces can be successfully naturally ventilated.  This is demonstrated by SKM’s experience at two hospitals in the UK: Queens Hospital, Romford where 50 per cent of the hospital is naturally ventilated;  and at the new ward block at Burnley Hospital, the entire hospital is naturally ventilated resulting in a measured energy use of one third of the UK Government target of 45 GJ/100m³/annum.

Interestingly, while the anecdotal evidence of various types of ventilation is abundant, the documented scientific benefits of natural ventilation and its benefits would seem to be in its infancy despite the long history of its use.  Furthermore modern natural ventilation benefits the application of automatic controls to allow continuous monitoring and operation.

Influencing standards

Most building and health regulatory agencies in the UK, Europe, Australia and North America continue to grapple with the establishment of clear, consistent standards for hospital ventilation system design.

In a wider context, there is an opportunity for the design and project delivery community to influence new energy regulations used in the delivery of hospitals and healthcare facilities.  The regulations need to be universal, evidence based and profound in their ability to ensure these facilities are built with significant improvements in their energy consumption. This should result in new levels of safety and well being for the staff, patients and the wider community.

It is clear the healthcare sector will play a pivotal role in helping nations adapt to the serious consequences of climate change and our respective roles as healthcare providers, planners, architects, engineers, regulators will be to influence better standards and deliver better outcomes.

SKM’s goal is to work with clients to develop integrated engineering solutions to deliver low and zero carbon hospitals with high quality healing environments. 

¹ Managing Energy Costs in Hospitals, National Grid, E-source
² NHS, Sustainable Development Unit, NHS Carbon Footprint
³ Media release, The NHS unveils plans to slash its carbon footprint, January 2009
⁴ Saving Carbon, Improving Health, July 2008, NHS England consultation document
⁵ Natural Ventilation for the Prevention of Airborne Contagion, Academic Editor, UCL, UK

About SKM and smarter healthcare projects:

SKM does not just deliver engineering skills to healthcare projects. We consider the needs of all relevant stakeholders to create centres of true medical excellence. We are committed to the principles of sustainable development in every project we deliver.  

We can demonstrate extensive experience in all aspects of building services engineering and understand your critical requirements to have these services integrated. Our expertise includes lighting and power, communications, fire protection and security, lift services, hydraulics, air conditioning, mechanical ventilation, air pressurisation and medical gases. Our services also include project management, design, civil and structural engineering.

Recent SKM research on “natural ventilation” has demonstrated a significant cost and energy saving strategy when combined with other efficiency measures ultimately leading to a low energy hospital. Working with clients, SKM’s goal is to develop new engineering solutions to deliver low and zero carbon hospitals and energy plans which will future proof against fuel shortages as we move forward beyond the age of fossil fuels.

© Sinclair Knight Merz
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