An award-winning hospital upgrades cooling, laundry, and waste disposal to the tune of millions in energy savings.
Modernizing the infrastructure and working environment of a health care facility that was first built nearly a century ago is bound to lead to an adjustment period. But centralized control of key energy-consuming facility systems can sure make the adjustment period more palatable—especially if the return on investment can be quantified in the seven-figure range on an annual basis. This is exactly what happened when Humility of Mary Health Partners upgraded the eight-story, 1-million-square-foot St. Elizabeth Health Center in Youngstown, OH, earlier this decade. It has seen a $1 million-plus-per-year return on reduced energy costs, largely due to construction of a new cooling plant and a major refurbishment of the center’s onsite laundry and medical waste-disposal facilities.
The project won a 2006 Governor’s Award for Excellence in Energy from the Ohio Department of Development’s Office of Energy Efficiency (OEE), which was established as part of the Ohio Energy Strategy. The strategy mandates a competitive awards program to recognize companies, organizations, and individuals.
According to Wayne Tennant, vice president of facilities and construction for Humility of Mary Health Partners/St. Elizabeth, the reason for the upgrade was purely the fact that the center was antiquated and not as cost-efficient as possible given available new technologies. “The building ranges from the first section being built in 1912 with the second section being completed in 2002, but the majority of the building was built between that 1912 and 1970 time frame; that houses most of our patients—that’s the largest capacity we have,” he says. “We recognized there was a need to upgrade to try to gain some efficiencies and our costs associated with that rather than get into full-blown new construction.”
The most inefficient system in the facility was the cooling system, which like many in older facilities evolved in a piecemeal fashion with each addition to the building. The result was a decentralized infrastructure of cooling systems dedicated to each addition. Mark Giardini, a project manager for Siemens Building Technologies who worked on the entire facility upgrade, notes that the controls in this disparate cooling system were mainly pneumatic or older digital types of controls.
“We brought in a team to look at all aspects of their business and what we could do to improve on their current practices and ultimately save them money in the long run,” Giardini says. “So we went through a pretty extensive survey and developed about 25 different improvement measures that could fit their needs.”
Even though St. Elizabeth was not being reconstructed, the solution to the inefficient cooling was to construct an entirely new cooling plant, centralize the plant controls, replace air handlers with more efficient ones, and replace direct-expansion cooling coils with water coils, which in this instance were more efficient because chilled water was very inexpensive to produce with new chillers.
Three 1,200-ton centrifugal chillers and a variable-speed pumping system were installed in the 6,000-square-foot central cooling plant. The chillers are not only more efficient than the ones they replaced—most of which were at least 30 years old—but they also utilize variable frequency drives (VFDs) that run them at less than full capacity when the weather dictates, resulting in significant energy savings during the course of a year.
“By consolidating them into one location, we were able to stage our chillers,” Tennant says. “Depending on the temperatures, we can run one primary chiller or add on if the temperatures or humidities increase. That aspect was, I think, the big driving force: Getting them all together gave us the ability to do that as well as some redundancy in case we had one chiller fail us.”
A Siemens Apogee building automation system allows the facilities staff to monitor and control the new cooling plant. The automation system includes networked panels located in the building’s mechanical rooms that tie together air handlers throughout the facility. The networked panels send operating data to, and receive commands from, an Insight server. Software gives the hospital’s authorized users the ability to set temperature parameters for the new cooling system and monitor the operating conditions on any computer. Parameters can be set on equipment such as filters and thermostats to activate alarms when temperatures fall outside of the set parameters. The facilities staff can also view via a graphic user interface the operation of any equipment that is incorporated into the automation system. The ability to monitor all of this equipment from a central location saves the staff the time of walking the entire facility and physically checking the various systems’ components.
The combination of the automation system and the VFD-equipped chillers also allows the facility to reduce its energy costs, Tennant adds. “Our shoulder months are sometimes problematic, but our control system gives us the leverage to control that,” he says. “Having that central control gives us the ability to monitor our demand and achieve some efficiencies as far as comfort for our patients and also for the utility side of things.”
Some of the older cooling systems in various parts of the facility have yet to be replaced, but many of them could be incorporated into the Apogee system. “That was done in order to centralize our chillers that were dispersed throughout the building,” Tennant says. “There’s no building to control those in any kind of sequential or centralized fashion.”
Mindful that incorporating automation in a project like this changes the staff’s way of doing things, Giardini indicates that automation improves systems management over the long haul. “What I find is that some of the older fellows don’t want to embrace it—they just want to keep things the way they were,” he says. “The newer employees and the younger guys, they look at it a little differently because they’re in the computer age. Some people feel threatened by this coming in, thinking that it’s going to replace them, and I explain to them that this is not designed to make anyone feel threatened about their job. It’s a tool, a valuable tool that will allow you to do your job better and allow you to do some of the preventative-maintenance things that you would do instead of putting out fires. It gives them a little bit of warning that something is going to go awry.”
“[Once such an automation system is online] they look at it and say, ‘This is great.’ I think it steps them all up one level. They’re not just Joe Boiler Man or Maintenance Man; they are now automation specialists, if you will. I think it does give them more responsibility and it’s just a great thing to challenge them to learn these things.”
Laundry Facilities
The hospital’s laundry operations had to remain onsite for cost reasons, but improving the process proved challenging. Tennant says the existing laundry operations handled about 5 million tons of laundry a year and were so energy-inefficient—not to mention uncomfortable for staff—that the owner considered outsourcing laundry functions, which would have been a very expensive solution. The facility was cleaning about 3,500 linens alone on a daily basis.
“Either we needed to upgrade our equipment, or we needed to think about outsourcing it or trying another approach to how we ran our laundry; our laundry supports all of our facility right now and has for a long time,” says Tennant. “It’s not typical for health care systems to really be in the laundry business; I see more and more hospitals getting out of it. But we made these changes and made the decision of keeping it in house.”
With that decision made, several front-loading washers were replaced with a Senking tunnel-wash system. This new system is not only more energy- and water-efficient than the front-loaders; it also is safer. The old front-loaders used to remove excess water from wet laundry by spinning; the new system utilizes a hydraulic press for this process. This change also saves the hospital a significant amount of water.
In the new process, laundry is sorted into homogenous loads consisting of such items as linen and towels in a “soiled sort room” located in the level above the tunnel washer. The loads go into large bags hanging from the ceiling and are then loaded into the tunnel washer. In the tunnel, the loads go through several cycles at different stages of the tunnel, such as pre-rinsing, minor soaking, a wash cycle, chemical injection, and water extraction. The different stages use a minimum of water.
After washing is complete, the loads are in the shape of a disk. The “disks” are conveyed to the hydraulic press, which squeezes out the excess water before the laundry goes into any of the five Senking DT-100 dryers. After the laundry is dry, it is put onto a conveyor and routed to folding or ironing machines. Downstream from these machines, the laundry is conveyed to an area where human intervention comes into play for the first time. Workers load the items onto carts for distribution throughout the hospital.
“It was all manual labor prior to this,” Tennant points out. “Everything had to be manhandled out of the washers into the dryers and then over to the ironers, folding equipment, et cetera. We still maintain about 35 people in the laundry; there are certainly other laundries out there that are more automated, given their space and the resources they have to do that.”
“We solicited a few companies that install tunnel washers,” says Giardini. “The request for proposals was to get [the hospital] up to 6 million pounds of laundry a year and do that within a six-day workweek. This laundry room was below and this tunnel washer came in one piece, so that was quite a rigging feat. As I remember, it was a six-week period [to get it online]. We got it in on time and up and running.”
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| One of the hospital’s three 1,200-ton centrifugal chillers awaits installation. |
Medical Waste Disposal
During the refurbishment planning, the owner also faced difficult decisions in regard to managing medical-biohazard—referred to as “red-bag”—waste. Previously, red-bag waste, and a significant amount of non-red-bag waste, was put into a gas-fired incinerator; not much focus was put on segregating the different kinds of waste. However, recently updated EPA regulations as well as the high maintenance and energy costs of operating the incinerator forced the ownership to investigate new ways to dispose of its red-bag waste. The new regulations’ emission standards would have required the owner to upgrade the incinerator, a move that was deemed financially unwise.
Sending out the red-bag waste for treatment would have been extremely costly, Tennant notes, adding that the most costly option of all would have been continuing to operate the incinerator, however. The most cost-effective option was onsite treatment through a combination of upstream segregation of the waste and installation of an autoclave where the incinerator had been located. The red-bag waste would then be disposed of as conventional trash.
“We have the ability to autoclave our own biohazard trash onsite, and that trash is then placed within our regular trash containers and sent to the landfill,” says Tennant. “It’s regulated, treated biohazard waste; we need the approval to do that, but we don’t have to send red bags out to a special place—that’s a significant savings. As we put the red-bag waste near the steam sterilizer, we have to do regular spore samples to ensure the efficacy of the process. Our process is routinely inspected by the department of health so that we’re in compliance.”
In addition to the autoclave installation, the new red-bag waste-disposal process required education of the staff, Tennant adds. “Within our facility we have trash chutes, and we have places where we pick up directly,” he says. “Our process is such that we’re not permitted to put red bags down the chute—those have to be picked up from the nursing units.”
Giardini notes there were additional challenges with disposal of the red-bag waste resulting from the below-grade location of the autoclave. “[When red-bag trash used to be incinerated], all of their waste came down the tunnel system through their main hospital across the street to the boiler side of the facility, which was two floors below grade,” explains Giardini. “In the past, all of the ashes from the incinerator had to be put into these big tubs, and they wheeled them to an elevator that wasn’t made for a man lift. They pushed the carts on there, pushed the button, went up two floors, and then walked up two flights of stairs. In the wintertime and rain or whatever, they would take them off the elevator, push them out into the yard, wait for a truck to come, and dump them.”
Red-bag waste is now collected from nurses’ stations and wheeled down to the autoclave. “We brought in a company whose business was conveyors and lifts, and we designed a lift system that would accept their Rubbermaid carts, which you see in a lot of hospitals,” Giardini continues. “We got the hospital onboard to use one size. This lift was built custom to accept those carts, so all they had to do was push this into the lift and push a button, and the lift took it up and dumped it into a new compactor system outside with a chute built around it. From below, one person could get rid of all of their trash once it was sterilized and push a button, and it would dump. We had the controls for the compactor below so that staff didn’t have to walk those flights of steps; it takes only one person to take care of this.”
Energy and Water Savings
All told, the upgrades resulted in about $5 million in utility and operational cost savings from 2002 to 2005. At that rate, the costs of the upgrades are expected to pay for themselves in 10 years or less as planned. The upgrades resulted in specific savings of nearly 87.6 million cubic feet of natural gas, 14.7 million kWh, and nearly 15 million cubic feet of water.
Besides the new cooling system, about 15,000 square feet of windows were replaced with 1.25-inch double-pane windows that yielded additional energy savings. “We did a lot of windows,” says Giardini. “The windows were old, they leaked, they had drafts. There were a lot of energy savings, and one of the biggest things the owner got out of this was how it really made the building look newer; it really made it look a lot nicer, and they got their energy savings out of it. It gave them a big facelift.” One feature of the windows is tinting that reduces cooling costs during the summer.
Further energy savings were achieved by changing lighting fixtures throughout the building from T12 magnetic ballasts to more efficient T8 electronic ballasts. “You get the same light output with about a 40% reduction in the energy use of those fixtures,” Giardini notes.
The new tunnel-wash system in the upgraded laundry facility has reduced laundry water consumption by an estimated two-thirds. It’s estimated the old front-load washers used about 3.5 gallons of water per pound of laundry and the new system uses only about 1 gallon per pound.
In addition, about 500 toilets were replaced with low-flow models that are yielding further water savings. “We were using about 15 million cubic feet, and the latest information I have is that we’re running about 10 million cubic feet,” says Tennant.
The water savings are due to a comprehensive analysis that Siemens undertook at the beginning of the project. “We surveyed the entire facility and looked at all of the opportunities,” Giardini says. “We found they were using the older-type higher-flow fixtures, so we went in and replaced those with low-flow china and low-flow flushometers. We also installed laminar-flow restrictors. Aerators introduce ambient air back into the airstream to create that bubbly feeling to make you feel like you’re getting the same amount of water. Laminar flows don’t do that. They use a series of screens and filters that separate the water where you get that same feeling of more water using less without introducing any ambient contaminants. That was a health issue, and that’s why we chose laminar-flow restrictors.”
Yet another part of the upgrade resulted in water savings: the new cooling plant. The water used to replace evaporated water in the cooling towers is metered so that the quantity is not counted toward the hospital’s sewer charge, says Tennant.