Retrofitting health-care facilities

Image courtesy Frost & Sullivan.

Few buildings were as directly affected in 2020 by the global COVID-19 pandemic as hospitals. Early in the year, health-care professionals scrambled to prepare their facilities to accept waves of patients suffering to wildly varying degrees from a little-understood new disease. They donned personal protective equipment (PPE) and reprioritized triage procedures, while struggling to prevent their workplaces from becoming hubs of outbreaks themselves.

Many of the changes were not new ideas per se, so much as they were hurriedly transformed from the ideas of pandemic planning into the realities of pandemic response. Moreover, existing trends in the evolution of hospitals accelerated their pace of adoption.

“Smart technologies provide ways to enhance care.”

Digital hospitals

By way of example, business consulting firm Frost & Sullivan suggested COVID-19 sparked a boom in ‘smart’ technologies to enhance patient care and improve staff efficiency and productivity in today’s ‘digital hospitals.’ Care professionals turned to such tools as robotics, remote health monitoring and artificial intelligence (AI) to help address the difficulties of containing the virus and accommodating a massive influx of patients. And given the gains that were seen as a result, the firm predicts the adoption of such technologies will rise further in the next two to three years.

“Digital hospitals address limitations of traditional providers, such as centralized care delivery, closed systems and a reactive approach through decentralized care, interoperable systems and outcome-driven and proactive approaches,” says Neeraj Nitin Jadhav, technical insights senior research analyst for Frost & Sullivan. “To improve patients’ satisfaction levels at every step of care delivery during their stay in the facility, digital hospitals are using technologies like hospital navigation, intelligent imaging platforms, medical robots, remote patient monitoring tools, medication management applications, communication tools, electronic health record (EHR) applications and clinical decision support solutions.”

Along with such digital tools come physical changes to the buildings themselves.

“Digital hospital operators need to focus on internal architecture, especially staff workstations and patient rooms that follow evidence-based design (EBD), as these are the areas where clinical decisions are made and care is provided, respectively,” says Jadhav. “Additionally, decentralized health-care staff workstations outside patient rooms can allow staff to be closer to the point of care, rather than a centralized area that increases travel distance.”

Among the technologies Frost & Sullivan says present the strongest prospects for hospitals are the following:

• Patient tracking to manage traffic flow, treatment progress, discharge and other hospital processes.
• EHR system implementation, with corresponding staff training, which can not only improve care, but also address health disparities in the local population.
• AI for supply chain management, using algorithms to process data from various departments to identify trends and provide insights.

HVAC

Another key factor in preventing the spread of COVID-19 is adequate ventilation, given how many superspreader events in 2020 involved people sharing the same airspace. And indeed, ASHRAE responded to the pandemic with a host of recommendations in this area, including many for the health-care sector.

One was to increase filtration levels where possible, speeding up fans and increasing the frequency of variable-frequency drives (VFDs). In some cases, ASHRAE recommended MERV-13 and MERV-14 filters could be retrofitted to existing systems to better filter particles. And for systems that already have MERV-14 to MERV-16 levels of filtration, recirculation could reduce the contaminant levels similarly to the approach of increasing the percentage of outside air being brought in.

“Adequate ventilation is key in preventing the spread of COVID-19.”

Relative humidity (RH) of 40% to 60% is recommended to reduce infection spread. Such levels are difficult to achieve in a Canadian winter without causing other health problems through increased condensation from outward vapour pressure. There was a window of opportunity before winter, however, to add more humidifiers.

For the new Jim Pattison Children’s Hospital in Saskatoon (see profile here), Daniels Wingerak Engineering designed mechanical systems to enable a 100% fresh air ‘pandemic mode,’ using the building automation system (BAS). This feature was of course implemented in early 2020 in response to COVID-19, allowing its design to be tested in a real-world crisis situation.

Such approaches could become more common for new and retrofitted hospitals in the future, given the lessons of 2020. At the same time, however, there will be concerns about the potential to increase energy consumption.

Energy efficiency will be improved for B.C.’s East Kootenay Regional Hospital. Photo courtesy Johnson Controls.

Energy efficiency

British Columbia’s Interior Health Authority is currently providing an example of how to improve energy efficiency for hospitals. The health authority recently partnered with Johnson Controls to install new infrastructure at East Kootenay Regional Hospital.

 The upgrades, which also support the provincial CleanBC plan to expand the ‘clean energy’ industry, include LED lighting, occupancy controls, solar walls, pre-heating remediation, retro-commissioning, building envelope updates, variable air volume (VAV) systems and demand controlled ventilation (DCV). Through an energy performance contract (EPC), the costs of these upgrades are compensated through guaranteed utility and operational savings over a 15-year-plus payback agreement.

“Our experience with EPCs allows us to align our services to Interior Health’s energy-saving mission,” Andrew Nartey, an account executive with Johnson Controls, which will continue to work with the authority and the hospital’s administrators throughout the contract’s term to ensure the reduction targets are met.