opening a new hospital: a case study - bcxa …€¦ · opening a new hospital: a case study...
TRANSCRIPT
Opening a New Hospital: A Case StudyHealthcare Commissioning and the Authority Having Jurisdiction
Matthew Tunnard, PE, CCP, LEED AP, Senior EngineerHorizon Engineering Associates, LLP
AIA Quality Assurance
The Building Commissioning Association is a Registered Provider with The American Institute of Architects Continuing Education Systems (AIA/CES). Credit(s) earned on completion of this program will be reported to AIA/CES for AIA members. Certificates of the Completion for both AIA members and non-AIA members are available upon request.
This program is registered with AIA/CES for continuing professional education. As such, it does not include content that may be deemed or construed to be an approval or endorsement by the AIA of any material of construction or any method or manner of handling, using, distributing, or dealing in any material or product.
Questions related to specific materials, methods, and services will be addressed at the conclusion of this presentation.
2
Learning Objectives
At the end of this session participants will be able to:
3
1. Explain how commissioning can help ensure smooth certification from the AHJ
2. Describe the commissioning authority’s role in the building walk through
3. Identify the critical elements of healthcare facilities that require special attention
4. Specify scope for levels of effort for the Cx authority to meet expectations
Agenda for Session• Project Background• Cx Scope of Work
• Healthcare specific• AHJ and turnover
• Walkthroughs• Occupancy
• Calls for service, energy efficiency• Lessons Learned
• How to specify
Bibliography• Evan Mills. 2009 “Building Commissioning: A Golden Opportunity for Reducing Energy Costs and Greenhouse-gas Emission”• Misc. Photos – University of Michigan
Acknowledgements• University of Michigan
– Mary L. Krasny– Mary Pinegar-Koster– Frank Marcinkiewicz– Phil Shaughnessy
C.S. Mott Children’s Hospital & Von Voigtlander Women’s Hospital
C.S. Mott Children’s Hospital & Von Voigtlander Women’s Hospital
Project Background• 1.1 Million Sqft Hospital and Medical Office Building (MOB)• Pediatric and Women’s care specialty hospital• $750 million total project budget• LEED Silver Certified• Combination of self generated utilities and fed from central plant
Project Background• 29 - Air Handlers, 9 – Stair Pressurization Units, 2 – Energy Recovery Units
– Feeds VAV system with Reheat. – 4 pipe Fan Coil Unit for process loads– Entire Hospital is HEPA Filtered
Project Background• 4 – 1400 Ton Chillers with 4 Cooling Towers
– Electric Centrifugal Chillers– Ability to utilize free cooling– Primary/ Secondary loop
Project Background• Heating Hot Water
– 3 Steam to Water Heat Exchangers
• Steam supplied from Central Plant• Domestic Hot Water
– 2- Heat Exchangers– 3- Booster pumps for each hot and cold water
Project Background• 4 – 2 Mega Watt Diesel Generator
– Paralleling gear with load shedding– Transfer switches– Substations
Project Background
• 16 Operating Rooms• Regional Infection Control Unit (RICU)• Radiology with 3 MRI’s• Emergency Department• Bone Marrow Transplant Unit (BMT)
Project Background• Labor, Delivery, Recovery, Post-Partum (LDRP)• Neonatal Intensive Care Unit (NICU)• Pediatric Cardiothoracic Intensive Care Unit (PCTU )• Pediatric Intensive Care Unit (PICU)
Owner Expectations• Reduced Energy Cost• High reliability• Low occupant complaints• Reduce construction issues
– Change orders– Time delays
Cx Scope of Work– HVAC
• 100% testing of all equipment including VAVs– Electrical Distribution, 100% check to panel level– Plumbing, 100% supply side, 10% fixture check– Medical Gas
• Witness blow down of system• Work with inspector and certifier to witness necessary tests
Cx Scope of Work• Security, 100% verification of all devices• Infant Abduction, 100% verification of all devices• Fire Alarm
– Verification of all interaction with other systems• Security, HVAC, Infant Abduction
Cx Scope of Work• Fire Protection – Work with mechanical inspector to witness any tests.
– Coordinate all tests and certifications of fire pump– Witness testing of Pre-Action systems– Pre-testing of Helipad Foam system
• Pneumatic Tube– Review installation and test final system
Cx Scope of WorkHealthcare Specific Performance Tests
• Operating Rooms – Designed with 25 air changes per hour– HEPA filtered– Must be positive pressure to adjacent spaces– Transplant rooms must be able to raise temp from 55F to 95F in 15 minutes
Cx Scope of WorkHealthcare Specific
• Operating Room
Cx Scope of WorkHealthcare Specific
• Bone Marrow Transplant Area– Severely Immuno-compromised patients– Area needs to provide a clean space with minimum amount of contamination– Patient rooms are positive pressure– HEPA Filtered– Room pressure monitors on all rooms
Cx Scope of WorkHealthcare Specific
• Neonatal Intensive Care Unit (NICU)– Area that cares for premature and high risk infants– Immuno-compromised patients– Need space for family – Adjustable lighting levels from minimum to clinical care– Precise temperature control
Cx Scope of WorkHealthcare Specific
• NICU
Cx Scope of WorkHealthcare Specific
• Labor, Delivery, Recovery, Post-partum– Rooms where women prepare, deliver, and recover from giving birth– Need area for family, comfortable room (can spend days here)– Need to incorporate proper lighting and HVAC controls
Cx Scope of WorkHealthcare Specific
• LDRP
Cx Scope of WorkHealthcare Specific
• Regional Infection Control Unit (RICU)– Floor that can be turned into an isolation area for an outbreak of an infectious disease. (ex: SARS, Ebola)– Normal operation is standard patient floor– RICU operation turns the entire area negative pressure to adjacent spaces with no HVAC return air.– Need interlocks on entrance doors and with Fire Alarm– In RICU mode, 100% OA
Cx Scope of WorkHealthcare Specific
• Isolation Rooms• Room Pressure Monitors
• Radiology• Wall protection and magnetic protection
• Cafeteria and Kitchen• Kitchen hoods, sanitation
Responsibilities in Building Performance• Designers
– Overall responsible for design and meeting code• Authorities Having Jurisdiction
– Responsible for ensuring building meets code, not performance
• Cx Authority– Responsible for ensuring building meets design performance
AHJ and Turnover• Authorities Having Jurisdiction on the Project
– UM Mechanical Inspector– UM Electrical Inspector– UM Fire Marshall for all business occupancy– State of Michigan Fire Marshall for hospital– State of Michigan Department of Health for hospital and kitchen
AHJ and Turnover• Cx interface with AHJ on different issues
– During construction• Mechanical - Med Gas Blow Down, Duct work installation, Generator Stack Sealing• Electrical – Equipment clearance• Fire Marshall – Pre-testing of all fire systems• Health Department – HVAC and lighting systems
AHJ and Turnover• Generator Stack Testing
AHJ and TurnoverWalkthroughsMechanical
• Plumbing – Hot water at fixtures
• Mechanical – Duct Cleaning– Pressurization– Equipment Clearance
AHJ and TurnoverWalkthroughsUM Fire Marshall – Business Occupancy
• Fire Alarm Pre-test• Audible levels• Fire Door Latching• Stair Pressurization• Exit Signs
AHJ and TurnoverWalkthroughState Fire Marshall – Healthcare Occupancy
• Fire Alarm Pre-test• Audible levels• Fire Door Latching• Stair Pressurization• Exit Signage• Space Pressurization• Interface with Infant Abduction and RICU
AHJ and TurnoverWalkthroughHealth Department
• Space Pressurization• Lighting• Sequence of Operations• Staff Notification of Issues/Alarms• RICU Operation
Issues During AHJ Walkthrough
State Fire Marshall• Stair Pressurization
– Provide a certified report as “Special Inspector”• FA Pre-testing
– Ensure that all pre-testing occurred– Made sure the final testing went very quickly
Issues During AHJ WalkthroughState Fire Marshall
• Testing of Release of exit doors in RICU and with Infant Abduction• Helipad Foam System• Audible Level Testing• Smoke Capture Test in Kitchen• Fire/Smoke Damper Inspections
– Provided a report showing all dampers
Issues During AHJ Walkthrough
Issues During AHJ WalkthroughState Health Department
• Positive Pressure Rooms– BMT rooms control reset
• Negative pressure rooms– Issues with Balancing, Rebalance
• Lighting levels in OR• Sequence of Operations
– RICU
OccupancyDuring Construction over 3,500 deficiencies identified and corrected
• Power Loss tests found numerous issues that would affect operation• Fire Damper inspections found numerous issues• Testing of controls systems
Occupancy• Pediatric Emergency Room
OccupancyAreas where Cx helped project
• Driving controls schedule• Managing LEED concerns• Temp Heating and Cooling• Pre-testing of systems for AHJ• Getting all deficiencies completed before occupancy
OccupancyBuilding Opening – Calls for Service
• Patients were moved from the old hospital over a period of 12 hours• During opening month about 10 calls for service• Building occupants were very happy with the building• Patients and family were overwhelmed by the upgrade
Occupancy• Peds ICU
OccupancyEnergy Efficiency
• Found numerous issues where the sequence of operation did not match the design• Found areas where the design sequences didn’t work as anticipated• Found numerous valves and dampers that leaked by
Lessons Learned• Commissioning was integral to completing the project on time• Construction Scheduling made functional testing very difficult
– Floor completion did not match up with MEP systems• Controls contractor needed more hand holding
– Fell behind schedule• Integrated Power Loss Testing for durations was critical to finding issues
Lessons LearnedHow to specify
• Owner needs to determine the level of effort– Cost is directly related to increased scope
• Owner needs to identify systems they want checked– Systems such as Med Gas, Nurse Call, Fire Alarm, etc– MEP is standard
Lessons LearnedHow to specify
• Get commissioning involved early– Can help with construction scheduling
• Owner to set clear requirements for successful outcome (OPR)• Owner needs to identify a partner not just based on cost, Cx is a professional service
