Feeling Greener Already: The Healing Industry Takes on Sustainability*

Hospitals and clinics use lots of energy. So the green building movement is taking aim at this important sector.

Hospitals and clinics are among the most conspicuous energy consumers on the planet. The need for infection control introduces a fog of harsh chemicals that are rough on lungs as well as the wastewater stream. Air quality has to be monitored and changed frequently. And because hospitals never sleep, neither do expensive, sensitive respirators and scanning machines. Add to that an interminable flow of disposable needles, gloves and blood bags, and you can understand why so many hospitals have a Godzilla-sized carbon footprint.

At the same time, as healing spaces, hospitals are striving to gain ground within the green movement. Healthcare administrators recognize that green buildings are healthy buildings, promoting speedier recovery rates and improving staff performance, while simultaneously saving energy and reducing operations costs.

Within the building materials industry, the desire to align the healthcare industry with green practices has prompted a healthy response. Manufacturers are working hard to retool for the new movement, explains Greg Bergmiller, LEED AP of The S/L/A/M Collaborative. Peer pressure is building and as successful case studies become available, you will be seeing green ideas becoming more mainstream.

Green Blueprints

Many healthcare environments, of course, are already on the bandwagon, attempting to establish green practices in a multitude of categories.

Pharmaceutical giant Pfizer recently completed construction of a Clinical Trials Research Unit (CRU) in New Haven that is so energy-efficient and health-friendly that it became the first building in Connecticut to achieve the Silver LEED certification by the U.S. Green Building Council (USGBC). It also earned the Three Globes designation from the Green Building Initiative, boasting 20 percent more energy efficiency than the reference EPA Energy Star Target Finder building.

According to Robert F. Pulito, AIA, Principal-in-Charge of the Pfizer project and president of The S/L/A/M Collaborative, “the Pfizer CRU meets the needs of its users while still incorporating leading-edge principles of sustainable design and construction. It is a striking example that these goals are both compatible and attainable.

One hospital currently being constructed with a green blueprint is Northern Westchester Hospital in Mount Kisco, New York. Like the Pfizer CRU, the hospitals architectural and construction plan misses no opportunity to limit impact on the waste stream, reduce energy consumption, and provide a cleaner, healthier environment for employees as well as patients.

Both projects are typical of green healthcare environments in their focus on six major areas:

The right site design. The important principle to remember is that no hospital or clinic is an island. It exerts an influence on the greater environmental community through water runoff, radiated heat and light. To maintain existing watershed patterns, healthcare environments must be carefully designed with detention structures that reduce runoff flows during construction. Sedimentation structures that remove suspended sediments from runoff water greatly reduce the chance of ecological damage and pollution to surface waters. Architects are wise to solve the problem from the top down, too, through use of green roof design, which can cut storm water runoff in half, while increasing the thermal barrier by 40 percent. To reduce the amount of heat absorbed and radiated through the roof, roofing materials should be light in color. (The same rule applies to non-road paving.) To prevent light pollution, there are some excellent exterior lighting options that prevent light from leaving the site.

Energy synergy. Saving energy is a synergistic enterprise between technology and smart human choices. And the choices are endless. For example, exterior envelope, mechanical systems, insulation and lighting can all be optimized to minimize energy use and even beat current code requirements. New equipment should include high efficiency motors, maximizing performance and minimizing energy use. Refrigerants should be CFC-free to minimize ozone depletion as well as global warming effects. Ideally, hospitals should be using renewable energy sources such as photovoltaic panels and solar thermal panels. When thats not possible, electricity can be conserved with energy-efficient ballasts on lighting fixtures as well as occupancy sensors to control and optimize energy use. Additionally, daylight sensors along a buildings perimeter can be programmed to turn lights off automatically when exterior conditions permit.

Green light. Its been proven through independent studies that poor indoor lighting increases stress levels in hospital workers, which can lead to poor patient care. To generate the most light (and energy-savings), high performance glazing almost goes without saying. But to reap the full energy-saving advantage, the building should be positioned to increase opportunities for day-lighting views to outdoors through enlarged windows and light wells an effect that can be enhanced through use of interior reflective surfaces. Daylighting has been shown to improve work performance as well as patient recovery rates. At the Pfizer Clinical Research Unit, exterior views are visible from every area, creating an open, light-filled ambience. Through eighty percent of the space, there is access to direct lighting, greatly reducing the need for overhead lighting. The building is also situated to provide a sheltered environment that reduces energy costs due to wind, snow and temperature extremes.

Respect for resources. To eliminate the large drain on municipal resources, hospitals are wise to implement a number of water-saving measures. Perhaps the simplest is to insist on drought-tolerant, native plants in landscaped areas and healing gardens. Water-saving plumbing fixtures and individual meters that monitor water use per department are now readily available and currently in demand. In the Pfizer CRU, mechanical innovation extended to faucets and showerheads that limit water flow, as well as low-flush toilets and waterless urinals. The buildings resource-wise plan also included materials selected for low maintenance: a brick façade, metal roof membrane and glass and curtain wall system were each specified for their durability and easy-care qualities.

Trimming waste. Waste reduction may seem like an uphill battle for hospitals, but the sooner it starts, the firmer the commitment. It should begin at ground-breaking with recycling of construction and demolition waste everything from cardboards and gypsum wallboard to acoustical tile, concrete, plastic, wood and glass. Existing bituminous pavement can be recycled on-site as a base material for new paved areas. Hospitals can also make a commitment to building materials with recycled content without compromising safety or quality. The Pfizer CRU, for example, includes ceiling tiles and light fixtures that were previously used and refurbished. And the unit makes room for recycling within its walls 1120 square feet are designated for the storage of recyclable waste.

Trimming waste also means trimming unnecessary costs or steps that add carbon to the atmosphere. For example, you can limit your materials inventory to those that were extracted, processed and manufactured locally (within 500 miles of the site), greatly reducing the impact of transportation costs on the environment. Foresight is a key ingredient in any waste reduction program. Hospitals are wise to build some flexibility into their floor plans from the start to avoid expensive additions and renovations. This is easily accomplished with modular planning grids and demountable and modular wall, floor and furniture systems.

Freshest air. Once again, this is an opportunity that, ideally, should start during construction with an air quality management plan. Problems that result from construction and renovation can be circumvented through proper sequencing of tasks to avoid contamination, as well as proper filtering of air during construction. Afterwards, make a commitment to materials and equipment that will keep the interior air as fresh and nontoxic as possible.

The newest eco-friendly air handling systems draw in and condition outside air, preventing buildup of carbon dioxide and pollutants. In the Pfizer CRU, the ventilation system flushes the interior with 100 percent outdoor air that is efficiently filtered (65 percent arrestance, at a minimum). Heat recovery equipment can also be installed to capture heat thats exhausted from the building to preheat in winter and pre-cool in summer in combination with highly efficient HVAC systems. Besides reducing energy requirements for cooling or heating, this type of system allows you to keep supply and exhaust air streams separate to eliminate cross-contamination in case of an airborne illness or other health-threatening problem.

A healing environment can be toxic if building materials and finishes arent chosen with care. Paints, coatings, adhesives, sealants, carpeting, and other materials should be selected to reduce volatile organic compounds such as formaldehyde. And thermostat switches and other stand-alone measuring devices that contain mercury should be avoided, since mercury is highly toxic when released. Any hazardous or flammable materials should be sequestered in secure, ventilated storage areas.

Critical Green

Given the strong link between individual and community health and the environments we create, hospitals above all other institutions can be luminaries in the green design movement. But they must first be exemplars of environmental responsibility and conservation. As awareness of global warming achieves critical mass, the greening of hospitals is expected to continue not as a trend but as a long-overdue response to a critical need.

  • Pfizer Clinical Research Unit, New Haven, Connecticut
    • Size: 62,000 square feet
    • Date Completed: April 2005
    • Project Team: The S/L/A/M Collaborative; Whiting Turner
    • Green building materials: Structural steel made from 80 percent recycled materials; recycle furnace slag in concrete; and extensive use of local material
    • (Image above of CRU courtesy of S/L/A/M & Woodruff-Brown Photography)
  • Northern Westchester Hospital, Mount Kisco, New York
    • Size: 45,000 square feet
    • Date To Be Completed: Spring 2009
    • Project Team: The S/L/A/M Collaborative; Syska Hennessy Group

*Daniel J. Fenyn AIA is an Associate Principal for The S/L/A/M Collaborative and the Market Sector Leader for Healthcare. He is a registered architect with over 20 years of experience in all phases of hospital planning and design, having directed efforts on both large and small, complex, multi-phased medical facilities in both the United States and overseas. He holds a Bachelor of Architecture degree from the University of Illinois and is a member of the American Institute of Architects (AIA), the Academy on Architecture for Health, and the Forum for Healthcare Planning. He has authored a number of articles and presentations on the planning and design of healthcare facilities.

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