Improving energy efficiency

After your initial foray into benchmarking energy performance, you notice that most of your health care facilities fall below the 50th percentile compared to similar buildings nationwide and some are even in the bottom quartile. Now what?

"We would recommend an energy audit," says J. Thomas Hawes, CEP, senior director of NRG’s Philadelphia-based energy efficiency group.

Systematic assessments of energy use, energy audits range in detail and cost from a simple walk-through to detect inefficiencies to a comprehensive analysis that involves placing submeters on individual building systems. Hospitals and health systems can hire energy service companies to conduct these audits and propose and implement solutions to pinpointed problems.

It isn't necessary to make a major capital investment to realize quick gains in energy efficiency, notes Clark A. Reed, national program manager for Energy Star Commercial Buildings, a division of the Environmental Protection Agency (EPA). The first step, he says, is to retro-commission, or fine-tune, existing equipment and controls in heating, ventilation and air conditioning (HVAC) systems, which tend to fall out of calibration over time.

"Sometimes you see economizers in need of repair or adjustment," Reed says. "Sometimes you see frozen dampers. Sometimes you see improper pressurization because the building envelope isn't sealed tightly and the fan system has to work much harder than it should.

"Savings of 10 percent in energy costs are common when facilities go through retro-commissioning."

In its "Sustainability Roadmap for Hospitals" website, the American Society for Healthcare Engineering (ASHE) recommends preventive maintenance of HVAC equipment to optimize energy efficiency and indoor air quality:

• Replace air-handling unit filters regularly.
• Clean cooling towers to maximize condenser performance.
• In chillers, remove calcium carbonate from copper tubing.
• Inspect water-cooled systems for leaks, and calibrate sensors.
The steam traps used in steam-heating systems offer health facilities a key opportunity to increase energy efficiency with a fast payback, Hawes says. According to the Department of Energy (DOE), as much as 20 percent of the steam generated by a typical boiler is lost due to leaking or failed steam traps.
"Health facilities may have hundreds or even thousands of steam traps, and the maintenance can be challenging to keep up with," Hawes says. NRG uses infrared photography to determine which ones are failing and calculates the economic return on investment (ROI) for replacing them with appropriate mechanical, thermostatic or thermodynamic options.

Upgrading lighting

One of the easiest ways for health facilities to reduce energy costs is to replace fluorescent, halogen and high-intensity discharge (HID) lighting with light-emitting diode (LED) technology wherever possible. Switching to LEDs can reduce lighting's share of a hospital's electricity consumption by more than 50 percent.

"You not only use less electricity with LEDs, but also you reduce maintenance costs because they last so much longer," Hawes says. Moreover, LED lights, which illuminate color more accurately than other types of lighting, aid in the diagnosis and monitoring of patients with liver conditions and other ailments affecting complexion.

To save energy, health facilities should also make sure that lights are turned off in unoccupied areas. ASHE's Sustainability Roadmap recommends installing motion sensors in spaces that are frequently unoccupied, such as restrooms, stairwells, service areas and mechanical plants.

Daylight harvesting is a more expensive upgrade that can provide significant energy savings, Hawes points out. Daylight harvesting systems feature controls that dim interior lighting in response to the amount of sunlight entering a room.]

"For a major lighting project, it's common to see a two- to four-year ROI just from energy savings," Hawes says.

Sophisticated solutions

Cleveland Clinic, which has more than 75 facilities in northeast Ohio alone, prioritizes energy management and other aspects of environmental sustainability. Named an Energy Star Partner of the Year, the health system has also been participating in the DOE's Better Buildings Challenge, which urged organizations to reduce their energy use intensity by 20 percent between 2010 and 2020.

"We currently are 9.4 percent below our baseline, which was set at the end of 2010," says Jon Utech, LEED AP, MBA, MSOD, senior director of Cleveland Clinic's Office of Healthy Environment. "That represents about a $5 million change per year in our energy usage."

To realize energy savings, Cleveland Clinic has implemented a chiller optimization program, steam trap replacements and light harvesting, among other initiatives, says Larry Rubin, CPE, CEM, CHFM, CHSP, the health system's senior director of facilities management.

The organization is currently rolling out an operating room airflow setback program. "We have 215 ORs throughout the enterprise. And when they're not occupied, we like to 'put them to sleep' so to speak," Rubin says. "With OR setbacks, we reduce the number of air changes per hour, from 20, the minimum required during surgeries, to six, while keeping the temperature, humidity and pressure of the OR the same."

The airflow setbacks are tied to the OR management component of Cleveland Clinic's electronic health record system. "The program knows when the surgeries are scheduled and when they're finished," Rubin explains. If a surgery runs longer than indicated, a built-in safety feature prevents the setback from occurring if the operating table light remains on.

Rubin estimates that the OR setbacks will save Cleveland Clinic $2 million per year in energy costs.

Computers constitute another huge energy waster in large health systems. Cleveland Clinic has implemented energy-management software that puts office computers into sleep mode automatically when not in use. "We have implemented this on 40,000 of our computers; we've saved about half a million dollars in electricity costs through this initiative," Utech says.

Win-win measures

In health care energy management, patient health and safety — and optimal working environments for staff — take precedence over saving money, Hawes notes. Stringent rules and regulations must be followed.

"When I work with healthcare clients, it's a very humbling experience because I see the bravery of the patients and the miracles that happen in these hospitals every day," Hawes says. "I must make sure that what I'm doing to save energy doesn't compromise the comfort of the patients and the staff."

Fortunately, says Hawes, by reducing a health system's carbon footprint and enhancing indoor air quality, most energy-conservation measures have a positive impact on patient outcomes and public health.

This is the second in a series of articles on energy management.