Rural hospital invests in hydrogen

KVH partnered with an energy services company to help assess and find funding for energy infrastructure upgrades.

Image courtesy of Klickitat Valley Health e

Rural and critical access hospitals throughout the U.S. are struggling under massive capital improvement needs. Many of these small hospitals that were built in the 1940s and 1950s following the passing of the Hill-Burton Act are today faced with aging and inadequate infrastructure that in many cases can become the final straw that cripples an organization.

Klickitat Valley Health (KVH) in Goldendale, Wash., was one of the first Hill-Burton-funded hospitals in Washington state, dedicated on Dec. 15, 1949. The 25-bed critical access hospital underwent major additions and renovations in 1967, 1985 and 2006.

Know your life cycle risk

To ensure the aging hospital would not succumb to infrastructure issues, the organization’s leaders needed to understand the life cycle and risk of the facility’s existing building stock and its mechanical, electrical and plumbing systems — both in terms of age, maintenance challenges and costs. Ideally, this assessment would have been grounded in science. However, without years of accumulated data, the process often felt like a series of spreadsheet-driven wild guesses. Many small facilities lack a comprehensive system for tracking capital assets.

One bright spot was that the finance department maintained a fixed-asset list, which tracked the original purchase prices, dates and names of individual assets. This was helpful, but because many of the names did not make sense decades later, for example, "Bob’s Office AC unit,”­ the facilities team’s first goal was to align this asset list with the current equipment, update it with expected lifespans based on guidelines from the National Fire Protection Association (NFPA) and ASHRAE, and create a risk assessment that factored in maintenance quality, redundancy and infection prevention concerns.

To enhance this assessment, the team cross-referenced the data with judgments on energy efficiency compared to modern alternatives. Each piece of equipment received a score, and those with the lowest scores were further scrutinized. The objective was to transform these wild guesses into actionable data by integrating the assets into the work order system, giving KVH the ability to track asset repair costs, introduce more detailed preventive maintenance and add trend logs to the building automation system (BAS). This project remains ongoing.

Addressing the non-equipment infrastructure, such as the building envelope, utilities and piping, posed another challenge. The facilities team first had to locate all utility meters — gas, water and electric — map the areas they serviced and begin tracking that data in ENERGY STAR^®. This process revealed significant issues. For instance, one building was consuming 10 times the expected amount of water per square foot, leading to the discovery of a 4.3-gallon-per-minute leak that likely dated back to the 1980s. Additionally, the city had been charging the hospital for a 3-inch water main that in reality was a much smaller three-quarter-inch line, resulting in a $30,000 refund for overpayments.

A recent facility master plan highlighted that the core buildings from 1949 and much of the 1967-renovated space were so outdated that renovating them would be prohibitively expensive. Consequently, a plan was developed to replace those spaces with a new medical-surgical wing.

Further assessment during an arc fault study on the facility’s electrical service and switchgear installed in 1967 revealed that the secondary potential short-circuit current rating (SCCR) from the utility was 23,915 amps. However, the switchgear lacked an SCCR rating. According to UL 508a, Training on Industrial Control Panels, in supplement SB, table SB4.1, unmarked terminals are assigned a 10-kiloampere SCCR. This indicated to the facilities team that there was a severe and potentially destructive short-circuit risk. Upon discovery, this issue was promptly reported to the local authority having jurisdiction and hospital staff.

Compounding this risk, the essential electrical system (EES) relied on two 100-kilowatt surplus generators and transfer switches dating back to World War II (WWII), far beyond their prime. Each monthly generator test was conducted with fingers crossed, often concluding with a visit from the third-party vendor that maintains these systems.

Despite these daunting challenges, the upfront work now equipped the facilities team with a more compelling narrative. This enabled staff to clearly articulate the needs and risks associated with neglecting the hospital’s infrastructure, presenting a case that resonated with KVH’s executive leadership team: tens of millions of dollars’ worth of infrastructure beyond its safe life cycle, juxtaposed with an annual repairs and capital replacement budget of less than a quarter-million dollars.

Strategic partnerships

Although the organization was aware of the many federal, state and utility grant programs designed to enhance resilience and energy efficiency, the complexity of overhauls needed for KVH’s infrastructure made it clear that the team needed expert support to help maximize the success rate in securing funding that would deliver the most impact. Partnering with an energy services company (ESCO) brought the necessary expertise to identify projects that would deliver the greatest energy and cost savings.

The ESCO conducted a comprehensive assessment at no upfront cost. The agreement, however, did contractually obligate KVH to either proceed with a financially viable project or pay an audit fee of $5,000. The audit helped to prioritize upgrades that aligned with grant opportunities and offered strong returns. The ESCO provided detailed data on energy savings and return on investment, which was crucial for both grant applications and gaining buy-in from the finance team.

The ESCO’s performance guarantee minimized KVH’s financial risk, instilling confidence in the projected savings. This collaboration was instrumental in transforming the hospital’s infrastructure while securing the funding needed to make these improvements. For publicly owned hospitals, working with an ESCO can streamline the funding process and drive significant advancements.

The first investment grade audit conducted by the ESCO identified three key projects:

1. Convert fluorescent lighting to LED.
2. Integrate the oldest air handlers into the digital BAS, replacing outdated pneumatic controls.
3. Add variable frequency drive control to six air handlers dating back to the 1960s.

Combined, these projects totaled $600,000 to complete. With the ESCO's assistance, KVH secured $214,000 in utility and state energy grants and financed the remaining balance based on the guaranteed energy savings, resulting in a 13-year simple payback, including fees.

The ESCO also helped to discover a significant underground water leak, amounting to 2,397,460 gallons per year. The hospital took on this fix internally, achieving an annual utility savings of more than $12,000. Additional savings were reaped from reduced lighting maintenance. Eliminating all fluorescent lighting ballasts in one go was particularly satisfying.

Investing in advanced energy systems

The most pressing project — replacement of WWII-era generators and outdated, dangerous switchgear — lacked an energy-savings component, requiring the facilities team to think creatively in terms of funding.

Part 2 of this article will delve deeper into the community engagement and grant writing processes that helped to resolve these issues. However, the basic outcomes and strategy unfolded as follows:

The ESCO developed a comprehensive series of facility improvement measures (FIMs), which included:

• Upgrade the central utility plant (CUP) by replacing inefficient equipment and adding redundancy, while sizing the CUP to accommodate a proposed new wing.
• Integrate the emergency department wing into the CUP, which was originally built as a standalone facility to cut construction costs.
• Upgrade the domestic hot water systems.

The existing electrical infrastructure could not support these FIMs, necessitating a complete replacement of the switchgear and WWII-era generators. These replacements were incorporated into the ESCO contract. However, since they lacked a direct energy-savings component, securing funding through traditional energy grants was challenging.

Improvements to KVH's infrastructure include the upgrade of its central utility plant.

Image courtesy of Rehlko

The ESCO demonstrated patience as KVH pieced together grants and loans over nearly three years to secure the $9 million needed for these FIMs.

As part of KVH’s community outreach and emergency preparedness efforts, the organization identified community interest in a solar microgrid project to support critical infrastructure during sustained power outages. KVH adopted the phrase “microgrid ready” as a design principle to help explain much of the infrastructure work to potential funders. This microgrid concept was strategic in securing a significant portion of the necessary funding.

For instance, one grant included funds to conduct a feasibility study on establishing a district-wide heating and cooling concept and solar/battery microgrid, which would integrate school district buildings and the hospital into an emergency preparedness district. Another grant opportunity came through the state of Washington for the funding of a demonstration hydrogen fuel cell project. By bundling the electrical upgrades and a 100-kilowatt fuel cell into a state legislative appropriations request, KVH successfully secured full funding for these two projects.

As of press time, the electrical upgrades — including for the EES — have been completed, the CUP and emergency department wing hydronic conversion are nearing completion, and the microgrid project has received grant funding through the design phase from the Federal Emergency Management Agency.

Fuel cell details and challenges

A basic definition of a hydrogen fuel cell is that it generates electricity by combining hydrogen and oxygen through an electrochemical process, similar to a battery but without depletion or recharging needs as long as hydrogen is supplied. The only byproducts are water and heat, making it a clean and efficient energy source.

When embarking on a hydrogen fuel cell project, there are several factors to consider, including means of production, regulations, safety and training.

Hydrogen production

There are several methods that can be used to produce hydrogen:

• Electrolysis. This process splits water into hydrogen and oxygen using electricity. When powered by renewables, it produces green hydrogen.
• Steam methane reforming. The most common method, this process uses natural gas and steam to produce hydrogen and carbon dioxide, resulting in grey hydrogen. With carbon capture, it becomes blue hydrogen.
• Biomass gasification. This process converts organic materials into hydrogen through high-temperature processing.
• Partial oxidation. This is a process in which hydrocarbons react with oxygen to produce hydrogen.
• Photolysis: This is an experimental method that uses sunlight to split water molecules.

Currently, green hydrogen is not widely available in Washington state, but the field remains hopeful about future access to this resource.

KVH's 100-kilowatt fuel cell system will help to supplement its power needs during outages.

Image courtesy of Klickitat Valley Health

The fuel cell installed at KVH was developed by Rehlko (formerly Kohler Energy) in collaboration with Toyota Motor North America. It incorporates two 50-kilowatt solid polymer electrolyte membrane fuel cells. Toyota's development of the Mirai fuel cell electric vehicle that combines hydrogen and oxygen to generate power began in 1992, with the first generation launched in 2014. The KVH units, integrated by Rehlko, mark the first stationary application of the Mirai technology.

KVH embraced the risk and challenges of integrating a hydrogen fuel cell system to help fund its electrical upgrades. With this project, the organization aims to demonstrate hydrogen’s potential to power a hospital’s EES and eventually replace standard diesel generators. Although the facility’s 100-kilowatt fuel cell system isn't large enough to run KVH’s 350-kilowatt EES, it will supplement normal power circuits during outages, simplifying the permitting process. Additionally, storage capacity currently falls short of the 36-hour runtime requirement for backup power systems.

Codes and standards

Navigating multiple regulations can be complex due to the relative novelty of fuel cell technology in health care. Codes and standards with relevance to this technology include:

• NFPA 70®, National Electrical Code®. This code governs safe electrical system integration.
• NFPA 853, Standard for the Installation of Stationary Fuel Cell Power Systems. This standard addresses safety aspects of stationary fuel cell systems.
• NFPA 55, Compressed Gases and Cryogenic Fluids Code. This code regulates the storage and handling of compressed gases like hydrogen.
• International Fire Code and International Building Code. These codes cover fire safety and structural requirements.
• Local codes and Occupational Safety and Health Administration (OSHA) standards. Local codes and OSHA standards add layers of safety and provide other operational guidelines.

Permitting issues

Consider the following issues when applying for permits for a fuel cell project:

• Setbacks from roadways, buildings, air intakes and other hazardous locations.
• Electrical classification for explosion risk in the tank storage area.
• Interpretation of NFPA 55's complex matrix of storage factors, such as hydrogen state, pressure, storage capacity and piping dimensions.

Training and safety perceptions

Historical accidents like the 1937 Hindenburg disaster continue to affect public perception even though modern hydrogen storage systems feature advanced safety measures, including high-pressure resistance design, leak detection and redundant safety mechanisms.

It is crucial that health care organizations ensure staff and first responders are properly trained in inspection, maintenance and emergency response procedures for hydrogen fuel cells. NFPA 55 outlines specific training requirements, including:

• Emergency procedures and equipment handling.
• Hazard communication and proper use of personal protective equipment.
• Regular drills and refresher training.

More to come

This ongoing project has been a learning experience, and the insights gained by KVH can help to guide other health care facilities in evaluating the potential use of fuel cells at their campuses.

Also, national laboratories, such as the Pacific Northwest National Laboratory (PNNL), Sandia National Laboratories and the Center for Hydrogen Safety, provide valuable resources and expertise. Sandia’s Hydrogen Plus Other Alternative Fuels Risk Assessment Models and the H2Tools website created by PNNL are especially helpful.

In a follow-up article, the strategy KVH used to secure alternative funding for its capital investment projects will be explored in more detail.

Jonathan Lewis is director of support services at Klickitat Valley Health (KVH) in Goldendale, Wash. He has extensive experience in health care facilities management and renewable energy projects. His recent work includes spearheading a cutting-edge hydrogen fuel cell initiative at KVH. He can be reached at jlewis@kvhealth.net.