The changes occurring in American healthcare affect every decision healthcare providers make today – right down to their HVAC systems.
In years past, patient comfort dictated the choice for heating and cooling equipment. But with increasing pressure on financial performance, healthcare providers must improve their physical environment by qualifying HVAC equipment and controls that can simultaneously create comfort, safety and cost-savings.
The shift in thinking has been dictated by a number of new factors impacting the healthcare industry but mostly by two primary issues:
 a sudden movement away from reimbursement structures that are “volume-driven” to those based on recovery and outcome compensation, and
 negatively impacted construction and operating budgets due to the present economy, political uncertainty, new legislation and healthcare reform.
As a result, newly mandated healthcare facility management approaches are emerging to improve patient outcomes yet reduce operating expenses. Maintenance departments, once perceived as a fixed-cost overhead, are now charged with overseeing issues such as temperature control to reduce their cost impact on the facility. These departments are now key players in discovering heating and cooling options that will dramatically impact the bottom line.
HVAC to Help Improve Patient Outcomes?
The Center for Disease Control and Prevention estimated 1.7 million Healthcare-Associated Infections
(HAIs) or nosocomial infections contribute to approximately 99,000 deaths per year, resulting in $25-$35 billion in costs. Further, a high rate of HAIs in a medical facility can have a detrimental effect on financial performance due to The Patient Protection and Affordable Care Act which compensates hospitals with lower infection rates and occurrences of re-admittance or extended stays. Accordingly, healthcare organizations are aggressively pursuing procedures to reduce nosocomial infections via the implementation of new HVAC equipment and control approaches that have been proven to contribute to the effort, like the ones described below
Advanced Filtration, Ultraviolet Germicidal Irradiation (UVGI) and Photocatalytic Oxidation
(PCO)
Through this filtration process, large toxic particles are captured from the air supply circulation, volatile organic compounds (VOCs) and small biologicals are eliminated, and microorganisms are prevented from reproducing. Contaminated air is cleaned and re-circulated to the occupied space to reduce the spread of infections among patients.
Heat Recovery
The use of heat recovery can help increase fresh-air ventilation rates and take advantage of the exhaust air’s already cold and conditioned temperature and humidity. Coil run-around systems are used to eliminate the cross-contamination of chemicals and viruses between the exhausted air and the ventilation air re-circulated back into a facility without the excessive utility (energy) penalty costs associated with having to temper raw, un-treated outdoor air to maintain patient

comfort. Sensible energy (change in temperature) is captured and recovered while the exchange of latent energy (change in humidity or moisture) that could be beneficial is left untouched.
Energy Recovery
Unlike the heat recovery approach, an energy recovery strategy transfers both sensible energy as well as latent energy to or from the exhaust air while decreasing the occurrence of chemical,
VOC or virus cross-contamination. The air is then treated and re-circulated back into the ventilation supply. The additional transfer or recovery of latent energy requires considerably less new energy input for tempering the ventilation air before it is delivered to the occupied space, resulting in improved process efficiencies. A properly sized heat-recovery device typically reduces the necessary size capacity of heating and air-conditioning equipment by 30-50 percent while providing energy savings ranging from 25-40 percent, thereby providing the added benefit of reducing building space heating and cooling requirements for HVAC systems. While this approach will not entirely eliminate cross-contamination, some energy recovery solutions have been found to meet the strict guidelines set forth to govern the use of energy recovery devices in healthcare and laboratory environments, and have been successfully applied without incident.
New Technology Reduces Noise
Patient comfort can be elusive in the midst of bright lights and needles -- and the non-stop noise produced by moving carts and equipment, foot traffic, conversation among staff and visitors, and beeping monitors. Facilities can do without the noise burden of HVAC systems that add to the environment’s stress level, especially since ambient noise levels have demonstrated improved recovery response and reductions in patient stays.
The goal of quiet vibration and noise-free environments has turned facility management directors in the direction of more advanced energy-efficient HVAC systems that also feature noise-reduction technology.
Such technologies lower noise levels through the use of air-handler fan arrays, consisting of two or more supply fans, that suppress sound levels produced beyond that of a single unit. While some fan arrays may use 16 or more fans, it is important for healthcare facility managers to weigh sound reduction and redundancy with the required service and maintenance of multiple components. However, an array of four to six fans typically provides a nice balance among performance, functionality and cost.
Many Cost-Effective HVAC Solutions to Address Increasing Energy Costs
The federal government has predicted energy costs will double over the next 25 years and some predictions say they may even quadruple in this timeframe. Therefore, it is likely utility costs will continue to rise, requiring an equal increase in a facility’s operational budget. This creates a problem when finances have been frozen or reduced, and the facility management director must dip into funds reserved for other anticipated, more mission-critical projects and upgrades in order to pay a higher-than-expected utility bill.
By upgrading to energy-efficient HVAC equipment and controls, facility managers can cut utility costs by reducing both gas and electricity use, but little emphasis has been placed on this endeavor. Previously, fuel charges were considered a necessary part of doing business and justified by patient comfort and satisfaction requirements. Today, facility managers are looking at the benefits of investing in energyefficient equipment upgrades that will help free up operational funds better spent elsewhere.
And their choices for technologies are many today as manufacturers compete for the industry’s business.
The HVAC industry now offers a broad array of high-efficiency solutions that can save energy and cut costs. New chillers have been manufactured to be 30 percent more energy-efficient than the units they are intended to replace. Also, novel technologies such as variable-speed compressors and fans, magnetic bearings, variable refrigerant volumes, refrigerant economizers and improved heat exchange surfaces

along with adaptive building automation systems are helping healthcare facilities comply with stringent energy code requirements, thus further reducing utility expenses spent on their operations.
Payback, Total Cost of Ownership Drive Decisions
The good news for facility maintenance directors is that it is relatively easy to meet or exceed the timeframe established by most organizations to prove energy savings or a return on investment based on a high-efficiency HVAC upgrade. By supplementing purchase requests with readily available payback and life cycle cost savings analysis information, financial decision makers gain a true and immediate understanding as to how the extra money spent on high-efficiency products today will return increased savings over the operating life of the equipment tomorrow.
The future’s “best in class” healthcare organizations will consist of high-performance operations relying heavily on the physical environment of its facilities to contribute substantially to its overall financial success. Hospital facility management directors, the role they play and the decisions they make when choosing HVAC equipment and controls, will be instrumental in improving patient outcomes and reducing operational costs and penalties.
A testament to this increased requirement is the growing number of healthcare maintenance personnel becoming involved in energy-efficiency groups and organizations, and energy management training and certification programs. The higher knowledge of advanced, eco-efficient HVAC solutions garnered by this audience will help healthcare organizations to grow and prosper in times filled with regulatory and financial obstacles never before recognized, while allowing them the ability to confidently write their own prescription for success and lower the frequency of cost-draining side-effects they endure.
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