Healthcare’s Aging Infrastructure Problem: Part 2

In part one of this two-part series, we focused on different strategies that can be adopted by healthcare facilities to identify the specific renovations and improvements needed to address infrastructure shortfalls. This follow-up article highlights recent trends in healthcare infrastructure upgrades including emerging technologies that are becoming more common, new innovations that are being considered, and how the programming and planning of spaces is changing with time. TRENDS WITHIN ENGINEERING INFRASTRUCTURE UPGRADES We need to better understand the problem to solve the problem. The following renovation and improvement strategies are being adopted by healthcare facilities to address infrastructure shortfalls: Sustainability and carbon emission reduction A focus on sustainability and carbon footprint reduction has been increasing worldwide in the last few years. The fact that carbon emissions are the most significant contributor to greenhouse gas (GHG) emissions and global warming is behind this development. Accordingly, the healthcare industry has also recently shifted its focus to sustainability and carbon reduction. Many leading healthcare providers and operators have set aggressive carbon reduction and environmental, social, and governance (ESG) goals. A company’s GHG emissions are classified in three scopes: Scope 1 – direct emissions from the source (fuel heating source, combustion from vehicles, refrigeration leaks, etc.) Scope 2 – owned indirect emissions from the generation of purchased energy from a utility Scope 3 – not owned indirect emissions that occur in the value chain (embodied carbon from building construction materials, transportation, etc.) Scopes 1 and 2 are relatively easier to measure and can be mitigated. Scope 3, on the other hand, is notoriously difficult to calculate and mitigate. With this being a new trend in the industry, healthcare organizations are at different spectrums on how they’re tackling the issue. Most organizations are trying to assess and formalize their ESG and carbon reduction goals. A great example is HCA Healthcare, the nation’s largest healthcare system. HCA assessed its Scope 1 and Scope 2 GHG emissions and is currently working on assessing Scope 3 emissions. Based on this assessment, HCA is implementing a plan to reduce Scope 1 and Scope 2 emissions over the next three-to-five years and formulate a strategy to improve environmental performance more broadly. Sixty-one of the nation’s largest hospital and health sector companies have committed to reducing GHG emissions by 50% by 2030. This includes two of the five largest US private hospital and health systems, Ascension and Common Spirit Health. Leading health sector suppliers like Pfizer and AstraZeneca have stepped up to achieve net-zero emissions ahead of the 2050 pledge timeline. Building electrification The most popular strategy for facilitating carbon and GHG reduction is building electrification and moving away from fossil fuel sources (mainly for heating purposes). There are still a lot of challenges that need to be overcome to successfully transform a large hospital to an all-electric facility. Upsizing the power service needed as well as the impact on energy bills may be the first hurdles to cross. In addition, a large amount of steam is used in hospitals for humidification and sterilization that is primarily powered by fossil fuel boilers. It will be interesting to see how the healthcare industry addresses these hurdles in the future as the move towards electrification becomes more prevalent globally. Energy efficiency improvements Hospitals are energy-intensive buildings meaning they are always under mounting pressure to do more with less resources while still complying with strict regulations, ever-changing technology, and variable health and safety measures. These pressures often lead to healthcare facilities improving the energy efficiency of their building systems. Building systems upgrades to address pandemic concerns The COVID-19 pandemic has forced healthcare facilities to consider some upgrades (or at least be ready) in case a similar emergency arises again. Some of the strategies, which are also being adopted as general best practices, include:

1. Increasing ventilation air change rates to address transmission concerns. However, it is not yet proven that this is necessary, and more research is underway.
2. Converting patient rooms to negative pressure isolation rooms to control airflow direction and limit transmission rates. This seems to be the most successful strategy.
3. Converting air handling units (AHUs) serving potential transmission areas to be capable of operating as 100% outdoor air units. AHUs recirculate air when operating in normal mode. When set to emergency mode, they can switch to 100% outdoor air and full exhaust.
4. Increasing filtration levels by adding provisional HEPA filtration in AHUs or ductwork.
5. The addition of newer technologies including ionization, ultraviolet (UV) lights, air cleaners, etc.
6. Upgrading medical gas systems to provide appropriate levels of medical grade air and oxygen to support the demand (including ventilators required) for treating the most critically ill patients. It is important to identify future ventilator load during this process. Ventilators require access to both medical air as well as oxygen, which is why it is difficult to convert traditional medical/surgical beds to intensive care unit (ICU)/critical care unit (CCU) beds.

Hybrid operating rooms (ORs) This is a rising trend due to an increasing demand for non-invasive methods of surgery. Hybrid ORs provide the ability to integrate diagnosis and perform image-guided operations via minimally invasive procedures in a single room. These spaces also offer a smooth transition from non-invasive procedures to open procedures if the need arises. Due to the dual need for diagnosis and imaging, hybrid ORs typically need a lot more equipment to be installed in the room compared to traditional ORs and hence need more engineering infrastructure. Technology upgrades Needed to support telehealth and the increase of overall technology use inside healthcare facilities. Integrated control systems New advances in technology and control systems make it increasingly possible to integrate traditionally separate facility systems together to form an “intelligent” hospital infrastructure. Such integrated control systems can simultaneously manage different systems like HVAC, lighting, power, security, patient transition, asset tracking, etc. Although these integrations have existed for years, the industry is now realizing the potential that these applications can have on energy management, safety, and patient satisfaction. The emergence of this integrated infrastructure control approach will lead to more and more building automation system (BAS) upgrades for healthcare facilities. Power system upgrades The rate at which new technologies are adopted in healthcare facilities is rapidly increasing, raising challenges in power system design. Power supplies to high-technology equipment must be more stable with fewer or no fluctuations than more robust legacy equipment can resist. These issues are driving increased utilization of power conditioning equipment and uninterruptible power supplies (UPSs). The continued emergence of new technologies is therefore likely to increase the use of emergency power to support the latest critical equipment. Fire alarm system upgrades Most fire alarm systems use proprietary equipment and operating protocol. This can make upgrades difficult because the facility is locked into one manufacturer for service and repairs. Complicating this further is the fact that many facilities use legacy systems that are no longer supported by manufacturers. As a result, facility managers typically replace the existing fire alarm system with a less proprietary option when service and repair or finding parts becomes more and more difficult. Upgrades from traditional fire sprinkler systems to water mist systems A water mist system is a new technology that atomizes water droplets into a non-conductive fog that suppresses fire without water damage. It is mostly used in data center applications but is now under consideration for healthcare facilities. It’s a promising option given that local authorities in some geographical locations have started considering it as an acceptable alternative to a traditional fire sprinkler system. Henderson Knows Infrastructure With more than 25 years of experience designing healthcare facilities, we have built up an extensive resume of healthcare infrastructure improvement projects. Working together with our sister company, Henderson Building Solutions, we provide well-thought out, accurate, constructive, and well-phased plans that keep healthcare facilities running smoothly and safely as intended. Learn more here.