Health Care Projects

MaineGeneral Alfond Center for Health

Background: MaineGeneral Health was in triage mode, considering how best to deal with a hodgepodge of aging health care facilities. The facilities included two acute care hospitals and outpatient clinics that served the residents of Maine’s Kennebec Valley. The Valley’s 122,000 residents – and the seasonal visitors who enjoy its beautiful lakes and rivers – were spread over almost 1,000 square miles.

MaineGeneral was facing more than $100 million in needed repairs to facilities acquired over the years, many through mergers. Consensus was quickly reached that the health care system’s facilities needed much more than $100 million worth of Band-Aids; it was time to address systemic facilities issues.

Details: Once a consolidated greenfield hospital was approved, it was determined that utilizing Integrated Project Delivery (IPD) to deliver a new regional facility would be explored. The MaineGeneral IPD team included SMRT and TRO Jung|Brannen, architects and engineers; and Robins & Morton and H. P. Cummings, for construction.

The working organization of an IPD team brings the owner, architect, engineers, construction manager, general contractor and major subcontractors together as one team – working side-by-side from the project inception and breaking down traditional role models.

The plumbing design team was an integral part of the project team from the outset. The American Institute of Architects (AIA) defines IPD as, “a project delivery approach that integrates people, systems, business structures and practices into a system that collaboratively harnesses the talents and insights of all participants to optimize project results, increase value to the owner, reduce waste and maximize efficiency through all phases of design, fabrication and construction.”

The plumbing design team and the plumbing contractor worked side-by-side during the design process, while being fully integrated with the other team members. The plumbing contractor was able to provide input to the components, systems and their constructability very early in the process, allowing them to pre-fab many construction pieces (including patient toilet rooms and med gas headwalls) in advance of the final documents.

One such offering from the plumbing contractor was to utilize an engineered single stack drainage system in the in-patient wings, reducing drainage and vent costs without sacrificing performance. The plumbing design team and plumbing contractor were able to produce coordination drawings using BIM during the design, limiting clashes in the field between systems that needed to be rethought.

The project utilized three 600 HP steam boilers with 26-inch diameter flues connecting to a common header. The project design team recognized the vast amount of energy potentially lost to atmosphere. As a result, a boiler stack economizer was implemented. Flue dampers in the boiler flue manifold were opened to direct gases through the economizer. A pumped loop pushed water through the economizer and a domestic hot water preheat heat exchanger, increasing the domestic water temperature feeding the water heaters to as much as 125°F. Waste energy from the boilers was used to reduce the amount of energy required to heat the domestic cold water feeding the domestic hot water heaters.

One key component to achieving significant water savings was the implementation of a rainwater collection and reuse system for HVAC make-up, predominantly the cooling towers. The system included a 20,000 gallon cistern on site, which featured a pump to feed the building cooling towers and other HVAC make-up with the collected rainwater, 10 and 5 micron filtration, UV sterilization, an expansion tank, and distribution pump. The components are tied into the building management system (BMS), and include a non-potable water connection for automatic swap over in the event the cistern runs out of rainwater.

Piped Natural Gas from a utility was not able to be installed prior to facility occupation, due to geographic unavailability. Liquefied propane (LP) was already going to be considered as a fuel source, but the design team needed to determine a back-up fuel source for the building’s heating system boilers. The answer developed by the team was a synthetic natural gas system. LP is pumped at an elevated pressure to a vaporizer skid where air and LP vapor are blended to achieve the same specific gravity as natural gas. Both the propane and the synthetic natural gas were piped into the central utility plant. By utilizing this dual gas system, the facility benefits from lower costs when compared to traditional oil fired boilers.

The largest challenge the plumbing design team faced was getting timely (less than 10 seconds) hot water from the faucets that had LEED-approved, laminar outlets installed. The design team limited the uncirculated branches (dead-legs) of hot water piping to just 10 feet wherever hand washing occurred. Where plumbing fixtures were stacked (in-patient wings), the hot water would run vertically behind the fixtures, in a chase. A recirculated branch would be pulled from the vertical riser, leaving only a dead-leg of 2 feet or less. In all other areas, the hot water branches were routed in the ceiling directly over the fixtures and a recirculated hot water branch was pulled from the end.

Results: MaineGeneral’s new 640,000 square foot facility was delivered 10 months ahead of schedule, while returning approximately $20 million in value added savings to the organization’s health care delivery system.

The design team set out to achieve LEED Silver, but earned one of the first LEED Gold for health care certifications. The plumbing design was able to reduce the water use at the plumbing fixtures by more than 37 percent and at the process equipment by nearly 50 percent, resulting in a total reduction of 3.6 million gallons of water annually.

A rainwater collection and re-use system was used for HVAC make-up. Low flow fixtures were implemented (1.28 GPF water closets, 0.125 GPF urinals, 1.5 GPM shower heads). Water sub-meters were installed to track the water usage at the largest areas of potable water consumption.

The engineering team designed the system to allow the MaineGeneral facilities team to track the water usage, identify and chart potential points of water inefficiencies and initiate any corrective actions that may be needed. The project engineers calculated the anticipated water usage for each piece of equipment. This tracking system allowed the facilities team to continuously monitor performance alignment through the life of the building. Any misalignment with design intent was identified early, to allow corrective actions can be taken.

The medical equipment did not include once-through cooling, which would have resulted in potable water being dumped to drain after each cooling cycle. The on-site laundry included a tunnel style clothes washer using .35 GPM/LB/cycle, in lieu of multiple washer/extractor types that can use as much as 2.5 GPM/LB/cycle.

Like all hospitals, plumbing is a critically central function. However, plumbing is many times not top-of-mind with clients. The implications of not planning plumbing systems in advance – at the outset of a complex project – tend to become apparent in post-occupancy with water usage inefficiencies, energy costs related to producing domestic hot water, and other avoidable costs. MaineGeneral and its IPD team recognized these challenges before proceeding with planning, thereby integrating sound plumbing engineering utilizing highly efficient technologies and plumbing systems, early in the design process.

NorthShore Skokie Hospital

Background: NorthShore Skokie Hospital, founded in 1963, is a large and diverse health care facility in north suburban Chicago, with particular expertise in orthopedics and cardiac care. As a part of the NorthShore University Health System, the hospital is in the midst of a multi-year, $300 million renovation initiative to expand its clinical services, enhance and improve patient care, and upgrade technology.

Major aspects of the plan include a new ambulatory care center (opened in January 2013), reconfiguration of multiple clinical departments, surgical pavilion enhancements, a new cardiac catheterization and interventional radiology suite, an MRI building renovation, a new gastrointestinal laboratory with five procedure rooms, and conversion of the five-story bed tower to all-private patient rooms.

The engineering and sustainability consulting firm Grumman/Butkus Associates (G/BA), of Evanston, Ill., has worked with hospital staff, architectural planners, and contractors on the ongoing renovation effort. The effort started in 2008 and is due to wrap up in 2017. Integrated Facilities Solutions Inc., of Skokie, Ill., has served as program manager on the project along with Dickerson Engineering Inc., of Niles, Ill., working on electrical engineering.

A new central plant, completed in 2011, supports the renovations and new construction. It includes energy-efficient chillers, steam boilers, cooling towers, domestic water heaters, domestic water and fire pumps, compressors, an electrical vault, and related equipment and fuel storage. In addition to these crucial infrastructure upgrades, G/BA has designed new medical gas, medical-surgical vacuum and waste anesthesia gas disposal services in support of both the bed tower renovation and the surgical pavilion expansion. Significant changes were also made to the site’s hot water distribution system.

Details: Renovation of the 105,000-square-foot bed tower has been staged in a top-down fashion, starting in 2012. So far, the fifth and fourth floors have been completed, with conversion to single rooms plus important technology improvements. Third-floor space reconfiguration is ongoing. Existing MEP systems are being completely replaced, with new mechanical distribution extending from the top down during consecutive floor renovations.

Simultaneously, the hospital’s surgical capabilities have been enhanced through a building addition linked to the bed tower. Before renovation, the hospital had eight operating rooms. It will now offer 12 in a 60,000-square-foot pavilion, plus an enlarged critical care unit, recovery areas, and sterile processing.

The project team created a new mechanical penthouse atop the bed tower, supporting large equipment including medical air compressors and vacuum pumps. The prior medical gas equipment was removed from a basement and a third-floor mechanical room. Previously, medical gas distribution was up-fed to the higher patient floors. All medical gas piping and outlets are being replaced, with patient rooms receiving a mix of prefabricated and built-in-place headwall units.

Additional medical air and medical-surgical vacuum pumps, as well as a waste anesthesia gas disposal pump, are being installed in reconfigured space under the surgical addition. New nitrous oxide, nitrogen, and carbon dioxide medical gas manifolds have been provided to minimize downtime in the existing operating rooms.

To enhance reliability and redundancy, a crossover between medical air and medical-surgical vacuum was created between the medical gas and vacuum systems for the surgical pavilion and the bed tower.

“Previously they had redundancy only within each packaged medical-grade pump unit, but not the redundancy of a second complete package,” said G/BA Associate Joe Ficek, CPD, GPD, FASPE.

The domestic hot water systems were also upgraded, switching the distribution from a vertical to a horizontal piping configuration. Due to the many changes throughout the facility, a hot water return balancing procedure was provided to minimize waste of water and energy.

“All existing and new domestic supply and hot water return systems were identified, and new balancing valves were recommended in order to comply with the level of performance needed given modern low-flow plumbing fixtures,” said G/BA Senior Project Engineer Frank Sanchez, CPD, GPD.

Results: Due to careful scheduling, work has gone forward without interruption to the hospital’s medical services and with minimal disturbance to patients and staff. Ficek said that, although the plumbing design is not unique, the level of complexity required in dovetailing and phasing the projects has been unusual. The payoff includes enhanced sustainability and reliability, as well as easier access for ongoing maintenance.

“In many ways the med gas project affected almost the entire hospital,” Ficek said. “For instance, the new central plant received new master medical gas alarm panels. Essentially we touched the whole facility: new equipment, mains, outlets, system monitoring, and master alarms. The project took a 1960s facility and brought it into the 21st Century, along with all the trials of working in an older, occupied building with little to no available space above the ceilings.”

Ficek noted that N+1 redundancy is a major benefit associated with the med gas project.

“The crossover between the bed tower and the surgical addition provides excellent backup in case of any catastrophic failure. This is a feature that was not previously available,” Ficek said.

Jim Shults, PE, a vice president at G/BA and principal in charge of the project, added, “Failures as simple as an electrical breaker trip can take down an entire duplex medical pump/compressor unit. The internal packaged equipment redundancy is not truly redundant for this type of failure. Therefore, a piping interconnect provided between multiple medical pump/compressor units will greatly enhance redundancy for these critical systems in a hospital. Industrial facilities have adhered to this practice for years; medical facilities should strive for this level of redundancy.”

Trios Southridge Hospital

Background: Trios Hospital began as the Kennewick General Hospital in 1952. The hospital has grown to become a primary service care provider for the Tri-Cities area of Washington including Kennewick, Pasco and Richland. Trios Southridge Hospital is the newest addition to the Trios Health network.

In June 2012, Trios Health broke ground on a new hospital at Southridge in Kennewick, where David Brons, of Apollo Mechanical Contractors, was the general foreman at the Trios Southridge Hospital project. Apollo Mechanical, is a certified Native-American-owned business and one of the largest contractors in Washington state.

Details: Apollo Mechanical saved time on new hospital installations. Viega ProPress systems, up to 4 inches for domestic water and hydronics, and MegaPressG, up to 2 inches for fuel oil and natural gas, were installed.

The fittings were installed with around 30,000 feet of copper tubing and the carbon steel press fittings for water and gas were installed with approximately 1,500 feet of black iron pipe.

“There are so many different systems,” Brons said. “We’re looking at about 15 different systems from plastics to stainless to carbon to med gas. The biggest obstacle is keeping it straight and making sure the right stuff is being installed in the right place. Thus far it’s been good. It’s been an excellent job.”

Brons and his team appreciate saving time on the on the job.

“We love the fact that we don’t have to use torches all over the place, avoiding all the challenges that come with having an open flame in a building,” Brons said.

“The number one thing is that it’s going to save you labor hours. I do a lot of work in hospitals and it’s an excellent product for anywhere where an open flame is a hazard. New construction is a different deal, but whenever you’re talking a DOE project, I would recommend it in those applications due to the complexity of getting burn permits and all the things that go along with it,” Brons added.

The Trios Southridge Hospital project was Apollo Mechanical’s first experience with the MegaPressG system. Brons and his team want to be able to test systems to make sure that connections are secure. Viega press systems’ “Smart Connect” feature allows installers to easily verify that connections have been pressed.

Results: Trios Southridge Hospital opened on July 15, 2014. It is a 170,000-square-foot facility with three stories in addition to a daylight basement. The hospital features 74 licensed beds and 27 emergency and trauma service rooms. Additionally, many of its amenities are energy efficient.

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