ASHRAE Journal:
ASHRAE Journal presents.
Tim Peglow:
Getting an efficient operating infrastructure does help and it’s always cheaper to do it on the initial build than it is to go back and retrofit. Considering I think a lot of these systematically, I think would help move the bar so to speak in the energy use in healthcare. You want to be as efficient as you can, I think and energy bills for healthcare is not insignificant. Through smart thought process, you can get some wins in it.
ASHRAE Journal:
ASHRAE President Mick Schwedler and Tim Peglow discuss practical energy-efficient applications in hospitals and the 50% Advaned Energy Design Guide, a sensible approach for engineers and building owners and operators to easily achieve advanced levels of energy savings without having to resort to detailed calculations or analysis.
Tim Peglow:
My name is Tim Peglow, I'm the associate vice president of patient care facilities at UT MD Anderson Cancer Center in Houston, Texas. I manage about five million square feet of buildings. We've been number one cancer center in the United States for quite a few years now and really look forward to continuing that by applying advanced level research and providing those treatments to patients throughout the world. Looking forward to discussions on how we manage and use the AEDGs to help us in creating those environments.
Mick Schwedler:
Tim, it's great to be with you. I'm Mick Schwedler, I'm an applications engineer with Trane in my daytime job, I have been since 1982. Our group works with people to help put systems together. People like Tim's hospital and other large facilities are who I work with, primarily on the hydronic chilled water systems standpoint. I'm also an ASHRAE serial volunteer, this year I'm the ASHRAE president for the 2021-22 year and it's a privilege to do that. With response to the advanced energy design guides, I've served on two of the project committees, one for the 50% hospital and the other for the 50% office AEDG. We'll be going through primarily the hospital guide today. I also had the privilege to serve as the advanced energy design guide steering committee chair. We're going to start out with a little bit of background on the AEDGs. What are they, what aren't they.
First, they're advanced energy design guides; they're focused on energy. While we do look at costs, our primary guide is to reduce the energy usage. These are not actually ASHRAE publications, but they're publications put together by four different organizations: the American Institute of Architects; the Illuminating Engineering Society, that is the lighting folks; the US Green Building Council; and then ASHRAE. Each of these four organizations lends a person to serve on the steering committee as those four organizations and their members that decide what AEDGs get published, and then actually approve the advanced energy design guides. They also elect a chair for the AEDG steering committee. As I said, I had the chance to serve as chair of the committee. We have tremendous support from the US Department of Energy. They provide modeling expertise, they put together the information and the funding that makes this available from the inception of a guide like the 50% hospital design guide, to its publication. It's about a nine-month process, which is very, very quick for a publication of this type. That's due in great part to the DOE's funding and their support from a modeling standpoint.
I think that one of the important parts to understand about the guides is they aren't meant to be read from the beginning to the end, cover to cover, but rather to get you started. They give you, I'll say a two to three page menu of energy saving options for the particular building type in your climate zone. So you don't have to read the whole thing, but you start with those recommendation tables and then figure out what may work on this particular project in your location and for this particular owner.
Today, we're going to cover the 50% hospital advanced energy design guide. Tim and I both served on the committee that put together the guide. Tim, maybe you can share a little bit about how you got involved with the AEDGs.
Tim Peglow:
Thanks, Mick. I got involved with the AEDGs, couple different reasons. One, I was involved in 90.1 in working on that probably early on in my involvement with 90.1 and this came up as an opportunity. Second of all, I've been within leadership positions and have been past president American Society for Healthcare Engineering, so they call me from time to time to really work on projects where they have desire to participate. I've had a lot of experience running, managing hospitals and working with the regulatory environment. That's how I got involved.
But also one of the things I've recognized throughout my career has been the importance of both the energy and balance with environment that we provide in hospitals to care for patients. My goal has always been how do we keep that in balance? Because if we don't provide that healing, healthy environment for patients, we're not going to be successful.
We know that ASHRAE standard 170 is a great guide for how we manage airflow and filtration, but because of 170, we also were probably one of the most energy intensive buildings. I think the last time I saw, our square footage is about 2% of the buildings in the United States and we consume about 4% of the energy. I think the only thing in some of our base buildings within ASHRAE 90.1 that are more energy intensive are fast food. As we began to look at it, where are the opportunities for us in healthcare to get more energy efficient without necessarily compromising the environment we have which is critical to our delivery of care to our patients or some of our supporting services? There are key areas that we have that are particularly challenging. In the instance where I work right now at MD Anderson with cancer patients, many, many, many of our patients are immunocompromised and really would be very susceptible to airborne infections or contact level infections. So we have to work very diligently to make sure we minimize that. We may do more filtration, we may do more air changes and et cetera.
The other thing we're doing here too, is we have some pharmacy manufacturing facilities within our building where we'll take and we will customize drugs strictly for the patients. We're doing both cord blood and immunotherapy regimens for our cancer patients and those require onsite preparation within a very short timeframe of administering those to the patients. We have those facilities within the hospital that are using this clean room technology. Once again, requires a significant amount of energy and we're trying to help us reduce our costs.
From that perspective, we believe we also as proponents of healthcare, have a need to be energy efficient going forward as we operate. The AEDGs was a perfect example to bring out some great practices, as Mick earlier talked about, how do we do this? One of the things I really liked about the AEDGs and I was involved in a lot of the infrastructure pieces of the AEDGs and the point that Mick brings out, was how do I go to my climate zone, which is Houston, Texas, very hot, very humid climate, what can we do in Houston to design our facilities and manage them efficiently versus Mick's up in Wisconsin? Those are two very, very different climates, but at the same point in time, if you're running a hospital, you have an obligation to try to effectively manage that environment and manage it efficiently.
It was a great interchange, a lot of idea sharing by people on the committee to really help us develop different looks at experiences, or tricks of the trade, or things like that that maybe we knew individually, but maybe not the at large audience. The AEDG gave us a chance to begin to write some of that down, discuss it and then share it. It was written in a way that is also not ultra-technical so you could understand it if you are understanding, say basic buildings, without having an engineering degree or some of those kinds of things and gear it towards that designer, that architect, that building owner, and do a better job building a hospital.
Mick Schwedler:
One of the great parts about the AEDGs is that each guide has its own project committee and that project committee has expertise in a particular building type. For example, Tim was one of the hospital owners, but we also had one from the Cleveland Clinic and the owners really worked together with the rest of the team to make sure what we're doing is putting together recommendations that make sense and can actually be implemented. Also, on the committee were architects and we also had one of the architects doubled on the mechanical side. We had people from the lighting side, folks working with controls, so it's a very well-rounded committee. There's a lot of interchange, as Tim talked about.
For example, as a mechanical subcommittee person, we might have come up with some possible recommendations and Tim and his cohorts from Cleveland would say, "Well, you might try to do that, but here's what's actually going to happen within the hospital." So having that owner's knowledge and foresight really helped us develop those guides in clear language that laypeople can understand.
Tim, maybe you can give a little bit more background from a high-level owner's view of additional things that worked well and are working well for you from the 50% hospital AEDG.
Tim Peglow:
I was early on at MD Anderson when this got started and part of my original goals at MD Anderson was look at opportunities to improve our energy performance. So I listened very intently and through the idea sharing of the AEDGs, we were able to take some of the things that were outlined in here and bring back to our facilities and really save about $3 million a year in actual annual energy costs. A lot of that dealt with just getting smarter about how we were doing things, turning things off at night more aggressively, using a little bit better control strategy on some of the things. Not over cooling, which is very common down here in Houston.
We tried to reduce some of our cooling and it did two things. One, it not only reduced our energy bill, but we were able to improve our patient satisfaction scores on how comfortable they felt in the environment. I saw walking around, a lot less patients with sweaters on or something like that, which is not uncommon for people who are sick, in particular cancer patients who do tend to like it a little warmer. A lot of positives in that regard so it was really almost a double win for us on what this can do. Opened our eyes to the ability to reduce some expenses without negatively impacting the environment we're delivering care in, and also provide positive feedback to our patients and it's been great for us.
Mick Schwedler:
One of the things I recall and this made it into the forward of the AEDG, hospitals aren't there to save money and energy. That's a nice goal, that's a nice outcome. They're there to send the patients home healthier, to get them back to their families and their normal lives. This was addressed early on, and as we considered possible recommendations we always went back to how does this affect the patients? How does it affect their health? Does it enhance it? If it ever deterred from them healing and getting back to their daily lives and their families, it didn't make it in the guide. Having Tim and John from Cleveland Clinic on really helped us keep our focus there.
Tim Peglow:
We want to not waste energy. A couple of things that I looked at, which were extremely helpful: one, if I don't need it, turn it off and try to reduce that energy consumption by being more aggressive with lighting or night setbacks, unoccupied setbacks, some of those things. That was one of the ones I felt that was tremendously insightful of—you go, "Well, I do it at home, but I got to get more aggressive on it at work." Another area we looked at and it's still sometimes a difficult challenge is lighting and lighting controls. Lighting is not a tremendously large portion of the energy budget and bills for hospitals, but at the same token it's there. And if I don't need lights, can I get them to come on and come off? When I have daylighting, can I effectively use lighting and mechanical systems that take advantage of some of those differences? I'll talk a little bit about more about that in a second.
The other one was the addition of heat recovery chillers. I took that back coming out of the AEDG and did analysis on heat recovery chillers in hospitals for 90.1. Ended up being in the 2019 version, it was the largest energy savings change made and it only applied to hospitals. It really helps control the efficiency by not only providing the cooling but capturing and reusing that heat that's a byproduct of generating chilled water. It was huge and very insightful for us.
Now, the other thing that I did, which was we built an addition onto our hospital in about 2014 or so, and we stacked on top and we have the east half is served by an air handler for all our patient rooms and the west half is served by another. We let those things float based on the needs in each half of the floor. I'll go on some days where my air handler in the afternoon will be say, at 55 degrees on the west half of the floor, but the air handler on the east half of the floor may be 60 degrees. Just once again, helping us only apply the energy we need to satisfy the heat and humidity and comfort for the spaces we have. That was huge.
I go back, in fact, some of the committees I've been talking about, I talked to it almost about applying lean principles to energy. Only applying exactly what I need, when I need it to hit the end conditions I need. We're trying to do that a little bit more and more. We've been pretty successful in that with some of the control strategies. We're going to try to expand it even a little bit more, which then, like I said, just takes that little bit of waste out using the technology that's available and really helps us limit some of our overuse, over cooling or overheating that very easily sneaks in.
Mick Schwedler:
That makes a lot of sense. As you were talking about some of those things, you spoke about the lighting and I don't think either you or I are lighting experts.
Tim Peglow:
Absolutely not.
Mick Schwedler:
But what I find is that when I look at the difference advanced energy design guides, there's such a breadth of knowledge in them and it's written at a level where even an engineer can understand it. We learned about the lighting, we learned about the lighting controls. There's also some discussion on, for example, using daylight from the outside to reduce the lighting levels. That's great from an energy standpoint, but particularly in the behavioral health areas, for example, those dealing with mental illness. Studies have shown that having the daylight available to them helps their mental health. And combining the energy reductions with even the more important health conditions of the patients, is absolutely extraordinary.
You also mentioned the heat recovery. A lot of times people think that they have to subcool the air to wring the moisture out, particularly in a climate like yours down in Houston. But when the Department of Energy, when their laboratory did the analysis in every climate zone, the amount of reheat that was necessary was staggering. Because we would dehumidify the air by making it super cold and then we had to heat it back up. If we have an air conditioning load, as we're finding in many applications, let's recover that heat, like you said. Let's show people where to pipe that heat recovery unit into the system. Let's let them know that they don't need very hot temperatures. You can often bring heat with 100 to 110 degree Fahrenheit, heating water temperature, and then you don't have a lot more energy used by those compressors.
Another way to do this is to use a type three desiccant, and that is you don't have to get to very low temperatures in order to wring the humidity out to get to the low Dew points. That particular type of desiccant can get us to the comfort conditions that are needed in the operating suites and not having to use a lot of reheat. Those dovetailed on a couple of your top hitters, Tim. You have a couple more?
Tim Peglow:
Yeah, I think, Mick, one of the things that is an example and what you talked about on the desiccant, isn't in the 50% AEDG, because it wasn't allowed at that point in time. As some of these codes are changing, it's creating new opportunities for things like the desiccant wheels. Right now there's more opportunities to do unoccupied setback on both flow and temperature, which flow is the main one to go after and those provide new opportunities. I know one of the things we're going to look at aggressively on some of our building programs is the issue of how do we deploy some of these desiccant recovery systems as aggressively as we can because of the need to manage humidity all the time in Houston.
One of my biggest fears down here, and we've been able to avoid it, is I certainly don't need to have mold showing up someplace. When we're running huge amounts of humidity levels down here, it is a challenge to keep the buildings without the humidity and the mold and all those other things that can potentially go with it. But we've got programs designed and we've put them in place and a lot of it's due to the great range of publications that ASHRAE has put out. If you apply them, you can manage effectively energy, while still creating that environment with the right levels of filtration, et cetera for hospitals.
ASHRAE Journal:
Thanks for listening to the ASHRAE Journal podcast. We want your ideas. What topics do you want to hear about and who do you want to hear them from? Email us your ideas at podcast@ashrae.org. That's podcast@ashrae.org. Let's get back to the episode.
Mick Schwedler:
One of the things that I learned being on the project committee, this really helped me when I give presentations, is a question I always get asked is, "Can you really reduce the ventilation in the spaces, keep people healthy? Can you reduce the ventilation, even in operating suites?" And as we went through standard 170 in the facility guidelines do allow that to take place when they're not in full occupancy. But had I not been on the project committee, I would not be able to state that with the same level of confidence that I can, having heard it from people like yourself. You've been president of ASHE, you really are involved in that.
Tim Peglow:
Well, there's other things too, which we're using here and it's some newer technology, is we are routinely using pulsed UV in some spaces where we think we're at risk as well, which really is partially in the ASHRAE purview. But once again, a way to keep mold growth down and keep air cleaner. It's gotten a lot of traction lately as a tool for things like COVID and managing some of those types of things. The opportunities and the tools that are able to be used in healthcare are continuing to grow and it's how to use them smartly to hit the end target of creating that healthy environment for the patients and minimizing your overall energy use, et cetera, to do that. There's significant opportunities, I think going forward that we're just learning about now. Unfortunately, I think we're going to have to work through some of the COVID bias that people have on what this all needs to be. But I think it's a great opportunity for us to continue to examine what the best practice is from both the environment side and an energy side and make sure we keep those in balance.
Mick Schwedler:
One of the things you just said there reminded me, the expertise of the project committee is in the guides. I talked a little bit earlier about the recommendation tables. It literally is two to three pages that tells you what's recommended for your particular hospital in your location. But then the rest of the guide goes through how to do things. And within the recommendation tables are called “how-to tips” and there are a significant number of tips from the people who are operating the hospitals, who own them, who are building them, designing them. Those how-to tips are worth their weight in gold because they give you the information like Tim just shared but they also talk about things to stay away from, what can jump up and bite you, what can get in your way, and what can have a negative impact. People freely share their information, so those how-to tips get more into the details and also bring up those caveats what should we really avoid as we're using this particular recommendation?
Tim Peglow:
Mick, I think that's one of the key things and I think they're a great guide. The question, I think over time is at what point in time do they deserve to be refreshed? Because we've learned more and we've got more at our disposal today than when we had with the guides. I know there's been some banter back and forth too, of as we go down this path for greenhouse gas emission reductions, is a similar approach going to be helpful because there may be things that are not necessarily in the energy guide that would help hospitals become better at reducing their greenhouse gases? In a way, which I think is really helpful, Mick, was it's written in a language that people can understand and not only decide what they would want to implement, but I think they can read it and understand what the concepts are in many cases, without reading a eight page technical paper on the calculations involved in some of these strategies that would back it up.
You can always go to get that more information if you're really interested in it. But I think bringing these subjects up in a non-technical way can also resonate with the readers and say, "Gosh, I didn't think I could do that in healthcare," or, "Boy, I didn't know that was important as I'm remodeling a hospital." Just some of those things can make significant differences in the effective and efficient use of energy.
Mick Schwedler:
Exactly, correct. With respect to the future of the guides, the steering committee chair is now Chuck Gulledge, who's last year's ASHRAE president and our presidential member. They are looking at things like what should be done moving forward, should we concentrate more on reducing environmental emissions? How do we bring that information back? So this is still ongoing. You and I can't promise what's going to come out of that, but people are certainly looking at how do we use the success of the AEDGs to move forward, not only in hospitals, but in other buildings? And how do we pivot that to reduce the environmental emissions?
Finally, the top thing, I think that I learned being on the project committee, is the HVAC how-to tip number one. It gets back to something you said, Tim, but really doesn't have anything to do with HVAC. It has to do with space planning. How do you put the areas of the hospital together so entire systems can be turned off? That gets back to that integrated design. The architects need to speak with the owners. The owners need to speak with the mechanical folks. The mechanical folks need to speak with the lighting folks. Everybody needs to work together in order to plan the spaces so as you said, we can shut things off.
Tim Peglow:
Correct.
Mick Schwedler:
Because while it's not most efficient, it's the lowest energy usage when an entire wing of the hospital can be shut off because of the way we put the project together.
Tim Peglow:
Absolutely. The other thing I liked about the guide too, and it's similar to that approach, is the guides were built and written by people who weren't selling a product. It's not like I want an answer and it's motivated by somebody selling a product, which so much goes on today of let's go after a solution. Here it is. Oh, the person who wrote the article is the company I'm supposed to contact to buy the product from. Versus saying let's take an open approach and put the tools out on the table and not necessarily have any bias towards the manufacturer or the owner of that particular tool or technology that's out there, which can provide us all value. I like that as much as anything else in the guides, is it's, like I said, plain English and no bias towards products, techniques, or anything other than the science behind doing what we need to do in hospitals.
Mick Schwedler:
Great point, Tim. In fact, I just want to share with the listeners that there was a point when I had to leave the room. That is, I work for a chiller manufacturer and the discussion was taking place as how efficient should the equipment be? One of the rules from the advanced energy design guide steering committee is that nothing can be proprietary. It has to be available from at least two different manufacturers. So when the efficiencies of the chillers were being discussed, particularly heat recovery, I had to leave. The first time I saw the numbers published was when it went out for the 60% peer review. Because from a code of ethics standpoint, this needs to follow the ASHRAE code of ethics. We declare conflicts of interest if they occur. Then the entire project committee try to bring their best ideas forward and share them, as Tim has been saying, in ways that laypeople can understand them. And if laypeople can understand them, that means that, for example, if we're mechanical designers, we can understand the lighting part and we can help bring that knowledge forward to our clients and to our customers.
Let me give some final thoughts from an advanced energy design guide standpoint. I look at them as platinum referrals because they come from AIA, USGBC, IES, ASHRAE and is supported by the Department of Energy. This means they're approved by all of these societies and that allows you the confidence as somebody going to talk to others with respect to whether it's a guide on highway lodging, office spaces, a K through 12 school, or in this case, hospitals, it lets you go to your clients and your customers to say, "These are endorsed by the major organizations."
Then the two to three page recommendation tables, those are absolute gold. I don't think there will ever be any building built to all the recommendations in the tables, but they give you that menu of saving options and you can look at it for a new building, you can use them to retrofit existing buildings. Here are proven ways, off the shelf technology that are known to work, and that are economical from a practitioner's standpoint. That type of information is fantastic to be able to take to your clients.
Tim Peglow:
I 100% agree with you. One of the things I think of anything I wish could be done is almost the design community reads these and begins to apply them on every project. It is a tough market out there where I don't know that that discussion always occurs. Let's go down the list and really consider these. We don't have to take them all, but which ones of them really will make sense and really provide the value to the organization in the long term? We're building these hospitals to last 30 to 50 years, and you generally don't make huge changes to the infrastructure in the first 30 years that you have them. You may make some, but you're not going to do a major upgrade. So getting an efficient operating infrastructure does help, and it's always cheaper to do it on the initial build than it is to go back and retrofit.
Considering, I think a lot of these systematically I think, would help move the bar so to speak in the energy use in healthcare. You want to be as efficient as you can, I think and energy bills for healthcare is not insignificant and through smart thought process, you can get some wins in it. If I'm doing windows or envelope, what's the right amount of insulation I need to put in my envelope? What kind of windows really provide that right scenario for A: visibility to my patients to be able to see outside and recognize it, but say in my case, I don't want a lot of heat infiltration in the summer coming in through the windows now. Like I said, that's different in different climate zones, but how do you make that right choice for some of those things that are just going to be there almost forever in some of these buildings. Probably not significant cost on first design of being able to adjust, say, just if I look at envelope and its impact on energy performance.
Mick Schwedler:
And where do we put the windows so that you can get the daylight deeper into the space and reduce the electric lighting load and get the natural light to help the patients get better more quickly?
Tim Peglow:
Absolutely, absolutely.
Mick Schwedler:
Well, Tim, it's been a privilege to serve with you on the 90.1 committee. I learned a lot when we worked on the AEDGs together. And each time that I get a chance to speak with you, I learn and I'm drinking from a fount of knowledge and a building owner's and practitioner’s standpoint. So thanks for taking the time today.
Tim Peglow:
Absolutely. I look at it as a great opportunity to share from a hospital side, because exactly a lot of the things that ASHRAE does and they promote, helps me provide the right solutions to our environment, to help our patients get better. I couldn't have been successful making decisions on what we're doing with COVID without looking at a lot of the stuff that ASHRAE was producing and a lot of their recommendations. Like I said, we're looking at all this stuff all the time because it's quality information that ASHRAE publishes. And the AEDGs with a great group of oversight and involved people really just poured their energy into how can we make this better? It's really been a positive experience and continue to learn from it, continue to apply it.
ASHRAE Journal:
The ASHRAE Journal podcast team is editor John Falcioni; producer and associate editor Chadd Jones; assistant editor Kaitlyn Baich; and associate editors Tani Palefski and Rebecca Matasovski. Copyright ASHRAE. The views expressed in this podcast are those of individuals only and not of ASHRAE, its sponsors or advertisers. Please refer to ashrae.org/podcast for the full disclaimer.