Energy Efficiency:  Integrated Design and HVAC Systems
                            HEALTHCARE -  TOP 5 GREEN BUILDING STRATEGIES

                                                            EPA Publication 909-F-07-001

  What? Energy use in healthcare facilities is higher than nearly all other building types.
           With rising energy costs and climate change concerns energy efficiency is
           financially  prudent and increasingly  expected.  Efficiency can be gained from
           integrated  design practices, including systems to control heat gain, and increase
           the efficiency of heating, ventilation, and air conditioning (HVAC)  systems.


   Why? Enhanced Community Reputation:

             •  Increases energy efficiency and
               reduced climate  impact
             •  Demonstrates environmental
               stewardship

           Environmental /Staff/Patient Benefit:

             •  Improves patient and staff comfort
               with less intrusive indoor environment

           Cost Competitive:

             •  Lowers HVAC size and rating through
               integrated design

             •  Improves facility's overall operational efficiency

             •  Reduces operational costs

   How?   •  Use integrated design (viewing building systems as interrelated instead of
               separate)
             •  Focus on  building envelope
             •  Perform energy audit of existing  facilities (consider using ENERGY STAR for
               Healthcare; www.energystar.gov)
             •  Model and plan energy use for new buildings
             •  Use benchmarking data
             •  Use high-efficiency HVAC, chiller, and variable speed pumps
             •  Install high performance windows

    Case   "  Emory  University
Studies   "  University of  Florida
Green Guide for Health Care (GGHC) Criteria: Construction: Energy & Atmosphere and Operations: Energy
Efficiency www.gghc.org
  This is one of 5 Building Healthy Hospitals case studies developed by EPA's Pacific Southwest Regional Office,
                  with Resource Conservation Challenge and Pollution Prevention funds.
                       www.epa.qov/reqion09/waste/p2/pro1ects/hospart.html
   Indoor Air • Sustainable Flooring • Process Water Efficiency • Lighting Efficiency • Energy Efficiency
Building Healthy Hospitals                1

This fact sheet was produced by EPA's Pacific Southwest Regional Office. Mention of trade names, products, or services does not
convey, and should not be interpreted as conveying official EPA approval, endorsement, or recommendation.
Printed on 100% recycled paper, 50% post-consumer content - process chlorine-free
2007

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                 Energy Efficiency:  Integrated Design and HVAC Systems
                           HEALTHCARE - TOP 5 GREEN BUILDING STRATEGIES
                CASE STUDY 1: HIGH EFFICIENCY CHILLERS
                Applicability:
                Environmental
                Impact:
                Other Benefits:
New construction or major renovation projects.

 •   40 to 50 percent reduction in energy use required
    for space cooling
 •   48 percent savings in cooling tower energy use.
Long term operating efficiency.
Background
Electrical centrifugal water chillers (chillers) represent the single largest
electrical load in most institutional and commercial facilities, accounting
for 35-50 percent of a building's annual electricity use1.  Though chillers
generally operate below full-load, chillers are rated at full load efficiency,
application  part load value (APLV), and integrated part load value
(IPLV).  To  reduce long-term operating costs, Emory installed two 350-
ton high  efficiency chillers with a coefficient of performance (COP) of 5.2 at the Winship
Cancer Institute.  The high efficiency units  run in parallel and are connected to one of
Emory's four chiller plants, using 0.676 kilowatt-hours (kwh) per ton of cooling produced.

Performance
Emory recently  began metering the chillers separately to determine actual kilowatt tons per
hour per square foot  (kwh ton/hour/square foot). To  adjust for differences in  climate, this
data was divided by the degree cooling days for the month, providing a normalized metric
that can  be compared to facilities elsewhere in the country (see Exhibit 3).  Exhibit 4
compares Emory's chillers to commonly used efficiency standards.
The chillers are  included in the preventive maintenance and leak detection program for
other equipment on campus and data is recorded and analyzed using  a computer program.
The chillers at Winship Cancer Institute use refrigerant R134A,  a non-ozone-depleting
chemical used in high-pressure systems. Purge systems are primarily used in low-pressure
chillers; therefore, this maintenance activity is eliminated for Winship Cancer Institute.  No
additional unique maintenance activities are required to  operate the high efficiency chillers;
therefore, the operation and  maintenance (O&M) costs are comparable to standard chillers.
Emory has established detailed design and  construction specifications—applicable to all
construction and major remodel projects on campus—that include requirements for
  "Supply Side Focus: Chiller Equipment; The Elements of Energy Efficiency." Maintenance Solutions, August
  2004. Online: www.facilitiesnet.com/ms/article.asp7id = 1833
Building Healthy Hospitals
An EPA P2 Project
                                             2007

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                 Energy  Efficiency: Integrated Design and HVAC Systems
                          HEALTHCARE - TOP 5 GREEN BUILDING STRATEGIES
purchasing chillers2. In addition to design and operating features, Emory requires all new
building on campus to  use construction design specifications reflecting various green and
energy efficiency requirements; for chillers, Emory's specifications are as follows:
       •  Have minimum full load and part load efficiencies meeting or exceeding ASHRAE
          Standard 90.1-20043 (specifications allow the project manager to require a more
          stringent efficiency, as needed).
       •  Are manufactured by Carrier, Trane, or York (York chillers were selected for
          installation  at the Winship Cancer Institute).

    EXHIBIT 3 | WINSHIP CANCER INSTITUTE NORMALIZED CHILLER ENERGY USE



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                       July
June
               May
April
  Emory 2006 Design and Construction Standards, online: www.fm.emorv.edu/emorv-
  std/2006%20Emorv%20DesiQn%20&%20Construction%20Standards.pdf

  ASHRAE Standard 90.1 (2004) available online at:
  www. realread.com/prst/paaeview/browse.cai?book= 1931862664
Building Healthy Hospitals
An EPA P2 Project
                                         2007

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                Energy  Efficiency:  Integrated  Design and HVAC Systems
                          HEALTHCARE - TOP 5 GREEN BUILDING STRATEGIES
    EXHIBIT 4 | EMORY CHILLERS VERSUS FEMP CHILLER EFFICIENCY RECOMMENDATIONS

Centrifugal
Chiller Size
150-299 tons
300-2,000 tons
Part Load Optimized Chillers
ASHRAE
Standard
0.78
0.66
Note: IPLV = Integrated Part
FEMP = Federal Energy
Adapted from "How to
January 2004. Online:
American Society of He
online: http://www.ash
FEMP
IPLV
0.52 or less
0.45 or less
Best
Available
IPLV
0.47
0.35
Full Load Optimized Chillers
ASHRAE
Standard
0.84
0.68
FEMP
Full-Load
0.59 or
less
0.56 or
less
Best
Available
Full-Load
0.50
0.47
Winship
(350 tons)
0.676
Load Value
Management Program
Buy an Energy Efficient Water-Cooled Electric Chiller," Department of Energy,
http://wwwl.eere.enera.v.aov/femp/pdfs/wc chillers.pdf.
ating, Refrigeration, and Air-Conditioning Engineers (ASHRAE) Standards available
rae.org/.
Cost
High efficiency chillers are designed with enhanced controls, improved condenser sections,
and high-efficiency compressors; these features raised the initial cost to Emory by about 20
percent more than a comparable standard unit. However, the use of these chillers-
combined with the lower demand for chiller water through other energy conservation
measures—resulted in a 42 percent reduction in the energy required for space cooling and a
48 percent savings in cooling tower energy use. Emory estimates the  simple payback from
using the new chillers instead of units with standard energy efficiency at less than 4 years
(see Exhibit 5).
The simple payback for recovering  the cost premium of the chillers is directly related to the
cost of energy. At $0.05  per kilowatt-hour (kwh), Emory's energy costs are low compared
to elsewhere in the United States.  In addition,  Emory's energy costs are low despite recent
annual increases; costs have increased from $33.30 per megawatt-hour ($0.033/kwh)
between 2001 and 2006 (natural gas prices have more than doubled during this time as
well). As energy prices increase, Emory has been able to cost-justify more efficient
equipment with a higher cost premium.  At many other institutions and in many other parts
of the U.S. higher costs could easily yield payback periods for the cost premium of  1.0 year
or less.
Building Healthy Hospitals
An EPA P2 Project
2007

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                 Energy  Efficiency: Integrated  Design and HVAC Systems
                          HEALTHCARE - TOP 5 GREEN BUILDING STRATEGIES
    EXHIBIT 5 | COST/BENEFIT ANALYSIS - WINSHIP CANCER ENERGY-EFFICIENT CHILLER

Annual
Hours of
Operation
7,000
Standard ASHRAE
Efficiency
Annual
kwh
2,183,751
Annual
Cost
$109,187
Winship Cancer
Institute High-
Efficiency
Annual
kwh
1,263,387
Annual
Cost
$63,169
Cost
Premium
$100,000
Annual
Savings
$46,018
Payback
(years)
2.17
    Note:   Emory University energy costs approximately $0.05 per kwh in 2006.
           The chillers at the Winship Cancer Institute operate at 70% average load.
          Case Study Vitals
The following summarize success criteria for implementing this project at other healthcare
facilities:

       Develop or Adopt Green Design Standards - Emory's detailed design and
       construction specifications provide the University with a clear path to implementing
       energy efficiency strategies on every project. Further, Emory requires the standards
       as the "default" specifications for all  buildings on campus.  Though Emory's
       standards generally follow LEED standards, other organizations can  adopt standards
       wholesale or modify them to suite their needs.
       Establish Multi-Disciplinary Team - Healthcare facilities should ensure that its
       design team encompasses several disciplines so that collectively the design team
       understands expectations for energy efficiency projects and purchasing requirements
       for energy-intensive systems.
   -   Know Your Organizations Investment Parameters - Chillers are available in a
       variety of efficiency ratings with more efficient units coming with progressively
       higher initial costs.  The cost premium acceptable to a healthcare facility for
       purchasing an energy-efficient chiller typically depends on cost/benefit analyses
       (e.g., simple payback, internal rate of return) of the investment appropriate for the
       institution. Designers of healthcare  facilities typically have the benefit of using very
       long "useful life" design  horizons. In addition, areas with higher energy costs or
       increasing energy costs  will realize shorter payback.
       No Additional Installation or Operation Issues - Emory has used high efficiency
       chillers for several years with no additional installation or maintenance issues or
       concerns.
Building Healthy Hospitals
An EPA P2 Project
2007

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                Energy  Efficiency:  Integrated Design and HVAC Systems
                          HEALTHCARE - TOP 5 GREEN BUILDING STRATEGIES

               CASE STUDY 2: HIGH EFFICIENCY AND VARIABLE-SPEED PUMPS
               Applicability:        New construction or major renovation projects
               Environmental
               Impact:
               Other Benefits:
40 percent reduction in energy use required for pump
systems
Long-term operating efficiency
Background
Pumps serve a variety of purposes in HVAC systems, but primarily
function to move air or water within the system to control temperature.
Pumps have conventionally been designed to operate at a single-speed,
using the same amount of energy at all times of operation regardless of
load demand. Manufacturers have begun offering improved efficiency
pumps in two ways:
   •   Designing pumps with efficiency ratings 20 to 40 percent higher
      than standard new models.
   •   Including variable-speed motors that operate with variable energy loads depending
      on the amount of air or liquid that must be circulated at any given time, using only
      what energy is needed.

Performance
Emory's Winship Cancer Institute uses high-efficiency, variable-speed pumps to pump:  (a)
chilled water to the air handling units, and (b) condenser water from the chillers to the
cooling towers. A computer system installed in the  building controls the  pumps, monitoring
differential pressure to monitor load increases and decreases and set pumping requirements
accordingly; in this way the pump output (and therefore the energy input) changes to
match the HVAC requirements at the particular time of day.
Energy use associated with the pumps is estimated  at 40 percent less than a typical facility
of comparable size (see Emory's calculations using USGBC's LEED Calculator 2.0 results in
Attachment A). The savings in pump energy is due not only to the use of variable speed,
high-efficiency pumps, but also to HVAC equipment efficiency differences and energy
recovery methods. These HVAC system improvements resulted in a smaller amount of
chiller water being handled by the pumps. As a result, the pumps operate less frequently
and more efficiently, significantly reducing overall energy use.
Building Healthy Hospitals
An EPA P2 Project
                                           2007

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                Energy  Efficiency:  Integrated  Design and HVAC Systems
                          HEALTHCARE - TOP 5 GREEN BUILDING STRATEGIES
Cost
Emory installed the pumps as part of the new building construction at Winship Cancer
Center.

    EXHIBIT 6 | HIGH-EFFICIENCY, VARIABLE SPEED PUMP FEATURES
       Energy savings from pumps alone in the HVAC system is unavailable, but based on
       vendor data and operational history, Emory estimates payback of pumps at
       approximately 3 years.
       Variable-speed high-efficiency pumps have operating efficiency 40 percent better
       than standard new pumps
       Energy savings of approximately 205 kwh per year (LEED Calculator 2.0 estimate)
    Note:  Emory University energy costs approximately $0.05 per kwh in 2006.
          Pumps operate approximately 7,000 hours per year.
4_i_jr  I  Case Study Vitals
The following summarize success criteria for implementing this project at other healthcare
facilities:

       Look for Additional Benefits Accruing to Other Systems - Improving efficiency
       in  building systems can have a waterfall effect, reducing the energy demands in
       other related systems.  For example, in Emory's case HVAC equipment efficiency
       differences and energy recovery methods decreased the demand for chilled water,
       also  reducing the frequency pumps must operate.  It is important to understand the
       effects energy- and water-efficiency strategies will have on other systems and make
       design  decision using more efficient operating assumptions.

   •   Smaller Pumps are Good Candidates - Emory found payback on larger pumps
       (more than 10 HP) not as attractive because of the run duration and cycling.

       No Additional Installation or Operation - Emory has found no additional
       installation or maintenance issues or concerns with the variable speed pumps and
       has been using them successfully in numerous buildings across campus for many
       years.
Building Healthy Hospitals                                                    200?
An EPA P2 Project                        7

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                Energy Efficiency:  Integrated Design and HVAC Systems
                          HEALTHCARE - TOP 5 GREEN BUILDING STRATEGIES
               CASE STUDY 3:  LOW-E WINDOWS
               Applicability:
               Environmental
               Impact:
               Other Benefits:
New construction or major renovation projects;
windows selection is based on location and climate of
facility, as well as the building design and window
position
30 to 50 percent reduction in energy use
Long term operating efficiency; improved access to
daylight and natural views for occupants without
increasing energy costs for heating and cooling
Background
Windows are a critical part of the building envelope and provide
considerable aesthetic value to building occupants by introducing natural
light and providing a visual connection to the outside environment.
However, windows can also represent a large source of heat gain or loss.
Unmanaged solar energy can increase the heating load of the building,
demanding more of the air conditioning systems.  Similarly, windows with
a poor ability to keep heat in allow warm air to escape the building in the
winter, increasing the demands on heating systems.
Window manufacturers have developed many new insulating and glazing techniques to
improve the  performance of windows.  The National Fenestration Rating Council defines five
performance areas to consider when choosing windows most suited for your local climate4:
      U-Factor measures how well a product prevents heat from escaping a home or
      building. U-Factor ratings generally fall between 0.20 and 1.20 with lower numbers
      indicating a product better at keeping heat in.
   •  Solar Heat Gain Coefficient (SHGC) measures how well a product blocks heat from
      the sun from entering the building.  SHGC is expressed as a number between 0 and
      1, with a lower SHGC indicating a product that is better  at blocking  unwanted heat
      gain.
   •  Visible Transmittance (VT)  measures how much  light comes through a product. VT is
      expressed as a number between 0 and 1 with a higher VT indicating higher potential
      for daylighting.
  "The Facts About Solar Heat Gain and Windows." National Fenestration Rating Council; online at:
  www.nfrc.orQ/documents/SolarHeatGain.pdf
Building Healthy Hospitals
An EPA P2 Project
                                            2007

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                 Energy  Efficiency:  Integrated Design and HVAC Systems
                          HEALTHCARE - TOP 5 GREEN BUILDING STRATEGIES

   •  Air Leakage (AL) measures how much outside air comes into a home or building
      through a product. AL  rates typically fall in a range between 0.1 and 0.3 with a
      lower AL indicating a product that is  better at keeping air out.
Condensation Resistance (CR)  measures how well a product resists the formation  of
condensation.  CR is expressed as a number between  1 and 100 with a higher CR indicating
a product better able to resist  condensation.
More so than other green building strategies, window selection must be tailored to the local
climate of a facility and building orientation.  For example, facilities in warmer climates
should install windows with a lower SHGC and those in a cooler climate should install
windows with a lower U-factor. Low-e windows can be applied in different ways specific to
local climates and heating and cooling needs.  Low-e coatings applied to exterior
windowpanes prevent heat gains from exterior radiation; whereas low-e coatings applied to
interior windows prevent heat  loss.  Manufactures often offer several low-e coatings with
varying  degrees of solar gain.

Performance
Both Emory's Winship Cancer Institute and the University of Florida's Sports and Orthopedic
Surgery and Sports Medicine Institute installed low-e windows throughout their facilities.
Exhibit 7 compares the products installed at each facility against the ASHRAE 90.1 standard.
    EXHIBIT 7 | CASE STUDY LOW-E WINDOWS VERSUS ASHRAE 90.1 STANDARD


ASHRAE 90.1
Emory - Winship Cancer Inst.
U of F - Orthopedic Surgery
and Sports Medicine Institute
U-COG
0.571
0.370
0.38
SHGC
0.404
0.372
0.380
VT
0.732
0.328
Not Available
SC
0.43
0.47
0.42
    Note:   U-COG: U-Factor at center of glass
           SHGC: Solar heat gain coefficient
           VT: Visible transmittance
           SC: Shading coefficient
Emory installed low-e windows throughout the Winship Cancer Institute to reflect the sun's
radiant energy and reduce heat entering the building. Low-e interior glass was purchased
from Viracon, Inc. and low-e windows and curtainwall systems were purchased from EFCO.
These windows drastically reduced the cooling requirements of the building,  but also
resulted in a slight increase in heating needs during the winter months. Because both the
buildings at Emory and the University of Florida are located in a humid, subtropical climate,
the slight increase in heating needs was easily compensated for in the  reduced cooling
needs due to the installation of low-e windows.
Building Healthy Hospitals
An EPA P2 Project
2007

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                Energy Efficiency:  Integrated  Design and HVAC Systems
                          HEALTHCARE - TOP 5 GREEN BUILDING STRATEGIES


Cost
Windows manufactured with low-e coatings typically cost about 10 to 15 percent more than
regular windows, but they reduce energy loss by as much as  30 to 50 percent5.
Furthermore, this improvement in the building envelope—particularly when coupled with
other strategies that improve the efficiency of the building envelope—ultimately impacts the
demands of building HVAC systems. These benefits should be included in evaluating the
lifecycle costs of installing efficient windows.


  EXHIBIT 8 |  2005/2006 ENERGY USE DENSITY - HEALTHCARE FACILITIES:
             UNIV. OF FLORIDA ORTHOPEDICS CENTER
             EMORY WINSHIP CANCER CENTER
  •  Windows with  low-e coatings vary widely in cost depending on performance, glazing,
     and other factors; generally the price premium is 10 to 15  percent, approximately the
     cost premium for the buildings at both Emory and the University of Florida.
     Low-e coatings reduce energy loss from 30 to 50 percent.
     Neither  Emory nor the University of  Florida have data on energy reduction specifically
     from the windows.
  Univ. of Florida Orthopedic Center:
     Energy  use  density  for  the Orthopedic  Center  varies  between  210   to  380
     BTUs/day/square foot; the building contains 46 exam rooms with support services of
     Radiology,  Rehabilitation,  and  Biomechanics  representing  a relatively equal mix of
     patient  rooms, offices,  and therapy rooms.   The  building's energy use density is
     approximately 50 percent lower than other medical building on campus  (though the
     comparable buildings contain more energy-intensive diagnostic equipment).
     Univ. of Florida Energy  management staff estimate that  approximately 20 percent of
     that energy efficiency  at the Orthopedic Center is the result  of the windows used in the
     building based on their experience managing energy across  campus and data provided
     by the window vendor  and architect.
  Emory Winship Cancer Center:
     Energy  use density for  Winship Cancer varies between 560 to 680  BTUs/day/square
     foot; the building contains a large amount of energy-intensive  treatment and patient
     care equipment along with patient rooms and offices.  Comparisons to other buildings at
     Emory are difficult because of the lack of similar activities occurring elsewhere.
  •  Emory Building  Management staff estimate the simple payback of the windows used in
     the building at approximately 7  years.
5 "Low Emissivity Window Glazing or Glass." U.S. Department of Energy Efficiency and Renewable Energy.
  Online: www.eere.enerav.Qov.
Building Healthy Hospitals                                                    200?
An EPA P2 Project                        10

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                 Energy  Efficiency:  Integrated Design  and HVAC Systems
                           HEALTHCARE - TOP 5 GREEN  BUILDING STRATEGIES
       400
       350
       300
       250
       200
       150
                      Univ. of Florida Orthopedics Center - Energy Use Density
                                     [BTUs/day/square foot]
             Jan    Feb    Mar    Apr    May    Jun    Jul    Aug    Sep    Oct    Nov    Dec
  Note:    University of Florida energy costs are $0.954 per kwh in 2006.
                              Winship Cancer - Energy Use Density
                                     [BTUs/day/square foot]
      750
                                                                        Energy Density

                                                                     2006 Energy Density
      500 r-
            Jan    Feb    Mar     Apr    May    Jun     Jul     Aug    Sep    Oct    Nov     Dec
  Note:   Emory energy costs are $0.05 per kwh in 2006.
          Case Study Vitals
The following summarize success criteria for implementing similar projects at other
healthcare facilities:
Building Healthy Hospitals
An EPA P2 Project
                                        2007
11

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               Energy  Efficiency: Integrated Design and HVAC Systems
                        HEALTHCARE - TOP 5 GREEN BUILDING STRATEGIES

      Efficient windows are defined by the climate of the building in which they will be
      installed.  Engineers and vendors are able to make recommendations based on local
      climate and building orientation.
      Efficiency improvements to the building envelope directly impact the heating and
      cooling needs of the building; therefore, HVAC systems should be adjusted
      accordingly to account for decreased demands on the systems.
Building Healthy Hospitals                                                  200?
An EPA P2 Project                       12

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