Ecolibrium

THE OFFICIAL JOURNAL OF AIRAH

DECEMBER 2015 VOLUME 14.11

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Reinventing
Margaret Court Arena

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FE ATURE

A healthy swerve
At Echuca Regional Health the mechanical services
design team took healthcare facilities in a different direction,
aiming for both reduced energy use, and an improved patient
experience. As Sean McGowan reports, the team was inspired
to rediscover the underlying principles of good healthcare
design, and to marry these with proven technologies deployed
in new ways.
Innovation is not invention, says
Brett Seeney, associate mechanical
engineer with WSP | Parsons Brinckerhoff.
Innovation takes what we know
and rediscovers it.
And so it is that the redevelopment
of Echuca Regional Health (ERH),
in the picturesque Murray River
port town of Echuca, 222km north
of Melbourne, has rediscovered what
is possible in a healthcare setting.
Previously accommodated in the towns
original 130-year old red brick hospital,
the population within the Shire of
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E CO L I B R I U M D E C E M B E R 2 0 1 5

Campaspe and beyond is now served

by a purpose-designed modern facility
that better meets both the current
and future needs of the community.
Embracing the mantra of a dollar
spent on energy is a dollar taken from
patient care, the dedicated client and
design team applied some new thinking.
The team wanted to challenge common
practice in the engineering design of
hospitals. And with the two working
closely together, each came to better
understand the others drivers and the
roadblocks that would prevent progress.

A dollar spent on
energy is a dollar
taken from
patient care

Together, these obstacles were

overcome and systems were designed
that reduced energy, improved the patient
experience and made a positive impact
upon the design of healthcare services,
says Seeney.
Having provided technical advice
to ERH for a few years preceding the
redevelopment, Seeney and the team
at WSP | Parsons Brinckerhoff had become
acutely aware of the challenges the local
environment presented. And they were
also aware of staff and community
aspirations for the new facility.
Their initial involvement with ERHs
executive project manager Mark Hooper

FE ATURE

The team wanted

to challenge
common practice
in the engineering
design of
hospitals

led to the design and construction of a

500kW low-temperature evacuated-tube
solar cooling installation (see Ecolibrium,
July 2011).
In this system, hot water is generated
at around 95C, and then used by
a single-effect absorption chiller to
generate chilled water for use by the
operating theatre plant. This would
become something of a proving ground
for what the new hospital would become.
Its very rare you get to spend
$66 million building a new hospital
thats going to last in your community
for a long time, says Hooper.
Ive lived in Echuca all my life,
my mother worked in the hospital
for 30 years and I have four young
children, so I wanted to make a strong
statement that public money can be used
to do clever, sustainable engineering work
that provides a future for our children.

CHALLENGING
COMMON PRACTICE
Following the formal announcement
of the redevelopment of the ERH facility,
WSP | Parsons Brinckerhoff was engaged
in 2010 to provide mechanical services
engineering and design for the new
hospital. This was to be in keeping with
a project brief to deliver clinical services
in an energy-efficient manner.
Indeed, an aspiration for the project was
to ensure the new facility would use less
energy than the building it was replacing.
If we could double the size of
the hospital and use a similar or less
amount of energy, why wouldnt we?
says Hooper.
Although the new building would
naturally bring about reduced primary
energy consumption per unit of area,
it would occupy a significantly larger
footprint.
So against this backdrop of reducing
energy consumption, WSP PB worked
closely with Hooper and ERHs clinical

A 100 per cent fresh air system is in place at ERH.

lead on the project, Michelle Shingles,

to examine the premise upon which
effective healthcare ventilation is
determined.
This resulted in the team looking at the
methodologies that have evolved over
many years to meet the requirements of
the Department of Health and Human
Services in Victoria (DHHS).
Combined with feedback gained from
patients and staff, it led to the client
and consultant agreeing to base the
design of the ventilation system on
two principles: infection control and

individual control of environmental

conditions in patient rooms.
However, such an approach required
a departure from common practice,
and therefore close consultation
with the department.
When rethinking systems design,
it is at times unclear as to where
the outcomes will be, says Seeney.
Therefore it was of the upmost
importance that ERH and the
Department of Health and Human
Services both understood and supported
the approach we were adopting.
D E C E M B E R 2 0 1 5 E CO L I B R I U M

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The Department of Health and Human

Services were the enabler, Hooper says.
They gave us permission to put the case
forward on why we needed to do things
differently.
So we were able to combine our
knowledge of what we didnt want,
with our aspirations based on using
better technology and challenging
standards, and embedded our ESD.

An aspiration for the project was to ensure the new facility would use less energy
than the building it was replacing.

As healthcare engineering design tends

to favour systems with a long-term track
record of success, the approach taken
was not so much about unpicking the
department guidelines as it was forming
an understanding between each party
as to their intent.

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E CO L I B R I U M D E C E M B E R 2 0 1 5

From there, agreement was sought

and reached on an approach that
supported the ethos of the departments
guidelines while also providing enhanced
patient outcomes, both clinically and
through the patient experience.

Working in sight of the department,

the design team reviewed the ventilation
principles adopting strategies arising from
infection control. Using the Wells Riley
formula, WSP | Parsons Brinckerhoff
was able to calculate mean time to
infection and in the process, derived
new ventilation rates.
This led to the adoption of a 100 per cent
fresh air system an outcome that
Hooper says creates a far healthier
indoor environment for a hospital.
To counter the associated energy
penalty, thermal energy wheels have

FE ATURE

been installed on all seven air-handling

units (AHUs) housed in the facilitys
two roof plant rooms. These deliver
up to 80 per cent energy recovery.
Each AHU also features two sets
of zone heating and cooling coils.
This arrangement results in one unit
per department, and ensures no risk
of cross-contamination.
In the Emergency Department,
a higher ventilation value was created
than required by the guidelines for
treatment cubicles and waiting areas,
resulting in substantially increased
mean time to infection.
However, Seeney says dilution
of pathogens is only the first layer
of protection.
In conjunction with ERHs infection
control team, he explains, we designed
new airflow patterns across the hospital
based upon the premise of clinical
staff always being in clean air.

BUSHFIRE AND PANDEMIC MODE

Like many regional Victorian towns,
Echuca is prone to bushfires.
For this reason, the HVAC approach
adopted for the new Echuca Regional
Health (ERH) facility incorporates
a bushfire mode. The system can
automatically revert to recirculation
mode featuring a standard
10 per cent outside air make-up
and night-time purge in the event
of heavy smoke in the town.
If you are doing 90 air changes
an hour, you only need to be open

HVAC GEOMETRY
In the Emergency Department,
clean air is introduced at the staff base
and extracted above the patients beds.
For the inpatient rooms, clean air is

for one-ninth of an hour or less

than 10 minutes, to achieve what
everyone else is doing, says ERHs
Mark Hooper.
The Emergency Department features
a pandemic mode, which allows the
frequency of air change to double.
If weve got an influenza pandemic
where we know we have a higher
level of airborne pathogens,
Hooper says, we can elect to double
our air change for a week or two,
while maintaining conditions.

introduced between the door and the bed,

and extracted on the opposite side
of the room, typically above the window.
Both approaches reverse common
practice, particularly in patient rooms

D E C E M B E R 2 0 1 5 E CO L I B R I U M

39

FE ATURE

its operating range, with the airflow

in each room able to be set by simple
proportional control.
The terminals can also be linked to
the building management system (BMS),
allowing for multi-modal operation.
For instance, airflow can be set back
via the hospitals workflow-management
system when a bed is unoccupied, and
positive or negative regimes can also
be set.
Airflow patterns across the hospital are designed around clinical staff always being in clean air.

where air is generally relieved from

the room into the adjacent corridor
and extracted above the staff base.
To achieve this design, variable
geometry terminals were selected in
favour of a traditional VAV box approach.
These units were the starting point
for the system design, says Seeney.
We had considered conventional
VAV boxes but we could not achieve
the level of user control we desired.
With the control moved to the terminal
device, there is also no requirement to

MEAN TIME
TO INFECTION
We were interested in
understanding how empirically
derived air-change rates could be
placed in a statistical model, as this
would allow us to make quantified
comparisons between each,
says WSP | Parsons Brinckerhoffs
Brett Seeney.
Widely understood among clinicians,
Wells Riley was chosen. This method
is not so overly complex as to be
difficult to convey to those for whom
epidemiology is not their usual role.
According to Seeney, the method
assesses three variables in its
calculation of the time it takes a
pathogen to reach the test subject:
distance, time and dilution rate of
the pathogen.
The resultant calculation is quoted
as the mean time to infection.

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E CO L I B R I U M D E C E M B E R 2 0 1 5

access the ceiling void for maintenance.

The cone is able to be removed from
within the room and replaced with a
spare, resulting in minimal downtime.
The design team also concluded that
a VAV box would need to serve four
rooms to be as cost-effective as adopting
variable geometry terminals.
Ventilation is linked to the patient
handset, giving users the ability to better
control their environment.
Each terminal uses a motor to change
the face area of the diffuser to provide
a constant-distribution pattern across

Clearly, these are the exact

criteria that we as designers are
looking toward when appraising
the effectiveness of our ventilation
systems, Seeney says. We ran
many scenarios across many clinical
departments, and built up a table
of air-change rates against mean
time to infection.
It was interesting in that many
of the empirical air change rates
fared really well, and indeed
we did consider that a few of the
guideline rates could be reduced.
The design team concluded
that the greatest impact to
infection rates was to be found
in those departments where
infectious patients congregated
in significant numbers. Therefore
it was the Emergency Department
and its waiting room where
increased ventilation rates
had a corresponding decrease
in the mean time to infection.

The design of the ERH is such that

a slight pressure differential has been
created between the inpatient room
and the corridor, depending on the
ward (medical or surgical). This ensures
that clinical staff are always walking into
clean air as they enter an inpatient room.
A boost operation can even be applied
during times of pandemic isolation.
The ERH redevelopment is believed
to be the first project where variablegeometry terminals have been used
in such a manner.
As the terminals require a constant
static pressure in the system to act
as a control point, low leakage rigid
ductwork has been adopted across
the site. It is against this static pressure
that the control cone within the terminal
adjusts the air volume.
Seeney says the control static pressure
was set at 30Pa and the ductwork was
sized using the static regain method.
Whilst this ensured a constant
static throughout, it has to be
acknowledged that it does result in
significantly larger ductwork than sizing
by constant volume would. That said,
the duct leakage was negligible and the
noise regenerated was so low that we
did not need to install attenuators
in any of the air handling units.
The lower velocities in the ductwork
also resulted in fan energy being reduced.
Interestingly, no flexible ductwork has
been used across the site.
This determination was an ERH
briefing requirement based upon
cleaning ductwork as part of infection
control measures, and is a common
approach in Europe, says Seeney.
As the elements in the system design
were a departure from the letter of the
guidelines, each required the approval
of the DHHS.

FE ATURE

To gain this, WSP PB and the lead

team from ERH made a number of
presentations to the department began,
gaining acceptance of the proposals,
with the intent of achieving best practice.
The DHHS understood what we
were looking to achieve, Seeney says,
and provided the necessary challenge
to ensure we had sufficient rigour
in our approach.

SOLAR COOLING
One of the drawcards of Echuca and
the Murray River region for both
residents and visitors is its climate,
which features many cloudless days
throughout the year. This makes solar
an attractive proposition in any form,
but for a hospital that requires significant
amounts of hot water and cooling,
a solar collector makes sense.
Having already demonstrated the
advantages of micro-concentrator
technology (MCT), the client and design
team sought to apply the same technology
on a larger scale to meet new facilitys
cooling demand.
We initially aimed to achieve around
1MW of cooling energy through the
system, says Seeney. Producing water

PROJECT AT A GLANCE
The personnel
Architects: DWP Suters
Building services engineer:
WSP | PB
Client: Echuca Regional Health
Contractor: Hansen Yuncken
Mechanical contractor:
OP Industries

HVAC equipment
AHUs: ColAir
BMS: Innotech
Chillers: Thermax
Chilled water storage: APT
Diffusers: Fantech
Fans: Various
Grilles: Fantech
Pumps: KSB
Variable geometry terminals:
Rickards

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E CO L I B R I U M D E C E M B E R 2 0 1 5

The ventilation system design is based on two principles: infection control

and individual control of environmental conditions in patient rooms.

at 150C, we calculated a field of 300

panels would produce, via a double-effect
absorption chiller, the required 1MW
of chilled water. However, we couldnt
fit all the panels in the available area.
Not wishing to increase the water
temperature above 150C so as not
to risk thermal runaway, the MCT
systems output was limited to a field
of 270 panels generating 880kW.
To provide a level of redundancy,
the double-effect absorption chiller
comprises both a solar side and gas side.
Controls have been configured such
that the solar side is constantly operating,
with the gas side able to supplement
this energy if demand requires.

On an 18C day, we might get through

the whole day on the stored chilled water
from the tanks, Hooper says.
At the time of publishing, the MCT field
was expected to be online by the end
of the year.

HEALTHY OUTCOMES
Since the new ERH facility was handed
over mid-year, the vision to create a worldclass environment from first principles
would seem to have been achieved.

The addition of an electric chiller, which

can bypass the gas side of the absorption
chiller, provides further redundancy.

Not only are systems operating as

designed with extensive monitoring
equipment providing promising data
on energy use and indoor environment
quality but the redevelopment is
also providing a testing ground for
new approaches and applications of
technology in the healthcare sector.

In this way, we effectively side-stream

the solar-energy side of the chiller
to ensure that whatever solar energy
is available is used, says Seeney.

The team has driven hard to rediscover

the underlying principles of good
healthcare design and to marry these
with proven technologies deployed
in new ways, says Seeney.

And when there is an excess

of solar energy?
Cleverly, the hospitals mandatory CFA fire
tanks have been insulated (after gaining
special dispensation from the local
authority) so as to perform a secondary
role of thermal energy storage. Excess
chilled water is stored and used at the start
of the day before the chiller
set kicks in.

Just as Echucas previous hospital

stood the test of time, so too might
its redevelopment stand as an example
to those prepared to think differently,
and about the benefits such an approach
can bring to a community.
This project reinforces that our role as
an engineer is to not design in isolation,
Seeney says, but to design in response
to those upon whom our work touches.