LEED certification for untypical projects such as medical establishments, data centers, hotels, retail, schools, and warehouses has its features.
We are sharing the experience of our company HPBS in the medical facility certification. Such a facility that is certified according to the LEEDv4 BD+C: Healthcare system is an oncological clinic JSC Medicine located in Khimki.
LEEDv4 BD+C: Healthcare system developed for hospitals and other medical establishments working round-the-clock. Medical institutions should be resistant to any changes. LEED system in that case is an excellent tool to decrease the energy consumption of medical institutions, increase the quality of the internal environment and retain high-quality staff.
Oncological outpatient diagnostic center for nuclear medicine (JSC Medicine), covering 20,000 sq km, located in Khimki, a city in Moscow Oblast.
The HPBS goal was to achieve LEED Silver Certification in the construction phase and show the reduced effect of the project on the environment and the creation of space favorable to work and rest.
The building was designed and constructed according to strict ecological and energy-efficient requirements contained in the international LEED v4 Certification system. There are departments of radionuclide and radiation diagnostics and therapy, medical rooms for primary and consultative reception of patients, offices of personnel and administration, a conference room, and other support space. The project was implemented by JSC SSDI (State Specialized Design Institute).
Our team used the integrated approach that allowed us to achieve desired LEED Silver Certification bypassing significant extra costs for account of balanced solutions conceived at the conceptual stage.
The smart home automated systems are set in the center. The complex solution for climate, light, power supply, building’s engineering systems control was developed based on that system. The combination of these factors allows improving the quality of the internal environment and thus increase the staff’s efficiency and productivity as well as patients’ mental health.
The period of the project is from 2019 to 2021. Investments in this facility amounted to 8 billion rubles, of which 3.9 billion rubles were provided.
HPBS role:
LEED buildings consume 25% less power on average and have 19% lower operating costs. While JSC Medicine was designed, the digital model of the energy consumption was constructed with which the optimization of energy costs was performed. A mandatory requirement for LEED Certification is a proof of high energy efficiency. In JSC Medicine the energy consumption is decreased by 17%, the water consumption is reduced twice compared to similar facilities. The reduction of СО2 emissions is 15%, the emissions are 256 tons per year, the cost cut by 3,7 billion per year. The reduction of greenhouse gas allows the company to comply with the global climate agenda and improve its ESG resilience.
The local ground was reused for landscape dumping and planning. The compensation was carried out for cutting down green spaces, planting zoned plants. The organization of the irrigation system using collected and purified water, storm water treatment plants, waterproof coating of pedestrian sidewalks and parking lots, the organization of a place for separate collection and temporary waste storage were involved. Light shades of coating materials were employed: with a solar reflectance index (SRI) of at least 32.
Ensuring continuous airtightness of the facade through sealing, compaction to minimize air leakage. Using a low-emission (athermal) glass coating. The measures for thermal protection of entrances such as tambours, thermal curtains, revolving doors. Dirt-resistant entrances, wear-resistant interior decoration. Sound protection provides noise protection from external and internal sources of noise, the confidentiality of speech, sound comfort. Visual comfort for patient rooms provides direct visibility to the street by glazing 75% of the area of all rooms. The flexibility of planning solutions (where it is possible, considering the technology of medical processes).
Deployment of a solar power plant (SPP) with an installed capacity of 100 kW above the car parks. Direct current input from the SES into the internal electrical network using inverters and a central distribution board, which provides simultaneous power supply from the external and internal network. Voltage loss in the distribution network is not more than 3% of the planned load. Equipment with automatic controls at least 50% of all outlets. Install electricity gauge and heat meters in the building. Individual lighting control for 90% of patient positions + control of shading (curtains) from the bed. 3 light positions (off, 30-70%, on). In the auditoriums, meeting rooms, and conference rooms, there are 3 positions of light, the lighting zones at the screen and in the auditorium are separated. Lighting systems are equipped with motion sensors, light sensors and are automatically adjusted. Measures to reduce light pollution: at the border of the site, the vertical illumination does not exceed 2 lux, external indicators have a brightness of more than 200 candelas per m2 at night and 2000 candelas per m2 in the daytime.
The installed devices are water-saving by 20% less water of total value, relative to the base calculation, executed taking into account the EPA 1992 requirements.
Removal and reuse of excess heat flow from the Data Processing Center, as well as technological equipment, is provided. Eliminate the use of ozone-depleting substances in fire protection systems such as chlorofluorocarbons (CFCs) or halons.
The system’s features LEEDv4 BD+C: Healthcare. We will figure out the criteria for medical facilities:
LEED Certification system helps to create a complex designed process to consider the interaction between building systems and land. It allows fixing key project’s goals and achieving an effective interaction between systems.
Integrated project delivery (IPD) is a process of project realization that unites people, systems, organized structures, and practices. The process of the involvement of all participants’ skills and knowledge for optimization of the project results to increase the value for the owner, reduce the number of mistakes and maximize the efficiency through all phases of project implementation. (AIA)
Existing dense buildings and services.
Most people prefer to walk if the distance to the destination is less than 400 meters. People prefer to walk no more than 800 meters for regular walking, for example, to work.
DIFFERENCES:
Along with maintaining the requirements for the amount of residential development, the requirement for the minimum number of common zones within walking distance increases from 4 to 7.
Resting place
Access to fresh air, sunlight, and outdoor vegetation is important to human health. Being close to nature allows patients, visitors, and staff to experience a state of “relaxed wakefulness” in which stress and anxiety levels are reduced.
– Studies have shown that patients with access to nature recover faster, need less pain medication, and carry fewer complications after discharge.
– Staff access to nature relieves stress and improves well-being. Employees report fewer illnesses and better satisfaction with their place of work.
Reduced length of treatment and workforce retention have extremely positive economic benefits.
This criterion encourages the design of medical facilities with quality spaces with a variety of vegetation and providing spaces for physical activity. Such spaces should have protection from inclement weather and poor air quality, providing spaces for low-mobility populations.
If providing outdoor spaces is not possible, indoor spaces with unobstructed views of nature can provide similar benefits.
Direct access to the outdoors
This criterion is similar in benefit to the previous one, but different technically.
It is aimed exclusively at patients and encourages the design of medical buildings with direct access to the outside environment from wards, or common areas. These can be courtyards, terraces, and balconies. If the patient needs to use an elevator, stairs or to travel a long distance, this access to the outside environment is not taken into account.
Reducing sources of persistent, bioaccumulative, and toxic substances – Mercury
Mercury is a persistent chemical element, is a neurotoxin, and is capable of bioaccumulation. It breaks down extremely slowly in the environment, is able to accumulate in animal tissues and increase its overall concentration in the food chain. Once in the body, mercury can affect the central nervous system, damaging the brain, spinal cord, kidneys, and liver.
When released into the environment, contamination is difficult to contain. In buildings, mercury emissions can occur from broken mercury-containing lamps or from certain types of equipment. This criterion focuses on reducing mercury in components of lighting systems and medical equipment and disposing of them properly.
This criterion also requires the development of plans for handling mercury-containing components, at all stages of project life.
Reducing sources of persistent, bioaccumulative and toxic substances – Mercury
This criterion can be considered an extension of the previous one. The main objectives of the mandatory part of the criterion were to minimize the amount of mercury-containing components and their proper disposal. Unfortunately, it is not possible to completely eliminate mercury-containing components in all projects.
This criterion aims to reduce the overall use of mercury in the operation of components that could not be disposed of.
Longer lamp life contributes to lower mercury use because replacement is less frequent, reducing the cost of hazardous waste disposal. Less frequent replacement also reduces the likelihood of spills, which can expose staff and patients to contamination and result in costly remediation procedures.
Reducing sources of persistent, bioaccumulative and toxic substances – Lead, cadmium, copper
The criterion aims to provide benefits to both human health and the environment by motivating project teams to avoid using construction materials with lead and cadmium and to use construction methods and materials that protect against lead and copper corrosion.
Both lead and cadmium are persistent bioaccumulative toxins (PBTs) released during the production, use, or disposal of materials. They can be transported far from their source by wind and water, becoming more harmful the longer they remain in the food chain.
PBTs have a wide range of adverse health effects, including cancer, endocrine disruption, immune system disorders, impaired brain development, and birth defects.
Copper, another SBT, is corroded by exposure to air or water. Corrosion of copper pipes can release large amounts of copper into aquatic ecosystems, not only creating potentially toxic conditions for aquatic organisms, but also affecting human health as copper bioaccumulates and moves up the food chain.
Procedures for this criterion ensure that copper is not released during soldering or from soldered connection systems, thereby reducing the ability of copper piping to “dump” copper atoms.
Medical and other healthcare facility furniture
Furniture and furnishings made from environmentally friendly sources can improve indoor environmental quality, protect public health in the long run, and reduce a medical facility’s environmental footprint.
Avoiding materials with persistent bioaccumulative toxins (PBTs), heavy metals, hexavalent chromium, perfluorinated compounds, and other malaise-causing substances reduces risks to ecosystems and reduces the concentration of these substances in the population.
This criterion motivates design teams to choose furniture and furnishings without substances that are harmful to indoor air quality and human health. It also supports the use of products with environmentally responsible attributes and products from manufacturers who have taken steps to document and disclose quantitative environmental data on products in accordance with international standards.
Technology in health care is rapidly evolving, often requiring changes in the layout of health care facilities.
Because most medical facilities are designed without consideration for future remodeling, regular renovations can produce more waste than the construction of the original building. This increases the environmental footprint of the building and makes the original goals of energy efficiency and cost-effectiveness more difficult.
Healthcare facilities specifically designed for adaptive use are easier to renovate, reducing the resources and waste generation associated with renovations. This has a favorable impact on the building’s life cycle rate. Methods may include the use of movable partitions, modular systems in design, and the ability to adapt building utilities.
Minimal indoor air quality.
Without quality ventilation in health care facilities, patients, health care workers, and visitors can become infected through inhaling particles in the air. Poorly ventilated health care facilities are places where the likelihood of airborne pathogenic particles is quite high. These airborne pathogens can be found everywhere, and while most people can handle them using their healthy immune systems, some patients are susceptible to these pathogens or even normal airborne organisms from the environment, such as fungal spores. These organisms are found in higher concentrations in hospitals, so the design of medical facilities includes a more detailed consideration of ventilation systems.
Maintaining good indoor air quality depends on, among other things, controlling sources of contamination, removing contaminants from outdoor air, and supplying at least some outdoor air.
By diluting and removing pollutants created by patients, staff, and other sources of pollution, ventilation contributes to the comfort and well-being of residents.
The standards used in LEED certification define well-tested methods for determining the amount of outside air needed for each room type. These standards were chosen because they strike a balance between supplying fresh air and maintaining energy efficiency.
Different types of people, occupations, and equipment in a building will meet different indoor air quality parameters, so the requirements vary depending on both the type of room in the building and the type of project. For example, residential projects must meet additional prescriptive requirements that protect residents from indoor pollutants such as combustion byproducts and radon, while medical facilities have more stringent ventilation and room sealing requirements to prevent cross-contamination. Also different is the design of healthcare facilities in accordance with ASHRAE Standard 170-2008 Ventilation of Health Care Facilities (Version 170-2017 with LEED 4.1 certification)
Many studies have demonstrated how the conditions inside buildings directly affect people’s satisfaction and productivity.
Often temperature comfort is associated with air temperature alone, but it is a complex interaction of six factors: surface temperature, air temperature, humidity, air movement, people’s metabolic rate, and their clothing.
Changing one or more of the six thermal comfort factors can significantly improve users’ perception of the thermal environment, while supporting energy reduction goals. Using an integrated process in design, it is possible to maximize comfort by aligning design with operational policies. For example, a flexible dress code that allows seasonal clothing can allow the design air temperature to be adjusted upward during the summer season and downward during the heating season without affecting the occupants’ sense of comfort.
Indoor environment quality surveys conducted by the Center for Indoor Environment in buildings have shown a significant increase in satisfaction for people who self-control the thermostat or tear-off window.
Studies by the International Center for Indoor Environment and Energy, in turn, have shown that giving occupants local control of their air temperature by 3° C can result in a 2.7% to 7% increase in productivity.
DIFFERENCE:
The design of health care facilities must not only provide a certain percentage of individual and general work spaces, it adds the requirement to provide absolutely all patient rooms with individual temperature comfort controls.
Studies of lighting in buildings have shown that patients and staff feel more comfortable and productive in well-lit environments and where lighting controls are provided for individual and group control.
Besides, high-quality lighting helps eliminate distractions, creates visual interest, supports interaction and communication, promotes human well-being, and reduces health problems.
This criterion encourages designers to use lighting that significantly improves comfort and productivity of workers.
The criterion contributes to improving the quality of lighting in several ways:
– Optimizing the brightness of lighting fixtures helps reduce glare, which can cause eye injuries and discomfort.
– Using light sources with a CRI (color rendering index) greater than 80 helps to get closer to natural light.
– The use of long-life light sources can extend the period during which the integrity of the lighting structure is maintained; it also lowers maintenance costs and reduces material and resource costs.
– Designing spaces with less direct overhead lighting helps minimize glare, reduces the perceived brightness of direct luminaires, and reduces contrast between ceiling and luminaire.
– Identifying surfaces with high reflectivity helps to brighten the space through reflection.
DIFFERENCE:
At least 90 percent of patients in the wards need to be provided with lighting controls that will be easily accessible from the patient’s bed.
In multi-patient rooms, controls should be individual to control the bedside lighting.
In single wards, it is required to provide window curtains, blinds or curtain controls that are easily accessible from the patient’s bed.
Residents of buildings who can visually interact with the environment while performing everyday tasks experience greater satisfaction, are more attentive and productive. Views that include natural elements contribute to a «visual respite». Workers sitting at computers who often experience fatigue or dry eyes experience relaxation while looking at objects in the distance.
In healthcare facilities, giving patients view and access to nature can shorten hospital stays and reduce stress, depression, and taking painkillers.
Window views also link workers and patients to natural environmental factors, such as daily and seasonal changes in natural light, which are important for maintaining natural circadian rhythms. Disruption of these rhythms can lead to long-term health problems, including mental disorders.
At the design stage of medical facilities, in order to ensure high-quality views, it is important to take into account the orientation of the building and the design of the site, façade, and interior layout. Within the framework of health projects, it may be necessary to rethink the fundamental typology of buildings.
The design of healthcare facilities often results in a building looking like a closed corridor, with the outer ring of patient rooms with windows and the inner ring of staff. As a result, cafeterias and other employee areas are located in the center of the building and do not have direct access to daylight and view from the window.
The solution to this problem is to optimize the shape of the building and use courtyards to increase the perimeter with access to sunlight.
This criterion motivates designers to meet the sound and vibration requirements specified in the 2010 FGI Guidelines for Design and Construction of Health Care Facilities (“2010 FGI Guidelines”) and Sound and Vibration Design Guidelines for Health Care Facilities (“2010 SV Guidelines”).
Acoustic design of medical facilities includes:
– The arrangement of sound insulation to ensure the confidentiality of speech, acoustic comfort and minimize irritation from the sound source.
– Minimizing impact of background noise level generated by all engineering systems of the building and other noise sources at the facility.
– Minimizing influence of external noise from traffic, transport, outdoor equipment, and other objects affecting the medical institution.
In a highly competitive world, the LEED system helps to achieve the set efficiency goals, and is also a well-known and trusted sign of quality compliance. Thanks to a thorough GBCI inspection, LEED certification means that the project meets certain standards. According to it, the building systems function correctly, and taken environmental measures reduce the impact on the environment.