ASHRAE’s BEST

This article was published in ASHRAE Journal, April 2010. Copyright 2010 American Society of Heating, Refrigerating and Air-Conditioning
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SECOND PLACE: HEALTH-CARE FACILITIES, NEW

Kaiser Permanente Sand Canyon hospital in Irvine, Calif., is one of four completed hospitals that used a template design.

greening hospitals
By Paul Switenki, P.E., Member ASHRAE; and Christine Lee, Associate Member ASHRAE

K
aiser Permanente (KP), the largest nonprofit health-care plan provider in the United States, needed to replace many

of its hospitals in California due to its increased membership and the state’s new seismic regulations. KP decided

it was unnecessary to reinvent a hospital design for each hospital, and it commissioned a design template, from scheme

design up to design development phase, that would be flexible and adaptable to the specific needs of each new hospital.

This project comprised a 340,400 ft2
(316 242 m2) template hospital and a
28,500 ft2 (2648 m2) central utility plant
(CUP). The design accommodates 175
to 225 beds across a variable number of
patient-bed floors. The design forms a
template for the full design of 13 hos-
pitals and CUPs in California. The first
four (Sand Canyon [Irvine], Modesto,
Antioch, and Vacaville). were completed
in the fall of 2009.
Energy Efficiency
The Antioch facility serves as the true
template. It incorporates two redundant
high-pressure, high-efficiency steam
boilers, and three high-efficiency hot
water boilers. Both boiler types can use
natural gas and fuel oil. The chilled water
About the Authors
Paul Switenki, P.E., is a mechanical associate
and Christine Lee is an engineer at Arup in San
Francisco.

42 ASHRAE Journal ashrae.org April 2010

technology award case studies
Kaiser Permanente’s template hospitals are all designed according to California’s Title 24.
plant consists of two electric centrifugal
chillers, one gas-fired chiller, and five
draw-through cooling towers. Variable-
frequency drives (VFDs) modulate tower
fans, secondary chilled water pumps, and
secondary heating hot water pumps.
At Vacaville, life-cycle cost analyses
led KP to implement a cogeneration
scheme featuring two gas-fired microtur-
bines, sized to reject enough heat to meet
the new campus’s baseline 24/7 heating
loads. The electricity generated is used on
campus, offsetting less efficient energy
generated by an inefficient remote plant
and transmitted via the electrical grid.
Air-handling systems were designed to
supply 100% outdoor air to the hospital,
and energy is recovered via coils in the
exhaust air portion of the air-handling
units (AHUs). Small horsepower pumps
circulate water through these coils to
coils upstream of the supply air section’s
cooling coils, preheating or precooling the
outdoor air. Any additional cooling is sup-
plied by the units’ chilled water coils. This
type of energy recovery is estimated to be
45% to 55% efficient. Although not as ef-
ficient as a dry bulb-based economizer on
a recirculating unit, this means of energy
recovery, coupled with a 100% outdoor air
system, provides a high level of indoor air
quality to the patients and staff.
April 2010 ASHRAE Journal 43
All of the Kaiser template hospitals
were designed according to California’s
Title 24 requirements, which tend to be
more stringent than ASHRAE codes and
regulations. To illustrate code compliance
and exemplary hospital energy efficiency
the Kaiser Permanente Medical Center in
Antioch is used in this article, as the most
information exists for this facility.
The Antioch Template Hospital re-
ceived the 2005 Savings by Design (SBD)
Award, and according to the SBD com-
puter analyses, the hospital was predicted
to perform 23% better than an equivalent
building meeting the Title 24 require-
ments. Based on this, the annual energy
consumption would be approximately
22 GWh for the hospital alone. The as-
sociated avoided energy use would be
approximately 3.1 GWh/yr, the avoided
electrical demand approximately 442 kW,
and the avoided gas consumption around
29,900 therms/yr (3 154 450 MJ/yr).
The SBD analyses also determined
that occupancy sensors, efficient light
fixtures, and premium motors would
yield economically reasonable payback
periods compared to the Title 24 base-
line building. A study period of 25 years
was used using Department of Energy
Federal Energy Management Program
escalation rates.
Building at a Glance
Name: Kaiser Template Hospitals
Location: Four built in California so
far (Sand Canyon [Irvine], Modesto,
Antioch, and Vacaville)
Owner: Kaiser Permanente
Principal Use: Hospital
Employees/Occupants: 175 to 225
beds
Gross Square Footage: 340,000 ft2
Completion/Occupancy:
2005 – ongoing
Occupancy: 100%
National Distinctions/Awards:
Pacific Gas and Electric’s 2005
Savings by Design Award
Data from the Antioch facility’s Pacific
Gas & Energy (PG&E) utility bills for the
last 12 months of operation are shown in
Figure 1. According to this, the annual
energy consumption is 35 GWh. This
data was taken from a main meter that
monitors the hospital building, CUP, and
the medical office building (MOB). If
PG&E data are prorated to include only
the hospital program space (to match
the SBD basis), the annual consumption
is estimated as just under 20 GWh/yr.
Although this comparison is only ap-
proximate due to the available energy
consumption data, it can be seen that
the Antioch template hospital exceeds
Title 24 and ASHRAE requirements. It
is expected that the cogeneration system
implemented at the Vacaville facility will
drive that campus’s energy consumption
even lower.
Indoor Air Quality & Thermal Comfort
Local code ventilation and thermal
comfort requirements are generally based
on the American Institute of Architects
(AIA) Guidelines for Design and Con- 4,000,000

Energy Consumption (kWh)

struction of Healthcare Facilities. The Gas Electricity
3,500,000
template hospital was designed around
3,000,000
the 2001 California Mechanical Code and
was reviewed by the California Office of 2,500,000

Statewide Health Planning and Develop- 2,000,000

ment (OSHPD), a state-run agency that 1,500,000
reviews all proposed hospitals to ensure 1,000,000
compliance with these codes.
500,000
ASHRAE Standard 62.1-1999, in ef-
0
fect at the time of permit, advised that 6/08 7/08 8/08 9/08 10/08 11/08 12/08 1/09 2/09 3/09 4/09 5/09
outdoor air should not contain contami-
nants beyond Environmental Protection Figure 1: Kaiser Antioch facility energy consumption.
Agency thresholds or, if so, that it was
effectively filtered. The Antioch site’s ambient air pollutants Ventilation effectiveness is maximized based on code re-
fell within California state thresholds for all such pollutants, quirements and AIA recommendations. In operating rooms,
with the exception of ozone. The data at the time of analysis nurseries, and invasive procedure rooms, air is supplied at
indicated, however, that ambient ozone levels were, in fact, de- the ceiling and is removed at a low level. In patient isolation
creasing. Based on this and financial constraints, carbon filters rooms, nurseries, and recovery areas, air is directed from
were not included in the design. cleaner spaces into dirtier ones. Due to
The 100% outdoor air-handling system code-driven airflow and space tempera-
ensures hospital air exchange rates meet
Energy at a Glance ture requirements, thermal comfort is not
or exceed exchange rates dictated by code Energy Use Intensity (Site): directly addressed in terms of ASHRAE
and by Standard 62-1999’s Ventilation 2
350 kBtu/ft ·yr Standard 55. However, the design meets
Rate Procedure (even when considering the ranges of temperature and humidity
the multiple space method). Sources of Natural Gas: 177 kBtu/ft2·yr required by California code. The mild
unusual indoor contaminants are treated 2
Electricity: 173 kBtu/ft ·yr California climate and typical off-AHU
with local exhaust ventilation systems. air conditions will result in indoor rela-
2
These include negative pressure patient Annual Source Energy: 763 kBtu/ft tive humidity falling within the 30% to
isolation rooms; grease hoods and dish- 60% range throughout most of the year.
washer hoods in the kitchen; sterilizers Local humidification has been provided
and cart washers in the central sterilization department; fume for code-mentioned “sensitive spaces” where RH is otherwise
hoods and biological safety cabinets in laboratories and phar- expected to slip below this range. Nonsensitive spaces are
macies; and grossing station hood and backdraft systems in allowed to drop below 30% RH, but it is expected that these
microscope cleaning areas and pathology work areas. times will not exceed 10% of the year.

Electricity Natural Gas Simple

Option Description Consumption Demand Cost Consumption Cost Payback
(kWh) (kW) ($) (Therms) ($) (Years)

Base Base Case 22,959,918 3,214 2,312,598 164,556 134,545 N/A

1 ECM-1 Occupancy Sensors 22,722,742 3,183 2,288,850 164,923 134,831 5.9

2 ECM-2 T-8XPS Light Fixtures 22,614,284 3,168 2,277,983 164,094 134,964 0.8

3 ECM-3 Occupancy Sensors + T-8XPS Light Fixtures 22,408,966 3,141 2,257,513 164,421 134,218 3.1

4 ECM-4 Premium Motors 22,881,414 3,202 2,304,582 164,594 134,574 1.0

5 ECM-5 Bundle ECM-1 + ECM-4 22,643,682 3,170 2,280,786 164,961 134,860 4.7

6 ECM-6 Bundle ECM-3 + ECM-4 22,330,630 3,128 2,249,527 164,458 134,246 2.8

Table 1: Data from the Antioch facility’s Pacific Gas & Energy (PG&E) utility bills for the last 12 months of operation.

44 ASHRAE Journal ashrae.org April 2010

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Mechanical peer reviewers, design-assist contractors, project managers and facility representatives continuously reviewed the template designs.

A more accurate indicator of the HVAC system’s ability to

provide comfortable conditions may be that Antioch’s facilities
management indicates that there have not yet been any occupant
complaints regarding thermal comfort or indoor air quality.
Design setpoints and control sequences of operation for all
controlled systems were verified by a third-party commissioning
agent for all of the template sites.

Innovation
Innovation and creativity are demonstrated by the design
but more so by the design process. The original (2007–08) KP
template hospital project generated a single hospital and central
plant design that could be used on multiple sites within Califor-
nia. More importantly to KP, it merged three individual projects
into a single submittal for coincident review by California’s Of-
fice of Statewide Health Planning and Development (OSHPD).
The OSHPD completed a review of the original template
package in only 11 months, approximately seven months
quicker than usual for a typical, single hospital project. This,
combined with an expedited design period, shaved nearly
one full year off what would have otherwise been a five-year
concept-to-completion process. And, as it was the second gen-
eration of template hospital, Vacaville’s timeline was further
reduced by six months.
Throughout the project, the design team maintained aware-
ness of the global vision needed to fulfill the client’s brief,
while still accommodating specific local requirements (climate,
soil properties, program, etc.) and dealing with the individual
owner, site architect, and contractor teams involved with the
first four built hospitals.
The short, but intense, template design period led to combined
design efforts from Arup’s San Francisco and Los Angeles
offices. The combined team met the individual, sizeable chal-
lenges, and also managed to meet (and exceed) the client’s
design, construction and programming goals.
Designing hospitals using templates saved significant time in the
design and review phases by merging individual projects into one.
Maintenance and Operation
The template hospital and CUP designs were reviewed
virtually continuously by mechanical peer reviewers, design-
assist contractors, and KP’s project managers and facility
representatives. These reviews, combined with life-cycle cost
analyses undertaken to determine major HVAC systems, meant
that maintenance and operation issues and costs were always
important considerations.
At Kaiser Vacaville the thermal fluid boilers rely on heated
oil to convert water to steam and drive the sterilization and
humidification processes. Implementing this technology im-
proved on the original template hospital design of high pressure,
dual-fuel steam boilers requiring 24/7 boiler observation (per
California Code).
Chilled water plants at the various sites are a hybrid configu-
ration of electric centrifugal chillers and natural gas engine

46 ASHRAE Journal ashrae.org April 2010

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chillers to allow for flexibility in utility consumption. The gas
chillers are sized to match 24/7 process loads such as the main
IT rooms.
Large rooftop AHUs incorporate service vestibules that
protect valves, gages and other piping accessories from the ele-
ments. KP maintenance staff only need to open a door to access
these items. This design solution, combined with minimization
of rooftop ductwork, reduces initial roofing costs, as well as
future maintenance costs.
The template CUP was designed for expansion to accom-
modate future campus buildings. By designing a “punch out”
wall on one end of the CUP, the team was able to defer major
construction costs until the time expansion becomes necessary.
Terminal units were located above patient rooms instead of
corridors to minimize potential disruption to the hospital staff’s
daily function.
Cost-Effectiveness
As noted previously, the typical permit timeframe and con-
struction escalation costs were minimized. The owners met their
budget and programming goals, and their employees and pa-
tients benefit from a friendly, comfortable, healing environment.
As discussed in the Energy Efficiency section, major HVAC
system selections were based on life-cycle cost analyses. KP’s
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48 ASHRAE Journal April 2010
2001 standards indicated a preference for a 100% outdoor air
system with energy reclaim via runaround loops. This con-
figuration was tested for the template layout and compared to
a typical recirculating (mixed-air) AHU.
The 100% outdoor air system proved to have a significantly
lower first cost due to savings in exhaust air ductwork, without
sacrificing energy performance. On three of the four sites, the
100% outdoor air system offers annual energy and operation
and maintenance savings, while the third provides a small an-
nual premium, although so small that a recirculating system
did not offer a reasonable payback. What was not taken into
account was the savings in potential coordination conflicts and
resulting change orders that might have been necessary had a
recirculating system been implemented. The 100% outdoor air
system typically required only two ducted system types: general
supply and general exhaust.
Environmental Impact
With the reduction in energy consumption resulting from
energy-efficient design, less electricity and natural gas are
required, reducing carbon emissions, while the specification of
modern and advanced building services equipment eliminated
CFCs. Sometimes the client bottom line (cost reduction) can
go hand-in-hand with environmentally favorable practices.
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