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Issue link: https://mcdmag.epubxp.com/i/105316
anything we would use in the states. If I were to review the project using U.S. codes and standards, I'd have to throw the whole HVAC system out. Yet, the building stands, and serves patients. So, here is the question I think is worth asking: are we getting an infection control benefit? Is the airborne infection rate in the U.S. substantively better than it is in Rio Negro, Colombia, or Canada or Europe? Is all this air moving through our building providing better patient care? I ask these questions quite earnestly. I have looked for the answers, and I really don't know. If you are reading this and have some insight, I would love to hear it. Obviously, if patients in the U.S. benefit from ventilation rates, we should keep using them. But, if not, we should try something else. HVAC designers in the U.S. are between a rock and a hard place. With energy efficiency as an industry trend, there is a strong push to do things differently, to innovate. However, the knowledge and experience of the past decades pulls us back. One simple idea is to adopt an international standard into a U.S. building standard (I might recommend the UK's HTM 2025). But, French and British hospital standards allow natural ventilation in many areas. The "Scandinavian model" hospital, much detailed by the University of Washington study group, uses natural ventilation extensively, and seems to show an energy benefit. www.mcdmag.com In fairness, ventilation standards are not the only driver of high-energy use in hospital buildings. There are other factors; i.e., regulatory, architectural and operational. But, driving with the brakes on is a known contributor, and a big one at that. So, let me go back to food, as promised. In the opening paragraph, I stated hospitals were the second most energyintense buildings in the U.S. EIA's 2003 CBECS survey. First place are food service buildings. Food service buildings use lots of energy because it takes lots of energy to prepare food. In the CBECS dataset, cooking and refrigeration account for about 40 percent of the buildings' energy. Think of this as a primitive metric of building energy efficiency. Forty percent of the energy used by food service buildings goes to preparing food. Forty percent of the energy directly contributes to the core business — the revenue — the economic value proposition for which we built the building in the first place. In other words, they are driving hard because they are going far. We're driving hard, in large part, because we have the brakes on. Travis R. English, P.E., LEED AP, is engineering team manager, NFS Facilities Planning, of Kaiser Permanente. He can be reached at Travis.R.English@kp.org. January/February 2013 | Medical Construction & Design 61