ELECTRICITY SYSTEMS FOR HOSPITALS

A tutorial for ensuring safety, reliability and efficiency Angelo Baggini

March 2011 Electricity is only of third-rate interest to hospitals. Their core business is the welfare of its patients, for which medical appliances are required, which, on their turn, require electricity. That said, electricity is a vital utility which malfunctioning or interruption can easily lead to disastrous consequences. This combination - being absolutely vital but far from the main interest domain of the organization entails a certain risk. Standards and regulations prescribe how a hospitals electrical installation should be conceived to ensure safety and reliability. Those regulations are complemented by the prescriptions of the equipment manufacturers. All those rules, however, create a fairly complex tangle for the user, making it difficult to figure out which rule has to be applied where and how exactly it has to be implemented. In this tutorial we will try to shed light on those regulations and give a comprehensive overview. Once safety and reliability are taken care of, the focus can shift towards energy efficiency. The fact that efficiency is only of second priority for a hospitals electrical installation does not mean its impact cannot be significant. By focussing on energy efficiency, hospitals can often make surprisingly large savings on the total cost of ownership (TCO) of their installations. In this paper we will tackle a few major energy efficiency topics relevant to medical building management.

I.

THE GENERAL ELECTRICAL INSTALLATION

A. SAFETY AND RELIABILITY
1. ENSURING SAFETY : STANDARD IEC 60364-7-710

All low voltage electrical installations have to comply with the general international standard for electrical safety IEC 60364. Section 710 of this standard is particularly dedicated to medical locations, prescribing some additional requirements for these premises. It is included in the seventh part of IEC 60364, hence the code IEC 60364-7-710. Most national regulations on electrical safety in medical locations are derived from IEC 60364-7710. It applies to hospitals, medical clinics, medical and dental surgeries, rooms for physiotherapy, beauty centres and veterinary surgeries. The standard also applies to medical rooms integrated into non-medical buildings, such as industrial premises, offices, or residential buildings. Albeit primarily a safety standard, it also provides some rules on ensuring availability (see further). Standard IEC 60364-7-710 classifies all medical rooms into three groups, primarily based on the use of applied parts. An applied part is any part of an electro-medical device that might come into contact with a patient. Group 2 includes all rooms where a discontinuity of power supply may endanger the patients life. It also includes all medical locations in which applied parts are used for intra-cardiac procedures (risk on micro-shock on cardiac muscles). Finally, it includes all rooms related to operations with general anaesthesia: pre-operation rooms, operating theatres, surgical plaster rooms, and post operation waking-up rooms. Group 1 includes all medical locations that dont belong to group 2 and where applied parts are used, externally or invasively. Group 0 includes all medical locations where no applied parts are used, such as outpatient rooms, massage rooms without electro-medical devices, offices, store rooms, canteens, changing rooms, corridors, staff hygiene facilities, waiting rooms, etcetera.

Assigning the rooms to one of these three groups must be done by qualified medical personnel. If no such personnel is available, the national healthcare organisation must be called in. Often, the function of a room is changed during the lifetime of a hospital, for instance because of changed needs. It can therefore be wise to equip certain rooms for a higher group than their initial use demands. Those rooms will then be upgradable without significant costs for the electrical installation. The IEC standard prescribes the following protective measures for each group: For group 0, no extra measures have to be taken, additional to the general prescriptions for electrical safety in buildings (standard IEC 60364). For groups 1 and 2, additional measures are prescribed for protection against electrocution through direct or indirect contact with live parts of the system. Direct contact means a person touches a live part of the electrical system. Indirect contact means a person touches a conductive (metal) part which is normally not live, but which has become live due to a fault in the electrical insulation.

Protection against direct contact is straightforward. All live parts must have a proper electrical insulation, barrier, or casing. The insulation protection level should be the stringent IPXXD (IP4X automatically guarantees the protection level IPXXD) for horizontal surfaces within reach, and the slightly less stringent IPXXB (IP2X automatically guarantees the protection level IPXXB) in all other cases. For protection against indirect contact, the following measures are prescribed.

a)

P ROTECTION THROUGH AUTOMATIC CIRCUIT BREAKING

The standard IEC 60364-7-710 specifies that the protection must be compatible with the earth connection method used by the network. In case a TN earthing connection method is used, an automatic miniature circuit breaker is sufficient, but a Residual Current Device (RCD) is advisable. The reaction times of the protection must be as follows:

Voltage phase-earth

Reaction time terminal circuits 0.4 s 0.2 s 0.06 s

Reaction time distribution circuits 5s 5s 5s

120 V 230 V 400 V

In case a TT earthing connection system is used, the use of a Residual Current Device is mandatory, for which the following formula must be satisfied: RE Idn 25 In which: RE = earth resistance of earth plate (ohm) Idn = maximum rated residual current (amperes) On top of that, the standard specifies that an RCD with a rated residual current 30 mA is mandatory for: Group 1 locations: terminal circuits that supply sockets outlets with a rated current of up to 32 A Group 2 locations: all circuits that are not powered by a Medical IT System (see further), unless they are supplying fixed devices which are positioned at least 2.5 m above the floor and which cannot enter the patients environment.

Note that in any case for medical locations: The protection device should bring the possible contact voltage in case of an incident below 25 V. (Whereas the maximum contact voltage for non-medical locations is 50 V.) The type of Residual Current Device (AC, A or B) should be in correspondence with the type of devices in the network to ensure its well-functioning. In case a TN earth connection method is used, the TN-S variant should be used downstream of the main distribution switchboard.

b)

P ROTECTION TROUGHT M EDICAL IT S YSTEM .

This shall be applied to all circuits in Group 2 medical locations supplying: Medical equipment located at less than 2.5 meter from the walking surface, or which could enter the patients environment Socket outlets (except those powering devices of more than 5 kVA and radiological devices)

A Medical IT System guarantees the continuity of power supply to critical medical operations after a first earth fault, while at the same time ensuring protection against indirect contact. This is made possible thanks to a medical insulating transformer, which galvanically separates a terminal circuit from the rest of the electrical system. Insulation transformers exist with a power of 3.5 kVA, 5 kVA, 7.5 kVA and 10 kVA. As transformers have a long life span (several decades), it is better to over-estimate the power load to enable future extension without the need to exchange the transformer. Specifications for the medical insulating transformer are given in standard IEC 60364-7-710. Should a second earth fault in another part or device occur, the medical insulation transformer cannot anymore guarantee the safety and well-functioning of the system. For this reason, the Medical IT System should contain a device for permanent earth insulation resistance monitoring. This device will give an alarm (alarm light plus acoustic signal) when a first earth fault occurs, so that the required measures can be taken to rectify it as soon as possible. The monitoring device itself can be placed inside the electrical switchboard of the medical IT system (see further), but the acoustic and optical signals must be placed at a location with continuous presence of qualified healthcare personnel. Specifications for the insulation monitoring device are given in standard IEC 61557-8. The medical IT system should be connected to a separate switchboard, or to a separate section in the main switchboard. It should have an ordinary power supply as well as an emergency power supply (see further). The switchboard of the medical IT system typically contains: the insulating transformer, an insulating monitoring device for the 230 V circuit, an insulating monitoring device of the 24 V circuit, a transformer 230/24 V 1 kVA, a surge arrester, and a temperature probe PT100. The circuits of the medical IT system are preferably installed in separate cable ways (pipes, ducts, boxes). In case ducts or boxes are shared with other circuits, an insulation barrier should be installed between both circuits. In any case, group 2 medical locations can never contain cable ways supplying power to other locations. In group 2 medical locations, all conductors should be shielded. Ducts should be protected by omnipolar automatic miniature circuit breakers. Moreover, circuits of medical IT systems should be protected with fuses or thermomagnetic automatic miniature circuit breakers. 4

c)

P ROTECTION THROUGH C LASS II DEVICES .

Class II medical electrical equipment have a double insulation, avoiding any risk of persons touching conductive part. In group 0 and group 1 locations, these devices do not need to be connected to equipotential bonding and to the earth. In group 2 locations, however, class II medical devices must be connected to the local equipotential bus bar.

d)

P ROTECTION THROUGH SYSTEMS WITH VERY LOW SAFETY VOLTAGE (SELV AND PELV).

Protection against both direct and indirect contact can also be acquired by reducing the voltage of the circuit to maximum 25 V (alternating current) or 60 V (non-inverted direct current). This concept is called Safety Extra Low Voltage (SELV) or Protection Extra Low Voltage (PELV). The power is then supplied through a safety transformer or a battery. The circuits must be installed according to the standard IEC 60364-4 (clause 411.1). The active parts must be insulated with a protection level IP XXD for horizontal surfaces within reach, and with a level IP XXB for all other active parts. In group 2 locations, the safety transformer must be powered by the insulation transformer of the medical IT system. Moreover, all devices must be connected to the local equipotential bus bar. SELV and PELV systems are rarely used, except for particular equipment such as scialytic devices and infusion pumps.

e)

S UPPLEMENTARY EQUIPOTENTIAL BONDING .

Applicable for all group 1 and group 2 locations. Equipotential bonding is the connection of all conductive parts of the electrical system and conductive parts extraneous to the electrical system with each other, and subsequently connecting this bonding network to the earthing network. Extraneous conductive parts include for instance metal pipes, metal windows, and iron components of reinforced concrete. Equipotential bonding avoids that two metal parts could hold a different electrical potential, entailing the risk on electrocution if they were to be touched simultaneously. The general standard on electrical safety in buildings prescribes equipotential bonding for all rooms with a bath or shower. Standard IEC 60364-7-710 on medical locations obliges the equipotential bonding of all conductive parts extraneous to the electrical system that are entering the same building. Moreover, standard IEC 60364-7-710 requires supplementary equipotential bonding for all locations of group 1 and group 2. These rooms must be equipped with their own equipotential bonding bus bar to which all electrical devices and all extraneous conductive parts are connected. For group 2 locations, the electrical resistance between the (extraneous) conductive part and the bus bar shall not exceed 0.2 . Every conductive part should be connected separately to this bus bar without any additional sub-node, with the only exception of metal pipes and nearby sockets. The local bus bar can be placed on a wall inside the location or immediately outside the room. If the group 1 or 2 locations should contain a bath or shower, the metal parts of these installations must be connected to the bus bar as well. The cables used for the equipotential bonding network must have minimum cross sections as prescribed by the standard. The bus bar must be easy to access for inspection. It must be possible to disconnect each of the conductors from the bus bar, and all cables of the equipotential bonding network must be clearly identifiable.

2.

ENSURING RELIABILITY

A first category of measures to provide a high reliability of power supply are those ensuring the selectivity of the electrical protections. A protection has a high selectivity if it only disconnects these circuits where the safety problem occurs, leaving the power supply to the other circuits intact. Horizontal selectivity is achieved by subdividing the system into many different circuits with each a separate protection. For group 2 rooms and Medical IT systems, IEC 60364-7-710 prescribes a separate protection for each group of plugs. Vertical selectivity is achieved by ensuring that downstream protections trip before the upstream protections. For example, downstream automatic circuit breakers should have a lower trip current than the upstream automatic circuit breakers. In case of RCDs or circuit breakers, the upstream protection should trip with a time delay compared to the downstream protections. A second category of reliability measures are those ensuring the availability of power supply in case of blackouts or power interruptions. Although mainly a safety standard, IEC 60364-7-710 also prescribes certain rules on this. Those rules define, for certain category of devices: In which circumstances the emergency power supply should connect The maximum time delay in which the emergency power supply should connect (e.g. after maximum 0.5 s) The minimum time duration the emergency power supply should be able to serve all vital appliances (e.g. minimum 24 h)

A first category concerns all group 2 locations and group 1 appliances considered medically critical, for which the most stringent rules should be applied. For example, the reaction time of emergency lighting above a surgery table should be 0.5 s. A second category includes all other electro-medical devices. A third category includes all other equipment that is necessary for maintaining hospital services. The IEC 60364-7-710 standard also includes rules on safety lighting. Safety lighting is obliged on the following locations: Group 1 and group 2 medical locations Exit routes and safety exits, including the associated safety signs Rooms containing cabinets, electrical switchboards, or generation sets Rooms providing essential services, such as elevator motors, kitchens, air conditioning stations, data processing centres etcetera

In case of a power interruption, safety lighting must be switched to an emergency power supply in 0.5 s for lighting devices with a life support function and in 15 s for all other safety lighting devices. Emergency power can be supplied in the same way as for the other safety devices (see further), or by individual batteries for each device with an autonomy of at least 2 hours. These IEC standards are complemented by the general European standard EN 8-38 on emergency lighting in public buildings. 6

The emergency power can be provided in different ways. For low power (typically under 400 kVA), a static Uninterruptable Power Supply (UPS) will be used. This is a device that can provide near-instantaneous power by means of batteries and associated electronic circuitry. However, it has a limited autonomy (10 to 30 min) and must therefore be combined with a generator set (GenSet) for acquiring the required levels of autonomy. For higher power rates (typically 400 kVA), a dynamic UPS can be used. This is a device that integrates the UPS function with a diesel generator of flywheel for longer autonomy. In each case, emergency power should be provided by at least two UPS devices supplying 50% or less of their maximum power. In this way, overload problems are avoided and one UPS can stand in if the other one would malfunction or drop out. The type and size of the emergency power systems must be chosen with accuracy and according to case specific criteria. Moreover, buying the right device alone does not suffice, you have to ensure it will always operate as expected. It is therefore essential that the emergency power supply is installed by qualified experts and that its performance is tested on a regular base. As testing procedures are not included in the IEC standard, it is recommended to follow the prescriptions from manufacturers. Some EU countries hold a national law on mandatory periodic testing of emergency power supply systems (e.g. Italy).

3.

FUNCTIONAL EARTHING

The earthing of electrical devices and conductive parts is not only necessary for safety reasons, but also to ensure the well-functioning of the equipment. All electric and electronic devices send out electro-magnetic signals, which may disturb other devices. Preventing such disturbances is called functional earthing or ensuring Electro-Magnetical Compatibility (EMC). Functional earthing is not included in the hospitals standard IEC 60364-7-710, but in another section of the same general standard (i.e. IEC 60364-7-707). To ensure EMC, a classical connection to the earth is not sufficient. Designing an earthing network that filters out all mutual disturbances is a complex task, to be executed by a specialized engineer.

4. EQUIPMENT SPECIFICATIONS Standard IEC 60364-7-710 contains some limited prescriptions on the electrical safety of medical devices. More extensive prescriptions for medical electrical equipment are listed in a series of standards with number IEC 60601-xx.
On top of these, the technical specifications of equipment manufacturers sometimes mention EMC guidelines for their devices. Useful as that may be, an earthing network should always be designed from a systems perspective, and not from the perspective of one device. Moreover, equipment specifications tend to focus on functional earthing alone, without taking electrical safety into account. In some cases, functional earthing and earthing for safety reasons can come in conflict with each other. It is therefore important to leave the design of the earthing network to a specialized engineer who can guarantee both EMC and electrical safety.

5.

PROTECTION AGAINST LIGHTNING

Protection against lightning strikes is included in the general safety standard IEC 62-305. Two different risks have to be evaluated: the risk of losing a human life, and the risk of material damage and its corresponding financial losses. According to the IEC standard, the former risk should be no higher than 1 loss of life out of 100.000 direct lightning strikes on the building. The standard proposes clear protection measures to reduce this risk.

Concerning the latter, the IEC standard only provides an assessment method for evaluating the financial risk. Having this assessment at hand, it is up to the users to decide how much they want to invest in additional protective measures.

B.

ENERGY EFFICIENCY

Once the safety and reliability of the electrical system are guaranteed, attention can go to energy efficiency. A reduced energy consumption can be a crucial element in mitigating the continuous rise of hospitalization costs. Most energy efficiency gains in electrical installations are based on one physical principle: the energy losses in a conductor are inversely proportional to its cross section. This rule counts for cables as well as for the windings of electric motors and transformers. The minimum cross-sections of electricity cables is prescribed by the international safety standard IEC 60364. However, those standards only take safety aspects into account and not the energy efficiency. Over-sizing the cross-section compared to this standard is in most cases worthwhile the investment. The cross-section with the lowest Total Cost of Ownership (TCO) can be calculated out of the load pattern, future electricity prices, and a discount rate. The resulting energy savings will also positively influence the ecological footprint of the installation. Transformers are another part of the electrical system where significant savings can be achieved. Transformers may seem to have a relatively high energy efficiency compared to other electrical equipment (typically 98% to more than 99%), but they work in continuous operation and have a long life span (typically 20 to 30 years). As a result, a small efficiency increase can add up to significant savings over the lifetime of a transformer. In the large majority of cases, high efficient transformers have an attractive life cycle cost. Pay-back periods are often less than two years. In addition to the financial premiums, the energy savings also entail significant environmental benefits.

C.

OTHER IMPORTANT ISSUES CONCERNING THE ELECTRICAL SYSTEM

Some other important issues concerning the well-functioning of the electricity system are not included in the IEC standards: Mutual influences between devices affecting availability. Several medical devices (X-ray machines, MRIs, nuclear medical devices) are particularly sensitive to the quality of the electrical power supply. This quality is not only put at risk by power dips or interruptions on the public grid, it can also be affected by the very medical equipment itself. Devices involving a dynamic load (e.g. X-ray machines) can even cause power quality problems for the entire hospital facility. A proper design of the electrical system can avoid such problematic mutual influences. The patients quality of life. The IEC standard is adequate for ensuring electrical safety and the reliability of life-support functions. But patients want more than just that. The quality of life of patients inside the hospital can be enhanced by, among other things: o Minimising the unnecessary repetition of exams. This requires power availability rules which are much more stringent than those of the IEC standard. Providing clear information, and instructions on what to do, in case of a power interruption

Proper training of nurses and doctors. A lack of the personnels knowledge on electricity might lead to improper use of electro-surgery equipment, affecting electrical safety and availability. An adequate and regular training programme on this topic could prevent such problems.

II.

HVAC

Despite being a thermodynamic system, the Heating, Ventilation and Air Conditioning (HVAC) of a hospital has a strong interaction with the electrical system.

A.

INDOOR AIR QUALITY (IAQ)

The HVAC system for a hospital has to fulfil all classical comfort needs of a public building, but it also has requirements that go beyond just that. As patients stay in their room 24 hours a day, maintaining the right temperature, humidity and ventilation level is essential for supporting their recovery. Another crucial task is to maintain the Indoor Air Quality (IAQ) in all patients environments in order to limit the bacterial concentration and to avoid any cross-contamination between the patients. More particular for operating rooms, the IAQ is submitted to stringent requirements. To maintain the right IAQ, not only temperature, humidity and ventilation of the each room are regulated, but also the pressure level relative to the surrounding spaces. All these requirements result in a complex HVAC system that will at least use 50% of all energy consumption of the hospital.

B.

RELIABILITY VERSUS ENERGY EFFICIENCY ?

As HVAC is not only crucial for the patients comfort, but also for their health, the reliability of the system is of utmost importance. This means that sufficient redundancy has to be built into the system. Standby equipment has to be installed to take over in case the first line equipment is out of service. As a result of this redundancy, the capital investment cost of a hospitals HVAC system can mount high. This makes it hard to invest even more in the equipment in order to improve its energy efficiency. Nonetheless, such an investment can significantly reduce the Total Cost of Ownership of the installation. The following are three basic concepts to reduce energy consumption of the HVAC system:

1. MOTOR SYSTEM EFFICIENCY

HVAC systems include many electrical motors, mainly pump and fan motors. Important efficiency gains in those motor systems can he achieved. A first step is the proper sizing of the motor, as the energy efficiency of motors drops significantly when operating above or under their nominal load. This means that the HVAC system should be designed as efficient as possible in order to minimize the required motor power. Later efficiency gains at the mechanical side will have a reduced impact if they result in a motor operating under its rated power. For systems requiring a variable output, the type of motor control that is used if crucial for its efficiency. Best practice is to avoid mechanical control systems (throttles, gearboxes...) and change the output by means of a variable speed drive (VSD) connected to the motor. A throttle has a typical efficiency of 66%, while the efficiency of a VSD can easily mount up to 96%. A large difference in energy efficiency can also be made in the electrical motor itself. While a standard induction motor has an efficiency of typically 90%, a High Efficient Motor (HEM) can have an efficiency of 95% and more. In the EU, the efficiency of induction motors is labelled Eff 3, Eff 2 and Eff 1, the latter being the 9

highest efficiency category. With the exception of motors with a very low intensity of use, Eff 1 motors will always have the lowest Total Cost of Ownership. In 2008 a new international standard for the efficiency of electric motors was introduced (IEC 60034 30). On the contrary to the EU label, the numbers corresponding with this new standard go up with increasing efficiency (IE 1, IE 2, IE 3, IE 4). The lowest efficiency category of this new international label (IE 1) corresponds approximately with the middle category of the EU labels (Eff 2). The following example shows how the efficiency of a pump system can be increased from 31% to 72% by selecting the right equipment:

Conventional pumping system Device Efficiency Standard Induction Motor 90% Coupling 98% Pump 77% Throttle 66% Pipe 69% Total pumping system 31%

High efficienct pumping system Device Efficiency High efficient induction motor 96% Variable speed drive (VSD) 95% Efficient coupling 99% Efficient pump 88% Energy efficient pipe 90% Total pumping system 72%

(Source: Efficiency in Motor Driven Systems, Ronnie Belmans, Wim Deprez, KULeuven) Motors are often integrated into bigger entities purchased entirely from an OEM. This barrier can be countered by writing the use of Eff 1 (IE 3 or IE 4) motors and VSDs into the general equipment specifications of the hospital. Note that also operation and maintenance conditions can affect the efficiency of a motor system. An important factor to verify is the quality of the power supply. Voltage unbalance and harmonics are just two examples of power quality issues that can seriously deteriorate motor efficiency.

2. HEAT RECUPERATION
Heat (or cooling) recuperation can be realized by integrating heat exchangers in the ventilation system, transferring heat from the outgoing air to the incoming air or vice versa. In case the hospital has a large cooling need (situated in a hot climate), a heat pump can be connected to the chiller plant of the air conditioning system. In this way, the heat can be recuperated for producing hot water.

3. CO-GENERATION
Since a hospital has a large and relatively constant need for heating/cooling and hot water, it might be advantageous to install a co-generation system on site. The basic principle of co-generation is to simultaneously produce electricity and heat. The overall efficiency of such a system is higher than if electricity and heat are to be produced separately. Various types of co-generation technologies exist. In case of a hospital, co-generation with a gas motor is the most obvious choice. Such a motor is fuelled by natural gas and drives an electricity generator. Depending on the needs, heat can be recuperated in the intercooler (30 80C), the lubrication oil (75-95C), the cooling water (75 - 120C) and the exhaust gasses (400 550C) of the motor. A co-generation system should be dimensioned according to the heat requirements of the premise. As the system will be coupled to the electricity grid, any surplus in electricity can be supplied to the grid, and any shortage can be taken from the grid. But any heat surplus will inevitable be lost. Such heat losses seriously 10

compromise the efficiency of the system. To avoid this, the co-generation system is best conceived as an installation for heat production, while electricity is seen as a bonus that helps to pay-off the investment. That said, the electricity from the co-generation unit that is consumed locally will be less expensive than grid electricity, as it avoids transmission and distribution charges. In many countries, the electricity and heat produced through co-generation is rewarded with certificates, recompensing for the carbon emission reductions. In some cases, the co-generation unit can be used as an emergency generator. This should not prevent the cogeneration unit to be dimensioned based on heat demand. Designed in this way, the unit can only be used as an emergency generator if its electrical output at least equals the required emergency power.

III.

COMPRESSED AIR
1. MEDICAL AND TECHNICAL COMPRESSED AIR

The international standards on compressed air in hospitals distinguishes between medical and technical compressed air. Compressed air that drives surgical tools is considered medical compressed air and has to follow the standards of medical gasses. More specifically, standard ISO 7396-1:2007 specifies requirements for design, installation, function, performance, documentation, testing and commissioning of the distribution systems of medical gasses. Central medical gas systems are class IIb medicinal products. This means equipment manufacturing for those systems should comply with ISO EN 7396 1. Both medical and technical compressed air have to comply with ISO 8573-1:2010, which specifies the purity classes of compressed air with respect to particles, water, and oil. ISO 8573-1:2010 also specifies gaseous and microbiological contaminants.

2. ENERGY EFFICIENCY OF COMPRESSED AIR

Compressors no matter whether they supply a medical or a technical compressed air system - are driven by an electric motor. Consequently, what counts for fans and pumps, also goes for compressors: by opting for high efficient motors (HEMs) and variable speed drives (VSDs), important energy efficiency gains can be achieved that significantly reduce the Total Cost of Ownership of the installation (see also: HVAC, motor system efficiency) Other important energy savings in compressed air systems can be made by: Limiting demand: avoiding inappropriate use of compressed air, and limiting pressure drops to real needs Reducing distribution losses through a good design of the piping network, regular maintenance, and the repairing of leaks. Reducing the air inlet temperature: approximately 0.3% of the energy is saved with each degree. By placing the inlet outside, at the north end of the building, and far away from heat sources, temperature can often be reduced by 10C, resulting in energy savings of 3.5%. Heat recovery: installing a heat recovery system can have pay-back periods of less than two years 11

Central control: in larger, more complex compressed air systems, a centralized control system will ensure energy efficient responses

IV.

BUILDING AUTOMATION AND AUXILIARY SYSTEMS

1. AUXILIARY SYSTEMS

Many auxiliary systems in hospital buildings are driven by electric motors. Examples include elevators, automatic sliding doors and automatic sun blinds. For those motors, just like for the ones in HVAC and compressed air systems, opting for a High Efficient Motor (HEM) controlled through a Variable Speed Drive (VSD) can significantly reduce their energy consumption and the Total Cost of Ownership of the system.

2. CONVENTIONAL BUILDING AUTOMATION SYSTEMS

In many buildings of the tertiary sector, building automation systems are used to improve control of lighting and HVAC systems and limit their energy consumption. Those systems can, among other things, switch off the lights when enough natural light is entering the room, switch off the air-conditioning when windows are opened, set the heating at lower during night-time, automatically control sun blinds, etcetera. In buildings that operates 24 hours a day, 7 days a week, like a hospital, the efficiency gain achieved by those systems is limited although it is sill worthwhile investigating their potential benefit. Moreover, hospitals also include rooms that are only operational during working hours think of offices for instance. And in many cases, building automation systems can increase the feeling of comfort of patients and personnel. According to the European standard EN 15232, buildings with a class A building automation system achieve significant energy savings compared to buildings with no building automation system at all. The savings in electrical energy are estimated to be 9%, the savings in thermal energy are estimated to be 34%.

3. PATIENT ASSISTANCE AND TELE-MEDICINE

Assistance to patients is preferable automated as much as possible. Patients will feel more self-supporting and less embarrassed if they are assisted by an electrically driven system than if they have to call on the personnel for all help. In this way, the contact with the personnel will be more dedicated to what automates cannot provide: human conversation. Automated diagnoses and check-ups can increase the patients feeling of control. This increased involvement will often boost the patients esprit de corps and in this way speed up recovery. Some of those systems can also be used outside the hospital. By returning home faster, the patients quality of life will improve while treatment costs are reduced by saving on manpower. A positive example of this concept is the Carme project in Catalunya, Spain, providing tele-medecine for cardiac patients. Thanks to this project, the perception of the patients quality of life increased with 72%, while the days in hospital of cardiac patients decreased with an impressive 73%. To fully harvest the advantages of tele-medecine, three important aspects require attention. First of all, the hospitals ICT system should be well-adjusted for integrating the tele-medecine system and for reliably processing all signals. Second, doctors and patients should have full confidence in the system, otherwise it will only function as an addition on top of to the current techniques and costs will rise instead of going down. This confidence can only be expected when choosing mature systems with proven performance, and when appropriate training for doctors and all personnel involved is provided.

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4. HOSPITAL COMMUNICATION SYSTEMS

Concerning the communication systems in hospitals, reliability is the main point of attention. Achieving a high reliability for communications systems is only possible when the power supply to those systems is equally reliable. For the reliability of the power system, see chapter I.1.2 Ensuring reliability.

V.

ROUND UP

A hospitals first concern regarding the electrical installation is to ensure safety and the reliability of lifesupporting equipment. The international standard IEC 60364-7-710 on medical locations in buildings is very comprehensive regarding electrical safety. It classifies medical rooms into three groups and prescribes regulations for each of these groups. The same standard also includes some essential rules for ensuring a reliable power supply to vital equipment and emergency lighting. However, several additional elements regarding reliability have to be considered. To avoid that electr(on)ic devices disturb each other with electro-magnetic signals, a proper functional earthing is required. This is regulated by the standard IEC 60364-7-707. It requires, however, a specialized engineer to implement it. A specialized engineer is also required for ensuring a proper power quality in the hospitals electric network. This does not only depend on the reliability of the public grid; often it are the medical devices itself that inject electric pollution into the local network. Ensuring power quality at the point of connection with the grid alone is consequently not sufficient. The ambition of a hospital concerning the reliability of power supply should also go beyond the supply of lifesupporting equipment. The patients quality of life can be improved significantly by minimizing the downtime of any type of electrical device. Energy efficiency is often treated stepmotherly in hospitals, as it less vital than safety and reliability. This is a pity, because energy efficiency improvements can result in significant reductions of the total cost of ownership of the installations. Those cost reductions can be of benefit for the hospital, the patients, and public healthcare. One way to minimize energy losses, is to choose a larger cross-section for electric conductors than is required by safety prescriptions. High efficiency transformers can also make a significant difference. Perhaps the biggest efficiency gain that can be made is by adopting High Efficient Motor systems. Electric motors are integrated at various places in hospitals: in the fans and pumps of the HVAC system, in the compressors for medical and technical compressed air, and in auxiliary systems like elevators and sliding doors. As those systems are in general purchased through OEMs, energy efficiency should be tackled in the general prescriptions to the OEM. For answering the hospitals heating and hot water needs, a co-generation system with natural gas motor will in many cases be advantageous. Such a system simultaneously generates heat and electricity, with a higher efficiency than in case of separate generation. Another potential measure for reducing the hospitals energy consumption is the implementation of building automation systems. When adopted properly, those systems can reduce the thermal energy need with up to 34%.

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A.

REFERENCES

IEC 60364-7-710 Electrical installations of buildings - Part 7-710: Requirements for special installations or locations - Medical locations IEC 60364-7-707 Electrical installations of buildings. Part 7: Requirements for special installations or locations. Section 707: Earthing requirements for the installation of data processing equipment IEC 61557-8 Electrical safety in low voltage distribution systems up to 1 000 V a.c. and 1 500 V d.c. - Equipment for testing, measuring or monitoring of protective measures - Part 8: Insulation monitoring devices for IT systems IEC 62-305 Protection against lightning IEC 60034 30 Rotating electrical machines Efficiency classes of single-speed, three phase, cage-induction motors ISO EN 7396 1 Medical gas pipeline systems -- Part 1: Pipelines for compressed medical gases and vacuum ISO 8573-1 Compressed air -- Part 1: Contaminants and purity classes

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