Civista Medical Center La Plata, md



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Presentation Outline

  • Project Overview

  • Infection Control Risk Assessment

  • Technical Analyses

    • Mechanical: Steam Turbine vs. PRV
    • Electrical: Aluminum vs. Copper Conductors
  • Acknowledgement

  • Questions / Comments



Project Overview

  • Location: La Plata, MD

  • Building Occupant: Civista Health, Inc.

  • Scope

    • Addition: 122,864 SF
    • Renovations: 36,303 SF
  • Occupancy & Function

    • Institutional I-2
    • Medical Care
  • Size: 159,167 SF of total construction

  • Number of stories above grade / total levels: 4 / 4

  • Dates of Construction: 12/1/04 - 8/1/07 (33 months)

  • Total Project Cost: $ 43,941,344

  • Project Delivery Method: CM @ Risk w/ GMP



Project Overview (cont’d)

  • Existing Site Conditions

  • Foundation

    • Augered CIP Concrete piles
  • Structure

    • Elevated CIP Concrete
  • Building Envelope

    • Precast Stone Masonry Units w/ Modular Face Brick


Project Overview (cont’d)

  • Mechanical System

  • Electrical System

    • 480/277V: Lighting, Major Mech. Equip., Building Equip.
    • 208/120V: Lighting, Small Mech. Equip., Small Building Equip.
    • Building Service: 15 kV service


Infection Control Risk Assessment

  • Problem:

    • Civista requires an ICRA plan that is properly sequenced.
  • Goal:

    • Formulate an ICRA plan unique to Civista
    • Sequence an area of renovations
  • Analysis Techniques:

    • Overview of ICRA
    • Formulate ICRA plan for Civista renovation


Background

  • Infection Control Risk Assessment (ICRA)

    • A strategic plan intended to identify and alleviate potential risks associated with the air quality environment during the construction phase of a project
  • Interim Life Safety Measures (ILSM)

    • A series of actions required to be taken to temporarily compensate for hazards posed by existing Life Safety Code deficiencies or construction activities, allowing for safe execution of the ICRA.
  • American Institute of Architects (AIA) Guidelines for Design and Construction of Healthcare Facilities

    • Introduced ICRA in 2001
  • Joint Commission for Accreditation of Health Care Organizations (JCAHO)

    • Mandated ICRA in 2001


Implications of ICRA

  • Owner

    • Responsible for budget and ICRA completion prior to the commencement of work
  • Construction Management Team

    • Preconstruction planning and implementation of the infection control measures
    • Monitoring, documentation, and quality control
  • Trade Contractors

    • Abide by the provided infection control measures
    • Monetary penalties may result otherwise


ICRA Analysis

  • Step 1:

    • Identify Type of Construction Project Activity (Type A-D)
  • Step 2:

    • Identify the Patient Risk Group


ICRA Analysis

  • Step 3:

    • Match the Patient Risk Group with the planned Construction Project Type to find the Class of Precautions or level of infection control activities required.


Suggested Infection Control Actions

  • Dust proof plastic barrier with door and frame to be installed. Contains demo debris and dust, and protects patients

  • Air vents inside the work area will be sealed with plastic sheeting

  • Dust mats to be placed at entrances and exits of work areas

  • Negative air pressure to be maintained within work area utilizing HEPA equipped air filtration units

  • Construction debris to be transported in tightly covered containers

  • Inside work area to be completely cleaned prior to removal of plastic barrier

  • After removal of plastic barrier, area to be cleaned again with disinfectant

  • All staff in the area to be briefed prior to the commencement of work



Suggested Interim Life Safety Measures

  • Forms submitted and approved.

  • Fire door exits to be maintained for clear access at all times.

  • Hospital’s existing life safety systems not to be interrupted.

  • Additional fire fighting equipment to be available.

  • Staff to be briefed prior to the commencement of work.

  • Install dust proof plastic barriers to contain demo debris and protect occupants

  • Properly cover loads of debris

  • Clean interior area enclosed by barriers

  • Remove temporary barriers upon completion

  • Clean and disinfect entire area upon removal of temporary barriers



Additional ICRA Provisions Unique to Civista



Decision Tree

  • Invasive Work

    • Layout work plan
    • Use containment
    • Shield patients & visitors
    • Use dust mats
    • Signage as needed
    • Cover trash during removal
  • Type of Containment

    • 1-14 days: Plastic Wall
  • Affecting existing utilities?

    • Plan outages


Wall Mount Configuration

  • Minimizes number of wall penetrations by running cable and wiring down from the ceilings instead of through the walls



Outage Request Forms

  • Existing utilities and systems will be affected

  • (Ex.) Sheaves and belts on Air Handling Unit (AHU) #7 need replaced and upgraded

    • Affects occupied space being renovated
    • Requires schedule and approved system outage
    • Isolate areas - ventilation temporarily out of service
    • Highly sensitive at-risk patients may need to be moved to a more stable environment for the time being.


2nd Floor East Wing Sequencing

  • Risk Type

    • C – work generates moderate to high levels of dust
  • Patient Type

    • Highest Risk
  • Description

    • Additional Plumbing and sprinkler piping required above ceilings in patient rooms of the 2nd floor
    • Sequencing will involve two rooms at a time


2nd Floor East Wing Sequencing - (1)

  • Sequence 1, 2, 3, 6, 7, 8

  • General Trades

  • Remove furniture

  • Construct plastic dust barrier

  • Install floor protection

  • Install HEPA filters in both rooms

  • Cut drywall for tie-ins

  • Lay out piping on ceilings

  • Cut drywall ceiling for piping

  • Cut drywall ceiling in toilet room for sprinkler piping and head

  • Remove drywall debris

  • Plumbing Contractor

  • Lay out piping on ceilings

  • Core drill roof

  • Install hangers and piping

  • Perform pipe testing

  • Sprinkler Contractor

  • Install hangers and piping

  • Install sprinkler heads

  • General Trades

  • Patch drywall walls and ceilings

  • Finish paint

  • Clean entire rooms

  • Remove plastic dust barrier

  • Clean area



2nd Floor East Wing Sequencing – (2)

  • Sequence 1, 2, 3, 6, 7, 8

  • General Trades

  • Remove furniture

  • Construct plastic dust barrier

  • Install floor protection

  • Install HEPA filters in both rooms

  • Cut drywall for tie-ins

  • Lay out piping on ceilings

  • Cut drywall ceiling for piping

  • Cut drywall ceiling in toilet room for sprinkler piping and head

  • Remove drywall debris

  • Plumbing Contractor

  • Lay out piping on ceilings

  • Core drill roof

  • Install hangers and piping

  • Perform pipe testing

  • Sprinkler Contractor

  • Install hangers and piping

  • Install sprinkler heads

  • General Trades

  • Patch drywall walls and ceilings

  • Finish paint

  • Clean entire rooms

  • Remove plastic dust barrier

  • Clean area



2nd Floor East Wing Sequencing – (3)

  • Sequence 1, 2, 3, 6, 7, 8

  • General Trades

  • Remove furniture

  • Construct plastic dust barrier

  • Install floor protection

  • Install HEPA filters in both rooms

  • Cut drywall for tie-ins

  • Lay out piping on ceilings

  • Cut drywall ceiling for piping

  • Cut drywall ceiling in toilet room for sprinkler piping and head

  • Remove drywall debris

  • Plumbing Contractor

  • Lay out piping on ceilings

  • Core drill roof

  • Install hangers and piping

  • Perform pipe testing

  • Sprinkler Contractor

  • Install hangers and piping

  • Install sprinkler heads

  • General Trades

  • Patch drywall walls and ceilings

  • Finish paint

  • Clean entire rooms

  • Remove plastic dust barrier

  • Clean area



2nd Floor East Wing Sequencing – (4)



2nd Floor East Wing Sequencing – (5)



2nd Floor East Wing Sequencing – (6)



2nd Floor East Wing Sequencing – (7)



2nd Floor East Wing Sequencing – (8)



Steam Turbine vs. PRV

  • Problem:

    • Pressure Reducing Valve (PRV) used to reduce steam pressure.
  • Goal:

    • Redesign pressure reducing equipment from PVR to non-condensing backpressure steam turbine.
  • Analysis Techniques:

    • Overview of steam turbine system
    • Size equipment
    • Conduct energy analysis
    • Conduct cost analysis


Non-Condensing Backpressure Steam Turbine

  • Non-condensing (backpressure):

    • Operates above or in excess
    • of atmospheric pressure
    • Used where low steam loads are required
    • Steam passes over turbine blades, spins turbine blade shaft which directly connected to an electrical generator, generates electricity
    • Low efficiencies (~15-35%)


Sizing the Steam Turbine

  • Given Variables

    • Inlet Pressure (Pi) – 60 psig + 14.7 atm pressure = 74.7
    • Outlet Pressure (Po) – 10 psig + 14.7 atm pressure = 24.7
    • Total Capacity (m) – 3590 lb/hr
    • Temperature of Steam (T1) – est. 300oF (227oF to 307oF)
    • Efficiency Rate (n) – est. 20% (15 to 35%)
  • Find Power Rate:

    • Q = m h


Sizing the Steam Turbine (cont’d)

  • Find Enthalpy Using Steam Tables

    • hi = 269.8 BTU/lb
    • ho = 1190 BTU/lb
    • h = ho – hi = 920.5 BTU/lb
  • Q = m h = 3,635,975 BTU/hr

  • Factor in Efficiency

    • Q x n = 3,635,975 BTU/hr x 0.20 = 727,197 BTU/hr
  • Convert to kW

    • 727,197 BTU/hr x [(1 kW) / (3412 BTU)] = 213.13 kW
    • ** Equipment can now be sized according to kW output


Cost and Energy Analysis

  • Impractical to operate at full capacity

  • Assumed

    • 40% max capacity during Summer months (Jun – Oct): 85.25 kW
    • 60% max capacity during Winter
    • months (Nov – May): 127.88 kW
  • Chart would be most useful in the presence of steam charts



Cost and Energy Comparison

  • 5,759,158 kWh consumed

  • $508,907.24



Cost and Energy Comparison

  • Steam Turbine estimated performance over 9 month period

    • Saves over $17,000
    • Saves over 715,000 kWh
    • Cycle produces no emissions
    • Could be greater savings based on actual efficiency of equipment and actual capacity used.


Aluminum vs. Copper Conductors

  • Problem:

    • Civista wired with copper.
    • Reliable but expensive.
  • Goal:

    • Redesign copper feeders with Aluminum Alloy (AA-8000 series) alternative.
  • Analysis Techniques:

    • Compare material properties
    • Resize feeders and conduit
    • Conduct cost analysis
    • Conduct schedule comparison


Background

  • Copper shortage – 1965

  • Aluminum was a cheaper alternative

  • Steel receptacle screws replaced brass

  • Aluminum to steel connection far more sensitive than copper to brass

  • Thermal expansion and creep

    • Oxidation – Resistance - hot
    • Corrosion
  • Faulty connections, even fires resulted

  • No contractor wants to take the risk



Material Composition

  • Previous Aluminum Classifications

    • AA-1350
    • EC (Electrical Conductor) aluminum
    • 99.5% pure aluminum
  • Current Aluminum Alloy Classification

    • AA-8000 series
    • 0.001 to 0.3% zinc
    • 0.001 to 0.03% titanium
    • 0.001 to 0.5% manganese
    • 0.03 to 0.4% silicon
    • Combination yields excellent strength & resistance to corrosion


Problems / Solutions

  • Improper Installation

    • Use appropriate tools (i.e. stripping wire)
    • Wrap wire in a clockwise manner (i.e. tightens while being screwed in placed)
    • Sufficiently tightened (i.e. adequate contact area at the connection)
  • Oxidation / Corrosion

    • AA-8000 series - thermal expansion and creep similar to copper
    • Proper tightening
    • Oxide inhibitor








Cost and Schedule Comparison

  • Saves over $8,000 in conductor and conduit costs of feeders

  • Saves 4 days in construction time

  • Savings would be greater when including branch circuits



Acknowledgements

  • AE Faculty

    • Dr. Michael Horman
    • Dr. James D. Freihaut
    • Professor Richard Mistrick
    • Professor Kevin Parfitt
  • Industry Contacts

    • Ben Alexander - Gilbane Building Co.
    • Greg Dunkle - Gilbane Building Co.
    • Mike DuLaney - Gilbane Building Co.
    • Melanie Townsend - Gilbane Building Co.
    • Dan Kerr - McClure Company
    • Gary Hall - Civista Health, Inc.
  • Fellow AE Students

    • Alexis Kreft
    • David Potchek
    • Andrew Rhodes


Questions ???





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