Civista Medical Center La Plata, md

• Civista Medical Center

• La Plata, MD

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 ???