Green Takes Root in Military Medicine

05/01/2011 By Lidia Berger

The U.S. Army and Department of Defense will soon open the premier military community hospital in the country—and what is considered to be one of the world's first hospitals to successfully marry today's accepted evidence-based design (EBD) principles with Leadership in Energy and Environmental Design (LEED) green building requirements. The new Fort Belvoir Community Hospital will be a 1.27 million-square-foot facility, providing the best of care for military personnel and their families.

Early in the project, the joint task force responsible for the new hospital challenged the HDR/Dewberry design team to make the hospital "world-class," which it defines as "a medical facility… where the best of the art and science of medicine come together in a focused effort to meet the needs of the patient by providing the best in physical, mental, social and spiritual care."

As a result, the new Fort Belvoir Community Hospital, located just south of Washington D.C., provides a real-life example of patient focus in a "world-class" facility with a superior healing environment. It also showcases the five evidence-based design principles that have been adopted by the Military Health System (MHS) for all of its healthcare environments moving forward.

  1. Create a patient- and family-centered environment. This principle reflects the MHS culture of caring, and encourages environments for both the patient and family members.
  2. Improve the quality and safety of healthcare. Improving safety should be at the top of the list of goals and objectives in any new construction or renovation.
  3. Enhance care of the whole person by providing contact with nature and positive distractions. Connections to nature, such as views to the outdoors and access to gardens, can decrease patient, staff and family stress.
  4. Create a positive work environment. Healing environments not only contribute to patient well-being, but also to the well-being of the caregivers, facilities staff and administrators who work in the building. These positive work environments contribute greatly to improved staff recruitment and retention.
  5. Design for maximum standardization, future flexibility and growth. Constant advances in medical diagnostics and treatment modalities, along with their associated technologies, means hospitals must have the capability to adapt to these changes efficiently and with minimal investment. Designers and planners can accommodate this need by designing in flexibility.

Multiple design charrettes were held early on, with all disciplines involved in the project. HDR Architecture's Healthcare Consulting professionals championed the evidence-based design principles and collaborated with the company's Sustainable Design Solutions staff, who helped guide the process of identifying specific sustainability measures that would win LEED Silver certification.

The following explores some of the parallels between the EBD features of the new hospital and LEED requirements.

Green Roof
A green roof highlights the main building below the bed tower, providing views of nature to patients and staff. Abundant greenery is a building's external component in a healing environment. Survey findings of both patients and non-patients show that merely looking at elements of nature can quickly and significantly calm stress, and lessen pain for patients and staff. Blood pressure is lowered and heart rate reduced, and observers have also seen a long-range positive effect on patients' medical outcomes. The growing evidence of the link between green roofs and healing gardens with patient recovery has made these features much more prevalent in healthcare facilities today.

In terms of LEED credits, the green roof reduces stormwater runoff and fluctuations of surface temperatures. It will act as a kind of sponge, absorbing rainwater and, through transpiration, slowly releasing moisture back to the atmosphere.

Ultraviolet (UV) Technology
This technology uses UV wavelengths to destroy both DNA and RNA, killing or deactivating it. They also effectively stop both surface organisms that grow inside HVAC systems and airborne microbes, including viruses, bacteria, and mold and its spores. This contributes to infection control in certain areas of a hospital environment. The technology will be placed inside the air handlers to help keep their coils clean. This causes less static, thereby reducing energy consumption.

On the LEED side, in addition to energy efficiency impacts, this technology promotes good indoor air quality under the Innovation in Design category.

Energy Conservation
The building will consume 27.6 percent less energy (based on regulated energy savings) than a typical hospital, which equates to $449,299 saved per year. It will also save approximately 4,000 tons in CO2 emissions. Energy savings are being achieved by a multi-stack heat recovery chiller system for reheating, high-efficiency variable speed drive chillers, variable air volume devices, an energy-efficient lighting design including daylight harvesting, and a rainscreen system.

CO2 Monitoring
Primarily used in high-occupancy areas where carbon dioxide can escalate, such as conference rooms, cafeterias, auditoriums and classrooms, CO2 monitors will help sustain occupant comfort and well-being in the Fort Belvoir facility. CO2 monitoring equipment connects directly to the HVAC system, automatically bringing in fresh air when high carbon dioxide levels are detected. This feature qualifies for a LEED credit under the Indoor Environmental Quality category.

High-Efficiency Particulate Arresting (HEPA) Filtration
HEPA filtration traps particles as tiny as .3 microns with an efficiency rating of 99.97 percent. This technology is obviously important in a hospital setting in reducing incidences of infection, especially for immune-compromised and other high-risk patients. It will be installed in various locations in the new hospital.

In the LEED credit tally, its efficiency puts added load on the HVAC system, therefore drawing more energy, which seems counterproductive to energy savings. However, this technology's benefits outweigh energy use in a medical setting and HEPA filtration adds to indoor environmental quality, promoting well-being for building occupants.

Lighting and Thermal Control
This environmental factor affects both patients and staff, especially night- shift workers whose circadian rhythms may be disrupted. Providing good-quality lighting and thermal controls for individual occupants and specific group spaces will promote staff productivity and support a healing environment for patients, adding to their comfort and reducing stress. Providing these controls in appropriate areas of the hospital will earn Indoor Environmental Quality credits for Controllability of Systems.

In a related area of EBD, the owner has cited the abundance of daylight and views of nature as top priorities for the hospital. Taking advantage of natural light minimizes the need for electric lighting during the daytime, saves energy and money, and lifts the spirits of building occupants. Also, daylighted hospital units have been found to have less bacteria and related health concerns. The new hospital will have abundant daylight and beautiful vistas of healing gardens that effectively bring the outside in.

Water Conservation
The project will save 1.6 million gallons of potable water per year by utilizing a rainwater and condensate collection system. Water will be directed from the swooped roofs to two underground cisterns that hold a combined total volume of 160,000 gallons, which will be reused to irrigate the landscaping on site. Native and adaptive plantings contribute to the water savings, and restore native species to the site.

The quality, quantity and rate of stormwater runoff will not exceed the amount prior to construction thanks to landscaping 60 percent of the site with native and adaptive plantings; use of the green roof; use of pervious pavement and curbless parking spaces, rain gardens and river rock beds; and stream restoration projects in the surrounding areas.

Low-Emitting Materials and Furniture All products meet or exceed low-emitting materials requirements, including paints, coatings, adhesives, sealants, carpet systems, composite wood, agri-fiber products and furniture. This reduces the amount of indoor air contaminants that are odorous, irritating and/or harmful to the comfort and well-being of construction installers and all eventual occupants. All furniture meets GREENGUARD indoor air quality standards to significantly reduce the levels of pollutants in indoor air, and greatly enhance patient recovery and care for all occupants.

Green Cleaning
Green cleaning means using products, methods and technologies that are environmentally friendly in the daily maintenance of a facility. The government will establish and oversee a contract for green cleaning that minimizes chemical use, employs products that are less noxious and enhances worker safety. In addition, using low-decibel-rated vacuums will reduce noise stress, improve speech intelligibility, and eliminate noise and chaotic environments. These healing environment measures will be submitted for LEED credit under the Innovation in Design category.

Hospitals today are no longer thought of as cold institutions, filled with hard, unyielding surfaces chosen more for durability and ease of maintenance than for warmth and comfort. As the healthcare field has closely examined models of care, operational efficiencies, space planning and product development, the result is hospitals that are more patient-centered and welcoming.

As the Fort Belvoir Community Hospital illustrates, many design interventions can help create a healthy, healing environment that is sustainable for years to come. It is well on its way to becoming a world-class hospital and a model for the future of the Military Health System.

Lidia Berger, MEM, IIDA, LEED BD+C, O+M, is vice president and national sustainable director for the Federal Program for HDR Architecture. Berger was a founding member of the USGBC National Capital Region Chapter in 1999, and was involved in the development of the LEED CI rating system and served on the LEED EB (Existing Buildings) Core Committee charged with developing the LEED rating system for existing buildings. She received her Master's Degree in Environmental Management – Leadership in Environmental Policy from Duke University in 2009.

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