Integrating Sustainable Principles into the Project Delivery Process

(From the Green Healthcare Construction Guidance Statement of the ASHE Green Building Committee)

The ASHE Green Building Committee developed guidance to answer the question of what sustainable or "green" building means in the context of a health care facility. This material is intended as a guideline for new building projects, although many of the principles can be applied to existing buildings as well. The Roadmap covers most of these principles in greater detail throughout the site, with an emphasis on improving existing facilities.

1. Integrated Design

Vision Statement. Achieving an effective and sustainable design requires a collaborative process that engages multiple design disciplines as well as users, construction managers, contractors, and facility managers. The merging of ideas, perspectives, and areas of expertise facilitated by an open communication process reaps multiple benefits as the project team moves from the optimization of single systems in isolation to the optimization of the entire building enterprise. Establishing vertical support throughout the organization helps ensure success.

Goals

• Enhance cost-effectiveness by recognizing interrelationships between systems.
• Enhance building performance by integrating efficient and sustainable design elements.
• Encourage cross-disciplinary problem-solving.
• Build support among key constituencies for sustainable design.

Suggested Strategies

• Develop an environmental health vision statement for the project.
• Reinforce corporate/institutional commitments to environmental health and community responsibility.
• Use a project team approach that includes cross-disciplinary design, decision-making, and charrettes.
• Use goal-setting workshops to facilitate and reinforce team-building.
• Engage owner, staff, contractors, user groups, and community groups; educate them on the benefits of green design, and integrate them into the design process.
• Use computer-modeling tools (such as eQUEST, TAS or Radiance) to optimize the interactions of different design elements (e.g., orientation, insulation, HVAC sizing).

2. Site Design

Vision Statement. The introduction of a building to a site inevitably causes disruptions that affect the health of the local ecosystem. Good site design recognizes the ecological integrity of a site and pursues strategies that minimize disruptions (e.g., erosion and habitat displacement) and contribute to site restoration. Understanding the building as a series of flows enables the physical structure to achieve a good fit with the site. Site location should reflect a consideration to lessen the ripple effect of the building on the surrounding community by enabling easy access by healthy transportation modes such as walking, bicycling, and mass transit.

Goals

• Maintain, restore, and improve site biodiversity.
• Minimize the site development footprint.
• Reduce storm water runoff.
• Eliminate toxic chemical applications for pest and vegetative control.
• Optimize design for the local microclimate and reduce dependence on mechanical systems for building operations.
• Reduce reliance on single-occupancy vehicles by providing easy transit access and amenities (e.g., showers and lockers for bike commuters).
• Integrate design and building orientation to take advantage of local microclimate for heating, cooling, shading, ventilation, and daylighting.
• Eliminate light trespass from the building site, improve night sky access, and reduce development impact on nocturnal environments.

Suggested Strategies

• Evaluate brownfield sites to determine appropriate reuse for health care facilities.
• Reuse and renovate existing buildings.
• Site buildings in urban areas with existing infrastructure.
• Avoid siting on agricultural land, 100-year floodplains, threatened or endangered species habitat, wildlife corridors, and wetlands.
• Orient buildings to make best use of solar energy for heating or daylighting.
• Orient buildings to encourage natural ventilation and passive cooling.
• Design to minimize air pollution, erosion, and runoff into sewer systems.
• Reduce building footprint, optimize layouts, and reduce size of roads, parking, and other site improvements to concentrate and limit total paving and other site disturbances.
• Minimize impervious cover by using open-grid and pervious paving materials.
• Maximize preservation and restoration of biodiverse open space/habitat.
• Use native trees, shrubs, and plants.
• Develop and implement an integrated pest management plan.
• Use vegetative and other shading techniques to assist passive cooling and ventilation of buildings and public and paved areas.
• Site in proximity to transit options.
• Establish a transportation plan. Support alternatives to fossil-fueled single-occupancy vehicles (transit access, preferred van/carpool parking, bike parking and changing facilities, electric car charging, and other alternate vehicle fueling). Reduce paved parking area appropriately.
• Design in accordance with Illuminating Engineering Society of North America (IESNA) footcandle requirements as stated in the IESNA Recommended Practice Manual: Lighting for Exterior Environments, and design interior and exterior lighting such that zero direct beam illumination leaves the building site.

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3. Water

Vision Statement. Water efficient design strategies balance water quality and quantity demands within a building and are responsive to the watershed's capacity as source and sink. Public works projects, such as treatment plants and sewage systems, are unable to adequately remove or process the toxic materials that infiltrate these systems, potentially threatening public health. Take a systematic look to identify potential water sources, how water is used in the building and how it flows around the building site to reduce water usage and wastewater discharges.

Goals

• Minimize the use of potable water while conserving water quality and availability.
• Minimize off site treatment of wastewater.
• Minimize storm water release from the site.
• Maximize use of on-site water resources, (e.g., rainwater, graywater).
• Match water quality with end use requirements.
• Maximize aquifer recharge.

Suggested Strategies
(Refer to the Roadmap’s Water Top 10+ and Water Performance Improvement Measures for more information on specific strategies.)

• Specify EPA Energy Star appliances and high-performance fixtures and equipment (e.g., low-flow and pressure-assist toilets and urinals; waterless urinals; low-flow showerheads and faucets; automatic use activation on sinks, toilets, and urinals; ozone-injected laundry equipment).
• Maximize water conservation in cooling towers by using non-potable, site-recycled water for cooling tower makeup, or use non-evaporative condenser heat rejection equipment (air-cooled or ground source).
• Specify native plants that are tolerant of local climate, soil, and water conditions.
• Install drip irrigation and high-efficiency irrigation control (moisture sensors, weather-based controllers).
• Implement appropriate safe strategies to recycle site wastewater (i.e., graywater or condensate) and/or municipal secondary treated water for irrigation, sewage conveyance, and toilet flushing.
• Collect storm water runoff from roofs and site for irrigation, sewage conveyance, toilet flushing, and/or HVAC/process makeup water, or recharge into aquifer.
• Minimize hard surfaces, and install permeable paving and other pervious surface materials.
• Create wetlands or other systems to locally recharge underground water flows.

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4. Energy

Vision Statement. The burning of fossil fuels is the single largest contributor to global climate change and a major source of toxic emissions that impair the environmental health of local communities and the world at large. Rising energy prices impose a significant economic imperative that requires careful examination of how best to ensure a comfortable and healthy indoor environment that supports patient recovery yet requires a significantly reduced energy demand. Use a comprehensive, systematic approach to building and site energy flow to reduce energy bills, evaluate opportunities for reliance on renewable energy sources, and improve environmental health outcomes.

Goals

• Reduce building energy demand.
• Reduce emissions from energy use.
• Reduce reliance on energy generated by fossil fuels.
• Maximize use of energy generated by renewable sources.

Suggested Strategies
(Refer to the Roadmap’s Energy Top 10+ and Energy Performance Improvement Measures for more information on specific strategies,)

• Use ANSI/ASHRAE/IES Standard 90.1: Energy Standard for Buildings Except Low-Rise Residential Buildings as the basis of design to optimize thermal envelope performance and evaluate and document opportunities to exceed performance requirements.
• Use energy simulation tools, such as eQUEST, TAS or Radiance, to optimize design and interactions between building elements.
• Optimize layout and orientation of building for maximum energy performance.
• Design daylighting strategies to reduce heat gain and to control glare and contrast.
• Specify efficient lighting fixtures.
• Specify user controls and ambient condition lighting controls integrated with daylighting.
• Specify efficient HVAC equipment (high-efficiency, appropriately sized, low NOX).
• Specify EPA Energy Star electrical equipment and appliances.
• Specify solar water heating and low-flow hot water fixtures and appliances.
• Specify zoning and controls for mechanical equipment to optimize use.
• Specify EPA Energy Star roofing materials and/or green roofs to reduce cooling loads and heat island effect.
• Develop a commissioning plan and hire an independent commissioning agent.
• Specify HVAC, refrigeration, and fire suppression equipment that doesn’t use CFCs or halon. When reusing existing base building HVAC equipment, develop a comprehensive CFC phase-out conversion plan. Balance th e ozone depletion potential (ODP) of HCFC alternatives with global warming potential (GWP).
• Evaluate the feasibility of using cogeneration, fuel cells, renewable energy systems (e.g., photovoltaics, wind, biomass, and low-impact hydroelectric), and other alternative energy sources, and specify those that are appropriate.
• Design for continued monitoring and verification of system performance.
• Purchase green energy (where available) that meets the Center for Resource Solutions Green-e products certification requirements.

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5. Indoor Environmental Quality

Vision Statement. Growing awareness about the relationship between indoor environmental quality (determined by materials, lighting, and thermal comfort) and human health and productivity has catalyzed substantial research to support healthier buildings. Eliminating materials identified as allergens, mutagens, carcinogens, and endocrine disruptors, while providing access to daylight, views, and comfortable indoor climate, are fundamental sustainable building goals. Engage in a design process that balances the objectives of having an indoor environment that is well-daylighted, comfortable, energy-efficient, and nontoxic and achieving improved productivity and patient outcomes.

Goals

• Provide an environment that is healthy for occupants and encourages rapid patient recovery and staff productivity.
• Minimize production and distribution of pollutants.
• Provide occupants with access to daylight and views.
• Provide energy-efficient thermal comfort.
• Provide occupant environmental controls (light, view, temperature, ventilation).
• Provide appropriate air changes with a sufficient percentage of fresh air.

Suggested Strategies

• Ensure high-quality indoor air by meeting or exceeding ANSI/ASHRAE Standard 62.1: Ventilation for Acceptable Indoor Air Quality as a basis of design.
• Ensure thermal comfort by meeting or exceeding ANSI/ASHRAE 55: Thermal Environmental Conditions for Human Occupancy as a basis of design.
• Specify low-VOC/low-toxicity finishes and materials, such as Green Seal-certified paints; composite wood and agrifiber products with no added urea-formaldehyde resins; carpet systems certified by the Carpet & Rug Institute Green Label Program; and adhesives meeting South Coast Air Quality Management District guidelines.
• Minimize use of carpets and other materials that attract, absorb, and re-release indoor pollutants.
• Specify permeable wall coverings and other materials to prevent trapping of water and microbial growth.
• Establish green housekeeping (environmental services) protocols.
• Design to reduce pest infestation opportunities.
• Install permanent entryway systems (e.g., grates) to trap dirt and particulates.
• Position air intakes to prevent contamination from vehicle exhaust and other sources, paying attention to prevailing winds.
• Provide easy access to inspect and clean filters and ductwork in each straight run.
• Ventilate enclosed parking areas and other source areas (e.g., smoking areas, environmental services (housekeeping) rooms, copying rooms, hazardous waste).
• If a building cannot be 100 percent non-smoking, provide total environmental separation for non-smokers and ensure smoke cannot feed into the ventilation system.
• Provide building occupants with access to daylight, views, and operable windows where appropriate.
• Provide user controls for airflow, temperature, and light (integrated with daylighting).
• Provide a CO2 monitoring system for feedback on space ventilation performance.
• Specify materials, products, mechanical systems, and design features to attenuate sound and vibration, not to exceed room criteria (RC) ratings listed for hospitals and clinics in Table 34 of Chapter 46: Sound and Vibration Control, 2007 ASHRAE Application Handbook. [Do you want to consider referring to the noise criteria in the 2010 FGI Guidelines instead?]

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6. Materials and Products

Vision Statement. Use of sustainable materials can significantly enhance a building's environmental health performance. The sustainable harvest of materials enhances the health of habitats and protects biodiversity. The memorandum of understanding between the U.S. EPA and the American Hospital Association (AHA) establishes the importance of minimizing production of persistent and bioaccumulative toxins (PBTs) and reducing waste as priorities for the health care industry. Review material specifications to eliminate materials that harm human and environmental health.

Goals

• Reduce resource depletion from manufacture of materials.
• Reduce embodied energy in materials.
• Reduce toxins generated throughout the life cycle of materials.
• Reduce waste.
• Reduce impact of reuse or disposal of building.

Suggested Strategies

• Reuse existing structures.
• Specify materials free from ozone-depleting substances and/or equipment using CFCs, HCFCs, and halon, balancing ozone depletion potential (ODP) with global warming potential (GWP).
• Specify materials that are free from toxic chemicals and do not release toxic by-products throughout their life cycle, particularly toxins that are carcinogenic, persistent, or bioaccumulative. Key materials to avoid include mercury (switching equipment), arsenic (pressure-treated wood), urea formaldehyde (engineered wood), and asbestos.
• Specify materials and products that are:

• Design for efficient material use (i.e., use fewer materials and standard sizes to reduce waste).
• Design for adaptability of building design as user needs change (e.g., reusable movable office divider walls and raised floor systems to facilitate future flexibility).
• Design for disassembly and recycling or reuse at the end of building life.
• Prioritize sensitive areas (e.g., neonatal intensive care units, pediatrics, and maternity departments).
• Specify a careful product substitution review procedure to ensure that environmental health performance is not degraded by contractor substitutions.

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7. Construction Practices

Vision Statement. The construction process affects every facet of design, including site, materials, mechanical systems, indoor environmental quality, and waste generation. Construction practices will have a significant direct impact on the health of the local environment during construction and will determine if the building achieves its long-term health and sustainability goals. The construction team, including construction management, general contractor, and subcontractors, are all integral to achieving these goals. The team in place during construction administration needs to be fully informed of and preferably have a role in developing the project's sustainable design vision and goals.

Goals

• Establish a partnering relationship between all parties [engaged in project construction?]; engage subs and crews.
• Maximize reduction, reuse, or recycling of construction, demolition, and land-clearing debris.
• Establish appropriate protocols for safe, appropriate management of toxins associated with renovation and demolition.
• Eliminate use of toxic substances, particularly persistent and bioaccumulative materials.
• Protect materials from contamination.
• Ensure good indoor air quality.
• Control erosion to reduce negative impacts on water and air quality.

Suggested Strategies

• Implement a waste management plan for separation and recycling or reuse (including composting, chipping, mulching) of construction, demolition, and land-clearing debris (CD&L) and proper disposal of residual materials. Crush and reuse demolished concrete, asphalt, and masonry for beneficial on-site or off-site use.
• Survey for hazardous materials in demolition or renovations (mercury, asbestos, and lead) and plan for safe remediation or removal and disposal.
• Minimize packaging waste and reuse or return packaging waste to suppliers or manufacturers for reuse/recycling; recycle all packaging that cannot be reused or returned.
• Sequence work phases to minimize negative impacts on habitat and on ambient and indoor air quality.
• Implement a site sedimentation and erosion control plan.
• Follow the Sheet Metal & Air Conditioning Contractors National Association IAQ Guidelines for Occupied Buildings Under Construction (e.g., dust control measures, protection of absorptive materials from moisture damage, sequencing installation of interior materials to avoid absorption of volatile organic compounds).
• Allocate time prior to occupancy for building flush-out appropriate to climate using new filtration media to ensure removal of initial outgassing emissions.
• Engage crews, including subcontractor crews, in education sessions to familiarize them with sustainable design and construction practices and to solicit their input.

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8. Commissioning

Vision Statement. The health facility commissioning process ensures the building owner and occupants that all mechanical, electrical and plumbing equipment is operating consistent with the design intent and exceeds conventional testing and balancing procedures. An independent third-party commissioning agent offers an objective review and should be part of the design team from the earliest stages.

Goals

• Ensure that building elements are installed and calibrated properly to meet the project’s environmental health goals in addition to mechanical, electrical, and plumbing system performance parameters.
• Ensure that building occupants are appropriately trained and that thorough, explicit written materials are located in easily identifiable and accessible places to ensure proper operating and maintenance of building systems to meet goals.

Suggested Strategies

• Contract an independent commissioning agent.
• Clearly document design intent.
• Specify commissioning requirements, including a commissioning plan.
• Review carefully at construction document and occupancy phases.
• Develop an operations and maintenance manual for systems operations and ongoing monitoring and calibration.
• Verify installation and operation to specifications, training, documentation, and access to documentation.
• Evaluate postoccupancy commissioning at six-month or one-year intervals to ensure continued system effectiveness.

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9. Operations and Maintenance

Vision Statement. Planning and implementation of effective building operations and maintenance are essential to reap the full benefit of a building’s sustainable design features. Buildings are designed to last many decades, and practices employed during the life of the building should reflect a commitment to the hallmarks of sustainable building: high-performing mechanical systems, healthy indoor air quality, and continual recognition of the life cycle impacts of materials and methods employed.

Goals

• Reduce the "ecological footprint" associated with materials and methods used during a building's occupancy phase.
• Commit to a process of continuous improvement to enhance the building's environmental health performance.
• Educate the community about the building’s sustainability and environmental impact.

Suggested Strategies

• Program and design adequate dedicated storage and flow space to facilitate recycling and composting of waste.
• Program and design adequate dedicated storage and flow space and cleaning/sanitation facilities to encourage reuse of items such as medical products, linens, and food service items that can replace disposables and reduce waste.
• Program and design adequate dedicated storage and flow space for separation and management of hazardous wastes.
• Provide educational opportunities (e.g., meetings, newsletters, etc.) for all building staff on the building’s sustainable design features and benefits and on the staff’s role in optimizing performance.
• Prepare building operating manuals that include:

• Provide community education (e.g., press releases, newsletters, meetings, tours, and interpretive displays) on the building’s sustainable features.

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10. Innovation

Every building is a unique blend of site, program, people, and budget, and each comes with its unique set of challenges and opportunities. Innovative, integrative design practices recognize that new solutions emerge from a process that engenders creative problem-solving and "thinking outside the box." We encourage you to delve into an exploratory process to discover new benchmarks for 21st century health care facilities.

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