Healthcare Design - September 2017 - 48

In Focus

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ventilation in healthcare facilities. Spaulding Rehabilitation Hospital, a 132bed post-acute care hospital in Boston that opened in 2013, and Royal Jubilee
Hospital's 500-bed Patient Care Centre (PCC) in Victoria, British Columbia,
that opened in 2011, offer case studies on how goals for natural ventilation
were achieved and how the systems have been used since opening.
S P A U L D I N G R E H A B I L I T A T I O N H O S P I T A L 

During the design of LEED Gold-certified Spaulding by Perkins+Will (Boston), stories from Hurricane Katrina-mechanical systems failing, stifling
heat, staff breaking windows with furniture to get patients some air-were
front-of-mind, says David Burson, a senior project manager with Partners
HealthCare (Boston), owner of the facility. Recognizing the waterfront facility's vulnerability to rising sea levels and the increasing frequency and severity
of North Atlantic storms, Spaulding's leadership decided to incorporate operable windows as part of a larger commitment to passive survivability (the ability to continue to function in an extended power outage or other emergency).
Spaulding's environmental control system primarily relies on mechanical HVAC, with natural
PCC'S OPERABLE
ventilation used as an ancillary mode. The design
WINDOWS GET PLENTY
team's challenge was to integrate these methods
to achieve patient comfort without wasting a lot
OF USE THANKS TO
of energy. In patient rooms, the solution is simMILD TEMPERATURES.
ple, Burson says. Each room has an operable sash
that stays locked except in cases of a mechanical
HVAC failure, when the staff can use a key to open each window.
In activity spaces, such as multipurpose rooms, patient lounges, and therapy
gyms, the value of operable windows as an amenity as well as a safeguard warranted a more complex solution. In these spaces, staff and patients can
open banks of windows to provide access to the sounds, scents, and fresh air of
the Boston Harbor. However, to avoid wasting energy, the switches that open
these windows also cut off the delivery of mechanically tempered air.
Spaulding's experience with its system has been mixed. Boston's hot
summers and cold winters mean its windows are open mostly on fair days
during the shoulder seasons-less often than expected, Burson says. When
the windows do get opened in summer, heat and humidity can become uncomfortable if occupants don't actively manage the system over the course
of the day. Even after the windows close again, spaces can remain uncomfortable while the mechanical system catches up. Burson says a refinement
for the future (or for other facilities considering operable windows) could
include exterior sensors to close the windows automatically, providing a
faster response to outside conditions and preventing temperature and humidity levels from exceeding patient comfort ranges. "We're still learning
how to adapt to a more dynamic patient care environment than most staff
are used to, at least in this country," he says. "It's a work in progress."
R O Y A L J U B I L E E ' S P C C   

While emergency functionality was a significant consideration for Royal
Jubilee's PCC, a LEED Gold-certified medical, surgical, and mental health
inpatient facility designed by CannonDesign (former Vancouver, British
Columbia, office), the primary goal in incorporating natural ventilation was
to create a more patient-centric environment, says David Leadbetter, Royal
Jubilee's director of special projects. Every patient room, common area,
and office window has an operable component: a cast-aluminum vent about
2 feet wide by 4 inches high. For security, the vents are set in screened and
lockable aluminum housings. Occupants are able to set room temperatures
between 70 and 79 degrees Fahrenheit, and the building automation system

48

SEPTEMBER 2017

will maintain that set point. But when a vent is open,
temperatures are allowed a wider range. "Depending who's in the room, that can really improve patient comfort at different times of year," says Michael
Munro, general manager for PCC.
To address HVAC efficiency, a magnetic switch
in the window frame breaks a circuit when the vent
opens, shutting off the supply of mechanically tempered air to the room. However, the mechanical system continues to extract air, which draws fresh air in
through the window, to maintain required air changes
per hour.  To answer project team members' concerns
regarding infection control, PCC leaders invited the
team to locate published studies that substantiated
those concerns, says Leadbetter, but none were found.
Instead, they found reports suggesting that introducing outside air and its naturally occurring bacteria reduces the pooling of internally held pathogens.
Since opening six years ago, PCC's operable windows have gotten plenty of use in Victoria's mild yearround temperatures. But summer temperatures do
spike, and staff often find it counterintuitive to close
a window when they get too hot, so Munro says he
sends out periodic reminders that the air conditioning will turn on when the windows are closed.
LOOKING AHEAD

As Spaulding Rehabilitation Hospital and Royal
Jubilee Hospital's PCC illustrate, incorporating
natural ventilation into healthcare facilities requires adjustments and adaptations as facilities
learn to balance operational efficiency with staff
and patient comfort. The ASHRAE task group
recognizes the challenges of these systems and includes some caveats in its report. The group advises design teams considering natural ventilation to
fully address some fundamental challenges-space
appropriateness, climate appropriateness, acoustics, security, and outdoor air quality-and to anticipate that natural ventilation will be unfamiliar
to many commissioning and air balance providers.
Going forward, the task group's recommendations
will be reviewed in September by the larger committee responsible for the standard. If and when consensus is established on a final version of the position
paper, the work of developing text for incorporation
into the standard will begin. 
Katharine Logan is an independent writer based in
Victoria, British Columbia. She can be reached through
her website at K A T H A R I N E L O G A N . C O M . 

MORE ONLINE: For more online, including
images of these projects, visit HCDmagazine.
com/natural-ventilation. 

HCDMAGAZINE.COM


http://www.KATHARINELOGAN.COM http://HCDmagazine.com/natural-ventilation http://HCDmagazine.com/natural-ventilation http://www.HCDMAGAZINE.COM

Table of Contents for the Digital Edition of Healthcare Design - September 2017

Healthcare Design - September 2017
Contents
Editorial
The HCD 10
From the Publisher
Class Project
5 Strategies for Ambulatory Facility Planning
Making Room for Wound Care
First Look
Breath of Fresh Air
Engineering Winds of Change
Product Spotlight Wayfinding
The Center
Face Time
HCD Expo 2017
Healthcare Design - September 2017 - Healthcare Design - September 2017
Healthcare Design - September 2017 - Cover2
Healthcare Design - September 2017 - 1
Healthcare Design - September 2017 - Contents
Healthcare Design - September 2017 - 3
Healthcare Design - September 2017 - 4
Healthcare Design - September 2017 - 5
Healthcare Design - September 2017 - 6
Healthcare Design - September 2017 - 7
Healthcare Design - September 2017 - 8
Healthcare Design - September 2017 - Editorial
Healthcare Design - September 2017 - The HCD 10
Healthcare Design - September 2017 - From the Publisher
Healthcare Design - September 2017 - 12
Healthcare Design - September 2017 - Class Project
Healthcare Design - September 2017 - 14
Healthcare Design - September 2017 - 15
Healthcare Design - September 2017 - 5 Strategies for Ambulatory Facility Planning
Healthcare Design - September 2017 - Making Room for Wound Care
Healthcare Design - September 2017 - 18
Healthcare Design - September 2017 - First Look
Healthcare Design - September 2017 - 20
Healthcare Design - September 2017 - 21
Healthcare Design - September 2017 - 22
Healthcare Design - September 2017 - 23
Healthcare Design - September 2017 - 24
Healthcare Design - September 2017 - 25
Healthcare Design - September 2017 - 26
Healthcare Design - September 2017 - 27
Healthcare Design - September 2017 - 28
Healthcare Design - September 2017 - 29
Healthcare Design - September 2017 - 30
Healthcare Design - September 2017 - 31
Healthcare Design - September 2017 - 32
Healthcare Design - September 2017 - 33
Healthcare Design - September 2017 - 34
Healthcare Design - September 2017 - 35
Healthcare Design - September 2017 - 36
Healthcare Design - September 2017 - 37
Healthcare Design - September 2017 - Breath of Fresh Air
Healthcare Design - September 2017 - 39
Healthcare Design - September 2017 - 40
Healthcare Design - September 2017 - 41
Healthcare Design - September 2017 - 42
Healthcare Design - September 2017 - 43
Healthcare Design - September 2017 - 44
Healthcare Design - September 2017 - 45
Healthcare Design - September 2017 - 46
Healthcare Design - September 2017 - Engineering Winds of Change
Healthcare Design - September 2017 - 48
Healthcare Design - September 2017 - 49
Healthcare Design - September 2017 - Product Spotlight Wayfinding
Healthcare Design - September 2017 - 51
Healthcare Design - September 2017 - The Center
Healthcare Design - September 2017 - 53
Healthcare Design - September 2017 - 54
Healthcare Design - September 2017 - 55
Healthcare Design - September 2017 - Face Time
Healthcare Design - September 2017 - Cover3
Healthcare Design - September 2017 - Cover4
Healthcare Design - September 2017 - HCD Expo 2017
Healthcare Design - September 2017 - Expo2
Healthcare Design - September 2017 - Expo3
Healthcare Design - September 2017 - Expo4
Healthcare Design - September 2017 - Expo5
Healthcare Design - September 2017 - Expo6
Healthcare Design - September 2017 - Expo7
Healthcare Design - September 2017 - Expo8
Healthcare Design - September 2017 - Expo9
Healthcare Design - September 2017 - Expo10
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Healthcare Design - September 2017 - Expo12
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